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The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Magnetic resonance elastography (MRE) is an imaging technique that combines low-frequency mechanical vibrations with magnetic resonance imaging to create visual maps and quantify liver parenchyma stiffness. As in recent years, diffuse liver diseases have become highly prevalent worldwide and could lead to a chronic condition with different stages of fibrosis. There is a strong necessity for a non-invasive, highly accurate, and standardised quantitative assessment to evaluate and manage patients with different stages of fibrosis from diagnosis to follow-up, as the actual reference standard for the diagnosis and staging of liver fibrosis is biopsy, an invasive method with possible peri-procedural complications and sampling errors. MRE could quantitatively evaluate liver stiffness, as it is a rapid and repeatable method with high specificity and sensitivity. MRE is based on the propagation of mechanical shear waves through the liver tissue that are directly proportional to the organ's stiffness, expressed in kilopascals (kPa). To obtain a valid assessment of the real hepatic stiffness values, it is mandatory to obtain a high-quality examination. To understand the pearls and pitfalls of MRE, in this review, we describe our experience after one year of performing MRE from indications and patient preparation to acquisition, quality control, and image analysis.

The aim of this study was to compare CT radiomics and morphological features when assessing benign lymph nodes (LNs) in colon cancer (CC). This retrospective study included 100 CC patients (test cohort) who underwent a preoperative CT examination and were diagnosed as pN0 after surgery. Regional LNs were scored with a morphological Likert scale (NODE-SCORE) and divided into two groups: low likelihood (LLM: 0-2 points) and high likelihood (HLM: 3-7 points) of malignancy. The T -test and the Mann-Whitney test were used to compare 107 radiomic features extracted from the two groups. Radiomic features were also extracted from primary lesions (PLs), and the receiver operating characteristic (ROC) was used to test a LN/PL ratio when assessing the LN's status identified with radiomics and with the NODE-SCORE. An amount of 337 LNs were divided into 167 with LLM and 170 with HLM. Radiomics showed 15/107 features, with a significant difference ( p < 0.02) between the two groups. The comparison of selected features between 81 PLs and the corresponding LNs showed all significant differences ( p < 0.0001). According to the LN/PL ratio, the selected features recognized a higher number of LNs than the NODE-SCORE ( p < 0.001). On validation of the cohort of 20 patients (10 pN0, 10 pN2), significant ROC curves were obtained for LN/PL busyness (AUC = 0.91; 0.69-0.99; 95% C.I.; and p < 0.001) and for LN/PL dependence entropy (AUC = 0.76; 0.52-0.92; 95% C.I.; and p = 0.03). The radiomics ratio between CC and LNs is more accurate for noninvasively discriminating benign LNs compared to CT morphological features.

Introduction: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature., Methods: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology., Conclusions: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Diffuse liver diseases are highly prevalent conditions around the world, including pathological liver changes that occur when hepatocytes are damaged and liver function declines, often leading to a chronic condition. In the last years, Magnetic Resonance Imaging (MRI) is reaching an important role in the study of diffuse liver diseases moving from qualitative to quantitative assessment of liver parenchyma. In fact, this can allow noninvasive accurate and standardized assessment of diffuse liver diseases and can represent a concrete alternative to biopsy which represents the current reference standard. MRI approach already tested for other pathologies include diffusion-weighted imaging (DWI) and radiomics, able to quantify different aspects of diffuse liver disease. New emerging MRI quantitative methods include MR elastography (MRE) for the quantification of the hepatic stiffness in cirrhotic patients, dedicated gradient multiecho sequences for the assessment of hepatic fat storage, and iron overload. Thus, the aim of this review is to give an overview of the technical principles and clinical application of new quantitative MRI techniques for the evaluation of diffuse liver disease., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2022 Marta Zerunian et al.)

Background: to assess the performance and speed of two commercially available advanced cardiac software packages in the automated identification of coronary vessels as an aiding tool for inexperienced readers. Methods: Hundred and sixty patients undergoing coronary CT angiography (CCTA) were prospectively enrolled from February until September 2021 and randomized in two groups, each one composed by 80 patients. Patients in group 1 were scanned on Revolution EVO CT Scanner (GE Healthcare), while patients in group 2 had the CCTA performed on Brilliance iCT (Philips Healthcare); each examination was evaluated on the respective vendor proprietary advanced cardiac software (software 1 and 2, respectively). Two inexperienced readers in cardiac imaging verified the software performance in the automated identification of the three major coronary vessels: (RCA, LCx, and LAD) and in the number of identified coronary segments. Time of analysis was also recorded. Results: software 1 correctly and automatically nominated 202/240 (84.2%) of the three main coronary vessels, while software 2 correctly identified 191/240 (79.6%) (p = 0.191). Software 1 achieved greater performances in recognizing the LCx (81.2% versus 67.5%; p = 0.048), while no differences have been reported in detecting the RCA (p = 0.679), and the LAD (p = 0.618). On a per-segment analysis, software 1 outperformed software 2, automatically detecting 942/1062 (88.7%) coronary segments, while software 2 detected 797/1078 (73.9%) (p < 0.001). Average reconstruction and detection time was of 13.8 s for software 1 and 21.9 s for software 2 (p < 0.001). Conclusions: automated cardiac software packages are a reliable and time-saving tool for inexperienced reader. Software 1 outperforms software 2 and might therefore better assist inexperienced CCTA readers in automated identification of the three main vessels and coronaries segments, with a consistent time saving of the reading session.

The clinical chart of 621 patients with III-IV haemorrhoids undergoing Stapled Hemorrhoidopexy (SH) with CPH34 HV in 2012-2014 was consecutively reviewed to assess its safety and efficacy after at least 12 months of follow-up. Mean volume of prolapsectomy was significantly higher (13.0 mL; SD, 1.4) in larger prolapse (9.3 mL; SD, 1.2) (p < 0.001). Residual or recurrent haemorrhoids occurred in 11 of 621 patients (1.8%) and in 12 of 581 patients (1.9%), respectively. Relapse was correlated with higher preoperative Constipation Scoring System (CSS) (p = 0.000), Pescatori's degree (p = 0.000), Goligher's grade (p = 0.003), prolapse exceeding half of the length of the Circular Anal Dilator (CAD) (p = 0.000), and higher volume of prolapsectomy (p = 0.000). At regression analysis, only the preoperative CSS, Pescatori's degree, Goligher's grade, and volume of resection were significantly predictive of relapse. A high level of satisfaction (VAS = 8.6; SD, 1.0) coupled with a reduction of 12-month CSS (Δ preoperative CSS/12 mo CSS = 3.4, SD, 2.0; p < 0.001) was observed. The wider prolapsectomy achievable with CPH34 HV determined an overall 3.7% relapse rate in patients with high prevalence of large internal rectal prolapse, coupled with high satisfaction index, significant reduction of CSS, and very low complication rates.

CPH34 HV, a high volume stapler, was tested in order to assess its safety and efficacy in reducing residual/recurrent haemorrhoids. The clinical charts of 430 patients with third- to fourth-degree haemorrhoids undergoing SH in 2012-2013 were consecutively reviewed, excluding those with obstructed defecation (rectocele >2 cm; Wexner's score >15). Follow-up was scheduled at six and 12 months. Rectal prolapse exceeding more than half of CAD was reported in 341 patients (79.3%); one technical failure was reported (0.2%) without any serious untoward effect; and 1.3 stitch/patient (SD, 1.7) was required to achieve complete haemostasis. Doughnuts volume was higher (13.8 mL; SD, 1.5) in patients with a large rectal prolapse than with smaller one (8.9 mL; SD, 0.7) (P value <0.05). Residual and recurrent haemorrhoids occurred in 8 of 430 patients (1.8%) and 5 of 254 patients (1.9%), respectively. A high index of patient satisfaction (visual analogue scale = 8.9; SD, 0.9) coupled with a persistent reduction of constipation scores (CSS = 5.0, SD, 2.2) was observed. The wider prolapse resection well correlated with a clear-cut reduction of haemorrhoidal relapse, a high index of patient satisfaction, and clinically relevant reduction of constipations scores coupled with satisfactory haemostatic properties of CPH34 HV.

In the tetraalkylation of p-tert-butyl[3.1.3.1]homooxacalixarene with BrCH2CO2R and K2CO3 in acetone, the initially formed cone conformer is converted into the more stable 1,4-alternate conformer when R = Me or Et, but not when R = i-Pr or t-Bu. In the case of R = i-Pr, derivatives in fixed 1,4-alternate conformation and in partial cone conformation were also isolated. Compounds in fixed cone conformation are good ligands for tetramethylammonium, acetylcholine, and N-methylpyridinium salts in CDCl3, but the partial cone isomer proved to be somewhat better and even the 1,4-alternate conformer turned out to be active. The possible involvement of the ester functions as additional binding sites is discussed; moreover, an insight into the energetics of the complexation and conformational isomerization processes is given.

[structure: see text] The whole set (five compounds) of partially O-methylated products of p-tert-butyl[3.1.3.1]homooxacalixarene, currently named p-tert-butyltetrahomodioxacalix[4]arene, have been prepared. Their structure has been investigated in solution through NMR techniques and in the solid state by single-crystal X-ray diffraction. A systematic investigation, extended to the parent tetraphenol and to the tetramethyl ether derivative, has been carried out on the complexation of tetramethylammonium, acetylcholine, N-methylpyridinium, and tetraethylammonium picrate in CDCl3. The observed trends in the binding and in the selectivity of the strictly related hosts could be analyzed on the basis of the varying importance of intramolecular hydrogen bonding and its effects on the conformation of the free and of the complexed ligands. On increasing the number of methyl ether functions, the cone conformation appears to be relatively less stable but deeper, so small organic cations can be more effectively encircled.

In the title compound, 4,7,13,16,21,24-hexaoxa-1,10-diazoniabicyclo[8.8.8]hexacosane dioxo[7,13,21,27-tetraphenyl-3,17-dioxapentacyclo[23.3.1.1(5,9).1(11,15).1(19,23)]ditriaconta-1(29),5,7,9(30),11(31),12,14,19(32),20,22,25,27-dodecaene-29,30,31,32-tetraolato]uranium dimethyl sulfoxide trisolvate, (C(18)H(38)N(2)O(6))[U(C(54)H(40)O(6))O(2)].3C(2)H(6)OS, the uranyl ion is bound to the four phenoxide groups of the deprotonated p-phenyltetrahomodioxacalix[4]arene ligand in a cone conformation, resulting in a dianionic complex. The diprotonated [2.2.2]cryptand counter-ion is located in the cavity defined by the eight aromatic rings of the homooxacalixarene, where it is held by cation-anion, cation-pi and possibly C-H...pi interactions. Dimerization in the packing leads to the formation of sandwich assemblages in which two diprotonated [2.2.2]cryptands are encompassed by two uranyl complexes.

The title compound, C(34)H(22)N(4)O(4), results from the reaction of 2,3,6,7-tetrahydroxy-9,10-dimethyl-9,10-dihydro-9,10-ethanoanthracene with 2,3-dichloroquinoxaline. The molecule, which contains a binary crystallographic symmetry axis, comprises two planar 'wings' around a central bicyclic unit. The non-ideal geometry of the latter evidences some strain, as in previous compounds with the same central core. Each molecule is involved in pi-pi interactions with four of its neighbours, oriented upside-down, which results in the formation of sheets of tightly packed molecules.

In the title compound, [UO(2)(C(13)H(10)O(2))(C(11)H(19)N(3))].C(3)H(6)O, the U atom is in a pentagonal-bipyramidal environment, with the three N atoms of the 2,6-bis[(dimethylamino)methyl]pyridine ligand and the two O atoms of the dianionic 2,2'-methylenediphenolate ligand in the equatorial plane. The geometry is compared with that of previously reported 1:2 uranyl-diphenoxide complexes.

Two related compounds containing p-tert-butyl-o-methylene-linked phenol or phenol-derived subunits are described, namely 5,5'-di-tert-butyl-2,2'-dihydroxy-3,3'-methylenedibenzaldehyde, C(23)H(28)O(4), (I), and 6,6'-di-tert-butyl-8,8'-methylenebis(spiro[4H-1,3-benzodioxin-2,1'-cyclohexane]), C(35)H(48)O(4), (II). Both compounds adopt a 'butterfly' shape, with the two phenol or phenol-derived O atoms in distal positions. Phenol and aldehyde groups in (I) are involved in intramolecular hydrogen bonds and the two dioxin rings in (II) are in distorted half-chair conformations.

The title compound, [UO(2)(C(33)H(38)N(2)O(2))(2)](CF(3)SO(3))(2).2C(5)H(5)N, has been obtained by reaction of U(IV) trifluoromethanesulfonate with p-tert-butyltetrahomodioxacalix[4]arene in pyridine. The uranyl ion lies on an inversion centre and is bound to two O atoms from each diphenoxide ligand, which gives the usual square-planar equatorial environment. The zwitterionic diphenoxide species results from nucleophilic attack by pyridine on the benzylic ether C atoms of the homooxacalixarene, assisted by initial U coordination to the ether groups, with subsequent metal oxidation giving the uranyl moiety.

In the title dinuclear uranyl complex, (C(18)H(38)N(2)O(6))[(UO(2))(2)(NO(3))(4)(OH)(2)].H(2)O, each pair of uranyl ions in the two independent centrosymmetric dianionic dimers is bridged by the two hydroxide ions, with the nitrate ions ensuring equatorial hexagonal coordination. The dihydro[2.2.2]cryptand (4,7,13,16,21,24-hexaoxa-1,10-diazabicyclo[8.8.8]hexacosane) dication presents an 'in-in' conformation (endo protonation) and it is hydrogen bonded to the hydroxide ions, either directly or via a water molecule, resulting in the formation of linear hydrogen-bonded polymers.

To investigate how solubility and steric issues affect the laccase-catalysed oxidation of phenols, a series of oligomeric polyphenol compounds, having increasing size and decreasing solubility in water, was incubated with laccase. The extent of substrate conversion, and the nature of the products formed in buffered aqueous solutions, were compared to those obtained in the presence of an organic cosolvent, and also in the presence of two mediating species, i.e. N-hydroxyphthalimide (HPI) and 2,2,6,6-tetramethylpiperidin-1-yloxy (TEMPO). This approach showed not only an obvious role of solubility, but also a significant role of the dimension of the substrate upon the enzymatic reactivity. In fact, reactivity decreases as substrate size increases even when solubility is enhanced by a cosolvent. This effect may be ascribed to limited accessibility of encumbered substrates to the enzyme active site, and can be compensated through the use of the appropriate mediator. While TEMPO was highly efficient at enhancing the reactivity of large, less soluble substrates, HPI proved less effective. In addition, whereas the laccase/HPI system afforded the same products as laccase alone, the use of TEMPO provided a different product with high specificity. These results offer the first evidence of the role of 'oxidation shuttles' that the mediators of laccase may have, but also suggest two promising routes towards an environmentally friendly process for kraft pulp bleaching: (a) the identification of mediators which, once oxidized by laccase, are able to target strategic functional groups present in lignin, and (b) the introduction of those strategic functional groups in an appropriate pretreatment.

Two compounds containing 1,3-benzodioxin groups are reported, namely (+/-)-6-tert-butyl-8-hydroxymethyl-2-phenyl-4H-1,3-benzodioxin, C(19)H(22)O(3), (I), and 2,2,2',2',6,6'-hexamethyl-8,8'-methylenebis(4H-1,3-benzodioxin), C(23)H(28)O(4), (II). The hydroxy groups of neighbouring molecules in (I) are hydrogen bonded to each other, giving rise to double-row chains. The molecule in (II) adopts a 'butterfly' conformation, with the O atoms in distal positions. In both compounds, the dioxin rings are in distorted half-chair conformations.

Four derivatives of 2,6-bis(hydroxymethyl)phenol, with various para substituents, have been investigated; these are 2,6-bis(hydroxymethyl)-4-methylphenol, C(9)H(12)O(3), (I), 2,6-bis(hydroxymethyl)-4-methoxyphenol, C(9)H(12)O(4), (II), 2,6-bis(hydroxymethyl)-4-phenoxyphenol, C(14)H(14)O(4), (III), and 2,6-bis(hydroxymethyl)-4-[1-(4-methoxyphenyl)-1-methylethyl]phenol, C(18)H(22)O(4), (IV). All four structures display hydrogen-bonding networks resulting in sheets, with possible weak inter-sheet pi-pi interactions in one case. In all the structures but one, the molecules form centrosymmetric dimeric subunits held together by two hydrogen bonds between the hydroxymethyl groups and, in two cases, by probable pi-pi interactions.

The title compound, 13,21,35,43-tetramethyl-3,6,9,17,25,28,31,39,46,49-decaoxaheptacyclo[21.21.3.3(11,33).0(2,41).0(10,15).0(19,24).0(32,37)]pentaconta-1,10,12,14,19,21,23,32,34,36,41,43-dodecaene, C(44)H(52)O(10), differs from previously reported 1,3-bridged calix[4]arene[bond]bis-crown compounds in having an enlarged calixarene ring and shorter polyoxyethylene bridges. The cavity is partly filled by the bridges.

Uranyl nitrate hexahydrate reacts with bis[2-(2-hydroxyphenoxy)ethoxy]ethane (C(18)H(22)O(6)), denoted LH(2) hereafter, in the presence of triethylamine to give triethylammonium aqua[2,2'-(3,6-dioxaoctane-1,8-diyldioxy)diphenolato-kappa(2)O,O'](nitrato-kappa(2)O,O')dioxouranium(VI), (Et(3)NH)[UO(2)(H(2)O)L(NO(3))], which possesses a symmetry plane. The uranyl ion is coordinated to the two phenoxide O atoms, a nitrate ion and a water molecule (first sphere); the water molecule is itself held in the crown ether chain by hydrogen-bonding interactions, thus ensuring second-sphere coordination by the ligand L.

2,3,6,7-Tetrahydroxy-9,10-dimethyl-9,10-dihydro-9,10-ethanoanthracene crystallizes with 1,4-dioxane to give a bis-solvate, C(18)H(18)O(4).2C(4)H(8)O(2). The bis(catechol) molecule is located on a twofold axis and the two aromatic rings form a dihedral angle of 130.61(4) degree. Hydrogen bonds are formed between the hydroxyl groups and either a neighbouring bis(catechol) molecule or the ether-O atom of a dioxane molecule.

The title compound, 2,2'-(3-oxapentane-1,5-diyldioxy)diphenol, crystallizes as a methanol solvate, C16H18O5*CH4O. The methanol molecule, roughly perpendicular to the mean plane of the polyether molecule, is hydrogen bonded to the two polyether OH groups and to the central ether O atom. Possible C-H...pi intermolecular interactions are present.

Three methoxy-ether and one methoxy-ether/crown-ether derivatives of p-tert-butyltetrahomodioxa- and p-R-octahomotetraoxacalix[4]arenes (R = methyl, tert-butyl, H) have been investigated. The first three compounds, 7,15,21,27-tetra-tert-butyl-29,30,31,32-tetramethoxy-3,11-dioxapentacyclo[23.3.1.1(5,9).1(13,17).1(19,23)]ditriaconta-1(29),5,7,9(30),13,15,-17(31),19,21,23(32),25,27-dodecaene, C(50)H(68)O(6), 33,34,35,36-tetramethoxy-7,15,23,31-tetramethyl-3,11,19,27-tetraoxapentacyclo[27.3.1.1(5,9).1(13,17).1(21,25)]hexatriaconta-1(33),5,7,9(34),13,15,17(35),21,23,25(36),29,31-dodecaene, C(40)H(48)O(8), and 7,23-di-tert-butyl-33,34,35,36-tetramethoxy-3,11,19,27-tetraoxapentacyclo[27.3.1.1(5,9).1(13,17).1(21,25)]hexatriaconta-1(33),5,7,9(34),13,15,17(35),- 21,23,25(36),29,31-dodecaene, C(44)H(56)O(8), in the partial-cone or 1,2-alternate conformations, present the common feature of methoxy-ether self-inclusion, while the fourth, 42,43-dimethoxy-7,15,23,31-tetramethyl-3,11,19,27,34,37,40-heptaoxahexacyclo[15.15.9.1(5,9).1(21,25).0(13,41).0(29,33)]tritetraconta-5(42),6,8,13(41),14,16,21(43),22,24,29(33),30,32-dodecaene, C(42)H(50)O(9), adopts the 1,3-alternate conformation owing to the presence of a 1,3-polyether chain.

The title compound, 7,13,21,27-tetramethyl-3,17-dioxapentacyclo[23.3.1.1(5,9).1(11,15).1(9,23)]ditriaconta-1(29),5,7,9(30),11(31),-12,14,19(32),20,22,25,27-dodecaene-29,30,31,32-tetraol, C34H36O6, assumes in the solid state a very distorted cone-like conformation stabilized by intramolecular simple and bifurcated hydrogen bonds involving both phenolic and ether O atoms. One part of the molecule, comprising an ether link, is included in the cavity of an adjacent calixarene related by a screw axis, giving rise to a one-dimensional self-inclusion polymer.

The title compound, 7,13,21,27-tetra-tert-butyl-3,17-dioxapentacyclo[23.3.1.1(5,9).1(11,15).1(9,23)]ditriaconta-1(29),5,7,9(30),11(31),12,14,19(32),20,22,25,27-dodecaene-29,30,31,32-tetraol, crystallizes as a solvate with one molecule of chloroform and one molecule of tetrahydrofuran, C46H60O6.CHCl3).C4H8O. The calixarene assumes a cone-like conformation stabilized by intramolecular hydrogen bonds involving both phenolic and ether O atoms. The two solvent molecules are located in each of the two half-cone cavities of the calixarene.