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

Remarks on some tardigrades of the African fauna with the description of three new species of Macrobiotus Schultze 1834

Ten species of tardigrades are recorded. Three of them, Macrobiotus radiatus, Macrobiotus vanescens, and Macrobiotus iharosi are new for science; two species, Macrobiotus sapiens Binda & Pilato 1984 and Isohypsibius kristenseni Pilato et al. 1989, are new for the African fauna. Macrobiotus radiatus n. sp. differs from the other species of the harmsioorthi group in the characters of the eggs and in other characters regarding various structures (buccal armature, or placoids length, or the insertion point of the stylet supports, or the claws length). Macrobiotus vanescens n. sp. is similar to Macrobiotus richtersi Murray 1911 and to Macrobiotus peteri Pilato et al. 1989 but differs from them in some characters regarding the bucco-pharyngeal apparatus, the claws and the eggs. Macrobiotus iharosi n. sp. differs from Macrobiotus echinogenitus Richters 1904 in the characters of the eggs, and from Macrobiotus sapiens Binda & Pilato 1984 in some characters of the bucco-pharyngeal apparatus and of the claws

The impact of transanal local excision of early rectal cancer on completion rectal resection without neoadjuvant chemoradiotherapy: a systematic review

Background The impact of transanal local excision (TAE) of early rectal cancer (ERC) on subsequent completion rectal resection (CRR) for unfavorable histology or margin involvement is unclear. The aim of this study was to provide a comprehensive review of the literature on the impact of TAE on CRR in patients without neoadjuvant chemoradiotherapy (CRT). Methods We performed a systematic review of the literature up to March 2020. Medline and Cochrane libraries were searched for studies reporting outcomes of CRR after TAE for ERC. We excluded patients who had neoadjuvant CRT and endoscopic local excision. Surgical, functional, pathological and oncological outcomes were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Results Sixteen studies involving 353 patients were included. Pathology following TAE was as follows T0 = 2 (0.5%); T1 = 154 (44.7%); T2 = 142 (41.2%); T3 = 43 (12.5%); Tx = 3 (0.8%); T not reported = 9. Fifty-three percent were > T1. Abdominoperineal resection (APR) was performed in 80 (23.2%) patients. Postoperative major morbidity and mortality occurred in 22 (11.4%) and 3 (1.1%), patients, respectively. An incomplete mesorectal fascia resulting in defects of the mesorectum was reported in 30 (24.6%) cases. Thirteen (12%) patients developed recurrence: 8 (3.1%) local, 19 (7.3%) distant, 4 (1.5%) local and distant. The 5-year cancer-specific survival was 92%. Only 1 study assessed anal function reporting no continence disorders in 11 patients. In the meta-analysis, CRR after TAE showed an increased APR rate (OR 5.25; 95% CI 1.27-21.8; p 0.020) and incomplete mesorectum rate (OR 3.48; 95% CI 1.32-9.19; p 0.010) compared to primary total mesorectal excision (TME). Two case matched studies reported no difference in recurrence rate and disease free survival respectively. Conclusions The data are incomplete and of low quality. There was a tendency towards an increased risk of APR and poor specimen quality. It is necessary to improve the accuracy of preoperative staging of malignant rectal tumors in patients scheduled for TAE

Are eco-friendly “green” tires also chemically green? Comparing metals, rubbers and selected organic compounds in green and conventional tires

Tires are a major source of synthetic and natural rubber particles, metals and organic compounds, in which several compounds are linked to negative environmental impact. Recent advances in material technology, coupled with focus on sustainability, have introduced a new range of tires, sold as “green, sustainable, and eco-friendly”. Although these “green” tires may have lower impact on the environment on a global scale, there is no current knowledge about the chemical composition of “green” tires, and whether they are more eco-friendly when considering the release of tire wear particles or tire-associated chemicals. Here we have investigated the chemical composition of nine “green” vehicle tires, one “green” bike tire and seven “conventional” vehicle tires. No significant difference was found between “green” and “conventional” tires tested in this study. For N-(1,3-dimethylbutyl)-N'-phenyl-p-phenylenediamine (6PPD), the average concentration in “green” tires were higher (16 ± 7.8 μg/mg) compared to “conventional” tires (8.7 ± 4.5 μg/mg). The relationship between metals, selected organic compounds and rubbers demonstrated large variation across brands, and lower variability between tires grouped according to their seasonal use. This study indicates that more work is needed to understand how the shift towards sustainable tires might change the chemical composition of tires

Selection of the optimal extraction protocol to investigate the interaction between trace elements and environmental plastic

The interaction between environmental plastic and trace elements is an issue of concern. Understanding their interaction mechanisms is key to evaluate the potential threats for the environment. To this regard, consolidating confidence in extraction protocols can help in understanding the amount of different species present on plastic surface, as well as the potential mobility of trace elements present inside the plastic matrix (e.g., additives). Here we tested the efficacy of different reagents to mimic the elemental phases bonded to meso- and microplastic in the environment, in relation to the grade of ageing and the polymer composition. Results showed that a relatively high portion of trace elements is bonded in a weak phase and that other phases abundant in other matrices (e.g., oxides and bonded to organic matter) are only present to a limited degree in the plastic samples. The comparison of different sample types highlighted the important role of plastic ageing in governing interactions with trace elements, while the polymer composition has a limited influence on this process. Finally, the future steps toward a tailored extraction scheme for environmental plastic are proposed

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

Computation of Electrostatic Field near Three-Dimensional Corners and Edges

Theoretically, the electric field becomes infinite at corners of two and three dimensions and edges of three dimensions. Conventional finite-element and boundary element methods do not yield satisfactory results at close proximity to these singular locations. In this paper, we describe the application of a fast and accurate BEM solver (which usesexact analytic expressions to compute the effect of source distributions on flatsurfaces) to compute the electric field near three-dimensional corners and edges. Results have been obtained for distances as close as 1$\mu m$ near the corner/edge and good agreement has been observed between the present results and existing analytical solutions.Comment: Presented in International Conference on Computational and Experimental Engineering and Sciences held at IIT Madras, Chennai, India, during 1-6 December, 200

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis

Background: In Western countries, the incidence of acute diverticulitis (AD) is increasing. Patients with uncomplicated diverticulitis can undergo a standard antibiotic treatment in an outpatient setting. The aim of this systematic review was to assess the safety and efficacy of the management of acute diverticulitis in an outpatient setting. Methods: A literature search was performed on PubMed, Scopus, Embase, Central and Web of Science up to September 2018. Studies including patients who had outpatient management of uncomplicated acute diverticulitis were considered. We manually checked the reference lists of all included studies to identify any additional studies. Primary outcome was the overall failure rates in the outpatient setting. The failure of outpatient setting was defined as any emergency hospital admission in patients who had outpatient treatment for AD in the previous 60 days. A subgroup analysis of failure was performed in patients with AD of the left colon, with or without comorbidities, with previous episodes of AD, in patients with diabetes, with different severity of AD (pericolic air and abdominal abscess), with or without antibiotic treatment, with ambulatory versus home care unit follow-up, with or without protocol and where outpatient management is a common practice. The secondary outcome was the rate of emergency surgical treatment or percutaneous drainage in patients who failed outpatient treatment. Results: This systematic review included 21 studies including 1781 patients who had outpatient management of AD including 11 prospective, 9 retrospective and only 1 randomized trial. The meta-analysis showed that outpatient management is safe, and the overall failure rate in an outpatient setting was 4.3% (95% CI 2.6%-6.3%). Localization of diverticulitis is not a selection criterion for an outpatient strategy (p 0.512). The other subgroup analyses did not report any factors that influence the rate of failure: previous episodes of acute diverticulitis (p = 0.163), comorbidities (p = 0.187), pericolic air (p = 0.653), intra-abdominal abscess (p = 0.326), treatment according to a registered protocol (p = 0.078), type of follow-up (p = 0.700), type of antibiotic treatment (p = 0.647) or diabetes (p = 0.610). In patients who failed outpatient treatment, the majority had prolonged antibiotic therapy and only few had percutaneous drainage for an abscess (0.13%) or surgical intervention for perforation (0.06%). These results should be interpreted with some caution because of the low quality of available data. Conclusions: The outpatient management of AD can reduce the rate of emergency hospitalizations. This setting is already part of the common clinical practice of many emergency departments, in which a standardized protocol is followed. The data reported suggest that this management is safe if associated with an accurate selection of patients (40%); but no subgroup analysis demonstrated significant differences between groups (such as comorbidities, previous episode, diabetes). The main limitations of the findings of the present review concern their applicability in common clinical practice as it was impossible to identify strict criteria of failure

Is the outpatient management of acute diverticulitis safe and effective? A systematic review and meta-analysis

Background: In Western countries, the incidence of acute diverticulitis (AD) is increasing. Patients with uncomplicated diverticulitis can undergo a standard antibiotic treatment in an outpatient setting. The aim of this systematic review was to assess the safety and efficacy of the management of acute diverticulitis in an outpatient setting. Methods: A literature search was performed on PubMed, Scopus, Embase, Central and Web of Science up to September 2018. Studies including patients who had outpatient management of uncomplicated acute diverticulitis were considered. We manually checked the reference lists of all included studies to identify any additional studies. Primary outcome was the overall failure rates in the outpatient setting. The failure of outpatient setting was defined as any emergency hospital admission in patients who had outpatient treatment for AD in the previous 60 days. A subgroup analysis of failure was performed in patients with AD of the left colon, with or without comorbidities, with previous episodes of AD, in patients with diabetes, with different severity of AD (pericolic air and abdominal abscess), with or without antibiotic treatment, with ambulatory versus home care unit follow-up, with or without protocol and where outpatient management is a common practice. The secondary outcome was the rate of emergency surgical treatment or percutaneous drainage in patients who failed outpatient treatment. Results: This systematic review included 21 studies including 1781 patients who had outpatient management of AD including 11 prospective, 9 retrospective and only 1 randomized trial. The meta-analysis showed that outpatient management is safe, and the overall failure rate in an outpatient setting was 4.3% (95% CI 2.6%-6.3%). Localization of diverticulitis is not a selection criterion for an outpatient strategy (p 0.512). The other subgroup analyses did not report any factors that influence the rate of failure: previous episodes of acute diverticulitis (p = 0.163), comorbidities (p = 0.187), pericolic air (p = 0.653), intra-abdominal abscess (p = 0.326), treatment according to a registered protocol (p = 0.078), type of follow-up (p = 0.700), type of antibiotic treatment (p = 0.647) or diabetes (p = 0.610). In patients who failed outpatient treatment, the majority had prolonged antibiotic therapy and only few had percutaneous drainage for an abscess (0.13%) or surgical intervention for perforation (0.06%). These results should be interpreted with some caution because of the low quality of available data. Conclusions: The outpatient management of AD can reduce the rate of emergency hospitalizations. This setting is already part of the common clinical practice of many emergency departments, in which a standardized protocol is followed. The data reported suggest that this management is safe if associated with an accurate selection of patients (40%); but no subgroup analysis demonstrated significant differences between groups (such as comorbidities, previous episode, diabetes). The main limitations of the findings of the present review concern their applicability in common clinical practice as it was impossible to identify strict criteria of failure

Comparison of blood and milk non-specific immune parameters in heifers after calving in relation to udder health

A practical protocol to study udder immune status in field conditions was planned with the aim to assess different non-specific immune parameters in milk samples from dairy heifers during the periparturient period. Five herds located in northern Italy were selected and overall 39 heifers were enrolled in the trial. Milk samples were taken at 7, 14, 21, 28, 45, 60, and 75 days after calving. The parameters assessed were N-acetyl-\u3b2-glucosaminidase (NAGase), lysozyme, respiratory burst (RB), somatic cell counts (SCC) and serum protein profile. SCC and NAGase were higher in the first sampling after calving, while lysozyme showed large variations during the observation period without a definite trend. The levels of RB observed in the first two weeks after calving, even if lower, were not statistically different from the values observed in samples taken over the following weeks. This study confirmed that the levels of immune components in milk are different from what is observed at blood level in the same cow. A significant decrease in RB in milk polymorphonuclear leukocytes (PMN) post-calving was not observed; milk PMN from healthy cows showed low RB levels, while the values from infected quarters were significantly higher. Significant differences between healthy and infected animals were also observed for milk NAG, lactoglobulin and albumin. These data suggest that udder immune response could be influenced both by the cow immune status and by external factors such as pathogens and management. Therefore, the reduction in immune defences, particularly in heifers, is not unavoidable and methods to boost PMN activity should be explored