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Excess salt intake impacts on blood pressure (BP) and the pathogenetic mechanisms of atherosclerosis predisposing to stroke and other cardiovascular disorders. The influence of salt starts early in life. Two randomized controlled trials in newborn infants suggest a direct association between dietary sodium intake and BP since the first few months of life. Newborn infants display aversion to the salt taste to develop a "preference" for salt only at age 2-3 years, in part in relation to post-natal events: this preference might be associated with later development of hypertension. The amount of sodium to be retained by an infant for proper physiological growth is largely covered by breast feeding (or low sodium formula milk) in the first six months, and later on by the gradual implementation of complementary feeding, without the need for any added salt upon food preparation. Given the lack of dose-dependence data, reference nutrient intakes (RNI) or adequate intakes (AI) for sodium have been established by national health institutions in various countries. The U.K. RNI was set at 242 mg a day for infants 0-6 months with gradual increase to 0.5 g up until age 3. The U.S. AI is somewhat lower for age 0-6 months but larger for age 1-3 years. According to a recent report, the average sodium intake in U.S. children is close to the AI up to age 2 years, to become progressively greater exceeding the Institute of Medicine recommendation later on.

II rettocele e una condizione anatomoclinica estremamente frequente. Viene definito come un’ernia della parete anteriore del retto attraverso il setto rettovaginale. Le sue manifestazioni sono polimorfe: ginecologiche sotto forma di tumefazione vaginale eventualmente associata a prolasso urogenitale o digestive sotto forma di costipazione terminale e, in questo caso, spesso associata a una procidenza interna del retto. La decisione di intervenire si basa su un completo studio clinico pelviperineale e su uno studio funzionale che si fonda sulla valutazione radiologica anorettale (defecografia con opacizzazione delle anse del tenue o imaging defecatorio con RMN), sulla manometria anorettale e sullo studio urodinamico. La correzione dei rettoceli isolati avviene preferenzialmente per via inferiore, perineale. La via transanale tradizionale (Sullivan, Khubchandani) permette di eseguire la plicatura endoluminale della muscolare rettale e una resezione della mucosa rettale distesa dal rettocele. Essa tende a essere sostituita dalle tecniche di resezione rettale transanale con suturatrici (STARR e trans-STARR) (Longo). La via perineovaginale permette di accedere al rettocele dalla sua faccia esterna: la confezione di «borse di tabacco» concentriche e la rimessa in tensione della fascia rettale lo riducono; una miorrafia dei muscoli elevatori dell’ano con conservazione del calibro vaginale rinforzera la riparazione e rimettera in tensione il pavimento pelvico. La sospensione vaginale al legamento sacrospinoso (Richter) completa spesso utilmente l’insieme dell’intervento chirurgico. L’impiego di protesi di rinforzo del setto rettovaginale per via perineale e oggetto di controversia a causa del rischio di infezione e di esposizione del materiale innestato. Queste due tecniche hanno morbilita essenzialmente locale. I loro risultati funzionali, complessivamente buoni, restano pero dipendenti dal contesto clinico e dalla scelta dell’indicazione chirurgica. L’accesso alto viene preferito quando sono necessari atti associati sull’apparato urinario e/o genitale, per un rettocele associato ad altri elementi di prolasso. Essa permette, dopo clivaggio rettovaginali e resezione del Douglas, di rinforzare il setto rettovaginale con una protesi non riassorbibile e di sospendere senza tensione le facce anteriore del retto e posteriore della vagina al promontorio lombosacrale. L’accesso laparoscopico e oggi predominante nella realizzazione dell’intervento di sospensione del settore posteriore della pelvi. Il trattamento chirurgico e indicato in presenza di qualsiasi rettocele sintomatico e quando la riabilitazione mediante biofeedback di un asincronismo addominosfinteriale e il trattamento medico della costipazione non abbiano corretto l’alterazione funzionale. In assenza di fattori predittivi del risultato operatorio il paziente dovra essere informato del rischio di correzione incompleta dei sintomi o di insuccesso. Le anomalie associate della statica pelvica dovranno essere identificate al momento della presa in carico del rettocele e dovranno essere trattate contemporaneamente.

This analysis compares the performance of 7 different diagnostic criteria of metabolic syndrome (MS) with regard to the prevalence of the syndrome, the characteristics of subjects with a positive diagnosis, and the ability to correctly identify individuals at high calculated cardiovascular (CV) risk or with signs of systemic inflammation or early organ damage. The diagnostic criteria proposed by the World Health Organization (1998); European Group for the Study of Insulin Resistance (EGIR) (1999); Adult Treatment Panel III (ATP III) (2001); American Association of Clinical Endocrinologists (AACE) (2003); ATP III (2004); International Diabetes Federation (IDF) (2005); and American Heart Association/National Heart, Lung, and Blood Institute (2005) were applied to the population of 933 men aged 59.5 years (range, 33-81 years) attending the 2002-2004 examination of the Olivetti Heart Study. Standardized measurements were available for body mass index, waist circumference, blood pressure, fasting serum total and high-density lipoprotein cholesterol, triglyceride, glucose, insulin, high-sensitivity C-reactive protein, and microalbuminuria. Insulin resistance was estimated by the homeostasis model assessment index; and CV risk, by the Prospective Cardiovascular Munster algorithm. The MS prevalence ranged from 8.6% (AACE) to 44.5% (IDF). Among MS-positive subjects, insulin resistance ranged from 94.8% (EGIR) to 49.2% (IDF), whereas type 2 diabetes mellitus (excluded by EGIR and AACE criteria) rated 59.9% by World Health Organization and 22% to 24% by ATP III, IDF, or American Heart Association/National Heart, Lung, and Blood Institute. By most criteria, MS-positive subjects had greater calculated CV risk than MS-negative subjects; but in general, the ability to correctly identify individuals at high CV risk was dampened by limited sensitivity (maximum 60%). Lowering the cutoff for abdominal adiposity (waist circumference

Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The IGF-I system is deregulated in obese subjects in proportion to their degree of visceral adiposity.To examine the association among IGF-I, IGF-binding protein (BP)-1 and -3 levels and different measures of adiposity in a sample of adult male population in Southern Italy.A complete database for this analysis was available for 229 (age range 50-82 yr) participating at 2002-2004 Olivetti Heart Study follow-up.After adjustment for age, IGF-I was inversely associated with body mass index (BMI) and waist circumference (p0.05). IGFBP-1 was inversely associated with BMI, waist circumference, SST, homeostasis model assessment (HOMA) index, fat mass. HOMA index, age, and SST significantly predicted the IGFBP-1 plasma levels, with 24% of IGFBP-1 variability explained at a linear regression analysis.IGFBP-1 inversely correlated to adiposity and HOMA index. Among adiposity indexes, SST was the best predictor of IGFBP-1 levels. The evaluation of some components of the IGF system, and simple measures of body adiposity, such as SST, may represent a further tool to better evidence phenotype profiles associated to the pathogenetic mechanism of cardiovascular risk factor clustering in male adults.

Background: Apart from waist circumference, other adiposity measures, such as subscapular skin fold (SST), arouse growing interest due to their relationship to metabolic complications and cardiovascular risk. The Insulin-like Growth Factor (IGF)-1 system is deregulated in obese subjects in proportion to their degree of visceral adiposity. Aim : To examine the association among IGF-1, IGF-Binding Protein (BP)1 and 3 levels and different measures of adiposity in a sample of adult male population in Southern Italy. Materials and Methods: A complete database for this analysis was available for 229 (age range 50–82 years) participating at 2002-2004 Olivetti Heart Study follow-up. Results: After adjustment for age, IGF-1 was inversely associated with BMI and waist circumference (p

Gastrojejunocolic fistulae, a late complication of gastroenterostomy, are presently uncommon. Patients can present with symptoms of a fistula 20 years or more after their original gastric surgery. The knowledge of this rare condition can allow prevention, through a better operative strategy and a medical treatment at the phase of stomal ulcer with proton pump inhibitor and Helicobacter pylori eradication. We present a case of gastrojejunocolic fistula and discuss the modern management of this condition. Its etiological, clinical, and surgical features were briefly discussed.

Prosthetic meshes give excellent results in groin hernia repair. However, although recurrence rates are very low, chronic pain remains frequent and mesh fixation may play a role in the occurrence of this complication. The use of fibrin sealant to secure the mesh may represent a useful alternative for the prevention of chronic pain. The aim of this study is to confirm that the mesh may be secured by spraying fibrin sealant and to assess the reduction in the incidence of chronic pain.Seventy hernias were operated on in 57 patients and were evaluated on a prospective basis. The procedure involved placement of a plug and patch mesh which was secured with fibrin sealant alone. These patients were compared to a matched retrospective series of 57 patients who underwent the same procedure, except that conventional non-absorbable suture was used to secure the mesh.The two groups were equivalent for inclusion criteria and preoperative data. The complication rate was similar in the two groups. The operative time was shorter in the fibrin sealant group: 7 min for unilateral hernia (p=0.0017) and 16 min for bilateral hernia (p=0.0008). The length of hospital stay was also shorter in the fibrin sealant group (1.8 days vs. 2.5 days: p0.0001). There was no recurrence in the fibrin sealant group after a minimum follow-up of 12 months and no recurrence in the suture group after a minimum follow-up of 25 months. Finally, a significant reduction in chronic pain was observed in the fibrin sealant group (3.5% vs. 22.8%: p=0.042).This study confirms the effectiveness of fibrin glue in securing prosthetic meshes and reducing chronic inguinal pain.

Leiomyosarcoma of the oesophagus is a malignant tumor that originates from smooth muscle cells. The filiation between oesophageal leiomyoma and leiomyosarcoma is controversial, with few cases reported in literature. The authors describe un uncommon situation with the simultaneous presence of a leiomyoma and a leiomyosarcoma of the oesophagus in a 75 year-old man, which have been successfully treated with surgical resection. It could probably be a case of a malignant transformation of a previous pre-existing multiple non-confluent leiomyoma.

s / Digestive and Liver Disease 46 (2014) e85–e127 e95 4.5±0.6pg/ml, mean FT4 1.2± .4 ng/dl. TSH levels were above cutoff laboratory range in 10% of our population and the 2 patients (0.2%) of the whole population presented TSH≥10 UI/ml. We found a significant positive correlation between TSH levels and BMI z-score (rho=0.121, p=0.001), even after adjustment for age and sex (r=0.117, p=0.001); a positive correlation was also observed between FT3 and BMI z-score (rho=0.161, p

Effects of a 20-h fermentation on cell wall polysaccharides from the mucilage of pulped coffee beans were examined and compared to those of unfermented beans, on alcohol insoluble residues (AIRs), their hot-water-soluble crude pectic substances (PECTs), and their hot-water-insoluble residues (RESs). Yields and compositions were very similar: AIRs, which consisted of approximately 30% highly methylated pectic substances, approximately 9% cellulose, and approximately 15% neutral noncellulosic polysaccharides, exhibited no apparent degradation. However, PECTs from fermented beans were shown to have undergone a slight reduction of their intrinsic viscosity and weight-average molecular weight by capillary viscosimetry and high-performance size-exclusion chromatography. After fermentation, hot-water-insoluble pectic substances of RES exhibited partial de-esterification. Removal of coffee bean mucilage by natural fermentation seems to result from a restricted pectolysis, the mechanism of which remains to be elucidated.

Introduction Le reflux gastro-œsophagien (RGO) est une des complications rapportees apres chirurgie bariatrique. Il existe peu de donnees de la prevalence du RGO avant cette chirurgie. Le but de cette etude prospective etait de preciser la symptomatologie et les resultats des explorations fonctionnelles et endoscopiques œsophagiennes dans une population d’adultes obeses adresses pour chirurgie bariatrique. Patients et Methodes Tous les patients avec un IMC > 30 kg/m2 adresses pour chirurgie bariatrique ont eu, un interrogatoire standardise, une fibroscopie, une pHmetrie de 24 h et une manometrie œsophagienne de haute resolution (36 capteurs). L’interrogatoire precisait la presence de symptomes digestifs evocateurs (pyrosis, regurgitation, epigastralgie et dysphagie), ou compatibles (ORL, toux, douleurs thoraciques) avec un RGO. Les donnees ont ete analysees selon le pourcentage de temps passe a pH inferieur a 4 (seuil de 4,2 %). Resultats Les donnees de 55 patients (46 femmes, IMC : 47 ± 7 kg/m2, âge : 42 ± 11 ans) ont ete analysees. Il existait au moins une anomalie manometrique chez 40 (72 %) patients (hypotonie du sphincter inferieur de l’œsophage (SIO) = 26, troubles du peristaltisme = 16, ondes polyphasiques = 11). L’exposition acide œsophagienne etait pathologique chez 21 patients (groupe RGO+) et normale chez 34 (groupe RGO-). Le jeune âge etait correle a la duree de l’exposition acide. La hauteur de la hernie hiatale etait correlee au poids (p Conclusion Dans cette population majoritairement feminine, vue pour chirurgie bariatrique, nos resultats confirment la prevalence elevee (75 %) des symptomes compatibles avec un RGO, et du reflux acide (38 %) chez l’obese. Ces resultats montrent la necessite d’une recherche du RGO avant chirurgie bariatrique pour permettre une caracterisation fiable de ces symptomes en post-operatoire.

Graphical Abstract, Highlights • Multi-Criteria Decision Analysis applied to SARS CoV-2 pandemic • Creating a model to prioritize hospitalization of COVID-19 patients in low- and middle-income countries • Eleven criteria selected considering their feasibility in low-resource settings • Reducing the risk of non-standardised approaches and improving the response of health systems to new pandemics, Objective To use Multi-Criteria Decision Analysis (MCDA) to determine weights for eleven criteria in order to prioritize COVID-19 non-critical patients for admission to hospital in healthcare settings with limited resources. Methods The MCDA was applied in two main steps: specification of criteria for prioritizing COVID-19 patients (and levels within each criterion); and determination of weights for the criteria based on experts’ knowledge and experience in managing COVID-19 patients, via an online survey. Criteria were selected based on available COVID-19 evidence with a focus on low- and middle-income countries (LMICs). Results The most important criteria (mean weights, summing to 100%), are: PaO2 (16.3%); peripheral O2 saturation (15.9%); chest X-ray (14.1%); Modified Early Warning Score-MEWS (11.4%); respiratory rate (9.5%); comorbidities (6.5%); living with vulnerable people (6.4%); body mass index (5.6%); duration of symptoms before hospital evaluation (5.4%); CRP (5.1%); and age (3.8%). Conclusions At the beginning of a new pandemic, when evidence for disease predictors is limited or unavailable and effective national contingency plans are difficult to establish, the MCDA prioritization model could play a pivotal role in improving the response of health systems.

The problem of finding multi-constrained paths has been addressed by several QoS routing algorithms. While they generally satisfy the application requirements, they often do not consider the perspective of service providers. Service providers aim at maximizing the throughput and the number of accepted requests. These goals have been addressed by traffic engineering algorithms considering bandwidth as the sole application requirement. We propose a proper length function for an existing QoS routing algorithm (SAMCRA) that attempts to optimize network utilization while still offering QoS guarantees. This paper presents a comparison between several proposed algorithms via simulation studies. The simulations show that SAMCRA with a proper length performs similarly or even better than the best among the other algorithms and it has a fast running time.

We present some interesting research studies conducted over both a Differentiated services (Diffserv) and a Multi Protocol Label Switching (MPLS) experimental testbed Diffserv operation over an MPLS backbone is also investigated The trials have been performed on a network made of Linux routers and the measures have been collected by exploiting state-of-the-art open source software, either available from other researchers or developed at our own university.