Management of acute perforated diverticulitis with generalized peritonitis: is this the end of the Hartmann's era?

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Practice parameters for the treatment of colonic diverticular disease: Italian Society of Colon and Rectal Surgery (SICCR) guidelines

The mission of the Italian Society of Colorectal Surgery (SICCR) is to optimize patient care. Providing evidence-based practice guidelines is therefore of key importance. About the present report it concernes the SICCR practice guidelines for the diagnosis and treatment of diverticular disease of the colon. The guidelines are not intended to define the sole standard of care but to provide evidence-based recommendations regarding the available therapeutic options

Pupillometry correlates of visual priming, and their dependency on autistic traits

In paradigms of visual search where the search feature (say color) can change from trial to trials, responses are faster for trials where the search color is repeated than when it changes. This is a clear example of "priming" of attention. Here we test whether the priming effects can be revealed by pupillometry, and also whether they are related to autistic-like personality traits, as measured by the Autism-Spectrum Quotient (AQ). We repeated Maljkovic and Nakayama's (1994) classic priming experiment, asking subjects to identify rapidly the shape of a singleton target defined by color. As expected, reaction times were faster when target color repeated, and the effect accumulated over several trials; but the magnitude of the effect did not correlate with AQ. Reaction times were also faster when target position was repeated, again independent of AQ. Presentation of stimuli caused the pupil to dilate, and the magnitude of dilation was greater for switched than repeated trials. This effect did not accumulate over trials, and did not correlate with the reaction times difference, suggesting that the two indexes measure independent aspects of the priming phenomenon. Importantly, the amplitude of pupil modulation correlated negatively with AQ, and was significant only for those participants with low AQ. The results confirm that pupillometry can track perceptual and attentional processes, and furnish useful information unobtainable from standard psychophysics, including interesting dependencies on personality traits

Ultrafast Electrochemical Self-Doping of Anodic Titanium Dioxide Nanotubes for Enhanced Electroanalytical and Photocatalytic Performance

This study explores an ultrarapid electrochemical self-doping procedure applied to anodic titanium dioxide (TiO2) nanotube arrays in an alkaline solution to boost their performance for electroanalytical and photocatalytic applications. The electrochemical self-doping process (i.e., the creation of surface Ti3+ states by applying a negative potential) is recently emerging as a simpler and cleaner way to improve the electronic properties of TiO2 compared to traditional chemical and high-temperature doping strategies. Here, self-doping was carried out through varying voltages and treatment times to identify the most performing materials without compromising their structural stability. Interestingly, cyclic voltammetry characterization revealed that undoped TiO2 shows negligible activity, whereas all self-doped materials demonstrate their suitability as electrode materials: an outstandingly short 10 s self-doping treatment leads to the highest electrochemical activity. The electrochemical detection of hydrogen peroxide was assessed as well, demonstrating a good sensitivity and a linear detection range of 3–200 µM. Additionally, the self-doped TiO2 nanotubes exhibited an enhanced photocatalytic activity compared to the untreated substrate: the degradation potential of methylene blue under UV light exposure increased by 25% in comparison to undoped materials. Overall, this study highlights the potential of ultrafast electrochemical self-doping to unleash and improve TiO2 nanotubes performances for electroanalytical and photocatalytic applications

Disappointing long-term results of the artificial anal sphincter for faecal incontinence

Faecal incontinence can severely affect quality of life, but as it has no influence on life expectancy, the long-term efficacy of any treatment must be taken into account.Most reports on new treatments for faecal incontinence describe short-term results and are rarely followed by a later review of the same group of patients; the few long-term reviews of traditional surgery are disappointing. The authors evaluated long-term outcome after implantation of an artificial bowel sphincter (ABS) (ActiconTM Neosphincter ABS; American Medical System, Minnetonka, Minnesota, USA) to determine whether the results tend to worsen with time. In the present study, obstructed defaecation was a frequent problem that led several patients to deactivate the pump. Together with the manometric findings of low anal canal resting pressure, even with the device activated, this suggests that the ABSmay function as a passive obstacle to the passage of faeces in the long term, like Thiersch’s sling, rather than as a dynamic sphincter. Furthermore, the ABS, like any foreign matter placed in the human body, may displace or erode, either to the rectum or to the perineum. Overall, the present study shows that the results of anal sphincter replacement using an ABS dynamic prosthesis deteriorate with time and that the long-term results may not be as good as reported previously

How to clean and safely remove HF from acid digestion solutions for ultra-trace analysis: a microwave-assisted vessel-inside-vessel protocol

The complete dissolution of silicate-containing materials, often necessary for elemental determination, is generally performed by microwave-assisted digestion involving the forced use of hydrofluoric acid (HF). Although highly efficient in dissolving silicates, this acid exhibits many detrimental effects (e.g., formation of precipitates, corrosiveness to glassware) that make its removal after digestion essential. The displacement of HF is normally achieved by evaporation in open-vessel systems: atmospheric contamination or loss of analytes can occur when fuming-off HF owing to the non-ultraclean conditions necessarily adopted for safety reasons. This aspect strongly hinders determination at the ultra-trace level. To overcome this issue, we propose a clean and safe microwaveassisted procedure to induce the evaporative migration of HF inside a sealed \u201cvessel-inside-vessel\u201d system: up to 99.9% of HF can be removed by performing two additional microwave cycles after sample dissolution. HF migrates from the digestion solution to a scavenger (ultrapure H2O) via a simple physical mechanism, and then, it can be safely dismissed/recycled. The procedure was validated by a soil reference material (NIST 2710), and no external or cross-contamination was observed for the 27 trace elements studied. The results demonstrate the suitability of this protocol for ultra-trace analysis when the utilization of HF is mandatory

Management of perforated diverticulitis with generalized peritonitis. a multidisciplinary review and position paper

La diverticolite perforata è una condizione clinica emergente e la sua gestione è impegnativa e ancora dibattuta. Lo scopo di questo documento di posizione era di rivedere criticamente le prove disponibili sulla gestione della diverticolite perforata e della peritonite generalizzata al fine di fornire suggerimenti basati sull'evidenza per una strategia di gestione. Quattro società scientifiche italiane (SICCR, SICUT, SIRM, AIGO), esperti selezionati che hanno identificato 5 temi clinicamente rilevanti nella gestione della diverticolite perforata con peritonite generalizzata che trarrebbero beneficio da una revisione multidisciplinare. Sono state affrontate le seguenti 5 problematiche: 1) Criteri per decidere tra trattamento conservativo e chirurgico in caso di diverticolite perforata con peritonite; 2) Criteri o sistema di punteggio per scegliere l'opzione chirurgica più appropriata quando è confermata la peritonite diffusa 3); La procedura chirurgica appropriata in pazienti emodinamicamente stabili o stabilizzati con peritonite diffusa; 4) La procedura chirurgica appropriata per i pazienti con peritonite generalizzata e shock settico e 5) Terapia medica ottimale in pazienti con peritonite generalizzata da perforazione diverticolare prima e dopo l'intervento chirurgico. Nella diverticolite perforata la chirurgia è indicata in caso di peritonite diffusa o fallimento della gestione conservativa e la decisione di operare non è basata sulla presenza di aria extraluminale. Se la peritonite diffusa è confermata, la scelta della tecnica chirurgica si basa sui risultati intraoperatori e sulla presenza o il rischio di shock settico grave. Ulteriori fattori prognostici da considerare sono lo squilibrio fisiologico, l'età, le comorbidità e lo stato immunitario. Nei pazienti emodinamicamente stabili, la laparoscopia di emergenza presenta vantaggi rispetto alla chirurgia a cielo aperto. Le opzioni includono resezione e anastomosi, procedura di Hartmann o lavaggio laparoscopico. Nella peritonite generalizzata con shock settico, è preferibile un approccio chirurgico aperto. La resezione non restaurativa e / o la chirurgia per il controllo del danno sembrano essere le uniche opzioni praticabili, a seconda della gravità dell'instabilità emodinamica. La gestione medica multidisciplinare dovrebbe essere applicata con gli obiettivi principali di controllare l'infezione, alleviare il dolore postoperatorio e prevenire e / o trattare ileo postoperatorio. In conclusione, la complessità e la diversità dei pazienti con perforazione diverticolare e peritonite diffusa richiede una strategia personalizzata, che preveda un'accurata classificazione dello squilibrio fisiologico, la stadiazione dell'infezione intra-addominale e la scelta della procedura chirurgica più appropriata.Perforated diverticulitis is an emergent clinical condition and its management is challenging and still debated. The aim of this position paper was to critically review the available evidence on the management of perforated diverticulitis and generalized peritonitis in order to provide evidence-based suggestions for a management strategy. Four Italian scientific societies (SICCR, SICUT, SIRM, AIGO), selected experts who identified 5 clinically relevant topics in the management of perforated diverticulitis with generalized peritonitis that would benefit from a multidisciplinary review. The following 5 issues were tackled: 1) Criteria to decide between conservative and surgical treatment in case of perforated diverticulitis with peritonitis; 2) Criteria or scoring system to choose the most appropriate surgical option when diffuse peritonitis is confirmed 3); The appropriate surgical procedure in hemodynamically stable or stabilized patients with diffuse peritonitis; 4) The appropriate surgical procedure for patients with generalized peritonitis and septic shock and 5) Optimal medical therapy in patients with generalized peritonitis from diverticular perforation before and after surgery. In perforated diverticulitis surgery is indicated in case of diffuse peritonitis or failure of conservative management and the decision to operate is not based on the presence of extraluminal air. If diffuse peritonitis is confirmed the choice of surgical technique is based on intraoperative findings and the presence or risk of severe septic shock. Further prognostic factors to consider are physiological derangement, age, comorbidities, and immune status. In hemodynamically stable patients, emergency laparoscopy has benefits over open surgery. Options include resection and anastomosis, Hartmann’s procedure or laparoscopic lavage. In generalized peritonitis with septic shock, an open surgical approach is preferred. Non-restorative resection and/or damage control surgery appear to be the only viable options, depending on the severity of hemodynamic instability. Multidisciplinary medical management should be applied with the main aims of controlling infection, relieving postoperative pain and preventing and/or treating postoperative ileus. In conclusion, the complexity and diversity of patients with diverticular perforation and diffuse peritonitis requires a personalized strategy, involving a thorough classification of physiological derangement, staging of intra-abdominal infection and choice of the most appropriate surgical procedure

Exploring the Adsorption of Pb on Microalgae-Derived Biochar: A Versatile Material for Environmental Remediation and Electroanalytical Applications

Biochar, a carbon material obtained by pyrolysis of biomasses, is increasingly applied in environmental remediation and sensing thanks to its functional properties, cost-effectiveness and eco-friendliness. The adsorption capacity of biochar, strictly dependent on its specific surface area, heteroatom doping and surface functional groups, is crucial for these applications. Here, biochar produced at low temperature (350◦ C) from a marine microalga (Nannochloropsis sp.) is proposed as an efficient adsorbent of lead (II) ions in aqueous solution; this production strategy promotes the natural self-doping of biochar without requiring harsh conditions. The kinetics and thermodynamics of the adsorption process, as well as the effect of pH, ionic strength and dissolved organic matter on the adsorption efficiency were systematically assessed. The microalgae-derived biochar shows superior adsorption performances compared to a nutshell-derived one (used as a reference of lignocellulosic feedstocks) under all the tested conditions. The microalgae-derived biochar was finally used to decorate screen-printed carbon electrodes to improve the electroanalytical performances towards the voltammetric detection of lead (II) ions. A two-fold increase in sensitivity was obtained compared to the unmodified electrode thanks to the enhanced electron transfer and adsorption properties provided by biochar. These results highlight the potentialities of microalgae-derived biochar for environmental and sensing applications

Dietary habits and gut microbiota in healthy adults: Focusing on the right diet. a systematic review

Diet is the first to affect our intestinal microbiota and therefore the state of eubiosis. Several studies are highlighting the potential benefits of taking certain nutritional supplements, but a dietary regime that can ensure the health of the intestinal microbiota, and the many pathways it governs, is not yet clearly defined. We performed a systematic review of the main studies concerning the impact of an omnivorous diet on the composition of the microbiota and the production of short-chain fatty acids (SCFAs). Some genera and phyla of interest emerged significantly and about half of the studies evaluated consider them to have an equally significant impact on the production of SCFAs, to be a source of nutrition for our colon cells, and many other processes. Although numerous randomized trials are still needed, the Mediterranean diet could play a valuable role in ensuring our health through direct interaction with our microbiota

Handmade clay bricks: chemical, physical and mechanical properties

The clay brick masonry that is much used in historical structures often is in a rather poor state of conservation. In order to intervene correctly in these buildings, it is convenient to characterize the old material. For this purpose, a large sample of clay brick specimens from the 12th to 19th century were collected from six Portuguese monasteries, and were characterized chemically, physically and mechanically. A large variability of the properties was found. Additionally, a sample of handmade new bricks, which are commonly used as replacing material, was also analysed. The results were compared to the old bricks and could be possibly adequate as substitution bricks. Still, significant differences were found in chemical composition, and in water absorption and porosity, which are much lower in modern handmade bricks. With respect to mechanical properties, the range of values found in old bricks was rather high and the degree of deterioration exhibited a large scatter, meaning that a conclusion is hardly possible.The authors gratefully acknowledge the Instituto de Gestao do Patrimonio Arquitectonico e Arqueologico (IGESPAR) for providing the old clay bricks used in the present work. The first author acknowledges the partial funding of this work by the FCT through the following scholarships POCTI SFRH/BD/6409/2001 and POCTI SFRH/BPD/26706/2005