Outcomes of Metabolic and Bariatric Surgery in Populations with Obesity and Their Risk of Developing Colorectal Cancer: Where Do We Stand? An Umbrella Review on Behalf of TROGSS—The Robotic Global Surgical Society

Introduction: Obesity is a chronic disease associated with increased risk for several cancers, including colorectal cancer (CRC), a leading cause of cancer-related mortality. The majority of CRC cases are associated with modifiable risk factors. Metabolic and bariatric surgery (MBS) is a proven, durable, and successful intervention for obesity. This study aimed to evaluate the impact of MBS on CRC risk through measures of association, such as relative risk (RR) and odds ratio (OR). Methods: A systematic search of PubMed, Scopus, Web of Science, ScienceDirect, and Embase was conducted to identify systematic reviews (SR) and meta-analyses examining the relationship between obesity treated with MBS and CRC incidence. The PICO framework guided inclusion criteria, and three independent reviewers screened articles using Rayyan software. Quality assessment was performed using AMSTAR2. Results: Of 1336 screened articles, 10 SR met inclusion criteria, encompassing 53,452,658 patients. Meta-analyses consistently showed a significant reduction in CRC risk following MBS in patients with severe obesity. Risk reductions were reported by Liu et al. (RR: 0.46, 95% CI: 0.32–0.67, p < 0.01), Chierici et al. (RR: 0.46, 95% CI: 0.28–0.75, p = 0.018), Wilson et al. (RR: 0.69, 95% CI: 0.53–0.88, p = 0.003), and Pararas et al. (RR: 0.56, 95% CI: 0.40–0.80, p < 0.001). Sensitivity analyses supported these findings. For colon cancer, Liu and Chierici both reported an RR of 0.75 (95% CI: 0.46–1.21, p = 0.2444) with significant heterogeneity (I2 = 89%). A trend towards reduced rectal cancer risk (RR: 0.74, 95% CI: 0.40–1.39, p = 0.3523) was noted but limited by fewer studies. Sex-specific analyses revealed protective effects in both sexes, with a more pronounced impact in females (RR: 0.54, 95% CI: 0.37–0.79, p = 0.0014). Conclusions: This umbrella review synthesizes current evidence on the impact of MBS on CRC risk, highlighting a consistent protective association. The findings also indicate a potential risk reduction for both colon and rectal cancer, with a more pronounced effect observed among females compared to males. Given the profound implications of MBS on cancer incidence, morbidity, and mortality, further high-quality, long-term studies are essential to deepen our understanding and optimize its role in cancer prevention and patient care. © 2025 by the authors

Corte internazionale di giustizia

La voce descrive la storia, il funzionamento e l'evoluzione dei poteri della Corte internazionale di giustizia. Si concentra principalmente sul ruolo della Corte come garante della corretta applicazione del diritto internazionale in conformità alle norme della Carta delle Nazioni Unit

Influence of gender on Behçet's disease phenotype and irreversible organ damage: Data from the International AIDA Network Behçet's Disease Registry

Objectives: Gender impact on phenotypical expression of Behçet's disease (BD) has been specifically investigated only in a few large-scale studies. The main goal of the study was to examine gender differences in a large cohort of patients affected by BD. Methods: Data were retrieved from the International AIDA Network Registry for BD. We assessed differences between males and females in terms of Behçet's syndrome Overall Damage Index (BODI), differences in the disease manifestations at onset and in the cumulative manifestations throughout disease course, as well as differences in the cardiovascular risk. Finally, predictive factors leading to major organ involvement were investigated. Results: In total, 1024 BD patients (567 males, 457 females) were enrolled in the study, with a male-to-female ratio of 1.24/1. Males displayed a significantly higher mean ± SD BODI (1.92 ± 2.09) at the last follow-up, compared to female patients (1.25 ± 1.87) (P < 0.0001). Uveitis (P < 0.0001) and vascular involvement (P = 0.0076) were significantly more frequent among males whereas female patients were significantly over-represented in arthralgia (P < 0.0001), arthritis (P = 0.00025), isolated headache (P < 0.0001), central nervous system (CNS) involvement (P = 0.040), and gastrointestinal involvement (P = 0.00046). Regarding cardiovascular risk, no differences between the two groups emerged (P = 0.617). Four variables were associated with the development of major organ involvement: male gender (OR = 2.104, P = 0.001), current treatment with biologic agents (OR = 2.257, P = 0.0003), origin from endemic countries (OR = 2.661, P = 0.0009), and disease duration (OR = 1.002, P = 0.024). Conclusion: BD displays a more severe course among males. This subgroup develops more irreversible damage and presents more frequently ocular and vascular involvement during disease course. On the other hand, female patients are prone to experience articular involvement, headache, CNS and gastrointestinal involvement. These data suggest the existence of a gender-driven disease expression

The contribution of cryptocurrencies to portfolio diversification

Cryptocurrencies have attracted significant attention due to their high risk, extreme volatility, regulatory controversies, and scandals. Investors and policymakers are drawn to them for their potential to enhance diversification and deliver high returns. This study examines the impact of incorporating cryptocurrencies into investment portfolios, focusing on their ability to improve risk-adjusted returns and diversification. A rolling asset allocation strategy employing the maximum Sharpe Ratio within a Markowitz framework was applied to weekly data from 2018 to April 2024. The analysis compares two unconstrained portfolios and two constrained portfolios, which impose a concentration limit on cryptocurrency investments. Results reveal that in 70% of the rolling periods examined, portfolios with cryptocurrency allocations outperformed non-cryptocurrency portfolios in terms of Sharpe Ratios. However, the heightened volatility of cryptocurrencies significantly increased portfolio risk, with annualized weekly standard deviations ranging from 18% to 25%, compared to 12% to 15% for portfolios without cryptocurrency exposure. These findings illustrate the dual nature of cryptocurrencies: they can act as both a source of instability and an opportunity for diversification. The study underscores the necessity of a cautious and strategic approach to incorporating cryptocurrencies into investment plans, given their inherent risks and unpredictable behavior

Exploring paths underlying Industry 4.0 implementation in manufacturing SMEs: A fuzzy-set qualitative comparative analysis

The purpose of this article is to develop a configurational approach based on the TOE framework (Technology, Organization, Environment) to understand the degree of implementation of I4.0 technologies in manufacturing SMEs. Specifically, the study considers technological infrastructure and competence, I4.0 integration capabilities, organizational agility and strategic flexibility, environmental dynamism, and industry-specific forces as simultaneous pre-conditions for achieving an effective implementation of I4.0 technologies. This study uses the fuzzy-set Qualitative Comparative Analysis (fsQCA) methodology as it allows for asymmetric and configurational-focused testing of proposition and sound theoretical development. 305 responses were collected through a survey administered to SME managers in Europe and the UK. The study examines the influence of technology, organizational, and environmental aspects on I4.0 technologies implementation in SMEs. High I4.0 degree of implementation is structured around 5 configurations, while other 4 configurations are related to low levels of I4.0 implementation. This study proposes a configurational approach for SMEs to become I4.0 ready and how they may successfully implement I4.0 technologies. Such findings represent an original and novel contribution to existing research, offering a broad view on the I4.0 implementation by manufacturing SMEs

Deciphering islets and circulating microRNAs signatures to explore new putative key regulators of glucose tolerance and beta cell dysfunction in Type 2 Diabetes

The complex pathogenesis of Type 2 Diabetes (T2D) involves a progressive decline in beta cell function, coupled with insulin resistance. A deeper understanding of how beta cells adapt or fail in response to insulin resistance represents a critical gap to elucidate the natural progression of the disease. However, research into human islet morphology remains limited due to difficulty of accessing pancreatic tissue samples. Moreover, the lack of specific circulating biomarkers mirroring islet plasticity and impairment further complicates the prediction of rapid disease progression. Circulating non-coding RNAs (ncRNAs), such as microRNAs (miRNAs), offer promise as stable, detectable biomarkers in plasma, reflecting metabolic states of pancreatic islets and potentially aiding in the understanding of beta cell failure mechanisms in T2D. To dissect ncRNAs profile in pancreatic islets and in plasma samples during glucose tolerance stages progression, we took advantage from a cohort of Normal Glucose Tolerant (NGT), Impaired Glucose Tolerant (IGT) and Type 2 Diabetic (T2D) living donors undergoing partial pancreatectomy together with their accurate metabolic characterization. The analysis of small RNAs, conducted on pancreatic islets and plasma samples from individuals with different stages of glucose tolerance (NGT, IGT, T2D), revealed that miRNAs constitute the predominant class and exhibit significant associations with metabolic parameters and beta cell function. Within pancreatic islets, four miRNAs were differentially expressed among the NGT, IGT, and T2D groups, with two of them (miR-129-5p and miR-148a-3p) showing differential expression even according to a new stratification based on parameters such as glucose and rate sensitivity, which are useful for identifying specific markers of beta cell dysfunction. Among these, miR-148a-3p emerged as the most promising islet marker due to its association with the target gene ATP6AP2, suggesting a key role in regulating incretin-mediated insulin secretion. As for circulating miRNAs, plasma analysis identified eleven miRNAs differentially expressed among NGT, IGT, and T2D groups, with three (miR-34a-5p, miR-1306-5p, and miR-335-5p) specifically correlated with beta cell dysfunction. This set of three circulating miRNAs, combined with a minimal set of clinical baseline data, demonstrated the ability to predict rate sensitivity, i.e. early alterations in insulin secretion, making them as promising biomarkers for assessing T2D development risk. Overall, these findings suggest that specific miRNAs, both islet-derived and circulating, may serve as novel tools for the early detection of beta cell dysfunction and damage, offering new opportunities for the diagnosis and treatment of T2D

Nanoplastic-Induced Developmental Toxicity in Ascidians: Comparative Analysis of Chorionated and Dechorionated Phallusia mammillata Embryos

Nanoplastics pose a growing threat to marine ecosystems, particularly affecting the early developmental stages of marine organisms. This study investigates the effects of amino-modified polystyrene nanoparticles (PS-NH2, 50 nm) on the embryonic development of Phallusia mammillata, a model ascidian species. Both chorionated and dechorionated embryos were exposed to increasing concentrations of PS-NH2 so morphological alterations could be assessed with a high-content analysis of the phenotypes and genotoxicity. PS-NH2 induced the same morphological alterations in both chorionated and dechorionated embryos, with dechorionated embryos being more sensitive (EC50 = 3.0 μg mL−1) than chorionated ones (EC50 = 6.26 μg mL−1). Interestingly, results from the morphological analysis showed two concentration-dependent mechanisms of action: (i) at concentrations near the EC50, neurodevelopmental abnormalities resembling the ones induced by exposure to known endocrine disruptors (EDs) were observed, and (ii) at higher concentrations (15 μg mL−1 and 7.5 μg mL−1 for chorionated and dechorionated embryos, respectively), a nonspecific toxicity was evident, likely due to general oxidative stress. The phenotypes resulting from the PS-NH2 treatment were not related to DNA damage, as revealed by a genotoxicity assay performed on neurula embryos. Our data suggest that PS-NH2-induced toxicity is primarily mediated through oxidative stress, probably triggered by interactions between the positive charges of the PS NPs and the negative charges on the cell membranes. The lack of a protective chorion further exacerbated these effects, highlighting its role in mitigating/protecting against NP-induced damage

Verso l'unificazione dei redditi finanziari. Il ruolo degli intermediari e i regimi di tassazione

Nell’ordinamento vigente, i redditi di natura finanziaria sono tassati secondo tre distinti regimi – regime dichiarativo, risparmio amministrato e risparmio gestito – fortemente differenziati in relazione a molteplici profili, che interessano principalmente: le modalità di determinazione della base imponibile; la rilevanza dei costi di produzione del reddito; il ruolo riconosciuto agli intermediari finanziari; la tempistica di applicazione del prelievo. L’art. 5, co.1, lett. d), della legge delega per la riforma fiscale (L. n. 111/2023) prefigura il superamento di tale articolato sistema, attraverso la creazione di un’unica categoria reddituale e la convergenza verso una tassazione ispirata al principio di cassa.Under the current legislation, financial income is taxed according to three different regimes – directly through the income tax return, with the “administered savings method” and with the “managed savings method” - strongly differentiated in relation to multiple profiles, which mainly concern: the way tax base is determined; the significance of the cost of producing income; the role of financial intermediaries; and the timing of application of the levy. Art. 5, co.1, lett. d), of the law delegating for the tax reform (L. n. 111/2023) prefigures the overcoming of this complex system, through the creation of a unique income category and the convergence towards a taxation inspired by the cash principle

Le forme della composizione: incandescenza e ripetizione nel film

Il volume sviluppa un’indagine di carattere teorico e analitico sulle forme della composizione cinematografica a partire da due ampie prospettive: da un lato si concentra sui luoghi testuali – inquadrature, scene o sequenze, o rapporti e connessioni tra loro - in cui, lungo il corso del suo farsi, un film si fa capace di conseguire e mostrare le unità di senso più radicali e più dense che informano e orientano il suo intero lavoro costruttivo; dall’altro si sofferma sull’ampio spettro delle dinamiche di ripetizione che, a diversi livelli, hanno posto nell’attività elaborativa e formativa di un testo filmico. Abitato e spesso orientato da nodi e motivi di pensiero ejzenštejniani, il libro attiva una serie di confronti analitici con opere dovute ad autori molto diversi tra loro, da Barnet a Donen e Kelly, da Lattuada a Varda, da Pasolini a Truffaut, da Kieślowski a Martone, da Novikova a Folman, da Eastwood a Godard