Seated anorectal manometry during simulated evacuation. A physiological exercise or a new clinically useful diagnostic test?

Symptoms such as a feeling of incomplete evacuation, straining, absence of the call to stool, anal blockage or digitation suggest the presence a functional defecation disorder. As symptoms do not distinguish between patients with and without functional defecation diosrder, Rome IV criteria recommend that this disorder is diagnosed when two of three tests are positive: balloon expulsion test (BET), anorectal manometry (ARM) and defecography. However previous studies have demonstrated that the agreement among these tests is limited. In this issue of Neurogastroenterology and Motility, Sharma et al tested the hypothesis that conducting the ARM in a seated position would increase the diagnostic accuracy of the test in discriminating between patients with normal and prolonged BET. This minireview discusses the current knowledge on the role of the techniques to diagnose defecation disorder and the potential role of the ARM in a seated position

La condizione detentiva, il trattamento e la relazione professionale con il detenuto autore di reati sessuali. Una visione esperienziale

L’articolo, partendo dalla presentazione di una innovativa esperienza trattamentale nei confronti di sex offender attuata nella Casa Circondariale di Chieti, vuole proporre l’importanza che i percorsi di inclusione nei confronti di tali autori di reato assumono quale presupposto indiscutibile per l’attuazione di programmi trattamentali specifici. L’esperienza svolta dagli operatori del carcere di Chieti si è avvalsa anche di una collaborazione con l’Università “G. d’Annunzio” che ha evidenziato come in tali autori di reato siano presenti significative distorsioni cognitive su cui è importante intervenire al fine di ottenere il recupero della persona e la riduzione della recidiva. Vengono esposti i risultati della ricerca svolta su 24 sex offender e non che ha evidenziato una presenza più significativa di distorsioni cognitive negli autori di reati sessuali rispetto agli autori di reato non a sfondo sessuale, soprattutto a danno di vittime maggiorenni piuttosto che minorenni. Vengono analizzati modelli trattamentali applicati a livello nazionale e internazionale e indicati successivi sviluppi di ricerca al fine di proporre programmi di intervento sulla stessa popolazione detenuta nel carcere di Chieti. Résumé À partir de la présentation d’un programme novateur axé sur la réinsertion de délinquants sexuels, mis en œuvre dans la prison italienne de Chieti (Casa Circondariale), l’article souligne l’importance de l’inclusion de ces délinquants en tant que condition essentielle à la réalisation de programmes de réinsertion spécifiques. Grâce à la collaboration entre le personnel pénitentiaire et les chercheurs de l’universitéUniversité « G. d’Annunzio », cette expérience prouve que ce type de délinquants est affecté par d’importants préjugés cognitifs. C’est pourquoi, il est important de réaliser une intervention de débiaisement afin d’une meilleure réhabilitation de la personne et pour contribuer à la réduction de la récidive. Les résultats de la recherche menée auprès de 24 personnes (dont certaines sont des délinquants sexuels, d’autres non) montrent que les délinquants sexuels sont affectés plus que les autres par des préjugés cognitifs et en particulier dans le cas où leurs victimes ont plus de 18 ans. En outre, dans cet article, les auteurs analysent les modèles italiens et internationaux de traitement et enfin proposent de nouvelles activités de recherche afin d’étendre ce type de programme à la totalité de la population carcérale de la prison de Chieti. Abstract Starting from the presentation of an innovative program addressing the rehabilitation of sex offenders, implemented inside the Italian prison of Chieti (Casa Circondariale), the article proposes the importance of the inclusion of these offenders as an essential condition for the implementation of specific rehabilitation programs. Thanks to the collaboration between the prison staff and the researchers coming from the University “G. d’Annunzio”, this experience shows that such offenders are affected by significant cognitive biases. Therefore, it is important to apply a debiasing intervention to better rehabilitate the person and contribute to the reduction of recidivism. The results of the research that was carried out on 24 people (some of them are sex offenders, some others not) show that the sex offenders are affected more than the others offenders by cognitive biases, and particularly when their victims were over 18. Moreover, in this paper the authors analyse Italian and international treatment models and finally they propose new research activities in order to extend this kind of program to the entire inmate population of the prison of Chieti

Abnormalities of mucosal serotonin metabolism and 5-HT3 receptor subunit 3C polymorphism in irritable bowel syndrome with diarrhoea predict responsiveness to ondansetron

BackgroundIrritable bowel syndrome with diarrhoea (IBS‐D) is a common condition, greatly reducing the quality of life with few effective treatment options available.AimsTo report the beneficial response shown in our trial with the 5‐hydroyxtryptamine (5‐HT) receptor 3 antagonist, ondansetron in IBS‐DMethodsA randomised, placebo‐controlled, cross‐over trial of 5 weeks of ondansetron versus placebo in 125 patients meeting modified Rome III criteria for IBS‐D as previously described. Patients were compared to 21 healthy controls. 5‐HT and 5‐HIAA were measured in rectal biopsies. Whole gut transit time was assessed using a radio‐opaque marker technique. Whole blood DNA was genotyped for an insertion polymorphism in the promoter region of the serotonin transporter gene SLC6A4, as well as single nucleotide polymorphisms (SNPs) of the tryptophan hydroxylase gene TPH1 and 5‐HT3 receptor genes HTR3A, C and E. ResultsPatients’ biopsies showed significantly higher 5‐HIAA levels (2.1 (1.2‐4.2) pmol/mg protein vs 1.1 (0.4‐1.5) in controls, P < .0001). 39 patients used < 4 mg/d (“super‐responders”) while 55 required ≥ 4 mg/d. 5‐HT concentrations in rectal biopsies were significantly lower in super‐responders (21.3 (17.0‐31.8) vs 37.7 (21.4‐61.4), P = .0357) and the increase in transit time on ondansetron was significantly greater (15.6 (1.8‐31) hours vs 3.9 (−5.1‐17.9) hours). Stool consistency responders were more likely to carry the CC genotype of the SNP p.N163K rs6766410 of the HTR3C gene (33% vs 14%, P = .0066). ConclusionIBS‐D patients have significant abnormalities in mucosal 5‐HT metabolism. Those with the lowest concentration of 5‐HT in rectal biopsies showed the greatest responsiveness to ondansetron

Colonic Biopsies to Assess the Neuropathology of Parkinson's Disease and Its Relationship with Symptoms

The presence of Lewy bodies and Lewy neurites (LN) has been demonstrated in the enteric nervous system (ENS) of Parkinson's disease (PD) patients. The aims of the present research were to use routine colonoscopy biopsies (1) to analyze, in depth, enteric pathology throughout the colonic submucosal plexus (SMP), and (2) to correlate the pathological burden with neurological and gastrointestinal (GI) symptoms.A total of 10 control and 29 PD patients divided into 3 groups according to disease duration were included. PD and GI symptoms were assessed using the Unified Parkinson's Disease Rating Scale part III and the Rome III questionnaire, respectively. Four biopsies were taken from the ascending and descending colon during the course of a total colonoscopy. Immunohistochemical analysis was performed using antibodies against phosphorylated alpha-synuclein, neurofilaments NF 220 kDa (NF) and tyrosine hydroxylase (TH). The density of LN, labeled by anti-phosphorylated alpha-synuclein antibodies, was evaluated using a quantitative rating score. Lewy pathology was apparent in the colonic biopsies from 21 patients and in none of the controls. A decreased number of NF-immunoreactive neurons per ganglion was observed in the SMP of PD patients compared to controls. The amount of LN in the ENS was inversely correlated with neuronal count and positively correlated with levodopa-unresponsive features and constipation.Analysis of the ENS by routine colonoscopy biopsies is a useful tool for pre-mortem neuropathological diagnosis of PD, and also provides insight into the progression of motor and non-motor symptoms

Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms : Results from a multicenter randomized double-blind placebo-controlled gluten challenge

Non-celiac gluten sensitivity (NCGS) is characterized by the onset of symptoms after eating gluten-containing food. We aimed to single out NCGS subjects among subjects with functional gastrointestinal symptoms. Patients were enrolled in a multicenter double-blind placebo-controlled trial with crossover. Symptoms and quality of life were evaluated by means of 10-cm VAS and SF36. Iron parameters, transaminases and C reactive protein (CRP) were evaluated. After a three-week-long gluten-free diet (GFD), responsive patients were randomly assigned to gluten intake (5.6 g/day) or placebo for seven days, followed by crossover. The primary endpoint was the worsening of symptoms (VAS increase 653 cm) during gluten ingestion compared to placebo. One hundred and forty patients were enrolled and 134 (17 males, mean age 39.1 \ub1 11.7 years, BMI 22.4 \ub1 3.8) completed the first period. A total of 101 subjects (10 males, mean age 39.3 \ub1 11.0 years, BMI 22.3 \ub1 4.0) reported a symptomatic improvement (VAS score 2.3 \ub1 1.2 vs. 6.5 \ub1 2.2 before and after GFD, p = 0.001). 98 patients underwent the gluten challenge and 28 (all females, mean age 38.9 \ub1 12.7 years, BMI 22.0 \ub1 2.9) reported a symptomatic relapse and deterioration of quality of life. No parameters were found to be statistically associated with positivity to the challenge. However, 14 patients responded to the placebo ingestion. Taking into account this finding, about 14% of patients responding to gluten withdrawal showed a symptomatic relapse during the gluten challenge. This group is suspected to have NCGS

Carta de 1981-08-11 a José Ferrater Mora des de Oviedo (Espanya)

Comunica que ha rebut les respostes del qüestionari i que sortirà publicat com a entrevista en el proper númer

Individual Training Processes and Tools. The implementation of the research in Pescara prison

Motivating, involving prisoners in their learning is hard as security and learning needs need to be combined and often do have different prioritisation. meeting prisoners, investigating on their wishes but especially on their needs and demands require professionals specific competences and knowledg