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Objectives: Crohn's perianal fistula represents a challenging condition to treat. Sphincters-preserving surgical techniques are increasingly being adopted as repeated surgical procedures may lead to various degrees of incontinence. This prospective study aims to assess the long-term efficacy of collagen paste application in patients with simple and complex Crohn's perianal fistulas. Methods: Patients with Crohn's perianal fistula (simple or complex) and inactive luminal disease were enrolled. The fistula tract was treated by curettage and injection of acellular, porcine dermal collagen paste between 2019 and 2021. The primary endpoint was the clinical healing of the fistula at 12 and 24 months, defined as the absence of suppuration on clinical examination. The trial was preregistered on a public repository (ClinicalTrials.gov; NCT03776825). Results: Fourteen patients were included in the study, ten patients (71%) had complex perianal fistula. All patients underwent previous fistula operations. Nine patients (64%) reached complete clinical remission at 12 months, two patients (14%) had a clinical recurrence six months after surgery, and three patients (21%) at 12 months follow-up. Three relapsed patients presented postoperative abscesses. Twelve patients (86%) were followed up at 24 months, no further clinical recurrences or complications were observed and the complete healing rate was 58%. No continence disturbances were recorded after collagen paste injection. Conclusions: The results suggest that collagen paste injection may represent a safe and effective option for Crohn's perianal fistulas, worth further investigation in larger trials.

Inflammatory bowel diseases (IBD) and psoriasis are chronic inflammatory conditions belonging to the heterogeneous group of immune-mediated inflammatory diseases (IMIDs). A significant bidirectional link between these two entities has been observed, conditioning an increased risk of IBD in patients with psoriasis and vice-versa. Biological therapies used for IBD may lead to the occurrence of psoriasis as a “paradoxical reaction.” The objective of this study is to analyze the current evidence on the association between psoriasis and IBD, particularly finding case reports of the appearance or aggravation of psoriasis under therapy with interleukin-12/23 (IL-12/23) and IL-23 inhibitors. We conducted comprehensive research to identify studies examining the association between psoriasis and IBD and to find case presentations that reported the appearance or aggravation of psoriasis under biologic therapy with IL-12/23 and IL-23 inhibitors up to March 2024. Clinical trials for IL-12/23 and IL-23 inhibitors in IBD were analyzed to find cases of paradoxical psoriasis as registered adverse events. The sources of evidence are PubMed and ClinicalTrials.gov. For each included case report, data on patient characteristics concerning their age, sex, and comorbidities were selected. Moreover, information regarding the indication for biologic therapy, time to onset of paradoxical psoriasis after starting treatment, clinical presentation, and management of the paradoxical psoriasis was extracted. We found 10 reported cases of ustekinumab-induced new-onset or worsening psoriasis and one reported case of paradoxical psoriasis induced by risankizumab in the literature. Four cases of paradoxical psoriasis have been also registered in clinical trials involving ustekinumab treatment in IBD. Psoriasis can constitute a rare paradoxical adverse event of ustekinumab treatment, but further studies are needed to better clarify the cytokine imbalance that leads to this phenomenon induced by inhibition of IL-12/23 and IL-23. Still, few real-world data exist to draw any conclusions, but risankizumab may positively treat psoriasis induced by ustekinumab.

The monk seal is the most endangered pinniped in the world and the only one found in the Mediterranean, where its distribution and abundance have suffered a drastic decline in the last few decades. Data on its status are scattered due to both its rarity and evasiveness and records are biased towards occasional, mostly coastal encounters. Nowadays, molecular techniques allow us to detect and quantify minute amounts of DNA traces released into the environment (eDNA) by any organism. A species-specific molecular assay is now available for detecting the recent presence of the monk seal in the water column through the analysis of sea-water samples collected from the sea surface. The project “Spot the Monk” uses this non-invasive detection tool to monitor monk seal occurrence in Mediterranean waters by means of eDNA analysis. The simplicity in the acquisition of samples together with the need to collect samples in multiple points simultaneously made the project well suited to the involvement of the general public. Up to today, about 350 samples have been collected and analysed in the central-western Mediterranean by researchers and a multifarious range of citizen scientists - from recreational sailing organisations, both amateur and competitive sportsmen, to fishermen. This work announces the launch of an open-source Observatory (https://www.spot-the-monk-observatory.com/) where the project outcomes are publicly accessible as soon as they are produced. Embracing the principles of Open Science, we believe that such an approach can contribute to filling the knowledge gap about the distribution of this charismatic species in our seas, providing, at the same time, a proof of concept on how data collected by a variety of actors can be returned to the scientific and non-scientific communities in an innovative format for immediate consultation.

Virtual Reality (VR) technologies have entered many aspects of daily life (e.g., workplace, education, gaming). VR users report that time flows faster when immersed in a virtual environment. Such an effect is supported by recent scientific evidence (Mullen & Davidenko, 2021). Indeed, a familiarity effect could foster such a time compression effect. To investigate this possibility, a between-subject design was adopted: in one condition, participants explored a virtual environment through a head-mounted display (HMD), whereas in the control condition, participants explored the same environment through a standard monitor. Participants were all instructed to produce an interval of 4 minutes so that longer produced durations in an interval production task were evidence of underestimation. Adopting a prospective time estimation paradigm, the time intervals produced were compared between the two conditions. Results confirmed the time compression effect: participants in the VR condition reported longer produced intervals than participants in the control condition. Furthermore, the significant interaction with levels of prior experience with VR technologies suggests that time compression effects may be more pronounced for VR newcomers, thus favoring an interpretation in terms of familiarity. The present findings provide valuable insights into the perception of time in virtual environments, suggesting the importance of continued research in this emerging technology. Limits, implications, and the need for further research are finally discussed.

The ubiquity of human art prompted evolutionary psychologists to explore its origins as a potential adaptation to the environment. Here we focus on emotionally charged art and posit that affective affordances embedded into some artworks play a pivotal role in explaining why these artworks are enjoyed from an evolutionary perspective. Such features, recurring in various art forms, are interpreted as cues to the emotional state of others, enabling art consumers to engage in empathetic experiences and vicarious emotions. We explore the adaptive value of deriving pleasure from vicarious emotions, while also addressing the seemingly counterintuitive enjoyment of artworks that evoke negative emotions. We discuss the appreciation of vicarious emotions irrespective of their valence and maintain this appreciation to hold adaptive significance for three key reasons. Firstly, it aids art consumers in refining their interpretational schemes of internal states, potentially enhancing emotional regulation skills. Secondly, it contributes to a deeper understanding of the emotions of others, thereby fostering emotional intelligence and empathy. Lastly, the enjoyment of affectively charged artworks reinforces social cohesion by harmonizing the emotions of group members. This perspective provides a comprehensive framework for understanding the evolutionary underpinnings of the human capacity for art appreciation and emotional engagement.

Artificial intelligence (AI) is a rapidly developing technology that has the potential to create previously unimaginable chances for our societies. Still, the public’s opinion of AI remains mixed. Since AI has been integrated into many facets of daily life, it is critical to understand how people perceive these systems. The present work investigated the perceived social risk and social value of AI. In a preliminary study, AI’s social risk and social value were first operationalized and explored by adopting a correlational approach. Results highlighted that perceived social value and social risk represent two significant and antagonistic dimensions driving the perception of AI: the higher the perceived risk, the lower the social value attributed to AI. The main study considered pretested AI applications in different domains to develop a classification of AI applications based on perceived social risk and social value. A cluster analysis revealed that in the two-dimensional social risk × social value space, the considered AI technologies grouped into six clusters, with the AI applications related to medical care (e.g., assisted surgery) unexpectedly perceived as the riskiest ones. Understanding people’s perceptions of AI can guide researchers, developers, and policymakers in adopting an anthropocentric approach when designing future AI technologies to prioritize human well-being and ensure AI’s responsible and ethical development in the years to come.

The ongoing COVID-19 pandemic has led to several changes in academic teaching practices. Although educational digital technologies have been crucial during the initial phases of the pandemic, their forced adoption has led to negative consequences.In the present study, we aimed to integrate the Technology Acceptance Model theoretical framework (Davis, 1989) by exploring the effects of some possible factors that influence the willingness to adopt digital learning tools in the future when the pandemic is over. Among them, technostress was considered one of the external factors that could have adversely affected digital teaching technology adoption in the future. In contrast, the perception of technical support offered by the university was considered a potential protective factor.A total of 463 Italian university faculty completed an online questionnaire at the end of the first semester (a.y. 2020–21). The frequency of distance teaching technologies usage behavior was measured objectively by extracting teachers' activities from the University's e-learning databases. Key findings indicated that distance teaching technologies' frequency of use increased technostress, which in turn negatively impacted the perception of ease of use. The latter influences - both directly and indirectly through perceived usefulness - the intentions to adopt distance learning tools after the pandemic. Organizational support negatively predicted technostress. Implications to help public institutions develop functional strategies to cope with the technological changes brought by the pandemic are discussed.

Atherosclerotic cardiovascular disease and stroke are the leading causes of morbidity and mortality worldwide. Along to the traditional risk factors for these diseases, chronic inflammation is known to be an important player in accelerating the process of atherosclerosis, which can result in an increased incidence of arterial thromboembolic events. As in other chronic inflammatory diseases, in the past few years, several studies suggested that subjects affected by inflammatory bowel diseases (IBD) may also be at an incremented risk of atherosclerotic disease, especially during the periods of disease's flare. Therefore, IBD treatment may assume an important role for achieving both disease remission and the control of the atherosclerotic risk. In this article we aimed to perform a comprehensive review on evidence on the increased risk of arterial thromboembolic events in patients affected by IBD and discuss the potential role of IBD therapy in reducing this risk.

Arianna Dal Buono,1 Roberto Gabbiadini,1 Virginia Solitano,1,2 Edoardo Vespa,1,2 Tommaso Lorenzo Parigi,1,2 Alessandro Repici,2,3 Antonino Spinelli,1,2,4 Alessandro Armuzzi1,2 1IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 2Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; 3Endoscopy Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 4Colon and Rectal Surgery Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, ItalyCorrespondence: Alessandro Armuzzi, IBD Center, Humanitas Research Hospital – IRCCS, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Rozzano, Milan, Italy, Tel +39(0)282245555, Fax +39(0)282242591, Email alessandro.armuzzi@hunimed.euBackground and Aims: Patients affected by moderate-to-severe Ulcerative Colitis (UC) demand a challenging management. Small molecules, administrated as oral agents, have the ambition of overcoming the limitations of the biologic agents (ie, parenteral administration, rapidity of action, primary and secondary non-responsiveness). Beyond tofacitinib, a pan-Janus kinase (JAK) inhibitor already approved for the treatment of moderate-to-severe UC, novel more selective molecules like filgotinib are being currently evaluated in randomized clinical trials. We aimed to review the current evidence on filgotinib, a JAK-1 preferential inhibitor, in the treatment of UC and its place in therapy in the current scenario.Methods: PubMed and EMBASE were searched to identify relevant studies: those investigating the efficacy and safety of filgotinib in the treatment of UC patients were included in this narrative review.Results: The current preliminary data have shown that filgotinib is safe and effective in inducing clinical end endoscopic response in both biologic-naïve and biologic-experienced patients with moderate-to-severe UC, also with high inflammatory burden at baseline. In the SELECTION trial, one case of pulmonary embolism occurred with filgotinib 200 mg induction, and three venous thrombosis cases were observed in the placebo maintenance/LTE; the incidence of herpes zoster was ≤ 1% in all UC treated patients. Filgotinib represents an appealing treatment option for its high selectiveness, route of administration and rapidity of action; cost-effectiveness studies and head-to-head trials are needed to better define its place in therapy.Keywords: ulcerative colitis, filgotinib, Janus kinase inhibitors, efficacy, safety

Inflammatory bowel diseases (IBD) and psoriasis are chronic inflammatory conditions belonging to the heterogeneous group of immune-mediated inflammatory diseases (IMIDs). A significant bidirectional link between these two entities has been observed, conditioning an increased risk of IBD in patients with psoriasis and vice-versa. Biological therapies used for IBD may lead to the occurrence of psoriasis as a "paradoxical reaction." The objective of this study is to analyze the current evidence on the association between psoriasis and IBD, particularly finding case reports of the appearance or aggravation of psoriasis under therapy with interleukin-12/23 (IL-12/23) and IL-23 inhibitors. We conducted comprehensive research to identify studies examining the association between psoriasis and IBD and to find case presentations that reported the appearance or aggravation of psoriasis under biologic therapy with IL-12/23 and IL-23 inhibitors up to March 2024. Clinical trials for IL-12/23 and IL-23 inhibitors in IBD were analyzed to find cases of paradoxical psoriasis as registered adverse events. The sources of evidence are PubMed and ClinicalTrials.gov. For each included case report, data on patient characteristics concerning their age, sex, and comorbidities were selected. Moreover, information regarding the indication for biologic therapy, time to onset of paradoxical psoriasis after starting treatment, clinical presentation, and management of the paradoxical psoriasis was extracted. We found 10 reported cases of ustekinumab-induced new-onset or worsening psoriasis and one reported case of paradoxical psoriasis induced by risankizumab in the literature. Four cases of paradoxical psoriasis have been also registered in clinical trials involving ustekinumab treatment in IBD. Psoriasis can constitute a rare paradoxical adverse event of ustekinumab treatment, but further studies are needed to better clarify the cytokine imbalance that leads to this phenomenon induced by inhibition of IL-12/23 and IL-23. Still, few real-world data exist to draw any conclusions, but risankizumab may positively treat psoriasis induced by ustekinumab. [ABSTRACT FROM AUTHOR]

Background and Aims: Subcutaneous (SC) formulations of infliximab (IFX) and vedolizumab (VDZ) are approved for the treatment of inflammatory bowel diseases (IBDs). Our aim was to evaluate the effectiveness of switching from intravenous (IV) to SC formulations of IFX and VDZ in IBDs. Methods: This multicentre, retrospective study collected data of adult patients with Crohn's disease (CD) or ulcerative colitis (UC) switched to SC IFX or VDZ. The primary endpoint was clinical remission at 12 months stratified based on timing of switch. A composite endpoint consisting of therapy discontinuation, reverse‐switch, need for steroids, and drug optimization was evaluated. A multivariate analysis investigated the association between patients' characteristics and outcomes. Results: Two hundred and thirty‐one patients (59% UC, 53% male, mean age 44 ± 15 years, 68% IFX) from 13 centres were included. The switch occurred at Week 6 in a third of cases (36%). Median time to switch was 13 months. Most patients switched to SC IFX and VDZ were in clinical remission at 3 (87% and 77%), 6 (86% and 83%) and 12 (63% and 60%) months. In the multivariate analysis, there was no difference in clinical remission rate at 12 months; however, patients switched at Week 6 had a higher rate of experiencing any therapeutic changes at 3 (false discovery rate (FDR) =.002), 6 (FDR <1 × 10−10) or 12 months (FDR =.08). Clinical disease activity at baseline (only in UC) (FDR =.07) and previous exposure to biologics (FDR =.001) were risk factors for composite endpoint at 6 and 12 months. Conclusion: SC IFX and VDZ are effective in daily clinical practice in IBD patients. Switching patients in remission reduces the risk of negative outcomes. [ABSTRACT FROM AUTHOR]

Background and aims: Inflammatory bowel diseases (IBD) are multifactorial chronic inflammatory disorders affecting the gastrointestinal tract. However, a broad spectrum of extraintestinal manifestations (EIMs) is associated with IBD, affecting several organs and systems, such as the skin, musculoskeletal and hepatobiliary systems, and, not least, the eye. Approximately 10% of IBD patients can develop ocular EIMs (O-EIMs) with a higher prevalence in Crohn’s disease (CD). Eye-redness, photophobia, pain, and blurred vision are the common symptoms, with a wide rate of severity and clinical impact on the quality of life. This narrative review aims to summarize the prevalence, pathogenesis, and current evidence-based management of O-EIMs, underlying the importance of a holistic approach and specialties collaboration for a prompt diagnosis and treatment. Methods: PubMed was searched up to December 2023 to identify relevant studies investigating the pathogenesis, epidemiology, and treatment of O-EIMs in IBD patients. Results: The mechanisms underlying O-EIMs are partially unknown, encompassing immune dysregulation, shared antigens between the eye and the gut, genetic predisposition, and systemic inflammation driven by high levels of interleukins and cytokines in IBD patients. The complexity of O-EIMs’ pathogenesis reflects in the management of these conditions, varying from topical and systemic steroids to immunomodulatory molecules and biologic therapy, such as anti-tumor necrosis factor (TNF)-alpha. A multidisciplinary approach is the backbone of the management of O-EIMs.

Abstract The young adult can experience psychological difficulties related to the delicate phase of life he/she is going through. Many of them show psychological difficulties but only a small portion receive the needed care. In this regard, internet-based interventions represent an important resource. MindBlooming is a seven-week intervention delivered through a mobile application for university students with mild to moderate psychological difficulties. The application is the result of the interdisciplinary work between the Department of Psychology and the Department of Informatics, Systems and Communication of the University of Milan-Bicocca. The intervention focused on symptoms of depression, anxiety, sleep problems, self-destructive thoughts, job- and study-related stress and burnout, and chronic pain. It is based on different approaches (multi-approach), primarily psychoeducation, Cognitive-Behavioral Treatment (CBT), and third-wave CBT. During the first pilot study, the intervention consisted of a 7-week treatment on two problematic areas according to each students’ personal needs, identified through an initial assessment. The achieved results are promising especially in terms of interest shown by students. However, we encountered technical problems that hampered the pilot study. A second pilot will be performed to further test the application. The MindBlooming project will be discussed in light of the need for further multidisciplinary research that confirms how biomarkers can be sensitive to non-pharmacological internet-based interventions. Keywords cognitive-behavioral treatment; internet-based intervention; university students. Disclosure of Interest None Declared

Accurate disease characterization is the pillar of modern treatment of inflammatory bowel disease (IBD) and endoscopy is the mainstay of disease assessment and colorectal cancer surveillance. Recent technological progress has enhanced and expanded the use of endoscopy in IBD. In particular, numerous artificial intelligence (AI)-powered systems have shown to support human endoscopists' evaluations, improving accuracy and consistency while saving time. Moreover, advanced optical technologies such as endocytoscopy (EC), allowing high magnification in vivo, can bridge endoscopy with histology. Furthermore, molecular imaging, through probe based confocal laser endomicroscopy allows the real-time detection of specific biomarkers on gastrointestinal surface, and could be used to predict therapeutic response, paving the way to precision medicine. In parallel, as the applications of AI spread, computers are positioned to resolve some of the limitations of human histopathology evaluation, such as interobserver variability and inconsistencies in assessment. The aim of this review is to summarize the most promising advances in endoscopic and histologic assessment of IBD.

Simple Summary: Hereditary colorectal cancer syndromes (HCCS) and inflammatory bowel disease (IBD) carry a high risk of developing colorectal cancer (CRC). The co-occurrence of IBD and HCCS is extremely rare. Individuals with HCCS and IBD are prone to developing CRC at a younger age compared to those without IBD, with patients who have ulcerative colitis at such an especially high risk. The interplay between chronic inflammation and genetic predispositions remains poorly understood. Background and aims: Hereditary colorectal cancer syndromes (HCCS), including familial adenomatous polyposis (FAP) and Lynch syndrome (LS), are the two most important high-risk conditions for colorectal cancer (CRC). Inflammatory bowel disease (IBD) increases the risk by two to six times compared with that in the general population. The intersection of these two conditions has rarely been documented in literature. We aimed to summarize the prevalence, pathogenesis, and current evidence-based management of IBD and HCCS and the underlying molecular mechanisms of accelerated carcinogenesis due to combined inflammation and genetic predisposition. Methods: PubMed and Scopus were searched until June 2024 to identify relevant studies investigating the epidemiology, pathogenesis, and management of IBD and coexisting hereditary CRC syndromes. Results: Co-occurrence of IBD and hereditary CRC syndromes is exceptionally uncommon. Individuals with LS and IBD tend to develop CRC at a younger age than those without IBD, with patients with ulcerative colitis facing particularly elevated risks. The interaction between mismatch deficiency and chronic inflammation requires further investigation. [ABSTRACT FROM AUTHOR]

Introduction The influence of personality on field of study choice is comparable to that of cognitive skills. Additionally, personality traits seem linked with academic motivation, and engagement. Choosing the most suitable career is also related to students’ personal well-being and work success. Objectives To explore how personality traits are associated with the choice of university courses among Italian students. Methods A web-survey was spread on social networks between March and June 2020 through Google Forms. Eligibility criteria for inclusion were: 1) Being a university student between 18 and 35 years of age; 2) Attending a course in an Italian university; 3) Good comprehension of Italian language. On-line informed consent, socio-demographic, and career data were collected during the survey. Personality traits were assessed using the Big Five Inventory (BFI). We computed multinomial linear regressions to calculate potential associations between personality traits and university courses. Results Lower Conscientiousness, higher Neuroticism, and higher Openness to experience are associated with the attendance of Humanities compared with students of Health faculties. Higher Neuroticism traits are associated with the attendance of a scientific course compared with Health faculties. High Conscientiousness is significantly associated with the attendance of Law-related courses compared with Health courses. Non significant differences were detected in the other domains according to the big five personality model. Conclusions Our results suggest interesting associations between personality traits and educational choices. Future research may investigate this relationship in high-school students to implement appropriate strategies for better addressing students’ educational needs and career outcomes. Disclosure No significant relationships.

In the treat-to-target era, endoscopy has become the backbone of the assessment of remission, defined as mucosal healing, in inflammatory bowel disease (IBD) patients. Current recommendations indicate that endoscopic procedures should be performed with high-definition white-light endoscopy (HD-WLE), as it guarantees the best possible visualization of the mucosa. With respect to endoscopic surveillance, the preventive strategy for dysplasia and colorectal cancer (CRC) in long-standing IBD, is the use of dye-chromoendoscopy (DCE), which enhances the mucosal pattern of the colonic walls. DCE has been established as the gold standard for dysplasia detection and is at present incorporated in all international guidelines. Over the past years, novel technologies, such as high-definition endoscopic imaging, and optical and digital enhancement tools have revolutionized the quality and level of fine details of vascular and mucosal patterns. These endoscopic images have the ambition to reflect histological changes for suspected neoplastic lesions and inflammation or healing and are emerging as potential alternatives to DCE. Indeed, the comparison of DCE with high-definition imaging is an open issue that deserves further investigation. We aimed to examine and summarize the technical aspects and the current evidence on endoscopic technologies with a specific focus on the surveillance in IBD patients.

Background and aims: Inflammatory bowel diseases (IBD) are chronic disorders associated with a reduced quality of life, and patients often also suffer from psychiatric comorbidities. Overall, both mood and cognitive disorders are prevalent in chronic organic diseases, especially in the case of a strong immune component, such as rheumatoid arthritis, multiple sclerosis, and cancer. Divergent data regarding the true incidence and prevalence of mental disorders in patients with IBD are available. We aimed to review the current evidence on the topic and the burden of mental illness in IBD patients, the role of the brain–gut axis in their co-existence, and its implication in an integrated clinical management. Methods: PubMed was searched to identify relevant studies investigating the gut–brain interactions and the incidence and prevalence of psychiatric disorders, especially of depression, anxiety, and cognitive dysfunction in the IBD population. Results: Among IBD patients, there is a high prevalence of psychiatric comorbidities, especially of anxiety and depression. Approximately 20–30% of IBD patients are affected by mood disorders and/or present with anxiety symptoms. Furthermore, it has been observed that the prevalence of mental illnesses increases in patients with active intestinal disease. Psychiatric comorbidities continue to be under-diagnosed in IBD patients and remain an unresolved issue in the management of these patients. Conclusions: Psychiatric illnesses co-occurring in IBD patients deserve acknowledgment from IBD specialists. These comorbidities highly impact the management of IBD patients and should be studied as an adjunctive therapeutic target.