The Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colonproctologia) guidelines for the management of acute and chronic hemorrhoidal disease.

The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (Società Italiana Unitaria di Colon-Proctologia, SIUCP) on the diagnosis and management of hemorrhoidal disease, with the goal of guiding physicians in the choice of the best treatment option. A panel of experts was charged by the Board of the SIUCP to develop key questions on the main topics related to the management of hemorrhoidal disease and to perform an accurate and comprehensive literature search on each topic, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in multiple rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to PICO (patients, intervention, comparison, and outcomes) criteria, and the statements were developed adopting the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. In cases of grade 1 hemorrhoidal prolapse, outpatient procedures including hemorrhoidal laser procedure and sclerotherapy may be considered the preferred surgical options. For grade 2 prolapse, nonexcisional procedures including outpatient treatments, hemorrhoidal artery ligation and mucopexy, laser hemorrhoidoplasty, the Rafaelo procedure, and stapled hemorrhoidopexy may represent the first-line treatment options, whereas excisional surgery may be considered in selected cases. In cases of grades 3 and 4, stapled hemorrhoidopexy and hemorrhoidectomy may represent the most effective procedures, even if, in the expert panel opinion, stapled hemorrhoidopexy represents the gold-standard treatment for grade 3 hemorrhoidal prolapse.

Nociception level index variations in ICU: curarized vs non-curarized patients - a pilot study.

PURPOSE: Pain is a major physiological stressor that can worsen critical medical conditions in many ways. Currently, there is no reliable monitoring tool which is available for pain monitoring in the deeply sedated ± curarized critically ill patients. This study aims to assess the effectiveness of the multiparameter nociception index (NOL®) in the critical care setting. We compared NOL with traditionally used neurovegetative signs and examined its correlation with sedation depth measured by bispectral index (BIS®) electroencephalographic (EEG) monitoring. METHODS: This retrospective monocentric cohort study was conducted in a general intensive care unit, including patients who required moderate-to-deep levels of sedation with or without continuous neuromuscular blockade. The performance of NOL was evaluated both in the entire studied population, as well as in two subgroups: curarized and non-curarized patients. RESULTS: NOL demonstrated greater accuracy than all other indicators in pain detection in the overall population. In the non-curare subgroup, all indices correctly recognized painful stimulation, while in the patients subjected to neuromuscular blocking agent's infusion, only NOL properly identified nociception. In the former group, EEG's relation to nociception was on the border of statistical significance, whereas in the latter BIS showed no correlation with NOL. CONCLUSION: NOL emerges as a promising device for pain assessment in the critical care setting and exhibits its best performance precisely in the clinical context where reliable pain assessment methods are most lacking. Furthermore, our research confirms the distinction between sedation and analgesia, highlighting the necessity for distinct monitoring instruments to accurately assess them.

Psychometric properties of the Quiet Ego Scale (iQES) within the Italian cultural context.

Introduction: The quiet ego indicates a more compassionate conception of self-identity that integrates others into the self by lowering the intensity of the ego and enhancing the awareness of the present moment. The Quiet Ego Scale (QES) is a 14-item self-report measure of quiet ego, and it is composed of the following four psychological domains: detached awareness, inclusive identity, perspective taking, and growth. The present study aimed to test the psychometric properties of the Quiet Ego Scale within the Italian cultural context (iQES). Methods: A total of 160 Italian university students aged between 20 and 42 years, with a mean age of 22.85 years (SD = 3.41), completed the measures of the iQES and of other psychological dimensions. The psychometrics properties of iQES were assessed based on its internal consistency, test-retest reliability, and construct validity through comparisons with other correlated psychological measures. Results: Analyses confirmed the psychometrics properties of iQES. As in previous studies, the quiet ego was positively associated with the indicators of resilience (p < 0.01), happiness (p < 0.05), self-esteem (p < 0.01), and psychological wellbeing (p < 0.01). Discussion: The study discussed the possible uses of the iQES in the field of mental health, specifically focusing on improving adherence to psychological therapies and enhancing psychological and social well-being. The results indicated strong psychometric properties of the iQES in measuring the quiet ego construct. Our findings enrich the literature on the validity of the iQES and highlight the multidimensional nature of the quiet ego construct.

Plant Physiological Analysis to Overcome Limitations to Plant Phenotyping.

Plant physiological status is the interaction between the plant genome and the prevailing growth conditions. Accurate characterization of plant physiology is, therefore, fundamental to effective plant phenotyping studies; particularly those focused on identifying traits associated with improved yield, lower input requirements, and climate resilience. Here, we outline the approaches used to assess plant physiology and how these techniques of direct empirical observations of processes such as photosynthetic CO2 assimilation, stomatal conductance, photosystem II electron transport, or the effectiveness of protective energy dissipation mechanisms are unsuited to high-throughput phenotyping applications. Novel optical sensors, remote/proximal sensing (multi- and hyperspectral reflectance, infrared thermography, sun-induced fluorescence), LiDAR, and automated analyses of below-ground development offer the possibility to infer plant physiological status and growth. However, there are limitations to such 'indirect' approaches to gauging plant physiology. These methodologies that are appropriate for the rapid high temporal screening of a number of crop varieties over a wide spatial scale do still require 'calibration' or 'validation' with direct empirical measurement of plant physiological status. The use of deep-learning and artificial intelligence approaches may enable the effective synthesis of large multivariate datasets to more accurately quantify physiological characters rapidly in high numbers of replicate plants. Advances in automated data collection and subsequent data processing represent an opportunity for plant phenotyping efforts to fully integrate fundamental physiological data into vital efforts to ensure food and agro-economic sustainability.

The Italian Unitary Society of Colon-proctology (SIUCP: Società Italiana Unitaria di Colonproctologia) guidelines for the management of anal fissure.

INTRODUCTION: The aim of these evidence-based guidelines is to present a consensus position from members of the Italian Unitary Society of Colon-Proctology (SIUCP: Società Italiana Unitaria di Colon-Proctologia) on the diagnosis and management of anal fissure, with the purpose to guide every physician in the choice of the best treatment option, according with the available literature. METHODS: A panel of experts was designed and charged by the Board of the SIUCP to develop key-questions on the main topics covering the management of anal fissure and to performe an accurate search on each topic in different databanks, in order to provide evidence-based answers to the questions and to summarize them in statements. All the clinical questions were discussed by the expert panel in different rounds through the Delphi approach and, for each statement, a consensus among the experts was reached. The questions were created according to the PICO criteria, and the statements developed adopting the GRADE methodology. CONCLUSIONS: In patients with acute anal fissure the medical therapy with dietary and behavioral norms is indicated. In the chronic phase of disease, the conservative treatment with topical 0.3% nifedipine plus 1.5% lidocaine or nitrates may represent the first-line therapy, eventually associated with ointments with film-forming, anti-inflammatory and healing properties such as Propionibacterium extract gel. In case of first-line treatment failure, the surgical strategy (internal sphincterotomy or fissurectomy with flap), may be guided by the clinical findings, eventually supported by endoanal ultrasound and anal manometry.

Characterization of artisanal saffron ricotta cheese produced in Sicily: Physicochemical, microbiological, sensory, and antioxidant characteristics.

The present study aims to characterize the artisanal saffron ricotta cheese produced from the whey of Piacentinu Ennese protected designation of origin (PDO) cheesemaking, including via technological parameters detected during the production process and by assessment of the main physicochemical, microbial, sensory, and antioxidant characteristics. A survey on the manufacture process of saffron and control ricotta cheese was conducted on 3 farms, located in the production area of the Piacentinu Ennese PDO cheese. pH and temperature followed a specific behavior, characterized by an inverse trend where pH decreased and temperature increased, playing an important role in the production process. All the analytical parameters were affected by the presence of saffron, also showing high between-farm variability, with significantly higher total solids and fat contents in saffron ricotta cheese compared with the control cheese (28.68% vs. 23.86%, and 19.83% vs. 14.22%, respectively). Microbial analysis showed significantly lower values in saffron compared with control ricotta cheese, for coliforms (1.51 vs. 1.91 log10 cfu/g, respectively), yeasts (1.55 vs. 2.06 log10 cfu/g, respectively), and molds (1.03 vs. 1.30 log10 cfu/g, respectively), denoting potential reduction of microbial growth asserted by saffron. Escherichia coli concentration (1.26 log10 cfu/g) in saffron ricotta cheese was in accordance with EU Regulation 2073/2005 and then safe for consumption. The presence of saffron influenced all sensory attributes, particularly color and aroma. Interestingly, high total antioxidant activity was found in saffron ricotta cheese (372 µC) compared with the control cheese. Thus, this artisanal dairy production could be considered a suitable option for functional foods with antimicrobial properties, due to the presence of saffron, which may contribute to extend the shelf life of the product. Further studies need to focus on the bioactive compounds that affect the antioxidant proprieties, characterization of the microbiota of saffron ricotta cheese, and evaluation of consumers' acceptance and perception as well as market demand.

The 'microbiome counterattack': Insights on the soil and root-associated microbiome in diverse chickpea and lentil genotypes after an erratic rainfall event.

Legumes maintain soil fertility thanks to their associated microbiota but are threatened by climate change that causes soil microbial community structural and functional modifications. The core microbiome associated with different chickpea and lentil genotypes was described after an unexpected climatic event. Results showed that chickpea and lentil bulk soil microbiomes varied significantly between two sampling time points, the first immediately after the rainfall and the second 2 weeks later. Rhizobia were associated with the soil of the more productive chickpea genotypes in terms of flower and fruit number. The root-associated bacteria and fungi were surveyed in lentil genotypes, considering that several parcels showed disease symptoms. The metabarcoding analysis revealed that reads related to fungal pathogens were significantly associated with one lentil genotype. A lentil core prokaryotic community common to all genotypes was identified as well as a genotype-specific one. A higher number of specific bacterial taxa and an enhanced tolerance to fungal diseases characterized a lentil landrace compared to the commercial varieties. This outcome supported the hypothesis that locally adapted landraces might have a high recruiting efficiency of beneficial soil microbes.

Metabolic Background, Not Photosynthetic Physiology, Determines Drought and Drought Recovery Responses in C3 and C2 Moricandias.

Distinct photosynthetic physiologies are found within the Moricandia genus, both C3-type and C2-type representatives being known. As C2-physiology is an adaptation to drier environments, a study of physiology, biochemistry and transcriptomics was conducted to investigate whether plants with C2-physiology are more tolerant of low water availability and recover better from drought. Our data on Moricandia moricandioides (Mmo, C3), M. arvensis (Mav, C2) and M. suffruticosa (Msu, C2) show that C3 and C2-type Moricandias are metabolically distinct under all conditions tested (well-watered, severe drought, early drought recovery). Photosynthetic activity was found to be largely dependent upon the stomatal opening. The C2-type M. arvensis was able to secure 25-50% of photosynthesis under severe drought as compared to the C3-type M. moricandioides. Nevertheless, the C2-physiology does not seem to play a central role in M. arvensis drought responses and drought recovery. Instead, our biochemical data indicated metabolic differences in carbon and redox-related metabolism under the examined conditions. The cell wall dynamics and glucosinolate metabolism regulations were found to be major discriminators between M. arvensis and M. moricandioides at the transcription level.

The functional significance of the stomatal size to density relationship: Interaction with atmospheric [CO2] and role in plant physiological behaviour.

The limits for stomatal conductance are set by stomatal size (SS) and density (SD). An inverse relationship between SS and SD has been observed in fossil and living plants. This has led to hypotheses proposing that the ratio of SS to SD influences the diffusion pathway for CO2 and degree of physiological stomatal control. However, conclusive evidence supportive of a functional role of the SS-SD relationship is not evident, and patterns in SS-SD may simply reflect geometric constraints in stomatal spacing over a leaf surface. We examine published and new data to investigate the potential functional significance of the relationship between SS and SD to atmospheric [CO2] in multiple generation adaptive responses and short-term acclamatory adjustment of stomatal morphology. Consistent patterns in SS and SD were not evident in fossil and living plants adapted to high [CO2] over many generations. However, evolutionary adaptation to [CO2] strongly affected SS and SD responses to elevated [CO2], with plants adapted to the 'low' [CO2] of the past 10 million years (Myr) showing adjustment of SS-SD, while members of the same species adapted to 'high' [CO2] showed no response. This may suggest that SS and SD responses to future [CO2] will likely constrain the stimulatory effect of 'CO2-fertilisation' on photosynthesis. Angiosperms generally possessed higher densities of smaller stomata that corresponded to a greater degree of physiological stomatal control consistent with selective pressures induced by declining [CO2] over the past 90 Myr. Atmospheric [CO2] has likely shaped stomatal size and density relationships alongside the interaction with stomatal physiological behaviour. The rate and predicted extent of future increases in [CO2] will have profound impacts on the selective pressures shaping SS and SD. Understanding the trade-offs involved in SS-SD and the interaction with [CO2], will be central to the development of more productive climate resilient crops.

The evolution of diffusive and biochemical capacities for photosynthesis was predominantly shaped by [CO2] with a smaller contribution from [O2].

The atmospheric concentration of carbon dioxide ([CO2]) and oxygen ([O2]) directly influence rates of photosynthesis (PN) and photorespiration (RPR) through the enzyme ribulose-1,5-bisphosphate carboxylase/oxygenase (RubisCO). Levels of [CO2] and [O2] have varied over Earth history affecting rates of both CO2 uptake and loss, alongside associated transpirative water-loss. The availability of CO2 has likely acted as a stronger selective pressure than [O2] due to the greater specificity of RubisCO for CO2. The role of [O2], and the interaction of [O2] and [CO2], in plant evolutionary history is less understood. We exposed twelve phylogenetically diverse species to combinations of sub-ambient, ambient and super-ambient [O2] and [CO2] to examine the biochemical and diffusive components of PN and the possible role of [O2] as a selective pressure. Photosynthesis, photosynthetic capacity and stomatal, mesophyll and total conductance to CO2 were higher in the derived eudicot and monocot angiosperms than the more basal ferns, gymnosperms and basal angiosperms which originated in atmospheres characterised by higher CO2:O2 ratios. The ratio of RPR:PN was lower in the monocots, consistent with greater carboxylation capacity and higher stomatal and mesophyll conductance making easier CO2 delivery to chloroplasts. The effect of [O2] and [CO2] on PN/RPR was less evident in more derived species with a higher conductance to CO2. The effect of [O2] was less apparent at high [CO2], suggesting that atmospheric [O2] may only have exerted a strong selective pressure on plant photosynthetic processes during periods characterised by low atmospheric CO2:O2 ratios. Current rising [CO2] will predominantly enhance PN rates in species with low diffusive conductance to CO2.