Risk perception, knowledge about SARS-CoV-2, and perception towards preventive measures in Italy: a nationwide cross-sectional study

Introduction: After COVID-19 outbreak, governments adopted several containment measures. Risk perception and knowledge may play a crucial role since they can affect compliance with preventive measures. This study aimed to explore the extent and the associated factors of risk perception, knowledge regarding SARS-CoV2, and perception towards preventive measures among the Italian population. Methods: A nationwide cross-sectional study involving adults was conducted in April-May 2021: an online survey was distributed through social media. The outcomes were: Knowledge Score (KS) (0 to 100%: higher scores correspond to higher COVID-19-related knowledge); Risk Perception Score (RPS) (1 to 4: higher values indicate higher concern); Preventive measures Perception Score (PPS) (1 to 4: higher values indicate higher confidence). Multivariable regression models were performed. Results: A total of 1120 participants were included. Median KS was 79.5%  (IQR=72.7%-86.4%). Lower education and poor economic conditions were negatively associated with the KS.  Median RPS was 2.8 (IQR=2.4-3.2). Female gender, sharing house with a fragile person, suffering from a chronic disease, having a family member/close friend who contracted SARS-CoV-2 infection were positively associated with the RPS. Median PPS was 3.1 (IQR=2.8-3.4). Lower educational level was negatively associated with the PPS. Vaccine hesitancy was negatively associated with all three outcomes. The three scores were positively associated with each other. Conclusions: Fair levels of knowledge, risk perception and perception towards preventive measures were reported. Reciprocal relationships between the outcomes and a relevant relationship with vaccine hesitancy were highlighted. Further investigations should be focused on studying underlying determinants and consequences

COVID-19 and Pregnancy: An Updated Review about Evidence-Based Therapeutic Strategies

The COVID-19 pandemic posed a significant challenge for clinicians in managing pregnant women, who were at high risk of virus transmission and severe illness. While the WHO declared in May 2023 that COVID-19 is no longer a public health emergency, it emphasized that it remains a global health threat. Despite the success of vaccines, the possibility of new pandemic waves due to viral mutations should be considered. Ongoing assessment of the safety and effectiveness of pharmacological therapies is crucial in clinical practice. This narrative review summarizes the evidence-based therapeutic strategies for pregnant women with COVID-19, considering over three years of pandemic experience. The review discusses the safety and effectiveness of various drug regimens (antivirals, anticoagulants, corticosteroids, immunoglobulins, monoclonal antibodies, and therapeutic gases) and procedures (prone positioning and extracorporeal membrane oxygenation). Drugs with contraindications, inefficacy during pregnancy, or unknown adverse effects were excluded from our evaluation. The aim is to provide healthcare professionals with a comprehensive guide for managing pregnant women with COVID-19 based on lessons learned from the pandemic outbreak

Clinical and Radiographic Outcomes and Treatment Algorithm for Septic Arthritis in Children

Background: Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2-7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments-arthrocentesis, arthrotomy, and arthroscopy-provides better results in children and when to use them. Methods: Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings. Results: A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique. Conclusions: We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it

Coexistence of endometriosis and thyroid autoimmunity in infertile women: impact on in-vitro fertilization and reproductive outcomes

Objective: To evaluate the prevalence and impact of impaired thyroid-stimulating hormone (TSH) levels on the reproductive outcomes of in vitro fertilization patients diagnosed with endometriosis and compared to controls without endometriosis. Design: Retrospective cohort study on prospectively collected data Setting: Tertiary care University Hospital Participants: Infertile women with histopathological diagnosis of endometriosis. Methods: for 12 months (January 2018 to January 2019), women were deemed suitable and subsequently divided according to serum thyroid-stimulating hormone levels above or below 2.5 mIU/L and compared to patients without endometriosis. Needed sample size was at least 41 patients for each cohort of women. Co-primary outcomes were the live birth rate (LBR), clinical pregnancy rate (CPR) and pregnancy loss rate (PLR). Results: 226 women (45 with endometriosis and 181 controls without endometriosis) were included. Diagnoses of Hashimoto thyroiditis were significantly more frequent in women with rather than without endometriosis (14/45 (31.1%) vs 27/181 (14.9%); p=0.012). Similarly, in women with endometriosis, Hashimoto diagnosis rates were higher with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (9/15 (60%) vs 5/30 (16.6%); p=0.001), so were the Hashimoto diagnosis rates in control group (women without endometriosis) with TSH ≥2.5 mIU/L compared to TSH <2.5 mIU/L (17/48 (35.4%) vs 10/133 (7.5%), respectively; p=0.001). Effect size analysis confirmed an increased risk of Hashimoto thyroiditis in women with endometriosis and TSH ≥2.5 mIU/L compared to women with endometriosis and TSH <2.5 mIU/L ((risk ratio (RR) 3.60 (95% CI 1.46 to 8.86)) and in women with endometriosis and TSH ≥2.5 mIU/L compared to non-endometriotic euthyroid patients (RR 7.98 (95% CI 3.86 to 16.48)). Dysmenorrhea risk was higher in endometriotic euthyroid women compared to euthyroid patients with no endometriosis (RR 1.87 (95% CI 1.21 to 2.87)). The risk was still increased in euthyroid women with endometriosis relative to dysthyroid women with no endometriosis (RR 1.97 (95% CI 1.11 to 3.50)). There were no significant differences between the four groups for CPR, LBR, PLR and retrieved oocytes, immature oocytes, degenerated and unfertilized oocytes, cultured blastocysts, embryos and transferred embryos. Limitations: Retrospective design, limited sample size and use of different ovarian stimulation protocol. Conclusions: Thyroid autoimmunity seems more common in women with endometriosis and thyroid-stimulating hormone over 2.5 mIU/L. However, there was no significant impact on in vitro fertilization and reproductive outcomes related to the coexistence of endometriosis, Hashimoto disease and higher thyroid-stimulating hormone levels. Due to limitations of the study, additional evidence is required to validate the abovementioned findings

Piezoelectric Barium Titanate Nanostimulators for the Treatment of Glioblastoma Multiforme

Major obstacles to the successful treatment of gliolastoma multiforme are mostly related to the acquired resistance to chemotherapy drugs and, after surgery, to the cancer recurrence in correspondence of residual microscopic foci. As innovative anticancer approach, low-intensity electric stimulation represents a physical treatment able to reduce multidrug resistance of cancer and to induce remarkable anti-proliferative effects by interfering with Ca2+ and K+ homeostasis and by affecting the organization of the mitotic spindles. However, to preserve healthy cells, it is utterly important to direct the electric stimuli only to malignant cells. In this work, we propose a nanotechnological approach based on ultrasound-sensitive piezoelectric nanoparticles to remotely deliver electric stimulations to glioblastoma cells. Barium titanate nanoparticles (BTNPs) have been functionalized with an antibody against the transferrin receptor (TfR) in order to obtain the dual targeting of blood-brain barrier and of glioblastoma cells. The remote ultrasound-mediated piezo-stimulation allowed to significantly reduce in vitro the proliferation of glioblastoma cells and, when combined with a sub-toxic concentration of temozolomide, induced an increased sensitivity to the chemotherapy treatment and remarkable anti-proliferative and pro-apoptotic effects

Piezoelectric Barium Titanate Nanostimulators for the Treatment of Glioblastoma Multiforme

Major obstacles to the successful treatment of gliolastoma multiforme are mostly related to the acquired resistance to chemotherapy drugs and, after surgery, to the cancer recurrence in correspondence of residual microscopic foci. As innovative anticancer approach, low-intensity electric stimulation represents a physical treatment able to reduce multidrug resistance of cancer and to induce remarkable anti-proliferative effects by interfering with Ca2+ and K+ homeostasis and by affecting the organization of the mitotic spindles. However, to preserve healthy cells, it is utterly important to direct the electric stimuli only to malignant cells. In this work, we propose a nanotechnological approach based on ultrasound-sensitive piezoelectric nanoparticles to remotely deliver electric stimulations to glioblastoma cells. Barium titanate nanoparticles (BTNPs) have been functionalized with an antibody against the transferrin receptor (TfR) in order to obtain the dual targeting of blood-brain barrier and of glioblastoma cells. The remote ultrasound-mediated piezo-stimulation allowed to significantly reduce in vitro the proliferation of glioblastoma cells and, when combined with a sub-toxic concentration of temozolomide, induced an increased sensitivity to the chemotherapy treatment and remarkable anti-proliferative and pro-apoptotic effects

An Utstein-based model score to predict survival to hospital admission: The UB-ROSC Score

Abstract Aims To develop and validate a multi-parametric practical score to predict the probability of survival to hospital admission of an out-of-hospital cardiac arrest (OHCA) victim by using Utstein Style-based variables. Methods All consecutive OHCA cases occurring from 2015 to 2017 in two regions, Pavia Province (Italy) and Canton Ticino (Switzerland) were included. We used random effect logistic regression to model survival to hospital admission after an OHCA. We computed the model area under the ROC curve (AUC ROC) for discrimination and we performed both internal and external validation by considering all OHCAs occurring in the aforementioned regions in 2018. The Utstein-Based ROSC (UB-ROSC) score was derived by using the coefficients estimated in the regression model. The score value was obtained adding the pertinent score components calculated for each variable. The score was then plotted against the probability of survival to hospital admission. Results 1962 OHCAs were included (62% male, mean age 73 ± 16 years). Age, aetiology, location, witnessed OHCA, bystander CPR, EMS arrival time and shockable rhythm were independently associated with survival to hospital admission. The model showed excellent discrimination (AUC 0.83, 95%CI 0.81–0.85) for predicting survival to hospital admission, also at internal cross-validation (AUC 0.82, 95%CI 0.80–0.84). The model maintained good discrimination after external validation by using the 2018 OHCA cohort (AUC 0.77, 95%CI 0.74–0.80). Conclusions UB-ROSC score is a novel score that predicts the probability of survival to hospital admission of an OHCA victim. UB-ROSC shall help in setting realistic expectations about sustained ROSC achievement during resuscitation manoeuvres

The AOM/DSS murine model for the study of colon carcinogenesis: From pathways to diagnosis and therapy studies

Colorectal cancer (CRC) is a major health problem in industrialized countries. Although inflammation-linked carcinogenesis is a well accepted concept and is often observed within the gastrointestinal tract, the underlying mechanisms remain to be elucidated. Inflammation can indeed provide initiating and promoting stimuli and mediators, generating a tumour-prone microenvironment. Many murine models of sporadic and inflammation-related colon carcinogenesis have been developed in the last decade, including chemically induced CRC models, genetically engineered mouse models, and xenoplants. Among the chemically induced CRC models, the combination of a single hit of azoxymethane (AOM) with 1 week exposure to the inflammatory agent dextran sodium sulphate (DSS) in rodents has proven to dramatically shorten the latency time for induction of CRC and to rapidly recapitulate the aberrant crypt foci-adenoma-carcinoma sequence that occurs in human CRC. Because of its high reproducibility and potency, as well as the simple and affordable mode of application, the AOM/DSS has become an outstanding model for studying colon carcinogenesis and a powerful platform for chemopreventive intervention studies. In this article we highlight the histopathological and molecular features and describe the principal genetic and epigenetic alterations and inflammatory pathways involved in carcinogenesis in AOM/DSS-treated mice; we also present a general overview of recent experimental applications and preclinical testing of novel therapeutics in the AOM/DSS model

Endometrial Biopsy: Indications, Techniques and Recommendations. An Evidence-Based Guideline for Clinical Practice

This practice guideline provides updated evidence for the gynecologist who performs endometrial biopsy (EB) in gynecologic clinical practice. An international committee of gynecology experts developed the recommendations according to AGREE Reporting Guideline. An adequate tissue sampling is mandatory when performing an EB. Blind methods should not be first choice in patients with suspected endometrial malignancy. Hysteroscopy is the targeted-biopsy method with highest diagnostic accuracy and cost-effectiveness. Blind suction techniques are not reliable for the diagnosis of endometrial polyps. In low resources settings, and in absence of the capacity to perform office hysteroscopy, blind techniques could be used for EB. Hysteroscopic punch biopsy allows to collect only limited amount of endometrial tissue. grasp biopsy technique should be considered first choice in reproductive aged women, bipolar electrode chip biopsy should be preferred with hypotrophic or atrophic endometrium. EB is required for the final diagnosis of chronic endometritis. There is no consensus regarding which endometrial thickness cut-off should be used for recommending EB in asymptomatic postmenopausal women. EB should be offered to young women with abnormal uterine bleeding and risk factors for endometrial carcinoma. Endometrial pathology should be excluded with EB in nonobese women with unopposed hyperestrogenism. Hysteroscopy with EB is useful in patients with abnormal bleeding even without sonographic evidence of pathology. EB has high sensitivity for detecting intrauterine pathologies. In postmenopausal women with uterine bleeding, EB is recommended. Women with sonographic endometrial thickness > 4mm using tamoxifen should undergo hysteroscopic EB