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Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a T H 1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.

The origin of black hole mergers discovered by the LIGO 1 and Virgo 2 gravitational-wave observatories is currently unknown. GW190521 3 , 4 is the heaviest black hole merger detected so far. Its observed high mass and possible spin-induced orbital precession could arise from the binary having formed following a close encounter. An observational signature of close encounters is eccentric binary orbit 5 – 7 ; however, this feature is currently difficult to identify due to the lack of suitable gravitational waveforms. No eccentric merger has been previously found 8 . Here we report 611 numerical relativity simulations covering the full eccentricity range and an estimation approach to probe the eccentricity of mergers. Our set of simulations corresponds to ~10 5 waveforms, comparable to the number used in gravitational-wave searches, albeit with coarser mass ratio and spin resolution. We applied our approach to GW190521 and found that it is most consistent with a highly eccentric ( e = 0.6 9 − 0.22 + 0.17 ; 90% credible level) merger within our set of waveforms. This interpretation is supported over a non-eccentric merger with >10 odds ratio if ≳10% of GW190521-like mergers are highly eccentric. Detectable orbital eccentricity would be evidence against an isolated binary origin, which is otherwise difficult to rule out on the basis of observed mass and spin 9 , 10 . Massive black holes that are produced dynamically by black hole mergers are thought to involve eccentric orbits, whose imprint may remain in the gravitational waveform detected by the LIGO/Virgo Collaboration.

Background: The aim of the study was to evaluate the sella and craniofacial morphological features in growing patients with palatally displaced canines compared to controls. Materials and methods: Twenty-two subjects with palatally displaced canines were retrospectively selected and compared to 22 controls matched for age and gender. Lateral cephalograms were collected and sagittal and vertical cephalometric variables were measured, together with sella interclinoid distance, sella depth, and sella diameter. The independent samples T-test or Mann-Whitney U-test were used to compare all the variables between the two groups. A Pearson correlation was computed for the craniofacial and sella variables that differed significantly (p < 0.05) between the groups. Results: Patients with palatally displaced canines showed a smaller interclinoid distance and a greater SNA angle than control subjects. The interclinoid distance and the SNA angle were negatively correlated (–0.52, p = 0.017) in the experimental group. Conclusions: Growing patients with palatally displaced canines had smaller sella interclinoid distances and a greater SNA angle than control subjects.

In order to evaluate the predictive value of positron emission tomography–computed tomography (PET/CT) in discriminating the presence of a Richter’s syndrome (RS) or a second malignancy (SM), as well as to evaluate its prognostic value in patients with chronic lymphocytic leukemia (CLL), we retrospectively analyzed the data of 90 patients who, in the suspicion of a RS or a SM, underwent PET/CT followed by the biopsy of the involved tissue. The median maximum Standardized Uptake Value (SUV max ) in the presence of a CLL/small lymphocytic lymphoma, a diffuse large B-cell lymphoma (DLBCL), a Hodgkin lymphoma (HL), a SM were 3.5, 14.6, 7.0 and 6.3, respectively ( P ⩽0.0001). A SUV max cutoff value ⩾5 showed a sensitivity, specificity, positive and negative predictive values of 88.2, 71.2, 51.3 and 94%, respectively, for the presence of a more aggressive disease (DLBCL, HL and SM). A SUV max ⩾5 identified also a subset of treatment naive patients with an inferior progression-free survival ( P =0.011) and overall survival ( P =0.067). These findings suggest that PET/CT may helpfully integrate the biologically-based prognostic stratification of CLL. Prospective clinical trials including larger cohorts of patients are needed to conclusively define the role and prognostic impact of PET/CT in the routine management of CLL patients.

In order to reduce uncertainty in the estimation of Direct Aerosol Radiative Forcing (DARF), it is important to improve the estimation of the single scattering albedo (SSA). In this study, we propose a new data processing method to improve SSA retrievals for the SKYNET sky radiometer network, which is one of the growing number of networks of sun-sky photometers, such as NASA AERONET and others. There are several reports that SSA values from SKYNET have a bias compared to those from AERONET, which is regarded to be the most accurate due to its rigorous calibration routines and data quality and cloud screening algorithms. We investigated possible causes of errors in SSA that might explain the known biases through sensitivity experiments using a numerical model, and also using real data at the SKYNET sites at Pune (18.616° N/73.800° E) in India and Beijing (39.586° N/116.229° E) in China. Sensitivity experiments showed that an uncertainty of the order of ±0.03 in the SSA value can be caused by a possible error in the ground surface albedo or solid view angle assumed for each observation site. Another candidate for possible error in the SSA was found in cirrus contamination generated by imperfect cloud screening in the SKYNET data processing. Therefore, we developed a new data quality control method to get rid of low quality or cloud contamination data, and we applied this method to the real observation data at the Pune site in SKYNET. After applying this method to the observation data, we were able to screen out a large amount of cirrus-contaminated data and to reduce the deviation in the SSA value from that of AERONET. We then estimated DARF using data screened by our new method. The result showed that the method significantly reduced the difference of 5 W m−2 that existed between the SKYNET and AERONET values of DARF before screening. The present study also suggests the necessity of preparing suitable a priori information on the distribution of coarse particles ranging in radius between 10 μm and 30 μm for the analysis of heavily dust-laden atmospheric cases.

Introduction. Postoperative recurrence after surgery for Crohn’s disease (CD) is virtually inevitable, and its mechanism is poorly known. Aim. To review the numerous factors involved in CD postoperative recurrence (POR) pathogenesis, focusing on single immune system components as well as the immune system as a whole and highlighting the clinical significance in terms of preventive strategies and future perspectives. Methods. A systematic literature search on CD POR, followed by a review of the main findings. Results. The immune system plays a pivotal role in CD POR, with many different factors involved. Memory T-lymphocytes retained in mesenteric lymph nodes seem to represent the main driving force. New pathophysiology-based preventive strategies in the medical and surgical fields may help reduce POR rates. In particular, surgical strategies have already been developed and are currently under investigation. Conclusions. POR is a complex phenomenon, whose driving mechanisms are gradually being unraveled. New preventive strategies addressing these mechanisms seem promising.

The European Skynet Radiometers network (EuroSkyRad or ESR) has been recently established as a research network of European PREDE sun-sky radiometers. Moreover, ESR is federated with SKYNET, an international network of PREDE sun-sky radiometers mostly present in East Asia. In contrast to SKYNET, the European network also integrates users of the CIMEL CE318 sky–sun photometer. Keeping instrumental duality in mind, a set of open source algorithms has been developed consisting of two modules for (1) the retrieval of direct sun products (aerosol optical depth, wavelength exponent and water vapor) from the sun extinction measurements; and (2) the inversion of the sky radiance to derive other aerosol optical properties such as size distribution, single scattering albedo or refractive index. In this study we evaluate the ESR direct sun products in comparison with the AERosol RObotic NETwork (AERONET) products. Specifically, we have applied the ESR algorithm to a CIMEL CE318 and PREDE POM simultaneously for a 4-yr database measured at the Burjassot site (Valencia, Spain), and compared the resultant products with the AERONET direct sun measurements obtained with the same CIMEL CE318 sky–sun photometer. The comparison shows that aerosol optical depth differences are mostly within the nominal uncertainty of 0.003 for a standard calibration instrument, and fall within the nominal AERONET uncertainty of 0.01–0.02 for a field instrument in the spectral range 340 to 1020 nm. In the cases of the Ångström exponent and the columnar water vapor, the differences are lower than 0.02 and 0.15 cm, respectively. Therefore, we present an open source code program that can be used with both CIMEL and PREDE sky radiometers and whose results are equivalent to AERONET and SKYNET retrievals.

PurposeSymptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. A variety of surgical procedures have been used in the rectocele repair to enhance anatomical and functional results and to improve long-term outcomes.MethodsIn this prospective study, we treated 25 selected women suffering from simple symptomatic rectocele with transperineal repair using porcine dermal acellular collagen matrix Biomesh (Permacol®). Watson score and SF-36 questionnaire were used to evaluate postoperative outcomes and quality of life.ResultsFollow-up ranged from 12 to 24 months, the mean total Watson score was significantly lower than the preoperative score (P < 0.001), and every patient has improved functional outcomes. There were no major intraoperative or postoperative complications. Two cases of urinary infection and 4 patients delayed wound healing were reported. Those patients who were sexually active prior to surgery have not experienced problems with sexual function or dyspareunia.ConclusionsDespite lack of comparative study in literature, rectocele repair with Permacol® by the transperineal approach seems an effective and safe procedure that avoids some of the complications associated with synthetic mesh use.

SKYNET is an international research network of ground based sky – sunphotometers for the observation and monitoring of columnar aerosol properties. The algorithm developed by SKYNET is called SKYRAD.pack, and it is used on Prede instruments only. In this study, we have modified the SKYRAD.pack software in order to adapt it to Cimel sunphotometers. A one month database of Cimel data obtained at Burjassot (Valencia, Spain) has been processed with this program and the obtained inversion products have been compared with AERONET retrievals. In general, the differences found were consistent with the individual error assessments for both algorithms. Although the aerosol optical depth compared well for any aerosol burden situation (rmsd of 0.002–0.013 for all wavelengths), inversion products such as the single scattering albedo, refractive index and asymmetry parameter compared better for higher turbidity situations. The comparison performed for cases with an aerosol optical depth at 440 nm over 0.2 showed rms differences of 0.025–0.049 for single scattering albedo, 0.005–0.034 for the real part of refractive index, 0.004–0.007 for the imaginary part of the refractive index and 0.006–0.009 for the asymmetry parameter. With respect to the volume distributions, the comparison also showed a good agreement for high turbidity cases (mainly within the 0.01–7 μm interval) although the already known discrepancy in the extremes of the distribution was still found in 40% of the cases, in spite of eliminating data and instrumental differences present in previous studies.

An altered balance between effector and regulatory factors is supposed to sustain the tissue-damaging immune response in inflammatory bowel disease (IBD). Several studies demonstrate that severe active inflammation is a strong predictor for surgical complications and recurrence. Indeed, bowel resection in Crohn’s disease (CD) patients has a high surgical recurrence rate. In this review, we examined the IBD inflammatory pathways, the current surgical treatments, and the almost inevitable recurrence. The question that might arise is if the cure of intestinal CD is to be found in the surgical approach. A selective search of two databases (PubMed and the Cochrane Library) has been carried out without considering a specific time horizon as inclusion criteria. The scope of this literature review was investigating on the role of inflammation in the management of CD. The following key words have been used to develop the query string: (i) inflammation; (ii) Crohn’s disease; (iii) surgery; and (iv) postsurgical recurrence.