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Background and aims The present study was aimed to assess the risk of SARS-CoV-2 infection and associated factors among HCWs in endoscopy centers in Italy. Methods All members of the Italian Society of Digestive Endoscopy (SIED) were invited to participate to a questionnaire-based survey during the first months of the COVID-19 outbreak in Italy. Results 314/1306 (24%) SIED members accounting for 201/502 (40%) endoscopic centers completed the survey. Personal Protection Equipment (PPE) were available in most centers, but filtering face-piece masks (FFP2 or FFP3) and negative pressure room were not in 10.9 and 75.1%. Training courses on PPE use were provided in 57.2% of centers only; there was at least one positive HCW in 17.4% of centers globally, 107/3308 (3.2%) HCWs were diagnosed with COVID-19 with similar rates of physicians (2.9%), nurses (3.5%) and other health operators (3.5%). Involvement in a COVID-19 care team (OR: 4.96) and the lack of training courses for PPE, (OR: 2.65) were associated with increased risk. Conclusions The risk of COVID-19 among endoscopy HCWs was not negligible and was associated with work in a COVID-19 care team and lack of education on proper PPE use. These data deserve attention during the subsequent waves.

Marble sludge wastes (MSW) are investigated as solid precursor for the production of low-temperature calcium silicate hydrate (CSH). Calcined powder of MSW is ball-milled with rice husk ash (RHA) and the slurries are treated in oven at 100C for 24 hours in a context where water evaporation is minimized. The initial CaO:SiO2 molar ratio varies from 1 to 3 (CS, C2S and C3S) and the solution used for the preparation of the calcium silicate hydrate presents NaOH with concentration of 0, 1, 2 and 3 N. FTIR, XRD, Particle size distribution, BET surface area and Environmental Scanning Electron Microscope (ESEM) permitted to confirm the formation of CxS (x = 1, 2, 3) and CSH at 100C through pozzolanic reactions. The increase of the alkalinity of the solution improved the silica dissolution and enhances the formation of CxS and CSH up to 2N. Further increase of the alkalinity affected the silica polymerization, the particle size and the concentration of CxS and CSH into the final matrix. Precursor with CaO:SiO2 = 1 seem to promote more monomers while 2CaO:SiO2 and 3CaO:SiO2 resulted in orthosilicate chains and interlayer respectively. The high reactivity and fine particles (ϕ < 32 nm) of CSH obtained appeared promising for the design of low-cost, environmentally-friendly and sustainable binders as well as others engineering applications including refractory precursors, hydroceramics, insulating matrices, filtration and catalysis.

Solid liquid extraction (SLE) and ultrasound-assisted extraction (UAE) using food grade solvents were applied to Guayule leaves in order to obtain phenolic compound-rich extracts. The influence of solvent composition and time were evaluated for both techniques reaching the highest phenolic content with UAE using water and 25% aqueous ethanol (27.0 ± 0.2 and 22 ± 2 mg gallic acid equivalents/g dried leaves, respectively) and with SLE using water and 50% aqueous ethanol (16 ± 1 and 17 ± 1 mg/g, respectively). Antioxidant and antiradical activities of the selected extracts were evaluated by means of spectrophotometric procedures. In addition HPLC-ESI-QTOF-MS was used to characterize the bioactive compounds in the richest extracts. A variety of phenolic compounds, mainly phenolic acids and flavonoids, were identified for the first time in Guayule leaves. This study indicates that conventional extraction techniques, such as SLE and UAE, represent a powerful tool for the fast isolation of antioxidant compounds from Guayule.

Marble sludge wastes (MSW) are investigated as solid precursors for the production of low-temperature calcium silicate hydrate (CSH). Calcined powder of MSW is ball-milled with rice husk ash (RHA) and the slurries are treated in the oven at 100°C for 24 h in a context where water evaporation is minimized. The initial CaO:SiO2 molar ratio varies from 1 to 3 (CS, C2S and C3S) and the solution used for the preparation of the calcium silicate hydrate presents NaOH with concentration of 0, 1, 2 and 3 N. FTIR, XRD, Particle size distribution, BET surface area and Environmental Scanning Electron Microscope (ESEM) permitted to confirm the formation of CSH(I) at 100°C through pozzolanic reactions. The increase of the alkalinity of the solution improves the silica dissolution and enhances the formation of CxS and CSH up to 2N. Further increase of the alkalinity affected the silica polymerization, the particle size and the concentration of CSH into the final matrix. The precursor with CaO:SiO2 = 1 seems to promote C-S-H(I) with more monomers while 2CaO:SiO2 and 3CaO:SiO2 resulted in orthosilicate chains and interlayer respectively. The high reactivity and fine particles (diametre

The first frontal geopolymerization (FGP) took place in the same reaction medium in which the frontal polymerization (FP) of 1,6-hexanediol diacrylate (HDDA) was occurring, thus giving rise to an organic-inorganic hybrid in one step in just a few minutes. Because of their exothermicity, the two reactions support each other and sustain propagating fronts. By contrast, using the classical techniques (prolonged heating) instead of FP, due to large gas formation, the reaction is explosive or, if carried out at room temperature, phase separation occurred.

Frontal polymerization (FP) was successfully applied to the synthesis of poly(N-isopropylacrylamide)-grafted-acryloyl-β-cyclodextrin supramolecularly crosslinked hydrogels. It was established that acryloyl-β-cyclodextrin (AβCD) allowed performing successful frontal polymerizations with N-isopropylacrylamide even in the absence of any covalent crosslinker, which is something generally required. It was found that the swelling properties of the resulting hydrogels can be tuned by varying the amount of AβCD. Namely, when little amounts of this non-covalent crosslinker were used, superabsorbent hydrogels were obtained. Hydrogels containing also a covalent crosslinker were also prepared for comparison. These latter exhibited swelling ratios that are much lower than the others.

This review retrieves the determinant role of the solid precursor on the definition, chemistry, processing and applications of geopolymers. It is demonstrated that the process, the alkaline solution, the curing conditions as well as the orientation of the end-products in term of performance and potential application are governed by the intrinsic nature and characteristics of the aluminosilicate precursors. In particular, the amorphous fraction and the available Al and Si cations governs the geopolymerization. Solid precursors with relatively large amount of amorphous phase are easily activated with standard alkaline solution (6–8 M) leading to the formation of a gel, designated as cement or binder. Al-rich gels are efficient for the design of high strength concretes or composites. Solid precursors with low amorphous fraction need relatively high concentrated alkaline solution (>8 M), particularly aluminosilicates with crystalline habitus such as fly ash, volcanic ash, feldspars, granites, nepheline, etc. In these cases, both the dissolution and the curing steps require temperature above ambient. The pastes produced are dominated by non-reacted or incongruently dissolved particles more addressed for mortars and precast. When high concentrated alkaline solution is used, some additions of Si-rich or Al-rich reactive materials are needed to stabilize the extra alkali present within the matrix: steam or long-term curing are, therefore, required. Regarding the curing conditions, the temperature and relative humidity to be applied are directly linked to the nature of the solid precursor. This paper should be viewed as a significant contribution for the understanding and classification of geopolymer cement and composites as well as the science and technology of the geopolymers.

Magnetic resonance cholangio-pancreatography (MRCP) findings in people with chronic asymptomatic pancreatic hyperenzymemia (CAPH) have shifted the hypothesis that CAPH is always non-pathological. However, there have been no studies including both secretin-MRCP (S-MRCP) and endoscopic ultrasonography (EUS) to examine the pancreatic morphology in these subjects.To prospectively assess the diagnostic approach for CAPH using both pancreatic EUS and S-MRCP.In a case-control prospective study from January 2010 to December 2014, 68 consecutive subjects with CAPH were scheduled to undergo S-MRCP and EUS (CAPH group) in a tertiary care setting. In the same period, the EUS findings of this group were compared with 68 patients examined by EUS alone for submucosal lesions of the gastric fundus, matched for sex and age (control group).EUS detected pancreatic alterations in 60.3% of the CAPH group and 13.2% of controls (p0.001). S-MRCP showed pancreatic alterations in 51.5% in the CAPH group. With the combined procedures, pancreatic abnormalities were detected in 63.3%. The diagnoses established by the two techniques were concordant in 51 (75%) of the 68 CAPH subjects; in the remaining 17 (25%) the two methods gave additional information.In people with CAPH S-MRCP and EUS are both recommended in order to detect pancreatic abnormalities before this biochemical alteration is confirmed as benign CAPH, or Gullo's syndrome.

The bioactive flavonoid fisetin (FS) is a diet-derived antioxidant that is being increasingly investigated for its health-promoting effects. Unfortunately, the poor physicochemical and pharmacokinetic properties affect and limit the clinical application. In this study, novel polymeric nanoparticles (NPs), based on Poly-(ε-caprolactone) (PCL) and PLGA-PEG-COOH, encapsulating FS were formulated as suitable oral controlled release systems. Results showed NPs having a mean diameter of 140-200nm, and a percent loading of FS ranging from 70 to 82%. In vitro release studies revealed that NPs are able to protect and preserve the release of FS in gastric simulated conditions, also controlling the release in the intestinal medium. Moreover, the DPPH and ABTS scavenging capacity of FS, as well as α-glucosidase inhibition activity, that resulted about 20-fold higher than commercial Acarbose, were retained during nanoencapsulation process. In summary, our developed NPs can be proposed as an attractive delivery system to control the release of antioxidant and anti-hyperglycemic FS for nutraceutical and/or therapeutic application.

[Background] Immune-dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a lethal disease caused by mutations in a transcription factor critical for the function of thymus-derived regulatory T (Treg) cells (ie, FOXP3), resulting in impaired Treg function and autoimmunity. At present, hematopoietic stem cell transplantation is the therapy of choice for patients with IPEX syndrome. If not available, multiple immunosuppressive regimens have been used with poor disease-free survival at long-term follow-up. Rapamycin has been shown to suppress peripheral T cells while sparing Treg cells expressing wild-type FOXP3, thereby proving beneficial in the clinical setting of immune dysregulation. However, the mechanisms of immunosuppression selective to Treg cells in patients with IPEX syndrome are unclear., [Objective] We sought to determine the cellular and molecular basis of the clinical benefit observed under rapamycin treatment in 6 patients with IPEX syndrome with different FOXP3 mutations., [Methods] Phenotype and function of FOXP3-mutated Treg cells from rapamycin-treated patients with IPEX syndrome were tested by flow cytometry and in vitro suppression assays, and the gene expression profile of rapamycin-conditioned Treg cells by droplet-digital PCR., [Results] Clinical and histologic improvements in patients correlated with partially restored Treg function, independent of FOXP3 expression or Treg frequency. Expression of TNF-receptor-superfamily-member 18 (TNFRSF18, glucocorticoid-induced TNF-receptor–related) and EBV-induced-3 (EBI3, an IL-35 subunit) in patients’ Treg cells increased during treatment as compared with that of Treg cells from untreated healthy subjects. Furthermore inhibition of glucocorticoid-induced TNF-receptor–related and Ebi3 partially reverted in vitro suppression by in vivo rapamycin-conditioned Treg cells., [Conclusions] Rapamycin is able to affect Treg suppressive function via a FOXP3-independent mechanism, thus sustaining the clinical improvement observed in patients with IPEX syndrome under rapamycin treatment.

Introduction: Acute Pancreatitis (AP) is the most frequent complication after Endoscopic Retrograde Cholangiopancreatography (ERCP). Some prophylactic strategies are the use of pancreatic stents or peri-procedural nonsteroidal anti-inflammatory drugs (NSAIDs). Statins are widely used lipid-lowering drugs. Recent studies suggest that chronic statin intake may be associated to a lower incidence of AP. Methods: Our aim is to investigate whether chronic statin and/or acetylsalicylic acid (ASA) intake is associated to a lower incidence of PEP. Stark project is an international, multicenter, prospective, cohort study, developed under the auspices of “Pancreas 2000”. Consecutive patients undergoing ERCP in seven european centers, older than 18, were included prospectively. Demographic and medical data were retrieved by anamnesis. Patients were followed-up to detect those with PEP. The sample size was estimated to be 1, 016 participants. A univariate analysis and multivariate analysis (binary logistic regression) were performed. Results: 1150 patients were included. Mean age was 68.4 years (SD 14.5). 561 (48.8%) patients were female. 70 patients developed post-ERCP-AP (PEP) (6.1%) ; 25 patients (8.1%) under chronic statin treatment versus 45 patients (5.4%) who do not (p= 0.086). Multivariate analysis showed an aOR of 1.679 (0.941-2.994), p 0.079 for PEP incidence in statin users. Regarding ASA consumption, 11 patients (6.6%) under ASA treatment versus 59 patients (6%) who were not consuming ASA, developed PEP (p= 0.753). Multivariate analysis showed an aOR of 1.017 (0.487-2.127), p=0.963 for PEP incidence among ASA users. Conclusion: Our data suggest that chronic statin and/or ASA intake isnt statistically associated to an increase incidence of PEP.

Defect-free graphene is easily obtained by the liquid dispersion method, without any chemical manipulation. Tetraethylene glycol diacrylate (TEGDA) is used as liquid medium in which the above nanofiller is dispersed alone or together with fullerene C60. TEGDA is used because of its good dispersion properties and as a monomer to be eventually polymerized, thus directly obtaining the corresponding polymer nanocomposites. Polymerization is performed by using both the classical or the frontal polymerization, Moreover, polymeric films were also prepared. The interaction between the two fillers and the influence of the synthetic techniques on material properties are deeply studied. The optical properties of the obtained nanocomposites are analyzed by absorption and fluorescence spectroscopy. Graphene containing materials show absorption at ca. 280 nm and exhibited significant emission in the range between 600 and 800 nm. In contrast, fullerene containing materials do not show any fluorescence, which can be attributed to a charge transfer phenomenon from graphene to fullerene C60.

The polyphenols as nutraceutical and therapeutic agents are gaining growing interest for their beneficial effects and potential in human health. In order to protect their scaffolds and functionality, and to improve the bioavailability, the microencapsulation can represent a promising strategy. This study reports on the formulation of the natural resveratrol (RSV) into microcapsules (MCs) prepared by using different concentrations of chitosan (CS) and poly(D,L-lactic-co-glycolic acid) (PLGA) as polymeric matrix. MCs were prepared by W/O/W double emulsion method and characterized in terms of morphology, size, encapsulation efficiency, physicochemical and thermal properties. RSV release behavior from MCs was evaluated under simulated gastrointestinal fluids, and the long term stability was monitored at different storage conditions. MCs resulted to have spherical shape and different morphology, with size ranging from 11 to 20 μm, and encapsulation efficiencies of 40-52%, depending on the CS concentration. Moreover, MCs containing CS exhibited a significant lower release of RSV than those containing only PLGA. Furthermore, all tested formulations were able to ensure a good retention and stability of encapsulated RSV until 6 months. In summary, CS/PLGA MCs can be proposed as an attractive delivery system to control the release and long term protection of RSV.

Two different types of multi-stimuli-shrinking hydrogels were synthesized (IPNs and terpolymeric hydrogels) by properly polymerizing N-isopropylacrylamide, 2-hydroxyethyl methacrylate and 2-acrylamido-2-methylpropanesulfonic acid in various mutual ratios and different synthetic orders. Both classical (CP) and frontal (FP) polymerizations were used and the resulting material properties compared. The best compositions and synthetic routes were found and the swelling, morphological and thermal material properties were studied. The results show that some IPNs exhibit marked stimuli-shrinking properties while some terpolymers present an opposite behavior. IPNs swell more than terpolymers and show a sharper stimuli-response, with a larger swelling ratio variation. In addition, FP allowed obtaining samples with the same characteristic of CP materials, but with significant preparation advantages. It has been demonstrated that by varying monomer mutual ratio, synthetic technique (FP or CP) and structural architecture (terpolymers or IPNs), different materials having peculiar properties and characteristics can be obtained.

Background The prevalence of nine EUS features of chronic pancreatitis (CP) according to the standard Wiersema classification has been investigated in 489 patients undergoing EUS for an indication not related to pancreatico-biliary disease. We showed that 82 subjects (16.8%) had at least one ductular or parenchymal abnormality. Among them, 18 (3.7% of study population) had ≥3 Wiersema criteria suggestive of CP. Recently, a new classification (Rosemont) of EUS findings consistent, suggestive or indeterminate for CP has been proposed. Aim To stratify healthy subjects into different subgroups on the basis of EUS features of CP according to the Wiersema and Rosemont classifications and to evaluate the agreement in the diagnosis of CP with the two scoring systems. Weighted kappa statistics was computed to evaluate the strength of agreement between the two scoring systems. Univariate and multivariate analysis between any EUS abnormality and habits were performed. Results Eighty-two EUS videos were reviewed. Using the Wiersema classification, 18 subjects showed ≥3 EUS features suggestive of CP. The EUS diagnosis of CP in these 18 subjects was considered as consistent in only one patient, according to Rosemont classification. Weighted Kappa statistics was 0.34 showing that the strength of agreement was ‘fair’. Alcohol use and smoking were identified as risk factors for having pancreatic abnormalities on EUS. Conclusions The prevalence of EUS features consistent or suggestive of CP in healthy subjects according to the Rosemont classification is lower than that assessed by Wiersema criteria. In that regard the Rosemont classification seems to be more accurate in excluding clinically relevant CP. Overall agreement between the two classifications is fair.

New polymeric nanocomposite films containing graphene and Ag, Au or ZnO nanoparticles were synthesized, and their morphological, thermal, surface and dielectric properties were studied. Graphene was obtained by the sonication method, which allows to obtain “real” graphene, without any chemical manipulation of graphite. This method preserves graphene lattice symmetry, which is responsible for its exceptional properties. The interaction between graphene and the other nanoparticles (NPs) confers to these polymeric films interesting characteristics, thus making them suitable for different applications. For example, the wetting property can be tuned by the insertion of nanofillers. Furthermore, the presence of these latter increases the dielectric strength of the polymer films.

Thermoplastic polyurethane (TPU) nanocomposites containing graphene and graphene nanoribbons were obtained by polymerizing 1,4-butanediol with two diisocyanates (namely, 1,6-hexane diisocyanate or isophorone diisocyanate), in which the nanofillers were previously dispersed. Raman spectroscopy and Transmission Electron Microscopy demonstrated the formation of few-layer graphene and graphene nanoribbons dispersed in the monomers. At variance to the methods commonly reported in literature, that used in this work consists of the direct exfoliation of graphite without any chemical manipulation. Apart from the obvious cost and ease advantages, the so-obtained graphene does not contain any carboxy or alkoxy groups formed during the exfoliation process, which, at variance, are typically present in the most commonly reported methods. This finding paves the way toward the large-scale production of graphene and its nanoribbons, which are considered even more interesting than graphene itself for many potential applications. The obtained nanocomposites show a peculiar thermal and rheological behavior due to the presence of the nanofillers and to their reinforcing or plasticizing effect exerted on the TPU matrices.

The aim of this study was to investigate the effect of saturated fatty alcohols having different chain length (C 12 –C 18 ), formulated into Precirol-based lipid nanoparticles, on the ex vivo skin permeability of Econazole nitrate. Nanoparticles were prepared by o/w high shear homogenization using a mixture of Precirol and fatty alcohol as the lipid phase. A formulation containing only Precirol was used as a comparison. Lipid nanoparticles were characterized in terms of particle size, encapsulation efficiency and crystalline structure. After incorporation into hydrogels, ex vivo drug permeation tests were carried out through porcine stratum corneum. The particles had a mean diameter below 200 nm and the encapsulation efficiency ranged from 95 to 98%. Ex vivo permeation results demonstrated that the drug flux from formulations containing fatty alcohols increased as the alcohol chain length increased. The analysis of results revealed that the effect of fatty alcohols on the Econazole nitrate permeation is structure-dependent, and associated with an increase of the permeability coefficients that can improve the interaction between alcohols and skin lipids.

Background Magnetic resonance cholangio-pancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic cholangio-pancreatography (ERCP) are the most frequently employed second-step procedures to detect biliary and pancreatic abnormalities in patients with acute recurrent pancreatitis (ARP) of unknown aetiology. MRCP and EUS both give a better view of the bilio-pancreatic ductal system after secretin stimulation (MRCP-S, EUS-S). EUS also serves to identify changes in the pancreatic parenchyma consistent with chronic pancreatitis, at an early stage. However, no studies have compared MRCP-S, EUS-S, and ERCP in the diagnosis of recurrent pancreatitis. Aim To prospectively compare the diagnostic yield of MRCP-S, EUS-S, and ERCP in the evaluation of patients with acute recurrent pancreatitis with non-dilated ducts, of unknown aetiology. Methods Forty-four consecutive patients with ARP were prospectively scheduled to undergo MRCP-S, EUS-S and ERCP, in accordance with a standard protocol approved by the institutional review board. Diagnoses such as biliary microlithiasis, congenital variants of the pancreatic ducts, chronic pancreatitis and sphincter of Oddi dysfunction were compared between the three procedures. The diagnosis of chronic pancreatitis was established according to ductal morphology by MRCP-S and ERCP, ductal and parenchymal morphology by EUS-S. Results The three procedures combined achieved a diagnosis that could have explained the recurrence of pancreatitis in 28/44 patients (63.6%). EUS-S recognized ductal and/or parenchymal abnormalities with the highest frequency (35/44 patients, 79.5%). Both MRCP-S and EUS-S were superior to ERCP for detecting pancreatic ductal abnormalities. EUS-S showed up pancreatic parenchymal changes in more than half the cases. Both EUS and MRCP secretin kinetics were concordant in identifying two cases with sphincter of Oddi dysfunction. Conclusions The diagnostic yield of EUS-S in recurrent pancreatitis with non-dilated ducts and unknown aetiology was 13.6% and 16.7% higher than MRCP-S and ERCP respectively (although not significant), which both gave substantially similar diagnostic yields. In no case did ERCP alone find a diagnosis missed by the other two procedures. MRCP-S and EUS-S should both be used in the diagnostic work-up of idiopathic recurrent pancreatitis as complementary, first-line, techniques, instead of ERCP.

Background and aim Celiac disease is a common condition with many atypical manifestations, where histology serves as the “gold standard” for diagnosis. A useful new technique, optical coherence tomography, can depict villous morphology in detail, using light waves. This study examined the correlation between the sensitivity and specificity of optical coherence tomography in pediatric patients undergoing esophago-gastro-duodenoscopy for the diagnosis of celiac disease. Materials and methods A total of 134 children were prospectively enrolled, 67 with a serological suspicion of celiac disease (group 1) and 67 with negative histology for celiac disease (group 2). During a diagnostic esophago-gastro-duodenoscopy we acquired multiple images and films in the four quadrants of the second part of the duodenum, and biopsies were taken in the area where optical coherence tomography had been done. Three patterns of villous morphology were considered: pattern 1 = no atrophy (types 0, 1 or 2 of the Marsh classification); pattern 2 = mild atrophy (type 3a or 3b); pattern 3 = marked atrophy (type 3c). Results The diagnosis of celiac disease was histologically confirmed in all 67 children with positive antiendomysium and/or antitransglutaminase antibodies. Optical coherence tomography correlated with pattern 1 histology in 11/11 cases, pattern 2 in 30/32 (93.8%) and pattern 3 in 22/24 (91.6%). Sensitivity and specificity were 82% and 100%. In the control group there was 100% concordance between optical coherence tomography and histology. The overall concordance between optical coherence tomography and histology in determining patchy lesions was 75%. Conclusion Optical coherence tomography could be a helpful diagnostic tool in children with mild or marked villous atrophy for diagnosing celiac disease during upper gastrointestinal (GI) endoscopy, avoiding biopsies. However, duodenal biopsies are mandatory if the optical coherence tomography shows normal villous morphology in patients with positive antibodies.