Background Active fluid management systems such as IRRAflow aim to overcome the limitations of passive external drains by enabling simultaneous automated irrigation and aspiration in a closed circuit. In acute and chronic subdural hematoma (a/cSDH), it enables active subdural irrigation, whereas in subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), and ventriculitis, it allows continuous ventricular CSF exchange and, when indicated, intrathecal administration of therapeutic agents. Methods A literature analysis identified studies reporting IRRAflow use for SAH, SDH, IVH, or ventriculitis. Additionally, a single-center retrospective series of 13 consecutive patients treated with IRRAflow was analyzed, focusing on clinical course, complications, and outcomes. Results Thirty studies comprising 345 patients were included in the literature analysis. In cSDH, clinical resolution was reported in 40 cases (90.9%), with recurrence in 3 patients (6.8%) and no reported infections or catheter obstructions. In aSDH, only 1/11 patient experienced clinical deterioration and required conversion to craniotomy. In IVH, outcomes were more variable, with complete resolution in 14/36 cases (38.9%), clinical improvement in 15/36 (41.7%), deterioration in 1/36 (2.8%), and death in 6 (16.7%). In ventriculitis, largely reported in case reports and small case series, resolution or improvement was achieved in 27/35 patients (77.1%), while mortality was 8/35 (22.9%). In aSAH, 7/23 (30.4%) patients died from complications of the hemorrhage. Vasospasm occurred in 7/23 (30.4%) patients, including two who subsequently died, while 2/23 (8.7%) required permanent shunting; both were survivors who had experienced vasospasm. No device-related complications were reported. Our institutional cohort included 6 patients with IVH, 4 with cSDH, and 3 with ventriculitis. Among the IVH cases, 3/6 patients died before discharge, 1 died during follow-up, whereas the other 2 had an mRS score of 3 and 2 at last follow-up. Among patients with cSDH, 3/4 achieved favorable functional recovery at follow-up, while 1/4 died before discharge because of complications unrelated to IRRAflow. Among the 3 patients with ventriculitis, 1 died following a complication related to urokinase infusion after adjunctive urokinase administration, whereas the remaining 2 (66.7%) achieved resolution or improvement. Conclusions Both the institutional cohort and the literature search showed promising results for the use of IRRAflow in cSDH. Results on ventriculitis, aSAH and aSDH are still uncertain due to the small sample sizes. Regarding IVH, neither the exploratory review nor our institutional case series identified a clear clinical benefit associated with IRRAflow use. Nevertheless, the available evidence remains limited by predominantly observational, small and heterogeneous studies, precluding comparative conclusions.
This paper investigates the relationship between environmental energy taxes and firm-level renewable energy adoption, addressing existing literature gaps by providing microeconomic evidence and analyzing the moderating role of institutional quality, the effectiveness of formal and informal institutions in shaping incentives and reducing uncertainty in economic interactions. Using World Bank Enterprise Survey data (2018-2020) across a large cross-country sample of firms, the empirical analysis finds that energy taxes are, on average, positively associated with firms' renewable energy adoption, supporting the Porter Hypothesis. However, the extent of this impact depends on specific firm and country characteristics: it is significantly stronger for large corporations, as well as for firms in higher-income countries and those in environments with superior environmental performance, respectively, while remaining uniform across both manufacturing and service sectors. Additionally, energy taxation upgrades internal capabilities by stimulating R&D and strategic climate planning. Crucially, institutional quality operates through a dual pathway: it exerts a standalone direct influence that encourages firms' renewable adoption, while simultaneously acting as an indirect moderator that makes fiscal policy signals credible. The incentive effect of energy taxes is strictly contingent upon governance, becoming pronounced under higher levels of voice and accountability, control of corruption, and the rule of law. These findings carry clear policy implications, indicating that fiscal instruments and institutional reforms may need to proceed jointly, as energy taxation alone may fail to stimulate green adoption without robust institutional structures.
Mitochondrial DNA copy number (mtDNA-CN) is a critical marker of mitochondrial health and plays a key role in cellular bioenergetics. Alterations in mtDNA-CN have been associated with aging, metabolic disorders and neurodegenerative diseases. Recent studies have revealed that various plant-derived extracts, as well as the secondary metabolites they produce, known as phytochemicals, can modulate mtDNA-CN through mechanisms including the regulation of mitochondrial biogenesis, oxidative stress, and mtDNA repair. This review examines plant-derived extracts and phytochemical compounds from a wide range of plant species- including Ginkgo biloba, Crocus sativus, Curcumin and many others- able to modulate mtDNA dynamics, scavenging oxygen free radicals and improving antioxidant defense systems.
Considering the increasing Italian school drop-out rates, this study aims to analyze the phenomenon of school refusal, focusing on the main individual factors that characterize it. School refusal is a multifactorial issue involving emotional, affective and social difficulties. Given these considerations, the research is divided into two consecutive studies. Study 1 examines the factor structure of the SCREEN (Gall & eacute;-Tessonneau and Gana 2019) by comparing the original version, the 18-item three-factor version, and 12-item short form four-factor version, in order to identify the best-fitting structure for Italian adolescent students (N = 351; Mage = 15.8; SD = 0.99). Confirmatory factor analysis (CFA) suggests that the short four-factor version is the best fitting model for the Italian context. Study 2 investigated the mediating role of positive and negative affect in the relationship between resilient coping and the four dimensions of school refusal (N = 581; Mage = 16.1; SD = 1.00). A Structural Equation Model (SEM) with latent variables was used to evaluate the associations between variables. Results suggest that resilient coping is associated with positive and negative affect, which are in turn differentially associated with dimensions of school refusal. Study highlights the importance of early identification and intervention, suggesting that fostering resilient coping strategies and positive affect at school may be associated with lower risk of avoidance and better school well-being.
Oxidative stress (OS) and endothelial dysfunction are major drivers of cardiovascular disease (CVD) in peritoneal dialysis (PD). MOTS-c, a mitochondria-derived peptide, is emerging as a key regulator of skeletal muscle health, metabolic homeostasis, and vascular function, yet its role in the uremic environment remains unexplored. We investigated the relationship between MOTS-c levels, OS markers, and vascular stiffness in PD patients. This pilot, clinical study included 32 stable PD patients (mean age 60.7 ± 1.2 years, 62.5
