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Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

Background: In the absence of head-to-head trials, there is an unmeet need to better understand the relative effectiveness of different biologics in inflammatory bowel disease (IBD). The Sicilian Network for Inflammatory Bowel Disease (SN-IBD) is a group composed by all Sicilian centres which continuously enter in a web-based software all clinical data of IBD patients treated with biologics. Methods: Data of all incident Crohn’s disease (CD) patients treated with infliximab (IFX) and adalimumab (ADA) from January 2013 to April 2017 were extracted from the cohort of SN-IBD. Patients were divided in biologic-naïve and non-naïve, and the two groups were analysed singularly. We used a one-to-two propensity score matching (1 IFX: 2 ADA) accounting for the main baseline characteristics in naïve patients, and a one-to-one propensity score matching (1 IFX: 1 ADA) in non-naïve. Results: Seven hundred and forty-seven naïve and 188 non-naïve patients were included. After propensity score matching, 453 naïve (IFX: 151; ADA: 302) and 100 non-naïve patients (total treatments: 122; IFX: 61; ADA: 61) were analysed. Among naïve patients, the rates of response/remission at 12 weeks for IFX and ADA were 80.1% and 81.1%,, respectively (adjusted OR 0.97, p = 0.923); over a median follow-up of 11.8 months, the rates of response/remission for IFX and ADA were 70.2% and 66.2%, respectively, without significant differences (adjusted OR 1.14, p = 0.401). Among non-naïve patients, the rates of response/remission at 12 weeks for IFX and ADA were 68.9% and 60.7%, respectively (adjusted OR 1.54, p = 0.320); over a median follow-up of 8.9 months, the rates of response/remission for IFX and ADA were 57.4% and 54.1%, respectively, without significant differences (adjusted OR 1.96, p = 0.297). Cox regression analysis showed no differences in risk of treatment failure between ADA and IFX, neither in naïve (adjusted HR 1.23, p = 0.381) nor in non-naïve patients (adjusted HR 1.23, p = 0.488). At multivariable conditional logistic regression analysis of naïve CD patients, upper GI involvement (OR 0.18, p = 0.038), previous surgery (OR 0.24, p = 0.003), and older age (OR 0.97, p = 0.036) were associated with lower clinical benefit at 12 weeks, while previous surgery was the only independent predictor of treatment failure at the end of follow-up (HR 2.13, p = 0.03). Mixed effect Cox analysis showed that non-naïve patients experiencing more than one previous line of treatment with biologics have a significant higher risk of treatment failure compared with those previously treated with one biologic only (HR 2.57, p = 0.002) Conclusions: In this large, propensity score matched, real-life, multicentre, cohort study of CD patients, there was no significant difference in the effectiveness of ADA and IFX. Both drugs showed a good efficacy.

Background: The monitoring of appropriateness, costs, and clinical outcomes of biological therapy in inflammatory bowel disease (IBD) is a relevant need. We aimed to evaluate all these issues in Sicily through a web based network of all prescribing centers. Methods: From January 2013, all IBD patients starting a biological agent (incident cases) or already on treatment (prevalent cases) were entered in a web based software. Herein we report data of incident cases about the efficacy of biological therapy after twelve weeks and one year of treatment. Results: From January 2013 to October 2016, 1475 patients were included. Incident cases were 1090. Considering that 16% of patients experienced more than one line of therapy, a total of 1351 treatments were reported. Adalimumab was used in 622 Crohn’s disease (CD) patients and in 83 ulcerative colitis (UC)/unclassified colitis patients. Infliximab was prescribed in 275 CD patients (80 biosimilars) and in 279 UC patients (50 biosimilars). Golimumab was used in 32 UC patients, while vedolizumab in 40 CD patients and in 20 UC patients. In patients with CD, after twelve weeks and one year of therapy, the rates of remission with adalimumab were 43.9% and 60.2%, respectively, and the rates of response 40.9% and 25.8%, while the rates of remission with infliximab originator were 46.2% and 50.0%, and the rates of response 40.9% and 32.9% (biosimilars: remission 31.0% and response 51.7% after 12 weeks; remission 45.5% and response 36.4% after one year). In UC, after twelve weeks and one year of therapy, the rates of remission with adalimumab were 43.3% and 57.1%, respectively, and the rates of response 36.7% and 19.0%; the rates of remission with infliximab originator were 41.6% and 48.4%, and the rates of response 35.6% and 32.3% (biosimilars: remission 30.0% and response 63.3% after 12 weeks; remission 20.0% and response 40.0% after one year); the rate of remission after 12 weeks of therapy with Golimumab was 22.2%, and the rate of response was 33.3%. After twelve weeks of therapy with Vedolizumab, 28.6% of CD patients were in remission and 32.0% had a response, while the rates of remission and response in UC patients were 33.3% and 22.0%, respectively. Multivariable logistic regression analysis showed that age >50 years was independently linked to lower rates of remission/response at 12 weeks in CD patients (OR 0.613, p=0.046). Conclusions: In one of the largest series of IBD patients on biological therapy reported to date, CD patients older than 50 years showed a higher rate of non response at 12 weeks of treatment. Efficacy of biosimilars was overall comparable to that reported for infliximab originator.

Background and aim: The monitoring of appropriateness and costs of biological therapy in Inflammatory bowel disease (IBD) is a relevant need. We aimed to evaluate appropriateness, efficacy and safety of biological therapy in IBD in Sicily through a web based network of prescribing centers. Material and methods: The Sicilian network for the monitoring of biological therapy in IBD is composed by a super Hub coordinator center and five Hub plus ten Spoke centers. From January 2013 all IBD patients starting a biological agent (incident cases) or already on treatment (prevalent cases) were entered in a web based software. Herein we report data on remission and response after twelve weeks of biological therapy, and side effects until the end of follow-up of incident cases. Results: From January 2013 to June 2016, 1475 patients were included. Complete data were available in 1338 cases (983 with Crohn’s disease [CD], 345 with ulcerative colitis [UC], and 10 with unclassified colitis). Incident cases were 956 (673 CD, 274 UC, and 9 unclassified colitis). Considering that 12% of patients experienced more than one line of therapy, a total of 1098 treatments were reported. Adalimumab was used in 543 CD patients, in 69 UC patients, and in 4 with unclassified colitis. Infliximab was prescribed in 221 CD patients (64 biosimilars), in 226 UC patients (41 biosimilars), and in 5 patients with unclassified colitis. Golimumab was prebscribed in 29 UC patients, and in 1 patient with unclassified colitis. After twelve weeks, the rate of response with Adalimumab was 46% and the rate of remission was 38% in CD, while the rate of response with Infliximab originator was 48% and the rate of remission 42% (biosimilars: 37% and 50%, respectively). In UC the rate of response with Adalimumab was 46% and the rate of remission was 38%, the rate of response with Infliximab was 41% and the rate of remission 45% (biosimilars: 25% and 64%, respectively), while the rate of response with Golimumab was 47% and the rate of remission was 27%. Overall, the rate of side effects was 17% (9.2% with Adalimumab, 20% with Infliximab originator, 15% with biosimilars, and 17% with Golimumab). Conclusions: In one of the largest series of IBD patients on biological therapy reported to date, the rates of remission and response after twelve weeks were comparable to data from literature, and similar between the different biologics. Efficacy and safety of biosimilars were analogous to those reported for infliximab originator.

Introduction: The monitoring of appropriateness, costs, and clinical outcomes of biological therapy in inflammatory bowel disease (IBD) is a relevant need. Aims & Methods: We aimed to evaluate all these issues in Sicily through a webbased network of all prescribing centers. The Sicilian Network for Inflammatory Bowel Disease (SN-IBD) is composed by a super Hub coordinator centre and five Hub plus ten Spoke centres. From January 2013, all IBD patients starting a biological agent (incident cases) or already on treatment (prevalent cases) were entered in a web based software. Herein we report data of incident cases about the efficacy of biological therapy after twelve weeks and one year of treatment. As clinical end-point, we set remission (corresponding to a Mayo Partial Score 52 for UC, and to a Harvey-Bradshaw Index 55 for CD), and response (reduction of Harvey-Bradshaw Index

A 58 years healthy old woman was admitted to the Emergency Department (ED) with cardiac arrest due to ventricular fibrillation (VF). Appropriate cardiopulmonary resuscitation (CPR), multiple DC shocks and oro-tracheal intubation (OTI) were effective to induce recovery of spontaneous circulation (ROSC). After ROSC was achieved, the electrocardiogram (ECG) showed an idio-ventricular rhythm with atrioventricular dissociation. A transcutaneous pacing was hence applied and the patient was administered with isoproterenol. Simultaneously, her husband was evaluated in the ED for gastrointestinal symptoms occurred after assumption of home-made "tortelli" (ravioli-like pasta) stuffed with cheese and leaves of a plant which they supposed to be borage two days before admission. Borage, during the non-flowering seasons, can be easily confused with foxglove (Digitalis spp.), and this was the main clue to suspect poisoning. Both patients were given DigiFab®, a sheep antibody fragment with high affinity for digoxin. The woman was then admitted in intensive care unit (ICU), where a rapid clinical improvement occurred, thus allowing discharge in a few days. The husband was instead discharged from the ED after clinical observation and ECG monitoring. In both cases, a significant plasma concentration of digoxin could be measured.

Millennial catchment-mean erosion rates derived from terrestrial cosmogenic nuclides are generally based on the assumption that the lithologies of the parent rock each contain the same proportion of quartz. This is not always true for large catchments, in particular at the edge of mountainous plateaus where quartz-rich basement rocks may adjoin sedimentary or volcano-sedimentary rocks with low quartz content. The western Central Andes is an example of this type of situation. Different quartz contents may be taken into account by weighting the TCN production rates in the catchment. We recall the underlying theory and show that weighting the TCN production rate may also lead to bias in the case of a spatial correlation between erosion rate and lithology. We illustrate the difference between weighted and unweighted erosion rates for seven catchments (16 samples) in southern Peru and northern Chile and show variations up to a factor of 2 between both approaches. In this dataset, calculated erosion rates considering only granitoid outcrops are better correlated with catchment mean slopes than those obtained without taking into account the geological heterogeneity of the drained watershed. This dataset analysis demonstrates that weighting erosion rates by relative proportions of quartz is necessary to evaluate the uncertainties for calculated catchment-mean erosion rates and may reveal the correlation with geomorphic parameters.

La nota riporta alcune considerazioni sul meccanismo di spostamento di una grande e lenta colata attiva. della valle del fiume Basento, in Basilicata. Le principali caratteristiche cinematiche sono: uniformità. di spostamento nelle sezioni trasversali del canale, velocità sensibilmente decrescente da monte verso. valle, modeste variazioni stagionali di velocità. Tra le potenziali cause di spostamento, qui si esamina il. possibile ruolo dell’erosione al piede esercitata dal corso d’acqua con l’ausilio di analisi numeriche 2D. basate su metodi dell’equilibrio limite e agli elementi finiti.

This paper reports some considerations about mechanisms of movement of a large slow earthslide in Southern Italy. The main features of the displacement field are: uniformity in each transversal section, decrease in the downslope direction and only slight seasonal rate variations. Among the possible causes of movements, erosion induced by stream waters at the foot of the landslide seems the most probable one. Movements localized at the foot are clearly shown by geomorphological signs and fully justified by a simple back analysis based on limit equilibrium methods. The influence on the global safety factor by local instability of the foot is analysed by means of a simplified 2D numerical simulation.

Il progetto "Abitare il Museo" opera tre scelte: 1. Qualificazione del MEIS come struttura di ospitalità rendendo possibile l'esperienza attiva delle consuetudini della tradizione ebraica, del suo radicamento in Italia, con la realizzazione di un ostello per lo studio. 2. Conservazione integrale del complesso monumentale storico in cui ha sede,. 3. Innovazione/integrazione attraverso innesti a forte connotazione estetica ispirati all'alfabeto ebraico, ai suoi rapporti culturali e significati simbolici.

An experimental study has been carried out using a new resonant column – torsional shear cell to investigate the small strain behavior of an unsaturated compacted silty sand. The device, recently developed at the Dipartimento di Ingegneria Geotecnica di Napoli (Italy), is fitted for controlled-suction testing using the axis-translation technique. Both optimum and wet of optimum compacted specimens have been tested to analyze the effects of suction and fabric on soil behavior. Shear stiffness measurements have been taken during constant-suction tests. Collected data indicate an S-shaped initial shear stiffness versus suction variation, which can be explained considering the progressive change from a bulk-water regulated soil response to a menisci-water regulated soil response. A model is proposed to account for the observed trend. Results highlight significant effects of suction and fabric on soil behavior.

International audience; The Sayan fault is located at the boundary between the northernmost mountain belt of Central Asia (the Sayan- Baikal ranges) and the Siberian platform. This outstanding 500 km crustal structure defines an obvious and sharp morphotectonics feature easily recognizable on satellite imagery. Inherited from the Palaeozoic orogenes, the Sayan fault has been working as a left-lateral transform fault during the opening of the Baikal Rift in the Cainozoic time. Despite a very low instrumental seismic activity and few historical earthquakes, Holocene morphotectonics features along the fault attests of its activity and its capacity of producing strong earthquakes. The Sayan fault represents therefore a strong hazard for the city of Irkoutsk, which is located 70 km northwards of its south-eastern tip, and where more than one million people are living. In order to quantify the present kinematics of the fault, to estimate its slip rate and the potential magnitude of earthquakes, we carried out a morphotectonics study within its south-eastern part, between the Baikal Lake and the Irkut River (the only part of the fault relatively accessible, while further west the fault stands in a mountainous area covered with dense forest without any easy access). A reconnaissance trip allowed us finding out a small catchment basin cut by the fault and showing a cumulative offset of several tens of meters. We surveyed the site with a total station to produce a Digital Elevation Model, and we collected samples of the offset surface and the trapped sediments for radiocarbon and OSL dating. In progress analyses should allow us to provide a first estimate of the left-lateral slip rate along the Sayan fault.

International audience; The Transbaikal region extends over several hundreds of kilometres east of the Baikal Rift System. It is characterized by a number of sub-parallel Mesozoic grabens or half grabens generally filled with late Jurassic to Early Cretaceous clastic sediments interbedded with coal layers (1). Similar basins occur on an even larger area spanning from the Transbaikal region down to Korea implying a large-scale extensional process affecting most of the Amuria plate during the Mesozoic. In the Transbaikal region, the normal faults controlling the edges of the Mesozoic basins are generally superimposed to Palaeozoic ductile shear zones implying a strong localisation of the extensional deformation on inherited structures. Recent studies, associated to our own fieldwork demonstrated that some of the faults were again activated (2), still as extensional faults, during the Tertiary or Quaternary, and that some of them are presently active. The closure of the Mongol-Okhotsk ocean separating the Siberian plate from the Amurian block during the Mesozoic corresponds to a major event in the growth process of the East Asian continent. The oceanic suture zone is situated on the southern edge of the Transbaikal region and its roughly SW-NE direction is parallel to the basins (3). The timing of the closure of the Mongol-Okhotsk ocean is still highly debated: while sedimentological and tectonic data suggest that the oceanic closure and the following collision occurred in early Middle Jurassic (4), paleomagnetic studies advocate for a Early Cretaceous collision (5). Furthermore, several other questions remain on the localization, the size and the fate of the relief that most probably formed during the collision between the Amuria block and the Siberian craton. In order to answer those questions we used low temperature thermochronology data associated to tectonic, sedimentology and palinology to investigate the evolution of the Transbaikal grabens from Mesozoic to Present. Tectonic and thermochronology data provide evidences of exhumation and erosion along the eastern edge of the Siberian craton during the Middle Jurassic as well as a potential continuum of deformation between the Mesozoic extension and the initiation of the Baikal Rift System (6). Sedimentology and palinology reveals that the sediments deposited in the Transbaikal basin did not registered large-scale compressive deformation during or after their Late Jurassic - Early Cretaceous deposition and that they do not correspond to the dismantling of a strong compressive relief. (1) Tsekhovsky and Leonov, (2007), Lithology and Min. Res., 42, doi:10.1134/S0024490207040037 (2) Lunina and Gladkov, (2009), Geotectonics, doi:10.1134/S0016852109010051 (3) Zorin, (1999), Tectonophysics, 306, pp. 33-56 (4) Ermikov, (1994), Bull. Cent. Rech. Explor. Prod. Elf Aquitaine, 18, pp.123-134 (5) Metelkin et al., (2010), Gondwana Research, doi:10.1016/j.gr.2009.12.008 (6) Jolivet et al., (2009), Tectonics, doi:10.1029/2008TC002404

Unsaturated soils can be often encountered in practical applications. In particular, even though index properties of a soil as construction material are left unchanged, the compaction procedure (moulding water content, compaction energy, etc.) influences the mechanical response of the resulting material, its after compaction degree of saturation (i.e. suction) and, more generally, the earth constructions behaviour (Vinale et al., 1999). This paper tries to contribute to the discussion of the above mentioned aspects of soil behaviour presenting the results of a series of suction controlled triaxial tests performed on an optimum water content and wet of optimum compacted soil. Details on the used apparatus are reported in Rampino et al. (1999). The experimental program was conceived in order to analyse the effects of both suction and fabric on soil behaviour. Overall, it consisted of 23 tests, i.e. isotropic compression, constant mean net stress (p-ua) shear and “standard” shear tests, all carried out under drained conditions and constant suction. The investigated suction levels were 0, 100, 200, 300 kPa for the optimum compacted soil and 0, 100, 200 kPa for the wet compacted material. The optimum and the wet compacted specimens exhibited very different behaviour in all the stages of the tests. For example, during the equalisation stages, the optimum material swelled and absorbed water, while the wet soil shrunk and expelled water. This behaviour is explained by the measurements of the after compaction suction (ua-uw)o. Using the Imperial College tensiometer (ua-uw)o was measured as high as 800 kPa for the optimum material (then causing wetting during equalisation) and as low as 60 kPa for the wet specimens (then causing drying during equalisation) – a relevant effect of moulding procedure. The results of the isotropic compression tests highlight a strong effect of suction on soil compressibility. In particular, the compressibility index decreases about 25% from 0 to 200 kPa of suction. The greatest amount of this effects occurs in a limited suction range (0-100 kPa) while tends to a threshold value for (ua-uw) greater than 200 kPa. Comparing experimental findings on the optimum and the wet specimens, it is observed that an increase in moulding water content induces a severe increase in compressibility. In addiction, data indicate that both the shape and the position of the after compaction loading-collapse loci (LC) are largely affected by moulding water content. Thus, soil susceptibility to collapse strongly depends on preparation water content. The data of shear tests show that suction significantly affects large strain shear stiffness and resistance. For instance, in the range 0-200 kPa of suction, the strengthening with (ua-uw) is expressed by an apparent cohesion varying from 0 to 200 kPa for the optimum and from 0 to 150 kPa for the wet compacted soils. The results seems to be well grouped for suction levels and can be interpreted by straight fitting lines having the same M coefficient in the q:(p-ua) plane. The effect of moving from the optimum to the wet compaction water content is then a decrease in stiffness and in apparent cohesion, as well as a reduction of the size of the after compaction yield surface. The large series of experimental results obtained on Metramo silty sand can be satisfactorily modelled by the modern theories for unsaturated soils (Alonso 1990, Wheeler & Sivakumar 1995), if it is assumed that the different preparation procedures yield to different soils. The influence of suction and moulding water content on the observed behaviour clearly emerged in all the tests phases and highlights the need of carefully considering these two variables in handling engineering problems involving compacted soils as construction materials.

The dating of alluvial landforms by cosmogenic nuclides requires distinguishing the pre-deposition inheritance from the post-deposition history of the clasts in the studied marker. Moreover, estimating catchment-scale erosion rates from the concentrations of cosmogenic nuclides in active alluvia requires a good knowledge of the local/regional relationships between rock exhumation and transport through space and time. This is still poorly known for timescales of tens of thousand years. In order to document the evolution of clast exhumation and transport rates through time, we analyze in situ Be-10 concentrations in boulders and cobbles from hillslopes to outlet of an arid mountainous catchment located in Gobi-Altay, Mongolia, strongly affected by global climatic changes during the Pleistocene-Holocene period. Samples were collected on bedrock, abandoned alluvial deposits, active colluvia and alluvia. Our results show a large Be-10 scattering in the active river bed, consistent with a low and discontinuous catchment erosion rate dominated by mass wasting and fluvial incision. On the contrary, pre-exposure signal within abandoned terraces is much more homogeneous, consistent with climatic pulses responsible of strong erosional events on hillslopes and rapid fluvial transport. These results show that exhumation/transport processes at the catchment scale vary in style and intensity through time as a consequence of climatic oscillations. The occurrence of abrupt climatic changes during short periods of time recorded by Be-10 concentrations in abandoned alluvia raise questions about the temporal applicability of catchment erosion rates derived from cosmogenic nuclide concentrations measured in sediments of active rivers. On the other hand, strong and short erosion events limit and homogenize the pre-exposure Be-10 signal in associated deposits like debris-flows, making them particularly suitable markers for dating in active tectonic and paleoclimatic studies.

Report on the II International Conference on Unsaturated Soil held in Beijing (China) on August 27 – 31, 1998

International audience; We studied the patterns, rates and evolution of fluvial terraces and fault system during the building process of an intracontinental transpressional mountain in the Gobi-Altay (Mongolia). By analyzing incisions and offsets of fluvial terraces and alluvial fans, we show that the massif has grown by outward migration of thrust faults through time. On the northern flank, the present bounding thrust fault began its activity ~600 ka ago, while a more internal sub-parallel fault was still active until ~200-100 ka. Vertical offset of an alluvial fan abandoned ~100 ka ago allows an estimate of 0.1 mm/yr Upper Pleistocene - Holocene uplift rate. The morphology of the catchment-piedmont system strongly suggests a periodical formation of the alluvial surfaces, controlled by the climatic pulses, at the beginning of the wet interglacial periods. The abandonment of the alluvial terraces lags by several thousand years the abandonment of the alluvial fans, showing a diachronous incision propagating upstream. The incision rate deduced from the different elevations of straths exceeds of one order of magnitude the rock uplift rate. This excess is mostly due to ongoing drainage network growth at the core of the massif, and incision due to alluvial apron entrenchment near the outlet. This implies that fluvial response is mainly controlled by drainage growth, interaction with piedmont and cyclic climatic variations, rather than by rock uplift.

National audience