A paradigm of extreme rainfall pluvial floods in complex urban areas: The flood event of 15 July 2020 in Palermo (Italy)

In the last few years, some regions of the Mediterranean area have witnessed a progressive increase in extreme events, such as urban and flash floods, as a response to the increasingly frequent and severe extreme rainfall events, which are often exacerbated by the ever-growing urbanization. In such a context, the urban drainage systems may not be sufficient to convey the rainwater, thus increasing the risk deriving from the occurrence of such events. This study focuses on a particularly intense urban flood that occurred in Palermo (Italy) on 15 July 2020; it represents a typical pluvial flood due to extreme rainfall on a complex urban area that many cities have experienced in recent years, especially in the Mediterranean region. A conceptual hydrological model and a 2D hydraulic model, particularly suitable for simulations in a very complex urban context, have been used to simulate the event. Results have been qualitatively validated by means of crowdsourced information and satellite images. The experience of Palermo, which has highlighted the urgent need for a shift in the way stormwater in urban settlements is managed, can be assumed to be a paradigm for modeling pluvial floods in complex urban areas under extreme rainfall conditions. Although the approaches and the related policies cannot be identical for all cities, the modeling framework used here to assess the impacts of the event under study and some conclusive remarks could be easily transferred to other, different urban contexts

HEAT SHOCK PROTEINS AND ULCERATIVE COLITIS: THE START OF A NEW ERA?

We read with great interest the article written by Abou El Azm and coworkers, published in the last issue of the Arab Journal of Gastroenterology [1]. In this article, the authors investigated the molecular expression of heat shock proteins (HSP) 70 and 90 in relation to the grades of inflammation and dysplasia in patients with ulcerative colitis (UC) before and after treatment. In this study, in agreement with other published studies [2–4], the authors not only found a potential role for HSP 70 and HSP 90 for assessment of the activity and prognosis of UC, but also such markers predicted the presence of dysplasia and differentiated it from reactive atypia [1]. HSP had been found not only a marker of active disease, thus considering UC as a ‘‘chaperonopathy by mistake’’, but also show a key role in the psychosocial setting in which inflammatory bowel diseases manifest themselves [5]. Furthermore, they could represent a new diagnostic tool to differentiate the different phenotypes of UC, thus allowing to tailor a targeted approach to better manage UC patients [6]. However, some unresolved issues still remain about the potential roles of HSP in both the acute and the longstanding disease. First, it should be interesting to assess the role of HSP in the infections associated to UC flares, like Clostridium difficile and Cytomegalovirus (CMV) infections. In fact, HSP could be investigated as a further marker of inflammation in case of severe and steroid-refractory disease; with regard to CMV infection, mucosal levels of HSP could differentiate when CMV plays a role of direct pathogen or when it represents merely a ‘‘silent bystander’’. Second, in longstanding UC, an integrated approach of colorectal cancer surveillance, by using the advanced endoscopic imaging together with mucosal markers, like HSP, could result in being markedly helpful, both to clinicians and pathologist. In fact, current guidelines recommend that image-enhanced endoscopy (IEE) may increase the yield of detection of dysplasia, thus representing a reasonable alternative to the random sampling of colon using standard white light [7]. The use of both IEE and new biomarkers, like HSP, predicting future occurrence of colonic neoplasia, could lead to a more centralised approach of UC patients, in which a ‘‘biomarker-based surveillance’’ might play a pivotal rol

COLORECTAL CANCER IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: PRELIMINARY RESULTS FROM AN ONGOING CASE-CONTROL STUDY

Background and Aim:Understanding the risk factors for colorectal cancer (CRC) is crucial to the development of effective strategies for its prevention. meta-analysis and epidemiological studies have already shown that type 2 diabetes mellitus (DM) is associated with an increased risk of CRC and have provided data to support a positive relationship between these diseases. Material and Methods: We retrospectively evaluated 741 consecutive caucasian patients with type 2 DM who underewnt colonoscopic screening cof CRC and followed in our tertiary referrral center in 200-208 for incidence of CRC. Patients were stratified based on gender, age, body mass index (MBI), alchool and NSAIDS assumption, family history for cancer blood glycated hemoglobin levels, hypertension, hypertrigliceridemia, age at diabetes onset and duration, treatment with insulin or other hypoglicemic drugs. A total of 257 consecutive control patients were selected from a cohort of patients followed as outpatients for thyroid diseases. Results: At a median follow-up of 132,5 months (range 33,3-175,7) 56 cases of cancer (prevalence 7,56%) occurred; among these, 14 cases of CRC were reported (prevalence 18,8%) among the diabetic patients, while only one case (prevalence 0,004%) occurred in the control group, although this difference is not statistically significant (chi-square 2,9, P=0,08). Median duration of DM to CRC diagnosis was 156 months (range 1-768). At the univariate analysis older age (p=0,001), and diabetes duration (p=0,001) were related to higher risk of cancer, while metformin seems to be protective towards cancer (p=0,058). in the subset of patients with CRC, older age (p=0,001) and diabetes duration (p=0,001) were related to higher risk of CRC, such as treatment with sulphonylureas (p=0,01). Conclusions: Our preliminbar data show that the prevalence of CRC in the cohort of patients with type 2 DM was higher compared to that from our control group, and to that from the National Tumor Register up 2010 (0,5%). Furthermore we could interestingly hypotize that sulphonylureas may play a role in CRC carcinogenesis altering the physiological insulin secretion

Molecular and Cellular Mechanisms in Heart Failure

Pathophysiology and treatment of pediatric heart failure (HF) is poorly understood. A growing body of literature demonstrates age-related differences in mechanisms and in therapies efficacy. HF results from ventricular dysfunction due to volume or/and pressure overload. Circulatory, neurohormonal, and molecular alterations promote the progression of HF and ventricular remodeling; they include inflammation, oxidative stress, mitochondrial dysfunction, loss of cardiomyocytes, and fibrosis. Children and young affected by cardiomyopathies have the greatest risk of HF and heart transplantation. Genetic mutations of sarcomere, cytoskeleton, cell membrane proteins, and ion channels have been recognized as the main causes of many cardiomyopathy phenotypes. In particular, sarcomeric and cytoskeleton genes mutations seem to have an important role in the progression of HF. Prognostic stratification and clinical management could benefit from identification of biomarkers such as inflammatory mediators or microRNA (miRNA). miRNA and myocardial regenerative strategies are under investigations as potential novel therapeutic approaches

NEW THERAPEUTIC PERSPECTIVES IN IRRITABLE BOWEL SYNDROME: TARGETING LOW-GRADE INFLAMMATION, IMMUNO-NEUROENDOCRINE AXIS, MOTILITY, SDECRETION AND BEYOND

Irritable bowel syndrome (IBS) is a chronic, recurring, and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain, distention, and changes in bowel habits. Although there are several drugs for IBS, effective and approved treatments for one or more of the symptoms for various IBS subtypes are needed. Improved understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism, neurohormonal regulation, immune, dysfunction, the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of IBS. With regards to therapies for restoring intestinal permeability, multiple studies with prebiotics and probiotics are ongoing, even if to date their efficacy has been limited. In parallel, much progress has been made in targeting low-grade inflammation, especially through the introduction of drugs such as mesalazine and rifaximin, even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such drugs. This literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS, most recently developed in preclinical as well as Phase 1 and Phase 2 clinical studies

La misura del crown nella laminazione a caldo di semilavorati in lega di alluminio AA8011: misurazione e ottimizzazione

Il controllo della planarità dei laminati sottili in leghe di alluminio rappresenta una delle più importanti criticitàdi processo e influenza fortemente la qualità dei prodotti che, in larga parte, sono destinati al mercato dellatrasformazione ove sono sottoposti a processi di verniciatura, accoppiamento a polimeri, stampa litografica,tutte operazioni impossibili da realizzare su laminati non planari.Per ottenere laminati piani è fondamentale lavorare già a monte nella laminazione a caldo delle placche: lamisura del “crown”, ossia il profilo di spessore misurato sulla larghezza dei laminati a caldo e la sua forma,rappresenta un prerequisito fondamentale per ottenere successivi laminati a freddo piani.Preliminarmente al presente lavoro si è realizzata un’analisi causa-effetto del crown per capire quali sono iparametri che entrano in gioco durante la realizzazione di un profilo accurato (diagramma causa-effetto delcrown).Ci si è quindi concentrati sulla deformazione termica dei cilindri (bombatura termica) per cercare diottenere, su laminati a caldo, valori variabili del crown agendo sul raffreddamento dei cilindri di lavoro da partedel fluido lubro-refrigerante. Per verificare che i parametri esaminati avessero un effetto significativo sul crownè stata condotta un’analisi della varianza (ANOVA) a due vie con interazione.Come strumento di elaborazione statistica dei dati sono state utilizzate le superfici di risposta

Visceral adiposity index is associated with significant fibrosis in patients with non-alcoholic fatty liver disease

Background: Metabolic factors have been associated with liver damage in patients with non-alcoholic fatty liver disease (NAFLD). Aims To test a new marker of adipose dysfunction, the visceral adiposity index (VAI), in NAFLD patients to assess whether or not it is associated with host factors, and to investigate a potential correlation with histological findings. Methods One hundred and forty-two consecutive NAFLD patients were evaluated by liver biopsy, and clinical and metabolic measurements, including insulin resistance with the homeostasis model assessment (HOMA), and VAI by using waist circumference, body mass index, triglycerides and HDL. Serum levels of TNF\u3b1, IL-6, adiponectin and leptin were also assessed. All biopsies were scored for NAFLD activity score (NAS) and its components, and for staging (Kleiner). Results By multiple linear regression analysis, VAI was independently associated with higher HOMA (P = 0.04), and fibrosis (P = 0.04). In addition, an independent association was found between higher VAI and lower adiponectin levels (P = 0.002). Higher HOMA (OR 1.149, 95% CI 1.003-1.316, P = 0.04), higher VAI (OR 1.446, 95% CI 1.023-2.043, P = 0.03), lobular inflammation (OR 3.777, 95% CI 1.771-8.051, P = 0.001), and ballooning (OR 2.884, 95% CI 1.231-6.757, P = 0.01) were correlated with significant fibrosis (F2-F4) on multiple logistic regression analysis. In particular, the prevalence of significant fibrosis progressively increased from patients with a VAI 64 2.1 and HOMA 64 3.4 (26%) to those with a VAI > 2.1 and HOMA > 3.4 (83%). Conclusions In NAFLD patients, visceral adiposity index is an expression of both qualitative and quantitative adipose tissue dysfunction and, together with insulin resistance, is independently correlated with significant fibrosis. \ua9 2011 Blackwell Publishing Ltd

Impact of patient delay in a modern real world STEMI network

Background: The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has performance that meets the current recommended guidelines, is poorly investigated. Methods: We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) 64120 min. Independent predictors of pre-discharge decreased LVEF ( 6445%) were analyzed. Results: 490 STEMI patients with both ETW time 64120 min and available pre-discharge LVEF were evaluated. Mean age was 64.2 \ub1 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarction (MI), and 9.8% were in Killip class III\u2013IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62\u201395) minutes. 115 patients (23.4%) had pre-discharge LVEF 6445%. At multivariable analysis independent predictors of decreased LVEF ( 6445%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p < 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151\u20133.578, p = 0,014). These independent predictors were confirmed in patients with ETW time 6490 min. Conclusions: When system delay meets the recommended criteria for pPCI, patient delay becomes an independent predictor of pre-discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a significant proportion of patients continue to delay seeking medical care