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BACKGROUND/AIMS Anastomotic leak is a life threatening complication following surgery for rectal cancer below peritoneal reflection. Colostomy or ileostomy following colorectal or coloanal anastomosis protect the patients from general peritonitis or sepsis secondary to anastomotic leak. METHODOLOGY In this paper the experience of the last 100 cases of rectal cancer below the peritoneal reflection treated from 2004 to 2010 was reviewed. RESULTS In 79 cases, primary anastomosis was performed. In 44/79 cases virtual ileostomy was prepared and in 35/79 cases, based on risk factors and intraoperative decision of the surgeon, an open ileostomy was performed. In 8/44 cases virtual ileostomy was opened, thus avoiding in 35/79 cases a second operation. CONCLUSIONS The goal for a good clinical outcome of patients with virtual ileostomy is a strict postoperative follow-up focused on fever onset and quality of drainage discharge. In our experience virtual ileostomy is a good tool to avoid open ostomy at time of primary colorectal or coloanal anastomosis in a good number of cases.

Background Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. A professional approach is imperative to maintain confidentiality, honesty, and trust in the medical profession. Objective we aimed to examine, in a medically supervised Italian web community (SMsocialnetwotk.com) dedicated to people with Multiple Sclerosis (pwMS), the posts shared by users and to verify the reliability of contents of posts shared by users pinpointed as Influencers through an online questionnaire. Methods we grouped the posts published on SMsocialnetwork from April to June 2015 into those with medical content (scientifically correct or fake news), and those related to social interactions. Later, we gave a questionnaire to the community asking to identify the three users/Influencers providing the most reliable advice for everyday life with MS and the three users/Influencers providing the most useful information about MS treatments. Results 308 posts reported scientific and relevant medical information, whereas 72 posts included pieces of fake news. 1420 posts were of general interest. Four out of the 6 Influencers had written only posts with correct medical information (3 were pwMS, 1 was a Neurologist) and never any fake news. The remaining 2 appointed Influencers (2 pwMS) had written only posts about general interests. Conclusion the identification of fake news and their authors has shown that the latter are never appointed as Influencers. SMsocialnetwork.com acted as a “web safe environment” where the Influencers contributed by sharing only correct medical information and never fake news. We speculate that the presence of neurologists and psychologists supervising the information flow might have contributed to reduce the risk of fake news spreading and to avoid their acquisition of authoritative meaning.

Background: Magnetic Resonance Imaging (MRI) techniques provided evidences into the understanding of cognitive impairment (CIm) in Multiple Sclerosis (MS). Objectives: To investigate the role of white matter (WM) and gray matter (GM) in predicting long-term CIm in a cohort of MS patients. Methods: 303 out of 597 patients participating in a previous multicenter clinical-MRI study were enrolled (49.4% were lost at follow-up). The following MRI parameters, expressed as fraction (f) of intracranial volume, were evaluated: cerebrospinal fluid (CSF-f), WM-f, GM-f and abnormal WM (AWM-f), a measure of lesion load. Nine years later, cognitive status was assessed in 241 patients using the Symbol Digit Modalities Test (SDMT), the Semantically Related Word List Test (SRWL), the Modified Card Sorting Test (MCST), and the Paced Auditory Serial Addition Test (PASAT). In particular, being SRWL a memory test, both immediate recall and delayed recall were evaluated. MCST scoring was calculated based on the number of categories, number of perseverative and non-perseverative errors. Results: AWM-f was predictive of an impaired performance 9 years ahead in SDMT (OR 1.49, CI 1.12-1.97 p = 0.006), PASAT (OR 1.43, CI 1.14-1.80 p = 0.002), SRWL-immediate recall (OR 1.72 CI 1.35-2.20 p

The debonding phenomenon between fiber-reinforced polymer (FRP) composites and masonry is influenced by the presence of mortar joints that could reduce the bond capacity of the FRP-brick interface (i.e., in the absence of the joints). The actual estimate of the maximum load transferable at the FRP-masonry interface is cumbersome. Thus, the aim of this paper is twofold. First, the paper provides a set of useful key remarks to understand how the presence of joints influence the behavior of the FRP-masonry interface with respect to the FRP-brick interface. This is an important aspect of the paper because it summarizes previous work and provides guidance for designers and researchers. Secondly, this paper proposes a step-by-step procedure to obtain an approximate estimate of the maximum transferable load at the FRP-masonry interface provided that the characteristics of the FRP-brick and FRP-mortar interfaces are known or can be derived from codes and guidelines, and the thickness of brick and joints is assigned. To the best knowledge of the authors, an approximate formulation for the FRP-masonry interface is presented in this paper for the first time together with guidance to evaluate when an approximate formulation might be necessary based on the desired acceptable error. The comparison between the maximum load transferable at the FRP-masonry interface and its approximation presented in this paper provides a relative error of roughly 0.4% for case of practical interest. Finally, the paper provides an example application of the proposed procedure.

Background: Converging neuropsychological evidence suggests that in migraine executive functions (EF) may be affected during interictal periods. Objective: To evaluate the functional connectivity of the fronto-parietal networks (FPN) known to be associated with EF, in migraine without aura (MwoA) patients, in the interictal period, in comparison to healthy controls (HC). Methods: Using resting-state functional MRI (RS-fMRI), we compared functional connectivity within the FPN in 14 patients with MwoA versus 14 sex- and age-matched HC, and assessed the correlation between functional connectivity within FPN, clinical features of MwoA patients, and EF. We used voxel-based morphometry to assess whether between-group differences in functional connectivity were dependent on structural differences. Results: Neuropsychological data revealed no significant executive dysfunction in MwoA patients. RS-fMRI showed that MwoA patients, compared to HC, had significant functional connectivity reduction within the right FPN and specifically in the middle frontal gyrus (MFG) and the dorsal anterior cingulate cortex. In addition, we found that MFG reduced connectivity was negatively correlated with the pain intensity of migraine attacks. There were no structural differences between the two groups. Conclusions: Our data suggest that, even in the absence of clinically evident EF deficits, MwoA is associated with reduced FPN functional connectivity. This study provides further insights into the complex scenario of migraine mechanisms.

In previous research works, the authors have identified a key system parameter which controls the maximum rotational response under free and forced vibrations of one-storey linear-elastic systems representative of asymmetric seismic isolated building structures. This parameter (called “ALPHA”) has also led to the identification of a simplified procedure (called “ALPHA method”) for the estimation of the maximum rotational response of such systems. Main goal of this paper is to verify the properties of the ALPHA parameter and the predictive capabilities of the ALPHA method, when applied to one-storey systems representative of generic asymmetric building structures. The verification is carried out through a comprehensive set of 11600 numerical simulations developed with reference to different representative structures subjected to historically recorded ground motions, with special attention devoted to the identification of the sensitivity of the ALPHA parameter and the ALPHA method upon the fundamental period of vibration of the structure (not yet considered in previous research works). The results obtained (a) confirm the effectiveness of the ALPHA parameter to capture the intrinsic propensity of an eccentric system to develop a torsional response, (b) confirm the capacity of the ALPHA method to effectively estimate the maximum rotational response of a given eccentric system under seismic excitation, and (c) indicate that the ALPHA method is only weakly sensitive upon the period of vibration of the structure. The paper also introduces a simple code-like provision for conservative estimations of the maximum rotation developed under seismic input by asymmetric structures based upon the confidence interval concepts.

The study of the torsional response of buildings in the inelastic range of behaviour is of great interest since the ability of structures to resist strong earthquakes mainly relies on their ductility and capacity for energy dissipation. Furthermore, an examination of the performance of structures during past earthquakes demonstrates that plan-asymmetric buildings suffered greater damage due to torsional response. The paper deals with this subject by analysing a model which idealizes a one-storey building with resisting elements oriented along two perpendicular directions. In addition to the parameters of the elastic behaviour, the inelastic system response depends on full yield capacity and plan-wise strength distribution. The influence of the criterion adopted for the design of resisting elements on local ductility demand and damage has been evaluated by parametric analysis. In particular, a comparison has been carried out between systems with equal design levels for all elements and systems with design levels dependent on the element location. For a given elastic behaviour and total capacity, the strength distributions in plan have been defined which minimize ductility demand and structural damage. Finally, based on these findings, responses from models designed according to several seismic codes have been compared.

Background Despite the fact that the clinical features of migraine are well described, the relationship between migraine and cognitive performance is still poorly understood. Indeed, some authors have reported the presence of cognitive deficits in patients with migraine without aura (MwoA) and with aura (MwA) whereas others have not confirmed these findings. Although neuropsychological studies in migraine are not conclusive, the most likely pattern of neuropsychological impairment would relate to the cognitive domain of executive functions (EF) [1]. Recent imaging studies have shown a significant functional connectivity decrease within the fronto-parietal networks (FPN), known to be associated with EF, in patients with MwoA in absence of significant executive dysfunction [2]. Objective To further explore FPN functional connectivity in patients with MwA and patients with MwoA, in the interictal period. Methods Using resting-state functional magnetic resonance imaging (RS-fMRI), we compared functional connectivity within the FPN in 20 patients with MwA, versus 20 sex- and agematched healthy controls (HC). To examine the specificity of any observed differences in FPN functional connectivity between patients and HC, we further studied 20 age- and sex-matched patients with MwoA. Furthermore, we assessed the correlation between functional connectivity within FPN and EF in both migraine groups. Finally, we used voxel-based morphometry to assess whether between-group differences in functional connectivity were dependent on structural differences. Results Neuropsychological data revealed no significant executive dysfunction in both migraine groups compared to HC. RS-fMRI showed that both MwA and MwoA patients, compared to HC, had a significant functional connectivity decrease within the right FPN and specifically in the middle frontal gyrus and the dorsal anterior cingulate cortex. There were no structural differences between the three groups. Conclusions Our data demonstrate that, even in the absence of clinically evident EF deficits, MwA and MwoA are associated with reduced FPN functional connectivity. We suggest that disrupted FPN functional connectivity might be only a part of a complex cascade that terminates in a migraine attack. In this context, FPN abnormalities may be the neuronal substrate on which biological, genetic and environmental factors could induce, and in turn correlate with, migraine attacks mostly characterized by high pain intensity in patients with MwoA and aura phenomenon in patients with MwA. In other terms, observed FPN connectivity changes may represent a migraine biomarker, probably related to well-known maladaptive stress response in migraine patients. Written informed consent to publish was obtained from the patient(s).