Università degli Studi di Enna Kore

Background Total maxillectomy for malignant tumors presents significant challenges for functional and aesthetic rehabilitation. Advances in digital planning and additive manufacturing have reintroduced subperiosteal implants as a promising solution for primary reconstructions. Case report This report details the case of a 59-year-old male with squamous cell carcinoma of the hard palate extending contralaterally, treated with a total maxillectomy and primary reconstruction using an osteomyocutaneous fibula free flap combined with a custom-made, additively manufactured subperiosteal implant. Preoperative planning integrated craniofacial CT scans, dental impressions, and lower limb angiography to design both the implant and fibula cutting guides. The implant, fabricated via direct metal laser sintering, provided a stable framework for fibular segments and future prosthetic rehabilitation. At two years post-surgery, the patient remains disease-free, with no complications and fully functional prosthetic integration. Conclusions This case highlights the feasibility, adaptability, and potential benefits of additively manufactured implants in reconstructing total maxillectomy defects. Clinical trial number N/A

The COVID-19 pandemic was marked by restrictions on interpersonal contact, both at work and in the personal sphere, and significantly impacted the psychological health and subjective well-being of the global population. Among the risk factors, COVID-19 exhaustion negatively influenced well-being. Among the protective factors, adopting a future-time perspective correlates with positive well-being indicators in the literature. Our study aimed to assess whether 'psychological long COVID-19' may exist 2 years after the pandemic's onset. Participants were 649 young Italians aged 18–35 years. Structural equation modelling analyses revealed that, in 2023, COVID-19 exhaustion still influences the intention to maintain social distancing and life satisfaction. Furthermore, a positive future orientation negatively predicted COVID-19 exhaustion, suggesting that the former may be a protective factor for the pandemic’s negative biopsychosocial effects. The findings underscore the role of promoting personal resources from positive psychology in enhancing protective factors in adverse situations and improving psychosocial well-being.

The renal resistive index (RRI) has been widely shown to be related with subclinical vascular damage in individuals with essential hypertension, as well as in other populations. However, limited data exist regarding the association between RRI and cardiovascular (CV) events in hypertensive individuals. Additionally, it is unclear whether the 10-year risk of CV disease, as predicted by validated score equations, is associated with impaired intrarenal hemodynamics. The aim of our study was to analyze the relationship between RRI and both the FS and ASCVD in hypertensive individuals with no history of CV events. A total of 742 individuals with essential hypertension (40–75 years) were enrolled. RRI was assessed in all patients using Duplex–Doppler ultrasonography, and the 10-year risk of cardiovascular disease was calculated using both the Framingham risk score (FS) and atherosclerotic cardiovascular disease risk score (ASCVD) through validated equations. Higher RRI values were observed in patients with calculated CV risk ≥ 20% compared to those with lower risk (all p < 0.001). RRI was closely associated with both FS and ASCVD scores in the overall cohort (all p < 0.001), with no significantly differences between groups with glomerular filtration rate ≥ or < 60 mL/min/1.73m2. In multivariate analyses, these associations remained significant after adjusting for traditional risk factors included in the FS and ASCVD equations (p = 0.007 and p = 0.047, respectively). Receiver-operating characteristic curves indicated that RRI values >0.67 and >0.65 were associated with a high CV risk (≥ 20%), as calculated through FS and ASCVD equations, respectively. RRI can be considered a marker of overall CV risk in hypertensive patients, independent of renal function.

This study aimed to evaluate functional outcomes and anterograde ejaculation rates in patients undergoing monopolar, unilateral transurethral incision of the prostate (TUIP) with “Z” shaped incision with ejaculatory sphincter sparing for primary bladder neck obstruction (PBNO) in a case series performed by a single surgeon. Between December 2018 and July 2023, data from patients who underwent monopolar, unilateral TUIP were prospectively collected. Patients with a prostate volume of less than 30 mL were included. Functional outcomes, including maximum flow rate (Qmax, mL/s), post-void residual volume (PVR, mL), International Prostate Symptom Score (IPSS), and IPSS Quality of Life (IPSS QoL) score, were assessed preoperatively and at 1, 6, and 12 months postoperatively. A total of 106 patients met the inclusion criteria, with a median age of 42 years (range: 37–57) and a median prostate volume of 27 mL (range: 20–29). The median hospital stay was 1 day, and the median catheterization time was 3 days. At 1-month follow-up, the mean Qmax increased from 10.2 ± 2.5 mL/s to 22.8 ± 3.9 mL/s, while the mean IPSS score and IPSS QoL score decreased from 16 ± 2.7 to 6.9 ± 1.5 and from 4.3 ± 0.9 to 1.9 ± 1.6, respectively ( p < 0.001). The mean PVR volume decreased from 125.5 ± 16.1 mL to 27.7 ± 7.3 mL ( p < 0.001). Uroflowmetry results remained statistically significant at 12 months of follow-up (each p < 0.001). Anterograde ejaculation was preserved in all cases. Unilateral monopolar TUIP confirms to be a feasible and safe procedure for the treatment of BNO in young and sexually active patients.

Formal communications such as public calls, announcements, or regulations are supposed to exhibit respect for diversity in terms of gender, race, age, and disability. However, human writers often lack adequate inclusive writing skills. For instance, they tend to overuse the masculine as a neutral form, mainly because they are self-trained on biased text examples. To overcome this issue, we propose to leverage Generative Artificial Intelligence to support inclusive language writing. Focusing on formal Italian communications, we have designed and developed an AI-assisted tool for non-inclusive text detection and reformulation. Thanks to the joint work with a team of linguistic experts, we first define a set of linguistic criteria necessary to model inclusive writing forms in Italian. Based on these criteria, we collect and annotate a dataset of Italian administrative documents enriched with fine-grained inclusive annotations. Finally, we train deep learning models on the collected data for non-inclusive language detection and inclusive language reformulation tasks. We perform quantitative and human-driven evaluations on the trained models. The best detection model correctly classifies 89% of the sentences, whereas the best reformulation model produces 73% fully correct reformulations. Both models have been integrated into a writing assistance tool acting as a text proofreader and self-learning tool for non-expert writers, namely Inclusively . Once a non-inclusive piece of text is detected, the proposed approach suggests inclusive reformulations. The tool also provides explanations of the models’ outputs to increase system transparency. Furthermore, it allows expert end-users to provide further annotations for system fine-tuning. The trained models and the writing assistance tool are publicly available for research purposes.

Background The pathophysiology of Meniere’s disease (MD) is complex and intertwined with endolymphatic hydrops. Available experimental models have limitations. Objective This study aimed to analyze the impact of endolymphatic hydrops on cochleovestibular hydrodynamics through numerical simulations. Methods A comprehensive literature review was conducted following PRISMA guidelines for Scoping Reviews. Articles were sourced in June 2024 from PubMed and Google Scholar using a combination of MESH terms related to hydrodynamics, numerical simulation, and MD. Studies involving numerical simulations of hydrops in the vestibule, cochlea, or both were included. Results Eight studies on hydrodynamics in hydrops using numerical simulations were included. In cochlear models, hydrops affect basilar membrane mechanics, causing low-frequency hearing loss, auditory distortions, and frequency shifts. Vestibular models revealed increased static pressure in the horizontal semicircular canal, explaining abnormal vHIT findings in hydrops patients. Models also suggested chaotic fluid dynamics in dilated labyrinthine structures during caloric tests. The reviewed studies underscore the utility of numerical models in understanding the mechanics of MD; however, significant limitations were identified. Conclusions Numerical modeling offers valuable insights into the hydrodynamic changes caused by endolymphatic hydrops in MD, but future work should address the current limitations by incorporating more accurate anatomical features and chronic progression in simulations.

Purpose To evaluate the diagnostic accuracy, appropriateness of additional examination recommendations, and consistency of therapeutic regimens by ChatGPT-4 and Llama2 based on real otolaryngology cases. Methods A prospective controlled study was conducted on 98 anonymized otolaryngology cases. Clinical information was entered in ChatGPT-4 and Llama2 for reaching primary diagnoses, additional examination recommendations, and treatment strategies. Two independent otolaryngologists evaluated the AI outputs using the artificial intelligence performance instrument (AIPI), evaluating diagnostic accuracy, appropriateness of examination, and adequacy of treatment. Statistical comparisons were conducted between the AI systems and expert decisions. Interrater reliability was evaluated with kappa statistics. Results ChatGPT-4 diagnosed 82% correctly, outperforming Llama2 at 76%. For additional examinations, ChatGPT-4 suggested relevant and appropriate tests in 88% of the studies, while Llama2 did so in 83%. Treatment appropriateness was achieved in 80% of the cases through ChatGPT-4 and 72% through Llama2. Sometimes, both systems suggested inappropriate tests. The interrater reliability was high for AIPI scores (kappa = 0.85). Conclusion ChatGPT-4 and Llama2 have shown great potential as clinical decision-support tools in otolaryngology, with ChatGPT-4 exhibiting superior performance. At the same time, non-relevant recommendations indicate further refinement and human oversight to ensure safe application in clinical practice.

The co-occurrence of insulin resistance (IR)-related metabolic conditions with neuropsychiatric disorders is a major public health challenge. Evidence of the genetic links between these phenotypes is emerging, but little is currently known about the genomic regions and biological functions that are involved. To address this, we performed Local Analysis of [co]Variant Association (LAVA) using large-scale (N = 9,725–933,970) genome-wide association studies (GWASs) results for three IR-related conditions (type 2 diabetes mellitus, obesity, and metabolic syndrome) and nine neuropsychiatric disorders. Subsequently, positional and expression quantitative trait locus (eQTL)-based gene mapping and downstream functional genomic analyses were performed on the significant loci. Patterns of negative and positive local genetic correlations (|rg| = 0.21–1, pFDR < 0.05) were identified at 109 unique genomic regions across all phenotype pairs. Local correlations emerged even in the absence of global genetic correlations between IR-related conditions and Alzheimer’s disease, bipolar disorder, and Tourette’s syndrome. Genes mapped to the correlated regions showed enrichment in biological pathways integral to immune-inflammatory function, vesicle trafficking, insulin signalling, oxygen transport, and lipid metabolism. Colocalisation analyses further prioritised 10 genetically correlated regions for likely harbouring shared causal variants, displaying high deleterious or regulatory potential. These variants were found within or in close proximity to genes, such as SLC39A8 and HLA-DRB1, that can be targeted by supplements and already known drugs, including omega-3/6 fatty acids, immunomodulatory, antihypertensive, and cholesterol-lowering drugs. Overall, our findings highlight the complex genetic architecture of IR-neuropsychiatric multimorbidity, advocating for an integrated disease model and offering novel insights for research and treatment strategies in this domain.

Defensive structures in Poland are a testament to the diverse and rich history of construction techniques developed to protect against enemy incursions and attacks. Beginning with the earliest forms of defense in ancient villages surrounded by aggers, the study traces the evolution of defensive systems, from primitive wooden fortifications to the later use of defensive walls, the addition of towers, and the construction of stone castles. This progression culminated in the emergence of fortresses in the form of feudal castles, followed by the development of classical fortresses, general fortifications, and, eventually, fortified zones.These fortification systems, resulting from the strategic combination of specific elements, were designed to meet evolving defensive needs in response to changing military strategies and advancements in weaponry.This paper also explores the architectural and construction typologies underlying the transformations of fortifications over time and across various regions of Poland. It examines on one hand, the typological and structural characteristics of these fortifications, and, on the other, the spatial and geographical features of the surrounding landscape, highlighting the crucial role of the environment in shaping the design and adaptation of defensive systems throughout history.

The Fortress of Bergamo is an imposing architectural construction dating back to the 16th century characterized by a well-preserved city wall and a linear development of over 5 kilometers; in 2017 it was registered in the UNESCO World Heritage Site as a world heritage site. As part of the studies aimed at its conservation and valorization, a pilot project was launched on the gunboat of San Michele, an underground environment on the sides of the bastion and designated for "flanked cannonade" for the defense of the gate of Sant’Agostino on the street for Venice.The essay aims to illustrate the knowledge project resulting from the historical investigation, the metric-material and diagnostic survey, the graphic processing and the virtual restoration of the models and textures underlying the 3D rendering of the factory. A focus on new technologies aimed at communicating and enjoying cultural heritage resulting from an initial study of documentary sources, followed by precise mapping conducted on digital models, faithful copies of reality thanks to 3D laser scanner technology and HDR photogrammetry. The work allowed us to take an immersive journey in space and time right into the underground walls of the Walls at the end of the sixteenth century, in a virtual tour among bombers and men-at-arms grappling with cannons, fire buttresses, pikes and halberds.

The defensive system is composed of castle complexes and boundary walls with towers or isolated elements, constituting systems of observation and communication or linked to farms or Casali, which function as visual control of land ownership. Although many studies have been developed on coastal defence tower systems, only some contributions have been made to the census of elements of inland, land defence or internal defences, which ceased in Sicily in their functions already in the 16th century. The study proposed is related to two isolated elements on the sites of two destroyed Casali in central Sicily (Fundrò and Rossomanno, in the province of Enna), attested as historically infatuated to a relevant family of Tuscan origin and of Ghibelline faith, the Uberti, among the protagonists of the medieval events in Sicily, from the end of the thirteenth to the fifteenth century. The first element, in Fundrò, is currently associated with a Benedictine abbey founded in 1420, while the other structure, called locally “Torre or castellaccio degli Uberti”, in Rossomanno, is assumed to guard the homonymous ancient casale, destroyed in 1392.

The castle known as "Belvedere," located near the town of Fiumedinisi on the Ionian coast of Messina, is part of a network of defensive structures from the medieval period, which lost their defensive role as early as the 16th century. The structure belongs to a territorial control system networked and marked by natural riverbeds, upon which small urban settlements have been positioned, forming a historically and geographically homogeneous region. This study aims to promote the castle through a twofold strategy: firstly, by adopting an integrated approach to enhance the asset as an element within its historical-geographical context, and secondly, through the design of a visitor-friendly route within the fortified structure, incorporating additional aspects to access the levels of the original functions (access paths, walkways, and summit defence routes; tower structure). This approach is based on principles of greater durability, minimal invasiveness, and contemporaneity to improve the comprehensibility of this architecture in its essential relationships with the surrounding landscape, both outside and inside.

This work presents the Trojan Horse Method (THM) as a powerful technique for measuring nuclear reaction cross sections at astrophysical energies. We then explore the impact of THM-derived reaction rates on the predictions of Standard Big Bang Nucleosynthesis (SBBN) using the PRIMAT code. Primordial abundances are shown for the single rate impact and, for the first time, also for all the THM rates together. The result shows significant differences with the use of THM rates, which in some cases goes in the direction of improving the agreement with the observations with respect to the use of only reaction rates from direct data, especially for the $^7\hbox {Li}$ and deuterium abundances, which are still open issues for SBBN.

Enteric-type adenocarcinoma of the lung (lung-ETAC) is an exceptionally rare variant of lung adenocarcinoma, often presenting diagnostic challenges due to its histological resemblance to colorectal adenocarcinoma. This rarity has hindered the development of standardized treatment protocols, with most management approaches being empirical. Radiotherapy is used infrequently for lung-ETAC, predominantly reserved for palliative care in metastatic cases. Recent studies, however, suggest that lung-ETAC may have a better prognosis than other lung cancer subtypes, thus raising the need to explore alternative therapeutic strategies, including radiotherapy. We present the case of a 73-year-old female with stage IIIA lung-ETAC who was treated with curative-intent radiotherapy (60 Gy in 30 fractions) in combination with platinum-based chemotherapy. Despite transient pulmonary complications, the patient exhibited an almost complete response to treatment after 2 months, achieving sustained clinical remission with no further antitumor therapies. This case underscores the potential role of high-dose radiotherapy as a curative treatment for locally advanced lung-ETAC. Given the limited evidence, further research is needed to better define the role of chemoradiotherapy in the management of this rare histological subtype.

BACKGROUND Precision medicine is an emerging field that includes tumor-targeted delivery and tumor microenvironment. This review explores the synergistic potential of combining nano-drug delivery systems with low radiation doses to achieve optimized therapeutic outcomes, particularly in the context of cancer treatment. Nanoparticle-based drug carriers offer precise and targeted delivery, enhancing the therapeutic index of anticancer agents. The use of lower radiation doses has become a focus in radiation oncology to minimize off-target effects on healthy tissues in palliation treatment with high-target volume lesions. AIM To conduct a bibliometric review of nanomedicine and glioblastoma (GBM), all relevant studies from the last two decades were included. METHODS The search strategy comprised the keywords ”nanomedicine “and “glioblastoma” in the title and/or abstract. All English-language documents from 1 January 2000 to 31 December 2023 were considered for the analysis. R code (version 4.2.0) with R Studio (version 2022.12.0-353) and the Bibliometrix package (version 4.0.1) were used for the analysis. A total of 680 documents were collected. RESULTS We analyzed the bibliometric features of nanomedicine in glioma. With the limitations of the research, our analysis aims to highlight the increasing interest of researchers in the precision medicine field in GBM treatment and lead us to suggest further studies focusing on the association between nanomedicine and radiotherapy. CONCLUSION Due to the poor prognosis associated with GBM, new therapeutic approaches are necessary. There is an increasing interest in precision medicine, which includes nanomedicine and radiotherapy, for GBM treatment. This integration enhances the efficacy of targeted treatments and provides a promising avenue for reducing adverse effects, signifying a notable advancement in precision oncology.