Archivio istituzionale della ricerca - Alma Mater Studiorum Università di Bologna
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Facial Nerve Graft in Malignant Tumors: The Role of Facial Rehabilitation
Get PDFBackground: Oncological surgery of the parotid gland or of the temporal bone may require the contemporary sacrifice of the facial nerve (FN). In such cases, the immediate repair of the sacrificed FN is recommended. The aim of this study is to evaluate the impact of facial rehabilitation (FR) and, secondarily, of post-operative radiotherapy (PORT) on the FN outcome after FN sacrifice and reconstruction via cable graft. Methods: This is a multicentric retrospective study including patients affected by malignant tumors whose surgical excision required FN sacrifice and contextual FN reconstruction with a cable graft. Other FN reconstruction techniques were excluded. FN function was assessed using both House–Brackmann and Sunnybrook grading systems. Results: A total of 28 patients were included. Most of the patients underwent a total parotidectomy. The greater auricular nerve was the main donor for cable graft. FR and PORT were performed in 22 and 15 patients, respectively. In particular, 20 patients underwent neuro-muscular retraining (NMR). Patients who underwent FR had better FN outcomes compared to those who did not (p = 0.02 at 12 months and p = 0.0002 at 24 months). In contrast, there was no statistically significant difference between patients who underwent PORT and those who did not (p > 0.05). Pre-operative FN palsy is a risk factor of worse FN function outcomes after cable graft. Conclusions: Our study, even though it was limited to only 28 cases, may demonstrate that cable graft failure is not due to PORT, as widely believed among clinicians, but to the absence of a rehabilitation program. Moreover, we suggest that the key to obtaining the best possible FN function results after FN sacrifice is the association of a technically correct FN reconstruction with a proper and targeted FR
Place branding in rural areas: A literature review
Get PDFThe paper examines the concept of place branding in rural areas, highlighting its significance in increasing reputation, attracting investment, improving competitiveness, and fostering a sense of pride and belonging among local populations. This article provides a literature review of rural branding, examining the trends of the main topics, analyses, and methodological approaches used in investigating place branding. The analysis is based on 45 articles from the Scopus and Web of Science databases, organized into seven main topics: tourism, rural identity, rural and regional development, sustainability, food and gastronomy, stakeholders' involvement, and landscape. Additionally, the study integrates a conceptual framework that outlines the interplay between these themes, emphasizing the theoretical grounding of rural place branding. The findings indicate a positive trend in the number of articles published on rural place branding, a predominance of qualitative research methods, and a strong focus on theoretical framework analysis. The study also highlights the role of sustainability in rural place branding, demonstrating how the synergy of cultural heritage preservation, stakeholder collaboration, and landscape branding significantly enhances the local economy, fosters community pride, and promotes regional agri-food products and gastronomy. These elements contribute to the sustainable growth of rural regions while reinforcing their unique identity within competitive global markets
Open-source small language models for personal medical assistant chatbots
Get PDFMedical chatbots are becoming essential components of telemedicine applications as tools to assist patients in the self-management of their conditions. This trend is particularly driven by advancements in natural language processing techniques with pre-trained language models (LMs). However, the integration of LMs into clinical environments faces challenges related to reliability and privacy concerns. This study seeks to address these issues by exploiting a privacy by design architectural solution that utilises the fully local deployment of open-source LMs. Specifically, to mitigate any risk of information leakage, we focus on evaluating the performance of open-source language models (SLMs) that can be deployed on personal devices, such as smartphones or laptops, without stringent hardware requirements. We assess the effectiveness of this solution adopting hypertension management as a case study. Models are evaluated across various tasks, including intent recognition and empathetic conversation, using Gemini Pro 1.5 as a benchmark. The results indicate that, for certain tasks such as intent recognition, Gemini outperforms other models. However, by employing the “large language model (LLM) as a judge” approach for semantic evaluation of response correctness, we found several models that demonstrate a close alignment with the ground truth. In conclusion, this study highlights the potential of locally deployed SLMs as components of medical chatbots, while addressing critical concerns related to privacy and reliability
Editorial: The social brain: new insights from social, clinical, and biological psychology
No full textFrontiers in Psycholog
Il lungo decennio dei giovani del "Mulino". Dal centrismo all'apertura a sinistra
No full textIl contributo ricostruisce le principali analisi pubblicate dalla Rivista Il Mulino dalla sua fondazione alla metà degli anni Sessanta. I temi principali riguardano l'evoluzione del sistema politico italiano dal centrismo al centrosinistra e il ruolo del Paese all'interno del contesto della Guerra fredd
Length of stay after colorectal surgery in Italy: the gap between “fit for” and “actual” discharge in a prospective cohort of 4529 cases
Get PDFBackground It is common to observe a gap between the day on which the discharge criteria are reached and the actual day of discharge after colorectal surgery. The aim of this study is to understand the reasons for this difference and its clinical impact on the overall length of stay (LOS). Methods All patients enrolled in the prospective iCral3 study were analyzed regarding any difference and reason between the "fit for discharge" (FFD) and "actual discharge" (AD) dates. The association between the gap and the LOS in the whole population was then assessed through a multivariate regression model including other confounding variables. Results The analysis included 4529 patients, with a median [IQR] LOS of 6 [4-8] days. The median [IQR] LOS was 6 [4-8] days in the no-gap group (3,910 patients, 86.3%), significantly lower (p < .001) than 7 [6-10] days in the gap group (619 patients, 13.7%). Among the gap reasons, the "need for postoperative rehabilitation" compared to "not willing to return home" and "social constraints" was associated with the longest LOS (9 [6.0-12.5] days, p < 0.001 vs other reasons). The existence of the gap independently determined a 2.3-day lengthening of LOS. Conclusions Among other factors, the gap between FFD and AD had an independent impact on LOS. The most frequent reasons for this gap were "not willing to return home" and "social constraint", while the "need for postoperative rehabilitation" had the greater clinical impact
Identification of PET/CT radiomic signature for classification of locally recurrent rectal cancer: A network-based feature selection approach
Get PDFBackground: The modern approach to treating rectal cancer, which involves total mesorectal excision directed by imaging assessments, has significantly enhanced patient outcomes. However, locally recurrent rectal cancer (LRRC) continues to be a significant clinical issue. Identifying LRRC through imaging is complex, due to the mismatch between fibrosis and inflammatory pelvic tissue. This work aimed to develop a machine learning model for predicting LRRC using radiomic features extracted from 18F-FDG Positron Emission Tomography/Computed Tomography (PET/CT). Methods: CT and PET images of PET/CT examinations were retrospectively collected from 44 patients, with 29 cases of recurrence (66 %) and 15 cases with no local recurrence (34 %). The whole analysis was conducted separately for CT and PET images to evaluate their different predictive power. Radiomic features were extracted from suspected lesion volumes identified by physicians and the most relevant radiomic features were selected to predict the presence or absence of LRRC. Feature selection was performed using a novel approach derived from gene expression analysis, based on the DNetPRO algorithm. The prediction was done using a Support Vector Classifier (SVC) with a 10-fold cross-validation. The efficiency of the pipeline in predicting LRRC was evaluated according to the sensitivity, specificity, Balanced Accuracy Score (BAS) and Matthews's Correlation Coefficient (MCC). Results: CT features were found to be the most predictive, showing a sensitivity of 0.80, a specificity of 0.82, a BAS of 0.81 and an MCC of 0.61. PET features obtained a sensitivity of 0.93, a specificity of 0.61, a BAS of 0.77 and a MCC of 0.52. The combination of PET and CT features obtained a sensitivity of 0.80, a specificity of 0.75, a BAS of 0.77 and a MCC of 0.53. Conclusions: To the best of our knowledge, the DNetPRO algorithm was applied for the first time to medical image analysis and proved suitable for the selection of radiomic features with the highest predictive power, a crucial step in a radiomic pipeline. Our results confirmed the efficiency of radiomic features in predicting LRRC, with CT features outperforming PET features in identifying the characteristic texture of LRRC. The combination of both yielded no performance improvement
Waving the same flag? Government legislation and obstructionism during the COVID-19 crisis in Italy
Get PDFThis study examines the amendatory activities of the majority and opposition parties in the Italian 18th legislature (2018–2022) in response to the COVID-19 pandemic crisis. Following the rally around the flag hypothesis, we test whether both sides exhibited similar legislative behaviour during emergencies. We exploit an original database covering amendments tabled by Italian legislators on bills converting decreelaws. Results reveal that the COVID-19 pandemic affected amendment activities without aligning majority and opposition behaviours. In other words, the opposition did not pull in the same direction of the government legislation. This can be explained by contingent factors and pre-existing party polarization
Should Routine Radiographic Screening for Spino-pelvic Relationship Be Performed in Patients Undergoing Primary Total Hip Arthroplasty?
No full textShould routine radiographic screening for spino-pelvic relationships be performed in
patients undergoing primary total hip arthroplasty?
Response/Recommendation: There is no need for routine radiographic screening for the spinopelvic relationship, and this should be reserved for patients who have spinal disease and risk
factors for instability
The mechanistic understanding of the BRCA2-RAD51 interaction: an integrated structural biophysics study
No full textThe interaction of RAD51 with BRCA2 is a critical step of homologous recombination, a mechanism that maintains genome integrity. Through eight short repeats, BRCA2 recruits and transports RAD51 to the sites where DNA damage is processed. Nowadays, only the interaction of RAD51 with BRC4 has been structurally characterized through X-ray crystallography by removing the first 97 amino acids of RAD51. Nevertheless, due to the structural complexity and dynamics of RAD51, the mechanistic details of each step of RAD51 recruitment and DNA repair still need to be elucidated. We performed an integrative experimental-computational approach to shed light on the tight relation between these two proteins. We evaluated the mechanism of RAD51 defibrillation driven by BRC4 through negative staining transmission electron microscopy (TEM) experiments and size exclusion chromatography, revealing that BRC4 erodes RAD51 fibrils from their termini. Nevertheless, the propensity to oligomerization of the WT protein limited further biophysical studies. Therefore, we isolated a novel, fully human monomeric RAD51 form, which was exploited to study the interaction with BRC4 through orthogonal biophysical methods. SAXS experiments were also carried out on the full-length monomeric protein and its complex with BRC4 peptide, providing novel structural insights into their behavior in solution. Specifically, atomistic modeling of AlphaFold2 predictions revealed that both proteins display flexible N-terminal domains. These results and previous evidence on RAD51 WT fibrils suggest that BRC4 binding triggers a conformational rearrangement of the RAD51 N-terminal domain from a more ordered to an intrinsically disordered state. These data allowed a thorough understanding of the interaction between BRC4 and RAD51, suggesting that disassembling the RAD51 fibril operated by BRCA2 in the cytosol is the first critical step of homologous recombination. Importantly, we proved that the isolated RAD51 monomeric form is a novel and reliable platform for structural and biophysical analyses of the BRC repeats-RAD51 interaction. Indeed, this tool will help future works aimed not only at elucidating the role of the other BRC repeats in the cytosolic recruitment of RAD51 but also to understand how they support the priming of RAD51 to the site of DNA damage. Finally, the BRCA2-RAD51 interaction has been reported as an appealing target for developing anti-cancer treatments since its disruption would mimic a BRCAness condition. In this context, the concomitant administration of PARP inhibitors synergistically results in cell death, enlarging the synthetic lethality paradigm. Therefore, further understanding the BRCA2-RAD51 interaction will provide essential information for innovative anti-cancer therapies