In critically ill patients, extubation readiness is typically assessed using a spontaneous breathing trial (SBT). Among patients with acute brain injury (ABI), the optimal SBT method remains uncertain. We conducted a post-hoc analysis of the ENIO study (NCT03400904), including mechanically ventilated ABI patients with available SBT data, undergoing extubation attempt. SBTs were classified as T-piece, pressure support ventilation (PSV), or continuous positive airway pressure (CPAP). The primary outcome was extubation failure within 5 days. Associations between SBT modality and extubation failure were assessed using multivariable logistic regression and inverse probability of treatment weighting. Of 1,512 patients enrolled in ENIO, 839 met the inclusion criteria, of whom 270 (32.2
This review synthesizes current evidence and expert consensus on the long-term management of severe chronic rhinosinusitis with nasal polyps (CRSwNP) treated with biologics, as established by the Italian CHRONOS project. Accumulating real-world and clinical trial data confirm the sustained efficacy and safety of biologics targeting type 2 inflammation, enabling durable control and remission in a significant proportion of patients. Personalized dosing regimens, including dose-spacing strategies, appear feasible. The CHRONOS project provides practical guidance for optimizing long-term biologic therapy in severe CRSwNP. Response assessment should combine subjective and objective measures, especially for olfactory testing. Biologics may be considered before surgery only in selected complex cases. Dose-spacing strategies may be appropriate in stable patients but require multidisciplinary oversight in those with comorbid asthma. Adverse events are uncommon. The concept of disease modification is endorsed, recognizing biologics’ potential to alter the natural history of CRSwNP.
Refugees forced to migrate to host contexts as a result of armed conflict often experience high levels of distress due to the multiple stressors to which they are exposed. From an ecological perspective, social support becomes a key factor in fostering community resilience, thereby promoting the well-being of these individuals and buffering the effects of stress. The present study aims to investigate whether community resilience mediates the relationship between distress and well-being and to assess whether social support plays a moderating role between distress and community resilience among Ukrainian women refugees in the Italian host context. Through an online survey, 150 Ukrainian refugee women completed a questionnaire measuring community resilience, social support, distress, and well-being. A moderate mediation model was estimated. There is a direct relationship between distress and well-being and a partially mediated relationship through community resilience, which increases well-being. In the mediated relationship, increased well-being is achieved through increased social support. The results highlight the important role of social support and community resilience in mitigating the distress experienced by refugees. These results underscore the importance of fostering supportive contexts and promoting community resilience as essential factors in improving refugee well-being in host countries.
Background:Suicide rates have risen among young people, making it a leading cause of adolescent death worldwide. Although several pharmacological treatments have been approved in the context of definite underlying conditions, their broader efficacy in reducing suicidality remains unclear. Methods:A structured review was conducted on pharmacological treatments for suicidality in under 18s. PubMed, Embase, PsycINFO, and Cochrane Library were searched from inception to 31 July 2025. Eligible studies included patients <18 years with suicidality treated with antidepressants, mood stabilisers, or antipsychotics. Exclusion criteria were non-pharmacological interventions, non-suicidal self-injury-only studies, reviews, and grey literature. Both interventional and observational designs were considered. Four authors independently screened, extracted, and appraised data using Joanna Briggs Institute tools. The primary outcome was suicidality reduction, synthesised narratively. This study is registered with PROSPERO, CRD42024548628. Findings:Twenty-three articles out of 1747 met inclusion criteria, totalling 2235 participants. Risk of bias across studies was low-to-moderate for nearly all studies (22/23). However, the majority employed weaker study designs and targeted underlying diagnoses, with suicidality rarely assessed as a primary outcome. Esketamine (four studies, n = 211) and ketamine (four, n = 6) use in major depressive disorder induced rapid reduction of acute suicidality within 24 h. In the longer term, lithium (three, n = 923) was beneficial in reducing suicidality in youths with bipolar disorder. Sertraline, citalopram, escitalopram, fluoxetine and duloxetine (six, n = 906) yielded inconsistent results. Other agents, including valproate, lamotrigine and antipsychotics such as clozapine and quetiapine exhibited some benefit in reducing suicidality, but findings were limited to small-scale studies. Interpretation:Evidence remains scarce and heterogeneous. Esketamine and lithium appear promising for acute and chronic suicidality, respectively. Further high-quality studies investigating suicidal thoughts and behaviours as independent treatment targets are needed to guide clinical decision-making. Funding:None.
Abstract Background and aims Mechanical thrombectomy (MT) is effective for acute Basilar artery occlusion(BAO), but the optimal technique for quick recanalization and improved outcomes remains unclear. We compared Stent retriever (SR), Contact aspiration (CA) and combined SR plus CA technique as first-line approach during mechanical thrombectomy for BAO. Methods We emulated a hypothetical trial comparing CA, SR and combined technique as first-line in patients with BAO, using data from the Italian Registry of Endovascular Treatment. The primary outcome was first-pass effect (FPE), defined as mTICI 2b-3 with 1 pass of MT. We used inverse probability weighting (IPW) adjusted for prespecified covariates to weight each individual’s contribution to the outcome. Results We included 960 patients with BAO treated with MT: 570 with CA, 268 with SR, and 122 with combined technique as first approach. After applying IPW, SR was associated with lower odds of FPE as compared to CA (aOR 0.48[95%CI 0.33-0.70]), no differences were found comparing SR versus combined technique neither CA versus combined technique. First-pass mTICI 3 was less frequent with SR as compared to CA (0.62[95%CI 0.43-0.90]). 90-day mRS 0-3 after FPE was more frequent with CA as compared to both SR (aOR 0.57[95%CI 0.38-0.85]) and combined technique (aOR 0.50[95%CI 0.28-0.89]). The results were consistent across all the subgroups (p for interaction>0.05). Conclusions In patients with BAO, CA was more effective than SR and was associated with better oucome compared to other techniques. Therefore, less traumatic approaches might be preferred as first-line in BAO. Conflict of interest E.N. is member of the medical and scientific advisory board of Cercare Medical and declares speaker's honoraria from Boehringer Ingelheim; A.C. has nothing to disclose; V.S. has nothing to disclose; G.P. has nothing to disclose; P.N. has nothing to disclose; M.D. has nothing to disclose; M.R. has nothing to disclose; D.T. declares consulting or advisory board fees or speaker’s honoraria from Alexion, ASTRA Zeneca, Boehringer, Medtronic and Pfizer. Figure 1 - belongs to Methods Figure 2 - belongs to Results
