High-Volume Transanal Surgery with CPH34 HV for the Treatment of III-IV Degree Haemorrhoids: Final Short-Term Results of an Italian Multicenter Clinical Study

The clinical chart of 621 patients with III-IV haemorrhoids undergoing Stapled Hemorrhoidopexy (SH) with CPH34 HV in 2012-2014 was consecutively reviewed to assess its safety and efficacy after at least 12 months of follow-up. Mean volume of prolapsectomy was significantly higher (13.0 mL; SD, 1.4) in larger prolapse (9.3 mL; SD, 1.2) (p < 0.001). Residual or recurrent haemorrhoids occurred in 11 of 621 patients (1.8%) and in 12 of 581 patients (1.9%), respectively. Relapse was correlated with higher preoperative Constipation Scoring System (CSS) (p = 0.000), Pescatori's degree (p = 0.000), Goligher's grade (p = 0.003), prolapse exceeding half of the length of the Circular Anal Dilator (CAD) (p = 0.000), and higher volume of prolapsectomy (p = 0.000). At regression analysis, only the preoperative CSS, Pescatori's degree, Goligher's grade, and volume of resection were significantly predictive of relapse. A high level of satisfaction (VAS = 8.6; SD, 1.0) coupled with a reduction of 12-month CSS (Δ preoperative CSS/12 mo CSS = 3.4, SD, 2.0; p < 0.001) was observed. The wider prolapsectomy achievable with CPH34 HV determined an overall 3.7% relapse rate in patients with high prevalence of large internal rectal prolapse, coupled with high satisfaction index, significant reduction of CSS, and very low complication rates

Breaking the habit - the peculiar 2016 eruption of the unique recurrent nova M31N 2008-12a

Since its discovery in 2008, the Andromeda galaxy nova M31N 2008-12a has been observed in eruption every single year. This unprecedented frequency indicates an extreme object, with a massive white dwarf and a high accretion rate, which is the most promising candidate for the single-degenerate progenitor of a type-Ia supernova known to date. The previous three eruptions of M31N 2008-12a have displayed remarkably homogeneous multi-wavelength properties: (i) From a faint peak, the optical light curve declined rapidly by two magnitudes in less than two days; (ii) Early spectra showed initial high velocities that slowed down significantly within days and displayed clear He/N lines throughout; (iii) The supersoft X-ray source (SSS) phase of the nova began extremely early, six days after eruption, and only lasted for about two weeks. In contrast, the peculiar 2016 eruption was clearly different. Here we report (i) the considerable delay in the 2016 eruption date, (ii) the significantly shorter SSS phase, and (iii) the brighter optical peak magnitude (with a hitherto unobserved cusp shape). Early theoretical models suggest that these three different effects can be consistently understood as caused by a lower quiescence mass-accretion rate. The corresponding higher ignition mass caused a brighter peak in the free-free emission model. The less-massive accretion disk experienced greater disruption, consequently delaying re-establishment of effective accretion. Without the early refueling, the SSS phase was shortened. Observing the next few eruptions will determine whether the properties of the 2016 outburst make it a genuine outlier in the evolution of M31N 2008-12a

The Science Performance of JWST as Characterized in Commissioning

This paper characterizes the actual science performance of the James Webb Space Telescope (JWST), as determined from the six month commissioning period. We summarize the performance of the spacecraft, telescope, science instruments, and ground system, with an emphasis on differences from pre-launch expectations. Commissioning has made clear that JWST is fully capable of achieving the discoveries for which it was built. Moreover, almost across the board, the science performance of JWST is better than expected; in most cases, JWST will go deeper faster than expected. The telescope and instrument suite have demonstrated the sensitivity, stability, image quality, and spectral range that are necessary to transform our understanding of the cosmos through observations spanning from near-earth asteroids to the most distant galaxies.Comment: 5th version as accepted to PASP; 31 pages, 18 figures; https://iopscience.iop.org/article/10.1088/1538-3873/acb29

The James Webb Space Telescope Mission

Twenty-six years ago a small committee report, building on earlier studies, expounded a compelling and poetic vision for the future of astronomy, calling for an infrared-optimized space telescope with an aperture of at least $4m$. With the support of their governments in the US, Europe, and Canada, 20,000 people realized that vision as the $6.5m$ James Webb Space Telescope. A generation of astronomers will celebrate their accomplishments for the life of the mission, potentially as long as 20 years, and beyond. This report and the scientific discoveries that follow are extended thank-you notes to the 20,000 team members. The telescope is working perfectly, with much better image quality than expected. In this and accompanying papers, we give a brief history, describe the observatory, outline its objectives and current observing program, and discuss the inventions and people who made it possible. We cite detailed reports on the design and the measured performance on orbit.Comment: Accepted by PASP for the special issue on The James Webb Space Telescope Overview, 29 pages, 4 figure

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017.

BACKGROUND: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised

Robot-assisted re-do sacrohysteropexy after anterior abdominal wall hysteropexy

We report the case of a 49-year-old woman who came to our institution complaining of bowel constipation and bladder outlet obstruction due to the recurrence of a pelvic prolapse after anterior abdominal wall hysteropexy performed 1 year before

Chronic cerebrospinal venous insufficiency as a cause of inner ear diseases

ABSTRACT Conclusion: The present study confirms a correlation between chronic cerebrospinal venous insufficiency (CCSVI) diagnosis and Meniere’s disease (MD). CCSVI could be considered a new ultrasound vascular pattern of the cerebrospinal venous system in patients affected by definite MD. Conversely, the present results showed that CCSVI cannot be considered a pathogenic mechanism for idiopathic sudden sensorineural hearing loss (ISSNHL). Objectives: The aim of this study is to investigate the correlation between CCSVI and MD and to evaluate if CCSVI can be considered a risk factor also for ISSNHL. Moreover, this study seeks to establish if, even with a different timing of onset and natural history, MD and ISSNHL may share a common pathogenic mechanism. Method: One hundred and eighty-two patients affected by definite MD, 60 patients affected by ISSNHL, and 100 healthy control patients were enrolled in this study. All subjects underwent an echocolor Doppler (ECD) of the cerebrospinal venous flow. Results: One hundred and fifty-two patients affected by definite MD (83,5%) and 13 patients affected by ISSNHL (21.6%) were positive for CCSVI at the ECD examination of the cerebrospinal venous flow. The healthy control group consisted of 100 subjects and only 21 (21%) showed positivity for CCSV

PARP-1 drives metabolic changes in Alzheimer's disease models

Amyloid beta peptide (A beta) causes neurodegeneration by several mechanisms including oxidative stress, which is known to induce DNA damage with the consequent activation of poly (ADP-ribose) polymerase (PARP-1). To elucidate the role of PARP-1 in the neurodegenerative process, SH-SY5Y neuroblastoma cells were treated with A beta(25-35) fragment in the presence or absence of MC2050, a new PARP-1 inhibitor. A beta(25-35) induces an enhancement of PARP activity which is prevented by cell pre-treatment with MC2050. These data were confirmed by measuring PARP-1 activity in CHO cells transfected with amylod precursor protein and in vivo in brains specimens of TgCRND8 transgenic mice overproducing the amyloid peptide. Following A beta(25-35) exposure a significant increase in intracellular ROS was observed. These data were supported by the finding that A beta(25-35) induces DNA damage which in turn activates PARP-1. Challenge with A beta(25-35) is also able to activate NF-kB via PARP-1, as demonstrated by NF-kB impairment upon MC2050 treatment. Moreover, A beta(25-35) via PARP-1 induces a significant increase in the p53 protein level and a parallel decrease in the anti-apoptotic Bcl-2 protein. These overall data support the hypothesis of PARP-1 involvment in cellular responses induced by A beta and hence a possible rationale for the implication of PARP-1 in neurodegeneration is discussed