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Background: Biliopancreatic diversion (BPD), by ad hoc stomach (AHS-BPD) or ad hoc stomach ad hoc alimentary limb (AHS-AHAL-BPD), has been accepted as an effective surgical treatment for morbid obesity. Patients and Methods: From January 1, 1992 to December 31, 2003, 136 patients (F/M 117/ 19, mean age 40.2 (range 20-61) years) underwent AHSAHAL- BPD. Mean preoperative body weight was 136.4 (91- 236) kg, with a mean body mass index of 49.1 (38-75). Three of these patients were converted from a previous vertical banded gastroplasty to AHS-BPD (1 patient with stomach preservation). The last 4 patients underwent video-assisted BPD (representing an initial laparoscopic BPD experience that is presently in progress). After at least 36 months of follow-up, 10 patients underwent abdominal dermolipectomy (8 patients during incisional hernia repair, 1 patient in combination with thigh dermolipectomy). Results: Mean postoperative hospital stay was 12 (8-30) days. Follow-up is currently in progress in all patients. Weight loss of initial overweight was 75% in 124 patients with 24-month follow-up, with excellent long-term weight maintenance. Protein deficiency was the main specific complication, which was encountered in 6 patients (4.4%). Conclusions: Our clinical experience supports the effectiveness and safety of AHS-AHAL-BPD, despite some criticism. This procedure seems to be suitable for patients with severe obesity and elevated BMI who poorly tolerate food intake restriction, but accept a long-term follow-up. Careful preoperative clinical assessment and selection of patients reliable for long-term follow-up (especially for dietary regimen in the first postoperative months), are the keys of success with BPD in terms of weight loss and reduction of specific complications. [ABSTRACT FROM AUTHOR]

The article focuses on the Italian manufacturing sector features after the «ventennio infelice» (twenty years of economic and industrial long term slowdown) 1990-2010. In particular the research question concerns whether it is still possible to discuss this issue by analysing the industrial districts. They were rediscovered during the 1970s by Giacomo Becattini (1979). From that moment on great attention has been paid to this economic model and to its Italian empirical evidences (e.g. Piore - Sabel 1984; Porter 1990). Nowadays the industrial district is considered as an obsolete model by most observers, mainly due to the industrial decline and the pressure of globalization. By analysing several Italian districts cases of success - even if they need specific policies to strengthen their community services and infrastructures - the author aims at reversing this perspective: territory is here not merely understood as a stock of resources but as a living system, therefore it still plays a role in activating and sustaining economic and social development processes. [ABSTRACT FROM AUTHOR]

Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, P  = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, P  = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, P  = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.

The high-temperature superconducting cuprates are governed by intertwined spin, charge, and superconducting orders. While various state-of-the-art numerical methods have demonstrated that these phases also manifest themselves in doped Hubbard models, they differ on which is the actual ground state. Finite-cluster methods typically indicate that stripe order dominates, while embedded quantum-cluster methods, which access the thermodynamic limit by treating long-range correlations with a dynamical mean field, conclude that superconductivity does. Here, we report the observation of fluctuating spin and charge stripes in the doped single-band Hubbard model using a quantum Monte Carlo dynamical cluster approximation (DCA) method. By resolving both the fluctuating spin and charge orders using DCA, we demonstrate that they survive in the doped Hubbard model in the thermodynamic limit. This discovery also provides an opportunity to study the influence of fluctuating stripe correlations on the model's pairing correlations within a unified numerical framework. Using this approach, we also find evidence for pair-density-wave correlations whose strength is correlated with that of the stripes., Competing Interests: The authors declare no competing interest., (Copyright © 2022 the Author(s). Published by PNAS.)

West Nile virus (WNV) is endemic in the Po valley area in northern Italy. Regional health authorities have implemented integrated WNV surveillance following a One Health approach, based on collaboration between human, animal and environmental health institutions. We evaluated this integrated WNV surveillance system in Emilia-Romagna, Lombardy and Piedmont regions by means of a process evaluation. We examined the system's implementation fidelity, dose delivered and received, reach, and we identified strengths and weaknesses in the system. Qualitative and semi-quantitative data were obtained from three regional focus groups. Data were discussed in a follow up focus group, where participants suggested recommendations for improving the surveillance system. Inter-institutional and interdisciplinary integration and the creation of a 'community of practice' were identified as key elements for effective surveillance. We identified differences in the degree of interdisciplinary integration in the three regions, likely due to different epidemiological situations and years of experience in surveillance implementation. Greater collaboration and sharing of information, public engagement and economic assessments of the integrated surveillance approach would facilitate its social recognition and guarantee its sustainability through dedicated funding. We demonstrate that a transdisciplinary research approach based on process evaluation has value for designing and fine-tuning integrated health surveillance systems., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Osteomyelitis represents a challenging condition in the diabetic foot with an associated high risk of major amputation. S53P4 Bioactive Glass (BG) has bacterial inhibiting properties on the market and indicated to be used in osteomyelitis. The objective of the study was to test the efficacy and safety of BG in treating diabetic foot osteomyelitis. This was an observational, retrospective, single-centre study involving subjects with diabetes affected by osteomyelitis of the foot who underwent surgical debridement from 01/2016 to 10/2018. Overall, 44 diabetic patients (14 [31.8%] female, aged 68.0 ± 10.2 years, diabetes duration 26.8 ± 11.9 years) were studied: 22 (50%) treated with surgical debridement and a local application of BG; 22 (50%) treated by means of surgical debridement. The primary outcome was the osteomyelitis resolution. Revascularization was performed before surgical procedure in 31 (70.5%) of patients. Systemic antibiotics were used in both groups. The osteomyelitis resolution rate was significantly higher in subjects treated with BG than in subjects treated with traditional procedure (18 [90%] vs 13 [61.9%], respectively p = .03). The odds of BG to reach osteomyelitis resolution was 5.54 times greater than for traditional treatment (odds ratio 5.54, 95% confidence interval 1.10-30.5). The use of BG was associated with an 81% lower probability to need additional antibiotic therapy compared to subjects treated with traditional procedure (odds ratio 0.19, 95% confidence interval 0.04-0.87). The debridement of osteomyelitis followed by application of BG could be an effective and safe option in the treatment of osteomyelitis of the diabetic foot., (Copyright © 2020. Published by Elsevier Inc.)

Background: Although pharmacological treatment has increased the average life expectancy of patients with cystic fibrosis, the median survival of females is shorter than that of males. In vitro and in vivo studies have shown that estrogens play a relevant role in the disease progression. The aim of this study was to investigate the effects of 17β-estradiol and tamoxifen citrate (TMX) on calcium-activated chloride channel (CaCC) currents in human bronchial epithelial cells carrying the ΔPhe508-CFTR mutation both in homozygosis and in heterozygosis., Methods: Perforated patch clamp experiments were performed on single cells of the immortalized cell lines CFBE and IB3-1. Gramicidin (10 or 20 μM) was added to the electrode solution to reach the whole cell configuration. The electrical stimulation protocol consisted of square voltages ranging from - 80 to + 80 mV, in steps of 20 mV and with a duration of 800 msec., Results: The presence of 17β-estradiol significantly reduced the CaCC currents, both in basal conditions and in the presence of ATP (100 μM). The addition of TMX (10 μM) completely restored the currents abolished by 17β-estradiol, in basal conditions and after stimulation with ATP in both CFBE and IB3-1 cells. TMX had a strong, direct action on membrane current density, which significantly increased more than 4-fold in both cases. The membrane current stimulation produced by TMX was further enhanced by the addition of ATP. CFBE cells incubated for 24 h with 3 μM VX-809 (a CFTR corrector) and then acutely stimulated with VX-770 (a CFTR potentiator) in the presence of forskolin, showed an increase of chloride currents which were abolished by Inh-172. The chloride current density induced by TMX + ATP was, on average, greater than that obtained with VX-809 + VX-770 + forskolin. The currents elicited by TMX + ATP were abolished by the addition of NPPB, a CaCC inhibitor. The combined administration of TMX/ATP and VXs/FSK had an additional effect on chloride currents., Conclusions: Our results show that TMX restores CaCC currents inhibited by 17ß-estradiol and directly activates the transmembrane chloride currents potentiated by ATP, an effect which is mutation independent. The combined effect of TMX with current used treatments for cystic fibrosis could be of benefit to patients.