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The debate on climate change has increasingly attracted attention, especially among young people, since the foundation of the movement Friday for Future and the raising fame of Greta Thunberg. Social media websites can be used as a data source for mining public opinion on a variety of subjects including climate change. Twitter, in particular, allows for the evaluation of public opinion across time. Although it is a known problem that Twitter population is biased with respect to the whole population, it is also true that Twitter users are more likely to be young people. For this reason, the sentiment analysis of Twitter textual data on climate topics provides valuable insights into the climate discussion and could be considered as representative of the rising climate movement. In this study, a large dataset of Italian tweets between 2016 and 2022 containing a set of keywords related to climate change (e.g. Global warming, sustainable development, etc.) is analysed using volume analysis and text mining techniques such as topic modelling and sentiment analysis. Topic modelling, performed using word embedding, allows validating the keywords’ set and providing the prevalent discussion in Italy about the climate agenda and the major concerns related to climate emergency. Both daily volume and sentiment of tweets series have been analysed. The first series allows assessing the Italian participation to the climate debate, while the latter provides useful insights on the overall evolving mood during these years. In particular, we show that the major Italian concerns are related with global warming with a negative mood while a positive mood is recorded when public policies on environment are implemented.

In recent years, Eurostat promoted Experimental Statistics, i.e., statistics that “have not reached full maturity in terms of harmonization, coverage or methodology”. These statistics are based on new data sources, mainly Big Data, able to improve timeliness and provide new complementary measures to Official Statistics estimates. However, the use of Big Data implies new quality challenges, and a well-defined Big Data quality framework is not available. The Social Mood on Economy Index (SMEI) is among the first experimental statistics on Big Data published by the Italian National Statistics Institute (Istat) since 2018. SMEI is a daily index computed from the Italian Twitter’s public stream aimed at representing the evolution of the feelings on economics topics. The longevity of SMEI makes it a perfect candidate to investigate Big Data related quality issues. Its intrinsic multivariate approach hinders the interpretation of the index. Are we able to track its quality characteristics? What are specific uses of the SME index? The paper will report current discussion and solutions implemented at Istat, in particular it focuses on SMEI’s revision due to COVID-19 pandemic. The present work is aiming at contributing to the ESS debate on setting up quality standards for processing Big Data-based statistical products.

The primary aim of this study was to assess the reliability, intra- and inter-observer variation of the SPICE, Mucosal protrusion angle (MPA) and SHYUNG scores in differentiating a subepithelial mass (SEM) from a bulge.This retrospective multicentre study analysed the 3 scores, radiological studies, enteroscopy and/or surgical findings.100 patients with a potential SEM (mean age 57.6years) were recruited with 75 patients having pathology. In patients with a SEM the mean SPICE score was 2.04 (95% CI 1.82-2.26) as compared to 1.16 (95% CI 0.81-1.51) without any pathology (AUC 0.74, p0.001), with a fair intra-observer agreement (Kappa 0.3, p0.001) and slight inter-observer agreement (Kappa 0.14, p0.05). SPICE had a 37.3% sensitivity and 92.0% specificity in distinguishing between a SEM and bulge, whereas MPA90˚ had 58.7% and 76.0% respectively, with poor intra-observer(p = 0.05) and interobserver agreement (p = 0.64). The SHYUNG demonstrated a moderate intra-observer (Kappa 0.44, p0.001) and slight inter-observer reliability (Kappa 0.18, p0.001). The sensitivity of an elevated SHYUNG score (≥4) in identifying a SEM was 18.7% with a specificity of 92.0% (AUC 0.71, p = 0.002).Though these scores are easy to use, they have, at best, slight to moderate intra and inter-observer agreement. Their overall diagnostic performances are limited.

Background and Aims: Meckel's diverticulum (MD) may remain silent or be associated with adverse events such as GI bleeding. The main aim of this study was to evaluate indicative small-bowel capsule endoscopy (SBCE) findings, and the secondary aim was to describe clinical presentation in patients with MD. Methods: This retrospective European multicenter study included patients with MD undergoing SBCE from 2001 until July 2021. Results: Sixty-nine patients with a confirmed MD were included. Median age was 32 years with a male-to-female ratio of approximately 3:1. GI bleeding or iron-deficiency anemia was present in nearly all patients. Mean hemoglobin was 7.63 ± 1.8 g/dL with a transfusion requirement of 52.2%. Typical capsule endoscopy (CE) findings were double lumen (n = 49 [71%]), visible entrance into the MD (n = 49 [71%]), mucosal webs (n = 30 [43.5%]), and bulges (n = 19 [27.5%]). Two or more of these findings were seen in 48 patients (69.6%). Ulcers were detected in 52.2% of patients (n = 36). In 63.8% of patients (n = 44), a combination of double lumen and visible entrance into the MD was evident, additionally revealing ulcers in 39.1% (n = 27). Mean percent SB (small bowel) transit time for the first indicative image of MD was 57% of the total SB transit time. Conclusions: Diagnosis of MD is rare and sometimes challenging, and a preoperative criterion standard does not exist. In SBCE, the most frequent findings were double-lumen sign and visible diverticular entrance, sometimes together with ulcers.

BACKGROUND Pancreatic cystic lesions (PCLs) are considered a precursor of pancreatic cancer. Needle-based confocal endomicroscopy (nCLE) is an imaging technique that enables visualization of the mucosal layer to a micron resolution. Its application has demonstrated promising results in the distinction of PCLs. This study evaluated the utility of nCLE in patients with indeterminate PCLs undergoing endoscopic ultrasound fine-needle aspiration (EUS-FNA) to distinguish mucinous from non-mucinous lesions. AIM To evaluate the accuracy of nCLE in indeterminate PCLs undergoing EUS-FNA to distinguish mucinous from non-mucinous lesions. METHODS Patients who required EUS-FNA between 2015 and 2017 were enrolled prospectively. During EUS-FNA, confocal imaging, analyses of the tumor markers carcinoembryonic antigen and amylase, and cytologic examination were conducted. All patients were followed for at least 12 mo and underwent laboratory testing and computed tomography scanning or magnetic resonance imaging. nCLE videos were independently reviewed by 6 observers to reach a final diagnosis (mucinous vs non-mucinous) based on criteria derived from previous studies; if there was disagreement > 20%, a final diagnosis was discussed after consensus re-evaluation. The sensitivity, specificity, and accuracy of nCLE were calculated. Adverse events were recorded. RESULTS Fifty-nine patients were included in this study. Final diagnoses were derived from surgery in 10 patients, cytology in 13, and imaging and multidisciplinary team review in 36. Three patients were excluded from final diagnosis due to problems with nCLE acquisition. Fifty-six patients were included in the final analysis. The sensitivity, specificity, and accuracy of nCLE were 80% [95% confidence interval (CI): 65-90], 100% (95%CI: 72-100), and 84% (95%CI: 72-93), respectively. Post-procedure acute pancreatitis occurred in 5%. CONCLUSION EUS-nCLE performs better than standard EUS-FNA for the diagnosis of indeterminate PCL.

In the setting of chronic liver disease, capsule endoscopy is safe and well tolerated, making it an appealing diagnostic procedure. It is used mainly for the surveillance of esophageal varices, investigation of anemia, and exploration of the small bowel for complications of portal hypertension. Capsule endoscopy is recognized as a viable alternative in patients unable or unwilling to undergo upper gastrointestinal endoscopy for investigations of esophageal varices. In evaluating the small bowel of patients with liver disease and unexplained anemia, capsule endoscopy increases recognition of mucosal abnormalities, although their clinical significance is often unclear.

limited evidence is available to guide hepatologists regarding endoscopic surveillance of oesophageal varices (EV) in Hepatitis C Virus (HCV)-positive cirrhotic patients achieving a sustained virologic response. To address these issues, we conducted a long-term prospective study on 427 HCV-positive cirrhotic patients successfully treated by Direct Antiviral Agents (DAAs).Patients were divided into two groups according to their baseline Baveno VI status: Group 1 (92, 21.5%, favourable Baveno VI status) and Group 2 (335, 78.5%, unfavourable Baveno VI status). Each patient underwent baseline endoscopy and was endoscopically monitored for a median follow-up of 65.2 months according to Baveno VI recommendations.About 4.3% of Group 1 patients showed baseline EV compared with 30.1% of Group 2 patients (p .0001). No patients belonging to Group 1 without baseline EV developed EV at follow-up endoscopy compared with 6.5% in Group 2 patients (p = .02); 69/107 (64.5%) patients with baseline EV showed small varices. During the endoscopic follow-up, EV disappeared/improved in 36 (33.6%), were stable in 39 (36.4%) and worsened in 32 (29.9%) patients, all belonging to Group 2 (p = .001). Improvement in Baveno VI status was observed in 118/335 (35.2%, p .0001) of Group 2 patients and among those without pre-therapy EV, none developed EV throughout the follow-up.HCV-positive cirrhotic patients cured by DAAs showing baseline favourable Baveno VI status and no worsening during follow-up can safely avoid endoscopic screening and surveillance. Patients having unfavourable Baveno VI status without baseline EV who improve their status may suspend further endoscopic surveillance.

This is a prospective and comparative study including 76 consecutive patients performing EUS-FNB for pancreatic and extrapancreatic solid lesions, randomized by alternate allocation to macroscopic on-site evaluation (MOSE) (40 patients) or to a conventional technique (40 patients), with three passes each. MOSE samples were differentiated into score 0: no visible material, score 1: only necrotic or haematic material, score 2: white core tissue ≤ 2 mm, or score 3: white core tissue > 2 mm. The conventional technique consisted in pushing all the needle content into a test tube for evaluation by the pathologist. In both groups, a 22–25 Gauge Franseen-tip needle (Acquire, Boston Scientific Co., Natick, MA, USA) was used. The study evaluated the diagnostic accuracy and adequacy of MOSE compared to the conventional technique and whether MOSE could optimize the number of passes during EUS-FNB. Results: The analysis was performed on 76 patients (38 MOSE, 38 conventional). The overall diagnostic adequacy was 94.7% (72/76) and accuracy was 84.2% (64/76). The diagnostic accuracy was similar in the two groups: MOSE 86.8% (33/38 lesions), vs. conventional 81.6%, 31/38 lesions, p = 0.76). Regarding diagnostic adequacy, the MOSE technique was 97.4% (111/114 passes) compared to 92.1% (105/114 passes) with the conventional technique, p = 0.06. The accuracy increased according to the MOSE score evaluation: it was 43.5%, 65.5% and 78.3% in patients with score 1, score 2, and score 3, respectively. Moreover, if in the first two passes the MOSE score was 2 or 3, the accuracy was 82.6% (20/23), and upon adding a third pass, the accuracy increased to 87% (20/23), which was not significantly different from the general accuracy of the MOSE samples (86.8%) (p = 0.86). Conclusions: The MOSE score showed a comparable diagnostic accuracy to the conventional technique. However, MOSE allows endoscopists to perform an inspective evaluation of the material, tends to perform better than the conventional technique in terms of diagnostic adequacy, and may potentially reduce the number of passes.

Phenomena such as engagement, attention and curiosity rely heavily on the “optimal-level of stimulation (or arousal)” model, which suggests they are driven by stimuli being neither too simple nor too complex. Two points often overlooked in psychology are that each stimulus is simultaneously processed with its context, and that a stimulus complexity is relative to an individual’s cognitive resources to process it. According to the “optimal-level of stimulation” model, while familiar contexts may decrease the overall stimulation and favour exploration of novelty, a novel context may increase the overall stimulation and favor preference for familiarity. In order to stay closer to their optimum when stimulation is getting too high or too low, individuals can explore other stimuli, adopt a different processing style or be creative. The need and the ability to adopt such strategies will depend upon the cognitive resources available, which can be affected by contextual stimulation and by other factors such as age, mood or arousability. Drawing on empirical research in cognitive and developmental psychology, we provide here an updated “optimal-level of stimulation” model, which is holistic and coherent with previous literature. Once taken into account the role of contextual stimulation as well as the diverse factors influencing internal cognitive resources, such model fits with and enriches other existing theories related to exploratory behaviours. By doing so, it provides a useful framework to investigate proximate explanations underlying learning and cognitive development, and to develop future interventions related, for example, to eating, and learning disorders.

The Solimoes and Acre basins are complex geological units related to the Andean uplift, covering the Northwestern region of Brazil, being one of the most important units due to their fossil diversity. In order to produce a document that integrates part of the fossil records of this region, we compiled/georeferenced localities from literature on which tetrapods are described, focusing on Solimoes Formation but not restricted to this unit. We were able to recognize 208 localities, documented in over two centuries of reports of fossils from several taxonomic groups from the proto-Amazonia, 199 new entries in Paleobiology Database. We summarize, for each locality, its geographical position, geological information, age, and data of the paleodiversity. Most outcrops in the Amazonia region are located on river banks (~96%), while road cuts and other non-riverside outcrops represent the remainder (~4%). Most tetrapod are Mammalia, followed by Testudinata, and Crocodyliformes. This work reinforces the need for a more controlled and refined prospecting at the Solimoes/Acre Basins, especially in the Solimoes Formation, which represents the majority of fossiliferous records, to help answer old questions, such as dating, and new ones, here discussed, such as the paleodiversity patterns and temporal distribution among the mapped localities.

The aims of this observational “proof-of-concept” study were to analyze the clinical/psychological characteristics and gut microbiota/mycobiota composition of individuals with suspected non-celiac gluten/wheat sensitivity (NCGS/WS) according to responses to the double-blind-placebo-controlled (DBPC) crossover gluten challenge test. Fifty individuals with suspected NCGS/WS were subjected to the DBPC challenge test, anthropometric measurements, psychometric questionnaires, and fecal samples were collected. Twenty-seven (54%) participants were gluten responsive (NCGS), and 23 were placebo responsive, with an order effect. NCGS individuals displayed a significantly lower risk of eating disorders and a higher mental health score when compared to placebo-responsive participants, confirmed by multiple logistic regression analyses (OR = 0.87, 95% CI 0.76–0.98, p = 0.021, and OR = 1.30, 95% CI 1.06–1.59, p = 0.009, respectively). Principal coordinate analyses based on microbiota composition showed a separation by the DBPC response (p = 0.039). For Bacteroides (p = 0.05) and Parabacteroides (p = 0.007), the frequency of amplicon sequence variants was lower, and that for Blautia (p = 0.009) and Streptococcus (p = 0.004) was higher in NCGS individuals at multiple regression analyses. No difference in the mycobiota composition was detected between the groups. In conclusion, almost half of the individuals with suspected gluten sensitivity reported symptoms with placebo, they showed lower mental health scores, increased risk for eating disorders, and a different gut microbiota composition.

As the clinical applications of endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) take more and more root in everyday practice and these endoscopic procedures become increasingly more complex and interventional with a higher chance for complications, the demand for expert bilio-pancreatic endoscopists continues to increase. In response to this growing need, specific postgraduate fellowships have been developed, however the standardization of training programs and the assessment of the achieved competence still remains an open debate. ERCP and EUS competency often requires training beyond the scope of a standard GI fellowship program, which lasts at least 1-2 years, and there are some differences in the way to face the issues of advanced bilio-pancreatic endoscopy training between Europe, America and the Asian regions. Today there is no role for the self-teaching of ERCP and EUS through trial and error without supervision and, in the near future, it is necessary to critically revise current training guidelines, to establish a standardized curriculum for advanced bilio-pancreatic endoscopists and to implement universally validated skill assessment tools, able to ensure constant and targeted feedback to trainees.

Background and Aims Little is known about small-bowel (SB) capsule endoscopy (CE) in patients with a history of gastric surgery. This study aims to evaluate the feasibility and diagnostic yield (DY) of orally ingested SB-CE in patients with surgically altered gastric anatomy. Methods Twenty-four European centers retrospectively identified patients who had SB-CE after total or subtotal gastrectomy. The primary outcome was the DY of SB-CE (intermediate P1 to highly P2 relevant findings). Secondary outcomes were gastric and SB transit times, completion, cleanliness, and adverse event rates. Results Studied were 248 procedures from 243 patients (mean age, 62 years) with a history of partial gastrectomy (Billroth I, 13.1%; Billroth II, 34.6%), total gastrectomy (7.4%), Whipple procedure (12.8%), sleeve gastrectomy (7.2%), or gastric bypass surgery (24.7%). Obscure GI bleeding was the most frequent indication (85.1%). SB completion rate was 84.3%. One capsule retention in the SB was noted (adverse event rate, .4%). Median SB transit time was 286 minutes (interquartile range [235; 387]). Cleanliness was rated as adequate in 92.1% of procedures. After exclusion of abnormalities found at the upper anastomotic site, the DY was 43.6%, with inflammatory/ulcerated lesions observed more frequently (23.4%) than vascular lesions (21.0%). Conclusions SB-CE seems to be feasible and safe in selected patients with a history of major gastric surgery and comes with a high DY. The spectrum of abnormal SB findings in these patients may be different from what is known from the literature in nonoperated patients.

Melanosuchus latrubessei sp. nov. (Figure 2, 3, 4, 5 and 6) Zoobank species: urn:lsid:zoobank.org:act: BB6E5F62-348B-4880-BB42-423BA34E0EE4 Holotype. UFAC 2793, right part of a rostrum. Etymology. The specific epithet latrubessei is in honor to the Argentinean geomorphologist Dr. Edgardo M. Latrubesse. His geopaleontological contributions were very important to the increase of knowledge about origin and evolution of the Solimıes Formation. Dr. Edgardo also provided important scientific contributions for Universidade Federal do Acre through collaborations in partnership with Laboratório de Pesquisas Paleontológicas. Diagnosis. Melanosuchus latrubessei possess the following autapomorphies: (1) the contact between maxillamaxilla is elongated and extends from the space between the second and third alveoli until to the space between the sixth and seventh alveoli; and (2) the rostral ridge 2 is well-developed and well-marked, being anteroposteriorly inclined, and composed exclusively by the maxillary bone. Occurrence. The Talism „ outcrop is located on the bank of the Purus River, in Southern region of the Amazonas State, Brazil (08°46’37,8”S; 68°54’15,1”W; Figure 1). The outcrop has approximately eight meters of vertical length and the rocks are formed by fine grained silts and clays floodplain sediments, with secondary gypsum and carbonate veins. Presenting his maximum deposition 10.89 ± 0.13 Ma, being at least Tortonian in age (Bissaro- Júnior et al. 2019). Description. The skull fragment has a maximum length of 287 mm and maximum width of 87.7 mm (measured at the level of third maxillary alveolus). The holotype of M. latrubessei, UFAC 2793, consists on the right half of the rostrum, with only the posterior portion of the premaxilla preserved, almost complete maxilla and the nasal bone lacking the most posterior region (Figure 2, 3 and 4). A small fragment of the right ectopterygoid is also preserved and articulated with the posterior portion of the maxilla (Figure 3). The premaxilla lacks most of the lateral and anterior region; therefore, no alveoli is preserved. In dorsal view, the premaxilla, preserves the right lateral and posterior portions of the external nares (Figure 2) and, in ventral view, preserves only the right lateral margin of incisive foramen (Figure 3). The maxilla has preserved the joint surface with the jugal, which can be seen in the dorsal and lateral views (Figure 2 and 4). In ventral view, the maxilla presents, in its posterior middle corner, the articular surface of the anterior process of the palatine and on the lateral margin, twelve alveoli (Figure 4). No diagenetic torsions or modifications, beside those of the broken portions, are observed. M. latrubessei UFAC 2793 presents a well-marked bone ornamentation uniformly distributed along the entire dorsal surface of the rostrum, with exception of the region around the external nares (Figure 2 and 4). The ornamentation consists of irregular but usually round and well-marked pits, with small variations in size. The external nares have only the posterior margin and the posterior lateral margin preserved (Figure 2). The posterior margin, although not complete, appears to form an almost straight line, with a shallow convexity at the transition to the lateral margins. The lateral margin opens laterally, with the anterior portion more lateralized than the posterior, this inclination makes the anterior margin of the external nares wider than the posterior one (Figure 2). Only the right lateral middle portion of the incisive foramen is preserved, this portion represents a shallow concavity that is in the posterior portion of the premaxilla (Figure 3). However, in the absence of premaxillary alveoli and the fragmentary condition of the structure, the exact location and shape of the incisive foramen can only be tentatively inferred. This shallow concavity seems to be related to an anteroposteriorly long incisive foramen, which probably extends from the last and penultimate premaxillary alveoli to, at least, the third premaxillary alveoli (considering five premaxillary alveoli, found in Crocodylia—Brochu 1999, 2011, 2013). However, the shape of incisive foramen as a whole cannot be inferred. The right suborbital fenestra is partially preserved, and only the portions that contribute to the maxilla are present, with the anterior portion of the lateral margin and the lateral portion of the anterior margin (Figure 3). The preserved anterior margin is a shallow concavity and the lateral margin is straight and slightly inclined mediolaterally, with the anterior portion more medial than the posterior one (Figure 3). The maxillary margin of the suborbital fenestra is straight, without any projection in the fenestra; moreover, the anterior margin of suborbital fenestra reaches the space between the ninth and the eighth alveoli (Figure 3). The premaxilla, in dorsal view, has a posterior wedge-shaped process that extends until the position of the third maxillary alveolus. This posterior process has the apex aligned with the suture between the maxillary-nasal, being the lateral portion of the premaxilla posterior process sutured with the maxilla, in the most anterior part, and medially with the nasal bone (Figure 2 and 4). The premaxilla has a continuous crest delimiting the lateral and posterior limits of the external nares, which is here referred as narial crest (Figure 2 and 4). It is important to note that, in dorsal view, the right premaxilla sutures with the left premaxilla, at least dorsally, with this contact being located immediately posterior to the margin of the external nares (Figure 2). The premaxilla-premaxilla contact in dorsal view can be better evidenced in a sagittal cut, where the medial surface of the right premaxilla and right nasal can be observed (Figure 5). The posterior margin of the external nares, composed entirely by the premaxilla, is preserved and does not have sutures with the nasal bones (Figure 5 a, b). The anterior portion of the nasal bone is broken, immediately above the anterior portion of the premaxilla. However the premaxilla is complete, indicating an overlapping suture (i.e. at least at this anterior portion the premaxilla lies over the nasal) (Figure 5 a, d). This relation between premaxilla and nasal can be better understood due to the break of the nasal in ventral view, which evidences a contact between those bones and not a fusion demarcating a suture (Figure 5 c). Moreover, the medial surface of the premaxilla is rugose as expected to a premaxilla-premaxilla contact, while the nasal bones present a horizontal and parallel lines, as expected in nasal-nasal contact (Figure 5 d). The nasal bone is broad in the lateromedial direction, with its anterior wedge-shaped projection. The premaxillarymaxillary suture contacts the lateral limit of the nasal at the point where the wedge-shaped process begins (Figure 2). The maxilla, in dorsal view, contacts anteriorly with the premaxilla and nasal, while having exclusive medial contact with the nasal bone (Figure 2 and 4). There are a total of twelve maxillary alveoli. The longitudinal measurements of each alveolus, from the anterior most to the posterior most are, respectively (in mm): 6.88; 11.33; 14.75; 17.95; 9.58; 7.65; 7.29; 9.46; 11.32; 11.36; 10.9; and 8.19. The eighth alveolus has a preserved tooth, which did not have a complete dental eruption in vivo; therefore, the non-exposure of this tooth prevents a detailed description of its morphology. However, the apex of the tooth is visible and represents a convex structure. The lateral border of maxilla, in dorsal and ventral views, has the anterior (position anteriorly to the first maxillary alveolus) and posterior (position of the eleventh and twelfth maxillary alveoli) portions projecting laterally. At the level of the fourth alveolus, in both dorsal and ventral views, there is a well-developed convexity (Figure 2 and 4). In lateral view, the ventral margin of the maxilla has a well-marked concavity anteriorly to the convexity at the level of fourth maxillary alveolus, and posterior to this convexity there is another shallow concavity (Figure 4). In the posterior region of the maxilla, there is a surface corresponding to the contact between maxilla-jugal, where the jugal bone overlies the maxilla (Figure 2 and 4). However, the jugal is not preserved. The maxilla also has two well-developed rostral ridges (Figure 2 and 4). The first (rostral ridge 1) is associated with the high development of the canthi rostralii; thus, although the interorbital region is not preserved, the presence of a well-developed canthi rostralii is proposed. Therefore, this difference in saturation surface reinforces the idea of a premaxilla-premaxilla contact exposed in dorsal view. However, as the nasal is not entirely preserved, we cannot rule out the possibility of nasal bones with a continuous contribution with the anterior process within the external nares, passing bellow the premaxilla-premaxilla contact (Figure 5 d). In ventral view, the premaxilla-maxilla suture passes within the tooth occlusal pit. From the fourth dentary, and posteriorly to this excavation the suture has a small posterior wedge-shaped process that extend to the posterior end of the first maxillary alveoli (Figure 3). The other rostral ridge (rostral ridge 2) is entirely located within the maxilla next to the premaxilla-maxilla suture, in dorsal view (Figure 2 and 4), and represents a dorsoventrally inclined bone intumescence, with the anterior portion ventral to the posterior (Figure 4). In ventral view, the maxilla-maxilla suture extends straight from the third to the sixth alveolus (Figure 3). Prior to the maxilla-maxilla suture, there is a smooth maxillary portion that opens slightly laterally and is here interpreted as the contact surface with the vomer. At the posterior limit of the maxilla, immediately behind the intermaxillary suture, there is the sutural region of the palatine, which is evidenced by a surface with thin crests. Thus, the palatine extends anteriorly to the level of the sixth alveoli (Figure 3). At the posterior limit of the maxilla in ventral view, immediately posterior to the tooth row, there is the maxillaectopterygoid contact, with a small portion of the anterior region of the ectopterygoid being preserved (Figure 3). The ectopterygoid does not form the medial margin of any maxillary alveolus and the anterior process of this structure does not exceed the twelfth maxillary alveolus (Figure 3). The lateral portion of the maxilla to the suborbital fenestra is wide, being at least twice the width of the tenth alveolus (Figure 3). Despite the fact that the vomer is not preserved and the region between the maxilla and premaxilla is severely damaged, there are some clear evidences in both the premaxilla and the maxilla of the presence of the vomer, which will be presented below. The first evidence is the presence of the aforementioned smooth anterior surface to the end of the maxilla-maxilla suture, which opens laterally and corresponds to the articular surface between the maxilla and the vomer (Figure 2 and Figure 6 b, c). The second evidence can be seen in medial view, due to the sagittal cut where the ventral portion of premaxilla has an intumescent region, which is broken but clearly detectable, with this structure being correspondent to the posterior portion of the premaxilla that contacts the anterior limit of the vomer (Figure 6 a). Additionally, it is important to note that the broken pattern observed in the transition zone between premaxilla and maxilla can be expected for a specimen with an exposed vomer, as the presence of the vomer creates a fragilized zone in this portion of the rostrum. Comparisons. Melanosuchus latrubessei shares with Melanosuchus niger the presence of a vomer that is exposed and located between the premaxilla-maxilla suture, as well as the well-developed rostral ridges, mainly the second and most anterior one. Other similarities worth mentioning here are: (1) the external nares with a keyholeshaped or circular format; (2) the premaxilla which has a right and left posterior processes, in ventral view, that does not surpass posteriorly the first maxillary alveoli; (3) the premaxilla-premaxilla contact at the dorsal surface immediately behind the posterior margin of the external nares, which represents an intraspecific variation within M. niger; that can have the nasal bones reaching the external nares and being exposed dorsally inhibiting the premaxilla-premaxilla contact at this region; (4) the palatine, which projects well anterior to the end of the suborbital fenestrae and has an expanded anterior end; and, (5) the anterior margin of the suborbital fenestrae reaches the space between the eighth and ninth maxillary alveoli (differing from MCNC 243 specimen - former M. fisheri, which reaches the space between ninth and tenth alveoli). The vomer exposure on the palate between premaxilla and maxilla is a characteristic of M. niger (e.g. Mook 1921; Medem 1963; Iordansky 1973; Brochu 1999; Bona et al. 2017b), and this feature was used as diagnosis to assign the fossil specimens to this genus (e.g. Medina 1976). However, the bone has never been properly described, even in detailed works on M. niger (e.g. Mook 1921; Medem 1963; Iordansky 1973; Medina 1976; Brochu 1999; Vieira et al. 2016; Bona et al. 2017b). In this work, we recognize the vomer as a hollow paired bone, located between the premaxilla and maxilla, in the medial and anterior region of the rostrum, with the paired bones being attached only by a contact, and not by a real suture. This can be evidenced by the thin projections from the maxillae, which overlap ventrally and dorsally the posterior and lateral limits of the vomer (Figure 7). The anterior portion of the vomer attaches, without suturing, to the posterior premaxillary intumescence (Figure 7). The hollowness of the vomer, together with its weak contact towards the premaxilla and maxilla, make this bone and the surrounding area more fragile when the animal is dead; therefore, it is common the loss of the vomer with the break and/or disarticulation of associated bones, as observed in M. latrubessei (Figure 3; this is also evidenced in the studied M. niger, see Table 1). However, we reinforce that the existence of the vomer in M. latrubessei is supported by two features: (1) the anterior end of maxilla-maxilla suture at the palate culminates in a smooth maxillary surface that opens laterally (Figure 6 b, c); and, (2) the premaxilla, in medial view from a sagittal cut, has at the posterior portion of the ventral surface an intumescence that was broken in the M. latrubessei specimen, but the characteristic brands remained (Figure 6 a). The condition observed in M. latrubessei diverges from that seen in Caiman genus, which has the vomer restricted to the narial passage and located posteriorly, aligned with the prefrontals (e.g. Bona & Desojo 2011). It also diverges from Paleosuchus palpebrosus (Cuvier 1807) and the Caiman species by exhibiting premaxillae that are thicker and more robust than the maxillae (Figure 7 c, d). For vomer condition in Alligator see Rieppel (1993). Despite the aforementioned similarities shared between M. latrubessei and M. niger, they also present several differences that should be highlighted, such as: (1) M. latrubessei presents twelve maxillary alveoli, while M. niger has thirteen (including MCNC 243); (2) the narial crest in M. latrubessei is restricted to the border of the external nares and is isolated from the rostral ridges (Figure 4), while in M. niger the narial crest at the posterior corner of external nares has a posterior projection bordering the premaxilla-nasal suture, being associated with the rostral ridges (Figure 8); (3) the maxilla-maxilla contact, in the palatal surface, of M. latrubessei extends from the third to the sixth maxillary alveoli, while in M. niger (including MCNC 243), despite the intraspecific variability and asymmetrical development in some pathological specimens, this contact keeps restricted between the second and the fourth maxillary alveoli, or even less (e.g., in some specimens, this contact extends from the third to the fifth maxillary alveoli); (4) the anterior process of the ectopterygoid in M. latrubessei is inclined medially, stretching for one maxillary alveolus (the twelfth), while for M. niger (including MCNC 243), the anterior process is straighter and extends by two or three alveoli (reaching the twelfth/thirteenth maxillary alveoli); and, (5) despite the fact that M. latrubessei and M. niger exhibit two rostral ridges in the rostrum, it is important to mention that in M. latrubessei the rostral ridge 2 is developed and well-marked, being anteroposteriorly inclined, and completely composed by the maxilla without contacting the rostral ridge 1, while in M. niger (including MCNC 243), the rostral ridge 2 is located over or very close to the premaxilla-maxilla suture, extending from the dorsal surface until reaching the ventral margin of the aforementioned suture, being this ridge connected with the rostral ridge 2 (Figure 8). All studied specimens (see Table 1) present a similar pattern of ornamentation, with irregular, but generally round and well-marked pits along the entirely dorsal surface of the rostrum. However, only in M. latrubessei this bone ornamentation does not reach the margins of the external nares (Figure 2). Though fragmented, the preserved portion of the external nares in M. latrubessei enables to infer a circular or keyhole-shaped format, as stated earlier (Figure 2); this condition (character83[0]) is shared with all other studied specimens (see Table 1). The incisive foramen is only partially preserved in M. latrubessei (Figure 3), but since the lateral margin is well-preserved, based on the maximum curvature, it is possible to stipulate the anterior and posterior limits of the incisive foramen. In this scenario, the incisive foramen occupies less than half of the premaxillae maximum length (88[0]). The same condition is seen in other studied specimens, with exception of Caiman brevirostris and Caiman wannlangstoni Salas-Gismondi et al. 2015, which do not have this portion preserved. Regarding the location of the incisive foramen, in relation to the premaxillary toothrow, it is inconclusive to assert that in M. latrubessei this foramen protrudes between the first premaxillary alveoli, as can be seen in the fossil specimen UCMP 39978 and in M. niger, as well as in Caiman species. The anterior limit of the suborbital fenestra in M. latrubessei is located between the eighth and ninth maxillary alveoli, similar to observed in Caiman crocodilus (Linnaeus 1758), Caiman latirostris (Daudin 1802), Caiman yacare (Daudin 1802), M. niger and UCMP 39978. As it was already mentioned, the suborbital fenestra in MCNC 243 (former M. fisheri) reaches the space between the ninth and the tenth alveoli. The lateral margin of the suborbital fenestra com

The Solimões Formation (Eocene-Pliocene) is a well-known geological unit due to the great diversity of crocodylian species. Here we describe a new species of Melanosuchus, M. latrubessei sp. nov., from the Talismã locality, state of Amazonas, from the Upper Miocene of the Solimões Formation (Solimões Basin, Brazil). A new phylogenetic inference focused on Caimaninae is provided and the different evolutionary scenarios involving this new species are discussed. In addition, quantitative morphology studies are carried out and comments regarding the paleoecology aspects of this new species are made. M. latrubessei represents a medium-sized generalist predator, being proportional to the medium-sized M. niger. This new species inhabited the drainages of the Solimões Formation and was ecologically related to other taxa of crocodylians during the proto-Amazon Miocene. The evolutionary advantages of Melanosuchus genus are discussed to better understand the biogeographical occurrence of M. niger in South America, a species which survives to this day in contrast to several other species that became extinct during the Miocene-Pliocene periods. The extinction of the Miocene-Pliocene crocodylian taxa of the Solimões Formation, including Melanosuchus latrubessei, seems to be directly related with the uplift of the northern portions of the Andes, which generated significantly changes in drainages and Amazon paleoenvironments.

Melanosuchus and its prolific debates Melanosuchus was originally proposed by Gray (1862) as a monospecific genus to relocate the species Caiman niger described by Spix (1825). For a synonym list of Melanosuchus niger see Medem (1963). Regarding the phylogenetic relationships of the genus there are two main propositions: 1) nested within Caiman genus, frequently as sister of C. latirostris (e.g., Poe 1996; Brochu 1997, 1999; Souza-Filho et al. 2019); or, 2) as sister species of Caiman genus (e.g., Oaks 2011; Roberto et al. 2020). The validity of the Melanosuchus is still an open debate with some authors suggesting its synonymization with Caiman (Poe 1996), this discussion, for now, goes beyond the scope of the present contribution. However, we suggest that the propositions made by Fitzhugh (2016) for molecular inferences should be considered in future works addressing this question., Published as part of Souza-Filho, Jonas Pereira De, Guilherme, Edson, Toledo, Peter Mann De, Carvalho, Ismar De Souza, Negri, Francisco Ricardo, Maciente, Andr��a Aparecida Da Rocha, Cidade, Giovanne M., Lacerda, Mauro Bruno Da Silva & Souza, Lucy Gomes De, 2020, On a new Melanosuchus species (Alligatoroidea: Caimaninae) from Solim��es Formation (Eocene-Pliocene), Northern Brazil, and evolution of Caimaninae, pp. 561-593 in Zootaxa 4894 (4) on page 563, DOI: 10.11646/zootaxa.4894.4.5, http://zenodo.org/record/4316776, {"references":["Gray, J. E. (1862) A synopsis of the species of Alligators. Annals and magazine of natural history, 10 (3), 125 - 169.","Spix, J. B. (1825) Animalia nova sive species novae Lacertarum, quas in itinere per Brasiliam annis MDCCCXVII-MDCCCXX jussu et auspiciis Maximiliani Josephi I. In: De Pix, D. J. B. (Eds.), Bavaria Regis suscepto collegit et descripsit. Typis, Franc. Seraph. H ʾ bschamanni, Munich, pp. 1 - 110.","Medem, F. (1963) Osteologia Craneal, Distribucion geografica y ecologia de Melanosuchus niger (Spix) (Crocodylia, Alligatoridae). Revista de la Academia Colombiana de Ciencias Exactas, Fisicas y Naturales, 12 (45), 5 - 23. https: // doi. org / 10.1590 / S 0100 - 736 X 2016001000018","Poe, S. (1996) Data set incongruence and the phylogeny of Crocodilians. Systematic Biology, 45 (4), 393 - 414. https: // doi. org / 10.1093 / sysbio / 45.4.393","Brochu, C. A. (1997) Fossils, morphology, divergence timing. and the phylogenetic relationships of Gavia 1 is. Systematic Biology, 46, 479 - 522. https: // doi. org / 10.1093 / sysbio / 46.3.479","Brochu, C. A. (1999) Phylogenetics, taxonomy, and historical biogeography of Alligatoroidea. Journal of Vertebrate Paleontology, 19, 9 - 100. https: // doi. org / 10.1080 / 02724634.1999.10011201","Souza-Filho, J. P., Souza, R. G., Hsiou, A. S., Riff, D., Guilherme, E., Negri, F. R. & Cidade, G. M. (2019) A new caimanine (Crocodylia, Alligatoroidea) species from the Solimies Formation of Brazil and the phylogeny of Caimaninae. Journal of Vertebrate Paleontology, 38 (5), e 1528450. https: // doi. org / 10.1080 / 02724634.2018.1528450","Oaks, J. R. (2011) A time-calibrated species tree of Crocodylia reveals a recent radiation of the true crocodiles. Evolution, 65 (11), 3285 - 3297. https: // doi. org / 10.1111 / j. 1558 - 5646.2011.01373. x","Roberto, J. I., Bittencourt, P. S., Muniz, F. L., Hernandez-Rangel, S. M., Nobrega, Y. C., Avila, R. W., Souza, B. C., Alvarez, G., Miranda-Chumacero, G., Campos, Z., Farias, I. P. & Hrbek, T. (2020) Unexpected but unsurprising lineage diversity within the most widespread Neotropical crocodilian genus Caiman (Crocodylia, Alligatoridae). Systematics and Biodiversity, 18 (4), 377 - 395. https: // doi. org / 10.1080 / 14772000.2020.1769222","Fitzhugh, K. (2016) Sequence Data, Phylogenetic Inference, and Implications of Downward Causation. Acta Biotheoretica, 64 (2), 133 - 160. https: // doi. org / 10.1007 / s 10441 - 016 - 9277 - 0"]}

Pancreatic fluid collections (PFCs) develop as a result of damage to the major or peripheral pancreatic ducts, complication due to acute or chronic pancreatitis, trauma or iatrogenic causes. PFCs include pancreatic pseudocysts (PPs) and walled-off necrosis (WON). PFCs usually resolve spontaneously and are asymptomatic, but if they persist, increase in dimension or became symptomatics, therapeutic intervention is required. Available therapeutic interventions include surgical, percutaneous, and endoscopic drainage. The endoscopic approach is nowadays considered the first line-treatment of PFCs due to various advantages when compared with surgical or percutaneous drainage: decreased morbidity, length of hospital stay, and reduced costs. In the last few years, the endoscopic ultrasound (EUS)-guided transmural drainage, initially with plastic stents, gained popularity. More recently, fully covered self-expanding lumen-apposing metal stents (LAMS) have been demonstrated to be both, safe and effective with high clinical and technical success, reducing the risk of perforation, peritoneal leakage, migration and facilitating the drainage of necrotic contents. In the last few years, several studies evaluating the safety and efficacy of LAMS and their differences with plastic stents have been performed, but literature on the removal timing of this device and associated complications is still limited. The aim of this review is to analyze studies reporting information about the retrieval timing of LAMS and the related adverse events.

Background: The accuracy and costs of current diagnostic methods in the differential diagnosis of pancreatic cystic lesions still has ample room for improvement. Aims: The aim of the study was to confirm the diagnostic yield of intracystic glucose in the diagnosis of pancreatic cyst subtypes. Methods: We prospectively recruited all patients who underwent Endoscopic Ultrasound with Fine Needle Aspiration of pancreatic cyst at our Institution. Results: Fifty-six patients were included in the study. We found that intracystic glucose concentration < 50 mg/dL was significantly more sensitive than a concentration of Carcinoembryonic Antigen > 192 ng/mL (93.6% vs 54.8%; p = 0.003) for the diagnosis of mucinous cysts. In terms of specificity, the two markers were not different (96% vs 100%; p = 1). Regarding the diagnosis of non-mucinous cysts, intracystic glucose concentration >= 50 mg/mL showed higher sensitivity than Carcinoembryonic Antigen level < 5 ng/mL (96% vs 72%) although a statistical significance could not be reached (p = 0.07). The two markers were not statistically different in terms of specificity (93.6% vs 87.1%; p = 0.62). Conclusion: Given its diagnostic performance and ease of measurement, intracystic glucose may replace Carcinoembryonic Antigen in the differential diagnosis of mucinous versus non-mucinous pancreatic cysts.

Pancreatic schwannomas are very rare tumors, usually diagnosed incidentally after surgery. In literature, only 17 patients underwent endoscopic ultrasound (EUS) with fine-needle aspiration and diagnosis was reached only in 9 subjects. We report the case of a woman in whom a computed tomography revealed a mass in the uncinate process of the pancreas. EUS–fine-needle aspiration demonstrated a 1.3 × 1.1 cm hypoechoic lesion, cytology revealed sheets of spindle cells, and immunocytochemistry led to the diagnosis of schwannoma. Relying on EUS features and on the low proliferation index, a follow-up program was set. Four years later, the patient is asymptomatic and the mass is unchanged.

National Statistical Institutes are currently facing significant changes: innovative approaches that promote integration and standardization are replacing the traditional statistical production chain, based on the vertical integration of survey-specific tasks. Given the significant impact of such innovative approaches, it is necessary to manage and harness the changing process. The adoption of an Enterprise Architecture (EA) helps in this direction by identifying business needs, improving collaboration across an organization and ensuring that the technology is aligned to the strategic vision. In this scenario, CSPA offers a "reference architecture" for a wide spread of the "plug and play" approach in designing, imple- menting, sharing and reusing statistical software solutions, largely based both on statistical standards such as GSBPM and GSIM, and on the "service-oriented architecture" model. The implementation of modernization programs is a current issue, requiring several National and Supra-national investments. Istat is currently investing on CORE as the principal solution for SOA-based process industrialization. This paper presents CORE main features and highlights how CORE meets important goals, such as process automation, software sharing and support for collaborative work.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fósseis do clado Spinosauridae são reconhecidos dos paleoncontinentes Gondwana e Laurásia desde o Jurássico Superior (Thitoniano) até o Cretáceo Superior (Cenomaniano), com ampla distribuição paleobiogeográfica. Até a atualidade, 12 espécies foram descritas: (1) Spinosaurus aegyptiacus; (2) Siamosaurus suteethorni; (3) Baryonyx walkeri; (4) Spinosaurus maroccanus; (5) Sigilmassasaurus brevicollis; (6) Irritator challengeri; (7) Angaturama limai; (8) Cristatusaurus lapparenti; (9) Suchomimus tenerensis; (10) Oxalaia quilombensis; (11) Ichthyovenator laosensis; e (12) Ostafrikasaurus crassiserratus. Além destes, diversos outros materiais são referidos na literatura sem uma identificação específica ou genérica precisa ou a níveis taxonômicos mais abrangentes. Pelo menos dez pré-maxilares foram descritos compondo 6 dos 11 gêneros da família: Angaturama, Baryonyx, Cristatusaurus, Oxalaia, Spinosaurus e Suchomimus. Através de morfometria geométrica analisou-se a variação morfológica nos pré-maxilares para verificar se a variabilidade observada pode ser explicada por fatores causais em um contexto macroevolutivo. Na projeção dos indivíduos no morfoespaço (PCA) em ambas as vistas, ventral e lateral, a forma dos pré-maxilares se estrutura de maneira compatível com a filogenia, sendo evidente uma diferenciação quanto à geometria do focinho entre as sub-famílias “Baryonychinae” e Spinosaurinae, sendo mais evidente quando observada a geometria das configurações em vista ventral. A congruência entre a forma e a filogenia pôde ser observada nas análises fenéticas de agrupamentos, bem como na análise das distâncias de Procrustes e energia de deformação das grades de deformação. A morfologia dos pré-maxilares em Spinosauridae apresenta variação bastante relevante e permitem diagnosticar alguns clados. Pela primeira vez esta porção da anatomia destes animais foi explorada quantitativamente por meio de morfometria geométrica, os reultados alcançados permitiram quantificar e descrever de maneira mais clara a variação observada. Constatou-se que algumas diferenças observadas entre as duas sub-famílias são devidas à alometria. Embora as relações internas de Spinosauridae permaneçam com algumas lacunas, o monofileticismo de Spinosaurinae foi corroborado em todas as análises quantitativas da forma aqui realizadas. Já Baryonychinae pode não constituir um grupo natural, embora as novas evidências apresentadas aqui não sejam conclusivas a esse respeito. Fossils of Spinosauridae are recognized from the paleoncontinents Gondwana and Laurasia from the Upper Jurassic (Thitonian) to the Upper Cretaceous (Cenomanian), with a wide paleobiogeographic distribution. To date, 12 species have been described: (1) Spinosaurus aegyptiacus; (2) Siamosaurus suteethorni; (3) Baryonyx walkeri; (4) Spinosaurus maroccanus; (5) Sigilmassasaurus brevicollis; (6) Irritator challengeri; (7) Angaturama limai; (8) Cristatusaurus lapparenti; (9) Suchomimus tenerensis; (10) Oxalaia quilombensis; (11) Ichthyovenator laosensis; and (12) Ostafrikasaurus crassiserratus. In addition, several other materials are reported in the literature without specific or generic identification or at the broader taxonomic levels. At least 10 premaxillae were described composing 6 of the 11 genera of the family: Angaturama, Baryonyx, Cristatusaurus, Oxalaia, Spinosaurus and Suchomimus. Through geometric morphometry the morphological variation in the premaxilla was analyzed to verify if the observed variability can be explained by causal factors in a macroevolutionary context. In the projection of individuals in the morphospace (PCA) in both ventral and lateral views, the premaxilla shape is structured in a manner compatible with the phylogeny, being evident a differentiation in the geometry of the snout between the subfamilies "Baryonychinae" and Spinosaurinae, being more evident when observing the geometry of the configurations in ventral view. The congruence between shape and phylogeny could be observed in the cluster analysis, as well as in the analysis of the distances of Procrustes and bending energy of the deformation grids. The morphology of the premaxillaries in Spinosauridae presents a very relevant variation and allows to diagnose some clades. For the first time this portion of the anatomy of these animals was explored quantitatively by geometric morphometrics, the obtained results allowed to quantify and to describe more clearly the observed variation. It was found that some observed differences between the two subfamilies are due to allometry. Although the internal relations of Spinosauridae remains with some gaps, the monophyleticism of Spinosaurinae has been corroborated in all quantitative analyzes of the form performed here. Baryonychinae may not constitute a natural group, although the new evidence presented here is not conclusive in this regard.

We report a rare case of gastric fistulization in a patient with main-duct (MD) intraductal papillary mucinous neoplasm (IPMN). Fistulization to adjacent organs is a rare complication of this disease, mainly affecting the duodenum; the fact that the stomach was the only organ involved makes this case even more peculiar. The diagnosis of the fistula was made after examination with endoscopic ultrasound, since a previous computed tomography scan could not detect it.

Zollinger-Ellison syndrome (ZES) is a clinical syndrome characterized by gastric acid hypersecretion due to the ectopic secretion of gastrin by a gastrinoma, a neuroendocrine tumor (NET) which mostly develops in the duodenum and in the pancreas. This syndrome was first described by Zollinger and Ellison in 1964; if left untreated, ZES can lead to multiple complications mainly due to gastric hypersecretion and some patients can suffer from the complications of an advanced metastatic disease. Although its clinical features are considered typical, the diagnosis of ZES is often challenging for the clinician. A previous review was published in 2005 by our group, but in 12 years many things have changed: the diagnostic tools have been improved and many different therapeutical options are now available.