Subclinical coronary atherosclerosis is common but its biological aggressiveness and interplay with extracoronary disease in asymptomatic individuals remain unclear. We evaluated the prevalence of high-risk coronary plaques (HRPs) and their relationship with mild carotid atherosclerosis and coronary calcium in a cardiovascular (CV) high-risk cohort in primary prevention. This retrospective multicenter study enrolled 269 asymptomatic adults with multiple CV risk factors who underwent Coronary Computed Tomography Angiography (CCTA) after prior carotid duplex ultrasound (CDUS). Coronary artery disease (CAD) was graded as absent, non-obstructive (<50% stenosis) or obstructive (≥50%), and HRPs were identified by ≥1 adverse morphological feature (low attenuation, positive remodeling, napkin-ring sign, spotty calcification). Carotid disease was classified as CDUS 0 (no plaque), CDUS 1–49% (mild), or CDUS ≥ 50% (significant). Pre-specified analyses explored prevalence of HRPs across CDUS–calcium-score strata (cut-off 100 Agatston) and independent predictors within the CDUS 1–49% subgroup. CAD was absent in 31%, non-obstructive in 41%, and obstructive in 28%. HRPs were present in 30.9% of all cases, in 26.6% of non-obstructive and in 64.6% of obstructive CAD. HRPs prevalence rose step-wise from 10.0% (CDUS 0 + Ca < 100) to 27.7% (CDUS 1–49% + Ca < 100), 41.2% (CDUS 0 + Ca ≥ 100) and 59.4% (CDUS 1–49% + Ca ≥ 100). In patients with CDUS 1–49%, current smoking independently predicted HRPs (OR 2.1, 95% CI 1.0–4.5; p = 0.049). Nearly one-third of asymptomatic adults with high CV risk already showed HRPs. Mild carotid atherosclerosis synergized with a calcium score ≥ 100 to identify a subgroup in which six of ten individuals exhibited HRPs. Smoking was the only independent clinical correlate identified of plaque vulnerability. Combined carotid ultrasound, calcium scoring and CCTA may substantially refine primary prevention risk stratification beyond traditional factors.
BACKGROUND:Insomnia is common among people with mental health conditions and can exacerbate symptoms, impair functioning and negatively impact treatment outcomes. Community mental health services require practical data to quantify the burden of insomnia in routine care and to identify groups at a higher risk of experiencing clinically significant insomnia. METHODS:We conducted a retrospective analysis of anonymized routinely collected clinical data from adult psychiatric outpatients attending the Community Mental Health Center in Bra (Department of Mental Health, Asl Cuneo 2, Italy). Consecutive patients were included over a three-month period (1 September to 30 November 2025). Insomnia severity was assessed using the Insomnia Severity Index (ISI). Diagnoses were established by psychiatrists using the Structured Clinical Interview for DSM-5 (SCID-5). RESULTS:The sample included 506 patients (mean age: 45.1 ± 16.7 years; 265 women, 52.4%). The mean ISI total score was 12.18 ± 6.99. Clinically significant insomnia (ISI ≥ 15) was present in 205 out of 506 patients (40.5%), while severe insomnia (ISI ≥ 22) was present in 55 out of 506 patients (10.9%). The ISI score differed across diagnostic groups (ANOVA, F(8, 497) = 2.82, p = 0.0046, η2 = 0.043). Post hoc comparisons revealed higher ISI scores in patients with depressive disorders than in those with anxiety disorders (Tukey, p = 0.0056). In a multivariable logistic regression model (outcome: ISI score of at least 15), adjusted for age, sex, education and the complexity of concurrent psychotropic medication (number of medication classes), depressive disorders were associated with clinically significant insomnia (OR: 1.99; 95% CI: 1.07-3.73). Attention deficit hyperactivity disorder (ADHD) also showed higher odds (OR: 3.64; 95% CI: 1.26-10.55). Medication complexity was also associated with an ISI score of at least 15 (OR: 1.43 per additional class; 95% CI: 1.16-1.77). In a sensitivity model additionally adjusting for benzodiazepine prescription (yes/no), benzodiazepine prescription was associated with ISI ≥ 15 (OR 1.82; 95% CI 1.13-2.95), while the estimate for medication complexity was attenuated using this association (OR 1.17; 95% CI 0.90-1.53). The eating disorders group was excluded from multivariable models due to the very small sample size (n = 4). CONCLUSIONS:Clinically significant insomnia was prevalent among this sample of psychiatric outpatients, with modest differences in insomnia severity across diagnostic groups. Sensitivity analyses suggested that the signal of medication complexity may be partly accounted for by benzodiazepine prescribing, supporting the cautious interpretation of medication-related correlates in routine cross-sectional data. These findings support routine insomnia screening in psychiatric outpatient care, while prospective studies are needed to clarify directionality and clinical implications.
Understanding how volcanic systems evolve over time is a major challenge due to their complex behaviour and constantly changing conditions. This study explores a novel approach to detecting significant changes in multiparametric signals of volcanic unrest by analysing how different types of data, such as ground deformation, gas emissions, temperature, and earthquakes, interact with each other. Focusing on the Solfatara–Pisciarelli volcano system, which is a more active area in the Campi Flegrei Caldera (Southern Italy), we used two advanced methods to identify critical transitions in the system: one to model the nonlinear relationships between variables, and the other to detect key moments when the system’s behaviour shifts. By including time delays between signals (LAG), we found that our model became much more accurate in identifying these changes. In contrast, models that ignored time lags showed higher uncertainty. The results highlight the importance and effectiveness of using integrated multivariate approaches such as Multivariable Fractional Polynomial Analysis (MFPA) and Global Critical Point Analysis (GCPA) to gain deeper insights into the systemic behaviour of the caldera and its temporal evolution within a complex area like the Campi Flegrei over the selected time period.
Background: Regional anesthesia is a fundamental aspect of contemporary perioperative care. However, variability in practice, incomplete documentation, and inconsistent safety protocols continue to pose preventable risks. Although there are international checklist models for regional anesthesia and perioperative safety such as those developed by ASRA, ESAIC, and the WHO, Italy does not have a nationally endorsed checklist that is consensus-based and specifically tailored to local terminology, workflows, and legal requirements. Methods: To address this gap, we developed an evidence-based Locoregional Anesthesia Checklist (LRA Checklist) using established frameworks for healthcare checklist design. The development process included a needs assessment through a national survey of ESRA Italy members, a review of existing models, item drafting, expert consensus, and endorsement by the Board. We assessed content validity through a modified Delphi process involving 15 experts from the ESRA Italian Chapter Board. Additionally, we created a theoretical impact model to estimate the potential organizational and economic effects of implementing the checklist, using baseline institutional parameters. Results: Consensus was achieved for all checklist domains after two Delphi rounds, with minor edits to improve clarity, usability, and clinical relevance. The theoretical model indicates that adopting checklists may help reduce preventable complications, improve workflow, enhance documentation and traceability, and provide overall benefits to institutions in various scenarios. Conclusions: In conclusion, the LRA Checklist is a structured, consensus-based tool tailored for the Italian context, aimed at promoting safer and more standardized practices in regional anesthesia. To our knowledge, no prior Italian national consensus or checklist specifically dedicated to regional anesthesia has been formally published. Prospective multicenter studies are necessary to confirm its effectiveness in real-world settings and to quantify both clinical and economic outcomes.
Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic plaque and progression to clinically significant carotid stenosis. Non-invasive imaging techniques currently allow accurate characterization of carotid plaque in terms of composition, echogenicity, echostructure, presence of intraplaque hemorrhage, ulceration and vascular remodeling, all factors closely associated with plaque instability and the risk of ischemic events. At the same time, advances in medical therapy and revascularization techniques have improved clinical outcomes but have also increased the complexity of therapeutic decision-making in individual patients, requiring the integration of clinical, anatomical, hemodynamic and imaging data. Despite the availability of international guidelines, areas of uncertainty and significant heterogeneity remain in clinical practice, terminology, risk stratification criteria and indications for revascularization, particularly in asymptomatic patients or those with intermediate-grade stenosis. The aim of the present SICOA-GISE consensus document is to harmonize terminology between the different disciplines involved (cardiology, neurology, radiology and vascular surgery), promote a multidisciplinary approach and provide practical guidance on the appropriate use of imaging techniques, identification of high-risk carotid plaque and integration of medical and interventional therapy.
