Laparoscopic ovarian tissue collection for fertility preservation in children with malignancies: a multicentric experience.

Introduction: Long survivors after childhood cancer are increasing thanks to oncological improvements. Their quality of life and fertility-sparing should be considered in the early phases of each oncological pathway. Cryopreservation of ovarian tissue removed before starting gonadotoxic therapies is the only fertility sparing procedure available for prepubertal children affected by cancer and it does not affect the timing of the start of the treatment. Materials and methods: The present study shows the surgical and clinical outcomes following laparoscopic ovarian tissue collection (LOTC) for a total of 311 patients aged between 0 and 17 years old from four different European Centers. Results: Only two major complications were reported according to the Clavien Dindo classification (0.6%). Discussion: LOTC can be considered a safe procedure.

Can Creativity and Cognitive Reserve Predict Psychological Well-Being in Older Adults? The Role of Divergent Thinking in Healthy Aging.

The maintenance of psychological well-being (PWB) in the older adult population is a pivotal goal for our rapidly aging society. PWB is a multicomponent construct that can be influenced by several factors in the lifespan. The beneficial role of divergent thinking (DT) and cognitive reserve (CR) in sustaining older subjects' PWB has been scarcely investigated so far. The present study aims to investigate the relationships between DT, CR, and PWB in a sample of 121 healthy older adults (61 females; M age: 73.39 ± 6.66 years; M education: 11.33 ± 4.81 years). The results highlight that better DT performance predicts higher CR, which mediates an indirect positive effect of DT on emotional competence, one of the PWB factors. It follows that DT and CR can be considered protective factors in aging, and their effects go beyond cognitive functioning, revealing a positive effect even on some PWB components. The practical implications regarding targeted health interventions for prevention in the older adult population to support well-being and promote healthy aging are discussed.

The Effect of COVID-19 on Middle-Aged Adults' Mental Health: A Mixed-Method Case-Control Study on the Moderating Effect of Cognitive Reserve.

The COVID-19 pandemic has increased the vulnerability of adults to mental health effects, and the study of protective factors has become crucial. Cognitive reserve (CR) is a well-known protective factor against cognitive decline and several health factors; however, its protective effect on mental health during the pandemic has been rarely addressed. Thus, this study explored, through a mixed-method design, the effect of CR on perceived distress and PTSD-like symptoms in middle-aged participants who have survived severe COVID-19 and a matched control group. A total of 432 participants filled out self-report measures of CR, PTSD, depression, and anxiety, and were also asked to provide narration about their COVID-19-related experience. COVID-19 significantly affected the chances of reporting different mental health symptoms; levels of CR played a protective role in reducing their severity. Moreover, adults with higher CR seemed to be more realistic, focusing less on positive emotions, and elaborating more on the sense of anxiety when describing their experience: this might be an indication of a lower use of suppression to regulate emotions. Practical implications of these findings and future directions have been also discussed.

Pleural drainage vs video-assisted thoracoscopic debridement in children affected by pleural empyema.

BACKGROUND: Both thoracic drainage and video-assisted thoracic surgery (VATS) are available treatment for pleural empyema in pediatric patients. MATERIALS AND METHODS: This retrospective multicenter study includes pediatric patients affected by pleural empyema treated from 2004 to 2021 at two Italian centers. Patients were divided in G1 (traditional approach) and G2 (VATS). Demographic and recovery data, laboratory tests, imaging, surgical findings, post-operative management and follow-up were analyzed. RESULTS: 70 patients with a mean age of 4.8 years were included; 12 (17.1%) in G1 and 58 (82.9%) in G2. Median surgical time was 45 min in G1, 90 in G2 (p < 0.05). Mean duration of thoracic drainage was 7.3 days in G1, 6.2 in G2 (p > 0.05). Patients became afebrile after a mean of 6.4 days G1, 3.9 in G2 (p < 0.05). Mean duration of antibiotic therapy was 27.8 days in G1, 25 in G2 (p < 0.05). Mean duration of postoperative hospital stay was 16 days in G1, 12.1 in G2 (p < 0.05). There were 4 cases (33.3%) of postoperative complications in G1, 17 (29.3%) in G2 (p > 0.05). 2 (16.7%) patients of G1 needed a redosurgery with VATS, 1 (1.7%) in G2. CONCLUSIONS: VATS is an effective and safe procedure in treatment of Pleural Empyema in children: it is associated to reduction of chest tube drainage, duration of fever, hospital stay, time of antibiotic therapy and recurrence rate.

The Role of Cognition in Divergent Thinking: Implications for Successful Aging.

Promoting active and successful aging has become crucial to improve quality of life in later adulthood and reduce the impact of cognitive decline. Increasing evidence suggested that the ability to think creatively (e.g., via divergent thinking), similar to cognitive reserve, could represent a beneficial factor against the negative effects of aging. However, there is still little evidence investigating the relationships between divergent thinking, cognitive functions, and cognitive reserve in late adulthood. The present study explored these relationships in a sample of 98 individuals ranging from 61 to 88 years old (mean age: 72.44 ± 6.35). Results showed that visual, but not verbal, divergent thinking was affected by aging. Interestingly, visual divergent thinking performance was predicted by both the cognitive component of crystallized intelligence and cognitive reserve. Only the crystallized component of intelligence was found to mediate the aging effect on visual divergent thinking performance. These results suggest that in later adulthood a potential shift strategy to prior knowledge and semantic components over executive and control components of cognition could underlie a preserved ability to think divergently and, plausibly, creatively. Limitations of the study and implications for successful aging are discussed.

Healthcare professional and manager perceptions on drivers, benefits, and challenges of telemedicine: results from a cross-sectional survey in the Italian NHS.

BACKGROUND: The Covid-19 pandemic provided new challenges and opportunities for patients and healthcare providers while accelerating the trend of digital healthcare transformation. This study explores the perspectives of healthcare professionals and managers on (i) drivers to the implementation of telemedicine services and (ii) perceived benefits and challenges related to the use of telemedicine across the Italian National Health Service. METHODS: An online cross-sectional survey was distributed to professionals working within 308 healthcare organisations in different Italian regions. Quantitative and qualitative data were collected through a self-administered questionnaire (June-September 2021). Responses were analysed using summary statistics and thematic analysis. RESULTS: Key factors driving the adoption of telemedicine have been grouped into (i) organisational drivers (reduce the virus spread-80%; enhance care quality and efficiency-61%), (ii) technological drivers (ease of use-82%; efficacy and reliability-64%; compliance with data governance regulations-64%) and (iii) regulatory drivers (regulations' semplification-84%). Nearly all respondents perceive telemedicine as useful in improving patient care (96%). The main benefits reported by respondents are shorter waiting lists, reduced Emergency Department attendance, decreased patient and clinician travel, and more frequent patient-doctor interactions. However, only 7% of respondents believe that telemedicine services are more effective than traditional care and 66% of the healthcare professionals believe that telemedicine can't completely substitute in-person visits due to challenges with physical examination and patient-doctor relationships. Other reported challenges include poor quality and interoperability of telemedicine platforms and scarce integration of telemedicine with traditional care services. Moreover, healthcare professionals believe that some groups of patients experience difficulties in accessing and using the technologies due to socio-cultural factors, technological and linguistic challenges and the absence of caregivers. CONCLUSIONS: Respondents believe that telemedicine can be useful to complement and augment traditional care. However, many challenges still need to be overcome to fully consider telemedicine a standard of care. Strategies that could help address these challenges include additional regulations on data governance and reimbursements, evidence-based guidelines for the use of telemedicine, greater integration of tools and processes, patient-centred training for clinicians, patient-facing material to assist patients in navigating virtual sessions, different language options, and greater involvement of caregivers in the care process.

Successful Elective Thoracoscopic Resection of Complicate Extralobar Bronchopulmonary Sequestration after Intrafoetal Vascular Laser Ablation: The Paediatric Surgeon's Point of View.

Few reports of laser coagulation for foetal bronchopulmonary sequestration (BPS), a rare congenital malformation characterised by the absence of tracheobronchial connection and the presence of a systemic feeding artery, have been published. Additionally, very few of them focus also on the postnatal management, with results limited and controversial. Postnatal treatment of residual malformation remains debated, hence the need to share our experience of a combined pre- and postnatal approach to complicated extra-lobar BPS. We report the case of a female foetus with the diagnosis of a pulmonary lesion. Due to mediastinal shift, unilateral compressive hydrothorax, ascites, and hydrops, a foetal treatment with ultrasound-guided laser coagulation of the anomalous vessel was performed. At birth, due to the persistence of the malformation, an elective delayed thoracoscopical surgery was performed. Prenatal laser ablation for complicated BPS is a life-saving procedure not always resulting in lesion disappearance. Thoracoscopical surgical exploration in case of persistent lesions at birth offers the possibility of a minimally invasive sequestrectomy feasible and safe.

Decision-making abilities under risk and ambiguity in adults with traumatic brain injury: what do we know so far? A systematic review and meta-analysis.

Traumatic brain injury (TBI) is a major health and socio-economic problem since it is one of the major sources of death and disability worldwide. TBI patients usually show high heterogeneity in their clinical features, including both cognitive and emotional/behavioral alterations. As it specifically concerns cognitive functioning, these patients usually show decision-making (DM) deficits. DM is commonly considered a complex and multistep process that is strictly linked to both hot and cold executive functioning and is pivotal for daily life functioning and patients' autonomy. However, the results are not always in agreement, with some studies that report huge alterations in the DM processes, while others do not. The present systematic review and meta-analysis aims to integrate past literature on this topic, providing a clear and handy picture both for researchers and clinicians. Thirteen studies addressing domain-general DM abilities were included from an initial N = 968 (from three databases). Results showed low heterogeneity between the studies (I2 = 7.90, Q (12) = 13.03, p = .37) supporting the fact that, overall, TBI patients showed lower performance in DM tasks as compared to healthy controls (k = 899, g = .48, 95% CI [0.33; 0.62]) both in tasks under ambiguity and under risk. The evidence that emerged from this meta-analysis denotes a clear deficit of DM abilities in TBI patients. However, DM tasks seemed to have good sensitivity but low specificity. A detailed description of patients' performances and the role of both bottom-up, hot executive functions and top-down control functions have been further discussed. Finally, future directions and practical implications for both researchers and clinicians have been put forward.

Robotic approach to the uretero-vesical junction in children: An international multicentric retrospective study.

BACKGROUND: Robot-assisted approach to UVJ is getting more and more used in pediatric patients. METHODS: In this retrospective study 26 patients affected by nephro-urological malformations, robotic-surgically treated from 2016 and 2021 at 3 Pediatric Surgery Department were included: 3 (11.5%) primary obstructive megaureter, 2 (7.7%) dysplastic kidneys, 3 (11.5%) duplex collecting system, 18 (69.2%) primary vescico-ureteral reflux (VUR). RESULTS: Mean age at surgery was 6 years old. 22 (84.6%) underwent Lich Gregoire extravesical ureteral reimplantation, 4 (15.4%) total nephroureterectomy. Mean operative time was 230 min. No conversions or intraoperative complications. Median hospital stay was 4 days. There were 4 (15.38%) postoperative complications: 3 (11.54%) persistent VUR and 1 (3.84%) refluxing megaureter. 2 (7.7%) redo-surgery. CONCLUSIONS: Robotic Surgery should be considered a safe and effective technique for treatment of UVJ anomalies in children, because it firstly allows surgeons to approach both upper and lower ureteral ends without modifying trocars' placement.

Prenatal diagnosis of an adrenal mature teratoma mimicking a neuroblastoma.

Teratomas are defined by the presence of cell types from different germ layers, they typically involve the gonads or the sacrococcygeal region and are rarely retroperitoneal. Prenatally detected adrenal teratomas are extremely uncommon. Aim of this paper is to share our experience with an adrenal antenatal mass initially diagnosed as a left adrenal neuroblastoma that turned out to be a mature teratoma after microscopical examination. We present the case of a male fetus with antenatal diagnosis of a left adrenal cystic image at the 22nd week of amenorrhea. The fetal magnetic resonance imaging showed a non-calcified cystic mass of the left adrenal gland, compatible with a neuroblastoma. At birth an ultrasound confirmed the presence of an anechogenic lesion of the left adrenal gland. The infant was closely monitored during his first year and in the absence of significant regression of the adrenal mass, it was decided to perform a laparoscopic left adrenalectomy. Unexpectedly, the final pathological diagnosis was mature cystic adrenal teratoma. In conclusion, an adrenal mass diagnosed antenatally is generally a hemorrhage or a neuroblastoma. Adrenal teratomas are very rare and those diagnosed antenatally even more. At present, we have no clinical, biological, or radiological evidence to suspect them before surgical removal. There are only two other cases of unexpected adrenal teratoma in infants described in Literature.

Evolution of outcomes and complications of flip flap laparoscopic repair for inguinal hernia in children: 5 years' experience and practical implication in a third level Italian center.

BACKGROUND: Inguinal hernia repair is one of the most common pediatric surgeries that can be approached with an open or laparoscopic approach. The aim of this study was to describe outcomes and complications of flip flap inguinal hernia repair analyzing our experience in the last 5 years. METHODS: Between 2015 and 2020, 280 children admitted at our department with inguinal hernia requiring surgery were included. Secondary aim was to investigate how confidence of surgeons regarding VLS approach increase during time and how this particular technique represents a primary procedure useful to increase surgeons' skills in performing laparoscopic sutures. RESULTS: One hundred sixty children (57%) underwent open approach, whereas 120 (43%) laparoscopic ligations of hernia. For each group, clinical and surgical data were recorded. We focused on comparing postoperative complications: the most frequent complication was hydrocele (N.=4, 1.4%). Reported postoperative complication were not statistically different between two groups (open N.=3, 1.8% vs. laparoscopy N.=1, 0.8%). No other postoperative complications were documented in our cohort for both groups. In laparoscopic group we registered 3 cases of ipsilateral recurrence (1.6%) and no cases of metachronous hernia. The choice of laparoscopic approach significantly increased from 22% in 2015 to 74% in 2020 (P<0.05) as well as the percentage of male underwent to laparoscopic procedure (38% in 2015 to 74% in 2020, P<0.05). CONCLUSIONS: It is known that the rate of complication or recurrence is similar for open or minimally invasive inguinal hernia repair. Laparoscopy offers advantages such as the possibility of visualizing contralateral internal inguinal ring, reducing the incidence of metachronous inguinal hernia. Moreover, taking confidence with a minimally invasive technique such Flip Flap hernioplasty by performing it repeatedly over time, leads to an improvement of surgeons' skills also in performing laparoscopic sutures, that can be helpful for other complex or tricky procedures.

Aging and Psychological Well-Being: The Possible Role of Inhibition Skills.

(1) Background: Psychological well-being (PWB) is a multidimensional construct which is a key protective factor against chronic diseases in older adults. Numerous psychological and cognitive factors can influence older people's PWB. However, while most studies have explored the effect of general cognition, only a few investigated the role of specific cognitive functions such as the efficiency of executive functions. Thus, the present study aimed to directly explore the relationships between PWB, age, and the core executive functions (namely working memory, flexibility, and inhibition). (2) Methods: A sample of 51 healthy older adults (age range: 60-88) were enrolled and tested both for PWB (by Ryff's psychological well-being scale) and the core executive functions (by the Digit span backward, the Trail Making Test, and the Stroop test). (3) Results: Age and inhibitory skills are negatively correlated to the personal growth subscale of the PWB scale. Moreover, a hierarchical regression analysis showed that inhibition, but not working memory and flexibility, predicted the sense of continued growth and development (personal growth) of older adults, even after controlling for age and educational levels. Limitations and implications for future research and prevention interventions are discussed.

Challenge your Brain. Blogging during the COVID Lockdown as a Way to Enhance Well-Being and Cognitive Reserve in an Older Population.

BACKGROUND: The lockdown linked with COVID-19 restrictions has been reported to have severe consequences at an emotional and cognitive level, this was especially true for vulnerable populations, such as the older adults. This study aims at exploring the effect of a blog-based intervention implemented during COVID lockdown to increase the perceived well-being and cognitive reserve (CR) of a sample of American older adults. METHODS: Forty-one participants (63% female), age range from 64 to 83, participated in a blog-based 5-week intervention. Their level of well-being as well as cognitive reserve were assessed before and after the intervention with specific scales. Participants were matched by age, gender and education level to a quasi-equivalent control group living in the same area who was tested on the same variables. RESULTS: Results showed a significant increase in both perceived well-being and CR in the intervention group. A significant difference was also found when comparing the intervention group to the matched controls.

Divergent thinking and the core executive functions: a state-of-the-art review.

The study of the relationships between divergent thinking and the core executive functions is long standing. However, the literature on this topic is not conclusive. The present review was aimed to clarify the extent to which divergent thinking is related to the core executive functions, namely inhibition, working memory and cognitive flexibility. The main findings showed that divergent thinking is supported by inhibition in terms of flexible attention changes. Working memory appears to play a key role in enabling semantic associations when the focus of attention is narrowed. Then, although cognitive flexibility is a key element of divergent thinking, only a few studies independently investigated its contribution. Taken together, the results suggest that divergent thinking relies on the ability to switch between different mechanisms according to the individual's ability and task demands. Future research directions are also discussed.

Lichen sclerosus in pediatric age: A new disease or unknown pathology? Experience of single centre and state of art in literature.

Lichen Sclerosus (LS) is a chronic inflammatory skin disease with unknown etiology. In pediatric age the main disease "lichenlinked" is the phimosis in male. This is a retrospective study that reports the experience of our clinic and review of the literature. We included all patients affected by pathological phimosis, treated by circumcision between January 2015 and May 2020, older than 6 years old and with an histopathological diagnosis of lichen sclerosus. The aim was to identify prognostic factors based on histological report to plan the clinical management of patients. Statistical analysis was done. We included 207 patients. The mean age of children was 9,78 years (5-18 years, DS±3.29). Based on the histological features we divided patients in 2 groups: early lesions (70/207, 34%) and advanced (137/207, 66%). In term of complications lichen linked we considered meatal stenosis that needed of urethral dilatations. We included 7 patients (7/207, 3,4%). We report P value Statistical Significance in many aspects. An early diagnosis of LS and surgical treatment of foreskin are essential to prevent early and late complications in children. The size of sample is a limit of the study but results encourage our management.

Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability.

BACKGROUND: The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales. RESULTS: Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings - the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status. DISCUSSION: Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary.

Developmental Topographical Disorientation With Concurrent Face Recognition Deficit: A Case Report.

Developmental topographical disorientation (DTD) has been defined as a developmental deficit in human navigational skills in the absence of congenital or acquired brain damage. We report the case of Lost In Space Again (LISA), a 22-year-old woman with a normal development and no clinical history of neurological or psychiatric diseases, evaluated twice, with an interval of 5 years. The magnetic resonance imaging (MRI) examination did not reveal any morphological alteration, while diffusion tensor imaging (DTI) showed a structural connectivity deficit (a decreased fractional anisotropy-FA) in the parieto-prefrontal and parieto-premotor pathway. The behavioral assessment showed different deficits in spatial and navigational tasks, which seemed to be connected to a poor ability to form a cognitive map of the environment. Moreover, LISA displayed a poor performance in high-level face encoding and retrieval. The aim of this case report is to share new insight about DTD in order to deepen the knowledge of this specific neurodevelopmental disorder. In conclusion, this novel DTD case (1) supports the hypothesis of the existence of different DTD subtypes; (2) sustains the evidence that DTD can co-occur (or not) with deficit in face recognition; and (3) highlights the need for an in-depth examination from both a neurocognitive and behavioral point of view of a possible common developmental defect between the formation of cognitive maps and the recognition of faces that might be in mental imagery skills. Future directions will be also discussed.

Divergent Thinking Abilities in Frontotemporal Dementia: A Mini-Review.

A large number of studies, including single case and case series studies, have shown that patients with different types of frontotemporal dementia (FTD) are characterized by the emergence of artistic abilities. This led to the hypothesis of enhanced creative thinking skills as a function of these pathological conditions. However, in the last years, it has been argued that these brain pathologies lead only to an augmented "drive to produce" rather than to the emergence of creativity. Moreover, only a few studies analyzed specific creative skills, such as divergent thinking (DT), by standardized tests. This Mini-Review aimed to examine the extent to which DT abilities are preserved in patients affected by FTD. Results showed that DT abilities (both verbal and figural) are altered in different ways according to the specific anatomical and functional changes associated with the diverse forms of FTD. On the one hand, patients affected by the behavioral form of FTD can produce many ideas because of unimpaired access to memory stores (i.e., episodic and semantic), but are not able to recombine flexibly the information to produce original ideas because of damages in the pre-frontal cortex. On the other hand, patients affected by the semantic variant are impaired also in terms of fluency because of the degradation of their semantic memory store. Potential implications, limitations, and future research directions are discussed.

IT adoption and bank performance during the Covid-19 pandemic.

This paper examines the impact of pre-2020 information technology (IT) adoption on bank performance during the initial stages of the Covid-19 pandemic. We show that high IT adopters performed better in terms of market returns, Tobin's q and lending. Our findings also suggest that higher pre-crisis IT investments are associated with more loans issued under the US Paycheck Protection Program, and lower rates of loan modifications due to Covid-19. This study corroborates other recent findings that technology adoption fosters banks' resilience during crises, ultimately enhancing financial stability.

Clinically Differentiated Abnormalities of the Architecture and Expression of Myosin Isoforms of the Human Cremaster Muscle in Cryptorchidism and Retractile Testis.

AIM: To describe architecture and expression of myosin isoforms of the human cremaster muscle (CM) and to individuate changes in clinically differentiated abnormalities of testicular descent: cryptorchidism or undescended testis (UDT) and retractile testis (RT). BACKGROUND: The CM is a nonsomitic striated muscle differentiating from mesenchyme of the gubernaculum testis. Morphofunctional and molecular peculiarities linked to its unique embryological origin are not yet completely defined. Its role in abnormalities of testicular descent is being investigated. SUBJECTS AND METHODS: Biopsy samples were obtained from corrective surgery in cases of cryptorchidism, retractile testis, inguinal hernia, or hydrocele. Muscle specimens were processed for morphology, histochemistry, and immunohistology. RESULTS AND CONCLUSIONS: The CM differs from the skeletal muscles both for morphological and molecular characteristics. The presence of fascicles with different characterization and its myosinic pattern suggested that the CM could be included in the specialized muscle groups, such as the extrinsic ocular muscles (EOMs) and laryngeal and masticatory muscles. The embryological origin from the nonsomitic mesoderm is, also for the CM, the basis of distinct molecular pathways. In UDT, the histological alterations of CM are suggestive of denervation; the genitofemoral nerve and its molecular messengers directed to this muscle are likely defective. Compared with the other samples, RT has a distinct myosinic pattern; therefore, it has been considered a well-defined entity with respect to the other testicular descent abnormalities.