Management of acute diverticulitis with pericolic free gas (ADIFAS). an international multicenter observational study

Background: There are no specific recommendations regarding the optimal management of this group of patients. The World Society of Emergency Surgery suggested a nonoperative strategy with antibiotic therapy, but this was a weak recommendation. This study aims to identify the optimal management of patients with acute diverticulitis (AD) presenting with pericolic free air with or without pericolic fluid. Methods: A multicenter, prospective, international study of patients diagnosed with AD and pericolic-free air with or without pericolic free fluid at a computed tomography (CT) scan between May 2020 and June 2021 was included. Patients were excluded if they had intra-abdominal distant free air, an abscess, generalized peritonitis, or less than a 1-year follow-up. The primary outcome was the rate of failure of nonoperative management within the index admission. Secondary outcomes included the rate of failure of nonoperative management within the first year and risk factors for failure. Results: A total of 810 patients were recruited across 69 European and South American centers; 744 patients (92%) were treated nonoperatively, and 66 (8%) underwent immediate surgery. Baseline characteristics were similar between groups. Hinchey II-IV on diagnostic imaging was the only independent risk factor for surgical intervention during index admission (odds ratios: 12.5, 95% CI: 2.4-64, P =0.003). Among patients treated nonoperatively, at index admission, 697 (94%) patients were discharged without any complications, 35 (4.7%) required emergency surgery, and 12 (1.6%) percutaneous drainage. Free pericolic fluid on CT scan was associated with a higher risk of failure of nonoperative management (odds ratios: 4.9, 95% CI: 1.2-19.9, P =0.023), with 88% of success compared to 96% without free fluid ( P <0.001). The rate of treatment failure with nonoperative management during the first year of follow-up was 16.5%. Conclusion: Patients with AD presenting with pericolic free gas can be successfully managed nonoperatively in the vast majority of cases. Patients with both free pericolic gas and free pericolic fluid on a CT scan are at a higher risk of failing nonoperative management and require closer observation

Strategies for the Sustainable Reindustrialization of Brownfields

The rapid de-industrialization of Western economies has left an enormous impact on the urban landscape in Europe, leaving behind vacant warehouses and production facilities. Industrial sites reuse is a crucial issue for sustainable land and urban development. This work is concerned with the fundamental aspects of industrial heritage and the ways to incorporate brownfields back into the urban fabric as a value-adding element. Adaptive reuse represents the most sustainable form of reuse, as it is based on maximal conservation of built assets, minimizing time, materials, embodied energy waste, and preserving site identity. For industrial areas redevelopment and reuse often site remediation is required. This activity is usually designed, carried out and assessed before and independently from urban design, planning, and real estate strategies. This independence leads to higher remediation costs and often implies demolition of built industrial infrastructures, preventing any potential adaptive reuse. The former industrial site of Acciaierie Lucchini in Settimo Torinese, just outside of Turin, offered the chance to test a holistic approach, based on the multidisciplinary integration of knowledge and skills during the whole design process in order to define real policy proposals trying to improve the technical framework for more sustainable reuse procedures. In the 93.000 m2 area, abandoned and left to degenerate since 2000, trading in ferrous materials and then steel manufacturing was carried out for over fifty years, leaving a legacy in the form of heavy metal contaminated backfill material and underneath the soil. Isolation from the city center, poor accessibility for pedestrians and the location within an industrial zone make this site inadequate for any form of residential development. Whereas re-industrialization of this brownfield can bring new value to the site, transforming the abandoned spaces into an innovative industrial hub able to combine logistic, production, leisure, and temporary living, experimenting with mixed-use programs the new relation between innovative production and the city

Bovisa 2016. Un nuovo insediamento urbano

Il contributo pubblica relazione e progetto svolto in risposta all'invito fatto dal Politecnico di Milano in accordo con il Comune di Milano - assessorato all'urbanistica - per verificare le richieste dell'ATU, Area di Trasformazione Urbana, di PGT relative all'area della "goccia" di Bovisa, che prevede qui, fra le atre attività, la nuova espansione del Politecnico

Vedolizumab as Rescue Therapy in Carboplatin-Gemcitabine-Induced Triggered Acute Severe Ulcerative Colitis Flare-Up

Approximately 20% of patients with ulcerative colitis (UC) develop acute severe UC (ASUC), for which intravenous systemic steroid therapy and possibly infliximab-based rescue therapy are generally imposed. However, there are no significant guideline recommendations on ASUC regarding vedolizumab as an alternative in this setting. A case report was presented where a patient with steroid-dependent UC developed ASUC induced by second-line chemotherapy. Treatment with intravenous methylprednisolone was imposed, but there was no reduction in bowel movements in the days following admission. Rescue therapy with infliximab was contraindicated because of the oncologic history. Surgical consultation, contraindicated colectomy, and administration of vedolizumab 300 mg were initiated. After infusion with vedolizumab, there was a significant reduction in bowel movements starting the day after infusion until normalisation of bowel movements within three days and the concomitant normalisation of inflammatory indices. The patient is currently in clinical remission, on therapy with vedolizumab 108 mg subcutaneously every two weeks, and is in oncologic follow-up for pulmonary neoplasm. This case highlights the novel potential of vedolizumab as a possible rescue therapy in ASUC, especially in special populations, where it may offer a better safety profile. Although cyclosporine and infliximab still represent the mainstays of salvage therapy for steroid-refractory ASUC, new therapeutic agents may also be effective, such as vedolizumab, ustekinumab, and anti-Janus kinase agents

International Consensus Document (ICON): Common Variable Immunodeficiency Disorders

The International Collaboration in Asthma, Allergy and Immunology initiated an international coalition among the American Academy of Allergy, Asthma & Immunology; the European Academy of Allergy and Clinical Immunology; the World Allergy Organization; and the American College of Allergy, Asthma & Immunology on common variable immunodeficiency. An author group was formed and then divided into individual committees. Within the committee, teams of authors were subgrouped to generate content for specific sections of the document. Content was derived from literature searches, relevant published guidelines, and clinical experience. After a draft of the document was assembled, it was collectively reviewed and revised by the authors. Where evidence was lacking or conflicting, the information presented represents the consensus expert opinion of the group. The full document was then independently reviewed by 5 international experts in the field, none of whom was among the authors of the original. The comments of these reviewers were incorporated before submission for publicatio