Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine

Background: This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association. Methods: GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations. Results: The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]). Conclusions: This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice

Plant–environment interactions through a functional traits perspective: a review of Italian studies

Italy is among the European countries with the greatest plant diversity due to both a great environmental heterogeneity and a long history of man–environment interactions. Trait-based approaches to ecological studies have developed greatly over recent decades worldwide, although several issues concerning the relationships between plant functional traits and the environment still lack sufficient empirical evaluation. To draw insights on the association between plant functional traits and direct and indirect human and natural pressures on the environmental drivers, this article summarizes the existing knowledge on this topic by reviewing the results of studies performed in Italy adopting a functional trait approach on vascular plants, bryophytes and lichens. Although we recorded trait measurements for 1418 taxa, our review highlighted some major gaps in plant traits knowledge: Mediterranean ecosystems are poorly represented; traits related to belowground organs are still overlooked; traits measurements for bryophytes and lichens are lacking. Finally, intraspecific variation has been little studied at community level so far. We conclude by highlighting the need for approaches evaluating trait–environment relationship at large spatial and temporal scales and the need of a more effective contribution to online databases to tie more firmly Italian researchers to international scientific networks on plant traits

Insights into Mesalazine Use in Clinical Practice of Young Gastroenterologists

Background: Mesalazine is among the medications most prescribed by gastroenterologists, with variable and controversial use in different settings. We aimed to explore the use of mesalazine in the clinical practice of young gastroenterologists. Methods: A web-based electronic survey was distributed to all participants of the National Meeting of the Italian Young Gastroenterologist and Endoscopist Association. Results: A total of 101 participants took part in the survey, with a majority (54.4%) being aged >30 years, 63.4% of whom were trainees in academic hospitals, and 69.3% of whom were involved in the clinical management of inflammatory bowel disease (IBD). While both non-dedicated and IBD physicians generally agreed on the appropriate dose of mesalazine for mild ulcerative colitis (UC), significant differences were observed between the two groups for moderate-severe ulcerative colitis (UC). Additionally, in IBD patients who were starting immuno-modulators and/or biologics, 80% of IBD-dedicated physicians continued to prescribe mesalazine, compared to 45.2% of non-dedicated physicians (p = 0.002). Indeed, 48.4% of non-dedicated IBD physicians did not acknowledge mesalazine for colorectal cancer chemoprevention. With regards to Crohn's disease, it is mainly used by 30.1% of IBD physicians for preventing postoperative recurrence of Crohn's disease. Finally, 57.4% used mesalazine for symptomatic uncomplicated diverticular disease, and 84.2% did not recommend its use for irritable bowel syndrome. Conclusions: This survey showed heterogeneous behaviors in the daily use of mesalazine, mainly in the management of IBD. Educational programs and novel studies are needed to clarify its use

Andiamo al Museo. Esperienze e buone prassi per un patrimonio culturale accessibile alle persone sorde

Negli ultimi tempi si sente molto parlare di accessibilità e se questo da un lato può ridursi a un mero esercizio retorico, dall’altro inizia a produrre risultati tangibili che hanno un impatto sulla vita delle persone con disabilità. Le Istituzioni, i musei, i luoghi d’arte e cultura sono divenuti più sensibili e accoglienti sul tema dell’accessibilità e l’idea di turismo sociale, sostenibile, per tutti si sta progressivamente affermando. L’Ente Nazionale Sordi Onlus ha voluto accompagnare i propri progetti “sul campo” dedicati al patrimonio culturale (MAPS. Musei Accessibili per le Persone Sorde e AccessibItaly. Itinerari culturali per persone sorde e sordocieche) con questa raccolta di contributi. Un testo che attraverso l’apporto di esperti del settore e la riflessione su temi di carattere generale, nonché la descrizione di specifiche esperienze e modelli sperimentali, buone prassi, criticità e proposte, intende favorire una sempre maggiore diffusione e standardizzazione di servizi ideati e realizzati da e per le persone sordeIn recent times we hear a lot about accessibility and if on the one hand this can be reduced to a mere rhetorical exercise, on the other it begins to produce tangible results that have an impact on the lives of people with disabilities. Institutions, museums, places of art and culture have become more sensitive and welcoming to the issue of accessibility and the idea of ​​social, sustainable tourism for everyone is gradually establishing itself. The Italian Association of the Deaf (Ente Nazionale Sordi) wanted to accompany its "in the field" projects dedicated to cultural heritage (MAPS. Accessible Museums for Deaf People) and AccessibItaly. Cultural itineraries for deaf and deafblind people) with this collection of contributions. A text that through the contribution of industry experts and reflection on general topics, as well as the description of specific experiences and experimental models, good practices, critical issues and proposals, intends to promote an ever greater diffusion and standardization of services designed and implemented by and for deaf people

Probiotics: which and when?

There is a natural feeling between our intestinal flora and the gut. These microorganisms, living in the various tracts of human intestine, may affect the host homeostasis. Some of these bacteria can perhaps be a source of infection and sepsis when the bowel barrier is physically or functionally breached. The term 'probiotic' dates from the beginning of the last century and in the last years a market for probiotics worldwide, estimated to be worth billions of pounds, has developed. Although there is persuasive advertising for probiotics and there have been methodological advances in the study of the intestinal microbiota, much remains unproven, e.g. how probiotics work, which strains are effective, what can be expected to be achieved, and what dosage is required for effectiveness. This review of the literature is an evidence-based guide through the developing microbial universe affecting our life

Effects of SARS-CoV-2 emergency measures on high-risk lesions detection: a multicentre cross-sectional study

COVID-19 pandemic enforced the interruption of routine endoscopic examinations raising the issue of potential delays in the diagnosis of high-risk lesions. We conducted a multicentre study to assess the decrease of GI and pancreato-biliary high-risk lesions detection consequent to the reduction of the endoscopic activity. The lockdown period was compared to the equivalent timeframe of the previous 3 years. Endoscopic procedures decreased by 72.9% (elective 72.4% and urgent 51.3%); the overall cases of high-grade dysplasia/cancers decreased by 59.1% (23.4% pancreato-biliary cancers; 70.6% and 68.8% upper and lower GI lesions). The postemergency period should aim at limiting high-risk lesions delayed diagnoses

Effects of SARS-CoV-2 emergency measures on high-risk lesions detection: a multicentre cross-sectional study

COVID-19 pandemic enforced the interruption of routine endoscopic examinations raising the issue of potential delays in the diagnosis of high-risk lesions. We conducted a multicentre study to assess the decrease of GI and pancreato-biliary high-risk lesions detection consequent to the reduction of the endoscopic activity. The lockdown period was compared to the equivalent timeframe of the previous 3 years. Endoscopic procedures decreased by 72.9% (elective 72.4% and urgent 51.3%); the overall cases of high-grade dysplasia/cancers decreased by 59.1% (23.4% pancreato-biliary cancers; 70.6% and 68.8% upper and lower GI lesions). The postemergency period should aim at limiting high-risk lesions delayed diagnoses