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BACKGROUND The dermoscopic findings of papulopustular rosacea include tiny papules and pustules, follicular plugs and follicular dilatation. Demodex tails and Demodex follicular openings are dermoscopic indicators that are mainly found in primary demodicosis and, less frequently, in rosacea. AIM To describe the dermoscopic features of papulopustular rosacea and to investigate the differential dermoscopic features between patients with and without concomitant Demodex infestation. METHODS We conducted a prospective study of patients with almost-clear, mild or moderate papulopustular rosacea. For each patient, dermoscopic images were taken and a standardized skin surface biopsy was performed. RESULTS In this group of 60 patients, the most frequent dermoscopic findings were yellow dots, vascular polygons and follicular scales. Patients with moderate rosacea had more Demodex follicular openings compared with patients with mild rosacea (P = 0.02), while patients with mild rosacea had a higher frequency of follicular scales than did patients with almost-clear rosacea (P = 0.01). Patients with moderate rosacea had higher rates of Demodex follicular openings (P = 0.02), follicular scales (P

The LEXIS (Large-scale EXecution for Industry & Society) Weather and Climate Pilot is developing a system for the prediction of water-related phenomena and their associated socioeconomic impacts. The system is based on multiple models chained together, as global weather models, high-resolution regional weather models, domain-specific application models (hydrological and forest fire risk forecasts), and impact models providing information (such as air quality and rainfall intensity) for key decisions and policymakers. This chapter describes the key aspect of this pilot in terms of serving model output data and products with cloud and high-performance data analytics environments, on top of a Weather Climate Data API, as well as the porting of models on the LEXIS infrastructure via different virtualization strategies (as virtual machine and dockers).

Background Traditionally, KOH microscopy and fungal culture are the two preferred tests as gold standard for diagnosis of onychomycosis. Recently, other diagnostic methods have been developed to improve the microbiological diagnosis. The EUROArray dermatomycosis kit is a PCR-based microarray test system for the detection and direct identification of species that are most frequently involved in skin and nail infections. Objectives Our primary aim was to evaluate the real-life applicability of the EUROArray dermatomycosis kit in the diagnosis of onychomycoses. In addition, we compared the etiology of onychomycoses found in our patients with those described in the literature. Patients/methods We prospectively studied consecutive 100 patients with suspected onychomycoses. Samples of suspect toenails were taken as part of routine medical management. Nail specimens were evaluated by means of 3 diagnostic methods: KOH preparation, culture and EUROArray dermatomycosis kit. Results Onychomycosis was diagnosed in 47/100 patients who proved positive on at least one reference diagnostic test and in 49/100 patients who proved positive on PCR. The combination of microscopy and PCR had better sensitivity than microscopy (p=0.0397), fungal culture (p=0.0061) and PCR alone (p=0 .0117). Molds were more frequently positive in culture than in PCR (p=0.033). Dermatophytes proved positive more frequent than molds and yeasts in both culture and PCR; in particular, Trichophyton interdigitale was the most frequent pathogen. Conclusions In conclusion, introducing EUROArray dermatomycosis kit into the diagnostic algorithm of onychomycosis increases the sensitivity of direct microscopy and yields more rapid results than culture.

The LEXIS project (Large-scale EXecution for Industry & Society, H2020 GA825532) provides a platform for optimised execution of Cloud-HPC workflows, reducing computation time and increasing energy efficiency. The system will rely on advanced, distributed orchestration solutions (Atos YSTIA Suite, with Alien4Cloud and Yorc, based on TOSCA), the High-End Application Execution Middleware HEAppE, and new hardware capabilities for maximising efficiency in data processing, analysis and transfer (e.g. Burst Buffers with GPU- and FPGA-based data reprocessing). LEXIS handles computation tasks and data from three Pilots, based on representative and demanding HPC/Cloud-Computing use cases in Industry (SMEs) and Science: i) Simulations of complex turbomachinery and gearbox systems in Aeronautics, ii) Tsunami simulations and earthquake loss assessments which are time-constrained to enable immediate warnings and to support well-informed decisions, and iii) Weather and Climate simulations where massive amounts of in-situ data are assimilated to improve forecasts. A user-friendly LEXIS web portal, as a unique entry point, will provide access to data as well as workflow-handling and remote visualisation functionality. As part of its back-end, LEXIS builds an elaborate system for the handling of input, intermediate and result data. At its core, a Distributed Data Infrastructure (DDI) ensures the availability of LEXIS data at all participating HPC sites, which will be federated with a common LEXIS Authentication and Authorisation Infrastructure (with unified security model, user database and policies). The DDI leverages best of breed data-management solutions from EUDAT, such as B2SAFE (based on iRODS) and B2HANDLE. REST APIs on top of it will ensure a smooth interaction with LEXIS workflows and the orchestration layer. Last, but not least, the DDI will provide functionalities for Research Data Management following the FAIR principles ("Findable, Interoperable, Accessible, Reusable"), e.g. DOI acquisition, which helps to publish and disseminate open data products.

Traditional usage models of Supercomputing centres have been extended by High-Throughput Computing (HTC), High-Performance Data Analytics (HPDA) and Cloud Computing. The complexity of current compute platforms calls for solutions to simplify usage and conveniently orchestrate computing tasks. These enable also non-expert users to efficiently execute Big Data workflows. In this context, the LEXIS project (‘Large-scale EXecution for Industry and Society’, H2020 GA 825532, https://lexis-project.eu) sets up an orchestration platform for compute- and data-intensive workflows. Its main objective is to implement a front-end and interfaces/APIs for distributed data management and workflow orchestration. The platform uses an open-source Identity and Access Management solution and a custom billing system. The data management API allows data ingestion and staging between various infrastructures. The orchestration API allows execution of workflows specified in extended TOSCA. LEXIS uses innovative technologies like YORC and Alien4Cloud for orchestration or iRODS/EUDAT-B2SAFE for data management, accelerated by Burst Buffers. Three pilot use cases from Aeronautics Engineering, Earthquake/Tsunami Analysis, and Weather and Climate Prediction are used to test the services. On the road towards longer-term sustainability, we are expanding this user base and aiming at the immersion of more Supercomputing centres within the platform.

The knowledge of tropospheric water vapor distribution can significantly improve the accuracy of Numerical Weather Prediction (NWP) models. The present work proposes an automatic and fast procedure for generating reliable water vapor products from the synergic use of Sentinel-1 Synthetic Aperture Radar (SAR) imagery and Global Navigation Satellite System (GNSS) observations. Moreover, a compression method able to drastically reduce, without significant accuracy loss, the water vapor dataset dimension has been implemented to facilitate the sharing through cloud services. The activities have been carried in the EU H2020 TWIGA project framework, aimed at providing water vapor maps at Technology Readiness Level 7.

In the framework of the SINOPTICA project (EU H2020 SESAR, 2020 – 2022), different meteorological forecasting techniques are being tested to better nowcast severe weather events affecting Air Traffic Management (ATM) operations. Short-range severe weather forecasts with very high spatial resolution will be obtained starting from radar images, through an application of nowcasting techniques combined with Numerical Weather Prediction (NWP) model with data assimilation. The final goal is to integrate compact nowcast information into an Arrival Manager to support Air Traffic Controllers (ATCO) when sequencing and guiding approaching aircraft even in adverse weather situations. The guidance-support system will enable the visualization of dynamic weather information on the radar display of the controller, and the 4D-trajectory calculation for diversion coordination around severe weather areas. This meteorological information must be compact and concise to not interfere with other relevant information on the radar display of the controller.Three severe weather events impacting different Italian airports have been selected for a preliminary radar analysis. Some products are considered for obtaining the best radar approach to characterize the severity of the events for ATM interests. Combining the Vertical Integrated Liquid and the Echo Top Maximum products, hazard thresholds are defined for different domains around the airports. The Weather Research and Forecasting (WRF) model has been used to simulate the formation and development of the aforementioned convective events. In order to produce a more accurate very short-term weather forecast (nowcasting), remote sensing data (e.g. radar, GNSS) and conventional observations are assimilated by using a cycling three-dimensional variational technique. This contribution presents some preliminary results on the progress of the project.

The H2020 SINOPTICA Project (2020-2022) aims at exploiting the untapped potential of assimilating remote sensing (EO-derived and ground-based radar) as well as GNSS-derived datasets (including radio occultation data) and in-situ weather stations data. Those data will be used for very high-resolution, very short-range numerical weather forecasts to improve the prediction of extreme weather events to the benefit of Air Traffic Management (ATM) operations. This will be done by setting up a continuously updated database of remote sensing-derived, GNSS-derived and in-situ weather stations variables, in combination with an automated assimilation system to feed an NWP model. SINOPTICA weather forecast results will be integrated into ATM decision-support tools, visualizing weather information on the controller's display, and generating new 4D trajectories to avoid severe weather areas. This contribution presents the initial results of the assimilation of aforementioned observations into the WRF model, operated at cloud-resolving grid spacing, for two case studies: a hailstorm event occured on 11 May 2019 nearby Malpensa airport and a severe convection episode occurred near Punta Raisi airport (Palermo) on 15 July 2020.

Numerical models are operationally used for weather forecasting activities to reduce the risks of several hydro-meteorological disasters. The overarching goal of this work is to evaluate the Weather Research and Forecasting (WRF) model predictive capabilities over the Italian national territory in the year 2018, in two specific cloud resolving configurations. The validation is carried out with a fuzzy logic approach, by comparing the precipitation predicted by the WRF model, and the precipitation observed by the national network. The fuzzy logic technique, by considering different intensity thresholds, allows to identify the reliable spatial scales of the forecasts. The same approach is applied to evaluate the performances of COSMO-2I model, a state-of-the-art numerical model configuration used for operational activities. For the entire year, except for summer, the model predictive capabilities are high, with useful forecasts for structures of medium intensities down to O(10 km) length scales. In summer the skills decrease mainly because of localization errors. The work aims to provide a robust evaluation of the forecast performances of another convection permitting operational meteorological models currently available in Italy.

A novel Coronavirus strain, named “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS‐CoV‐2) was recently identified as the etiological agent of the COronaVIrus Disease 2019 (COVID‐19). Interestingly, a consistent number of COVID‐19‐associated skin manifestations seem to share a certain degree of vascular damage as common pathogenetic mechanism1. Vascular injury may be due to the direct damage of endothelial cells by the virus or may represents an epiphenomenon of a dysregulated host inflammatory responses triggered by the infection2. Here, we describe an unprecedented case of leukocytoclastic vasculitis presenting with a hemorrhagic bullous eruption in a patient affected by COVID‐19.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is creating an unprecedented global public health emergency with the continuous growth of infected individuals worldwide. Italy was one of the first European country to face the first wave of infection outside mainland China. The first case of COVID-19 was confirmed in Lombardy on February 20th , 2020, and subsequently, a rapid increase in the number of detected cases was observed, spreading through Italy and the rest of Europe.3 As of April 22nd , confirmed COVID-19 cases in Italy were 183,957.

Background Little is known about the pathogenesis of scleromyxedema, a life-threatening fibromucinosis disease with immunological dysregulation. Objectives To investigate on T-cell phenotype, function and cytokine biology in search of new insights supporting the immunopathogenesis of the disease. Methods We analysed the frequency of circulating lymphocyte subsets, the T-cell maturation stage, the generation of antigen-specific T-cell lines and T-cell cytokine secretion. Results The analysis of T-cell maturation stage and the TCR spectratyping findings revealed that scleromyxedema patients showed clear immunological signs of long-lasting immune system activation and stimulation leading to a skewed T-cell repertoire. Moreover, these analyses showed that both CD4+ and CD8+ T cells from scleromyxedema patients have a profound deficiency (even after stimulation) relatively to the production of IFN-γ and IL17 with respect to healthy donor control cells, while they are massively skewed towards IL4 secretion after stimulation. Conclusions Our data indicate that a chronic Th2-skewed T-cell response against an unknown target antigen leading to abnormally high IL4 secretion, a pro-fibrotic cytokine, is a main immunological hallmark of scleromyxedema patients. These results, never reported before, may have a translational therapeutic value due to the availability of anti-IL4 agents such as dupilumab.

BACKGROUND: Certolizumab, a pegylated tumour necrosis factor-α inhibitor, reduced disease activity in randomised trials of patients with psoriasis and psoriatic arthritis. Real-life data are missing. OBJECTIVE: To confirm the effectiveness and safety of certolizumab in patients with psoriasis and psoriatic arthritis in routine clinical practice. METHODS: In this retrospective study involving 11 Italian sites, patients with psoriasis and psoriatic arthritis received subcutaneous certolizumab (400 mg loading dose at 0, 2 and 4 weeks, followed by 200 mg every 2 weeks) for up to 52 weeks. Primary outcomes included mean change from baseline in Psoriasis Area and Severity Index (PASI) and modified Nail Psoriasis Severity Index (mNAPSI) scores, and the proportion of patients achieving a 75%, 90% or 100% reduction in PASI score. Other endpoints included Disease Activity Score computed on 44 joints correlated to the erythrocyte sedimentation rate during the first hour (DAS44-ESR), Tender Joint Count (TJC), Swollen Joint Count (SJC), pain (visual analogue scale [VAS] score), inflammatory markers and quality of life (QOL). RESULTS: In the study were enrolled 153 patients (mean age: 55 years). Certolizumab reduced the mean PASI score from baseline by 4.45, 6.30 and 7.58 at weeks 12, 24 and 52, respectively (p

Linear IgA bullous dermatosis (LABD) is characterized by presence of multiple IgA autoantibodies, and a comparatively lesser number of IgG antibodies, directed against different hemidesmosomal antigens. The main autoantigens are LAD-1, LABD-97, BP180 and BP230, type VII collagen and laminin 332. We retrospectively studied the serology of 54 Italian patients with LABD using enzyme-linked immunosorbent assay (ELISA), immunoblotting assay, and indirect immunofluorescence on monkey oesophagus and salt-split skin. Among these, indirect immunofluorescence of salt-split skin elicits the greatest sensitivity. Sixty-three percent of the sera were observed to be positive, with a lamina lucida pattern observed in 48%, a sub-lamina densa pattern in 2% and a mixed pattern in 13% of the cases. IgA reactivity to LAD-1 on immunoblotting was found in 52% of sera, to BP180-NC16A by ELISA in 32% and to BP230 in 26%. Only 17% of patients possessed circulating IgG autoantibodies. LAD-1 was determined to be a major autoantigen of the lamina lucida subtype. Combined serological assays demonstrated a high sensitivity (82%), suggesting that this approach could support diagnosis when a biopsy is not feasible or direct immunofluorescence results are negative.

Background Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable. Objective To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment. Methods A consensus document was written by an expert panel composed by dermatologists (n = 12) and rheumatologists (n = 6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) using the Delphi method. Results A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biologic disease-modifying antirheumatic drugs to be considered for the treatment of PsA have been reported. Conclusions The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Introduction La maladie xanthogranulomateuse de l’adulte est une rare hystiocytose a cellule non-Langerhans et mal diagnostiquee qui affecte la region orbitale et les annexes cutanees. Elle est classee en quatre types [le xanthogranulome de l’adulte (AOX), l’asthme de l’adulte et le xanthogranulome perioculaire (AAPOX), le xanthogranulome necrobiotique (NBX) et la maladie d’Erdheim–Chester (ECD)] avec des aspects pronostiques et therapeutiques differents. Dans cette communication, nous presentons le cas d’une patiente presentant un xanthogranulome orbital qui avait ete auparavant diagnostique comme un xanthelasma de la zone peri-oculaire. Materiel et methodes Une femme de 64 ans a ete admise dans notre service en se plaignant d’un gonflement palpebral bilateral empechant les mouvements palpebraux. L’examen physique a revele des plaques bilaterales brun-jaunâtre dures, sensibles et infiltrees dans la region periorbitaire. La patiente presentait un ectropion et un ptosis avec une amplitude limitee d’excursion des yeux. Aucune autre lesion de la peau n’a ete observee. L’examen ophtalmologique a exclu une keratite, une episclerite et une uveite anterieure. L’acuite visuelle etait preservee. Les antecedents medicaux du patient etaient : syndrome de Cogan avec hypoacousie depuis 2013, gammapathie monoclonale lambda de signification indeterminee (MGUS, type IgG) avec hypogammaglobulinemie diagnostiquee en 2015, et leucemie lymphoide chronique (LLC) diagnostiquee en septembre 2016 par biopsie de moelle osseuse (RAI 0). Resultats Une biopsie incisionnelle a ete realisee et l’examen histologique a montre un infiltrat inflammatoire cellulaire compose de nombreux histiocytes spumeux et des cellules geantes de type Touton accompagnes d’agregations de lymphocytes et de plasmocytes. Les colorations S-100 et le CD1a etaient negatifs. Sur la base de la presentation clinique du patient, de son histoire clinique et de l’histologie, le diagnostic de xanthogranulome necrobiotique (NBX) a ete pose. La therapie, non encore standardisee, consiste en l’utilisation d’injections intralesionnelles de corticosteroides, de traitements immunosuppresseurs (corticosteroides, cyclosporine et methotrexate) et de medicaments cytostatiques (vincristine, doxorubicine et cyclophosphamide). Le debulking chirurgical est une approche prevue, en particulier pour la forme NBX.

Compared to emergency surgery, self-expandable metallic stents are effective and safe when used as bridge-to-surgery (BTS) in operable patients with acute colorectal cancer obstruction. In this study, we report data on the new conformable colonic stents.To evaluate clinical effectiveness of conformable stents as BTS in patients with acute colorectal cancer obstruction.This was a retrospective study.The study was conducted at six Italian Endoscopic Units.Data about patients with acute malignant colorectal obstruction were collected between 2007 and 2012.All patients were treated with conformable stents as BTS. Technical success, clinical success, rate of primary anastomosis and colostomy, early and late complications were evaluated.Data about 88 patients (62 males) were reviewed in this study. Conformable SEMS were correctly deployed in 86 out of 88 patients, with resolution of obstruction in all treated patients. Tumor resection with primary anastomosis was possible in all patients. A temporary colostomy was performed in 40. Early complications did not occur. Late complications occurred in 11 patients. Stent migration was significantly higher in patients treated with partially-covered stents compared to the uncovered group (35% vs. 0%, P0.001). Endoscopical re-intervention was required in 12% of patients. One patient with rectal cancer had an anastomotic dehiscence after surgery and he was successfully treated with endoscopic clipping. One year after surgery, all patients were alive and local recurrence have not been documented.This was a retrospective and uncontrolled study.Preliminary data from this large case series are encouraging, with a high rate of technical and clinical success and low rate of clinically relevant complications. Partially-covered SEMS should be avoided in order to reduce the risk of endoscopic re-intervention.

Background: Hidradenitis suppurativa (HS) is a chronic relapsing inflammatory skin disease characterized by a significant impairment of patients’ quality of life (QoL). It has been recently found that clinical severity of HS does not correlate well with QoL. Therefore, it is important to enhance the evaluation of severity considering the disease burden on QoL. Recently, a new graphical tool able to better describe HS burden, the so-called HIDRAdisk, has been introduced. Objective: To investigate the utility of HIDRAdisk in clinical practice before and after treatment and to analyse whether specific factors such as age and gender may influence the outcomes in patients with moderate-to-severe HS. Methods: A single-centre retrospective study on 24 patients (13F/11M, mean age 38±15years) with moderate-to-severe HS was performed. Clinical data (disease severity and quality of life) were collected at baseline and after 12weeks of adalimumab. Results: HIDRAdisk showed significantly better improvements in males (69.8±6.2–49.6±10.8) compared to females (80.7±6.0–72.3±6.7), P&nbsp

With the appearance of tools to support the emerging paradigm of edge computing, we expect that low cost microcontrollers will become appealing execution platforms also for machine learning. To explore this field, we implemented Machine Learning eMbedded Library (ML)2 and tested it in a simple case (classifying human movement as normal or not) and with a benchmark dataset to have a first comparison in performance with other implemented algorithms. Results—in terms of accuracy and of execution time, both for training and classification—are promising, and encourage the next steps of our work, in the direction of extending the set of implemented algorithms and going more in depth with the testing. In any case, we believe that these preliminary results should spur the Internet of Things research community in devising distributed computing algorithms able to support ML computation as close as possible to the source.

Background: Hidradenitis suppurativa (HS) is a chronic, relapsing, inflammatory skin disease characterized by painful inflamed nodules, recurrent abscesses and fistulas located in apocrine gland–bearing body sites. The negative impact of HS on patient's quality of life (QoL) has been reported to be greater than other dermatologic conditions as psoriasis and atopic eczema, and its improvement is an important goal in disease management. Nowadays, there are no specific validated QoL instruments available for HS and generic dermatologic questionnaires are used. Objective: The objective of this study was to demonstrate the validity, reliability and responsiveness of HIDRAdisk, a new innovative tool designed for rapid assessment of HS burden and, at the same time, an intuitive graphic visualization of the measurement outcome. Methods: A multicentre, longitudinal, observational study was conducted to validate the HIDRAdisk compared with other validated questionnaires [Skindex-16, Dermatology Life Quality Index (DLQI), Work Productivity and Activity Impairment–General Health (WPAI:GH)] and to evaluate its correlation with disease severity in Italian patients with any degree of HS severity, as measured by Hurley stage and HS Physician Global Assessment (HS-PGA). Results: A total of 140 patients (59% women; mean age 34.9±11.0years) were enrolled in 27 dermatologic centres. HIDRAdisk showed a strong correlation with Skindex-16 and DLQI, and a good one with WPAI:GH (correlation coefficient: 0.7568, 0.6651 and 0.5947, respectively) and a statistically significant correlation with both Hurley stage and HS-PGA. Very good internal consistency (Cronbach coefficient >0.80; intraclass correlation coefficient >0.6), with correlation between the 10 items, good test–retest reliability (Spearman correlation coefficient, 0.8331; P&nbsp

Barrett’s Esophagus diagnosis is a combination between an endoscopic suspect and a histological confirmation of endoscopic biopsies showing intestinal metaplasia. Current guidelines codify biopsies protocols but none of these guarantees the recognition of intestinal metaplasia areas: sampling error is an-in-ambush pitfall and misdiagnosis is a concrete possibility.

Background and study aims Endoscopic treatment is the mainstay approach for gastrointestinal bleeding, in either upper (UGIB) or lower (LGIB) tract. The over-the-scope clip (OTSC) may overcome limitations of standard clips or thermocoagulation in high-risk bleeding lesions. We evaluate the main clinically relevant outcomes following endoscopic hemostasis with OTSC in high-risk lesions and/or patients. Patients and methods This was a retrospective analysis of prospectively collected databases including all patients with UGIB and LGIB who underwent OTCS placement as first-line treatment in eleven tertiary endoscopic referral centers. Technical success, primary hemostasis, rebleeding, blood transfusion, hospital stay, and hemorrhage-related mortality rates were evaluated. Results Data from 286 patients, with either UGIB (N = 214) or LGIB (N = 72) were available. Overall, 112 patients (39.2 %) were receiving antithrombotic therapy. Technical success and primary hemostasis rates were 97.9 % and 96.4 %, respectively. Early rebleeding occurred in 4.4 %, more frequently in those on antithrombotic therapy, and no late rebleeding was observed. Following a successful primary haemostasis, only 5.2 % patients needed blood transfusions, and the median hospital stay was 4 days (range: 3 – 11). Eighteen patients with either technical failure (N = 6) or rebleeding (N = 12) underwent radiological or surgical approaches. Overall, bleeding-related deaths occurred in 5 (1.7 %) patients, including 3 patients with technical procedural failure, and 2 in the rebleeding group. Conclusions Data from our large, multicenter study show that OTSC placement is an effective first-line treatment for hemostasis in high-risk patients and/or lesions both in upper and lower gastrointestinal tract.