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Background: Intestinal fibrosis and subsequent strictures represent an important burden in inflammatory bowel disease (IBD). Both the detection and evaluation of the degree of fibrosis in stricturing Crohn’s disease (CD) are important when deciding the best therapeutic strategy (medical anti-inflammatory therapy, endoscopic dilation, surgery). Ultrasound elastography (USE) is a non-invasive technique that has been proposed in the field of IBD for evaluating intestinal stiffness as a biomarker of intestinal fibrosis. Objective: The aim of this review is to discuss the ability and current role of ultrasound elastography in the assessment of intestinal fibrosis. Results and Conclusion: Data on USE in IBD are provided by pilot and proof-of-concept studies with small sample size. The first type of USE investigated was strain elastography, while shear wave elastography has been introduced recently. Despite the heterogeneity of the methods of the studies, USE has been proven to be able to assess intestinal fibrosis in patients with stricturing CD. However, before introducing this technique in current practice, further studies with larger sample sizes are needed. In addition, the use of homogeneous parameters, the assessment of reproducibility, and the identification of validated cut-off values are essential.

Abstract Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy (SAA) is technically challenging and associated with a significant number of failures. We examined the feasibility and efficacy of a novel technique for the management of bile duct stones (BDSs), called underwater cap-assisted ERCP (u-ERCP). Methods Between June 2019 and February 2020 all patients with SAA with jaundice or cholangitis secondary to BDSs who underwent u-ERCP were enrolled. The u-ERCP technique combines the underwater advancement of a pediatric colonoscope with a transparent cap fitted on the tip of the endoscope. We evaluated the technical success, clinical success, and adverse events associated with u-ERCP. Results We describe the technique itself and our initial experience in six patients. A complete and successful procedure was carried out in all patients, with the occurrence of no adverse events. None of the patients needed additional treatments for recurrence of symptoms during the follow-up period. Conclusions u-ERCP can be considered as a promising alternative for successful endoscopic management of biliary disease in patients with SAA.

Italy recorded its first case of confirmed acute respiratory illness because of coronavirus on February 18, 2020, soon after the initial reports in China. Since that time, Italy and nations throughout the world have adopted very stringent and severe measures to protect populations from spread of infection. Despite these measures, the number of infected people is growing exponentially, with a significant number of patients developing acute respiratory insufficiency. Endoscopy departments face significant risk for diffusion of respiratory diseases that can be spread via an airborne route, including aspiration of oral and fecal material via endoscopes. The purpose of this article is to discuss the measures, with specific focus on personal protection equipment and dress code modalities, implemented in our hospital to prevent further dissemination of COVID-19 infection.

We report the atypical presentation of Lafora disease in a Senegalese girl carrying the homozygous variant, c.560A>C, in the NHLRC1 gene. At 13 years, the patient developed myoclonic and visual seizures, progressive psychomotor slowing, and cognitive decline. At 14 years, a neurological examination showed severe hypomimia, bradykinesia, rigidity and low-amplitude myoclonic jerks. Flash-visual and somatosensory evoked potentials showed an increased amplitude of the cortical components, while an electroretinogram showed attenuated responses. An EEG showed diffuse polyspikes associated with positive-negative jerks as well as posterior slow waves and irregular spikes. The electroclinical picture suggested the diagnosis of Lafora disease regarding the association of visual seizures, cognitive deterioration, and action myoclonus, together with the EEG and evoked potential findings. Two uncommon findings were the prominence of extrapyramidal signs in the early stage of disease (which are rarely reported) and attenuation of electroretinal responses. We consider that Lafora disease should be included in the diagnostic work-up for juvenile Parkinsonism, when associated with epilepsy.

The ongoing pandemic of COVID-19 has forced governments to impose a lockdown, and many people have suddenly found themselves having to reduce their social relations drastically. Given the exceptional nature of similar situations, only a few studies have investigated the negative psychological effects of forced social isolation and how they can be mitigated in a real context. In the present study, we investigated whether the amount of digital communication technology use for virtual meetings (i.e., voice and video calls, online board games and multiplayer video games, or watching movies in party mode) during the lockdown promoted the perception of social support, which in itself mitigated the psychological effects of the lockdown in Italy. Data were collected in March 2020 (N = 465), during the lockdown imposed to reduce the COVID-19 spread. The results indicated that the amount of digital technology use reduced feelings of loneliness, anger/irritability, and boredom and increased belongingness via the perception of social support. The present study supported the positive role of digital technologies in maintaining meaningful social relationships even during an extreme situation such as a lockdown. Implications such as the need to reduce the digital divide and possible consequences of the ongoing pandemic are discussed.

The ongoing pandemic of COVID-19 has forced governments to impose a lockdown, and many people have suddenly found themselves having to reduce their social relations drastically. Given the exceptional nature of similar situations, only a few studies have investigated the negative psychological effects of forced social isolation and how they can be mitigated in a real context. In the present study, we investigated whether the amount of digital communication technology use for virtual meetings (i.e., voice and video calls, online board games and multiplayer video games, or watching movies in party mode) during the lockdown promoted the perception of social support, which in itself mitigated the psychological effects of the lockdown in Italy. Data were collected in March 2020 (

BACKGROUND: Recent studies suggest that about 6 out of 10 users have installed a fitness tracking application on their smartphone. Nevertheless, more than 59% of adults do not engage in sufficient daily physical activity and much remains unknown with regard to the effectiveness of mobile applications. By adopting the Theory of Planned Behavior, we tested whether the use of fitness apps for daily steps tracking could positively influence people’s health behavior. METHODS: Participants (N.=78) were randomly assigned to one of two experimental conditions; in one condition, they were asked to adopt a fitness app for two weeks. No information regarding mobile apps was given for participants in the control condition. In order to test the effects of using a fitness app, a series of two-way mixed ANOVAs were conducted. RESULTS: Participants in the experimental condition reported more favorable attitudes in the post-test compared to the pre-test, t(43)=4.09, P

Background and study aims COVID-19 has dramatically impacted endoscopy practice because upper endoscopy procedures can be aerosol-generating. Most elective procedures have been rescheduled. Endoscopic retrograde cholangiopancreatography (ERCP) is frequently performed in emergency or urgent settings in which rescheduling is not possible. We evaluated the impact of the COVID-19 pandemic on ERCP in Italy during the SARS-CoV-2 lockdown, in areas with high incidence of COVID-19. Patients and methods We performed a retrospective survey of centers performing ERCP in high COVID-19 prevalence areas in Italy to collect information regarding clinical data from patients undergoing ERCP, staff, case-volume and organization of endoscopy units from March 8, 2020 to April 30, 2020. Results We collected data from 31 centers and 804 patients. All centers adopted a triage and/or screening protocol for SARS-CoV-2 and performed follow-up of patients 2 weeks after the procedure. ERCP case-volume was reduced by 44.1 % compared to the respective 2019 timeframe. Of the 804 patients undergoing ERCP, 22 (2.7 %) were positive for COVID-19. Adverse events occurred at a similar rate to previously published data. Of the patients, endoscopists, and nurses, 1.6 %, 11.7 %, and 4.9 %, respectively, tested positive for SARS-CoV-2 at follow up. Only 38.7 % of centers had access to a negative-pressure room for ERCP. Conclusion The case-volume reduction for ERCP during lockdown was lower than for other gastrointestinal endoscopy procedures. No definitive conclusions can be drawn about the percentage of SARS-CoV-2-positive patients and healthcare workers observed after ERCP. Appropriate triage and screening of patients and adherence to society recommendations are paramount.

The term &ldquo, autism&rdquo, was originally coined by Eugen Bleuler to describe one of the core symptoms of schizophrenia. Even if autism spectrum disorder (ASD) and schizophrenia spectrum disorders (SSD) are now considered two distinct conditions, they share some clinical features. The present study aimed to investigate self-reported autistic traits in individuals with ASD, SSD, and non-clinical controls (NCC), using the Autism-Spectrum Quotient (AQ), a 50-item questionnaire. The study was conducted in the Psychiatry Unit of Policlinico &ldquo, G. Rodolico&rdquo, Catania, Italy. The AQ was administered to 35 adults with ASD, 64 with SSD, and 198 NCC. Overall, our data showed that the ASD sample scored significantly higher than NCC. However, no significant differences were detected between individuals with ASD and SSD. Notably, the three groups scored similarly in the subscale &ldquo, attention to detail&rdquo, AQ showed good accuracy in differentiating ASD from NCC (AUC = 0.84), while discriminant ability was poor in the clinical sample (AUC = 0.63). Finally, AQ did not correlate with clinician-rated ADOS-2 scores in the ASD sample. Our study confirms that symptoms are partially overlapping in adults with ASD and psychosis. Moreover, they raise concerns regarding the usefulness of AQ as a screening tool in clinical populations.

Importance Coronavirus disease 2019 (COVID-19) is a global pandemic and can involve the gastrointestinal (GI) tract, including symptoms like diarrhea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in feces. Objective To provide a pooled estimate of GI symptoms, liver enzyme levels outside reference ranges, and fecal tests positive for SARS-CoV-2 among patients with COVID-19. Data Sources An electronic literature search was performed for published (using MEDLINE/PubMed and Embase) and preprint (using bioRxiv and medRxiv) studies of interest conducted from November 1, 2019, to March 30, 2020. Search terms included “COVID-19,” “SARS-Cov-2,” and/or “novel coronavirus.” Study Selection Eligible studies were those including patients with SARS-CoV-2 infection who reported GI symptoms. Data Extraction and Synthesis Data on patients with GI symptoms (ie, diarrhea, nausea, or vomiting), liver enzyme level changes, and fecal shedding of virus were extracted. Quality of studies was examined using methodological index for nonrandomized studies. Pooled estimates (%) were reported with 95% CIs with level of heterogeneity (I2). Main Outcomes and Measures Study and patient characteristics with pooled detection rates for diarrhea, nausea or vomiting, liver enzyme levels outside reference ranges, and SARS-CoV-2 positivity in feces tests were analyzed. Results Of 1484 records reviewed, 23 published and 6 preprint studies were included in the analysis, with a total of 4805 patients (mean [SD] age, 52.2 [14.8] years; 1598 [33.2%] women) with COVID-19. The pooled rates were 7.4% (95% CI, 4.3%-12.2%) of patients reporting diarrhea and 4.6% (95% CI, 2.6%-8.0%) of patients reporting nausea or vomiting. The pooled rate for aspartate aminotransferase levels outside reference ranges was 20% (95% CI, 15.3%-25.6%) of patients, and the pooled rate for alanine aminotransferase levels outside reference ranges was 14.6% (95% CI, 12.8%-16.6%) of patients. Fecal tests that were positive for SARS-CoV-2 were reported in 8 studies, and viral RNA shedding was detected in feces in 40.5% (95% CI, 27.4%-55.1%) of patients. There was high level of heterogeneity (I2 = 94%), but no statistically significant publication bias noted. Conclusions and Relevance These findings suggest that that 12% of patients with COVID-19 will manifest GI symptoms; however, SAR-CoV-2 shedding was observed in 40.5% of patients with confirmed SARS-CoV-2 infection. This highlights the need to better understand what measures are needed to prevent further spread of this highly contagious pathogen.

Curcumin is the principal curcuminoid found in turmeric (Curcuma longa), a spice frequently used in Asian countries. Given its anti-inflammatory and antioxidant properties, it has been hypothesized...

Online video games are a popular leisure activity around the world; such virtual environments enable new ways for social identity to develop. This study investigated the motives affecting social identification processes in the massive multiplayer online role-playing game (MMORPG) World of Warcraft (WoW). In this video game, players interact with other players in a tridimensional virtual world through their avatar. A sample of 92 WoW players took part in a data collection Web survey. Building on the theory of social identity, we tested the predictive power of three identification motives: self-esteem enhancement, optimal distinctiveness, and uncertainty reduction. Additionally, considering previous research on MMORPGs, we added identification with the game character and membership duration as further predictors of virtual group identification. The construct of virtual group identification was analyzed at two levels: identification with the faction and guild of the character. Furthermore, the current study was a first attempt to understand whether online identification may lead to group behavior such as evaluative ingroup bias. Our results indicated that traditional motivational theories of social identity were mostly confirmed. Moreover, identification with the avatar emerged as a strong predictor of group identity. Additionally, at both levels of analysis, group attachment led to an evaluative differentiation between the ingroup and outgroup. The findings are discussed in light of modern theories of social identity and media research.

We report the case of a 23-year-old woman who presented to our Psychiatry Unit with a complex psychiatric symptomatology, 6 years after suffering from a form of encephalopathy which was retrospectively and hypothetically labeled as autoimmune limbic encephalitis. Over the years, several psychopharmacological therapies had been initiated, but none of them led to substantial remission of symptomatology. During the first visit, symptoms were characterized by dysphoric mood with suicidal ideation, anxiety, delusional thoughts. Self-harm and psychogenic seizures with daily frequency were also reported. A therapy with slow-release lithium sulfate, lurasidone, and lorazepam was prescribed. After 6 months of treatment, psychopathological manifestations significantly improved.

The survival of a virtual community is guaranteed by the users’ creation of content. However, the literature has found that the percentage of users who create innovative content is very modest. The content contribution process can also be interpreted as a social collective action in which we-intentions play a primary role. Nevertheless, some people choose not to participate in the collective action, but to benefit from the community’s resources and to maximize individual outcomes. In this study (N = 250), we investigated the effects of the free- riding tendency, conceived as the willingness to maximize personal outcomes. The specific setting was a virtual support forum, the most common type of web platform, generally used instrumentally by web users to find information and solutions to specific problems. We used the theory of planned behavior theoretical framework, plus social influence variables to test the effect of the free-riding tendency as a drawback for contributions, considering both the role of individual and we-intentions on the observed behavior. Findings showed that neither we-intentions nor I-intentions predicted the actual contribution behavior. Both types of intentions and contribution behavior were negatively influenced only by the free-riding tendency construct. Considerations and future developments of these results are discussed.

The paper presents a study about one of the most successful cases of social software: Wikipedia. In particular we focused on the investigation of some socio-psychological aspects related to the use of the Italian Wikipedia. In our study, we considered Wikipedia active users classified into three different roles: registered users, administrators, and bureaucrats in order to discuss our findings with respect to these different groups of users. Workflow Management Systems are applications designed to support the definition and execution of business processes. Since we consider that social aspects are relevant in the accomplishment and coordination of activities managed by such technologies, we advocate for a new class of Workflow Management Systems, i.e., Workflow Management Social Systems. These systems should emphasize the social nature of workflow management. For this reason, we propose to consider some of the relevant psychological aspects we identified in our study, interpreted in the light of some relevant socio-psychological theories, for the design of this socially enriched workflow technology.

In this paper, we propose a knowledge-based approach to design lower limb prostheses; in particular, we focus on the 3D modelling of the socket, the most critical component. First, the architecture of a dedicated design framework is described, detailing features of the main design steps. Then, the paper discusses the acquisition and formalisation of the knowledge related both to the prosthesis manufacturing process and to the considered component. Finally, we present the computer-aided module, named socket modelling assistant-SMA, we specifically developed to design the socket. It is a virtual laboratory where the socket virtual prototype is generated directly on the digital model of patient’s residual limb. It guides and supports the designer during each step in an automatic and/or semi-automatic way applying design rules and procedures. The modelling steps and available interactive tools that emulate orthopaedic technician’s operations are described. Results of the experimentation phase are described. At current state of the prototype development, they are encouraging and have permitted to preliminarily validate the proposed approach and envisage future improvements.

Computer-aided tools can help to realize custom-fit products characterized by a strict interaction with human body and definitely improve quality of life, in particular of people with disabilities. The paper refers to this context and to a specific custom-fit product, the lower limb prosthesis. It presents an innovative framework centred on virtual models of the patient’s body, to design and configure lower limb prosthesis, both transfemoral and transtibial. The framework integrates virtual prototyping and knowledge-based tools to support the orthopaedic technician during all the steps of the lower limb prosthesis design, suggesting rules and procedures for each task. First, the considered product is introduced, and then, the new design framework is described as well as main steps and related tools, from socket modelling to standards component selection and final prosthesis assembly. Results of preliminary experimentation and final remarks conclude the paper.

Modular lower limb prosthesis is composed by custom-fit parts, such as the socket containing the residual limb, and standard components available on market, such as knee or foot. For both custom and standard parts the support offered by existing design tools is not efficient or integrated enough and, as a result, most prosthetists do not use computer-aided tools and still rely only on their personal expertise. This paper presents an approach to design and configure complete lower limb prosthesis for transfemoral and transtibial amputees, using patient’s digital data (e.g., residual limb model acquired by MRI) and specification sheets of components. The ultimate goal is to realise a virtual laboratory where the technicians can design lower limb prosthesis guided step by step by the system. We have identified key patient’s characteristics guiding the prosthetist during the four main steps of the production process: acquiring patient’s data, socket modelling, standard components selection and prosthesis assembly and check. The developed innovative framework integrates different tools to guide the technicians during each design task providing specific knowledge and rules. Thus, it allows a quicker and easier definition of the virtual prosthesis, on which virtual test could be performed (e.g., pressure distribution on residual limb, gait evaluation) in order to be able to realize the definitive prosthesis at the first attempt. The results have been evaluated and validated with the technical staff of a certified orthopaedic laboratory.Copyright © 2011 by ASME

This paper presents a new approach to design lower limb prosthesis focusing the attention on geometrical model issues. The new design approach has been developed within national and international research projects and, at present, “ad hoc” tools to carry out specific tasks are under development. Within this context, an important role is played by product and process knowledge and by specific CAD tools to design the most critical component, the socket. The paper discusses acquisition and formalisation of the knowledge related to the prosthesis design, with particular attention to the socket, and presents main features of a CAD tool specifically intended for this highly customised component.Copyright © 2009 by ASME

This paper presents a 3D CAD system to design sockets of lower limb prostheses, both transfemoral and transtibial. The proposed system, named Virtual Socket Laboratory, can be seen as a virtual laboratory where the user has at her/his disposal virtual tools that permit to emulate the procedures applied by orthopaedic technicians during the traditional socket manufacturing. The module is centred on the digital model of the patient and is based on the specific domain knowledge to guide the user during socket modelling suggesting the most appropriate design rules and procedures. First, main steps of the new design-modelling process and system functionalities are presented. Then, for each step, procedures carried during the traditional process, how they are executed with the new module and tools specifically developed are described.

Objective: Because of the repetitive loading of the lower limb, patellar disorders are common in athletes and performing artists. Although this condition might be ascribed to different factors, the main cause is believed to be patellar maltracking. Design: Patellar maltracking is believed to be generated by an asymmetric activation of the vastus lateralis and vastus medialis obliquus muscles. A professional ballet dancer who suffered from anterior knee pain was examined. After clinical and MRI evaluations, he was subjected to surface electromyography (sEMG) of the vastus medialis obliquus and vastus lateralis. Results: We found a difference in the latency of onset of the vastus medialis obliquus and vastus lateralis of the painful right knee as compared to the asymptomatic left knee. Conclusion: Via sEMG, we demonstrate the role of the vastus medialis in patellar maltracking. sEMG is therefore a useful method to help diagnose and guide treatment in performing artists and elite athletes.

This paper presents a new design framework to configure lower limb prostheses, both transfemoral and transtibial, where the key elements are the patient digital avatar and the domain knowledge. The technician is supported during the design process by the knowledge acquired from analysis of the traditional process and represented in the framework. The last one integrates virtual prototyping tools and knowledge management techniques. A specific software tool, named Socket Modelling Assistant, has been developed to design the socket, the custom-fit component of the prosthesis. A commercial CAD system is used to model the standard components (e.g., knee, foot and tubes) and to create the final assembly. Patient avatar and his/her data (e.g., anthropometric and physiological parameters) are the backbone of the whole product design process. They guide both the selection of standard components and the modelling of the socket digital model.Copyright © 2010 by ASME