Faecal Incontinence

Fecal incontinence (FI) is an extremely common condition, whose true prevalence is difficult to assess. It was defined as the uncontrolled passage of fecal material recurring for >3 months. Fecal incontinence is related to many etiologic factors, but one of the most frequent causes is secondary to pelvic and/or anal and rectal surgery, childbirth-related damage, or other pelvic trauma. Fecal incontinence after surgery may be elicited by many pelvic, rectal, and anal surgical/obstetric procedures, which contribute through different mechanisms to incontinence. After accurate evaluation, the first line approach with medical and behavioral treatments often fails in treating FI. Rehabilitative therapy and less invasive procedures are preferred before performing standard surgical intervention, while invasive procedures are to be discouraged

SUSTAINABLE PRODUCTION OF FENNEL AND DILL BY INTERCROPPING

Intercropping is claimed to be one of the most significant cropping techniques in sustainable agriculture, and much research and many reviews attribute to its utilization a number of environmental benefits, from promoting land biodiversity to diversifying agricultural outcome. In this sense, intercropping is thought to be a useful means of minimizing the risks of agricultural production in many environments, including those typical of under-developed or marginal areas. In order to validate this hypothesis in a representative area of the semiarid Mediterranean environment, we evaluated the possibility of growing dill and fennel, both belonging to the family Apiaceae, in temporary intercropping. Our trial was performed in Sicily in 2000–01 and 2001–02; in the first year, fennel and dill were cultivated in a mixture using a substitution scheme, whereas in 2001–02 we evaluated the bio-agronomical and chemical features of fennel alone. The biological efficiency of the intercropping system was evaluated by using the Land Equivalent Ratio and the Competitive Ratio, and an estimate of the interaction effects of both crops was performed by analyzing the major vegetative and yield traits of plants, along with the chemical profile of volatiles of the fruits. Both in grain yield and in biomass yield, the most efficient cropping system was the intercropping ratio with a higher proportion of fennel, in which the competitive ratio values calculated for dill reached 1.90 for grain and 2.59 for biomass. Our results also indicate that the presence of dill exerted a clear stabilizing effect on fennel seed yield of the following year: whereas no difference in fennel seed yield was detected from one year to the following on the previously intercropped plots, in the repeated pure stand a 50% yield reduction was recorded. In the trial environment, the technique showed a good potential to improve the efficiency of resource utilization; further long-term experiments will be necessary in order to demonstrate the application of such a technique to other medicinal and aromatic plant mixtures

Stem cell plasticity and dormancy in the development of cancer therapy resistance

Cancer treatment with either standard chemotherapy or targeted agents often results in the emergence of drug-refractory cell populations, ultimately leading to therapy failure. The biological features of drug resistant cells are largely overlapping with those of cancer stem cells and include heterogeneity, plasticity, self-renewal ability, and tumor-initiating capacity. Moreover, drug resistance is usually characterized by a suppression of proliferation that can manifest as quiescence, dormancy, senescence, or proliferative slowdown. Alterations in key cellular pathways such as autophagy, unfolded protein response or redox signaling, as well as metabolic adaptations also contribute to the establishment of drug resistance, thus representing attractive therapeutic targets. Moreover, a complex interplay of drug resistant cells with the micro/macroenvironment and with the immune system plays a key role in dictating and maintaining the resistant phenotype. Recent studies have challenged traditional views of cancer drug resistance providing innovative perspectives, establishing new connections between drug resistant cells and their environment and indicating unexpected therapeutic strategies. In this review we discuss recent advancements in understanding the mechanisms underlying drug resistance and we report novel targeting agents able to overcome the drug resistant status, with particular focus on strategies directed against dormant cells. Research on drug resistant cancer cells will take us one step forward toward the development of novel treatment approaches and the improvement of relapse-free survival in solid and hematological cancer patients

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

Pelvic Organ Prolapse (POP) Working Group (SICCR): Doubts and Evidence for a Practical Guide

Pelvic Organ Prolapse (POP) can be defined as a downward descent of female pelvic organs, including the bladder, uterus, post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vaginal walls, uterus, or both. The International Continence Society includes also rectal prolapses. POP development is multifactorial

Red hot chili pepper and hemorrhoids: The explosion of a myth: Results of a prospective, randomized, placebo-controlled, crossover trial

PURPOSE: Spicy foods are appreciated by a large part of the world population but have been blamed for causing hemorrhoids or exacerbating their symptoms, although no epidemiologic studies have been performed supporting this hypothesis. In this double-blind, randomized, placebo-controlled, crossover trial, we have studied the effects of a single dose of red hot chili pepper on the hemorrhoidal symptoms. METHODS: Fifty patients with second-degree and third-degree symptomatic hemorrhoids were randomly assigned to take a capsule containing red hot chili powder or placebo during lunch, scoring five hemorrhoidal symptoms (bleeding, swelling, pain, itching, and burning) on a visual analog scale. After one week, crossover treatment was administered according to the same methodology. Other treatments and foods potentially related with anorectal symptoms were discontinued during the study periods. RESULTS: Patients assigned low scores to their hemorrhoidal symptoms before the study and the scores remained unchanged during the 48 hours after both placebo and chili pepper treatment, the latter showing no statistically significant effects. CONCLUSIONS: There is no scientific evidence that a spicy meal based on red hot chili pepper may worsen hemorrhoidal symptoms and, therefore, there is no reason to prevent these patients from occasionally enjoying a spicy dish if they so wish

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of the Orthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP was assessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain. The type of physical activity carried out as prevention was investigated by use of the International Physical Activity Questionnaires. The overall state of health and lifestyle was deter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stress were assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low back pain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess the associations between socio-demographic and working variables. Multiple logistic regression mod- els were used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period- prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP. Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groups with high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (for decision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI: 0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and is suitable for prevention programmes. The protective effect of physical activity and work-related stress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Assessment of the prevalence and risk factors of low back pain in operating room health workers: An observational study in Italy

Aim: The aim of this study was to assess the prevalence of low back pain (LBP) among healthprofessionals and the possible risk factors. Methods: The study was carried out from April 2018 to October 2018 among all health workers of theOrthopaedic Clinic and the Emergency Department of “Policlinico Umberto I” in Rome. LBP wasassessed using the Nordic Questionnaire Musculoskeletal Disorders in the section on lumbar pain.The type of physical activity carried out as prevention was investigated by use of theInternational Physical Activity Questionnaires. The overall state of health and lifestyle wasdeter- mined by the Short Form 12-item Health Survey. Job satisfaction and perceived work stresswere assessed through the 15-questions of Karasek’s Questionnaire. The intensity of the low backpain was assessed using a Numerical Rating Scale. A univariate analysis was conducted to assess theassociations between socio-demographic and working variables. Multiple logistic regression mod- elswere used to assess independent correlates of LBP. Results: One hundred thirteen subjects were enrolled, 52 women and 61 men. The annual period-prevalence of lumbar musculoskeletal disorder was found on 79.6% of participants with LBP.Mean value evidence of NRS was 2.66. The highest LBP risk over the 12 months was found in groupswith high job demand (OR = 1.18; 95%CI: 1.01 – 1.38), low decision-making opportunities (fordecision latitude OR = 0.87; (0-76 – 1.0), and low levels of physical activity (OR = 0.75; 95%CI:0.64 – 0.89). Conclusion: The working environment is a potential risk factor for the development of LBP and issuitable for prevention programmes. The protective effect of physical activity and work-relatedstress management indicate room for improvements for the prevention of LBP in these HCWs. Conflicts of interest: None declared

Problematic mobile phone use in adolescence:a cross-sectional study

Aim: In recent years, mobile phone use has become increasingly common among Italian youth, while a growing scientific literature has been identifying the occurrence of a problematic mobile phone use which seems to share some features of other conditions often referred to as behavioural addictions. The study aimed to assess the prevalence of problematic mobile phone use in a population of Italian adolescents and its association with other behavioural addictions. Subjects and methods: The Mobile Addiction Test (MAT) was administered to 2,790 high school students from Barletta, an Italian town, together with the South Oaks Gambling Screen-Revised for Adolescents (SOGS-RA), the Compulsive Buying Scale (CBS), the Internet Addiction Test (IAT), the Exercise Addiction Inventory (EAI), the Work Addiction Risk Test (WART). Results: MAT scores fitted a Gaussian distribution model. Scores ≥ 17 was found as a cut-off value over which identifying problematic mobile phone users. Overall prevalence of problematic mobile phone use was 6.3%; this condition was associated with other behavioural addictions like compulsive buying. Conclusion: Problematic mobile phone use in adolescence should become a public health issue, and it could be a cause of health problems and social costs. © 2011 Springer-Verlag