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Background Mild traumatic brain injury (mTBI), i.e. a TBI with an admission Glasgow Coma Scale (GCS) of 13–15, is a common cause of emergency department visits. Only a small fraction of these patients will develop a traumatic intracranial hemorrhage (tICH) with an even smaller subgroup suffering from severe outcomes. Limitations in existing management guidelines lead to overuse of computed tomography (CT) for emergency department (ED) diagnosis of tICH which may result in patient harm and higher healthcare costs. Objective To perform a systematic review and meta-analysis to characterize known and potential novel risk factors that impact the risk of tICH in patients with mTBI to provide a foundation for improving existing ED guidelines. Methods The literature was searched using MEDLINE, EMBASE and Web of Science databases. Reference lists of major literature was cross-checked. The outcome variable was tICH on CT. Odds ratios (OR) were pooled for independent risk factors. Results After completion of screening, 17 papers were selected for inclusion, with a pooled patient population of 26,040 where 2,054 cases of tICH were verified through CT (7.9%). Signs of a skull base fracture (OR 11.71, 95% CI 5.51–24.86), GCS < 15 (OR 4.69, 95% CI 2.76–7.98), loss of consciousness (OR 2.57, 95% CI 1.83–3.61), post-traumatic amnesia (OR 2.13, 95% CI 1.27–3.57), post-traumatic vomiting (OR 2.04, 95% CI 1.11–3.76), antiplatelet therapy (OR 1.54, 95% CI 1.10–2.15) and male sex (OR 1.28, 95% CI 1.11–1.49) were determined in the data synthesis to be statistically significant predictors of tICH. Conclusion Our meta-analysis provides additional context to predictors associated with high and low risk for tICH in mTBI. In contrast to signs of a skull base fracture and reduction in GCS, some elements used in ED guidelines such as anticoagulant use, headache and intoxication were not predictive of tICH. Even though there were multiple sources of heterogeneity across studies, these findings suggest that there is potential for improvement over existing guidelines as well as a the need for better prospective trials with consideration for common data elements in this area. PROSPERO registration number CRD42023392495.

In the treatment of end-stage heart disease, heart transplantation often represents the only viable option, particularly in terms of survival and quality of life. The evolution and refinement of medical therapy have substantially decreased mortality rates in cardiac patients, enabling them to progress to advanced stages of heart disease and consequently expanding the pool of eligible transplant candidates. A partial response to this growing demand has come from technological advancements in the development of devices designed to replace cardiac function. Meanwhile, the donor pool remains insufficient to cover the transplant demand, though expanded through multiple strategies, including increasing donor age, public awareness campaigns, research into xenotransplantation, and the use of hearts from donors who meet circulatory death criteria. Conventionally, since 1968, donors' death has been ascertained with brain death criteria; the use of cardiocirculatory death criteria, a recent rediscovery, has long been limited to organs other than the heart, considering also the significant differences among various countries' regulations. In Italy, the law requires 20 min of electrical asystole to ascertain death, a longer time than in other countries, raising doubts about the resumption of cardiac activity, thus limiting the use of such donors for heart donation in our country. However, as a result of the collaboration of experts, since May 2023 protocols have been developed to successfully include donors with circulatory death criteria in the heart donor pool. This review aims to provide the medical community with a detailed analysis of the ethical, legislative, technical, clinical, and scientific aspects that have enabled the opening of a new era in transplantation, with specific reference to heart transplantation. This innovation assumes a historical significance comparable to the first heart transplant performed in 1967, marking a fundamental turning point in the treatment of end-stage heart disease.

Nel trattamento delle cardiopatie terminali, il trapianto cardiaco costituisce sovente l’unica opzione praticabile, in particolare in termini di sopravvivenza e di qualità della vita. Lo sviluppo e l’ottimizzazione della terapia medica ha ridotto in modo significativo la mortalità dei pazienti con cardiopatia consentendo loro di raggiungere gli stadi terminali della malattia e quindi aumentando il numero dei possibili candidati a trapianto. Una risposta, seppur parziale, a tale crescente domanda è fornita dai progressi tecnologici nello sviluppo di macchine atte a vicariare la funzione cardiaca. Parallelamente, il pool di donatori rimane insufficiente a rispondere alla domanda trapiantologica, seppur incrementato grazie a strategie multiple, in particolare l’aumento dell’età dei donatori, le campagne di sensibilizzazione, la ricerca sullo xenotrapianto e l’utilizzo di cuori da donatori con criteri di morte cardiocircolatoria. Convenzionalmente, a partire dal 1968, la morte dei donatori viene accertata con criteri cerebrali; l’impiego dei criteri cardiocircolatori per l’accertamento di morte, di recente riscoperta, si è limitato a lungo al prelievo di organi distinti dal cuore, anche in ragione delle significative differenze tra le normative dei vari paesi. In Italia, la legge impone 20 min di asistolia elettrica per accertare il decesso, un tempo superiore ad altri paesi; tale prescrizione ha generato dubbi sulla ripresa dell’attività cardiaca e ha limitato l’uso di tali donatori per il prelievo di cuore nel nostro Paese. Tuttavia, grazie alla collaborazione di esperti, dal maggio 2023 sono stati sviluppati protocolli per includere con successo donatori con criteri di morte cardiocircolatoria nel pool di donatori di cuore. La presente rassegna si propone di fornire alla comunità medica un’analisi dettagliata degli aspetti etici, legislativi, tecnici, clinici e scientifici che hanno reso possibile l’apertura di una nuova era nella trapiantologia, con particolare riferimento al trapianto cardiaco. Tale innovazione assume una rilevanza storica paragonabile al primo trapianto di cuore eseguito nel 1967, segnando un punto di svolta fondamentale nella cura delle cardiopatie terminali.

Accurate modeling of excitation energies in complex environments is essential for interpreting spectroscopic signatures. A central challenge which is relevant to many systems, is achieving a balanced description of excited states with distinct electronic characters, such as locally excited (LE) and charge transfer (CT) states, while consistently incorporating environmental effects. Here, we compare the linear-response (LR) and state-averaged (SA) formulations of CASSCF when coupled to the polarizable AMOEBA force field. Using the LE and CT excitations of the substrate–cofactor pair in the photoenzyme CvFAP as a test case, we show that LR- and SA-CASSCF offer complementary strengths. LR-CASSCF provides an unbiased mapping of the excitation manifold, whereas SA-CASSCF can refine selected states to obtain a more quantitative description. This combined strategy offers a robust framework for interpreting spectroscopic features of embedded chromophores, especially in systems where CT character and environmental polarization play a decisive role.