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Burnet's text at Pl. Ti. 55c7–d6 is at least questionable, and opting for a different reading at 55d5 (θεός instead of θεόν) would shed light on an intriguing argumentative aspect of Plato's cosmological account: God confirms the metaphysical reasons why there is just one perfect world.

Physiological trauma that requires admission to an emergency department may result in psychological distress. As many as 20%-40% of civilians who experience trauma develop traumatic stress disorders and depression postinjury. Yet, less than 10% of trauma centers implement screening for traumatic stress and depression risk.This project aimed to develop, implement, and evaluate a traumatic stress and depression risk screening policy.Twelve trauma advanced practice providers implemented the newly developed traumatic stress and depression risk screening policy at an American College of Surgeons verified Level II trauma center. Trauma patients admitted for greater than 24 hr, 14 years of age or older, with a Glasgow Coma Scale score greater than 13 were eligible for screening using the Injured Trauma Survivor Screen.During the 6-week data collection period, 114 trauma patients presented to the emergency department. Of those, 82 (72%) met inclusion criteria, 77 (94%) eligible trauma patients were screened, and seven (9%) patients screened positive. Patients not eligible for screening were discharged within 24 hr or were too confused to answer questions. An evaluation survey revealed that the advanced practice providers thought that the screening policy was easy to use, feasible, not very time-consuming, and should be continued in the future.This project demonstrated the ease and effectiveness of implementing a traumatic stress and depression risk screening policy and that only minor changes are needed to make it sustainable.

It has been proposed that vaccines may exert an unspecific protective effect against infectious agents, different than expected. Coronavirus disease 2019 (COVID-19) is a pandemic infection with high mortality in older patients due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The high number of vaccinations may be one of the reasons why children show a lower susceptibility to SARS-CoV-2 infection and milder severity when compared to adults. We have designed a study aimed at investigating whether the influenza vaccine may reduce the susceptibility and severity of SARS-CoV-2 infection. We retrospectively enrolled 635 patients who accessed our Emergency Department from March 1st to June 30th, 2020, and were diagnosed with COVID-19 infection confirmed by an RT-PCR on an oropharyngeal swab. Clinical data, outcomes, and influenza vaccination status were collected from the electronic medical records of our Hospital. We also used data from the Italian Health Ministry to compare the prevalence of flu vaccination among the general population of the Lazio Region and our enrolled patients. We then compared clinical outcomes between vaccinated and non-vaccinated patients, by univariate and multivariate analysis. COVID-19-positive patients older than 65 years reported a lower prevalence of flu vaccination when compared to the general population residing in the Lazio (p = 0.004). After correction for gender, age, and comorbidities, we found a lower risk of death at 60 days in patients with flu vaccination than in not vaccinated patients (p = 0.001). Our study shows that flu vaccination could reduce the mortality of COVID-19. Prospective studies are needed to confirm this result.

Cognitive and affective impairments in processing body image have been observed in patients with Anorexia Nervosa (AN) and may induce the hypercontrolled and regulative behaviors observed in this disorder. Here, we aimed to probe the link between activation of body representations and cognitive control by investigating the ability to resolve body-related representational conflicts in women with restrictive AN and matched healthy controls (HC). Participants performed a modified version of the Flanker task in which underweight and overweight body images were presented as targets and distractors; a classic version of the task, with letters, was also administered as a control. The findings indicated that performance was better among the HC group in the task with bodies compared to the task with letters; however, no such facilitation was observed in AN patients, whose overall performance was poorer than that of the HC group in both tasks. In the task with body stimuli, performance among patients with AN was the worst on trials presenting underweight targets with overweight bodies as flankers. These results may reflect a dysfunctional association between the processing of body-related representations and cognitive control mechanisms that may aid clinicians in the development of optimal individualized treatments.

Fluxonorm® is a dietary supplement that includes water-soluble extracts of Solidago virga-aurea, Phyllantus niruri, Epilobium angustifolium, Peumus boldus and Ononis spinosa. The aim of the present study was to evaluate the tolerability and efficacy of Fluxonorm® in improving lower urinary tract symptoms in patients with benign prostatic hyperplasia (BPH) in combination with standard of care.Lower urinary tract symptoms can be improved by a marked anti-inflammatory action on the lower urinary tract (irritative symptoms) and/or by an anti-proliferative action (obstructive symptoms) on the prostate. Thirty patients were enrolled to evaluate the effect of Fluxonorm® on improving lower urinary tract symptoms. All patients complained of lower urinary tract symptoms (LUTS), such as hesitancy, poor flow, intermittent flow, incomplete voiding (obstructive symptoms), as well as increased frequency, nocturia and urgency (storage symptoms). All patients were treated with one tablet of Fluxonorm® (1200 mg) daily for 30 days to corroborate the results of our observation in which the food supplement (800 µg/mL) was also studied on the human prostate cancer PC3 cell line (antiproliferative activity) and on prostaglandin (PG)E2 production (anti-inflammatory activity). In addition, the effect of this compound on cyclooxygenase-2 (COX-2) gene expression was investigated. Finally, a bioinformatic analysis was conducted with the aim of unravelling the mechanism of action underlying the observed bio-pharmacological effects.As hypothesized in our preclinical research, adding Fluxonorm® to the therapy of enrolled patients improved all studied clinical parameters, including maximum flow (Qmax), after one month of treatment. In the preclinical evaluation, this formulation reduced PC3 cell viability and PGE2 production. The effects were also paralleled by reduced COX-2 gene expression and Fluxonorm®'s partly related content of catechin. While docking studies pointed out to the putative inhibition of matrix metalloproteinse-2 by gallic acid, as a further mechanism underlying the observed anti-proliferative effects, in PC3 cells exposed to Fluxonorm®.Fluxonorm® improved the efficacy of standard therapy, in terms of antioxidant/anti-inflammatory effects, for the management of lower urinary tract symptoms (LUTS). This could be related, albeit partially, to the blunting effect of this compound on PGE2 production.

Mild Traumatic Brain Injury (MTBI) in anticoagulated patients is a common challenge for Emergency Department (ED) Physicians. Anticoagulation is considered a risk factor for developing delayed intracranial hemorrhage (ICH) after MTBI. The occurrence of this event in patients on Vitamin K Antagonists (VKA) or Direct Oral Anticoagulants (DOACs) remains unclear. Primary endpoint: to analyze the role of anticoagulants as risk factors for developing delayed ICH after MTBI and evaluate the indications to repeat a cranial computed tomography (CT) after a period of observation. Secondary endpoint: to assess the difference in the prevalence rate of delayed ICH in patients on VKA versus those on DOACs.We evaluated all consecutive patients admitted to our ED for MTBI, which had a control CT for late ICH after a negative CT at admission. We used a propensity score match (PSM) on factors affecting the need for oral anticoagulation to adjust the comparison between anticoagulated vs. non-anticoagulated patients for the baseline clinical characteristics.Among 685 patients enrolled, 15 (2.2%) developed ICH at control CT. After PSM, the incidence of ICH, although slightly higher, was not statistically different in anticoagulated patients vs. non-anticoagulated (2.3% vs. 0.6%, p=0.371). Among the 111 patients on VKA, 5 (4.5%) had a late ICH, compared to 4 out of 99 (4.0%) on DOACs; the difference was not statistically significant (p=0.868).The risk of developing delayed ICH after MTBI in patients on anticoagulation therapy is low. After correction for baseline covariates, the risk does not appear higher compared to non-anticoagulated patients. Thus, a routine control CT scan seems advisable only for patients presenting a clinical deterioration. Larger, prospective trials are required to clarify the safety profile of DOACs vs. VKA in MTBI.

This chapter describes the technical aspects of abdominoperineal resection and Miles resection (extralevator) including patient positioning, instrumentation, type of incision, and approach and steps of dissection, resection, and reconstruction. The authors also offer pearls and pitfalls.

This chapter describes the technical aspects of open low anterior resection with diverting loop ileostomy, including patient positioning, instrumentation, type of incision, and approach. Steps of dissection and resection and steps of reconstruction are similar to the laparoscopic technique and discussion in Chap. 16.

This chapter describes the technical aspects of transanal total mesorectal excision including patient positioning, instrumentation, type of incision and port locations, approach, and dissection, resection, and reconstruction steps. The authors also offer pearls and pitfalls.

This chapter describes the technical aspects of loop ileostomy creation and closure including patient positioning, instrumentation, type of incision, and approach and steps of the procedures. The authors also offer pearls and pitfalls.

This chapter discusses the technical aspects of open sigmoid resection including instrumentation, patient positioning, and type of incision and abdominal entry approach. Dissection, resection, and reconstruction are described in Chap. 13.

This chapter describes the technical aspects of open right hemicolectomy, including patient positioning, instrumentation, type of incision, and approach. Steps of dissection and resection and steps of reconstruction are discussed in Chap. 15.

This chapter discusses the technical aspects of laparoscopic sigmoid resection, by both a lateral-to-medial approach and a medial-to-lateral approach. Technical aspects include instrumentation, patient positioning/operating room setup, type of incision and port placement, dissection approach, and resection and reconstruction steps. The authors also offer pearls and pitfalls.

This chapter describes the technical aspects of lateral internal sphincterotomy for fissure-in-ano including patient positioning, instrumentation, type of incision, and steps of the procedure. The authors also offer pearls and pitfalls.

A “malignant” polyp is defined as the presence of adenocarcinoma that extends beyond the basement membrane. It is important to assess specific characteristics of the polyp in order to decide whether further, more aggressive treatment is needed for adequate removal. Invasive polyps can be pedunculated or sessile. Pedunculated polyps contain a head, neck and stalk whereas sessile polyps are flat. In addition to the morphology of the polyp, important histopathological features including grade of differentiation, the presence of lymphovascular invasion, perineural invasion or tumor budding as well as inadequate resection margins (

This chapter describes the technical aspects of perianal abscess incision and drainage including patient positioning, instrumentation, type of incision, and steps of the procedure. The authors also offer pearls and pitfalls.

This chapter describes the technical aspects of laparoscopic right hemicolectomy, including patient positioning, instrumentation, type of incision and port placement, approach (lateral-to-medial and medial-to-lateral), steps of dissection and resection, and steps of reconstruction. In addition, the authors provide pearls and pitfalls.

This chapter describes the technical aspects of laparoscopic proctocolectomy with ileal pouch-anal anastomosis including patient positioning, instrumentation, trocar placement, operating room setup, type of incision, approach, and dissection, resection, and reconstruction steps. The authors also offer pearls and pitfalls.

This chapter describes the technical aspects of open Hartmann’s procedure, including patient positioning, instrumentation, type of incision, approach, steps of dissection and resection, and steps of reconstruction. In addition, the authors provide pearls and pitfalls.

This chapter describes the technical aspects of open proctocolectomy with ileal pouch-anal anastomosis including patient positioning, instrumentation, type of incision, and approach. Steps of dissection and resection and steps of reconstruction are similar to the laparoscopic technique and discussion in Chap. 18.

Anastomotic leak (AL) after low anterior resection (LAR) is associated with increased morbidity, mortality, cost and cancer recurrence rates. The aim of this study was to evaluate the impact of fluorescence angiography (FA) on AL following LAR for low rectal cancer. This is a single surgeon retrospective cohort study with a historical, consecutively sampled case matched control group. The institution’s prospectively maintained institutional review board (IRB)-approved database was queried for all patients who underwent a laparoscopic LAR for rectal neoplasia with a colorectal or coloanal anastomosis

This paper discusses Mauro Bonazzi’s excellent book on Middle Platonism, its relationship with Hellenistic philosophy and Plotinus. The overall evaluation is extremely positive: the book detects fundamental aspects of Middle Platonism by focusing on its (often disregarded) epistemology and carefully analysing puzzling—and telling—stages of its philosophical development.

We compute the topological entanglement entropy for a large set of lattice models in $d$-dimensions. It is well known that many such quantum systems can be constructed out of lattice gauge models. For dimensionality higher than two, there are generalizations going beyond gauge theories, which are called higher gauge theories and rely on higher-order generalizations of groups. Our main concern is a large class of $d$-dimensional quantum systems derived from Abelian higher gauge theories. In this paper, we derive a general formula for the bipartition entanglement entropy for this class of models, and from it we extract both the area law and the sub-leading terms, which explicitly depend on the topology of the entangling surface. We show that the entanglement entropy $S_A$ in a sub-region $A$ is proportional to $\log(GSD_{\tilde{A}})$, where \(GSD_{\tilde{A}}\) is the ground state degeneracy of a particular restriction of the full model to \(A\). The quantity $GSD_{\tilde{A}}$ can be further divided into a contribution that scales with the size of the boundary $\partial A$ and a term which depends on the topology of $\partial A$. There is also a topological contribution coming from $A$ itself, that may be non-zero when $A$ has a non-trivial homology. We present some examples and discuss how the topology of $A$ affects the topological entropy. Our formalism allows us to do most of the calculation for arbitrary dimension $d$. The result is in agreement with entanglement calculations for known topological models., 44 pages, 6 figures

We study models with fracton-like order based on $\mathbb{Z}_2$ lattice gauge theories with subsystem symmetries in $d=2$ and $d=3$ spatial dimensions. The $3d$ model reduces to the $3$-dimensional Toric Code when subsystem symmetry is broken, giving an example of a subsystem symmetry enriched topological phase (SSET). Although not topologically protected, its ground state degeneracy has as leading contribution a term which grows exponentially with the square of the linear size of the system. Also, there are completely mobile gauge charges living along with immobile fractons. Our method shows that fracton-like phases are also present in more usual lattice gauge theories. We calculate the entanglement entropy $S_A$ of these models in a sub-region $A$ of the lattice and show that it is equal to the logarithm of the ground state degeneracy of a particular restriction of the full model to $A$., Comment: 16 pages, 10 figures. Version to appear in PRB

The "mediastinal syndrome" is an oncological urgency but, in some situations as in the case report described below, it can present itself in a subtle and inextricable way with symptoms and signs that, if singularly evaluated, can be nonspecific. In particular, we report the case of facial edema and a rash that, developing in an unusual and progressive way during about 2 months, concealed a voluminous mediastinal formation due to the localization of non-Hodgkin B-cell lymphoma that caused a "superior caval vein syndrome".

How can the knowledge of probiotics and their mechanisms of action be translated into clinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in microbiota composition have been observed in patients who were developing acute diverticulitis, with a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli and Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence of anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious cycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut microbiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular dysfunction, thus favoring abdominal symptoms’ development. The possible role of dysbiosis and mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation from the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like receptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral tissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute diverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes clearer. For this review, articles were identified using the electronic PubMed database through a comprehensive search conducted by combining key terms such as “gut microbiota”, “probiotics and gut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics mechanism of action”. However, the amount of data present on this matter is not sufficient to draw robust conclusions on the efficacy of probiotics for symptoms’ management in diverticular disease.

Plutarch’s De Iside et Osiride has been studied from several points of view. In this paper I set out to demonstrate first of all that the core of the work fully rests on Plato’s philosophy, since according to Plutarch’s methodological assumptions Plato had grasped the truth hidden behind the Isis myth. Then I shall focus on the argumentative structure of the work, highlighting its twofold nature. The De Iside is entirely structured as a philosophical zetema, whose apex rests on Plato’s doctrine. Finally, I will argue that the ‘Platonic section’ (45-64) is framed in a different way, its aim being to progressively deepen Plutarch’s underlying assumption: the notion of the dualistic nature of being.

Creation of a coloanal anastomosis is a technically challenging procedure with potential morbidity. Knowledge of the literature is important as surgeons who perform proctectomy should combine clinical judgment with evidence-based literature on coloanal anastomoses to determine the most appropriate anastomotic approach for each patient. This chapter will outline the different sphincter-preserving coloanal anastomotic techniques as well as discuss stapled and hand-sewn anastomoses. Moreover, it will review the different outcomes such as postoperative morbidity and bowel function for each technique by comparing them to see which approach is best.

Scholars remain far from reaching agreement about the structure of Middle Platonist commentaries on Plato's dialogues: some take them to have been running line-by-line commentaries, while others believe that Middle Platonist commentaries were mainly specialist works. In this paper I propose a fresh and comprehensive analysis of extant sources in order to show that both views, while shedding light on important features of this literary genre in Middle Platonism, should be supplemented in order to draw a more complex picture. Extant sources suggest that the Middle Platonist commentaries were characterized by a set of features which shaped a specific conception of the literary genre: they were lemmatic and followed the development of a dialogue in its progression, yet at the same time they applied a thematic focus and hence admitted a substantial degree of selectivity.