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Laparoscopic Interval Appendectomy as Safe and Effective Treatment of Complicated Appendicitis after Failed Initial Conservative Approach: A Single-Center Experience
No full textBackground: Following the COVID-19 pandemic, antibiotic therapy has become the first-line treatment for acute appendicitis (AA) in many centers. Interval appendectomy (IA) is often needed later due to symptom recurrence. This paper aimed to report our experience with early, unplanned laparoscopic IA (LIA) over the past 2 years. Materials and Methods: All patients with previous AA initially managed with antibiotics who underwent LIA due to symptom recurrence over the period January 2022-March 2024 were enrolled. Parameters assessed included patients’ characteristics and operative outcomes. Results: The patient cohort included 40 girls and 31 boys, with a median age of 13.3 years (range 9-17). All LIAs were accomplished laparoscopically without conversions or intraoperative complications. The median operative time was 27 minutes (range 15-48). The appendix was ligated using two endoloops in 28/71 (39.4%) and resected using an automatic stapler in 43/71 (60.6%). A retrocecal appendix was found in 25/71 (35%), and adhesions between the appendix and the surrounding tissues in 31/71 (43%). Parasitic helminths were found in the lumen of the appendix in 5/71 (7%). Meckel’s diverticulum was negative in all cases. The median hospitalization was 32 hours (range 26-50). No postoperative complications occurred. Pathology confirmed intramural inflammation with peri-appendiceal fibrosis in all patients. Conclusions: Our study confirms that early laparoscopic appendectomy is a safe and feasible option after failed nonoperative management of complicated appendicitis. All procedures were completed laparoscopically without complications. Given the presence of adhesions and retrocecal appendix in many cases, further studies are needed to refine optimal treatment strategies and timing
Native and non-native monumental trees in cultural landscapes: a spatially heterogeneous source of biodiversity
No full textMonumental trees hold considerable ecological, cultural, and socio-economic values, providing crucial ecosystem services. Updated catalogues of monumental trees represent an essential starting point for the study and appropriate management of these entities. This study offers comprehensive insights into the composition, distribution, and ecological significance of the Italian monumental tree community. We used the Italian monumental trees inventory (4657 spatially explicit records) provided by the Ministry of Agriculture, Food Sovereignty, and Forestry. While native species dominate the monumental trees community, the noteworthy presence of non-native trees highlights ecological and historical dynamics at the national scale. Non-native species dominate the urban monumental trees community. Spatial analysis reveals clustering of monumental trees at provincial and local levels, suggesting the existence of biodiversity and cultural hotspots (e.g., parks, churches, historic villas, and royal palaces). We showed discrepancies concerning the application of monumentality criteria between native and non-native species, which also depend on their surrounding environment (e.g., urban settings favoring historical and architectural significance criteria). Native species are positively associated with criteria used to identify monumental trees such as age, circumference, crown size, shape, and ecological value, while non-native species are linked with historical, landscape, architectural, and botanical rarity values. Our findings highlight the multifaceted nature of the monumental tree community
Monographs on invasive plants in Europe: Ageratina adenophora (Spreng.) R.M. King & H. Rob
No full textAgeratina adenophora (Spreng.) R.M. King & H. Rob. (Crofton weed) is a triploid, apomictic perennial herb or sub-shrub native to Mexico that is highly invasive in many parts of the world. This species thrives in diverse habitats, from wet forest margins to dry slopes and disturbed urban areas. Initially introduced globally as an ornamental plant, it has now naturalized across many continents, including Europe, Asia, Africa, Oceania, and the Americas, often displacing native flora and altering ecosystems. Its introduction to Europe dates back to the 19th century, with naturalization first recorded on the French Riviera. Ageratina adenophora is now established in several southern European countries (Portugal, Spain, France, Italy, Croatia, Greece) and across the Macaronesian islands. It spreads via wind- and water-dispersed seeds and can also propagate vegetatively, particularly along riparian systems and disturbed sites. Despite its prolific reproduction and adaptability, its expansion in Europe has so far remained moderate, possibly due to climatic limitations and unsuitable habitats. Ecologically, A. adenophora exhibits remarkable phenotypic plasticity and physiological adaptations that enable it to survive a range of abiotic stresses including cold, drought, and variable light levels. The species benefits from mutualisms with soil microbes and displays enhanced nitrogen-use efficiency in introduced ranges. Although initially valued for ornamental and medicinal purposes, A. adenophora is now widely recognized as a harmful invader. It invades both natural and semi-natural habitats and has demonstrated a capacity to alter soil chemistry, suppress native vegetation through competition and allelopathy, and host diverse pathogens and endophytes. Ageratina adenophora negatively impacts biodiversity, ecosystem functioning, and agriculture by forming dense, monospecific stands and disrupting native communities. Its presence in biodiversity hotspots and protected areas—such as Himalaya, South Africa, and the Canary Islands—poses significant conservation challenges. Control efforts, including the use of biological agents such as Procecidochares utilis Stone 1947, have yielded mixed results. The most effective method for small areas is to physically remove A. adenophora before it sets seed. This can be done by hand-pulling or cutting. Given the continued spread and resilience of this species there is an urgent need for coordinated management strategies and increased awareness, especially in the face of climate change which may further facilitate its expansion in Europe and beyond
Risk and Association of Specific HLA Alleles With Nintedanib‐Induced Gastrointestinal Adverse Reactions: A Discovery Study in an Italian Population
No full textIdiopathic Pulmonary Fibrosis (IPF) is a progressive and fatal lung disease with limited treatment options. Nintedanib and pirfenidone are the only antifibrotic drugs approved by both the USA and European medicinal agencies, but their efficacy and tolerability remain concerns. This exploratory study investigates the association between genetic variation in the Major Histocompatibility Complex (MHC) region and adverse effects (AEs) of these therapies. HLA genotyping has been previously performed in a discovery cohort of 124 IPF Italian patients, with recorded drug-related AEs. Logistic regression analysis using an additive model identified HLA-C*06:02 as a significant risk factor, increasing the likelihood of AEs sixfold in nintedanib-treated patients (p = 0.0043, OR = 6.54, 95% C.I. 1.80–23.75). Notably, gastrointestinal toxicity—the most common AE—was strongly associated with this allele (p = 0.0005, OR = 11.85, 95% C.I. 2.94–47.71). These findings suggest a potential immune-mediated mechanism involving IL-23-driven inflammation and underscore the importance of pharmacogenetic tools in tailoring antifibrotic therapy. Implementing genetic screening could help minimize AEs and improve patient outcomes. Larger studies are warranted to validate these associations and guide personalized treatment strategies
Aging alters face expressions processing and recognition: insights on possible neural mechanisms
No full text: The present work investigated how aging influences the different stages of face expressions processing: fixation patterns, early perception, face motor response and recognition. Thirty-four participants (17 young, 17 senior) were subjected to i) recording of fixation patterns, ii) recording of the P100 and the N170 components of event-related potentials, iii) excitability of short intracortical inhibition (SICI) and intracortical facilitation (ICF) of the face primary motor cortex (face M1) , and iv) recognition task during the passive viewing of neutral, happy and sad faces expressions. senior subjects mostly looked at the mouth, had reduced pupil size and delayed N170 latency, regardless of expression, compared to young ones; and a reduced P100 amplitude when viewing sad faces. Senior subjects' excitability of face M1 (was enhanced compared to the young group; both groups had a reduced SICI when viewing happy faces, but only senior subjects exhibited reduced SICI for sad faces. Young subjects had better recognition accuracy and response times than senior ones, particularly for sad expressions. When viewing sad expressions, SICI was negatively correlated with pupil size and recognition accuracy, and positively correlated with N170 latency. Data suggested that aging reduces visual attention for sad faces which appears to be connected to an increased excitability of face M1, which in turn is linked to their impaired recognition skills, especially when processing negative face expressions. These findings prove new insights in the comprehension of how aging affects cognitive functions and the process of face expressions recognition
Precut disc of lyophilized amniotic membrane for recurrent full thickness macular hole management
No full textPurpose: To assess the efficacy of precut disc of lyophilized amniotic membrane (LAM) in the management of recurrent full thickness macular hole (FTMH), already treated with pars plana vitrectomy (PPV), internal limiting membrane peeling, and gas tamponade. Methods: Twenty-seven eyes of 27 patients with recurrent FTMH were included in this retrospective study and treated with 25G PPV, LAM graft (Visio Amtrix, TBF, Mions, France) and 20% SF6 gas tamponade. Spectral domain optical coherence tomography (SD-OCT) was used to assess anatomic FTMH closure 1 month postoperatively. Best corrected visual acuity (BCVA) was measured preoperatively and 1, 3, 6 and 12 months after surgery. Results: Twelve eyes presented large idiopathic FTMHs, 12 showed large FTMH associated with high myopia and the remaining 3 had large FTMH and retinal detachment in highly myopic eyes. Mean minimum FTMH diameter at baseline was 782±341.17 μm and mean BCVA was 1.02±0.63 LogMAR. Postoperatively, anatomical FTMH closure was achieved in 23/27 (85.2%) eyes one month after the surgery. Mean BCVA progressively improved during the follow-up period, reaching 0.55±0.42 LogMAR (p = 0.04) at 12-months follow-up. No adverse events were registered during follow-up. Conclusions: Results suggest that epiretinal graft of LAM precut discs is a safe and effective surgical procedure for large and recurrent FTMH treatment, leading to significant BCVA improvement
Risk of clinical events in virologically suppressed people with HIV switching to a two-drug regimen vs. remaining on a three-drug regimen: a target trial emulation
No full textBackground: Guidelines support the switch to a two-drug regimen (2DR) in virologically suppressed people with HIV (PWH) on a three-drug regimen (3DR). Randomized clinical trials have not included clinical outcomes in study endpoints. We provide estimates of 3-year clinical risk by means of a target trial emulation using the data of a large cohort of PWH in Italy. Methods: PWH from the Icona Foundation Study who were virologically suppressed (HIV-RNA ≤50 copies/mL) for ≥6 months on a 3DR on or after November 2014, were enrolled (database closure on July 31, 2024). PWH were classified according to therapeutic strategies: switching to 2DR (protease inhibitors or dolutegravir plus lamivudine or dolutegravir plus rilpivirine) or remaining on 3DR (any combination). The primary endpoint was the time to the first clinical composite event (cardiovascular disease [CVD], cancer [AIDS and non-AIDS related], or death). We calculated the difference in 3-year risk between therapeutic strategies, estimated using a weighted non-parametric Kaplan–Meier estimator. Findings: 7672 participants entered the analysis: 629 (8.2%) switching to 2DR and 7043 (91.8%) remaining on 3DR. Over the 3-year follow-up, 408 events were registered (64 CVD, 234 cancer, and 110 deaths). The 3-year adjusted risk estimate was 2.55 (95% CI 1.72, 5.33) in 2DR vs. 4.69 (95% CI 4.48, 6.17) in 3DR. The difference (−2.15% [95% CI −3.56%, −0.20%]) in favor of 2DR was mainly driven by events of non-AIDS related cancer and mortality. Interpretation: This study provides evidence that virologically suppressed PWH can be safely switched to 2DR, and may slightly reduce the 3-year risk of a composite clinical outcome. Funding: The Icona Foundation Study is supported by unrestricted grants from Gilead Sciences, ViiV Healthcare, Merck Sharpe & Dohme
Evaluation of Negative Pressure Wound Therapy dressing in the management of mommy makeover surgery wounds
No full textBackground: This investigation explores the potential impact of Negative Pressure Wound Therapy (NPWT) dressing on mommy makeover surgical wounds. The focus is on optimizing the healing process and post-surgical care to mitigate complications like wound dehiscence, seroma, and hematoma. Patients and methods: A prospective study spanned from October 2015 to April 2022, involving 40 patients undergoing mommy makeover surgery for aesthetic purposes. The randomized division resulted in two groups. Group one (n = 20) had donor sites covered with NPWT dressing, while group two (n = 20) received standard dressings lacking known healing-promoting agents. The assessment of complications served as an index of NPWT efficacy, and scars were evaluated using the Vancouver Scale. Results: Immediate post-surgical use of NPWT dressings significantly expedited wound healing compared to fine-mesh gauze dressings. Furthermore, it almost eradicated discomfort and pain in all patients, indicating excellent compliance. Patients tolerated NPWT well, with no instances of dressing failure or non-compliance. Conclusion: This study underscores the utility of NPWT dressing in managing mommy makeover surgery wounds. The dressing’s bio-occlusive properties create an optimal environment for wound healing, simultaneously minimizing pain, discomfort, and preventing key complications such as seroma and unfavorable scar appearance
