Thrombosed external haemorrhoids: A clinician’s dilemma

Haemorrhoids are highly vascular submucosal cushions that underlie the distal rectal mucosa and contribute approximately 15-20% of the resting anal pressure, ensuring complete closure of the anal cana

Therapeutic Targets and Tumor Microenvironment in Colorectal Cancer

Colorectal cancer (CRC) is a genetically, anatomically, and transcriptionally heterogeneous disease. The prognosis for a CRC patient depends on the stage of the tumor at diagnosis and widely differs accordingly. The tumor microenvironment (TME) in CRC is an important factor affecting targeted cancer therapy. The TME has a dynamic composition including various cell types, such as cancer-associated fibroblasts, tumor-associated macrophages, regulatory T cells, and myeloid-derived suppressor cells, as well as extracellular factors that surround cancer cells and have functional and structural roles under physiological and pathological conditions. Moreover, the TME can limit the efficacy of therapeutic agents through high interstitial pressure, fibrosis, and the degradation of the therapeutic agents by enzymatic activity. For this reason, the TME is a fertile ground for the discovery of new drugs. The aim of this narrative review is to present current knowledge and future perspectives regarding the TME composition based on strategies for patients with CRC

Ambient noise tomography reveals basalt and sub-basalt velocity structure beneath the Faroe Islands, North Atlantic

The Faroe Islands Passive Seismological Experiment (FIPSE) was funded by Sindri (contract C46-52-01) and formed a collaborative project between Dr. David Cornwell, Prof. Richard England (University of Leicester) and Prof. Graham Stuart (University of Leeds). Seismological equipment was loaned from the NERC geophysical equipment facility (GEF, loan 918), with field assistance from David Hawthorn and data processing assistance from Victoria Lane (SEIS-UK). We acknowledge the help, advice and support of Jarðfeingi, especially Thomas Varming, Uni Petersen, Bartal Højgaard, Romica Øster and Heri Ziska. Rannvá M. Arge and Magni Jøkladal are thanked for their assistance with fieldwork. Research undertaken in this article was supported by the Carnegie Trust for the Universities of Scotland, via a Collaborative Research Grant. Rosie Fletcher is thanked for her comments, which greatly improved the text.Peer reviewedPostprin

Georeferenced cartography dataset of the La Fossa crater fumarolic field at Vulcano Island (Aeolian Archipelago, Italy): conversion and comparison of data from local to global positioning methods

The present study illustrates the procedures applied for the coordinate system conversion of the historical fumarole positions at La Fossa crater, to allow their comparison with newly acquired global positioning system (GPS) data. Due to the absence of ground control points in the field and on both the old Gauss Boaga and the new UTM WGS 1984 maps, we had to model the transformation errors between the two systems using differential GPS techniques. Once corrected, the maps show a residual Easting shifting, due to erroneous georeferencing of the original base maps; this is corrected by morphological comparative methods. The good correspondence between the corrected positions of the historical data and the results of the new GPS survey that was carried out in 2009 highlights the good quality of the old surveys, although they were carried out without the use of accurate topographical instruments

Large-scale numerical modeling of hydro-acoustic waves generated by tsunamigenic earthquakes

Abstract. Tsunamigenic fast movements of the seabed generate pressure waves in weakly compressible seawater, namely hydro-acoustic waves, which travel at the sound celerity in water (about 1500 m s−1). These waves travel much faster than the counterpart long free-surface gravity waves and contain significant information on the source. Measurement of hydro-acoustic waves can therefore anticipate the tsunami arrival and significantly improve the capability of tsunami early warning systems. In this paper a novel numerical model for reproduction of hydro-acoustic waves is applied to analyze the generation and propagation in real bathymetry of these pressure perturbations for two historical catastrophic earthquake scenarios in Mediterranean Sea. The model is based on the solution of a depth-integrated equation, and therefore results are computationally efficient in reconstructing the hydro-acoustic waves propagation scenarios

Neuronal nitric oxide synthase (NOS I) in the buffalo epididymis

The localization of neuronal nitric oxide (NOS I) in the buffalo epididymis have been investigated by nicotinamide adenite dinucleotide phosphatase-diaphorase (NADPH-d) histochemichemistry to the light microscope (LM) and NOS immunoistochemistry to the scanning electron microscope (SEM), respectively. Histochemistry: examination of epididymis specimens revealed an intense NADPH-d staining in the basal cell epithelium and endothelium cells of blood vessel. The NADPH diaphorase staining was diffuse and granular only along the caput epididymal epithelium. NADPH diaphorase staining was less intense or absent in the corpus and in the cauda of epididymis. Dense NADPH diaphorase is labeling in the endothelium of blood vessels along the whole buffalo epididymis. Immunoistochemistry: intense NOS I immunoreactivity was detected in the caput epididymis specimen by immuno-SEM. The basal epithelium showed intense and wide-spread immunoreactivity. In the corpus and in the cauda of the epididymis not observed NOS I immunoreactivity. The specific localization of NOS I in buffalo epididymis suggest that nitric oxide may be involved to explain epididymal function: maturation and storage

Epiluminescence microscopy for the diagnosis of doubtful melanocytic skin lesions: Comparison of the ABCD rule of dermatoscopy and a new 7-point checklist based on pattern analysis

Objective: To compare the reliability of a new 7-point checklist based on simplified epiluminescence microscopy (ELM) pattern analysis with the ABCD rule of dermatoscopy and standard pattern analysis for the diagnosis of clinically doubtful melanocytic skin lesions. Design: In a blind study, ELM images of 342 histologically proven melanocytic skin lesions were evaluated for the presence of 7 standard criteria that we called the 'ELM 7-point checklist.' For each lesion, 'overall' and 'ABCD scored' diagnoses were recorded. From a training set of 57 melanomas and 139 atypical non-melanomas, odds ratios were calculated to create a simple diagnostic model based on identification of major and minor criteria for the '7-point scored' diagnosis. A test set of 60 melanomas and 86 atypical non-melanomas was used for model validation and was then presented to 2 less experienced ELM observers, who recorded the ABCD and 7-point scored diagnoses. Settings: University medical centers. Patients: A sample of patients with excised melanocytic lesions. Main Outcome Measures: Sensitivity, specificity, and accuracy of the models for diagnosing melanoma. Results: From the total combined sets, the 7-point checklist gave a sensitivity of 95% and a specificity of 75% compared with 85% sensitivity and 66% specificity using the ABCD rule and 91% sensitivity and 90% specificity using standard pattern analysis (overall ELM diagnosis). Compared with the ABCD rule, the 7-point method allowed less experienced observers to obtain higher diagnostic accuracy values. Conclusions: The ELM 7-point checklist provides a simplification of standard pattern analysis because of the low number of features to identify and the scoring diagnostic system. As with the ABCD rule, it can be easily learned and easily applied and has proven to be reliable in diagnosing melanoma

Endoscopic Pilonidal Sinus Treatment. A Tertiary Care Academic Center Experience

Background: Pilonidal disease (PD) represents one of the most common proctological diseases in young adults. Although several approaches to treating PD have been described, there is still a lack of agreement on which is the best. The aim of this study was to evaluate the long-term efficacy of endoscopic pilonidal sinus treatment (EPSiT) at a tertiary care academic center. Methods: Between June 2017 and January 2021, a total of 32 patients [12 women (37.5%) and 20 men (62.5%)] with a mean age of 29.22 ± 12.98 years were treated with EPSiT. Pre- and post-operative symptoms were assessed with a score of 0–5. Success was defined as the absence of any subjective symptoms, as well as by complete post-operative wound healing. Results: Most of the patients had a midline external opening (17/32; 53.1%), with a mean number of external openings of 2.41 (1–4) ± 1.04. The median post-operative pain score was 0, and the mean follow-up period was 22 (4–42) ± 11.49 months. The time to wound healing was reduced in patients with one opening (28.14 ± 4.06 days) compared to patients with two or more openings (33.64 ± 7.3 days) (p = 0.067). The mean operative time was longer in patients who subsequently had a recurrence (41.75 ± 6.24 vs. 34.18 ± 6.24 min; p = 0.031). The overall success rate was 87.5% (28/32), and the mean time to recurrence was 3.25 (2–5) ± 1.26 months. Conclusions: EPSiT represents a viable option for the treatment of PD. More evidence and a longer follow-up period are needed to validate the results

Mast cells, microRNAs and others: The role of translational research on colorectal cancer in the forthcoming era of precision medicine

Colorectal cancer (CRC) is a heterogeneous disease, molecularly and anatomically, that develops in a multi-step process requiring the accumulation of several genetic or epigenetic mutations that lead to the gradual transformation of normal mucosa into cancer. In fact, tumorigenesis is extremely complex, with many immunologic and non-immunologic factors present in the tumor microenvironment that can influence tumorigenesis. In the last few years, a role for mast cells (MCs), microRNAs (miRNAs), Kirsten rat sarcoma (KRAS) and v-raf murine sarcoma viral oncogene homologue B (BRAF) in cancer development and progression has been suggested, and numerous efforts have been made to thoroughly assess their correlation with CRC to improve patient survival and quality of life. The identification of easily measurable, non-invasive and cost-effective biomarkers, the so-called “ideal biomarkers”, for CRC screening and treatment remains a high priority. The aim of this review is to discuss the emerging role of mast cells (MCs), microRNAs (miRNAs), KRAS and BRAF as diagnostic and prognostic biomarkers for CRC, evaluating their influence as potential therapy targets in the forthcoming era of precision medicine

Esophageal resection in the ederly

The aging of the population and longer life expectancy entails an increased number of elderly patients with esophageal cancer and benign pathologies referred for surgical treatment. Esophageal cancer is a pathology that mainly involves elderly patients. The aim of this study is to assess the effects of age on the outcome of surgery for esophageal cancer and benign pathologies in patients treated in our departmen