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Background Strictureplasties [SXP] represent an alternative to bowel resection in Crohn's disease [CD]. Over the years, there has been growing interest in the role of non-conventional SXP for the treatment of extensive CD. A systematic review was performed on complications and recurrence following conventional and non-conventional SXP. Methods The available literature was screened according to the PRISMA statement, until June 2020. Results were categorised into three groups: studies reporting on conventional SXPs; studies with a mixed cohort of conventional and non-conventional SXPs [% non-conventional SXPs ≤15%]; and studies reporting on non-conventional SXPs. Considered endpoints were postoperative complications and overall and SXP site-specific surgical recurrence. Random-effect meta-analysis and meta-regression were used to obtain and compare combined estimates between groups. Results A total of 26 studies for a total of 1839 patients with CD were included. The pooled postoperative complication rates were was 15.5% (95% confidence interval [CI] 11.2%-20.3%), 7.4% [95% CI 0.2%-22.9%], and 19.2% [95% CI 5-39.6%] for the three groups, respectively. The rates of septic complications were 4% [95% CI 2.2%-6.2%], 1.9% [95% CI 0.4%-4.3%], and 4.2% [95% CI 0.9%-9.8%], respectively. Cumulative overall surgical recurrence rates were 27.5% [95% CI 18.5%-37.6%], 13.2% [95% CI 8.6%-18.7%], and 18.1% [95% CI 6.8%-33.3%]; and SXP site-specific surgical recurrence rates were 13.2% [95% CI 6.9%-21.2%], 8.3% [95% CI 1.6-19.3%], and 8.8% [95% CI 2.2%-19%], respectively. Formal comparison between the groups revealed no differences. Conclusions Non-conventional SXP did not differ from conventional SXP with respect to safety and long-term recurrence. Consistent heterogeneity was observed and partially limits the conclusions of this study. [ABSTRACT FROM AUTHOR]

Background and Aims Postoperative recurrence remains a challenging problem in patients with Crohn's disease [CD]. To avoid development of short bowel syndrome, strictureplasty techniques have therefore been proposed. We evaluated short- and long-term outcomes of atypical strictureplasties in CD patients with extensive bowel involvement. Methods Side-to-side isoperistaltic strictureplasty [SSIS] was performed according to the Michelassi technique or modification of this over the ileocaecal valve [mSSIS]. Ninety-day postoperative morbidity was assessed using the comprehensive complication index [CCI]. Clinical recurrence was defined as symptomatic, endoscopically or radiologically confirmed, stricture/inflammatory lesion requiring medical treatment or surgery. Surgical recurrence was defined as the need for any surgical intervention. Endoscopic remission was defined as ≤i1, according to the modified Rutgeerts score. Deep remission was defined as the combination of endoscopic remission and absence of clinical symptoms. Perioperative factors related to clinical recurrence were evaluated. Results A total of 52 CD patients [SSIS n =  12; mSSIS n =  40] were included. No mortality occurred. Mean CCI was 10.3 [range 0–33.7]. Median follow-up was 5.9 years [range 0.8–9.9]. Clinical recurrence [19 patients] was 29.7% and 39.6% after 3 and 5 years, respectively. Surgical recurrence [seven patients] was 2% and 14.1% after 3 and 5 years, respectively. At the end of the follow-up, 92% of patients kept the original strictureplasty and deep remission was observed in 25.7% of the mSSIS patients. None of the perioperative variables considered showed a significant association with clinical recurrence. Conclusions SSIS is safe, effective, and provides durable disease control in patients with extensive CD ileitis. [ABSTRACT FROM AUTHOR]

Background Despite improvements in medical therapy, the majority of patients with Crohn's disease still require surgery. The aim of this study was to report safety, and clinical and surgical recurrence rates, including predictors of recurrence, after ileocaecal resection for Crohn's disease. Methods This was a cohort analysis of consecutive patients undergoing a first ileocaecal resection for Crohn's disease between 1998 and 2013 at one of two specialist centres. Anastomotic leak rate and associated risk factors were assessed. Kaplan-Meier estimates were used to describe long-term clinical and surgical recurrence. Univariable and multivariable regression analyses were performed to identify risk factors for both endpoints. Results In total, 538 patients underwent primary ileocaecal resection (40·0 per cent male; median age at surgery 31 (i.q.r. 24-42) years). Median follow-up was 6 (2-9) years. Fifteen of 507 patients (3·0 per cent) developed an anastomotic leak. An ASA fitness grade of III (odds ratio ( OR) 4·34, 95 per cent c.i. 1·12 to 16·77; P = 0·033), preoperative antitumour necrosis factor therapy ( OR 3·30, 1·09 to 9·99; P = 0·035) and length of resected bowel specimen ( OR 1·06, 1·03 to 1·09; P < 0·001) were significant risk factors for anastomotic leak. Rates of clinical recurrence were 17·6, 45·4 and 55·0 per cent after 1, 5 and 10 years respectively. Corresponding rates of requirement for further surgery were 0·6, 6·5 and 19·1 per cent. Smoking (hazard ratio ( HR) 1·67, 95 per cent c.i. 1·14 to 2·43; P = 0·008) and a positive microscopic resection margin ( HR 2·16, 1·46 to 3·21; P < 0·001) were independent risk factors for clinical recurrence. Microscopic resection margin positivity was also a risk factor for further surgery ( HR 2·99, 1·36 to 6·54; P = 0·006). Conclusion Ileocaecal resection achieved durable medium-term remission, but smoking and resection margin positivity were risk factors for recurrence. [ABSTRACT FROM AUTHOR]

Background: A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative to ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn's disease [CD]. Methods: This type of strictureplasty was proposed to all patients with an extensive strictured [neo-] terminal ileal segment [> 20 cm]. Short- and long-term outcome data were retrieved from a prospectively maintained database. Safety and medium-term efficacy were studied, using both postoperative magnetic resonance enterography [MRE] and ileocolonoscopy at 6 months. Results: Between June 2009 and September 2014, 29 CD patients had a modified strictureplasty [male 9/29, median age 38 [range: 16-64] years]. The median length of strictureplasty was 50 [27110] cm. Twelve patients underwent a total of 30 additional procedures during surgery, mainly additional short strictureplasties, but also segmental resections. The majority had a laparoscopic-assisted procedure. Median length of hospital stay was 9 [6-17] days. Two patients had an early rescue procedure to oversew a small anastomotic leak. MRE and ileocolonoscopy at follow-up showed a remarkable regression of inflammation and bowel wall thickness. Clinical recurrence, necessitating initiation or modification of medical therapy, and surgical recurrence were reported in 11 and 1 patient after a median follow-up of 21 [1-54] months, respectively. Conclusion: A modified long Michelassi strictureplasty appears to be safe in patients with extensive stricturing Crohn's ileitis. Significant mucosal and bowel wall healing is observed and suggests that clearance of microbial stasis may play a role in this process. [ABSTRACT FROM AUTHOR]

Zinc is a well-known essential micronutrient, widely used as a food supplement, antimicrobial agent and food preservation. NOAEL was established at 50mg/person per day and an upper limit of 25mg/person per day was recommended. ZnONPs are GRAS substances approved by FDA. Nanotechnology is an emerging issue because of the industrial widespread use of ZnO nanoparticles and their potential toxicity and bioaccumulation. Aim of this study is to provide information regarding the quantification of ZnO-NPs, which may be intentionally or unintentionally added, in different brands of canned tuna (CT) and canned clam (CC), and to provide a first esteem of dietary exposure. Canned seafood was subjected to an alkaline digestion with TMAH. Assessment of ZnONPs was performed using a NexION 350D with the Syngistix Nano Application software (Perkin Elmer), allowing to identify number of particles, size and size distribution of metal NPs with the simultaneous quantification of the dissolved elemental concentration. Estimated Meal Intake was evaluated for adults by assuming a meal size of 227g, 70 years old and 70Kg of b.w. Results revealed a comparable mean size range between the considered food item (CT 69-80nm; CC 75-83nm). Concentration of ZnONPs are significantly higher in CC versus CT (CT 3.2-9.8 mg/Kg; CC 7.7-11.3 mg/Kg). The same we found for dissolved Zn concentration (CT 19.1-28.4mg/Kg; CC 27.4-39.2mg/Kg). For CT it was estimated an EMI of 0.018 mg/Kg bw for ZnONPs and 79.9 mg/Kg bw for dissolved Zn. For CC it was estimated an EMI of 0.031 mg/Kg bw for ZnONPs and 109 mg/Kg bw for dissolved Zn. Our findings revealed that ZnO-NPs have the potential to bioaccumulate in marine organisms, and seafood could be an important uptake route of ZnONPs. These results are a first important step to understand the ZnONPs human dietary exposure, but the characterization and quantification of ZnONPs is necessary for a large number of food items. [ABSTRACT FROM AUTHOR]

Background and Aims: Surgery for Crohn's disease [CD] can be complicated by an enhanced inflammatory response. This retrospective study aims to compare the inflammatory response measured by C-reactive protein [CRP] in patients operated for CD with patients undergoing similar surgery for colorectal cancer [CRC]. Methods: All CD patients undergoing an ileocaecal resection between February 2001 and December 2013 were retrieved from a prospectively maintained database. The same number of patients with a CRC of the ascending colon, undergoing a laparoscopic right hemicolectomy between March 2009 and June 2014, were retrieved from a CRC database. CRP level during the first 7 postoperative days was used as primary outcome. Results: Totals of 112 consecutive CD patients (male 40.2%; median age: 32.3 yrs; interquartile range [IQR]: 25.2-45.1) and 112 consecutive CRC patients [male 53.6%; median age 71.6 yrs; IQR: 64.7-77.5] were included. Postoperative CRP level in the CD group was on average 27% higher compared with the CRC group [p = 0.02]. The day-specific differences in CRP values were 21% (p = 0.021, 95% confidence interval [CI]: 3% 41%), 41% [p = 0.005, 95% CI: 11% - 79%], 49% [p = 0.007, 95% CI: 11% - 96%], and 49% [p = 0.006, 95% CI: 12% - 100%] higher for CD patients at Days 1, 4, 5, and 6 respectively. The difference in postoperative CRP level was partially due to differences in preoperative CRP level. Conclusion: CD patients develop a higher postoperative CRP level, probably reflecting an enhanced postoperative inflammatory response, which may be triggered by a higher preoperative inflammatory state. [ABSTRACT FROM AUTHOR]

Background A long-lasting good functional outcome of the pelvic pouch and a subsequent satisfying quality of life (QoL) are mandatory. Long-term functional outcome and QoL in a single-center cohort were assessed. Patients and methods A questionnaire was sent to all patients with an IPAA for UC, operated between 1990 and 2010 in our department. Pouch function was assessed using the Öresland Score (OS) and the ‘Pouch Functional Score’ (PFS). QoL was assessed using a Visual Analogue Score (VAS). Results 250 patients (42% females) with a median age at surgery of 38 years (interquartile range (IQR): 29–48 years) underwent restorative proctocolectomy. Median follow‐up was 11 years (IQR: 6–17 years). Response rate was 81% (n = 191). Overall pouch function was satisfactory with a median OS of 6/15 (IQR: 4–8) and a median PFS of 6/30 (IQR: 3–11). 24-hour bowel movement is limited to 8 times in 68% of patients (n = 129), while 55 patients (29%) had less than 6 bowel movements. 12 patients (6.5%) were regularly incontinent for stools, while 154 patients (82%) reported a good fecal continence. Fecal incontinence during nighttime was more common (n = 72, 39%). Pouch function had little impact on social activity (4/10; IQR: 2–6) and on professional activity (3/10; IQR: 1–6). 172 patients (90%) reported to experience an overall better health condition since their operation. The OS and the PFS correlated well (Pearson's correlation coefficient = 0.83). Overall pouch function was stable over time. Conclusion Majority of patients report a good pouch function on the long-term with limited impact on QoL. [ABSTRACT FROM AUTHOR]

Background Tetanus is a serious vaccine-preventable disease that remains a significant health risk in certain occupations. Since 2006, Italy has reported the highest number of cases in Europe. Some professions, such as construction workers, are more exposed to tetanus. Aims To evaluate tetanus immunity status and associated factors in construction workers in Italy. Methods A cross-sectional study of construction workers attending for periodic occupational health surveillance at one site in Italy between September 2011 and January 2013. Serum tetanus antitoxin levels were measured and analysed according to demographic and clinical variables. Results All 5275 workers attending for health surveillance between September 2011 and January 2013 agreed to participate. Protective tetanus antitoxin levels (>0.1 IU/ml) were found in 4116 workers (78%). Multivariate logistic regression analysis suggested that the following risk factors were significantly associated with inadequate immunization status: older age (age >58 years, odds ratio [OR] 1.78, 95% confidence intervals [CIs] 1.76–1.84), poor education (no formal education: OR 3.74, 95% CI: 3.69–3.78), unskilled work tasks (OR 2.71, 95% CI: 2.67–2.77) and country of origin (Egypt: OR 1.72, 95% CI: 1.67–1.77; Morocco: OR 1.69, 95% CI: 1.62–1.76). Conclusions In this study, a significant proportion of construction workers in Italy were not adequately immunized against tetanus, as required by Italian law. Occupational health professionals should promote and implement vaccination campaigns, especially among migrant workers, for public health and legal reasons. [ABSTRACT FROM AUTHOR]