The use of complementary and alternative medicine is frequent in patients with pancreatic disorder

BACKGROUND: Herbal remedies and other complementary and alternative medicine (CAM) are used by 30% of the patients with liver and inflammatory bowel diseases. However, there are no data regarding CAM use in patients with pancreatic disorders, including potential pancreatotoxicity. AIM OF THE STUDY: The aim of the study was to assess the prevalence of CAM use in patients with pancreatic disorders and screen for pancreatotoxicity. MATERIALS AND METHODS: This was a cross-sectional survey of consecutive outpatients seen at a Pancreas Center. Data were collected in a specific questionnaire. Descriptive statistics were used to analyze the prevalence and the patterns of CAM use. Characteristics associated with CAM use were analyzed by appropriate statistics. RESULTS: Of 108 patients (52% male; mean age, 65±13 years), 47 (43.5%) used CAM. The use of CAM was more frequent among patients with previous acute pancreatitis (47%). Reported reasons for the use of CAM were to help standard therapies and for an overall better feeling. About 61% of the patients reported advantages with treatment. As compared with nonusers, CAM users were more often female (55% vs. 42%), with a higher school degree (43% vs. 36%), more frequently performing physical activity (51% vs. 41%), and reporting anxiety (45% vs. 31%). However, none of these differences were statistically significant. Three patients with previous acute pancreatitis reported the use of Serenoa repens that is potentially pancreatotoxic. DISCUSSION: The rate of CAM use in patients with pancreatic disorders is similar to those reported for other digestive diseases. CAM use seems to be more frequent in women with a higher education level and a "healthier lifestyle." Patients might not be aware of the potential pancreatotoxicity of CAM, which should be carefully considered by physician

Holocene Critical Zone dynamics in an Alpine catchment inferred from a speleothem multiproxy record : disentangling climate and human influences

Disentangling the effects of climate and human impact on the long-term evolution of the Earth CriticalZone is crucial to understand the array of its potential responses to the ongoing Global Change. This task requires natural archives from which local information about soil and vegetation can be linked directly to climate parameters. Here we present a high-resolution, well-dated, speleothem multiproxy record from the SW Italian Alps, spanning the last ~10,000 years of the present interglacial (Holocene). We correlate magnetic properties and the carbon stable isotope ratio to soil stability and pedogenesis, whereas the oxygen isotope composition is interpreted as primarily related to precipitation amount, modulated at different timescales by changes in precipitation source and seasonality. During the 9.7-2.8 ka period, when anthropic pressure over the catchment was scarce, intervals of enhanced soil erosion are related to climate-driven vegetation contractions and occurred during drier periods. Immediately following the onset of the Iron Age (ca. 2.8 ka), by contrast, periods of enhanced soil erosion coincided with a wetter climate. We propose that the observed changes in the soil response to climate forcing were related to early anthropogenic manipulations of Earth\u2019s surface, which made the ECZ more sensitive to climate oscillations

The SUCCESSO-TERRA project: A lesson of sustainability from the terramare culture, middle bronze age of the po plain (Northern Italy)

This backstory article deals with the SUCCESSO-TERRA Project (2017–2020), an interdisciplinary research program aiming at reconstructing the land-use transformations that occurred during the development of the Terramare culture in the southern-central Po Plain of Northern Italy. Topics include climate-environment changes, human impact and exploitation of natural resources that are interconnected topics in human ecology and environmental sciences. These topics can only be understood in a long-term perspective integrating archaeology, geology, botany and other sciences. The text includes the theoretical basis, the research strategy and the main methodological approaches given by geoarchaeology and palynology, the two research sides constituting the partnership of the project

Geomorphology of the northwestern Kurdistan Region of Iraq: landscapes of the Zagros Mountains drained by the Tigris and Great Zab Rivers

We present the geomorphological map of the northwestern part of the Kurdistan Region of Iraq, where the landscape expresses the tectonic activity associated with the Arabia-Eurasia convergence and Neogene climate change. These processes influenced the evolution of landforms and fluvial pathways, where major rivers Tigris, Khabur, and Great Zab incise the landscape of Northeastern Mesopotamia Anticlinal ridges and syncline trough compose the Zagros orogen. The development of water and wind gaps, slope, and karsts processes in the highlands and the tilting of fluvial terraces in the flat areas are the main evidence of the relationship between tectonics, climate variations and geomorphological processes. During the Quaternary, especially after the Last Glacial Maximum, fluctuating arid and wet periods also influenced local landforms and fluvial patterns of the area. Finally, the intensified Holocene human occupation and agricultural activities during the passage to more complex societies over time impacted the evolution of the landscape in this part of Mesopotamia

Geomorphology of the northwestern Kurdistan Region of Iraq: landscapes of the Zagros Mountains drained by the Tigris and Great Zab Rivers

We present the geomorphological map of the northwestern part of the Kurdistan Region of Iraq, where the landscape expresses the tectonic activity associated with the Arabia-Eurasia convergence and Neogene climate change. These processes influenced the evolution of landforms and fluvial pathways, where major rivers Tigris, Khabur, and Great Zab incise the landscape of Northeastern Mesopotamia Anticlinal ridges and syncline trough compose the Zagros orogen. The development of water and wind gaps, slope, and karsts processes in the highlands and the tilting of fluvial terraces in the flat areas are the main evidence of the relationship between tectonics, climate variations and geomorphological processes. During the Quaternary, especially after the Last Glacial Maximum, fluctuating arid and wet periods also influenced local landforms and fluvial patterns of the area. Finally, the intensified Holocene human occupation and agricultural activities during the passage to more complex societies over time impacted the evolution of the landscape in this part of Mesopotamia

Long-term outcomes of acute severe ulcerative colitis in the rescue therapy era: A multicentre cohort study

BACKGROUND: The long‐term course of ulcerative colitis after a severe attack is poorly understood. Second‐line rescue therapy with cyclosporine or infliximab is effective for reducing short‐term colectomy but the impact in the long‐term is controversial. OBJECTIVE: The purpose of this study was to evaluate the long‐term course of acute severe ulcerative colitis patients who avoid early colectomy either because of response to steroids or rescue therapy. METHODS: This was a multicentre retrospective cohort study of adult patients with acute severe ulcerative colitis admitted to Italian inflammatory bowel disease referral centres from 2005 to 2017. All patients received intravenous steroids, and those who did not respond received either rescue therapy or colectomy. For patients who avoided early colectomy (within 3 months from the index attack), we recorded the date of colectomy, last follow‐up visit or death. The primary end‐point was long‐term colectomy rate in patients avoiding early colectomy. RESULTS: From the included 372 patients with acute severe ulcerative colitis, 337 (90.6%) avoided early colectomy. From those, 60.5% were responsive to steroids and 39.5% to the rescue therapy. Median follow‐up was 44 months (interquartile range, 21–85). Colectomy‐free survival probability was 93.5%, 81.5% and 79.4% at 1, 3 and 5 years, respectively. Colectomy risk was higher among rescue therapy users than in steroid‐responders (log‐rank test, p = 0.02). At multivariate analysis response to steroids was independently associated with a lower risk of long‐term colectomy (adjusted odds ratio = 0.5; 95% confidence interval, 0.2–0.8), while previous exposure to antitumour necrosis factor‐α agents was associated with an increased risk (adjusted odds ratio = 3.0; 95% confidence interval, 1.5–5.7). Approximately 50% of patients required additional therapy or new hospitalisation within 5 years due to a recurrent flare. Death occurred in three patients (0.9%). CONCLUSIONS: Patients with acute severe ulcerative colitis avoiding early colectomy are at risk of long‐term colectomy, especially if previously exposed to antitumour necrosis factor‐α agents or if rescue therapy during the acute attack was required because of steroid refractoriness