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Hemorrhoids are the most common proctological disorder with a high incidence per test and prevalence up to 39% in general population. This condition often leads to disruption in an individuals's personnel and working life.

To evaluate the long-term clinical and echocardiographic performance of mitral valve repair with the edge-to-edge technique.In-hospital results, actuarial freedom from all-cause mortality, cumulative incidence of cardiovascular mortality, recurrent mitral regurgitation ≥3+ and reoperation on the mitral valve were assessed in 180 consecutive patients undergoing mitral repair with the edge-to-edge technique for degenerative or functional regurgitation. Exercise echocardiography was performed in 24 patients to assess valve hemodynamics in the long-term follow-up.The edge-to-edge repair was applied as a first strategy in 157 patients (87.2%) or as a bail-out procedure in 23 patients (12.8%). At discharge, mitral regurgitation grade was absent in 152 patients (84.4%) and trivial in 28 patients (15.6%). Mean gradient was 2.8 ± 0.6 mmHg and effective orifice area was 2.9 ± 0.4 cm2. After a median follow-up of 6.5 (interquartile range 3.5-10.2) years, 93.6% patients were in NYHA functional class I-II. Actuarial survival at 15 years was 89.2 ± 2.7%, whereas the cumulative incidence of cardiovascular mortality was 7.0%, of recurrent mitral regurgitation ≥3+ 12.6% and of reoperation on the mitral valve 3.2%. Exercise stress echocardiography revealed a significant increase of functional area (3.1 ± 0.3 vs 4.0 ± 0.6 cm2, p0.001) and mean gradients (2.7 ± 0.4 vs 4.6 ± 1.2 mmHg, p0.001).The edge-to-edge technique effectively corrects degenerative and functional mitral regurgitation and represents a valid bail-out procedure in case other approaches failed to achieve adequate intraoperative valve competence. Long-term results are sustained up to 15 years, with significant improvement in functional status. Despite an altered geometry, the occurrence of iatrogenic mitral stenosis is avoided even at high workload conditions.

Background and aim of the work: Bullying involves a significant percentage of school-age children. According to the latest available surveillance data, in Sicily, the estimated prevalence among 11-15 years old children is 14%. This study aimed to estimate a prevalence of the bullying phenomenon, observed by teachers, in a sample of secondary schools of Palermo, Sicily. Moreover, after the conduction of preventive interventions among teachers, aimed to evaluate any modification in bullying prevalence. Methods: A cluster sampling selection according to socio-economic level of the school neighborhood was carried out. Two anonymous online questionnaires, pre and post-intervention, were administered to the 63 teaching staff, belonging to second and third year classes of ten secondary schools enrolled. Preventive interventions were conducted among teachers by experienced researchers. Results: Prevalence of bullying reported decreased significantly from 44.4% to 19.0% (p-value 0.001), comparing pre and post-intervention questionnaires. A reduction in the prevalence of verbal and physical bullying and a concomitant slight increase of indirect bullying were also observed. All the characteristics, reported by the teaching staff, for describing bullies, victims and observers of bullying have been categorized under three different content domains (affective-relational discomfort, sociocultural context, and character/natural disposition). Conclusions: The present study estimated the prevalence and the characteristics of bullying phenomenon in a sample of secondary schools of Palermo, evaluating the reduction of bullying episodes among students, after a preventive interventions conducted among teaching staff. Data obtained confirmed the effectiveness of this approach and suggested an extension of the project at Regional Level.

The aim of the paper is to describe the results of the application of a methodology based both on the use of time series analyses and of geospatial analyses of monthly climatic data (rainfall, wet days, rainfall intensity, and temperature), annual maximum of short-duration rainfall (from 1 hour to 5 days), and historical modification of land use in order to characterise the effects of these variables on the occurrence of landslide events. The methodology was applied in the Subappennino Dauno area, located on the eastern margin of the Southern Apennines thrust belt (Southern Italy). Despite the decreasing trend of rainfall and rainfall intensity and the increasing trend of temperatures and wet days, there is an increasing trend of landslide occurrence, highlighting the negative effect of anthropogenic modifications and the mismanagement of landslide-prone areas. This hypothesis was confirmed by comparing the distribution of landslides with the land use variations data (especially urban areas and wooded areas) collected from 1930 to 2006.

Two uniqueness theorems for an isothermal mixture of two miscible fluids are proved. The mixture F is incompressible in a generalized sense and able of exerting Korteweg stresses.

The marginal zone (MZ) of the spleen contains an innate-like subset of B cells that mount rapid protective antibody responses to polysaccharides and lipids from bloodborne viruses and bacteria. These antigens activate MZ B cells by engaging somatically recombined B cell receptors (BCRs) and germline-encoded patternrecognition receptors, including Toll-like receptors (TLRs). MZ B cells receive additional co-stimulatory signals from a proliferation-inducing ligand (APRIL) and B cellstimulating factor of the TNF family (BAFF), two tumor necrosis factor (TNF)-related cytokines released mainly by macrophages, dendritic cells and neutrophils in response to microbes. BAFF and APRIL stimulate MZ B cells through a poorly characterized receptor called transmembrane activator and CAML interactor (TACI). Here we show that TACI induces antibody production and class switching by activating the kinase mammalian target of rapamycin (mTOR) through MyD88, an adaptor protein usually associated with TLRs. The discovery of this rapamycin-sensitive signalling pathway may facilitate the development of novel strategies for the modulation of protective or pathogenic antibody responses emanating from MZ B cells., La zona marginal (ZM) de la melsa conté un subgrup de cèl∙lules B de tipus innat que organitzen de forma ràpida respostes d’anticossos protectors contra polisacàrids i lípids de virus i bacteris transmesos per la sang. Aquests antígens activen les cèl∙lules B de la ZM en interaccionar amb receptors de les cèl・lules B (BCR) que han patit recombinació somàtica i receptors de reconeixement de patrons, incloent els receptors de tipus Toll (TLR). Les cèl・lules B de la ZM reben senyals co-estimuladores addicionals del lligand inductor de proliferació (APRIL) i el factor estimulant de cèl・lules B de la família del TNF (BAFF), dos citocines relacionades amb el factor de necrosis tumoral (TNF) alliberades principalment per macròfags, cèl∙lules dendrítiques i neutròfils en desposta a microbis. BAFF i APRIL estimulen les cèl∙lules B de la ZM mitjançant un receptor poc caracteritzat anomenat activador de transmembrana i interactor de CAML (TACI). En aquest estudi demostrem que TACI indueix producció d’anticossos i canvi de classe de la cadena pesada de les immunoglobulines activant la quinasa diana de la rapamicina dels mamífers (mTOR) mitjançant MyD88, una proteïna adaptadora habitualment associada amb els TLRs. El descobriment d’aquesta via de senyalització sensible a la ramapicina podria facilitar el desenvolupament de noves estratègies per la modulació de les respostes protectores o patogèniques dels anticossos produïts per les cèl・lules B de la ZM.

International audience; Objective-Our aim was to analyze the regulation of CC Chemokine ligand 20 (CCL20) by LDL in human vascular smooth muscle cells (VSMC). Methods and Results-In asymptomatic subjects, circulating CCL20 levels were higher in patients with hypercholesterolemia (18.5Ϯ3.2 versus 9.1Ϯ1.3 pg/mL; PϽ0.01). LDL induced the expression of CCL20 in VSMC in a dose-and time-dependent manner. Increased levels of CCL20 secreted by LDL-treated VSMC significantly induced human lymphocyte migration, an effect reduced by CCL20 silencing. The upregulation of CCL20 by LDL was dependent on the activation of kinase signaling pathways and NF-B. By site-directed mutagenesis, electrophoretic mobility shift assay, and chromatin immunoprecipitation, we identified a NF-B site (Ϫ80/Ϫ71) in CCL20 promoter critical for LDL responsiveness. Lysophosphatidic acid mimicked the upregulation of CCL20 induced by LDL, and minimal oxidation of LDL increased the ability of LDL to induce CCL20 through a mechanism that involves lysophosphatidic acid receptors. CCL20 was overexpressed in atherosclerotic lesions from coronary artery patients, colocalizing with VSMC. CCL20 was detected in conditioned media from healthy human aorta and its levels were significantly higher in secretomes from carotid endarterectomy specimens. Conclusion-This study identifies CCL20 in atherosclerotic lesions and recognizes this chemokine as a mediator highly sensitive to the inflammatory response elicited by LDL.

Background: Fast-track program has been applied in several surgical fields. However, currently many surgical patients are elderly over 70 years of age, and discussion about the application of such protocols for elderly patients is inadequate. Materials and methods: The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients. A total of 76 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program (n = 40) or the conventional perioperative care protocol (control group, n = 36). The fast track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. Results: The length of time to regain bowel function, including the passage of flatus [32 (24–40) h vs 42 (32–52) h], and to start a liquid diet (13 [10–16] h v/s 43 [36–50] h) were significantly shorter in patients receiving the fast track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care [6 (5–7) days v/s 9.5 (7–12) days]. A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0% v/s 18%). Conclusion: Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years. The fast-track recovery program resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol.

The final value value problem for the Brinkman–Forchheimer–Kelvin–Voigt equations is analysed for quadratic and cubic types of Forchheimer nonlinearity. The main term in the Forchheimer equations is allowed to be fully anisotropic. It is shown that the solution depends continuously on the final data provided the solution satisfies an a priori bound in $$L^3.$$ L 3 . The technique employed avoids the use of a specialist method for an improperly posed problem such as logarithmic convexity.

This article reports the study protocol of a nationwide multicentric study in seven Italian regions aimed at assessing the effectiveness of a digitally supported approach for the early screening of frailty risk factors in community-dwelling older adults. SUNFRAIL+ is a prospective observational cohort study aimed at carrying out a multidimensional assessment of community-dwelling older adults through an IT platform, which allows to connect the items of the SUNFRAIL frailty assessment tool with a cascading multidimensional in-depth assessment of the bio–psycho–social domains of frailty. Seven centers in seven Italian regions will administer the SUNFRAIL questionnaire to 100 older adults. According to the answers provided by older adults, they will be subjected to one or more validated in-depth scale tests in order to perform further diagnostic or dimensional evaluations. The study aims to contribute to the implementation and validation of a multiprofessional and multistakeholder service model for the screening of frailty in community-dwelling older adult population.

Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.

BACKGROUND: An anal fissure is a small laceration in the tissue (mucosa) that lines the anus. Anal fissures can cause pain and bleeding with bowel movements. Anal fissures can be attributed to constipation or repeated straining: a hard-fecal bolus cut the mucosa of anal canal that is relatively soft at sphincter level. Management and treatment of the disease are controversial. Many studies recommend conservative and medical treatment modalities as the initial options, since they are noninvasive and do not have risks of sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. LigaSure™ (Medtronic, Dublin, Ireland) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. We have applied the use of this device to a group of patients complaining about chronic anal fissure in order to verify if there is any advantage in performing it, compared to traditional technique (blade, scissors, electrocautery). METHODS: A group of 436 patients were treated in our institution as proctological day-surgery patients from January 2016 to January 2021. Three hundred fifty-one underwent lateral internal sphincterotomy. As comparative group (CG), we considered the results of the systematic review of Boland et al. whose sphincterotomy group consisted of 349 patients (45% of 775patients) from 9 studies included. RESULTS: Of 351 patients who underwent to LIS pile excision, 322 healed within 9 weeks from treatment (91.73%) compared to 332 (95.1%) of the CG. Sixty-three out 85 (74.1%) of patients with AF + other treatments. In the LIS group the overall recurrence over a period of 6 months for all patients was 17 patients (4.84%) compared with 6.9% (24/349) over a period of 2-6 months follow-up. CONCLUSIONS: The use of LigaSure™ Small Jaw (SJ) (Medtronic) was never reported for anal fissures in literature. LigaSure™ SJ (Medtronic) is a bipolar device which allows to perform the procedure in a reduced time and in a safer way even if differences with traditional techniques are not significant. The costs of the operation are higher in LigaSure group. Literature up today does not report any article about the use of LigaSure™ (Medtronic) for treatment of anal fissures. It could be controversial for the cost of the device but is safer and quicker compared to traditional knife or scissors.

Background : Irritable bowel syndrome (IBS) is a common multifactorial condition that affects the large intestine and is characterized by chronic and relapsing abdominal pain and altered bowel habit. IBS is due to a combination of genetic, environmental and dietary factors. It's usually a lifelong problem very frustrating to live with and can have a big impact on quality of life, as single-agent therapy ra: Objective to analyze the approaches and solutions that address the social and health unmet needs of patients with IBS. Design: A quantitative-qualitative approach was adopted in the current study to identify and specify key digital solution and high impact user scenarios applied to IBS patients, through an adaptation of the “Blueprint on Digital Transformation in Health and Care in an Ageing Society” persona methodology. Settings: Digital health solutions bring the potential of supporting health interventions through mobile apps, wearable devices, telemedicine. Patients: A Survey was administered to a group of patients in an anonymous form, and no need for Medical Ethical Committee approval was identified. Interventions. The theoretical elaboration IBS personas was developed through an interdisciplinary Focus Group, which also mapped the pathway for the patient's management. Main Outcome : Three main needs were identified to be met to improve IBS patient’s lifestyle: access to psychological support, mHealth solutions supporting diet and adapted physical activity, and home-based digital health support. mHealth intervention has been identified for diet adherence, physical exercise and psychological well-being. The process has been mapped and adapted to integrate the new solutions into the care pathway. Limitation: Further research is needed to evaluate how mHealth services enable IBS patients to manage their conditions and improve their quality of life. Conclusion The person-centered approach was implemented through a multidisciplinary Focus group that enabled the identification of the need for a mHealth intervention

Thermal convection of a fluid filling an anisotropic porous medium, uniformly rotating about a vertical axis, with local thermal non equilibrium, is studied. The linear and nonlinear stability analysis are performed. In particular the coincidence between linear instability and nonlinear (global) stability thresholds is proved.

Although there is a strong evidence of prevalence of condylomata in the HIV-positive population, literature on HIV prevalence in HIV-unscreened population diagnosed with condylomata is still unconclusive. Our aim is to review literature about HIV screening and diagnosis of anal condylomata in order to evaluate medical aspects, ethical and legal issues concerning the management of this disease. We undertook an online search on Pubmed for the keywords "HIV", "screening" and "anal condylomata" and 23 papers were analysed, 2 being randomized controlled trial, 11 comparative studies and 10 reviews. A total of 1270 patients were reviewed. All authors strongly recommend HIV testing in patients with clinical evidence of anal condylomata. In undeveloped countries with high prevalence of HIV, a proctological evaluation could be a could represent an unexpected therapeutic option for HIV infected male patients to prevent anal cancer. Clinical trials and prospective studies are necessary to validate this interesting hypothesis. KEY WORDS: Anal condylomatosis, HIV screening, Papilloma virus.

We obtain the linear instability and nonlinear stability thresholds for a problem of thermal convection in a rotating bidispersive porous medium with a single temperature. We show that the linear instability threshold is the same as the nonlinear stability one. This means that the linear theory is capturing completely the physics of the onset of thermal convection.

The instability of a vertical fluid motion (throughflow) in a binary mixture saturating a horizontal porous layer, uniformly heated from below, uniformly salted from below by one salt and permeated by an imposed uniform magnetic field H , normal to the layer, is analyzed. By employing the order-1 Galerkin weighted residuals method, the critical Rayleigh numbers for the onset of steady or oscillatory instability, have been determined.

Faecal incontinence is a very debilitating problem. Many techniques have been proposed to treat this condition, with controversial results. Autologous transplant of fat tissue is an established procedure used for the repair of tissue damage, and recent studies revealed the potentiality of tissue regeneration by human adipose-derived stem cells. We treated this condition with the injection, in the intersphincteric anal groove, of lipoaspirate processed by an innovative technology (Lipogems). The aim of the study was to evaluate the efficacy of Lipogems injection for the treatment of faecal incontinence. In February 2014 we treated 3 patients with faecal incontinence. The surgical procedure required three phases: lipoaspiration, processing of lipoaspirate with the Lipogems system, and injection of the obtained product in the intersphincteric anal groove. An accurate proctological examination followed at 1 week, 1 month and 6 months after treatment. Each patient reported an improved Wexner incontinence score at 1 month after the procedure. We observed an increase of resting pressure (by at least 10 mm Hg) and thickness of the internal anal sphincter respectively at ano-rectal manometry and by ultrasound (US) evaluation at the sixth month of follow-up. Our preliminary results are encouraging, but multicentric studies with longer follow-up are needed to validate this novel technique for treatment of faecal incontinence.

We obtain the linear instability and nonlinear stability thresholds for a prob- lem of thermal convection in a bidispersive porous medium with a single temperature. It is important to note that we show that the linear instability threshold is the same as the nonlinear stability one. This means that the linear theory is capturing completely the physics of the onset of thermal con- vection. This result contrasts with the general theory of thermal convection in a bidispersive porous material where the temperatures in the macropores and micropores are allowed be different. In that case the coincidence of the stability boundaries has not been proved.

The gastrointestinal tract is the predominant site of extranodal non-Hodgkin lymphomas. Multiple lynphomatous polyposis is a type of appearance of mantle cell lymphoma. It is characterized by multiple polypoid lesions involving long gastrointestinal tracts and it accounts for only approximately 1-2% of non-Hodgkin lymphomas. A 78 years old patient was admitted to our Department of General Surgery with rectal bleeding, abdominal pain and weight loss. Multiple lymphomatous polyposis was detected by endoscopy. Endoscopic biopsies confirmed the diagnosis of mantle cell lymphoma. The patient was transferred to the Department of Hematology for cycles of chemotherapy.