Search

Roberto de Sire,1 Nicola Imperatore,1,2 Maria D’Armiento Snr,3 Pietro Coccoli,1 Imma Di Luna,1 Simona Ricciolino,1 Fabiana Castiglione,1 Antonio Rispo1 1Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy; 2Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy; 3Pathology, Department of Public Health, University Federico II of Naples, Naples, ItalyCorrespondence: Roberto de SireGastroenterology Unit, Department of Clinical Medicine and Surgery, University “Federico II” of Naples, Via Pansini 5, Naples, 80131, ItalyEmail roberto.desire@libero.itAbstract: Sclerosing mesenteritis (SM) is an idiopathic disorder affecting mesentery, characterized by fat necrosis, chronic inflammation and fibrosis. The clinical presentation varies from asymptomatic cases to acute abdomen. The diagnosis is suggested by imaging but can be definitely established only by biopsies. In this paper, we discuss ultrasonography-based management of SM.Keywords: sclerosing mesenteritis, mesenteric lipodystrophy, mesenteric panniculitis, retractile mesenteritis, ultrasonography

Background: Celiac disease (CD) is a chronic immuno-mediated enteropathy caused by dietary gluten in genetically susceptible individuals carrying HLA (Human Leukocytes Antigen) genes that encode for DQ2.5 and DQ8 molecules. TRAFD1 (TRAF-type zinc finger domain 1) is a gene recently found associated with CD and defined as a master regulator of IFNγ signalling and of MHC class I antigen processing/presentation. There is no specific drug therapy and the only effective treatment is the gluten-free diet (GFD). The great majority of celiac patients when compliant with GFD have a complete remission of symptoms and recovery of gut mucosa architecture and function. Until now, very few studies have investigated molecular differences occurring in CD patients upon the GFD therapy. Methods: We looked at the expression of both HLA DQ2.5 and TRAFD1 risk genes in adult patients with acute CD at the time of and in treated patients on GFD. Specifically, we measured by qPCR the HLA-DQ2.5 and TRAFD1 mRNAs on peripheral blood mononuclear cells (PBMC) from the two groups of patients. Results: When we compared the HLA-DQ mRNA expression, we didn't find significant variation between the two groups of patients, thus indicating that GFD patients have the same capability to present gliadin antigens to cognate T cells as patients with active disease. Conversely, TRAFD1 was more expressed in PBMC from treated CD subjects. Notably, TRAFD1 transcripts significantly increased in the patients analyzed longitudinally during the GFD, indicating a role in the downregulation of gluten-induced inflammatory pathways. Conclusion: Our study demonstrated that HLA-DQ2.5 and TRAFD1 molecules are two important mediators of anti-gluten immune response and inflammatory process.

Background: The transition from pediatric to adult healthcare in individuals with inflammatory bowel disease (IBD) poses significant challenges mainly due to the high burden of IBD during adolescence, a critical period of psychosocial development. So far, there are few longitudinal data linking transition readiness to long-term disease outcomes. Objective: We aimed to assess patients’ readiness to transition and its impact on clinical outcomes, quality of life, and adherence to therapy. Design: An observational, prospective study was conducted in a tertiary adult and pediatric center, including adolescents aged ⩾17 years with a diagnosis of IBD, who underwent a ‘structured transition’ program including two joint adult–pediatric visits. Methods: Transition readiness skills were assessed with the Transition Readiness Assessment Questionnaire (TRAQ). All patients completed the TRAQ at the time of recruitment, which occurred during the initial joint adult–pediatric visit, to determine those deemed ready for transition versus those not ready. The Morisky Medication Adherence Scale and the 36-Item Short Form Health Survey Questionnaire (SF-36) were also completed at baseline and after 12 months. Clinical outcomes were collected at the 12-month follow-up. Results: In all, 80 patients were enrolled who had transitioned through a structured transition clinic and completed 12 months of follow-up. In total, 54 patients were ready for the transition, with a mean TRAQ = 3.2 ± 0.5. The number of clinical relapses and hospitalizations at 12 months was lower in ready compared to not-ready patients ( p = 0.004 and p = 0.04, respectively). SF-36 did not differ between ready and not-ready patients and pre- and post-transition clinics ( p > 0.05). Based on the receiver operating characteristic curve, a TRAQ cutoff ⩾3.16 could predict medication adherence with a sensibility of 77%, a specificity of 82%, and an AUC of 0.81 (0.71–0.91; p

Polyphenolic compounds constitute a diverse group of natural components commonly occurring in various plant species, known for their potential to exert both beneficial and detrimental effects. Additionally, these polyphenols have also been implicated as endocrine-disrupting (ED) chemicals, raising concerns about their widespread use in the cosmetics industry. In this comprehensive review, we focus on the body of literature pertaining to the estrogenic properties of ED chemicals, with a particular emphasis on the interaction of isoflavones with estrogen receptors. Within this review, we aim to elucidate the multifaceted roles and effects of polyphenols on the skin, exploring their potential benefits as well as their capacity to act as ED agents. By delving into this intricate subject matter, we intend to provoke thoughtful consideration, effectively opening a Pandora’s box of questions for the reader to ponder. Ultimately, we invite the reader to contemplate whether polyphenols should be regarded as friends or foes in the realm of skincare and endocrine disruption.

Patients suffering from inflammatory bowel disease (IBD) face a two to three-fold higher risk of developing colorectal cancer (CRC) compared to the general population. In recent years, significant progress has been made in comprehending the natural history of IBD-associated CRC (IBD-CRC) and refining its treatment strategies. The decreased incidence of IBD-CRC can be attributed to improved therapeutic management of inflammation, advancements in endoscopy, and early detection of precancerous lesions via surveillance programs. Advanced imaging technologies have made previously undetectable dysplasia visible in most cases, allowing for a much more precise and detailed examination of the mucosa. Additionally, new tools have facilitated the endoscopic resection (ER) of visible lesions in IBD. Particularly, the key to effectively manage colitis-associated colorectal neoplasia (CAN) is to first identify it and subsequently guarantee a complete ER in order to avoid surgery and opt for continuing surveillance. Advanced ER techniques for CAN include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and hybrid ESD-EMR (h-ESD). This narrative review aims to consolidate the current literature on IBD-CRC, providing an overview of advanced techniques for ER of CAN in IBD, with a particular emphasis on the impact of ESD on the long-term outcomes of IBD patients.

In Italy tuberculosis is a relatively rare disease and people coming from developing nations are usually affected. The radiological findings are variable and depend on the tuberculosis activity, if primary or post-primary. In literature, few data are reported about the co-existence of COVID-19 and lung tuberculosis. In this case report, authors describe the imaging features of latent lung tuberculosis in a patient with SARS-CoV-2 disease. The important role of CT imaging in identifying and diagnosing other infectious lung diseases presenting in the setting of the polymorphism and severity of SARS-CoV-2 disease is also discussed.

Aim: Crohn's disease has debilitating effects on patients' quality of life. Currently, there are limited data on the effect of anastomotic configuration on health‐related quality of life after ileocaecal resection for Crohn's disease. This study aimed to assess the impact of Kono‐S anastomosis on quality of life after ileocolic resection, compared to the conventional side‐to‐side anastomosis. Method: Patients with primary or recurrent Crohn's disease participating in the ongoing SuPREMe‐CD trial were interviewed about quality of life using the Inflammatory Bowel Disease Questionnaire (IBDQ). The primary endpoint was disease‐specific quality of life, assessed with IBDQ. Secondary outcomes were quality of life related to bowel symptoms, systemic symptoms, social function and emotional function. Results: Of the 94 patients included, 51 (54%) received the conventional side‐to‐side anastomosis and 43 (46%) the Kono‐S anastomosis. Demographics were comparable between the two groups. The IBDQ was assessed at a mean follow‐up of 54.0 ± 18.7 months from surgical intervention. The mean total IBDQ score was 155.1 ± 28.07 in the conventional group and 163.8 ± 25.23 in the Kono‐S group (P = 0.11). When considering bowel symptoms and social function, mean scores were 50.7 and 23.5 in the conventional group, and 56.3 and 26.5 in the Kono‐S group (P = 0.002 and P = 0.02, respectively). Kono‐S anastomosis was independently associated with improved quality of life regarding bowel symptoms (P = 0.006) and social function (P = 0.03) after correcting for other confounding factors on linear regression analysis. Conclusion: Compared to conventional side‐to‐side anastomosis, patients with Kono‐S anastomosis presented significantly better bowel symptoms and social function scores at 54 months after surgery. [ABSTRACT FROM AUTHOR]

Intestinal ultrasound (IUS) plays a crucial role as a non-invasive and accurate tool to diagnose and assess inflammatory bowel disease (IBD). The rationale for using IUS in Crohn’s disease (CD), a transmural disease, is widely acknowledged. While the use of IUS in ulcerative colitis (UC), a mucosal disease, is often underestimated, but, recently, it is increasingly expanding. In the context of a treat-to-target approach, the role of IUS is shifting toward a monitoring tool for predicting response to therapy. Hence, adjusting therapeutic strategies based on IUS response could reduce the burden related to endoscopy and speed the decision process with the ultimate goal to alter the natural course of IBD. Assessment of bowel wall thickness (BWT) is the most reliable IUS measure. However, the development of validated and reproducible sonographic scores to measure disease activity and the identification of parameters of therapeutic response remain relevant issues to implement the daily adoption of IUS in clinical practice. Accordingly, this review focuses on the current literature investigating the impact of IUS on CD with emphasis on the concept of transmural healing (TH) and the main related advantages. We further explore new insights on the role of IUS in UC and its clinical implications.

In modern cities, the abundance of allergenic plant species has contributed to making less healthy the urban environment, as on-going and direct contact of humans with the urban flora can increase the negative effects on people allergic to pollens. The allergenicity of ornamental species should be considered, and above all quantified, when designing new urban green areas. Numerous studies reported the detailed description of the flora present in cities, but only in some rare cases their allergenic power and related pollen seasons were mentioned. In the present study, starting from the existing data in literature on the vascular flora of the Royal Park of Portici, Southern Italy, tree and shrub species have been classified based on their ability to cause respiratory allergies. Thus, to estimate the allergenic potential of urban green space, two preliminary approaches were defined based on the biological characteristics of the plant species as sources of pollen emissions.

Background: The transition from pediatric to adult healthcare in individuals with inflammatory bowel disease (IBD) poses significant challenges mainly due to the high burden of IBD during adolescence, a critical period of psychosocial development. So far, there are few longitudinal data linking transition readiness to long-term disease outcomes. Objective: We aimed to assess patients' readiness to transition and its impact on clinical outcomes, quality of life, and adherence to therapy. Design: An observational, prospective study was conducted in a tertiary adult and pediatric center, including adolescents aged ⩾17 years with a diagnosis of IBD, who underwent a 'structured transition' program including two joint adult–pediatric visits. Methods: Transition readiness skills were assessed with the Transition Readiness Assessment Questionnaire (TRAQ). All patients completed the TRAQ at the time of recruitment, which occurred during the initial joint adult–pediatric visit, to determine those deemed ready for transition versus those not ready. The Morisky Medication Adherence Scale and the 36-Item Short Form Health Survey Questionnaire (SF-36) were also completed at baseline and after 12 months. Clinical outcomes were collected at the 12-month follow-up. Results: In all, 80 patients were enrolled who had transitioned through a structured transition clinic and completed 12 months of follow-up. In total, 54 patients were ready for the transition, with a mean TRAQ = 3.2 ± 0.5. The number of clinical relapses and hospitalizations at 12 months was lower in ready compared to not-ready patients (p = 0.004 and p = 0.04, respectively). SF-36 did not differ between ready and not-ready patients and pre- and post-transition clinics (p > 0.05). Based on the receiver operating characteristic curve, a TRAQ cutoff ⩾3.16 could predict medication adherence with a sensibility of 77%, a specificity of 82%, and an AUC of 0.81 (0.71–0.91; p < 0.001). Conclusion: Patients ready for transition had better outcomes at 12 months compared to those who were not ready. Therefore, readiness assessment tools should be integrated into transition management to ensure that interventions are targeted, patient-centered, and responsive to individuals' changing needs. Plain language summary: Transition readiness associated with improved clinical outcomes The transition for individuals with inflammatory bowel disease (IBD) is a dynamic and complex process that must be planned and cannot simply be performed once the patient is 18 years old. Since it does not depend solely on the patient's age but also on developmental readiness, it requires preparation and education starting from early adolescence. In the current study, a 'joint-visit' including both pediatric and adult providers yields positive clinical outcomes over 12 months. Patients ready for transition reported fewer relapses, hospitalizations, and improved therapy adherence compared to those not ready. Readiness assessment tools should be integrated into transition clinics to facilitate targeted interventions for IBD patients based on the changing needs of individuals. [ABSTRACT FROM AUTHOR]

AbstractMost of the neutronic core calculation schemes used by industrialists for nuclear reactor studies are based on a two-step deterministic scheme: A two-dimensional transport calculation at the assembly level produces homogenized and condensed nuclear data used by a full three-dimensional core solver under the diffusion approximation. The validity domain of such schemes is driven by the hypotheses of the diffusion approximation, implying wide meshes (10 to 20 cm), and is hence limited to studies that do not require a thinner description of neutron behavior. Consequently, local phenomena and heterogeneous interfaces are not yet fully validated with industrial two-level calculation schemes. For instance, the axial core-reflector interface, which is characterized by extra thermalization of neutrons leading to a local (≈2-cm height) increase of the neutron flux at the axial edges of fuel pins, is specifically challenging for deterministic methods. To cope with this issue, specific safety studies are performed with reference Monte Carlo simulations. This paper shows that enhancing the equivalence method enables flux discrepancies to be reduced from 12% to 6% for mixed oxide fuels and from 9.3% to <1% for uranium oxide fuel (impacting the power discrepancy from 5% to 3% and from 0.3% to almost 0.0%, respectively) between Monte Carlo and deterministic simulations (SCIENCE V2). The improved equivalence method uses dedicated discontinuity factors and constants, according to an optimized mesh composed by a mesh for each medium and a refined mesh in the fuel region. [ABSTRACT FROM AUTHOR]