University of Palermo

Introduction: The increasing prevalence of cardiometabolic diseases highlights the urgent need for practical interventions to mitigate their associated public health burden. Whey protein supplementation has emerged as a potential intervention for improving markers of cardiometabolic health. The aim of this systematic review and meta-analysis was to examine the effect of whey protein ingestion on car-diometabolic profile in adults. Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library from inception until June 2024. Eligible RCTs compared the effect of whey protein supplementation compared to placebo or a carbohydrate-based control on markers of cardiometabolic health. Using the random effects inverse-variance model, we estimated the mean difference (MD) in blood pressure, high-and low-density lipoproteins (HDL-cholesterol, LDL-cholesterol), total cholesterol, triglycerides, and homeostatic model assessment for insulin resistance (HOMA-IR) index. Results: This meta-analysis included 21 RCTs. Whey protein supplementation had no effect on HDL-cholesterol concentration but did elicit a reduction in LDL-cholesterol in individuals aged <50 years (P < 0.01) and when combined with exercise (MD: À5.38, 95 % confidence interval (95 % CI): À8.87 to À1.88, I 2 ¼ 0 %, P < 0.01). Total cholesterol was reduced with interventions that combined whey protein supplementation and exercise (MD: À8.58, À14.32 to À2.83, I 2 ¼ 55 %, P < 0.01), irrespective of age, protein dose, and body mass index !25 kg/m 2 (MD: À6.71, 95 % CI: À11.60 to À1.83, I 2 ¼ 74 %, P < 0.01). Whey protein supplementation of !12 weeks was associated with reduced triglyceride levels (MD: À6.61, 95 % CI: À11.06 to À2.17, I 2 ¼ 70 %, P < 0.01). There was no clinically relevant effect of whey protein supplementation on blood pressure and HOMA-IR, however, changes pertinent to HDL-cholesterol, total cholesterol, and triglyceride reduction were primarily displayed in healthy adults. Clinical Nutrition 44 (2025) 109e121 Conclusions: Whey protein supplementation may be an effective intervention for reducing LDL and total cholesterol levels, particularly in healthy, overweight/obese adults aged <50 years, with the greatest benefits observed when combined with exercise. Healthy adults also showed a benefit regarding tri-glyceride levels.

The state’s monopoly on sovereignty can be challenged by criminal systems capable of gaining legitimacy within communities. Understanding the psychological basis of such legitimacy requires broadening traditional conceptualizations of authority to consider how it operates without legal backing and outside formal channels. This research introduces the Legitimacy of Secret Power (L-SP) Scale, a tool measuring individuals’ appraisal of illegal groups’ power. We validated L-SP through three studies ( N total = 3,173). Findings demonstrate a reliable, 20-item mono-factorial structure. Study 3 tested L-SP’s measurement invariance in the UK, Italy, Japan, and the US. Across studies, L-SP correlated with support for illegality, ideologies of masculine honor, and social dominance. It was inversely related to the perceived national threat of criminal groups, democratic attitudes, and police legitimacy. Notably, L-SP predicted individuals’ willingness to report criminal groups independently of their fear of these groups or perceptions of police legitimacy. Theoretical implications and future directions are discussed.

Background The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis. Methods Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use. Results In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10 ⁻¹⁰ ). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use. Conclusions Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.

Purpose To describe the clinical characteristics and outcomes of patients with nosocomial pneumonia (NP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) and to compare them to patients with NP caused by carbapenem-susceptible (CS)-GNB. Methods Prospective observational multicenter study including patients with bacteremic NP caused by GNB from the ALARICO Network (June 2018-January 2020). The primary outcome measure was 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated. Results Overall, 167 patients with GNB NP were included: 101 with bacteremic NP caused by CR-GNB (n = 39 by KPC-producing Klebsiella pneumoniae, n = 29 by carbapenem-resistant Acinetobacter baumannii, n = 28 by carbapenem-resistant Pseudomonas aeruginosa, n = 5 by MBL-producing Klebsiella pneumoniae) and 66 cases of bacteremic CS-GNB NP. Thirty-day mortality rate was higher in patients with NP caused by CR-GNB compared to those with NPcaused by CS-GNB (46.5% vs 30.3%, p = 0.036). On multivariable analysis, age (HR 1.044, 95% CI 1.021–1.067, p < 0.001), hematological malignancy (HR 4.307, 95% CI 1.924–9.643, p < 0.001) and septic shock (HR 3.668, 95% CI 2.001–6.724, p < 0.001) were factors independently associated with 30-day mortality, while the receipt of adequate antibiotic therapy within 24 h from infection onset (HR 0.495, 95% CI 0.252–0.969, p = 0.04) was a protective factor. Carbapenem resistance was not associated with increased risk of mortality (HR 1.075, 95% CI 0.539–2.142, p = 0.837). Conclusions Patients with bacteremic NP caused by CR-GNB have high mortality rate. Strategies to reduce the time from infection to the administration of adequate antibiotic therapy should be implemented in patients with NP.

In subsurface drip irrigation systems (SDI), the emitter flow rate is affected by the root intrusion phenomena and by the so-called back pressure that limits the buried emitters’ outflow. This paper suggests a methodology to investigate the effect of root intrusion and back pressure in SDI performance, for different root guard emitter treatments in a 6-year experimental campaign (2018–2023), carried out in Sicily (Italy). Inlet discharges and pressure heads were collected over time, and their variations were used to quantify the effect of root intrusion in terms of local losses. The change in the SDI hydraulic performance was studied using a modified Hardy Cross method (HCM), which is suitable for lopped drip irrigation networks. The HCM applications also considered local losses and back pressure, requiring a comprehensive hydraulic characterisation of the soil to estimate accurately the factors influencing back pressure. Specifically, the influence of root intrusion in different emitters was analysed by considering the time variation of the fraction α of the kinetic head. The results showed diverse behaviours among the root guard emitter treatments. Emitters treated with different herbicides (He 1 and He 2), revealed no significant α-fraction variation over time, denoting the effectiveness of He 1 and He 2 treatments in root intrusion protection. Whilst, for Copper (Cu) and control (Ctrl) treatments, a severe decrease in emitter flow rate was observed, confirmed by high α-fraction variations over the investigated period.

Fabry disease (FD) is a rare lysosomal storage disorder that is characterized by renal, neurological, and cardiovascular dysfunction. Four treatments are currently available for patients with FD; three enzyme replacement therapies (ERTs; agalsidase alfa, agalsidase beta, and pegunigalsidase alfa) and one pharmacological chaperone (migalastat). This review focuses on the evidence for the benefits of ERTs and migalastat, and provides an overview of their impact on disease manifestations and quality of life (QoL). Agalsidase beta is associated with renal, neurological, and cardiovascular benefits, and may prevent renal disease progression. Agalsidase alfa provides stabilizing effects across all main organ systems, although minor sex-specific differences exist in patients with more advanced baseline disease. The benefits of agalsidase alfa and agalsidase beta are similar but depend on the extent of baseline disease. Some data indicate that agalsidase beta may be preferable over the longer term. Both agalsidase alfa and agalsidase beta are associated with improved gastrointestinal and pain symptoms, as well as improved QoL. Patients with advanced end-organ damage tend not to respond as optimally to ERTs as those who initiate ERTs before irreversible organ fibrosis develops, highlighting the need for early treatment initiation. Migalastat, which is only approved for patients with amenable missense gene variants, generally stabilizes renal parameters and provides cardiovascular benefits. Migalastat also improves diarrhea and pain, and stabilizes QoL (although ERT may be more effective for pain management), but the neurological effects of migalastat have not been studied. Real-world data raise concerns about effective in vivo amenability of some genetic variants. Future studies with direct treatment comparisons in patients with FD are needed.

We here describe a rare case of a 26‐year‐old male patient, presenting to our hospital after a motorcycle–car accident for the surgical management of long‐bone fractures to the tibia and femur and shoulder dislocation and undergoing orthopedic surgery, who postoperatively developed seizure, coma, and respiratory failure due to a cerebral fat embolism. After some hours after the surgery, a loss of consciousness was described by caregivers, and the ICU team was alerted, and the patient was admitted to ICU. Intracranial hemorrhage and stroke were subsequently excluded and, finally, a whole‐body computed tomography angiography scan and head magnetic resonance imaging showed lesions consistent with cerebral fat embolism. Patent foramen ovale was then suspected by contrasted echocardiography. An early diagnosis helped to choose the correct management, with early tracheostomy, and to correctly interpret and manage hemodynamic dysregulations. Overall, the care provided lead to positive long‐term outcomes, as the patient was discharged alive and successfully completed neurological rehabilitation, regaining many functional abilities. The initial management, diagnostic pathway, and ICU management are here described.

Syphilis is a re-emerging disease, and suspicion of syphilis infection should be considered in all cases with atypical skin manifestations, mainly when there is a history of unprotected sexual intercourse. Here, we describe a case of secondary syphilis in a woman aged 42 years, who presented with an atypical, painful and itchy skin rash with vegetative cerebriform lesions, which resolved after the administration of penicillin. Multiplex PCR targeting Treponema pallidum on vaginal and lesion swabs, along with syphilis serology, confirmed the diagnosis.

Background The Child Opportunity Index (COI) is a new and innovative tool designed to assess the environment in which children grow up, offering a broad evaluation of the opportunities available to them in different neighborhoods. This initiative aims to ensure improvements in children’s living conditions and future health outcomes. Methods The study was performed in the cities of Palermo and Rome. Our Italian COI consists of three main domains: education, health and environment, and economy, each subdivided into specific indicators. We collected information, when available, useful for our indicators from institutional sites and municipal archives. Furthermore, in the city of Rome, we distributed a questionnaire through local pediatricians, collecting data in 2 randomly chosen neighborhoods with questions on children’s health and quality of life, proposing an initial approach that, when implemented using data provided by the government and public and private health institutions, aims to evaluate the correlation between socio-economic opportunities and the psycho-physical health of children, as demonstrated in the literature. Results As a result, many aspects, such as the rate of air pollution or the illegal occupation of houses, were not taken into consideration. We therefore consider our COI proposal only a starting model that will have to be implemented once all the necessary information has been obtained. However, what can be deduced from this first descriptive study is how the opportunities in different neighborhoods are not the same for all children. The number of educational opportunities as well as the number of environmental opportunities differs between the various districts and is not homogeneous between different cities or within the same city. Conclusions In conclusion, it is not simple to analyze in a scientific manner the child’s health impact of living in different areas. The COI could be a useful and simple tool that can give us this information. Pediatricians could collaborate with institutions to implement intervention plans and to reduce existing differences, social and health inequalities. Future studies will have to implement this pilot study to create and validate an Italian model of COI to be used as a useful tool in children’s assistance.

Background The parallel wire technique (PW) is a classic part of the antegrade strategy to open chronic total coronary occlusions (CTO). Aims With modern wires and dual‐lumen catheters (DLC) the approach has evolved, but this progress had not been evaluated in a contemporary registry of CTO interventions. Method This analysis is based on 26,589 CTO procedures performed by 36 operators with > 50 procedures annually between 2015 and 2022. The different strategies and techniques were analyzed with respect to clinical and lesion characteristics, procedural resource use and periprocedural complications. Within the antegrade approach, PW was compared to antegrade wire escalation (AWE) and antegrade‐dissection re‐entry (ADR). Results The primary antegrade approach was used in 65.9%, primary retrograde in 16.9% and a strategy change in 17.2% with a wide inter‐operator variability. In primary antegrade approach, PW was applied in 10.8% and ADR in 5.3%. Lesion complexity was higher in AWE and PW than with single wire, and highest in ADR procedures, leading to more complex procedures with higher contrast and radiation usage. Complications increased with ADR, while they were similar with PW and AWE. Through the observation period PW adoption increased steadily from 6.7% to 10.7%, as the DLC use facilitating PW increased from 8.3% to 17.0% over the observation period. Conclusion In this largest database of contemporary CTO PCI from Europe, PW adoption increased over time but remained low at about 10%. While there was a wide individual variety among the operators, it was a safe and successful technique.

The Italian telephone-based Mini-Mental State Examination (Itel-MMSE) is considered a very easy tool for screening individuals with dementia, gained importance during COVID-19, but lacks validation and faces a ceiling effect. In the present study, we conducted a study standardizing and validating it, establishing cut-off values for two versions. Across 24 Italian sites, 707 healthy individuals (50–89 years, men: 268, women: 439) with diverse educational levels (3–24 years) were recruited. Subjects met criteria for normal conditions investigated through a semi-structured interview covering neurological, psychiatric, general medical, and psychopharmacological history. Two test versions were created to assess test–retest reliability at 45-day intervals. We also enrolled 187 subjects with Mild Cognitive Impairment (MCI) and 181 with Alzheimer's Disease (AD) for validation. The raw scores obtained on both versions of Itel-MMSE were set as dependent variables in linear regression models that included age, education, and gender as independent variables. Mean raw Itel-MMSE1 score was 20.82 (range: 13–22). Multiple linear regression demonstrated significant effects of sociodemographic variables for age and education, establishing a new cut-off ≥ 18.49. Mean raw Itel-MMSE2 score was 20.97 (range: 10–22), with a new cut-off ≥ 18.45. Validation showed high informative values, with areas under the curve (AUCs) for MCI and AD conditions and both versions (Itel-MMSE1: MCI AUC = 0.801, AD AUC = 0.907; Itel-MMSE2: MCI AUC = 0.827, AD AUC = 0.977). The Itel-MMSE proves valuable as a screening method for detecting and monitoring dementia in remote phone screenings, with different cut-offs aiding MCI patient identification in clinical settings.

The Mediterranean diet has gained significant attention for its potential health benefits on diverse pathological conditions including osteoarthritis (OA), a prevalent degenerative joint disease characterized by cartilage breakdown and inflammation. Numerous observational studies have suggested that adherence to the Mediterranean diet, may have protective effects against OA. The abundance of antioxidants and anti-inflammatory compounds and omega-3 fatty acids, among the Mediterranean diet components is believed to contribute to its beneficial effects on OA. Research investigating the association between the Mediterranean diet and OA has shown promising results. Several observational studies have reported that adherence to the Mediterranean diet is associated with a reduced risk of developing OA and with lower severity of OA symptoms. Additionally, intervention studies have demonstrated improvements in pain, function, and quality of life among OA patients following a Mediterranean diet intervention. Furthermore, emerging evidence suggests potential mechanisms underlying the protective effects of the Mediterranean diet against OA, including its ability to reduce inflammation, oxidative stress, and cartilage degradation. However, further well-designed randomized controlled trials and mechanistic studies are needed to elucidate the precise mechanisms and establish causality. In conclusion, the Mediterranean diet appears to be a promising dietary approach for the prevention and management of OA. Its rich array of nutrients and bioactive compounds may exert protective effects against OA development and progression, although more research is warranted to confirm these findings and elucidate underlying mechanisms. Graphical abstract

The anomaly known as a bifid rib is difficult to quantify in bioarchaeological collections not only because of its rarity in the population itself (less than 1.5%), but also because of vulnerability to postmortem damage of this part of the skeleton as well as similarity to other developmental anomalies, which can lead to its misidentification. This work presents five cases of rib bifurcation (from four individuals) from four different populations living in Kujawy region in north-central Poland from the Neolithic until the Early Modern Era. Morphological analyses are matched by a paleoradiological investigation. Furthermore, this study endeavours to summarize all known cases of rib bifurcation in archaeological collections and discuss the correctness of the diagnoses. Additionally, criticism of the arguments allegedly proving the presence of naevoid basal cell carcinoma syndrome (NBCCS, Gorlin-Goltz syndrome) in the archaeological populations based on available photographic data of bifurcated ribs and associated anomalies is made. Finally, a new proposal for the classification of this anomaly in osteological material is presented.

Objectives We investigated the extent of access to Meckel's cave (MC) and the middle cranial fossa (MCF) protecting the internal carotid artery (ICA) using the retrosigmoid approach with endoscopic-assisted reverse anterior petrosectomy (EA-RAP). Methods Five specimens were dissected using the limited and extended EA-RAP. Based on the bone removal of the internal acoustic meatus (IAM) and subarcuate fossa, exposure of the MC and ICA were statistically compared. Results The limited and extended EA-RAP allowed access to the medial and anterior MC (4 mm posterior to the first genu of the cavernous ICA, and 20 mm posterior to foramen rotundum [FR]). The access to the lateral MC varied with distance of 12 and 8 mm medial to the foramen ovale for the limited and extended EA-RAP, respectively. In the extended EA-RAP, the exposure of the ICA was gained by drilling with the 0-degree endoscope (3 mm) versus 45-degree endoscope (9 mm). The working distances from the midpoint of the IAM to the most medial point of the exposed ICA was 24 mm. The most lateral point of the exposed ICA varied between 0- and 45-degree endoscopes with a distance of 21 and 13 mm, respectively. Conclusion A coronal plane from the posterior genu of the cavernous ICA and a sagittal plane to the common crus of the semicircular canals can define the area of MCF accessed by the EA-RAP. Drilling of the temporal bone should be carefully customized according to the patient and can be aided by endoscopic assistance for direct visualization to minimize the risk of injuries to ICA.

Striae distensae (SD) appear clinically as parallel striae, lying perpendicular to the tension lines of the skin. SD evolve into two clinical phases, an initial inflammatory phase in which they are called “striae rubrae” (SR) and a chronic phase in which they are called striae albae (SA). This study investigates the synergistic effect of nanofat and platelet-rich plasma (PRP) injections on collagen production in fibroblasts derived from SA (SAF). A prospective, randomized single-blind study was conducted in fifty women presenting with SA in the abdominal region who had voluntarily sought a conventional abdominoplasty procedure and accepted to test an autologous treatment for their SDs. SA were treated using: PrP 10 ml; PrP 2ml (20%) + nanofat 8ml (80%); nanofat 10ml. Following the abdominal dermolipectomy, biopsies from treated and untreated SDs were taken and analyzed for type I collagen quantification. Results were processed through statistical analysis models using the Student’s t test. Collagen concentration in untreated SA biopsies was significantly lower than in healthy skin. Both PRP and nanofat treatments significantly increased collagen biosynthesis compared to controls, with the combined PRP-nanofat treatment showing the highest increase in collagen levels (p < 0.0001). A superior clinical improvement was observed in the areas that received the combined treatment of PRP and nanofat (p = 0.001). Our findings indicate that both PRP and nanofat treatments effectively enhance collagen production in SA, with the combined PRP-nanofat treatment showing a synergistic effect. This combined therapy holds promise for effectively treating SA, providing a new potential treatment avenue for SMs and similar skin conditions. Further studies are needed to validate these results and explore clinical applications. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background Unicompartmental knee arthroplasty (UKA) is a surgical procedure for managing osteoarthritis of one joint compartment, most commonly the medial side. This systematic review investigates the causes of UKA revision. The outcomes of interest were establishing the revision rate, time to revision, and the most common causes of revision in the long- and midterm follow-up. Methods This study was conducted according to the 2020 PRISMA statement. In October 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the clinical studies investigating the rate and causes of revision in UKA were accessed. Only studies with a minimum of 10 years of follow-up were considered. Results Data from 56 studies (13,540 patients) were collected. Of them, 65.6% were women. The mean length of the follow-up was 13.1 ± 3.0 years. The mean age of the patients was 65.6 ± 5.6 years, and the mean BMI was 28.5 ± 2.2 kg/m². Revisions were performed in 8.8% (2641 of 30,140) of implanted UKAs. The mean time to revision was 6.5 ± 2.6 (range, 2.5 to 13.0) years. Conclusion 8.8% (2641 of 30,140) of UKAs were revised at a mean time of 6.5 ± 2.6 years. Level of evidence Level IV, systematic review.

The use of biostimulants in agriculture provides a sustainable and efficient technology to improve resource‐use efficiency. Biostimulants may boost vegetative growth, enhancing plant tolerance to biotic and abiotic stress. The tomato (Solanum lycopersicum L.) is sensitive to drought stress, particularly during fruit setting and fruit development stages. In Italy, long‐storage tomato genotypes characterised by drought resistance were selected. In this 2‐year study, the foliar application of different biostimulants (betaine, seaweed extracts, vegetal protein hydrolysate and animal protein hydrolysate) was evaluated to determine effects on yield and quality of a local tomato landrace (Pizzutello) cultivated in Sicily without irrigation. The highest dry matter (9.9%) and solid soluble content (6.9° Brix) were observed in plants treated with betaine. Plants treated with A. nodosum or animal protein hydrolysate showed the highest potassium concentrations, whereas those supplied with vegetal protein hydrolysate had the highest calcium concentrations. Tomato treated with betaine were found to have the highest nitrate concentrations. The highest marketable yield (13.8 t ha⁻¹) was recorded in plants treated with vegetal protein hydrolysate, with an increase of 17.4% compared to the control plants. The highest unmarketable yield was observed in control plants and in those treated with betaine (1.1 t ha‐1). In conclusion, we can say that each biostimulant had a different effect on the different parameters analysed. Overall, the application of biostimulants has improved tomato growth, productivity and quality in limited water conditions. Our results highlight the potential of biostimulant applications to optimise both the yield and fruit quality of renowned local varieties. This study demonstrated the improvement in the agronomic performance of the Pizzutello tomato, which is particularly significant not only in response to the growing consumer demand for high‐quality traditional tomatoes, but also for the enhancement of the technological traits valued by the food industry.

This article offers for the first time a facial approximation of the Ancient Egyptian Pharaoh Amenhotep III (reigned ca. 1388–1351 BC) based on photographic material of his mortal remains and anthropometric data collected at the time, and by adopting a novel technique previously used in similar research by our team. A comprehensive discussion of the mummy attributed to Pharaoh Amenhotep III is also annexed to the study, focusing on the bioarcheological and embalming aspects.