Intractable diarrhea (ID) could be defined as a syndrome of severe chronic diarrhea associated with malnutrition not easily resolved by conventional management.
To provide an overview on etiology and ...management of ID patients in Italy in the last 12 years.
The members of Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) enrolled all ID patients seen between January 1, 2011 and December 31, 2022.
69 children were enrolled (49 M, 20 F; median age at ID onset 9.5 days) from 7 tertiary care pediatric centers. Overall 62 patients had genetic diseases; 3 had infantile Inflammatory Bowel Disease and 1 autoimmune enteropathy in absence of genetic mutations; 2 undefined ID. Defects of intestinal immune-related homeostasis caused ID in 29 patients (42 %).
ID is a rare but challenging problem, although the potential for diagnosis has improved over time. In particular, molecular analysis allowed to identity genetic defects in 90 % of patients and to detect new genetic mutations responsible for ID. Due to both the challenging diagnosis and the treatment for many of these diseases, the close relationship between immune system and digestive tract should require a close collaboration between pediatric immunologists and gastroenterologists, to optimize epidemiologic surveillance and management of ID.
The pathophysiology of psoriasis is very complex and involves an interplay between immune cells and keratinocytes. The keratinocyte production of calprotectin (S100A8/A9), induced by the inflammatory ...psoriatic milieu, may be involved in initiating immune cell invasion, as well as in propagating inflammation. However, the exact role of calprotectin in psoriasis remains unclear. Therapeutic approaches utilizing adalimumab, etanercept and ustekinumab are widely used in psoriatic treatment, but their anti-inflammatory mechanisms are not fully understood. The aim of this study was to investigate, by immunohistochemical analysis, the expression of the heterocomplex S100A8/A9 in lesional skin from psoriatic patients undergoing biological therapy with adalimumab, etanercept or ustekinumab. Our results showed that S100A8/A9, absent or present at very low level in skin biopsies from healthy subjects, is dramatically upregulated in each epidermal layer from psoriatic patients. Interestingly, calprotectin was mainly localized in keratinocyte nuclei from psoriatic patients, suggesting a role of S100A8/A9 in keratinocyte nuclear function. Furthermore, we have shown that the biological treatment induced a drastic reduction of S100A8/A9 expression in skin biopsies from treated patients, correlating with PASI reduction. Our results suggest that calprotectin may play a crucial role as a significant marker of inflammation in psoriasis, and that its reduction of expression may be considered a favourable prognostic marker in psoriasis.
Since a few decades volcanic long period (LP) events have been recorded on many active volcanoes and their study has been recognized as an important tool to characterize volcanic activity. LP event ...analyses through moment tensor (MT) inversions have led to kinematic descriptions of various source mechanisms. The main challenge in these inversions is to ‘strip out’ the propagation effect in order to isolate the source; hence the velocity model used controls the accuracy of the retrieved source mechanism. We first carry out several synthetic tests of inversions on Mt Etna volcano (Italy). Four geological models with topography are considered with increasing complexity: the most complex model is used to generate synthetic data, while the other three models are used to calculate the Green's functions for inversions. The retrieved solutions from the three velocity models are similar. The MT solutions for a deeper source are well retrieved, while a shallower source test suffers from high uncertainties and strong misinterpretation of the source orientation. The homogeneous model gives the lowest misfit value, but source location and mechanism decomposition are inaccurate. When a complex model different from the true one is used, a high misfit value and a wrong solution is obtained. We then incorporate our findings into the MT inversion of an LP event recorded on Mt Etna in 2008. We obtain very different solutions among the three models in terms of source location and mechanism decomposition. The overall shape of the retrieved source time functions are similar, but some amplitude differences arise, especially for the homogeneous model. Our work highlights the importance of including the unconsolidated surface materials in the computation of Green's functions especially when dealing with shallow sources.
Although split regimen is associated with higher adenoma detection and is recommended for elective colonoscopy, its adoption remains suboptimal. The identification of patient-related barriers may ...improve its implementation. Our aim was to assess patients' attitude towards split regimen and patient-related factors associated with its uptake.
In a multicentre, prospective study, outpatients undergoing colonoscopy from 8:00 to 14:00 were given written instructions for 4 L polyethylene glycol bowel preparation, offering the choice between split-dose and day-before regimens and emphasising the superiority of split regimen on colonoscopy outcomes. Uptake of split regimen and association with patient-related factors were explored by a 20-item questionnaire.
Of the 1447 patients (mean age 59.2±13.5 years, men 54.3%), 61.7% and 38.3% chose a split-dose and day-before regimens, respectively. A linear correlation was observed between time of colonoscopy appointments and split-dose uptake, from 27.3% in 8:00 patients to 96% in 14:00 patients (p<0.001, χ
for linear trend). At multivariate analysis, colonoscopy appointment before 10:00 (OR 0.14, 95% CI 0.11 to 0.18), travel time to endoscopy service >1 h (OR 0.55, 95% CI 0.38 to 0.79), low education level (OR 0.72, 95% CI 0.54 to 0.96) and female gender (OR 0.74, 95% CI 0.58 to 0.95) were inversely correlated with the uptake of split-dose. Overall, the risk of travel interruption and faecal incontinence was slightly increased in split regimen patients (3.0% vs 1.4% and 1.5% vs 0.9%, respectively; p=NS). Split regimen was an independent predictor of adequate colon cleansing (OR 3.34, 95% CI 2.40 to 4.63) and polyp detection (OR 1.46, 95% CI 1.11 to 1.92).
Patient attitude towards split regimen is suboptimal, especially for early morning examinations. Interventions to improve patient compliance (ie, policies to reorganise colonoscopy timetable, educational initiatives for patient and healthcare providers) should be considered.
NCT02287051; pre-result.
We report simultaneous laboratory measurements of seismic velocities and fluid permeability on lava flow basalt from Etna (Italy) and columnar basalt from Seljadur (Iceland). Measurements were made ...in a servo-controlled steady-state-flow permeameter at effective pressures from 5–80
MPa, during both increasing and decreasing pressure cycles. Selected samples were thermally stressed at temperatures up to 900
°C to induce thermal crack damage. Acoustic emission output was recorded throughout each thermal stressing experiment.
At low pressure (0–10
MPa), the P-wave velocity of the columnar Seljadur basalt was 5.4
km/s, while for the Etnean lava flow basalt it was only 3.0–3.5
km/s. On increasing the pressure to 80
MPa, the velocity of Etnean basalt increased by 45%–60%, whereas that of Seljadur basalt increased by less than 2%. Furthermore, the velocity of Seljadur basalt thermally stressed to 900
°C fell by about 2.0
km/s, whereas the decrease for Etnean basalt was negligible. A similar pattern was observed in the permeability data. Permeability of Etnean basalt fell from about 7.5×10
−16
m
2 to about 1.5×10
−16
m
2 over the pressure range 5–80
MPa, while that for Seljadur basalt varied little from its initial low value of 9×10
−21
m
2. Again, thermal stressing significantly increased the permeability of Seljadur basalt, whilst having a negligible effect on the Etnean basalt. These results clearly indicate that the Etnean basalt contains a much higher level of crack damage than the Seljadur basalt, and hence can explain the low velocities (3–4
km/s) generally inferred from seismic tomography for the Mt. Etna volcanic edifice.
After a drastic decline in 1983, hydrothermal activity at La Soufrière lava dome (Guadeloupe, Lesser Antilles) has been progressively increasing in the summit area since 1992, raising the threat of a ...renewed eruptive activity. To better constrain the geometry of the hydrothermal system, an extensive high-resolution self-potential survey was performed on the dome and three multi-method profiles combining electrical resistivity tomography, self-potential, ground thermometry and soil CO2 diffuse degassing measurements were carried out to cover its southern periphery in January 2011. Results indicate that hydrothermal ascending flows are currently restricted to a proximal area including the dome and its very vicinity. The extension of hydrothermal alteration inferred from electrical resistivity tomography reflects the presence of a heat source just below the dome. A first-order correction of topography-related self-potential variations allows the identification of major hydrothermal fluid circulations pathways, as well as significant meteoric infiltration zones. Local shifting of hydrothermal fluids towards the dome periphery is favored by the presence of major axes. The regional La Ty fault appears as the major axis draining large volumes of hydrothermal and magmatic fluids. However hydrothermal activity remains confined inside a collapse structure surrounding the dome, that formed in the last 9000years as a result of recurrent edifice collapses, the latest occurring at the onset of the 1530AD eruption. The combination of these qualitative results with structural analysis leads to a synthetic model of magmatic and hydrothermal fluids circulation inside the dome, which may be useful for the assessment of potential hazards associated with a renewal of fluid pressurization, and a possibly associated partial flank-failure.
•We carried out a multi-method geophysical campaign in 2011 on La Soufrière volcano.•We identify the sources of SP variations on the dome itself.•We infer the extension of the hydrothermal system (and relation to structural limits).•We propose a general fluid circulation pattern for La Soufrière dome.
PDF
