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Background: Among patients with non-ST-segment elevation myocardial infarction (NSTEMI) the presence of a bifurcation left main (LM) disease represents a particular subset graved by both clinical and technical challenges. We sought to assess the long-term outcomes of patients with NSTEMI treated either by single or double stent strategy, having an LM bifurcation culprit lesion. Methods: We retrospectively analyzed the procedural and medical data of consecutive patients referred to our center for NSTEMI due to complex LM bifurcation disease as the culprit lesion, treated using either single or dual stenting (provisional stenting, T or T-and-Protrusion (TAP), Culotte, and Nano-inverted-T (NIT)) techniques between January 2008 and May 2018. Target lesion failure (TLF) was defined as the composite of cardiovascular death, target-vessel myocardial infarction (MI), and clinically driven target lesion revascularization (TLR). Results: Four hundred and forty-five patients (54.1% males, mean age 70.3 ± 12.8 years, mean Syntax score 31.6 ± 6.3) were evaluated. Of these, 155 patients (34.8%) were treated using a single stent while the remaining were treated with a double stent strategy. After a mean follow-up of 37.1 months (IQR 22.1-39.3), TLF rate was 8.7% (n = 39): 5/155 (3.2%) in the crossover group; 10/53 (18.8%) in T/TAP group, 14/89 (15.7%) in the culotte group, and 10/148 (6.7%) in the NIT group of patients. Cardiovascular mortality rate was 2.9% (n = 13) while stent thrombosis was 0.89% (n = 4). On multivariate analysis dyslipidemia, Syntax score > 25, triple vessel disease, additional LM ostial, or LM body lesions and the use of Rotablator, were independent predictors of TLF. Conclusions: Either a single or double stent strategy resulted in low rates of TLF, cardiovascular death, and stent thrombosis in the long-term period in NSTEMI LM patients with contraindications or refusal of surgery. A single stent strategy appeared to have a slightly better outcome compared to a 2-stent strategy.

Background: Detailed anatomic variants of the interatrial septum in patients with right-to-left shunt and contribution of specific anatomies to the risk of ischaemic recurrences has not yet been comprehensively classified. Objective: To report a classification of the anatomic variants of the interatrial septum as observed by intracardiac echocardiography and its correlation with clinical and functional characteristics. Methods: We retrospectively reviewed the medical and instrumental data of 520 consecutive patients (mean age 44±15. 5 years, 355 women) who had over a 10-year period undergone intracardiac echocardiography and right-to-left shunt catheter-based closure. The four main features used to analyse were: (a) diameter of the oval fossa, (b) presence and length of the channel, (c) presence and degree of atrial septal aneurysm, and (d) rim thickness. The presence of Eustachian valve was also tabulated. Results: The combinations of interatrial septum anatomical features were classified into six main anatomical subgroups. Recurrent embolism, multiple ischaemic foci on brain magnetic resonance imaging, high grade shunt, and permanent shunt before transcatheter closure procedure were associated with type 2, type 4, and type 6. Type 4 anatomical subtype (OR 4.1, 1.5–8 [95% CI], p<0.001) and type 2+presence of Eustachian valve (OR 4.3, 1.6–9 [95% CI], p<0.001) were the strongest predictors of recurrent ischaemic events before transcatheter closure. Conclusion: Our study showed that interatrial septum anatomy greatly differs among patients with right-to-left shunt, as well as the risk of ischaemic recurrences in different anatomies.

Major Depressive Disorder (MDD) with suicidal ideation, intent, or behavior is a psychiatric emergency with controversial care management. Our study describes the comprehensive treatment pathways of this population in Italian routine clinical practice. ARIANNA [NCT 04463108] is an observational prospective and retrospective cohort study involving both primary data collection and secondary data extract. A total of 137 adult MDD patients with suicidality were enrolled from 24 Italian care sites and followed for 90 days. Other than the description of treatment patterns, the impact of treatment on depressive symptoms and suicidality, the burden on the patient's and caregiver's quality of life, healthcare resource utilization and costs were described. Of the 133 eligible patients, 68.4% were female, and the median age was 47. Approximately half of the study population had a current severe major depressive episode. Treatment strategies at the time of active suicidal ideation with intent definition/confirmation (t0) were heterogeneous, increasing in complexity during observation. According to the MADRS, patients with remission at t0+1 day were 2.6%, with the mean total score decreasing from 37.2 at t0 to 32.3. The study sites were not randomly selected. To the best of our knowledge, this is the first cohort study that prospectively describes the characteristics of patients with MDD and suicide risk in Italy, and how they are treated in clinical practice. The study confirms this is a difficult-to-treat population. In addition, a lack of rapid, effective treatment for reducing depressive symptoms and suicidality is observed. •First hybrid-design study describing patients with MDD and suicide risk in Italy.•At the confirmation of suicidality, a change in MDD treatment strategy occurred.•Comprehensive treatments administered in this critical population are heterogenous.•During the 90-day follow-up, about 48% of patients had depressive symptoms' remission.•Healthcare resource consumption is high and driven by hospitalizations.

This paper describes a coupling framework for parallel execution of different solvers for multi-physics and multi-domain simulations with an arbitrary number of adjacent zones connected by different physical or overlapping interfaces. The coupling architecture is based on the execution of several instances of the same coupling code and relies on the use of smart edges (i.e., separate processes) dedicated to managing the exchange of information between two adjacent regions. The collection of solvers and coupling sessions forms a flexible and modular system, where the data exchange is handled by independent servers that are dedicated to a single interface connecting two solvers’ sessions. Accuracy and performance of the strategy is considered for turbomachinery applications involving Conjugate Heat Transfer (CHT) analysis and Sliding Plane (SP) interfaces.

The abandonment and deterioration of historic rural buildings in Europe raise significant issues, including hydrogeological risks, the loss of productive land, and cultural heritage decline. Despite being underestimated, these structures hold significant potential for cultural and productive activities. Renovating these structures is crucial for local communities committed to preserving their heritage, and it is a more sustainable approach than constructing new buildings. This study explores activities undertaken in the Interreg IT/AT project “SHELTER” in Valbrenta (IT): through a participatory approach involving communities, stakeholders, designers, and researchers, an energy concept is developed for refurbishing an abandoned tobacco farm, chosen by the community, to be an alpine hut. Due to the inability to connect to the city electricity grid, the new energy concept focuses on minimizing consumption through envelope refurbishment, efficient heating, and domestic hot water systems. Additionally, the integration of renewable energy sources, particularly Building Integrated Photovoltaics (BIPV), is emphasized to preserve the building’s original appearance. This study demonstrates the feasibility of meeting seasonal energy needs entirely through renewables and explores the potential integration of biomass for meeting annual energy requirements.

The objectives of this study were to investigate the current attitudes of veterinarians towards the use of locoregional anaesthesia in non-conventional animal species and to identify areas for future useful research on this topic. A questionnaire was circulated online. A total of 417 veterinarians, including American and European specialists/specialists-in-training in both zoological medicine and anaesthesia/analgesia (ACZM/ECZM and ACVAA/ECVAA), participated in the study. Fifty-nine percent of respondents performed locoregional anaesthesia in rabbits, with intratesticular injections and local infiltration being the most commonly-reported techniques. ACZM/ECZM specialists reportedly performed dental blocks in rabbits more frequently than ACVAA/ECVAA specialists (p = 0.030). Forty percent of respondents performed locoregional anaesthesia in rodents, with intratesticular injections, topical/splash blocks and local infiltration being the most commonly reported techniques. The proportions of respondents who reportedly used locoregional anaesthesia in ferrets, birds and reptiles were 37.9%, 34.5% and 31.2%, respectively. The use of Tuohy (p < 0.001) and spinal needles (p < 0.001), as well as of ultrasonography (p = 0.009) and nerve-stimulators (p < 0.001), was more common among ACVAA/ECVAA compared to ACZM/ECZM specialists. Major topic areas for future research were identified as dental block techniques for rabbits and rodents and blocks for the wings of birds.

This study investigates the social acceptance of integrated photovoltaic (IPV) systems in heritage and landscape contexts, focusing on Italian stakeholders in the construction sector. As part of the “BIPV meets History” research project, this study aims to identify barriers, potentials, drivers, and challenges for widespread PV technology adoption, considering heritage conservation, land preservation, energy production, and climate mitigation. A survey exploring opinions on PV technology integration was conducted. The survey was improved and extended to a total of 271 respondents, using the online method of Computer-Aided Web Interviewing (CAWI), to understand how perceptions of integrated photovoltaics have changed after COVID-19 and the European energy crisis, emphasizing aesthetic, environmental, economic, and personal aspects. The results indicate a general awareness of the technologies, with increasing acceptance in protected contexts, for historic buildings (from 51 to 68%) and especially landscapes (from 44 to 71%), driven by energy and environmental benefits. Cultural concerns, particularly the risk of impacting historical and natural identities, emerge as major barriers. Additionally, it is evident that awareness of PV panel recycling methods is still limited.

Background Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray. Methods A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues’ responses. Stata 16.1 software was used for the analyses. Results Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement. Conclusions This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients.

Objectives: To assess the risk of lung cancer mortality related to occupational exposure to titanium dioxide (TiO2). Methods: A mortality follow-up study of 15,017 workers (14,331 men) employed in 11 factories producing TiO2in Europe. Exposure to TiO2dust was reconstructed for each occupational title; exposure estimates were linked with the occupational history. Observed mortality was compared with national rates, and internal comparisons were based on multivariate Cox regression analysis. Results: The cohort contributed 371,067 person-years of observation (3.3% were lost to follow-up and 0.7% emigrated). 2652 cohort members died during the follow-up, yielding standardized mortality ratios (SMRs) of 0.87 (95% confidence interval [CI] 0.83-0.90) among men and 0.58 (95% CI 0.40-0.82) among women. Among men, the SMR of lung cancer was significantly increased (1.23, 95% CI 1.10-1.38); however, mortality from lung cancer did not increase with duration of employment or estimated cumulative exposure to TiO2dust. Data on smoking were available for over one third of cohort members. In three countries, the prevalence of smokers was higher among cohort members compared to the national populations. Conclusions: The results of the study do not suggest a carcinogenic effect of TiO2dust on the human lung.

Gastropods comprise nearly 60,000 species of aquatic as well as terrestrial mollusks, primarily snails and slugs. The giant African land snail ( ) is one of the most popular pet snails worldwide. This gastropod mollusk is known as the intermediate host of several parasites that cause severe diseases in pets, free-ranging vertebrates, and humans. The aim of this survey was to investigate the occurrence of parasites in giant African land snails kept as pets in southern Italy. Fresh fecal samples were collected from a total of 60 giant African land snails kept in three private collections in Campania region (Italy). In addition, microscopic analysis of mucus and histological examination of biopsy samples from the foot muscle of 30 individual snails were performed. Coprological examination revealed the presence of rhabditid nematodes identified by both morphological and molecular assessment as in two out of three examined samples, and sp., and in one coprological sample. No parasites were detected in the muscle biopsy samples, or in the mucus. Due to the potential harm of rhabditid nematodes, their presence in giant African land snails potentially in contact with both pets and humans should not be disregarded.