Evidence of greater severity of diabetic foot ulcers during COVID-19 pandemic: A real-life single-centre cohort study

Aims: In the Sars-Cov-2 pandemic era, patients with diabetes mellitus (DM) manifested more severe forms of Sars-Cov-2 with greater mortality than non-diabetic patients. Several studies documented more aggressive forms of diabetic foot ulcers (DFU) during the pandemic period even though the results were not unanimously confirmed. The aim of this study was to evaluate the clinical-demographic differences between a cohort of Sicilian diabetic patients hospitalised for DFU in the pre-pandemic 3 years and a cohort of patients hospitalised in the pandemic 2 years.Materials and Methods: One hundred and eleven patients from the pre-pandemic period 2017-2019 (Group A) and 86 patients from the pandemic period 2020-2021 (Group B) with DFU, admitted to the division of Endocrinology and Metabolism of the University Hospital of Palermo, were retrospectively evaluated. The clinical assessment of the type, staging and grading of the lesion, and the infective complication from DFU was performed.Results: No differences in HbA1c values were observed between the two groups. Group B showed a significantly higher prevalence of male subjects (p = 0.010), neuro-ischaemic ulcers (p < 0.001), deep ulcers with involvement of bones (p < 0.001), white blood count levels (p < 0.001), and reactive C protein (p = 0.001) compared to group A.Conclusions: Our data show that in the COVID-19 pandemic, a greater severity of ulcers requiring a significantly greater number of revascularisations and more expensive therapy, but without an increase in the amputation rate, was observed. These data provide novel information on the impact of the pandemic on diabetic foot ulcer risk and progression

Ultrasound Parameters Can Accurately Predict the Risk of Malignancy in Patients with "Indeterminate TIR3b" Cytology Nodules: A Prospective Study

The increase in the incidence of thyroid nodules with cytological findings of TIR3b requires the identification of predictive factors of malignancy. We prospectively evaluated 2160 patients from January 2018 to June 2022 and enrolled 103 patients with indeterminate cytology TIR3b nodules who underwent total (73 patients) and hemi-thyroidectomy (30 patients). Among them, 61 had a histological diagnosis of malignancy (30 classic papillary thyroid carcinoma, 19 had follicular papillary thyroid carcinoma variant, 3 had Hurtle cell carcinoma and 9 had follicular thyroid carcinoma), while 42 had a benign histology. Clinical, ultrasonographic and cytological characteristics were recorded. In addition, BRAF mutation was analysed. Patients with a histological diagnosis of malignancy had a higher frequency of nodule diameter <= 11 mm (p = 0.002), hypoechogenicity (p < 0.001), irregular borders (p < 0.001), peri- and intralesional vascular flows (p = 0.004) and microcalcifications (p = 0.001) compared to patients with benign histology. In contrast, patients with benign histology had more frequent nodules with a halo sign (p = 0.012) compared to patients with histological diagnosis of malignancy. No significant differences were found in BRAF mutation between the two groups. Our study suggests that the combination of ultrasonographic and cytological data could be more accurate and reliable than cytology alone in identifying those patients with TIR3b cytology and a histology of malignancy to be referred for thyroidectomy, thus reducing the number of patients undergoing thyroidectomy for benign thyroid disease

Practical therapeutic approach in the management of diabetes mellitus secondary to Cushing’s syndrome, acromegaly and neuroendocrine tumours

Cushing’s syndrome, acromegaly and neuroendocrine disorders are characterized by an excess of counterregulatory hormones, able to induce insulin resistance and glucose metabolism disorders at variable degrees and requiring immediate treatment, until patients are ready to undergo surgery. This review focuses on the management of diabetes mellitus in endocrine disorders related to an excess of counterregulatory hormones. Currently, the landscape of approved agents for treatment of diabetes is dynamic and is mainly patient-centred and not glycaemia-centred. In addition, personalized medicine is more and more required to provide a precise approach to the patient’s disease. For this reason, we aimed to define a practical therapeutic algorithm for management of diabetes mellitus in patients with glucagonoma, pheochromocytoma, Cushing’s syndrome and acromegaly, based on our practical experience and on the physiopathology of the specific endocrine disease taken into account. This document is addressed to all specialists who approach patients with diabetes mellitus secondary to endocrine disorders characterized by an excess of counterregulatory hormones, in order to take better care of these patients. Care and control of diabetes mellitus should be one of the primary goals in patients with an excess of counterregulatory hormones requiring immediate and aggressive treatment

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Ab initio quartic force field of stannane and rotational analysis of the \u3bd1 infrared band of H120SnD3

Stannane, SnH4, has been studied both theoretically, using high-level ab initio methods, and experimentally, using high-resolution spectroscopy to analyze the Sn-H stretching fundamental band of the (HSnD3)-Sn-120 isotopologue. The geometry and the anharmonic force field of the molecule have been calculated ab initio, using the coupled-cluster with single, double, and perturbative triple excitations level of theory. (HSnD3)-Sn-120, present as minor isotopologue in (SnD4)-Sn-120, has been studied by Fourier transform spectroscopy at an effective resolution of ca. 0.005 cm(-1) near 1900 cm(-1) and the nu(1) band was identified. About 360 ro-vibration transitions with J' up to 18 and K up to 10 have been assigned. Since the spectrum evidenced the existence of some perturbations, the transitions were analyzed either neglecting, or including in the model A(1)/E Coriolis-type interactions with nearby dark states. The standard deviation of the fits, ca. 1.5 x 10(-3) cm(-1), is about one order of magnitude larger than the estimated experimental precision, and is only slightly dependent on the adopted model. The spectroscopic parameters obtained from this and from previous analyses of stannane isotopologues have been compared with the theoretical results. The theoretical force field is also used to obtain semi-experimental harmonic frequencies and the equilibrium geometry

Crystal Structure of the 9‑Anthracene–Carboxylic Acid Photochemical Dimer and Its Solvates by X‑ray Diffraction and Raman Microscopy

The photodimerization of anthracene derivatives constitutes a model system for intermolecular [4 + 4] cycloadditions. In this paper we deal with the elusive 9-anthracene–carboxylic case and study the crystal state of the head-to-tail dimer, obtained by the reaction of the monomer in various solvents both in its unary and solvated forms, by X-ray diffraction and confocal Raman microscopy in the lattice phonon region. A number of solvates have been identified, and their structures have been solved and here presented. The 9-anthracene–carboxylic acid dimer appears to be an exemplary case of a molecular crystal easily prone to host solvent molecules in the interstices of the framework generated by homomolecular hydrogen bonds. Alternatively, the hydrogen bonds between solvent molecules and the carboxylic group may establish supramolecular structures of closely packed architectures. Raman microscopy has also allowed us to investigate the short-lived dimer, which is produced in the crystal-to-crystal photoreaction triggered by the irradiation of the monomer single crystal

Short-term air pollution exposure and mechanisms of plaque instability in acute coronary syndromes: An optical coherence tomography study

Background and aims: Air pollution is emerging as an important risk factor for acute coronary syndrome (ACS). In this study, we investigated the association between short-term air pollution exposure and mechanisms of coronary plaque instability evaluated by optical coherence tomography (OCT) imaging in ACS patients. Methods: Patients with ACS undergoing OCT imaging were retrospectively selected. Mechanism of culprit lesion instability was classified as plaque rupture (PR) or intact fibrous cap (IFC) by OCT. Based on each case's home address, the mean daily exposures to several pollutants, including particulate matter 2.5 (PM2.5), on the same day of ACS and in the immediate days (up to 6 days) prior to the index ACS, were collected. Results: 139 ACS patients were included [69 (49.6%) had PR and 70 (50.4%) IFC]. Patients with PR, compared to those with IFC, had higher PM2.5 exposure levels on the same day of ACS, without differences in the immediate 6 days before index ACS. At multivariate analysis, PM2.5 exposure on the same day of ACS was the only independent predictor of PR [OR = 1.912 per SD (8.6 μg/m3), CI95 % (1.087-3.364), p = 0.025]. Patients with PR presented a steady increase in PM2.5 daily exposure levels in the days preceding the occurrence of ACS, with a peak the day of ACS (p for trend = 0.042) CONCLUSIONS: This study demonstrates for the first time that a higher short-term PM2.5 exposure, on the same day of ACS, is associated with an increased risk of PR as a pathobiological mechanism of coronary plaque instability

The ASI Integrated Sounder-SAR System Operating in the UHF-VHF Bands: First Results of the 2018 Helicopter-Borne Morocco Desert Campaign

This work is aimed at showing the present capabilities and future potentialities of an imaging radar system that can be mounted onboard flexible aerial platforms, such as helicopters or small airplanes, and may operate in the UHF and VHF frequency bands as Sounder and as Synthetic Aperture Radar (SAR). More specifically, the Sounder operates at 165 MHz, whereas the SAR may operate either at 450 MHz or at 860 MHz. In the work, we present the first results relevant to a set of Sounder and SAR data collected by the radar during a helicopter-borne campaign conducted in 2018 over a desert area in Erfoud, Morocco, just after the conclusion of a system upgrading procedure. In particular, a first analysis of the focusing capabilities of the Sounder mode and of the polarimetric and interferometric capabilities of the SAR mode is conducted. The overall system, originally developed by CO.RI.S.T.A. according to a ASI funding set up in 2010, has been upgraded in the frame of a contract signed in 2015 between ASI and different private and public Italian Research Institutes and Universities, namely CO.RI.S.T.A., IREA-CNR, Politecnico di Milano and University of Trento

Air pollution and plaque healing in acute coronary syndromes

N/