A Framework for Measuring and Improving Social Inclusion with Network Science

Promoting social inclusion in childhood is a crucial step in creating a more equitable and inclusive society. Socially included students improve their self-esteem, self-confidence, academic outcomes, mental health, social relationships, openness to diverse cultures, sense of social responsibility and justice. This study describes our framework for measuring and improving the social inclusion of study participants using network science techniques. We describe each framework component starting from theory, such as definitions, measures and improving procedure and ending with a practical application, such as measuring a school class and improving social inclusion in the most isolated subjects. We built a device prototype for data collection activities by recording social interactions in frequency and duration. After defining a case study and on-field data collection, we shape the network analysed to identify the most interesting students and network structure properties. In the case study, we identify the students who are most isolated, most popular, and most frequently bridges for students’ interactions. Considering how much the network is heterophile or homophile by interaction degree, we connect the most isolated with the most popular student through a bridge student, thus increasing the social inclusion of the least included student

A difficult diagnosis of coeliac disease: Repeat duodenal histology increases diagnostic yield in patients with concomitant causes of villous atrophy

Villous atrophy in absence of coeliac disease (CD)-specific antibodies represents a diagnostic dilemma. We report a case of a woman with anaemia, weight loss and diarrhoea with an initial diagnosis of seronegative CD and a histological documented villous atrophy who did not improve on gluten-free diet due to the concomitant presence of common variable immunodeficiency (CVID) and Giardia lamblia infection. This case report confirms that CD diagnosis in CVID patients is difficult; the combination of anti-endomysial antibodies (EmA-IgA), anti-tissue transglutaminase antibodies (tTG-IgAb) antibodies and total IgA is obligatory in basic diagnostic of CD but in CVID are negative. Furthermore, the typical histological aspects of the intestinal mucosa in CVID (absence of plasma cells and switch to the IgD immunoglobulins), cannot rule out a concomitant CD diagnosis. HLA typing in this setting has a low positive predictive value but should be considered. Histological response to a gluten-free diet on repeat biopsy and the concomitant treatment of other causes of villous atrophy leads to a definite diagnosis of CD

INFLAMMATORY BOWEL DISEASE (IBD) IN PREGNANCY: ANALYSIS OF THE POSSIBLE EFFECTS OF THE DISEASE ON THE FETUS AND THE NEWBORN AND THERAPEUTIC APPROACHES

The Inflammatory Bowel Diseases(IBD), are a group of inflammatory diseases characterized by the presence of chronic inflammation, i the absenc of infectious ethiology. The two most well-known diseases in this group are: Crohn's disease (CD) and Ulcerative Colitis (UC). In cases where iti is not possible to distinguish between CD and UC, it is called Indeterminated Colitis. IBD can affect women pregnant. The causes of IBD are unknown, and the clinical course of the sdisease is characterized by phases of activity and remission. UC is a chronic inflammation of the mucosa of the colon and involving predominantly the left colon and rectum. It is associatred with presence of blood and mucus in the stool, diarrhea and anemia. characteristically, CD involves entire mgastrointestinal tract, from the mouth to the anus. In CD, the inflammatory infiltrate involves the entire intestinal wall. Clinically manifested by abdominal pain, diarrhea, loss of appetite and weight loss. The complications are stenosis, fistulas, abscesses, and perianal involvement. In IBD TNF_alpha and proinflammatory cytokines are overexpressed. The analysis of the scientific literature shows that fertility, in pregant women suffering from IBD, is preserved. It shows slightly reduced for CD and ileo-anal pouch. Women with active disease at the time of conception have an increased risk of spontaneous abortion, preterm birth, with low birth weight and congenital malformations of the fetus. The indications for surgical treatment are the same as for non-pregnant women. The inactive disease or ileo-anal pouch is not a contraindication to spontaneous vaginal delivery, as is happens in the case of active colitis or perirectal fistulas or rectovaginal fistulas. Safe drug during pregnancy are: 5-aminosalicylic acid (5-ASA), steroids, 6-Mercaptopurine (&MP), Atatioprine (AZA) and Infliximab. Contraindicateddrugs are Metrotrexate and Thalidomide. In conclusion, the expectations about pregnancy, in women affected of IBD, is similar to the general population, especiually if the conception occurs in inactive phase of the disease

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

INFLAMMATION IN IRRITABLE BOWEL SYNDROME: MYTH OR NEW TREATMENT TARGET?

Low-grade intestinal inflammation plays a key role in the pathophysiology of irritable bowel syndrome (IBS), and this role is likely to be multifactorial. The aim of this review was to summarize the evidence on the spectrum of mucosal inflammation in IBS, highlighting the relationship of this inflammation to the pathophysiology of IBS and its connection to clinical practice. We carried out a bibliographic search in Medline and the Cochrane Library for the period of January 1966 to December 2014, focusing on publications decribing an interaction between inflammation and IBS. Several evidences demonstrate microscopic and molecular abnormalities in IBS patients. Understanding the mechanism underlying low-grade inflammation in IBS may help to design clinical trials to test the efficacy and safety of drugs that target this pathophysiologic mechanism

EFFICACY OF PNEUMATIC DILATATION FOR THE TREATMENT OF IDIOPATIC ACHALASIA: A SINGLE-CENTRE EXPERIENCE

Pneumatic dilatation (PD) and surgical miotomy (SM) are presentely the best treastments for untreated achalasia, with similar efficacy. There is no information on the relative efficacy of PD in younger compared to older patients. Aim of our study was to compare success rate and safety of PD patients under fifty years old in our Unit with graded PD under fluoroscopic view. Five male and 15 female with a median age of 47 years were treated. Twelve patients were less than fifthy years old (group I) while 8 were older (group II). Median dysphagia questionnaire score was 14 and 13 in group I and II respectively. Technical success was achieved in all patients. Seven patients were previously treated through other techniques. In group I all patients achieved a complete remission of symptoms with significant decrease of the dysphagia questionnaire (3). in group II all patients achieved a complete remissionof symptoms with significant decrease of the dysphagia questionnaire score (4,5) but 3 of them repeated the procedure. In boths groups the efficacy of the dilation was radiologically confirmed. Neither early nor late complications were reported in either groups. In our experience PD was an effective and safe procedure both in young and old patients although the older group had more recurrences, all successfully re-dilated

THE INTESTINAL ECOSYSTEM AND PROBIOTICS

The term "probiotic" comes from the greek "pro bios" and means "pro life": Nowadays, an increasing number of pharmaceutical preparations and functional foods are enriched with probiotics and for the patients it is increasingly important to receive information needed to know how to orient in the choice. The benefits from probiotics are many and include the modulation of the intestinal microflora (stimulation of beneficial bacteria and inhibition of pathogens), the support of bowel function and the stimulation of the immune system. This broad spectrum of beneficial effects to maintain efficient the intestinal ecosystem. Therefore, probiotics are an useful tool to prevent the formation of disorders and/or pathologies. The aim of this review is to describe the intestinal ecosystem and how probiotics could be effective in the treatment and prevention of possible alterations

Impact of the COVID-19 Outbreak on Anesthesiologist Assistance for Endoscopic Procedures

Background/Aims: The coronavirus disease 2019 (COVID-19) outbreak has modified the activities of endoscopy units worldwide. Herein, we investigated the impact of the COVID-19 outbreak on anesthesiologist assistance for endoscopic procedures in Lombardy, Italy. Methods: A questionnaire concerning anesthesiologist assistance provided from October 26 to December 6, 2020, in comparison with the same period in 2019, was sent to endoscopic units in Lombardy. Results: Approximately 54% (34/63) of the units responded. A reduction in the number of all endoscopies (-33.5%; 18792 in 2020 vs. 28264 in 2019) and anesthesiologist-assisted endoscopies (-15.3%; 2652 in 2020 vs. 3132 in 2019) was reported. A greater reduction in anesthesiologist assistance was observed in government community units (-29.5%) than in academic (-14%) and private community units (-4.6%). Among all units, 85% reported a reduction in anesthesiologist assistance; 65% observed a delay/cancellation of procedures; 59%, a restricted patient selection; 17%, the need to transfer some patients to other hospitals; and 32%, a related worsening of procedure quality. Conclusion: The COVID-19 pandemic compromised the anesthesiologist assistance for endoscopic procedures in Lombardy, which worsened the procedure quality mainly in government community units. The COVID-19 “stress test” suggests a more balanced allocation of anesthesiologic resources in the future

Exercise performance, haemodynamics, and respiratory pattern do not identify heart failure patients who end exercise with dyspnoea from those with fatigue

AIMS: The two main symptoms referred by chronic heart failure (HF) patients as the causes of exercise termination during maximal cardiopulmonary exercise testing (CPET) are muscular fatigue and dyspnoea. So far, a physiological explanation why some HF patients end exercise because of dyspnoea and others because of fatigue is not available. We assessed whether patients referring dyspnoea or muscular fatigue may be distinguished by different ventilator or haemodynamic behaviours during exercise. METHODS AND RESULTS: We analysed exercise data of 170 consecutive HF patients with reduced left ventricular ejection fraction in stable clinical condition. All patients underwent maximal CPET and a second maximal CPET with measurement of cardiac output by inert gas rebreathing at peak exercise. Thirty-eight (age 65.0 \ub1 11.1 years) and 132 (65.1 \ub1 11.4 years) patients terminated CPET because of dyspnoea and fatigue, respectively. Haemodynamic and cardiorespiratory parameters were the same in fatigue and dyspnoea patients. VO2 was 10.4 \ub1 3.2 and 10.5 \ub1 3.3 mL/min/kg at the anaerobic threshold and 15.5 \ub1 4.8 and 15.4 \ub1 4.3 at peak, in fatigue and dyspnoea patients, respectively. In fatigue and dyspnoea patients, peak heart rate was 110 \ub1 22 and 114 \ub1 22 beats/min, and VE/VCO2 and VO2 /work relationship slopes were 31.2 \ub1 6.8 and 30.6 \ub1 8.2 and 10.6 \ub1 4.2 and 11.4 \ub1 5.5 L/min/W, respectively. Peak cardiac output was 6.68 \ub1 2.51 and 6.21 \ub1 2.55 L/min (P = NS for all). CONCLUSIONS: In chronic HF patients in stable clinical condition, fatigue and dyspnoea as reasons of exercise termination do not highlight different ventilatory or haemodynamic patterns during effort