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Coloproctological diseases, including both benign and malignant conditions, are among the most common diagnoses in clinical practice. Several disorders affect both men and women, while others are unique to women, or women are at a greater risk of developing them. This is due to anatomical, biological, and social conditions and also due to females' exclusive capabilities of reproduction and pregnancy. In this context, the same proctological disease could differ between men and women, who can experience different perceptions of health and sickness. There is a raised awareness about the impact of different diseases in women and a growing need for a personalized approach to women's health. In this review, we aim to summarize the specific features of the main coloproctological diseases, specifically in the female population. This includes common complaints during pregnancy, conditions linked to vaginal delivery, functional consequences after colorectal resections, and conditions presenting a gender disposition.

Background: Flywheel resistance training has become more integrated within resistance training programs in a variety of sports due to the neuromuscular, strength, and task-specific enhancements reported with this training., Objective: This paper aimed to present the consensus reached by internationally recognized experts during a meeting on current definitions and guidelines for the implementation of flywheel resistance training technology in sports., Methods: Nineteen experts from different countries took part in the consensus process; 16 of them were present at the consensus meeting (18 May 2023) while three submitted their recommendations by e-mail. Prior to the meeting, evidence summaries were developed relating to areas of priority. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of flywheel resistance training technology in sports. The process to gain consensus had five steps: (1) performing a systematic review of systematic reviews, (2) updating the most recent umbrella review published on this topic, (3) first round discussion among a sample of the research group included in this consensus statement, (4) selection of research group members-process of the consensus meeting and formulation of the recommendations, and (5) the consensus process. The systematic analysis of the literature was performed to select the most up-to-date review papers available on the topic, which resulted in nine articles; their methodological quality was assessed according to AMSTAR 2 (Assessing the Methodological Quality of Systematic Review 2) and GRADE (Grading Recommendations Assessment Development and Evaluation). Statements and recommendations scoring 7-9 were considered appropriate., Results: The recommendations were based on the evidence summary and researchers' expertise; the consensus statement included three statements and seven recommendations for the use of flywheel resistance training technology. These statements and recommendations were anonymously voted on and qualitatively analyzed. The three statements reported a score ranging from 8.1 to 8.8, and therefore, all statements included in this consensus were considered appropriate. The recommendations (1-7) had a score ranging from 7.7 to 8.6, and therefore, all recommendations were considered appropriate., Conclusions: Because of the consensus achieved among the experts in this project, it is suggested that practitioners and researchers should adopt the guidelines reported in this consensus statement regarding the use of flywheel resistance technology in sports., (© 2024. The Author(s).)

Introduction: Hypnic headache (HH) is a primary headache, and it is considered a rare condition in children. The underlying mechanisms of HH are not yet fully understood. This systematic review aims to provide a comprehensive description of the clinical features of all published cases of pediatric HH. It will also discuss the differences in headache features between children and adults, the increased diagnostic sensitivity of the new diagnostic criteria (ICHD-3), potential pathophysiological hypotheses explaining the higher incidence in adults, differential diagnoses, and therapeutic options for children., Methods: A systematic search was conducted to identify and analyze articles reporting cases of HH in patients under the age of 18. The search was performed in major medical databases including Cochrane Library, EBSCO, Embase, Medline, PubMed, Science Direct, Scopus, and Web of Science. The search covered the period from 1988 to April 2023. Relevant studies were screened for eligibility, and data extraction was performed using a standardized approach., Results: Seven children with HH were included in the analysis. The mean age of onset for headache attacks was 10 ± 4.3 years (range 3-15 years). The average time from the start of headaches to diagnosis was 15.8 ± 25.0 months (range 1-60 months). Headache features in children differed from those observed in adult HH patients. Children experienced throbbing/pulsating pain, while adults reported dull/pressure-like pain. Children also had lower frequency and shorter duration of attacks compared to adults. The use of ICHD-3 criteria appeared to be more sensitive and inclusive for diagnosing HH in children compared to the previous ICHD-2 criteria. The association of headache attacks with sleep suggests that HH may be a primary disorder with a chronobiological origin. Hypothalamic dysfunction and melatonin dysregulation, which are more prevalent in older individuals, could potentially explain the higher incidence of HH in adults. Other primary headaches and secondary causes should be ruled out. Melatonin prophylactic therapy may be considered for pediatric patients., Discussion: Further evaluation of the clinical features of HH in children is needed. The development of specific diagnostic criteria for pediatric cases could improve diagnostic rates and enhance the management of children with HH., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Ferretti, Velardi, Fanfoni, Di Nardo, Evangelisti, Foiadelli, Orsini, Del Pozzo, Terrin, Raucci, Striano and Parisi.)

Background: Sclerotherapy with 3% polidocanol foam is becoming increasingly popular for the treatment of symptomatic I-II or III degree haemorrhoidal disease (HD). However, there are no studies that have reported a follow-up of more than 1 year. The purpose of this study was to analyse the long-term outcomes of sclerotherapy with 3% polidocanol foam in the treatment of II-degree HD., Methods: This was an open label, single-arm, phase 2b trial conducted in 10 tertiary referral centres for HD. A total of 183 patients with II-degree HD, aged between 18 and 75 years with symptomatic HD according to the Goligher classification and unresponsive to medical treatment, were included in the study and underwent sclerotherapy with 3% polidocanol foam. The efficacy was evaluated in terms of bleeding score, haemorrhoidal disease symptom score (HDSS) and short health scale for HD (SHS-HD) score. Successful treatment was defined as the complete absence of bleeding episodes after 7 days (T1) according to the bleeding score., Results: The overall success rate ranged from 95.6% (175/183) at 1 year to 90.2% (165/183) after the final 3 year follow-up. The recurrence rate, based on the primary outcome, ranged from 12% (15/125) to 28% (35/125). The greatest increase in recurrence (15) was recorded between 12 and 18 months of follow-up, then another five between 18 and 24 months. Both the HDSS and the SHS score remained statistically significant (p < 0.001) from a median preoperative value of 11 (10-13) and 18 (15-20) to 0 (0-2) and 4 (0-4), respectively. Symptom-free (HDSS = 0) patients, excluding patients converted to surgery, increased from 55.5% (101/182) at 1 year to 65.1% at 3 years (110/169). There were no intraoperative complications in redo-sclerotherapy nor additional adverse events (AEs) compared to the first 12 months., Conclusions: Sclerotherapy with 3% polidocanol foam is gradually establishing itself in the treatment of bleeding HD due to its repeatability, safety, convenience in terms of direct and indirect costs with the absence of discomfort for the patient as well as AEs rather than an excellent overall success rate., (© 2022 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Background: The aim of the present study was to evaluate the efficacy and safety of 3% polidocanol foam for treating 2nd-degree haemorrhoids., Methods: A multicentre, open-label, single-arm, phase 2 trial involving 10 tertiary referral centres for haemorrhodal disease (HD) was performed. Between January and June 2019, patients with 2nd-degree haemorrhoids were prospectively included in this study. The primary outcome was to establish the success rate after one sclerotherapy session in terms of complete resolution of bleeding episodes one week after the injection. The Hemorrhoidal Disease Symptom Score (HDSS), the Short Health Scale for HD (SHS-HD) score and the Vaizey incontinence score were used to assess symptoms and their impact on quality of life and continence. Pain after the procedure, subjective symptoms and the amount and type of painkillers used were recorded. Patients were followed up for 1 year., Results: There were 183 patients [111 males; 60.7%, mean age 51.3 ± 13.5 (18-75) years]. Complete resolution of bleeding was reached in 125/183 patients (68.3%) at 1 week and the recurrence rate was 12% (15/125). Thirteen patients (7.4%) underwent a second sclerotherapy session, while only 1 patient (1.8%) had to undergo a third session. The overall 1-year success rate was 95.6% (175/183). The HDSS and the SHS score significantly improved from a median preoperative value of 11 and 18 to 0 and 0, respectively (p < 0.001). There were 3 episodes of external thrombosis. No serious adverse events occurred., Conclusions: Sclerotherapy with 3% polidocanol foam is a safe, effective, painless, repeatable and low-cost procedure in patients with bleeding haemorrhoids., (© 2022. The Author(s).)

Purpose: Local and systemic inflammatory markers and pro-inflammatory cytokines are increased in children with obstructive sleep apnea syndrome (OSAS). Therefore, systemic or topical anti-inflammatory agents are used to treat this syndrome. We evaluated the treatment with systemic corticosteroids in children with severe OSAS and adenotonsillar hypertrophy before surgery., Methods: This was an unblinded open label study. Children with severe OSAS (diagnosed through polysomnography, obstructive apnea-hypopnea index [AHI] > 10 eV/h) were recruited. Exclusion criteria included age < 3 years, history of acute or chronic cardiorespiratory or neuromuscular or metabolic disease; major craniofacial abnormalities; and chromosomal syndromes and epilepsy. Computer-generated random numbers were used for simple randomization of subjects. All children were treated with intranasal beclomethasone spray, and 15 children additionally received oral betamethasone and 0.1 mg/kg per day for 7 days. Sleep clinical record (SCR) and pulsoximetry were performed before and after 7 days in all children., Results: Among 28 children with severe OSAS mean age was 4.5 ± 1.8 years, AHI 20.4 ± 1.8 eV/h). In children treated with intranasal and oral corticosteroids, mean (95.3 ± 1.1 vs 97.0 ± 0.8%, p = 0.0001) and minimum oxygen saturation (78.8 ± 6.3 vs 89.2 ± 4.2, p = 0.001) improved, and the SCR score (12.6 ± 1.2 vs 8.3 ± 1.1, p = 0.0001) was reduced. Children treated only with intranasal beclomethasone spray showed no differences in outcome measures before and after treatments. When we considered the oximetry measures, after corticosteroid treatment, we obtained statistical differences between the 2 groups (p < 0.01)., Conclusions: These results seem to suggest that a short course of oral betamethasone could be useful to treat children with severe OSAS and adenotonsillar hypertrophy waiting for surgery., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: The main aim of this study was (1) to find an index to monitor the loading intensity of flywheel resistance training, and (2) to study the differences in the relative intensity workload spectrum between the FW-load and ISO-load., Methods: twenty-one males participated in the study. Subjects executed an incremental loading test in the squat exercise using a Smith machine (ISO-load) or a flywheel device (FW-load). We studied different association models between speed, power, acceleration, and force, and each moment of inertia was used to find an index for FW-load. In addition, we tested the differences between relative workloads among load conditions using a two-way repeated-measures test., Results: the highest r2 was observed using a logarithmic fitting model between the mean angular acceleration and moment of inertia. The intersection with the x-axis resulted in an index (maximum flywheel load, MFL) that represents a theoretical individual maximal load that can be used. The ISO-load showed greater speed, acceleration, and power outcomes at any relative workload (%MFL vs. % maximum repetition). However, from 45% of the relative workload, FW-load showed higher vertical forces., Conclusions: MFL can be easily computed using a logarithmic model between the mean angular acceleration and moment of inertia to characterize the maximum theoretical loading intensity in the flywheel squat.

Pilonidal disease (PD) is a relatively common, benign but challenging condition of the natal cleft. This consensus statement was drawn up by a panel of surgeons, identified by the Italian Society of Colorectal Surgery (SICCR) as having a "special interest" in PD, with the aim of recommending the best therapeutic options according to currently available scientific evidence. A three-step modified-Delphi process was adopted, implying: (1) choice of the panelists; (2) development of a discussion outline and of target issues; and (3) a detailed systematic review of the current literature. The agreement/disagreement level was scored on a five-point Likert scale as follows: "A + : strongly agree; A-: agree; N: unsure/no opinion; D-: disagree; D + : strongly disagree. Each panelist contributed to the production of this manuscript, and the final recommendations were reviewed by the Clinical Practice Guidelines Committee., (© 2021. The Author(s).)

Purpose: This study aimed to analyze mechanical performance and mechanical losses across different sets and repetitions of unilateral leg extensions under flywheel loading conditions., Methods: In a cross-over design, 23 physically active participants executed 3 sets of 30 repetitions using two different loads. Angular speed, angular acceleration and power were monitored, and mean and peak values of these variables were calculated for each set of repetitions. We analyzed time-course differences every five repetitions (described as 'clusters'). Differences in the mechanical profile for Load by Set and in the mechanical losses for Load by Set by Cluster repetitions were analyzed using an ANOVA repeated measures test. A Principal Components (PC) analysis was also conducted., Results: Only peak acceleration showed a significant Set by Load interaction (p = 0.006) in mechanical performance. At the intra-set level, all consecutive clusters showed a significant decrement in all variables, but with different magnitudes (speed < acceleration < power). Although all variables showed significant Set by Cluster and Load by Cluster interactions, only the acceleration variables showed a significant Set by Load interaction (p < 0.05). All the variables showed a single PC. Higher fatigue was found around the concentric peak for each variable., Conclusions: The most sensitive variable for detecting fatigue using real-time feedback seems to be the angular acceleration of the flywheel. Peak acceleration can be used to monitor training workload and training volume in real time in leg extension exercises using flywheel training devices., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The possibility of depositing precisely mass-selected Ag clusters (Ag 1 , Ag 3 , and Ag 7 ) on Ru(0001) was instrumental in determining the importance of the in-plane coordination number (CN) and allowed us to establish a linear dependence of the Ag 3d 5/2 core-level shift on CN. The fast cluster surface diffusion at room temperature, caused by the low interaction between silver and ruthenium, leads to the formation of islands with a low degree of ordering, as evidenced by the high density of low-coordinated atomic configurations, in particular CN = 4 and 5. On the contrary, islands formed upon Ag 7 deposition show a higher density of atoms with CN = 6, thus indicating the formation of islands with a close-packed atomic arrangement. This combined experimental and theoretical approach, when applied to clusters of different elements, offers the perspective to reveal nonequivalent local configurations in two-dimensional (2D) materials grown using different building blocks, with potential implications in understanding electronic and reactivity properties at the atomic level., Competing Interests: The authors declare no competing financial interest., (© 2021 The Authors. Published by American Chemical Society.)

In this work, we characterize the adsorption of pentacene molecules on Ir(111) and their behaviour as a function of temperature. While room temperature adsorption preserves the molecular structure of the five benzene rings and the bonds between carbon and hydrogen atoms, we find that complete C-H molecular break up takes place between 450 K and 550 K, eventually resulting in the formation of small graphene islands at temperatures larger than 800 K. Most importantly a reversible temperature-induced dehydrogenation process is found when the system is annealed/cooled in a hydrogen atmosphere with a pressure higher than 5 × 10 -7 mbar. This novel process could have interesting implications for the synthesis of larger acenes and for the manipulation of graphene nanoribbon properties., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

The transport properties of iron under Earth's inner core conditions are essential input for the geophysical modelling but are poorly constrained experimentally. Here we show that the thermal and electrical conductivity of iron at those conditions remains high even if the electron-electron-scattering (EES) is properly taken into account. This result is obtained by ab initio simulations taking into account consistently both thermal disorder and electronic correlations. Thermal disorder suppresses the non-Fermi-liquid behavior of the body-centered cubic iron phase, hence, reducing the EES; the total calculated thermal conductivity of this phase is 220 Wm -1  K -1 with the EES reduction not exceeding 20%. The EES and electron-lattice scattering are intertwined resulting in breaking of the Matthiessen's rule with increasing EES. In the hexagonal close-packed iron the EES is also not increased by thermal disorder and remains weak. Our main finding thus holds for the both likely iron phases in the inner core.

Introduction: Various pain management strategies for patients undergoing open excisional hemorrhoidectomy have been proposed, yet postoperative pain remains a frequent complaint., Objective: To determine whether mesoglycan (30 mg two vials i.m. once/day for the first 5 days postoperative, followed by 50 mg 1 oral tablet twice/day for 30 days) would reduce the edema of the mucocutaneous bridges and thus improve postoperative pain symptoms., Patients and Methods: For this prospective observational multicenter study, 101 patients undergoing excisional diathermy hemorrhoidectomy for III-IV degree hemorrhoidal disease were enrolled at 5 colorectal referral centers. Patients were assigned to receive either mesoglycan (study group SG) or a recommended oral dose of ketorolac tromethamine of 10 mg every 4-6 hours, not exceeding 40 mg per day and not exceeding 5 postoperative days according to the indications for short-term management of moderate/severe acute postoperative pain, plus stool softeners (control group CG)., Results: Postoperative thrombosis (SG 1/48 versus CG 5/45) ( p < 0.001) and pain after rectal examination ( p < 0.001) were significantly reduced at 7-10 days after surgery in the mesoglycan-treated group, permitting a faster return to work ( p < 0.001); however, in the same group, the incidence of postoperative bleeding, considered relevant when needing a readmission or an unexpected outpatient visit, was higher, possibly owing to the drug's antithrombotic properties., Conclusions: The administration of mesoglycan after an open diathermy excisional hemorrhoidectomy can reduce postoperative thrombosis and pain at 7-10 days after surgery, permitting a faster return to normal activities.

Purpose: Data in the literature suggest that myofunctional therapy (MT) may be able to play a role in the treatment of children with sleep-disordered breathing (SDB). Our study investigated the effectiveness of MT in reducing respiratory symptoms in children with SDB by modifying tongue tone., Methods: Polysomnographic recordings were performed at baseline to assess obstructive sleep apnea (OSA) severity in 54 children (mean age 7.1 ± 2.5 years, 29 male) with SDB. Patients were randomly assigned to either the MT or no-MT group. Myofunctional evaluation tests, an assessment of tongue strength, tongue peak pressure, and endurance using the Iowa Oral Performance Instrument (IOPI), and nocturnal pulse oximetry were performed before (T0) and after (T1) 2 months of treatment., Results: MT reduced oral breathing (83.3 vs 16.6%, p < 0.0002) and lip hypotonia (78 vs 33.3%, p < 0.003), restored normal tongue resting position (5.6 vs 33.4%, p < 0.04), and significantly increased mean tongue strength (31.9 ± 10.8 vs 38.8 ± 8.3, p = 0.000), tongue peak pressure (34.2 ± 10.2 vs 38.1 ± 7.0, p = 0.000), and endurance (28.1 ± 8.9 vs 33.1 ± 8.7, p = 0.01) in children with SDB. Moreover, mean oxygen saturation increased (96.4 ± 0.6 vs 97.4 ± 0.7, p = 0.000) and the oxygen desaturation index decreased (5.9 ± 2.3 vs 3.6 ± 1.8, p = 0.001) after MT., Conclusions: Oropharyngeal exercises appear to effectively modify tongue tone, reduce SDB symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of SDB.

Background: The bulk of research on motherhood has focused on perinatal depression, largely overlooking indicators of women's positive mental health which can likewise have pervasive consequences on family functioning., Objective: The aim of the present study was to address this issue by exploring the impact of parity and childbirth on both women's perinatal depression and psychological well-being., Methods: A convenience sample of 81 women was followed during pregnancy (Time 1) and postpartum (Time 2). At both times, participants completed the Edinburgh Depression Scale and the Psychological Well-being Scales, measuring perceived autonomy, environmental mastery, personal growth, positive relations, purpose in life, and self-acceptance., Results: Significant negative correlations were observed between depression and psychological well-being dimensions. ANCOVA and mixed ANOVA analyses showed that depression levels did not differ between primiparous and multiparous women, or between pre- and postpartum assessments. By contrast, after childbirth, primiparous women reported higher values of environmental mastery and self-acceptance than multiparous women. In addition, levels of self-acceptance and personal growth increased from pregnancy to postpartum among primiparous women, while no differences were detected over time in the scores of all the psychological well-being dimensions among multiparous women., Conclusions: This study highlighted some dimensions of positive psychological functioning that specifically contribute to women's well-being in the transition to motherhood, and their different relevance for primiparous and multiparous mothers. Future trials are needed to integrate this information in tailored intervention for the promotion of mothers' complete mental health.

The purpose of this study was to analyse the raw lifting speed collected during four different resistance training exercises to assess the optimal sampling frequency. Eight physically active participants performed sets of Squat Jumps, Countermovement Jumps, Squats and Bench Presses at a maximal lifting speed. A linear encoder was used to measure the instantaneous speed at a 200 Hz sampling rate. Subsequently, the power spectrum of the signal was computed by evaluating its Discrete Fourier Transform. The sampling frequency needed to reconstruct the signals with an error of less than 0.1% was f 99.9  = 11.615 ± 2.680 Hz for the exercise exhibiting the largest bandwidth, with the absolute highest individual value being 17.467 Hz. There was no difference between sets in any of the exercises. Using the closest integer sampling frequency value (25 Hz) yielded a reconstruction of the signal up to 99.975 ± 0.025% of its total in the worst case. In conclusion, a sampling rate of 25 Hz or above is more than adequate to record raw speed data and compute power during resistance training exercises, even under the most extreme circumstances during explosive exercises. Higher sampling frequencies provide no increase in the recording precision and may instead have adverse effects on the overall data quality.

Aim: Many different surgical techniques have been reported for the surgical treatment of full-thickness external rectal prolapse. Perianal stapled prolapse resection (PSP) is a relatively newly reported technique for full thickness external rectal prolapse. The aim of this prospective multicentre study was to evaluate the results of this procedure., Method: Consecutive patients who underwent a PSP resection for full-thickness external rectal prolapse at five centres were recruited to the study. Median operating time, hospital stay, complications, recurrence and functional results according to the Wexner Incontinence Scale and obstructive defaecation syndrome score were recorded., Results: There were 27 patients treated by PSP. The median Wexner incontinence score improved from 10 presurgery to 5 after surgery (P < 0.001); the median obstructed defaecation syndrome score improved from 12 presurgery to 5 (range 4-10) after surgery (P < 0.001). A laparoscopically assisted procedure was performed in three patients (11.1%). The median number of cartridges used was six (range four to nine). The median operating time was 48 min. Early complications occurred in six patients (22.2%) and late complications in two (7.4%). The median length of hospital stay was 5 days. The recurrence rate at a median follow-up of 30.3 months was 14.8%., Conclusion: PSP appears to be an easy, fast and safe procedure. Early functional results are good. The recurrence rate compares favourably with other perineal procedures like the Delorme or the Altemeier operations. Long-term functional results need to be investigated further., (Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.)

The atomistic understanding of the dissociation mechanisms for large molecules adsorbed on surfaces is still a challenge in heterogeneous catalysis. This is especially true for polycyclic aromatic hydrocarbons, which represent an important class of organic compounds used to produce novel graphene-based architectures. Here, we show that coronene molecules adsorbed on Ir(111) undergo major conformational changes during dissociation. They first tilt upward with respect to the surface, still keeping their planar configuration, and subsequently experience a rotation, which changes the molecular axis orientation. Upon lifting, the internal C-C strain is initially relieved; as the dehydrogenation proceeds, the molecules experience a progressive increase in the average interatomic distance and gradually settle to form dome-shaped nanographene flakes. Our results provide important insight into the complex mechanism of molecular breakup, which could have implications in the synthesis of new carbon-based nanostructured materials.

We report on the temperature dependence of the electrical resistivity of solid iron at high pressure, up to and including conditions likely to be found at the centre of the Earth. We have extended some of the calculations of the resistivities of pure solid iron we recently performed at Earth's core conditions (Pozzo et al. in Earth Planet Sci Lett 393:159-164, 2014) to lower temperature. We show that at low temperature the resistivity increases linearly with temperature, and saturates at high temperature. This saturation effect is well known as the Mott-Ioffe-Regel limit in metals, but has been largely ignored to estimate the resistivity of iron at Earth's core conditions. Recent experiments (Gomi et al. in Phys Earth Planet Int 224:88-103, 2013) coupled new high pressure data and saturation to predict the resitivity of iron and iron alloys at Earth's core conditions, and reported values up to three times lower than previous estimates, confirming recent first principles calculations (de Koker et al. in Proc Natl Acad Sci 109:4070-4073, 2012; Pozzo et al. in Nature 485:355-358, 2012, Phys Rev B 87:014110-10, 2013, Earth Planet Sci Lett 393:159-164, 2014; Davies et al. in Nat Geosci 8:678-685, 2015). The present results support the saturation effect idea.

The different aspects that contribute to quality of life in patients with diabetes mellitus, such as mood, are of great importance for the treatment of this disease. These aspects not only influence the well-being of patients but also influence treatment adherence, therefore affecting the course of the disease. A panel of experts from Argentina, Chile, and Uruguay performed a review of the main aspects affecting quality of life in patients with diabetes: physical activity, mood disorders, and sexual activity. The consensus of the panel was that physical activity is important in the treatment of patients with diabetes because it reduces morbidity, mortality, and disease complications, and it should be performed on a regular basis, bearing in mind the patient's characteristics. Increased physical activity is associated with better glycemic control, and in individuals with glucose intolerance, it delays progression toward diabetes. In patients with diabetes, there is a high prevalence of depression, which can influence treatment adherence. Therefore, early detection of depression is essential to improve the course of diabetes. Regarding sexual activity, erectile dysfunction may be a significant sign in the case of suspected diabetes and the early diagnosis of vasculopathy in patients with diabetes. In conclusion, greater emphasis should be placed on improving patient knowledge, early detection, and multidisciplinary approaches to deal with the aspects of diabetes that affect patients' quality of life.

Objectives: To investigate the activity of the autonomic nervous system (ANS) during sleep in children with obstructive sleep apnea (OSA), in order to detect a possible cardiac ANS imbalance analyzing heart rate variability (HRV)., Methods: 43 subjects between 4 and 12 years of age (7.26 ± 2.8 years), undergoing a diagnostic assessment for OSA were evaluated. A time domain index (R-apnea index) was developed to evaluate HRV strictly related to obstructive events during sleep. Poincaré plot of RR intervals during the whole night was calculated., Results: R-apnea index was negatively correlated with apnea hypopnea index (AHI) (r=-0.360, p=0.028). AHI and the duration of the disease were the only variables that were significantly correlated with R-apnea index. Three groups were subsequently created according to polysomnographic findings considering AHI. R-apnea index resulted significantly lower in patient with severe OSA compared to primary snoring/mild OSA subjects (p<0.05). Looking at Poincaré plot, SD1 showed a diminishing trend with severity of OSA, however not reaching statistical significance., Conclusions: Our findings suggest an autonomic impairment in OSA children evidenced by the altered HRV both in the very short term (R-apnea index) and in short term (SD1)., Significance: R-apnea index is an easy and cheap method to undelay early ANS imbalance., (Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Importance: Although polysomnographic (PSG) testing is the gold standard for the diagnosis of obstructive sleep apnea syndrome (OSAS) in children, the number of pediatric sleep laboratories is limited. Developing new screening methods for identifying OSAS may reduce the need for PSG testing., Objective: To evaluate the combined use of the sleep clinical record (SCR) and nocturnal oximetry testing for predicting PSG results in children with clinically suspected OSAS., Design, Setting, and Participants: Prospective study over 10 months. A cohort of 268 consecutive children (mean [SD], age 6 [3] years) referred for clinically suspected OSAS was studied at a pediatric sleep center at a university hospital. Children with disorders other than adenotonsillar hypertrophy or obesity were excluded., Main Outcomes and Measures: Mild OSAS (obstructive apnea-hypopnea index [AHI], 1-5 episodes/h) and moderate-to-severe OSAS (AHI, >5 episodes/h) were the main outcome measures. Sleep clinical record scores greater than or equal to6.5 were considered positive, as were McGill oximetry scores (MOS) greater than 1, and these positive scores were the main explanatory variables in our study. Each participant was evaluated by the SCR, followed by pulse oximetry test the first night and PSG test in the sleep laboratory the second night., Results: Of the total participants, 236 (88.1%) were diagnosed with OSAS, 236 (88.1%) had a positive SCR score, and 50 (18.7%) had a positive MOS. Participants with positive SCR scores had significantly increased risk of an AHI greater than or equal to 1 (adjusted odds ratio [AOR], 9.3; 95% CI, 3.7-23.2; P < .001). Children with an MOS greater than 1 were significantly more likely to have an AHI greater than 5 episodes/h than children with an MOS equal to 1 (AOR, 26.5; 95% CI, 7.8-89.2; P < .001). A positive SCR score had satisfactory sensitivity (91.9%) and positive predictive value (91.9%) but limited specificity (40.6%) and negative predictive value (40.6%) for OSAS. An MOS greater than 1 had excellent specificity (97.4%) and positive predictive value (94%) but low sensitivity (39.2%) and fair negative predictive value (60.8%) for moderate-to-severe OSAS among children with a positive SCR score. The combination of SCR scores and MOS correctly predicted primary snoring, mild OSAS, or moderate-to-severe OSAS in 154 of 268 (57.4%) participants., Conclusions and Relevance: The combined use of the SCR score and nocturnal oximetry results has moderate success in predicting sleep-disordered breathing severity when PSG testing is not an option.

The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.

Purpose: To determine whether celiac children are at risk for EEG-neurological features and sleep disordered breathing (SDB), and whether an appropriate gluten-free diet (GFD) influences these disorders., Methods: We consecutively enrolled 19 children with a new biopsy-proven celiac disease (CD) diagnosis. At CD diagnosis and after 6 months of GFD, each patient underwent a general and neurological examination, an electroencephalogram, a questionnaire about neurological features, and a validated questionnaire about SDB: OSA (obstructive sleep apnea) scores<0 predict normality; values>0 predict OSA., Results: At CD diagnosis, 37% of patients complained headache that affected daily activities and 32% showed positive OSA score. The EEG examinations revealed abnormal finding in 48% of children. After 6 months of GFD headache disappeared in 72% of children and EEG abnormalities in 78%; all children showed negative OSA score., Conclusion: According to our preliminary data, in the presence of unexplained EEG abnormalities and/or other neurological disorders/SDB an atypical or silent CD should also be taken into account., (Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To analyze the effect of an eccentric-overload training program (ie, half-squat and leg-curl exercises using flywheel ergometers) with individualized load on muscle-injury incidence and severity and performance in junior elite soccer players., Methods: Thirty-six young players (U-17 to U-19) were recruited and assigned to an experimental (EXP) or control group (CON). The training program consisted of 1 or 2 sessions/wk (3-6 sets with 6 repetitions) during 10 wk. The outcome measured included muscle injury (incidence per 1000 h of exposure and injury severity) and performance tests (countermovement jump [CMJ], 10-m and 20-m sprint test)., Results: Between-groups results showed a likely (ES: 0.94) lower number of days of absence per injury and a possible decrement of incidence per 1000 h of match play in EXP than in CON. Regarding muscle performance, a substantial better improvement (likely to very likely) was found in 20-m sprint time (ES: 0.37), 10-m flying-sprint time (ES: 0.77), and CMJ (ES: 0.79) for EXP than for CON. Within-group analysis showed an unclear effect in each variable in CON. Conversely, substantial improvements were obtained in CMJ (ES: 0.58), 20-m sprint time (ES: 0.32), 10-m flying-sprint time (ES: 0.95), and injury severity (ES: 0.59) in EXP. Furthermore, a possible decrement in total injury incidence was also reported in EXP., Conclusions: The eccentric-based program led to a reduction in muscle-injury incidence and severity and showed improvements in common soccer tasks such as jumping ability and linear-sprinting speed.