Background/Objectives: Chest X-ray (CXR) is currently the most used investigation for clinical follow-up after major noncardiac thoracic surgery. This study explores the use of lung ultrasound (LUS) as an alternative to CXR in the postoperative management of patients who undergo major thoracic procedures. Methods: The patients in our cohort were monitored with both a CXR and a lung ultrasonography after surgery and the day after chest drain removal. The LUS was performed by a member of the medical staff of our unit who was blinded to both the images and the radiologist’s report of the CXR. Findings were compared between the two methods. Results: In the immediate postoperative evaluation, 280 patients were compared, finding general agreement between the two procedures at 84% (kappa statistic, 0.603). The LUS showed a sensibility of 84.1%, a specificity of 84.3%, a positive predictive value (PPV) of 60.9%, and a negative predictive value (NPV) of 94.8%. We evaluated 219 out of 280 patients in the postdrainage-removal setting due to technical issues. Concordance between the methods in the postdrainage-removal setting was 89% (kappa statistic, 0.761) with the LUS demonstrating an 82.2% sensibility, a 93.2% specificity, a PPV of 85.7%, and an NPV of 91.3%. Conclusions: The results of this study showed a substantial agreement between LUS and CXR, suggesting that the LUS could reduce the number of X rays in certain conditions. The high NPV allows for the exclusion of PNX and pleural effusion without the need to expose patients to radiation. Discrepancies were noted in cases of mild pneumothorax or modest pleural effusion, without altering the clinical approach.

Introduction: Several studies have previously demonstrated an increased risk of dementia and brain amyloid deposition in individuals with heterozygous NPC1 mutations. Moreover, in a recent study, we identified the first family with autosomal dominant late‐onset Alzheimer's disease (AD) caused by a heterozygous NPC1 mutation. Unfortunately, there are currently no effective treatments available for this condition. Miglustat, which impacts the metabolism of oxysterols, has been shown to exert an anti‐amyloidogenic effect in a human cellular model of AD. Methods: In our exploratory uncontrolled study, three patients from the previously published family were orally treated with miglustat for 12 months. They underwent monthly clinical evaluations and routine blood tests. Additionally, neuropsychological evaluations, brain amyloid‐PET imaging, and biochemical analyses on plasma and CSF were performed. Results: All three patients achieved clinical stability, showed a sustained reduction in serum oxysterol levels, and experienced a marked decrease in brain amyloid burden. Discussion: Based on our preliminary observations and hypothesis‐generating findings, along with the growing evidence suggesting AD as a lipid disorder, miglustat should be further tested in a larger cohort of heterozygous NPC1 mutated patients and probably evaluated as a potential disease‐modifying treatment for AD.

Background/Objectives: Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was reclassified as a non-malignant entity in 2016 to reduce overtreatment. A proportion of NIFTP-containing glands nonetheless harbour a synchronous differentiated thyroid carcinoma (DTC). We quantified its prevalence and pathological profile and assessed whether routinely collected pre-operative variables identify affected patients. Methods: A multicentre retrospective cohort of 1185 adults with NIFTP confirmed at second histological review, operated on between 2017 and 2023 in 22 centres. The outcome was a synchronous DTC in the surgical specimen. A weighted random forest and an elastic-net logistic regression based on 13 pre-operative predictors were evaluated with 20-times repeated five-fold cross-validation, with all data-driven steps nested within training folds, and with leave-one-centre-out and temporal validation. Results: A synchronous DTC was present in 61 patients (5.1%; 95% CI 4.0–6.6; 6.2% after review of the stored reports), with marked between-centre variation (none recorded in eight centres). Fifty-eight carcinomas (95%) were pT1a; none had gross extra-thyroidal extension or nodal metastasis (nodes examined in 27 patients), and none met the 2025 American Thyroid Association criteria mandating a more extensive operation. No pre-operative variable differed between groups after multiplicity adjustment. The cross-validated AUROC was 0.56 (95% CI 0.47–0.65) for the random forest and 0.58 (0.48–0.67) for the elastic net; the within-centre concordance was 0.48 and the temporal-validation AUROC 0.39, and decision-curve analysis showed no net benefit over default strategies. Conclusions: About one in twenty NIFTP-containing specimens harbours a synchronous DTC, usually a low-risk papillary microcarcinoma. Routinely available pre-operative variables do not identify these patients; management should be guided by the pathology of the carcinoma itself.

Familial, recurrent or genetic acute necrotizing encephalopathy (F/R/G ANE) is triggered by infections in children with genetic susceptibility. We conducted a systematic review to characterize clinical-neuroradiological features, therapy and outcome of F/R/G ANE in children, and to evaluate vaccination implications. A systematic literature review was conducted in PubMed, Scopus, and Web of Science, adhering to the PRISMA guidelines, and registered in PROSPERO. An institutional case was also described. Ninety-two patients were analysed (91 literature cases and 1 novel case) (median onset age 24 months; 62% male; RANBP2 mutations in 81% of tested individuals). In total, 142 clinical events occurred in the 92 patients: 108 definite/probable ANE events, and 34 atypical events (25 infection-triggered encehalopathy events without bithalamic involvement, 9 other acute neurological events without bithalamic involvement and encephalopathy). In 13% of patients, atypical episodes preceded a subsequent ANE event. Routine immunization was documented in 18/19 patients pre-ANE and 5/20 resumed vaccination post-ANE (no vaccine-related relapses over a median follow-up of 19 months). These findings highlight the central role of RANBP2 variants and the clinical-radiological variability of F/R/G ANE, including atypical pre-ANE events. Limited immunization data support the need for prospective studies to establish safe, prophylactic strategies.

Background: Obesity is a major public health issue in developed countries, primarily managed through dietary interventions and physical activity. Food portion sizes influence the estimation of energy intake, particularly through bites, of which characteristics remain insufficiently defined. This study investigates the variability in bite energy content. Methods: This observational study was conducted over 14 months. Thirteen types of packaged food were provided to 30 Italian healthy volunteers (mean age 26.8 ± 8.5 years) in a semi-naturalistic dietary feeding setting. Participants’ anthropometric measurements were recorded. A total of 1850 bites were weighed and 420 bites were assessed for volume and energy content. Results: Bite volume and mass explained bite energy content at different rates. The most influential anthropometric feature was waist circumference. Gender modified the association between waist circumference and bite characteristics; males showed increased bite volume, mass, and energy content as waist circumference increased, whereas females showed little or no association. Age was inversely associated with bite volume and mass, with younger participants having larger bites. Gender significantly influenced average bite size, with females showing lower values than males. The use of a fork was associated with higher bite volume, mass, and energy compared to a spoon. Food eaten with bare hands had lower mass but higher energy content compared to food eaten with a spoon. The variability in bite energy was considerably greater per bite than per gram, reflecting the combined influence of food texture, bite size, and cutlery used. Conclusions: Bite energy variability, influenced by intrinsic factors (gender, age, waist circumference) and extrinsic factors (cutlery, food texture), significantly impacts portion size effect. Future bite counters should consider these elements for accurate dietary assessment.

Background/Objectives: Patients with pancreatic neuroendocrine tumors (PanNETs) often have a good prognosis with long overall survival. We evaluated quality of life (QoL) after surgery for PanNETs, using the new EORTC-specific questionnaires. Methods: PanNET patients operated on in our unit (1990–2023) received three EORTC questionnaires (QLQ-C30 and the new P.NET15 and P.NET19). We evaluated the following: (1) QLQ-C30 outcomes; (2) mixed domains from QLQ-C30, P.NET15, and P.NET19; and (3) domains from P.NET19 and P.NET15 only. Functional and symptom scales were investigated in relationship with clinical variables. Gamma regression and multivariable analyses were performed with R software. Results: The 100 patients enrolled (median time 133 months after surgery) showed a good QoL (median 83.3/100). Old age was related to worse QoL and physical functioning (p = 0.007 and p < 0.001, respectively). Diabetes negatively influenced QoL (p < 0.001), physical functioning (p = 0.005), and fatigue (p = 0.03). Patients undergoing parenchyma-sparing surgery showed less fatigue (p = 0.046), while non-insulinoma PanNET diagnosis was related to worse QoL (p = 0.039). Multiple comorbidities were negatively associated with physical functioning (p = 0.010), fatigue (p = 0.001), and pain (p = 0.021). According to the new questionnaires, the most affected outcome was muscle energy, depending on age (p = 0.042), diabetes (p = 0.014), type of surgery (p = 0.018), and non-insulinoma diagnosis (p = 0.007). Conclusions: A good QoL evaluated with EORTC questionnaires is reported in PanNET patients after surgery. Elderly and diabetic patients who underwent standard resection for gastrinoma/non-functioning PanNETs showed worse QoL outcomes.