https://hdl.handle.net/10807/41 Sun, 12 Jul 2026 00:50:30 GMT 2026-07-12T00:50:30Z https://hdl.handle.net/10807/342696 Titolo: I presupposti delle teorie fisiche atemporali e la realtà scientificamente irriducibile del divenire Autori: Antonino Ventura Abstract: This paper critically analyses different theses of contemporary physicists on becoming and the relationship between time and the natural world. In particular, it examines the attempt to conceive the universe as a timeless reality and the antithetical position in which time is considered the most real and the only truly fundamental aspect of our experience. First, it is emphasised that the two positions cannot both be presented as provable theses, because they are in open contradiction. Then it is clarified that these positions derive from simple presuppositions and constitute non-scientific options that can be refuted philosophically. The conclusions show that even from a naturalistic perspective, becoming remains an undeniable et not merely emergent reality that cannot be scientifically transcended. Furthermore, they highlight that a supposed unity of the universe, besides not being admissible, does not prevent the exclusion that becoming is original. Wed, 01 Jan 2025 00:00:00 GMT https://hdl.handle.net/10807/342696 2025-01-01T00:00:00Z https://hdl.handle.net/10807/342676 Titolo: PERSoN4: A multiparametric ultrasound model to improve CEUS LI-RADS for HCC Autori: Esposto, Giorgio; Santini, Paolo; Galasso, Linda; Ainora, Maria Elena; Giamperoli, Alice; Cerrito, Lucia; Borriello, Raffaele; Mignini, Irene; Garcovich, Matteo; Paratore, Mattia; Riccardi, Laura; Pompili, Maurizio; Ponziani, Francesca Romana; Gasbarrini, Antonio; Piscaglia, Fabio; Zocco, Maria Assunta Abstract: Background & Aims: Dynamic contrast-enhanced ultrasound (D-CEUS) could be a valuable tool for the non-invasive diagnosis of hepatocellular carcinoma (HCC) with atypical vascular imaging features. Methods: Between January 2021 and November 2023, consecutive patients with chronic liver disease and liver nodules who were candidates for liver biopsy were enrolled in this cohort study. CEUS was performed in all patients before biopsy and categorized according to the CEUS Liver Imaging Reporting and Data System (LI-RADS). Clips were examined using VueBox® software. Clinical and ultrasound parameters were compared among the different histological entities, analyzed with univariable analysis, and incorporated into a logistic regression model for HCC diagnosis. The diagnostic accuracy of the identified model was evaluated by receiver operating characteristic (ROC) curve and relative AUC. The model was then tested on a validation cohort comprising consecutive patients from two centers. Results: A total of 88 patients (57 with HCC, 17 with intrahepatic cholangiocarcinoma, 11 with liver metastases, and three with benign lesions) were enrolled. Statistically significant differences between patients with and without HCC in the training cohort were incorporated in an optimal logistic regression model that included the following predictive variables: sex, number of nodules ≥4, peripheral rim-like hyperenhancement, and peak enhancement (PE) ratio (PE–rim-like enhancement–Sex–Nodules≥4; PERSoN4). The model displayed high accuracy (AUC 0.91) for the diagnosis of HCC. In the validation cohort, the model showed a sensitivity of 48.8% and a specificity of 100.0%, with a positive predictive value (PPV) of 100.0%, maintaining good diagnostic accuracy (AUC of 0.74). Conclusions: PERSoN4 could improve the performance of CEUS LI-RADS criteria, possibly leading to a non-invasive diagnosis of HCC in nearly 50% of patients currently referred for liver biopsy. However, this model requires further external validation before entering clinical practice. Impact and implications: Accurate non-invasive diagnosis of HCC remains challenging in patients with atypical vascular patterns on CEUS, providing the scientific rationale for developing a multiparametric D-CEUS-based risk model that integrates quantitative perfusion analysis with clinical and imaging features. Our findings suggest that the PERSoN4 model could meaningfully enhance the diagnostic performance of CEUS LI-RADS, particularly by identifying a subset of patients in whom HCC can be diagnosed with very high specificity and PPV, which is relevant for hepatologists, radiologists, and multidisciplinary tumor boards managing indeterminate nodules. This approach could reduce the need for liver biopsy in nearly half of currently eligible patients, streamlining diagnostic pathways and potentially lowering procedure-related risks and costs. However, given the moderate sensitivity and the limited sample size, further large-scale external validation is essential before widespread clinical implementation. Thu, 01 Jan 2026 00:00:00 GMT https://hdl.handle.net/10807/342676 2026-01-01T00:00:00Z https://hdl.handle.net/10807/342657 Titolo: Social Intermediation amid Extreme Marginalization: The Morpho-Regeneration of Fractured Reflexivity Autori: Sottini, Andrea; Giudici, Alessandro; Cannatelli, Benedetto Lorenzo Abstract: The literature on social intermediaries (SIs) highlights their role in alleviating poverty and promoting market inclusion in emerging economies through interventions that counterbalance pressures from formal and informal institutions. However, this research centers on interplays between intermediaries and institutions, implicitly assuming that beneficiaries (BENs) reject their condition of poverty and retain a minimally functioning capacity for reflexive agency, supporting engagement with such interventions. In contrast, our study of slums and rural communities in Kenya and Sierra Leone examines social intermediation amid conditions in which extreme marginalization has fractured BENs’ reflexive capacity, leaving them unable to orient toward purposive action. Using a critical realist relational lens, we develop a process model in which social intermediation unfolds through interdependent morpho-regenerative processes—institutional shielding, relational accompaniment, and entrepreneurial empowerment—that create prolonged protective spaces against oppressive pressures and repair reflexivity gradually until BENs can sustain it on their own. We theorize morpho-regeneration as a custodial practice of “with-in” intervention that restores individual capacities for social and economic participation, enabling more conventional outside-in and inside-up intermediation approaches. Our study offers new insights into the relational dimensions of poverty alleviation and their connection to community-level dynamics, with relevance to other contexts where agency is severely destabilized. Thu, 01 Jan 2026 00:00:00 GMT https://hdl.handle.net/10807/342657 2026-01-01T00:00:00Z https://hdl.handle.net/10807/342656 Titolo: Uterine artery pulsatility index as a functional biomarker of central precocious puberty: a scoping review Autori: Cammisa I; Rigante D; Cipolla C Abstract: Central precocious puberty (CPP) results from the premature activation of the hypothalamic-pituitary gonadal (HPG) axis. Although the GnRH stimulation test remains the gold standard for diagnosis, the uterine artery pulsatility index (PI) has been proposed as a functional indicator of pubertal activation. The aim of this review, which included 11 studies and 1,151 patients, was to summarize the current evidence regarding the diagnostic role of uterine artery PI in CPP evaluation. A consistent inverse relationship was observed between the PI and pubertal progression. The reported PI sensitivity for detecting pubertal onset ranges from 77% to 100%, while the specificity varies between 48% and 100%, depending on the cutoff values and study populations. Diagnostic accuracy improved when the PI was combined with uterine morphometric parameters. In girls with CPP undergoing GnRH agonist therapy, the PI increased significantly during treatment, suggesting its potential role as a marker of therapeutic response. Thus, uterine artery PI represents a physiologically plausible and clinically informative adjunctive tool that suggests HPG axis activation. Although not suitable as a stand-alone diagnostic test, its integration into a multimodal diagnostic framework may enhance the non invasive evaluation and monitoring of CPP. Thu, 01 Jan 2026 00:00:00 GMT https://hdl.handle.net/10807/342656 2026-01-01T00:00:00Z