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The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

The epidemiology and the outcomes of acute appendicitis in elderly patients are very different from the younger population. Elderly patients with acute appendicitis showed higher mortality, higher perforation rate, lower diagnostic accuracy, longer delay from symptoms onset and admission, higher postoperative complication rate and higher risk of colonic and appendiceal cancer. The aim of the present work was to investigate age-related factors that could influence a different approach, compared to the 2016 WSES Jerusalem guidelines on general population, in terms of diagnosis and management of elderly patient with acute appendicitis. During the XXIX National Congress of the Italian Society of Surgical Pathophysiology (SIFIPAC) held in Cesena (Italy) in May 2019, in collaboration with the Italian Society of Geriatric Surgery (SICG), the World Society of Emergency Surgery (WSES) and the Italian Society of Emergency Medicine (SIMEU), a panel of experts participated to a Consensus Conference where eight panelists presented a number of statements, which were developed for each of the four topics about diagnosis and management of acute appendicitis in elderly patients, formulated according to the GRADE system. The statements were then voted, eventually modified and finally approved by the participants to the Consensus Conference. The current paper is reporting the definitive guidelines statements on each of the following topics: diagnosis, non-operative management, operative management and antibiotic therapy.

The HEXACO Personality Inventory–Revised (HEXACO–PI–R) has become one of the most heavily applied measurement tools for the assessment of basic personality traits. Correspondingly, the inventory has been translated to many languages for use in cross-cultural research. However, formal tests examining whether the different language versions of the HEXACO–PI–R provide equivalent measures of the 6 personality dimensions are missing. We provide a large-scale test of measurement invariance of the 100-item version of the HEXACO–PI–R across 16 languages spoken in European and Asian countries (N = 30,484). Multigroup exploratory structural equation modeling and confirmatory factor analyses revealed consistent support for configural and metric invariance, thus implying that the factor structure of the HEXACO dimensions as well as the meaning of the latent HEXACO factors is comparable across languages. However, analyses did not show overall support for scalar invariance; that is, equivalence of facet intercepts. A complementary alignment analysis supported this pattern, but also revealed substantial heterogeneity in the level of (non)invariance across facets and factors. Overall, results imply that the HEXACO–PI–R provides largely comparable measurement of the HEXACO dimensions, although the lack of scalar invariance highlights the necessity for future research clarifying the interpretation of mean-level trait differences across countries.

Neural stem and progenitor cell (NSPC) depletion may play a crucial role in the cognitive impairment observed in many age-related non-communicable diseases. Insulin resistance affects brain functions through a plethora of mechanisms that remain poorly understood. In an experimental model of insulin resistant NSPCs, we identified a novel molecular circuit relying on insulin receptor substrate-1 (IRS-1)/ Forkhead box O (FoxO) signaling cascade and inhibiting the recruitment of transcription factors FoxO1 and FoxO3a on the promoters of genes regulating proliferation and self-renewal. Insulin resistance also epigenetically increased the expression of cyclin-dependent kinase inhibitor 1 (p21) and accelerated NSPC senescence. Of note, we found that stimulation of NSPCs with NSPC-derived exosomes (exo-NSPC) rescued IRS-1/FoxO activation and counteracted both the reduced proliferation and senescence of stem cells. Accordingly, intranasal administration of exo-NSPC counteracted the high-fat diet-dependent impairment of adult hippocampal neurogenesis in mice by restoring the balance between proliferating and senescent NSPCs in the hippocampus. Our findings suggest a novel mechanism underlying the metabolic control of NSPC fate potentially involved in the detrimental effects of metabolic disorders on brain plasticity. In addition, our data highlight the role of extracellular vesicle-mediated signals in the regulation of cell fate within the adult neurogenic niche.

Synchrotron X-ray tomography enables the examination of the internal structure of materials at submicron spatial resolution and subsecond temporal resolution. Unavoidable experimental constraints can impose dose and time limits on the measurements, introducing noise in the reconstructed images. Convolutional neural networks (CNNs) have emerged as a powerful tool to remove noise from reconstructed images. However, their training typically requires collecting a dataset of paired noisy and high-quality measurements, which is a major obstacle to their use in practice. To circumvent this problem, methods for CNN-based denoising have recently been proposed that require no separate training data beyond the already available noisy reconstructions. Among these, the Noise2Inverse method is specifically designed for tomography and related inverse problems. To date, applications of Noise2Inverse have only taken into account 2D spatial information. In this paper, we expand the application of Noise2Inverse in space, time, and spectrum-like domains. This development enhances applications to static and dynamic micro-tomography as well as X-ray diffraction tomography. Results on real-world datasets establish that Noise2Inverse is capable of accurate denoising and enables a substantial reduction in acquisition time while maintaining image quality.

Synchrotron X-ray tomography enables the examination of the internal structure of materials at submicron spatial resolution and subsecond temporal resolution. Unavoidable experimental constraints can impose dose and time limits on the measurements, introducing noise in the reconstructed images. Convolutional neural networks (CNNs) have emerged as a powerful tool to remove noise from reconstructed images. However, their training typically requires collecting a dataset of paired noisy and high-quality measurements, which is a major obstacle to their use in practice. To circumvent this problem, methods for CNN-based denoising have recently been proposed that require no separate training data beyond the already available noisy reconstructions. Among these, the Noise2Inverse method is specifically designed for tomography and related inverse problems. To date, applications of Noise2Inverse have only taken into account 2D spatial information. In this paper, we expand the application of Noise2Inverse in space, time, and spectrum-like domains. This development enhances applications to static and dynamic micro-tomography as well as X-ray diffraction tomography. Results on real-world datasets establish that Noise2Inverse is capable of accurate denoising and enables a substantial reduction in acquisition time while maintaining image quality.

Cleft lip and palate (CL/P) is the most prevalent craniofacial birth defect in humans. None of the surgical procedures currently used for CL/P repair lead to definitive correction of hard palate bone interruption. Advances in tissue engineering and regenerative medicine aim to develop new strategies to restore palatal bone interruption by using tissue or organ-decellularized bioscaffolds seeded with host cells. Aim of this study was to set up a new natural scaffold deriving from a decellularized porcine mucoperiosteum, engineered by an innovative micro-perforation procedure based on Quantum Molecular Resonance (QMR) and then subjected to in vitro recellularization with human bone marrow-derived mesenchymal stem cells (hBM-MSCs). Our results demonstrated the efficiency of decellularization treatment gaining a natural, non-immunogenic scaffold with preserved collagen microenvironment that displays a favorable support to hMSC engraftment, spreading and differentiation. Ultrastructural analysis showed that the micro-perforation procedure preserved the collagen mesh, increasing the osteoinductive potential for mesenchymal precursor cells. In conclusion, we developed a novel tissue engineering protocol to obtain a non-immunogenic mucoperiosteal scaffold suitable for allogenic transplantation and CL/P repair. The innovative micro-perforation procedure improving hMSC osteogenic differentiation potentially impacts for enhanced palatal bone regeneration leading to future clinical applications in humans.

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.

The inaccuracy of resting energy expenditure (REE) prediction formulae to calculate energy metabolism in children may lead to either under- or overestimated real caloric needs with clinical consequences. The aim of this paper was to apply artificial neural networks algorithms (ANNs) to REE prediction. We enrolled 561 healthy children (2-17 years). Nutritional status was classified according to World Health Organization (WHO) criteria, and 113 were obese. REE was measured using indirect calorimetry and estimated with WHO, Harris-Benedict, Schofield, and Oxford formulae. The ANNs considered specific anthropometric data to model REE. The mean absolute error (mean ± SD) of the prediction was 95.8 ± 80.8 and was strongly correlated with REE values (R2 = 0.88). The performance of ANNs was higher in the subgroup of obese children (101 ± 91.8) with a lower grade of imprecision (5.4%). ANNs as a novel approach may give valuable information regarding energy requirements and weight management in children.

Introduction Recurrence of endometrial cancer is an important clinical challenge, with median survival rarely exceeding 12 months. The aim of this study was to analyze patterns of endometrial cancer recurrence and associations of these patterns with clinical outcome. Methods The study included patients with endometrial cancer who underwent primary surgical treatment with or without adjuvant treatment between July 2004 and June 2017 at the Gynaecologic Oncology Unit of one of three tertiary hospitals of the Catholic University Network in Italy with complete follow-up data available. Information on the date and pattern of recurrence was retrieved for each relapse. Post-relapse survival was recorded as the time from the date of recurrence to the date of death or last follow-up. Survival probabilities were compared using log rank tests, and associations of clinico-pathological characteristics with post-relapse survival were tested using Cox's regression models. Results A total of 1503 patients were included in the analysis. We identified 210 recurrences (14.0%) and 105 deaths (7.0%) at a median follow-up of 34 months (range 1-162). One hundred and fifty-eight recurrences (78.1%) occurred during the first two years of follow-up. Most recurrences were multifocal (n=121, 57.6%) and involved extrapelvic sites (n=38, 65.7%). Parameters associated with post-relapse survival in the univariate analysis included histotype, grade, time to recurrence, pattern of recurrence, number of relapsing lesions, and secondary radical surgery. Only the pattern of recurrence and secondary radical surgery were independent predictors of post-relapse survival in the multivariate analysis (p=0.025 and p=0.0001, respectively). Conclusion Lymph node recurrence and the feasibility of secondary radical surgery were independent predictors of post-relapse survival in patients with recurrent endometrial cancer.

Overnutrition and metabolic disorders impair cognitive functions through molecular mechanisms still poorly understood. In mice fed with a high fat diet (HFD) we analysed the expression of synaptic plasticity‐related genes and the activation of cAMP response elementbinding protein (CREB)‐brain‐derived neurotrophic factor (BDNF)‐tropomyosin receptor kinase B (TrkB) signalling. We found that a HFD inhibited both CREB phosphorylation and the expression of a set of CREB target genes in the hippocampus. The intranasal administration of neural stem cell (NSC)‐derived exosomes (exo‐NSC) epigenetically restored the transcription of Bdnf, nNOS, Sirt1, Egr3, and RelA genes by inducing the recruitment of CREB on their regulatory sequences. Finally, exo‐NSC administration rescued both BDNF signalling and memory in HFD mice. Collectively, our findings highlight novel mechanisms underlying HFD‐related memory impairment and provide evidence of the potential therapeutic effect of exo‐NSC against metabolic disease‐related cognitive decline

Impairment of adult hippocampal neurogenesis is an early event in Alzheimer’s disease (AD), playing a crucial role in cognitive dysfunction associated with this pathology. However, the mechanisms underlying defective neurogenesis in AD are still unclear. Recently, the nucleoporin Nup153 has been described as a new epigenetic determinant of adult neural stem cell (NSC) maintenance and fate. Here we investigated whether Nup153 dysfunction could affect the plasticity of NSCs in AD. Nup153 expression was strongly reduced in AD-NSCs, as well as its interaction with the transcription factor Sox2, a master regulator of NSC stemness and their neuronal differentiation. Similar Nup153 reduction was also observed in WT-NSCs treated with amyloid-beta (Abeta) or stimulated with a nitric oxide donor. Accordingly, AD-NSCs treated with either a gamma-secretase inhibitor or antioxidant compounds showed higher Nup153 levels suggesting that both nitrosative stress and Abetaaccumulation affect Nup153 expression. Of note, restoration of Nup153 levels in AD-NSCs promoted their proliferation, as assessed by BrdU incorporation, neurosphere assay and stemness gene expression analysis. Nup153 overexpression also recovered AD-NSC response to differentiation, increasing the expression of pro-neuronal genes, the percentage of cells positive for neuronal markers and the acquisition of a more mature neuronal phenotype. Electrophysiological recordings revealed that neurons differentiated from Nup153-transfected AD-NSCs displayed higher Na+ current density, comparable to those deriving from WT-NSCs. Our data uncover a novel role for Nup153 in NSCs from animal model of AD and point to Nup153 as potential target to restore physiological NSC behavior and fate in neurodegenerative diseases.

Questo testo presenta un'ampia gamma di modelli statistici utili all'analisi dei dati comunemente incontrati nelle scienze sociali e psicologiche. Il testo presenta il modello lineare generale come base delle tecniche statistiche trattate, che spaziano dalla Correlazione, Regressione, ANOVA, Analisi Fattoriale, Equazioni Strutturali, arrivando a coprire tematiche attuali come la Moderazione e la Mediazione, i Modelli Misti, i Modelli Generalizzati. Basandosi su un modello unico declinato nelle varie situazioni di analisi dei dati, il testo presenta le varie tecniche statistiche concentrandosi sull'utilizzo pratico e sull'interpretazione dei risultati delle statistiche presentate. Vari riferimenti ai software più comuni (SPSS, R, SAS) sono spesso presenti, sebbene il libro sia fruibile indipendentemente dal software preferito dal lettore. A corredo sono stati introdotti alcuni inserti più avanzati: paragrafi aggiuntivi opportunamente segnalati e box integrativi, rivolti ai lettori più esperti, come studenti di dottorato dei primi anni, tesisti alle prese con tesi empiriche e ricercatori interessati.

Explicit measures of moral personality are not very successful in predicting specific moral actions. Recent theoretical developments suggest that measures based on associative processes may provide an alternative to improve prediction. In this contribution we have developed an Implicit Association Test (IAT) measure of the Moral vs. Immoral self-concept and used it alongside a direct self-rating of moral personality. In Study 1 this IAT measure uniquely predicted whether participants faithfully reported an outcome implying negative consequences. In Study 2 the IAT moral self-concept predicted an actual moral behavior, while a self-rating explicit personality measure predicted responses to hypothetical moral scenarios. Results are discussed in light of the role played by individual differences in associative structures representing personality and the self-concept. © 2009 Elsevier Inc. All rights reserved.

The alarming epidemic of obesity and physical inactivity at paediatric age urges societies to rise to the challenge of ensuring an active lifestyle. As one response to this, business enterprises are increasingly engaged in promoting sport and physical activity (PA) initiatives within the frame of corporate social responsibility (CSR). However, comparative analyses among industry sectors of CSR strategies for PA promotion with a particular focus on children are still lacking. This study aimed to explore (i) what are the CSR strategies for PA promotion adopted in different industry sectors and (ii) whether corporate engagement in promoting PA for children is supportive of children's rights to play and be physically active. Corporate pledges pertaining to CSR initiatives to promote PA were analysed. The hypothesis was that companies from different sectors employ different CSR strategies and that companies with a higher profile as regard to public health concerns for children tend to legitimate their action by adopting a compensatory strategy. Results show that the issue of PA promotion is largely represented within CSR commitments. CSR strategies for PA promotion vary across industry sectors and the adoption of a compensatory strategy for rising childhood obesity allows only a limited exploitation of the potential of CSR commitments for the provision of children's rights to play and be physically active. Actors within the fields of public health ethics, human rights and CSR should be considered complementary to develop mainstreaming strategies and improve monitoring systems of PA promotion in children.

The association between proton pump inhibitor (PPI) therapy and hypomagnesaemia has been recognized since 2006. We report the case of a 51-year-old woman who developed severe symptomatic hypomagnesaemia after a long-term PPI therapy given for recurrent peptic ulcer disease. Hypomagnesaemia could only partially be resolved during substitution therapy, but was corrected after withdrawal of the PPI. Recurrence of hypomagnesaemia occurred after retreatment with PPIs, supporting the causal relationship. An underlying gastric acid hypersecretion (Zollinger-Ellison syndrome) was highly suspected and eventually controlled by a combination of a histamine 2-receptor antagonist and octreotide, without the need for further PPI therapy after 2 years of follow-up.

We investigate the moderating effects of self-regulatory foci (Higgins, 1996a) on the impact of anticipated emotions in decision making. We hypothesise that regulatory focus moderates the relationships between anticipated emotions of success and failure of performing an act and evaluations of the act. A promotion focus should highlight the role of dissatisfaction-satisfaction emotions in predicting evaluations, whereas a prevention focus should emphasise the impact of relaxation-agitation emotions. Hypotheses were investigated in two studies. In the first, chronic self-regulatory orientations were assessed; in the second, self-regulatory concerns were manipulated. Results support the moderating effects of regulatory foci on the impact of negative anticipated emotions: Anticipated agitation induces more favourable action evaluations under a prevention focus; and anticipated dejection leads to more favourable action evaluations under a promotion focus. No interaction was detected involving positive emotions, suggesting that an asymmetry may exist in motivational regulation of emotional information.

The present study examined the validity of the Multicultural Personality Questionnaire (MPQ), an instrument designed to measure five personality dimensions linked to multicultural orientation and adaptation. First, the cross-cultural generalizability of the scales was investigated across Italian (N = 421) and Dutch (N = 419) student samples. Factorial invariance and generalizability of dimensions were tested by means of confirmatory multigroup factor analysis. Results show that the five dimensions are stable across the two countries. The MPQ dimensions were related to the Big Five dimensions and to a set of more specific potential predictors of international orientation in the expected direction. Moreover, the data revealed support for the incremental validity of the MPQ dimensions above these general (Big Five) and specific personality dimensions. © 2004 Elsevier Ltd. All rights reserved.

The present study tested the model of goal-directed behavior (MGB). The model proposes that behavioral intentions to perform instrumental behaviors are primarily motivated by desires to perform the acts. In turn, desires mediate the effects of attitudes, subjective norms, perceived control, and anticipated emotions on intentions. Construct validity for MGB variables is assessed, and the predictive utility of the MGB is compared with that of the theory of planned behavior (TPB). College students (N = 102) provided measures for MGB and TPB variables while participating in a training program to use statistical software. We focused on two goal-related instrumental behaviors: studying handbooks and practicing with the package. The results show that the MGB accounts for a greater proportion of variance in intentions and instrumental behaviors than does TPB. Although desires mediate most of the effects of other predictors on intentions to perform the instrumental behaviors, it is proposed that when the behavior is normatively relevant, or when self-efficacy appraisals play a major role, subjective norms and perceived behavioral control may directly affect intentions.

Luminosity functions from theoretical stellar evolution calculations are compared with observed ones of several galactic globular clusters (M30, M92, M68, NGC6397, M4, M80, NGC6352, NGC1851). Contrary to earlier results of Faulkner & Stetson (1993) and Bolte (1994) we find no significant discrepancy that could indicate the neglect of important physical effects in the models. However, it is confirmed that the subgiant branch is the most sensitive part and shows the largest deviations in the luminosity function comparison, if parameters are unappropriate. We also find that the main sequence is suited less than the Red Giant Branch for the calibration of theoretical luminosity functions. While for individual clusters different changes in the model assumptions might resolve mismatches, there is no systematic trend visible. It rather appears that the quality of the luminosity function in the subgiant part is insufficient and that improved observations of this particular region are necessary for a better comparison. At the present quality of luminosity functions theory is in agreement with observation and a postulation of WIMPs acting in stellar cores does not seem to be justified. Actually, fits using isothermal core models on the main sequence appear to be worse than those with standard stellar evolution assumptions., Comment: submitted to Astron. Astrophys

Luminosity functions from theoretical stellar evolution calculations are compared with observed ones of several galactic globular clusters (M30, M92, M68, NGC6397, M4, M80, NGC6352, NGC1851). Contrary to earlier results of Faulkner & Stetson (1993) and Bolte (1994) we find no significant discrepancy that could indicate the neglect of important physical effects in the models. However, it is confirmed that the subgiant branch is the most sensitive part and shows the largest deviations in the luminosity function comparison, if parameters are unappropriate. We also find that the main sequence is suited less than the Red Giant Branch for the calibration of theoretical luminosity functions. While for individual clusters different changes in the model assumptions might resolve mismatches, there is no systematic trend visible. It rather appears that the quality of the luminosity function in the subgiant part is insufficient and that improved observations of this particular region are necessary for a better comparison. At the present quality of luminosity functions theory is in agreement with observation and a postulation of WIMPs acting in stellar cores does not seem to be justified. Actually, fits using isothermal core models on the main sequence appear to be worse than those with standard stellar evolution assumptions., Comment: submitted to Astron. Astrophys

Background A large proportion of European children, adults and older adults do not engage in sufficient physical activity (PA). Understanding individual and contextual factors associated with PA behaviours is essential for the identification and implementation of effective preventative environments, policies, and programmes that can promote an active lifestyle across life course and can potentially improve health. The current paper intends to provide 1) a multi-disciplinary, Pan-European and life course view of key determinants of PA behaviours and 2) a proposal of how these factors may cluster. Methods After gathering a list of 183 potential PA behaviours-associated factors and a consensus meeting to unify/consolidate terminology, a concept mapping software was used to collate European experts’ views of 106 identified factors for youth (<19 years), adults (19–64 years), and older adults (≥65 years). The analysis evaluated common trends in the clustering of factors and the ratings of the distinct factors’ expected modifiability and population-level impact on PA behaviours across the life course. Priority for research was also assessed for each cluster. Results The concept mapping resulted in six distinct clusters, broadly merged in two themes: 1) the ‘Person’, which included clusters ‘Intra-Personal Context and Wellbeing’ and ‘Family and Social Economic Status’ (42 % of all factors) and 2) the ‘Society’, which included the remaining four clusters ‘Policy and Provision’, ‘Cultural Context and Media’, ‘Social Support and Modelling’, and ‘Supportive Environment’ (58 % of all factors). Overall, 25 factors were rated as the most impactful on PA behaviours across the life course and being the most modifiable. They were mostly situated in the ‘Intra-Personal Context and Wellbeing’ cluster. Furthermore, 16 of them were rated as top priority for research. Conclusions The current framework provides a preliminary overview of factors which may account for PA behaviour across th