La restituzione virtuale dell’architettura antica come strumento di ricerca e comunicazione dei beni culturali: ricerca estetica e gestione delle fonti

Raffaello Sanzio realized for the first time that the ancient world, as it appeared to his eyes, was the faded echo of the richness which characterized it in the arts. Today the technology allows to actualize Raffaello’s dream and to restore the appearance of the ancient buildings. It revolutions the cognition of the cultural heritage by the modern audience. During our ten-year long experience in the communication of the cultural heritage we could deal with examples as Domus Aurea or as Ara Pacis; realizing popular videos, applications for kiosk in museums and software to manage data of archaeological excavations. All our works focus our method of research: the attention to the language, as instrument of aesthetic understanding, and the computerizing management of the fonts, as apparatus of studies and instrument of scientific validation of the reconstructions.Raffaello Sanzio intuì per primo che il mondo antico, come lo vedevano i suoi occhi, non era che l’eco sbiadita di quella ricchezza che pur doveva caratterizzarne l’esperienza artistica. Oggi la tecnologia permette di realizzare il sogno di Raffaello e di restituire le immagini delle antiche architetture, rivoluzionando la percezione del patrimonio culturale da parte del pubblico moderno. La nostra esperienza decennale nel settore della comunicazione del bene culturale ha consentito di confrontarci con diversi casi: dalla Domus Aurea, all'Ara Pacis; dai filmati divulgativi agli applicativi pensati per le postazioni fisse dei musei, fino alla creazione di software per la gestione dei dati degli scavi archeologici. Sempre ponendo al centro di ogni lavoro i cardini del nostro modo di fare ricerca: l'attenzione al linguaggio, quale strumento di comprensione estetica, e la gestione informatizzata delle fonti, come apparato di studio e metodo di validazione scientifica delle ricostruzioni.[L’impostazione del saggio è comune ai due autori. In particolare, però, Stefano Borghini ha curato il paragrafo “Considerazioni generali”, mentre Raffaele Carlani “Alcune esperienze”]

New insights in IBS-like disorders: Pandora's box has been opened; a review

The most complained gastrointestinal symptoms are chronic diarrhea, bloating and abdominal pain. Once malignancies and inflammatory bowel diseases are excluded, irritable bowel syndrome (IBS) and the so called "IBS-like disorders" should be taken into account. The relationship between IBS as defined by Rome IV criteria and these clinical conditions is sometimes obscure, since many IBS patients identify food as a possible trigger for their symptoms. Here, we discuss IBS and the most common IBS-like disorders (celiac disease, non-celiac gluten sensitivity, fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs), lactose intolerance, small intestinal bacterial overgrowth (SIBO), α-amylase/trypsin inhibitor (ATIs), nickel allergic contact mucositis), focusing on epidemiologic, clinical, diagnostic and therapeutic aspects. Given the lack of specificity of symptoms, clinical investigation will be facilitated by awareness of these disorders as well as new specific diagnostic tools

Robotic colonoscopy: efficacy, tolerability and safety. Preliminary clinical results from a pilot study

BACKGROUND: Robotic colonoscopy (RC) is a pneumatically-driven self-propelling platform (Endotics System®) able to investigate the colon, in order to reduce pain and discomfort. AIMS: (1) to describe the progress in gaining experience and skills of a trainee in RC; (2) to show the clinical outcomes of RC. METHODS: Pilot study. An experienced endoscopist started a training on RC whose progress was assessed comparing the results of 2 consecutive blocks of 27 (Group A) and 28 (Group B) procedures. CIR (Cecal Intubation Rate), CIT (Cecal Intubation Time) and Withdrawal Time (WT) were measured. Polyp Detection Rate (PDR), Adenoma Detection Rate (ADR) and Advanced Neoplasia Detection Rate (ANDR) were calculated. Possible adverse events were recorded. At the end of the procedure all patients completed a visual analog scale (VAS) to measure their perceived pain during RC and reported their willingness to repeat RC. RESULTS: General CIR was 92.7%, reaching 100% in Group B. Comparing the two groups, CIT significantly decreased from 55 to 22 min (p value 0.0007), whereas procedures with CIT ≤ 20 min increased (p value 0.037). WT significatively reduced from 21 to 16 min (p value 0.0186). PDR was 40% (males 62.5%, females 14.3%). ADR was 26.7% (males 27.5%, females 14.3%). Most of patients judged the procedure as mild or no distress, with high willingness-to-repeat the RC (92.7%). CONCLUSIONS: Our results about RC are encouraging as preliminary experience, with clear individual learning progress, accurate diagnosis in a painless or comfortable procedure and with possibility to remove polypoid lesions. Studies with larger populations are needed to confirm obtained results

Results of 12-month rescue treatment with teduglutide in severely active and parenteral nutrition-dependent Crohn's disease

Short bowel syndrome (SBS) is caused by the loss of extensive segments of the small intestine as seen in Crohn’s disease (CD) (1,2) and is characterized by malnutrition; thus, patients with SBS often require parenteral nutrition (PN) (3). Alternatives can maximize the remnant intestinal absorptive capacity, e.g., glucagonlike peptide 2 analog teduglutide. It inhibits gastric acid secretion and motility, stimulates intestinal blood flow, increases the intestinal barrier, and enhances absorption (4). Teduglutide has a safety profile (5), but adverse events are mostly related to hyperplastic and hypertrophic effects. Thus, patients with SBS having fluctuations in disease activity, e.g., in active CD, have always been excluded from treatment with teduglutide. For the first time, we report the results of 12-month treatment with teduglutide in a 42-year-old Caucasian woman affected by severely active CD with SBS. Informed consent was obtained. The patient underwent total colectomy in 1991 because of supposed ulcerative colitis. Then, CD was diagnosed, and since 2010, she underwent many intestinal resections. Many treatments had been unsuccessfully attempted (corticosteroids, infliximab, azathioprine, adalimumab, methotrexate, and certolizumab). Given her precarious clinical conditions, treatment with 0.05 mg/kg/day teduglutide was started in August 2015. Before treatment, she was in a poor condition. Nutritional deficiency and electrolyte imbalance were present. PN was initiated 24 h/day and 7 days/week, with a total of 1600 kcal/day per 3000 mL/day. After 12 months, teduglutide played a key role in ameliorating her severe nutritional deficiencies and ensuring her survival with good quality of life. Without teduglutide, her life would have been seriously compromised. Our patient was unable to totally wean from PN and reduce the number of days of infusion, but the PN volume has been progressively reduced to 2500 mL/day (an almost 20% reduction), with occasional exceptions. Moreover, total PN calories have been reduced from 1600 to 1400 kcal. An increase was observed in her body weight and BMI (from 17.5 to 24.5 kg/m2). We are confident that more positive goals in PN reduction may be achieved with further therapy. Crohn’s disease complications and treatment side effects were excluded on close clinical, laboratory, and imaging (US, CT, and MRI) surveillance. More studies with a larger number of patients and prolonged treatment are necessary to confirm the usefulness and safety of teduglutide in those with severely active CD. Our experience provides elements to support its efficacy and may pave the way for future research on teduglutide, even in other gastrointestinal diseases with fluctuating activities

Culture of gastric biopsies in celiac disease and its relationship with gastritis and Helicobacter pylori infection

BACKGROUND: Celiac disease (CD) is a gluten-related multisystemic disorder. Duodenal biopsy organ culture is a reliable supporting tool for CD diagnosis and can reveal specific immunological activation in many intestinal tracts. AIM: we investigated the gastric gluten-dependent immunological activation in CD, compared to duodenum. Gastric cultural results were also compared with histology and HP findings. METHODS: 18 patients with suspected CD and HP infection underwent EGD. Biopsies from duodenum (bulb and second portion) and gastric antrum were collected for histology and organ culture system. RESULTS: all patients were diagnosed with CD and gastritis. Nine out of 18 (50%) patients were HP-positive. EMA and anti-tTG were positive in 18/18 (100%) cultures from duodenum, as well as in 17/18 (94.4%) gastric cultures. Anti-tTG were higher in duodenal cultures than in gastric ones (p <0.05). Anti-tTG in gastric cultures were similar in HP-positive and HP-negative patients. Nine out of 17 (53%) patients with positive EMA in gastric culture were HP-positive and 8/17 (47%) were HP-negative. No significant difference in EMA gastric culture results was observed between HP-positive and HP-negative patients. CONCLUSIONS: Our data reveal an involvement also of stomach in CD. HP seems to not affect anti-tTG and EMA results in gastric cultures

Onset of suspected ulcerative colitis after treatment with tocilizumab in patient with celiac disease and juvenile idiopathic arthritis

To the Editors, Celiac disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD), although their etiopathogenesis appear to be different and there are conflicting data about their association. The humanized anti- interleukin (IL)-6 receptor antibody tocilizumab is used for rheumatoid ar- thritis and sometimes for patients with UC refractory to conventional ther- apies. A few studies have reported that tocilizumab can aggravate pre-existing UC or cause de novo drug-induced IBD, probably because of failure to suppress intestinal IL-6 production. We report the case of a female pa- tient with a family history of CD and UC

RELATIONSHIP BETWEEN NICKEL ALLERGIC CONTACT MUCOSITIS AND NICKEL-RICH DIET IN SYMPTOMATIC WOMEN SUFFERING FROM ENDOMETRIOSIS

BACKGROUND: Nickel (Ni) is a ubiquitous element in nature and the gastrointestinal tract is an important route of exposure for humans. Once ingested, alimentary Ni often results in the allergic contact mucositis (ACM). Ni ACM is an emerging gastrointestinal disorder involving a type IV delayed hypersensitivity reaction and has an estimated prevalence that exceeds 30% of the general population. The resulting Ni-induced low-grade inflammation may present with both IBS-like symptoms and extra-intestinal manifestations. Gastrointestinal symptoms are also present in many women with endometriosis and Ni allergic contact dermatitis has already been observed in these women. Therefore, intestinal and extra-intestinal symptoms complained in endometriosis may depend on a Ni ACM. What is more, a low-Ni diet could suggestively improve symptoms. AIM: We wanted to study the prevalence of Ni ACM in women with symptomatic endometriosis and focus on the effects of a low-Ni diet on gastrointestinal, extra-intestinal and gynecological symptoms in these patients. MATERIALS AND METHODS: We consecutively recruited 34 women of fertile age (range 23-47 years, mean age 35 years) with endometriosis, symptomatic for gastrointestinal disorders. Sixteen out of 34 patients completed the study. They underwent Ni oral mucosa patch test (omPT), low-Ni diet and questionnaire for intestinal, extra-intestinal and gynecological symptoms. Clinical evaluation was performed at baseline (T0) and after 3 months (T1). RESULTS: Fourteen out 16 (87.5%) patients showed Ni omPT positive results, with Ni ACM diagnosis, whereas 2 out of 16 (12.5%) patients showed negative Ni omPT. After 3 months of low-Ni diet, all gastrointestinal, extra-intestinal and gynecological symptoms showed a statistically significant reduction (p &lt;0.05) or a downward trend. CONCLUSIONS: Given the resulting high prevalence of Ni sensitivity and the significant clinical benefit obtained from a low-Ni diet, Ni-rich foods may be triggers of gastrointestinal, extra-intestinal and gynecological symptoms complained by women with endometriosis

Anti-transglutaminase detection followed by endomysium antibody confirmation test on monkey esophagus is the best strategy to screen for celiac disease

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Beneficial Effects of a Low-Nickel Diet on Relapsing IBS-Like and Extraintestinal Symptoms of Celiac Patients during a Proper Gluten-Free Diet: Nickel Allergic Contact Mucositis in Suspected Non-Responsive Celiac Disease

Background and Aim: Nickel (Ni)-rich foods can induce allergic contact mucositis (ACM) with irritable bowel syndrome (IBS)-like symptoms in predisposed subjects. Ni ACM has a high prevalence (&gt;30%) in the general population and can be diagnosed by a Ni oral mucosa patch test (omPT). Many celiac disease (CD) patients on a gluten-free diet (GFD) often show a recrudescence of gastrointestinal and extraintestinal symptoms, although serological and histological remission has been achieved. Since a GFD often results in higher loads of ingested alimentary Ni (e.g., corn), we hypothesized that it would lead to a consequent intestinal sensitization to Ni in predisposed subjects. We wanted to (1) study Ni ACM prevalence in still symptomatic CD patients on a GFD and (2) study the effects of a low-Ni diet (LNiD) on their recurrent symptoms. Material and Methods: We recruited 102 consecutive CD patients (74 female, 28 male; age range 18&ndash;65 years, mean age 42.3 &plusmn; 7.4) on a GFD since at least 12 months, in current serological and histological remission (Marsh&ndash;Oberhuber type 0&ndash;I) who complained of relapsing gastrointestinal and/or extraintestinal symptoms. Inclusion criteria: presence of at least three gastrointestinal symptoms with a score &ge;5 on the modified Gastrointestinal Symptom Rating Scale (GSRS) questionnaire. Exclusion criteria: IgE-mediated food allergy; history of past or current cancer; inflammatory bowel diseases; infectious diseases including Helicobacter pylori; lactose intolerance. All patients enrolled underwent Ni omPT and followed a LNiD for 3 months. A 24 symptoms questionnaire (GSRS modified according to the Salerno Experts&rsquo; Criteria, with 15 gastrointestinal and 9 extraintestinal symptoms) was administered at T0 (free diet), T1 (GFD, CD remission), T2 (recurrence of symptoms despite GFD), and T3 (GFD + LNiD) for comparisons. Comparisons were performed using Wilcoxon signed-rank test. RESULTS: Twenty patients (all female, age range 23&ndash;65 years, mean age 39.1 &plusmn; 2.9) out of 102 (19.6%) were finally included. All 20 patients enrolled (100%) showed positive Ni omPT, confirming an Ni ACM diagnosis. A correct GFD (T0 vs. T1) induced the improvement of 19 out of the total 24 (79.2%) symptoms, and 14 out of 24 (58.3%) were statistically significant (p-value &lt; 0.0083 according to Bonferroni correction). Prolonged GFD (T1 vs. T2) revealed the worsening of 20 out of the total 24 (83.3%) symptoms, and 10 out of 24 (41.7%) were statistically significant. LNiD (T2 vs. T3) determined an improvement of 20 out of the total 24 (83.4%) symptoms, and in 10 out of 24 (41.7%) symptoms the improvement was statistically significant. Conclusions: Our data suggest that the recrudescence of gastrointestinal and extraintestinal symptoms observed in CD subjects during GFD may be due to the increase in alimentary Ni intake, once gluten contamination and persisting villous atrophy are excluded. Ni overload can induce Ni ACM, which can be diagnosed by a specific Ni omPT. Improvement of symptoms occurs after a proper LNiD. These encouraging data should be confirmed with larger studies