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An inverse association has been reported between coffee drinking and the risk of hepatocellular carcinoma (HCC) and chronic liver disease (CLD), but its magnitude is still unclear. Thus, we carried out a systematic review and meta-analysis of prospective cohort studies that investigated the association between coffee consumption and the risk of HCC or CLD. We separately estimated the relative risk (RR) of the two conditions, for regular, low, and high consumption compared with no or occasional coffee consumption; we also calculated the summary RR for an increment of one cup of coffee per day. Twelve studies on HCC (3414 cases) and six studies on CLD (1463 cases) were identified. The summary RRs for HCC were 0.66 [95% confidence interval (CI): 0.55–0.78] for regular, 0.78 (95% CI: 0.66–0.91) for low, and 0.50 (95% CI: 0.43–0.58) for high coffee consumption, respectively. The summary RR for an increment of one cup per day was 0.85 (95% CI: 0.81–0.90). The summary RRs for CLD were 0.62 (95% CI: 0.47–0.82) for regular, 0.72 (95% CI: 0.59–0.88) for low, 0.35 (95% CI: 0.22–0.56) for high, and 0.74 (95% CI: 0.65–0.83) for an increment of one cup per day. The present meta-analysis provides a precise quantification of the inverse relation between coffee consumption and the risk of HCC, and adds evidence to the presence of an even stronger negative association with CLD.

ObjectivesTo estimate the population-level incidence of emergency department (ED) visits for violent behaviour, identify associated factors and quantify the contribution of people presenting to ED for violent behaviour on the total number of ED visits for mental health problems.DesignRetrospective cohort study.SettingRegional healthcare authority serving a population of 1.2 million in Romagna, Italy, January 2022 to December 2023.Participants871 119 residents (70% of the regional population; 55.6% female) alive on 1 January 2022 with data on comorbidities. Participants were followed until 31 December 2023 with censoring at death.Primary and secondary outcome measuresPrimary outcome: incidence of ED visits for violent/homicidal. Factors associated with violent ED visits were examined. Secondary outcome: quantification of the contribution of people presenting to ED for violent behaviour on the total number of ED visits for any mental health problem.Results286 individuals (76.9% male) had 573 ED visits for violent behaviour, representing 4.2% of all psychiatric ED visits with an annual incidence rate of 3.48 per 10 000 person-years (95% CI 3.21 to 3.78). Male sex was associated with violent behaviour (OR 3.85, 95% CI 2.60 to 5.70; OR 4.64, 95% CI 3.12 to 6.92 among mental health service users). High comorbidity and prior mental health service use increased the risk. Having an ED visit for violent behaviour was associated with higher odds (OR 10.9, 95% CI 8.02 to 14.96) and higher incidence rate (incidence rate ratio 1.51, 95% CI 1.35 to 1.69) of psychiatric ED visits for other mental health problems.ConclusionsED visits for violent behaviour occur at relatively low population rates but predominantly affect high-risk groups: males with prior mental health service contact and either minimal or very high comorbidity. These findings supported the need for tailored interventions that address both the immediate risk of violence and underlying mental health issues, especially for high-risk groups.

Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area. The study population included CKD patients recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within this PIRP cohort as of 31.07.2020. COVID-19 incidence in CKD patients was 4.09% (193/4,716 patients), while in the general population it was 0.46% (5,195/1,125,574). The crude mortality rate among CKD patients with COVID-19 was 44.6% (86/193), compared to 4.7% (215/4,523) in CKD patients without COVID-19. The excess mortality of March-April 2020 was +69.8% than the average mortality of March-April 2015–19 in the PIRP cohort. In a cohort mostly including regularly followed up CKD patients, the incidence of COVID-19 among CKD patients was strongly related to the spread of the infection in the community, while its lethality is associated with the underlying kidney condition and comorbidities. COVID-19 related mortality was about ten times higher than that of CKD patients without COVID. For this reason, it is urgent to offer a direct protection to CKD patients by prioritizing their vaccination.

This retrospective case-control study was aimed at identifying potential independent predictors of severe/lethal COVID-19, including the treatment with Angiotensin-Converting Enzyme inhibitors (ACEi) and/or Angiotensin II Receptor Blockers (ARBs). All adults with SARS-CoV-2 infection in two Italian provinces were followed for a median of 24 days. ARBs and/or ACEi treatments, and hypertension, diabetes, cancer, COPD, renal and major cardiovascular diseases (CVD) were extracted from clinical charts and electronic health records, up to two years before infection. The sample consisted of 1603 subjects (mean age 58.0y; 47.3% males): 454 (28.3%) had severe symptoms, 192 (12.0%) very severe or lethal disease (154 deaths; mean age 79.3 years; 70.8% hypertensive, 42.2% with CVD). The youngest deceased person aged 44 years. Among hypertensive subjects (n = 543), the proportion of those treated with ARBs or ACEi were 88.4%, 78.7% and 80.6% among patients with mild, severe and very severe/lethal disease, respectively. At multivariate analysis, no association was observed between therapy and disease severity (Adjusted OR for very severe/lethal COVID-19: 0.87; 95% CI: 0.50-1.49). Significant predictors of severe disease were older age (with AORs largely increasing after 70 years of age), male gender (AOR: 1.76; 1.40-2.23), diabetes (AOR: 1.52; 1.05-2.18), CVD (AOR: 1.88; 1.32-2.70) and COPD (AOR: 1.88; 1.11-3.20). Only gender, age and diabetes also predicted very severe/lethal disease. No association was found between COVID-19 severity and treatment with ARBs and/or ACEi, supporting the recommendation to continue medication for all patients unless otherwise advised by their physicians.

PurposeTo evaluate the role of a diabetes risk reduction diet (DRRD) on pancreatic cancer risk.MethodsWe used data from a hospital-based case–control study conducted in Italy between 1991 and 2008; the study included 326 incident pancreatic cancer cases and 652 controls matched by age, gender and study center. Subjects’ usual diet was collected through a valid and reproducible food frequency questionnaire. A DRRD score was derived from 8 dietary components: cereal fiber, total fruit, coffee, polyunsaturated to saturated fats ratio and nuts (higher score for higher intake), and dietary glycemic index, red/processed meat and sugar-sweetened beverages/fruit juices (higher score for lower intake). The score ranged 8–37, with higher values indicating greater DRRD adherence. Odds ratios (ORs) of pancreatic cancer according to the DRRD score were estimated using multiple conditional logistic regression models.ResultsAfter allowance for confounding factors, the DRRD score was inversely related to pancreatic cancer risk, with ORs of 0.55 (95% confidence interval, CI 0.38–0.80) for the highest versus the lowest score tertile (p for trend across tertiles = 0.002) and 0.84 (95% CI 0.75–0.95) for a 3-point score increment. The exclusion of diabetic subjects and additional adjustment for vegetable intake did not change the results. Inverse associations were observed in subgroups defined by age, gender, education, body mass index, smoking and total energy intake.ConclusionStudy findings suggest a protective role of high adherence to a DRRD on pancreatic cancer risk.

Mass spectrometry has become an indispensable tool for the identification and quantification of epigenetic modifications, offering both high sensitivity and structural specificity. The two major classes of epigenetic modifications identified—DNA methylation and histone post-translational modifications—play fundamental roles in cancer development, underscoring the relevance of their precise quantification for understanding tumorigenesis and potential therapeutic targeting. In this scoping review, we included 89 studies that met the inclusion criteria for detailed methodological assessment. Among these, we compared pre-treatment workflows, analytical platforms, and acquisition modes employed to characterize epigenetic modifications in human samples and model systems. Our synthesis highlights the predominance of bottom-up strategies combined with Orbitrap-based platforms and data-dependent acquisition for histone post-translational modifications, whereas triple quadrupole mass spectrometers were predominant for DNA methylation quantification. We critically evaluate current limitations, including heterogeneity in validation reporting, insufficient coverage of combinatorial post-translational modifications, and variability in derivatization efficiency.

Acute appendicitis remains one of the most common surgical emergencies, with a lifetime incidence of approximately 7–8% in the USA and Europe. Despite the widespread adoption of the laparoscopic approach and advances made in perioperative care, post-operative infections—particularly intra-abdominal abscesses—continue to pose a substantial clinical challenge, with an overall probability that ranges from 5 to 15%. Nowadays, it is essential not only to improve patient outcomes by reducing these complications but also to promote responsible antibiotic use. This review provides an in-depth examination of post-appendectomy infections in adults, synthesizing research from the past decade. It explores the various risks involved, including those related to the patient, the disease itself, and the surgical techniques employed. There is particular emphasis on the impact of surgical approach, closure methods, timing of surgery, and intraoperative decisions such as drain placement, peritoneal lavage, and routine bacterial cultures. Part of the discussion is about emerging data regarding the use of antiseptic solutions and specimen retrieval techniques. Additionally, the review examines current approaches to managing postoperative intra-abdominal abscesses. It assesses when antibiotics are necessary, evaluates image-guided percutaneous drainage, and considers laparoscopic re-intervention as a possible solution. While recent studies offer valuable insights, the heterogeneity of available evidence highlights the pressing need for high-quality, standardized research. Ultimately, a deeper understanding of infection pathways and preventative strategies is vital—not only for reducing morbidity and hospital readmissions, but also for safeguarding the long-term efficacy of antibiotics and delivering safer, more effective surgical care.

(1) Background: Several studies have reported associations between maternal diet in terms of single foods or nutrients and human milk compounds, while the overall role of maternal diet and related dietary patterns has rarely been investigated. (2) Methods: Between 2012 and 2014, we enrolled 300 healthy Italian mothers, who exclusively breastfed their infant. During a hospital visit at 6 weeks postpartum, a sample of freshly expressed foremilk was collected and information on maternal dietary habits in the postpartum period was obtained through an interviewer-administered food frequency questionnaire. We applied principal component factor analysis to selected nutrients in order to identify maternal dietary patterns, and assessed correlations in human milk macronutrients and fatty acids across levels of dietary patterns. (3) Results: Five dietary patterns were identified, named “Vitamins, minerals and fibre”, “Proteins and fatty acids with legs”, “Fatty acids with fins”, “Fatty acids with leaves”, “Starch and vegetable proteins”. These dietary patterns were correlated with some milk components, namely fatty acids, and in particular ω-3 and its subcomponents. (4) Conclusions: This study showed that overall maternal dietary habits during breastfeeding may influence human milk composition, suggesting the importance of adequate maternal nutrition during lactation not only for the mother herself but also to provide the infant with milk containing adequate amount and quality of nutrients for a balanced nutrition.

Breast cancer is the most common cancer diagnosis and the leading cause of cancer death among women in the world, and differences across populations indicate a role of hormonal, reproductive and lifestyle factors. This study is based on a cohort of 78,050 women invited to undergo a mammogram by Local Health Authority of Milan, between 2003 and 2007. We carried out a nested case–control study including all the 3303 incident breast cancer cases diagnosed up to 2015, and 9909 controls matched by age and year of enrollment. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using logistic regression models. The ORs were 0.88 (95% CI: 0.78–0.98) for an age at menarche ≥14 years and 1.39 (95% CI: 1.07–1.81) for an age of 30 years or older at first pregnancy. Body mass index (BMI) was positively associated with breast cancer risk in women older than 50 years (OR = 1.89, 95% CI: 1.54–2.31, for BMI≥30 vs. <20), while the association tended to be inverse in younger women. A high mammographic density increased breast cancer risk (OR = 2.61, 95% CI: 2.02–3.38 for density >75% vs. adipose tissue). The ORs were 1.67 (95% CI: 1.47–1.89) and 2.04 (95% CI: 1.38–3.00) for one first‐degree relative and two or more relatives affected by breast cancer, respectively. Our study confirms the role of major recognized risk factors for breast cancer in our population and provides the basis for a stratification of the participants in the mammographic screening according to different levels of risk. This study is based on a uniquely large Italian cohort of participants of mammographic screening program and investigated several risk factors. Late menarche, and an early age at first pregnancy protected against breast cancer. A higher mammographic density, family history of breast cancer, and a higher body weight (in postmenopause) increased breast cancer risk. Our study provides the basis for a stratification of participants in the mammographic screening according to different levels of risk.

Background Diaphragmatic hernia (DH) presenting acutely can be a potentially life-threatening condition. Its management continues to be debatable. Methods A bibliographic search using major databases was performed using the terms “emergency surgery” “diaphragmatic hernia,” “traumatic diaphragmatic rupture” and “congenital diaphragmatic hernia.” GRADE methodology was used to evaluate the evidence and give recommendations. Results CT scan of the chest and abdomen is the diagnostic gold standard to evaluate complicated DH. Appropriate preoperative assessment and prompt surgical intervention are important for a clinical success. Complicated DH repair is best performed via the use of biological and bioabsorbable meshes which have proven to reduce recurrence. The laparoscopic approach is the preferred technique in hemodynamically stable patients without significant comorbidities because it facilitates early diagnosis of small diaphragmatic injuries from traumatic wounds in the thoraco-abdominal area and reduces postoperative complications. Open surgery should be reserved for situations when skills and equipment for laparoscopy are not available, where exploratory laparotomy is needed, or if the patient is hemodynamically unstable. Damage Control Surgery is an option in the management of critical and unstable patients. Conclusions Complicated diaphragmatic hernia is a rare life-threatening condition. CT scan of the chest and abdomen is the gold standard for diagnosing the diaphragmatic hernia. Laparoscopic repair is the best treatment option for stable patients with complicated diaphragmatic hernias. Open repair is considered necessary in majority of unstable patients in whom Damage Control Surgery can be life-saving.