Stefania Arena

Introduction Colorectal cancer (CRC) is one of the most common malignancies worldwide. The implementation of screening programs has been shown to significantly reduce mortality. Individual risk stratification using structured tools may improve the efficiency of screening programs by directing resources to individuals at higher risk while reducing unnecessary procedures for those at lower risk. However, the available literature reveals substantial heterogeneity among existing tools, with limited clinical validation and poor integration into screening programs. Objectives To systematically map questionnaire-based tools developed for CRC risk assessment and stratification in average-risk populations, evaluating their methodological characteristics, applicability, and validation status. Methods A scoping review was conducted following the Arksey and O'Malley framework and the Joanna Briggs Institute methodology, and reported according to the PRISMA-ScR guidelines. Searches were performed in Medline/PubMed, Embase, Scopus, and Web of Science up to July 24, 2025. Study selection was conducted using the Rayyan platform by three reviewers working in parallel. Studies describing, developing, or validating questionnaire-based tools (paper-based, digital, app-based, or risk algorithms) for CRC risk assessment in average-risk adults were included. Data extraction was performed using a standardized form. ChatGPT was used to support preliminary data extraction, which was subsequently verified by human reviewers. Results A total of 4,554 records were identified. After duplicate removal (n=2,467), 2,087 records underwent screening, and 106 full-text articles were assessed for eligibility. Nineteen studies met the inclusion criteria. Studies were published between 2006 and 2025 and originated from nine countries, primarily China, the Netherlands, Norway, and the United States. Ten studies (52.6%) developed study-specific tools, whereas nine (47.4%) used, adapted, or modified previously published instruments, most commonly the Asia-Pacific Colorectal Screening (APCS) score and its variants. Questionnaires contained between 4 and 29 items (median: 6), covering demographic, clinical, behavioral, and lifestyle-related risk factors. Measures of discrimination were reported in 13 studies, with AUC/C-index values ranging from 0.60 to 0.89 (median: 0.67). Overall, 40 validation analyses were identified across multiple outcomes, including incident CRC, advanced neoplasia, and precancerous lesions. Predictive performance varied substantially across target populations, assessed outcomes, and questionnaire compositions. External validation was reported for only a minority of tools. Conclusions This scoping review provides a comprehensive mapping of questionnaire-based tools for colorectal cancer risk assessment in average-risk populations. Although several instruments demonstrated acceptable discriminatory performance, substantial heterogeneity was observed in questionnaire content, target outcomes, modeling approaches, and validation strategies. The limited availability of external validation and the limited integration of these tools into organized screening programs represent important barriers to implementation. Future research should prioritize standardization, external validation, and evaluation of these tools in real-world screening settings to support risk-based colorectal cancer screening strategies.

Background: Peptide receptor radionuclide therapy (PRRT) with ¹⁷⁷Lu-DOTATATE has become a cornerstone in the management of neuroendocrine tumors (NETs). However, the efficiency of this targeted therapy is highly dependent on the radiopharmaceutical drug delivery system and its infusion kinetics, which influence systemic biodistribution and therapeutic efficacy. This study evaluates various gravity-based infusion fluid dynamics to optimize the drug delivery profile, ensuring standardized delivery while minimizing residual activity. Methods: A retrospective analysis of 127 administrations of ¹⁷⁷Lu-DOTATATE (7.4 GBq per cycle) was conducted across 35 patients with NETs to assess vial dilution kinetics. Four distinct infusion rate (IR) strategies were compared to evaluate mass balance and delivery efficiency: constant infusion rate (1-IR); a single rate increase at 10 min (2-IR); two rate increases at 10 and 30 min (3-IR); and three rate increases at 10, 30, and 40 min (4-IR). Results: Stepwise increases in the IR significantly accelerated the vial clearance kinetics and reduced radiopharmaceutical stagnation within the infusion lines. Successful delivery of the target dose (98% of the pre-infusion activity measured in each specific vial) was achieved in 56% of cases with the 1-IR protocol (9 injections) and increased to 87% with 2-IR (45 injections), 97% with 3-IR (60 injections), and 100% with 4-IR (13 injections). Conclusions: Modulating fluid dynamics through stepwise IR protocols significantly enhances radiopharmaceutical delivery efficiency. The 3-IR protocol offers a favorable balance between procedural efficiency and clinical safety.

Background: The use of HFNC (High Flow Nasal Cannula) in the management of acute respiratory failure has been fully established in clinical practice. Conversely, less data is available supporting its use in chronic hypoxemic–hypercapnic respiratory failure. The aim of the present study is to evaluate the efficacy of HFNC in chronic hypercapnic respiratory failure associated with stable COPD. Methods: In this retrospective single-center longitudinal observational study, 40 patients treated with HFNC at home followed at the COPD Clinic of Respiratory Diseases (University of Campania L. Vanvitelli Monaldi Hospital, Naples) were included. All patients are re-assessed at our clinic at T0, T3, T6 and T12 months through functional respiratory tests and blood gas analysis. Results: After 12 months, significant reductions in pCO₂ (arterial partial pressure of carbon dioxide) (from 58.5 to 48.0 mmHg) and lactates (from 1.60 to 0.90 mmol/L) were observed, and MIP and MEP improved significantly. Patients receiving HFNC flows ≥50 L/min experienced greater reductions in pCO₂ and fewer exacerbations. Multivariate analysis identified HFNC flow rate (p = 0.0046), hours of use/day (p = 0.0157), lactate levels (p = 0.0301), and FEV₁ (forced expiratory volume in 1 s) (p = 0.0491) as independent predictors of reduction in PaCO₂. Higher BMI and greater airway obstruction were associated with a reduced response. Conclusions: Treatment with HFNC represents a reasonable therapeutic choice to reduce AEs-COPD and reduce PaCO₂ and lactates in stable COPD patients.

The Mediterranean diet, recognized as being cultural heritage by UNESCO, is mostly plant-based and includes a high consumption of whole-grain, fruit, and vegetables with a moderate consumption of alcohol during meals. Thus, it provides a small amount of saturated fatty acids and a high quantity of antioxidants and fiber. For this reason, it has been considered to have an important role in preventing cardiovascular diseases, chronic kidney diseases, type 2 diabetes mellitus, and cancer, but its relationship with thyroid function and diseases is still under debate. The aim of this review was to search for the possible correlation between the Mediterranean diet and thyroid function, and to critically evaluate the pathophysiological link between selected food intake and thyroid disorders.

It is widely acknowledged that obesity is a growing public clinical issue involving both physical and psychological well-being. Nevertheless, the relationship between psychological features and weight gain is still unclear. Although emotional eating (EE) and personality traits are considered significant predictors of eating disorders, their role in obesity without eating disorders (OB-wed) is far from proven. The present study aimed at investigating the cumulative effect of EE and personality traits on overeating behavior in a sample of 266 university students (169 female; mean age = 21.85, SD = 2.39) stratified based on their body mass index (BMI; normal weight, overweight, obese). They were enrolled during free screening days promoted by the Human Dietetic and Sport Service of a Southern Italian university. The results show a psychological pattern of increasing overeating behavior and lower Self-Directedness combined with higher Sadness and Anger. However, OB-wed subjects overate regardless of this emotional/personological configuration.