Relationship between social cognition and premorbid adjustment in psychosis: a systematic review.

This systematic review provides a comprehensive overview of the association between premorbid adjustment and social cognition in people with psychotic spectrum disorder. Obtaining evidence of this association will facilitate early detection and intervention before the onset of psychosis. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Literature searches were conducted in Scopus, PubMed and PsycINFO. Studies were eligible if they included patients with a psychotic disorder or at a high-risk state; social cognition and premorbid adjustment were measured; and the relationship between premorbid adjustment and social cognition was analysed. The authors independently extracted data from all included articles, and discrepancies were resolved through discussion. Of 229 studies identified, 23 met the inclusion criteria. Different methods of assessment were used to measure premorbid adjustment, such as the Premorbid Adjustment Scale or premorbid IQ, among others. Social cognition was assessed as a global measure or by domains using different instruments. A total of 16 articles found a relationship between social cognition (or its domains) and premorbid adjustment: general social cognition (n = 3); Theory of Mind (n = 12); Emotional Recognition and Social Knowledge (n = 1). This review shows evidence of a significant relationship between social cognition and premorbid adjustment, specifically between Theory of Mind and premorbid adjustment. Social cognition deficits may already appear in phases prior to the onset of psychosis, so an early individualized intervention with stimulating experiences in people with poor premorbid adjustment can be relevant for prevention. We recommend some future directions, such as carrying out longitudinal studies with people at high-risk of psychosis, a meta-analysis study, broadening the concept of premorbid adjustment, and a consensual assessment of social cognition and premorbid adjustment variables. PROSPERO registration number: CRD42022333886.

Recommendations on the use of azole antifungals in hematology-oncology patients.

The administration of antifungals for therapeutic and, especially, prophylactic purposes is virtually a constant in patients requiring hematology-oncology treatment. Any attempt to prevent or treat Aspergillus or Mucor infections requires the administration of some drugs in the azole group, which include voriconazole, posaconazole and isavuconazole, noted for their activity against these pathogens. One very relevant aspect is the potential risk of interaction when associated with one of the antineoplastic drugs used to treat hematologic tumors, with serious complications. In this regard, acalabrutinib, bortezomib, bosutinib, carfilzomib, cyclophosphamide, cyclosporine A, dasatinib, duvelisib, gilteritinib, glasdegib, ibrutinib, imatinib, nilotinib, ponatinib, prednisone, ruxolitinib, tacrolimus, all-transretinoic acid, arsenic trioxide, venetoclax, or any of the vinca alkaloids, are very clear examples of risk, in some cases because their clearance is reduced and in others because of increased risk of QTc prolongation, which is particularly evident when the drug of choice is voriconazole or posaconazole.

Influence of COVID-19 Pandemic on Colorectal Cancer Presentation, Management and Outcome during the COVID-19 Pandemic.

The aim of the study was to investigate whether the COVID-19 pandemic and related measures had an influence on colorectal cancer (CRC) presentation, management, and outcomes; it was a retrospective monocentric study. CRC patients undergoing surgery during the COVID-19 pandemic (1 March 2020-28 February 2022) (group B) were compared with patients operated on in the previous two years (1 March 2018-29 February 2020) in the same unit (group A). The primary outcome was to investigate whether there were differences in concern regarding the stage at presentation, as a whole and after dividing groups based on cancer location (right colon cancer, left colon cancer, rectal cancer). Secondary outcomes included differences in the number of patients admitted from emergency departments and emergency surgeries between periods, and differences in the postoperative outcomes. A subanalysis within the pandemic group was conducted on the same outcomes, dividing the aforementioned group based on pandemic trends. Two hundred and eighty (280) were operated on during the study period: 147 in group A and 133 in group B. Stage at presentation was similar between groups; however, the subgroups analysis showed that in the pandemic group, the number of early-stage left colon cancer occurrences almost halves, yet not significantly. Emergency department referral was more common in group B (p-value: 0.003); in group B, they also had longer operations and there was a more frequent use of ostomy. No differences in the number of postoperative complications nor in the postoperative outcomes were found. Patients with CRC were more frequently referred through the emergency department during the COVID-19 pandemic and left-sided cancers appear to be generally diagnosed at a more advanced stage. Postoperative outcomes showed that high specialized colorectal units can deliver standard high-level treatment under high-pressure external conditions.

A Multiplex PCR and DNA-Sequencing Workflow on Serum for the Diagnosis and Species Identification for Invasive Aspergillosis and Mucormycosis.

There has been significant increase in the use of molecular tools for the diagnosis of invasive aspergillosis (IA) and mucormycosis. However, their range of detection may be too limited as species diversity and coinfections are increasing. Here, we aimed to evaluate a molecular workflow based on a new multiplex PCR assay detecting the whole Aspergillus genus and the Mucorales order followed by a species-specific PCR or a DNA-sequencing approach for IA and/or mucormycosis diagnosis and species identification on serum. Performances of the MycoGENIE Aspergillus spp./Mucorales spp. duplex PCR kit were analyzed on a broad range of fungal strains and on sera from high-risk patients prospectively over a 12-month period. The kit allowed the detection of nine Aspergillus species and 10 Mucorales (eight genera) strains assessed. No cross-reactions between the two targets were observed. Sera from 744 patients were prospectively analyzed, including 35 IA, 16 mucormycosis, and four coinfections. Sensitivity varies from 85.7% (18/21) in probable/proven IA to 28.6% (4/14) in COVID-19-associated pulmonary aspergillosis. PCR-positive samples corresponded to 21 A. fumigatus, one A. flavus, and one A. nidulans infections. All the disseminated mucormycosis were positive in serum (14/14), including the four Aspergillus coinfections, but sensitivity fell to 33.3% (2/6) in localized forms. DNA sequencing allowed Mucorales identification in serum in 15 patients. Remarkably, the most frequent species identified was Rhizomucor pusillus (eight cases), whereas it is barely found in fungal culture. This molecular workflow is a promising approach to improve IA and mucormycosis diagnosis and epidemiology.

A compact evolved antenna for 5G communications.

Flexible and bendable electronics are gaining a lot of interest in these last years. In this scenario, compact antennas on flexible substrates represent a strategical technological step to pave the way to a new class of wearable systems. A crucial issue to overcome is represented by the poor radiation properties of compact antennas, especially in the case of flexible and thin substrates. In this paper, we propose an innovative design of a miniaturized evolved patch antenna whose radiation properties have been enhanced with a Split Ring Resonator (SRR) placed between the top and the ground plane. The antenna has been realized on a flexible and biocompatible substrate polyethylene naphthalate (PEN) of 250 µm by means of a new fabrication protocol that involves a three-layer 3D-inkjet printing and an alignment step. The antenna has been characterized in terms of the scattering parameter S11 and the radiation pattern showing a good agreement between simulations and measurements.

Cannabinoid CB2 Receptors Modulate Microglia Function and Amyloid Dynamics in a Mouse Model of Alzheimer's Disease.

The distribution and roles of the cannabinoid CB2 receptor in the CNS are still a matter of debate. Recent data suggest that, in addition to its presence in microglial cells, the CB2 receptor may be also expressed at low levels, yet biologically relevant, in other cell types such as neurons. It is accepted that the expression of CB2 receptors in the CNS is low under physiological conditions and is significantly elevated in chronic neuroinflammatory states associated with neurodegenerative diseases such as Alzheimer's disease. By using a novel mouse model (CB2 EGFP/f/f), we studied the distribution of cannabinoid CB2 receptors in the 5xFAD mouse model of Alzheimer's disease (by generating 5xFAD/CB2 EGFP/f/f mice) and explored the roles of CB2 receptors in microglial function. We used a novel selective and brain penetrant CB2 receptor agonist (RO6866945) as well as mice lacking the CB2 receptor (5xFAD/CB2 -/-) for these studies. We found that CB2 receptors are expressed in dystrophic neurite-associated microglia and that their modulation modifies the number and activity of microglial cells as well as the metabolism of the insoluble form of the amyloid peptide. These results support microglial CB2 receptors as potential targets for the development of amyloid-modulating therapies.

Potentiation of amyloid beta phagocytosis and amelioration of synaptic dysfunction upon FAAH deletion in a mouse model of Alzheimer's disease.

BACKGROUND: The complex pathophysiology of Alzheimer's disease (AD) hampers the development of effective treatments. Attempts to prevent neurodegeneration in AD have failed so far, highlighting the need for further clarification of the underlying cellular and molecular mechanisms. Neuroinflammation seems to play a crucial role in disease progression, although its specific contribution to AD pathogenesis remains elusive. We have previously shown that the modulation of the endocannabinoid system (ECS) renders beneficial effects in a context of amyloidosis, which triggers neuroinflammation. In the 5xFAD model, the genetic inactivation of the enzyme that degrades anandamide (AEA), the fatty acid amide hydrolase (FAAH), was associated with a significant amelioration of the memory deficit. METHODS: In this work, we use electrophysiology, flow cytometry and molecular analysis to evaluate the cellular and molecular mechanisms underlying the improvement associated to the increased endocannabinoid tone in the 5xFAD mouse- model. RESULTS: We demonstrate that the chronic enhancement of the endocannabinoid tone rescues hippocampal synaptic plasticity in the 5xFAD mouse model. At the CA3-CA1 synapse, both basal synaptic transmission and long-term potentiation (LTP) of synaptic transmission are normalized upon FAAH genetic inactivation, in a CB1 receptor (CB1R)- and TRPV1 receptor-independent manner. Dendritic spine density in CA1 pyramidal neurons, which is notably decreased in 6-month-old 5xFAD animals, is also restored. Importantly, we reveal that the expression of microglial factors linked to phagocytic activity, such as TREM2 and CTSD, and other factors related to amyloid beta clearance and involved in neuron-glia crosstalk, such as complement component C3 and complement receptor C3AR, are specifically upregulated in 5xFAD/FAAH-/- animals. CONCLUSION: In summary, our findings support the therapeutic potential of modulating, rather than suppressing, neuroinflammation in Alzheimer's disease. In our model, the long-term enhancement of the endocannabinoid tone triggered augmented microglial activation and amyloid beta phagocytosis, and a consequent reversal in the neuronal phenotype associated to the disease.

Acute appendicitis in elderly during Covid-19 pandemic.

PURPOSE: During the past months, the Italian Government has reduced the restrictions and access to hospitals. Since then, up to 40% of non-traumatic abdominal emergencies have had unusual delayed treatment. Given the rapidly evolving situation and the absence of evidence to support recommendations during the pandemic, it is useful to assess how the current situation is influencing the management of elderly with acute appendicitis. METHODS: Between February 2020 and December 2020, all patients older than 68 years old undergone appendectomy were included. Surgical approach, hospital stay, post-operative complications, radiology reports, and histologic examination were included in the retrospective analysis and compared with a same sample of the same period before the pandemic. RESULTS: Twenty-seven patients underwent appendectomy for acute appendicitis during the pandemic and 34 patients in the pre-outbreak period. Laparoscopic approach was completed in 51.8% of the cases, while conversion to laparotomy in 22.3% of patients and open procedure in the 25.9%, before the pandemic 73.6%, 14.7%, and 11.7%, respectively. During the pandemic, complicated appendicitis occurred in 59.3% of the cases (26.5% before the outbreak). One patient was treated for a pelvic abscess, while no minor complications were detected. No mortality rate was reported, with a mean hospital stay of 5.64 days during the outbreak and 4.21 days before the pandemic. CONCLUSION: Our data highlighted a partial delay in diagnosis in the elderly group, and an increase in complicated appendicitis also demonstrated by the need for conversion to laparotomy.

Description of the methodology for dosimetric quantification in treatments with 177Lu-DOTATATE. / Descripción de la metodología para la cuantificación dosimétrica en tratamientos con 177Lu-DOTATATE.

Implementation of dosimetry calculations in the daily practice of Nuclear Medicine Departments is, at this time, a controversial issue, partly due to the lack of a standardized methodology that is accepted by all interested parties (patients, nuclear medicine physicians and medical physicists). However, since the publication of RD 601/2019 there is a legal obligation to implement it, despite the fact that it is a complex and high resource consumption procedure. The aim of this article is to review the theoretical bases of in vivo dosimetry in treatments with 177Lu-DOTATATE. The exposed methodology is the one proposed by the MIRD Committee (Medical Internal Radiation Dose) of the SNMMI (Society of Nuclear Medicine & Molecular Imaging). According to this method, the absorbed dose is obtained as the product of 2factors: the time-integrated activity of the radiopharmaceutical present in a source region and a geometrical factor S. This approach, which a priori seems simple, in practice requires several SPECT/CT acquisitions, several measurements of the whole body activity and taking several blood samples, as well as hours of image processing and computation. The systematic implementation of these calculations, in all the patients we treat, will allow us to obtain homogeneous data to correlate the absorbed doses in the lesions with the biological effect of the treatment. The final purpose of the dosimetry calculations is to be able to maximize the therapeutic effect in the lesions, controlling the radiotoxicity in the organs at risk.

Challenges in quantification of photocatalytic NO2 abatement effectiveness under real world exposure conditions illustrated by a case study.

Health risks due to NO2 exposure commonly exceed acceptable levels in modern societies. Among the measures to reduce such risks, photocatalytic materials present a promising technology. However, while the pollutant remediation of such materials has been extensively validated in laboratory studies, the performance under real world environmental exposure conditions is still subject to controversy. Indeed, a comparison of available in-situ monitoring studies manifests non-conclusive and highly scattered results regarding the photocatalytic effectiveness observed. The reasons for this behaviour must be carefully explored in order to prevent non-efficient photocatalytic applications from being put into practice on a larger scale. This paper presents a comprehensive large-scale study for assessing the photocatalytic NO2 remediation by active pavements in a street of Madrid (Spain), comprising different in-situ monitoring techniques. The discussion is enriched by relating the obtained results to those of other large-scale studies. The discrepancies between these results may be traced back to different circumstances, among them the distance between the active pavement and the pollutant concentration sampling inlet, as well as to significant site-specific and time-dependent variations of pollutant concentrations and climatic parameters. Under due consideration of these influences, for materials with relatively high initial effectiveness, it was concluded that in most such applications, the average NO2 removal effectiveness, if evaluated at a typical inlet height of Air Quality Stations (3 m), will not exceed a value of 4% (averaged over a sufficiently large number of measurement points in the area of application and a sustained amount of time, i.e. several months). When considering more realistic human exposure conditions (lower heights and daytime), it might be justified to assume somewhat higher average effectiveness.

Sclerotherapy with 3% polidocanol foam for third- and fourth-degree hemorrhoids as "bridge treatment" during the COVID-19 pandemic in Italy.

PURPOSE: In Italy, colorectal surgery has been strongly affected with the vast majority (90%) of operations treating benign diseases, with an estimated overall 12-week cancellation rate of 72%. Little is known on how to best manage patients with benign diseases and the consequences this interruption of care will have in post-pandemic times. Proctologic diseases have social, psychological, and healthcare repercussions for their high incidence and great impact on the quality of life. METHODS: We decided to treated 10 urgent cases affected from III- and IV-degree hemorrhoids with 3% polidocanol foam in attempt to reduce hemorrhoidal symptoms while waiting for surgery so called "bridge treatment". RESULTS: During the follow-up no complications were occurred, and all patients had resolution of bleeding and pruritus with a mean VAS of 1 (range, 0-1). CONCLUSIONS: This treatment could reduce the bleeding that is the main symptom from which patients suffer and for which they underwent proctological evaluation and surgery. According to our preliminary experience in the impossibility of accessing the surgery during the COVID-19 pandemic, ST could be considered as the treatment of choice in those patients who are suffering from grade III- and IV-degree hemorrhoids while waiting for surgery.

PET/CT with 18F-Fluordesoxyglucose in patients with suspected endovascular prosthesis infection. / PET/TC con 18F-Fluordesoxiglucosa en pacientes con sospecha de infección de prótesis endovasculares.

OBJECTIVE: Infection of large vessel prostheses is a rare but critical complication. The aim of this work is to assess the impact of PET/CT with 18F-Fluordesoxyglucose (PET-FDG) on the diagnosis of infection in our environment. MATERIAL AND METHODS: Thirty-five patients (38 scans) were evaluated for suspected prosthetic infection. A qualitative analysis was performed taking into account the distribution of the radiopharmaceutical, categorizing the studies as positive or negative for infection. Those with focal or multifocal deposits along the vascular prosthesis were considered positive, and negative if a homogeneous and diffuse distribution over the whole prosthesis was observed, or a total absence of uptake. A semi-quantitative analysis was performed using SUVmax and average SUV values, and a metabolic index was calculated (SUVmax of the graft / average SUV of the normal vascular pool). RESULTS: The PET-FDG study was positive in 20 patients, with a diagnostic accuracy of 84%. The 38 PET-FDG scans performed showed positive capture patterns (focal in 6, multifocal in 15, diffuse in 4) and negative pattern in the remaining 13. The sensitivity, specificity, positive and negative predictive values obtained for the PET-FDG were 95%, 89%, 90% and 94%, and for the AngioTC study 50%, 73%, 73% and 50%, respectively. The area values under the ROC curve were as follows: for the AngioTC 0.642 (not significant), and for the SUVmax values of 0.925 (p<0.005), average SUV of 0.922 (p<0.005) and for the metabolic index of 0.917 (p<0.005). CONCLUSIONS: The PET-FDG proves to be a tool with high diagnostic accuracy in the infection of vascular prosthesis, both visual analysis according to patterns and semi-quantitative.

NOx removal efficiency of urban photocatalytic pavements at pilot scale.

Photocatalytic technology implemented in construction materials is a promising solution to contribute to alleviate air quality issues found in big cities. Photocatalysis has been proved able to mineralise most harmful contaminants. However, important problems associated with monitoring the efficiency of these solutions under real conditions still remain, including the lack of affordable analytical tools to measure NOx concentrations with enough accuracy. In this work, two pilot scale demonstration platforms were built at two different locations to assess the photocatalytic NOX removal efficiency of ten selected materials exposed outdoors for AQmesh low-cost sensor PODs were used to measure ground-level to measure NO and NO2 concentrations during nearly one year. The pollutant removal efficiency of the materials was then calculated based on a comparison with simultaneously concentration measurements carried-out on reference, non-active materials. It was found that the NO2 removal efficiency presented large variations across the seasons, with maxima during the warmer months, while NO efficiencies were comparatively steadier. Statistical analysis delivered evidence that the efficiencies significantly depend on different meteorological variables (irradiance and relative humidity) besides NO, NO2 ambient concentrations. Lower efficiencies were observed for higher concentration levels and vice versa. The influence of water vapour could be related to two different effects: a short-term contribution by the instantaneous air humidity and a long-term component associated with the hygroscopic state of the material. The contribution of wind to the pollutant removal efficiencies was principally related to the humidity of air masses moving above the location and to the advection of pollutants from specific emission sources.

Effect of the Ages of Parasitoid and Host Eggs on Telenomus podisi (Hymenoptera: Platygastridae) Parasitism.

This study investigates the influence of parasitoid age and egg age of the hosts Euschistus heros (Fabricius) and Dichelops melacanthus (Dallas) on parasitism of Telenomus podisi Ashmead. Six separate bioassays were conducted: parasitism on eggs of E. heros (bioassay 1) and D. melacanthus (bioassay 2) by T. podisi females of different age (1, 5, and 10 days old); parasitism by T. podisi on eggs of different age (1, 2, 3, 4, and 5 days of embryonic development) of the hosts E. heros (bioassay 3) and D. melacanthus (bioassay 4); preference of T. podisi females for eggs at different embryonic developmental stages (eggs of 1, 2, 3, 4, and 5 days) of the hosts E. heros (bioassay 5) and D. melacanthus (bioassay 6). The age of T. podisi females and their hosts affected parasitism on both E. heros and D. melacanthus eggs. Overall, the parasitism rate was higher in older than younger parasitoids, independent of the tested host species, and host eggs between 1 and 3 days old were similarly parasitized. Thus, in T. podisi mass rearing facilities, it is recommended to use older adults (5 to 10 days old) as mother wasps to increase parasitism on the offered eggs. In addition, when hosts are completely absent in the field, or climatic conditions are unfavorable for release, mass-reared adults can be kept in the laboratory (25°C) for up to 10 days for later release in the field without any impairment of their subsequent parasitism performance.

Role of interleukin 1-beta in the inflammatory response in a fatty acid amide hydrolase-knockout mouse model of Alzheimer's disease.

The search for novel therapies for the treatment of Alzheimer's disease is an urgent need, due to the current paucity of available pharmacological tools and the recent failures obtained in clinical trials. Among other strategies, the modulation of amyloid-triggered neuroinflammation by the endocannabinoid system seems of relevance. Previous data indicate that the enhancement of the endocannabinoid tone through the inhibition of the enzymes responsible for the degradation of their main endogenous ligands may render beneficial effects. Based on previously reported data, in which we described a paradoxical effect of the genetic deletion of the fatty acid amide hydrolase, we here aimed to expand our knowledge on the role of the endocannabinoid system in the context of Alzheimer's disease. To that end, we inhibited the production of interleukin-1ß, one of the main inflammatory cytokines involved in the neuroinflammation triggered by amyloid peptides, in a transgenic mouse model of this disease by using minocycline, a drug known to impair the synthesis of this cytokine. Our data suggest that interleukin-1ß may be instrumental in order to achieve the beneficial effects derived of fatty acid amide hydrolase genetic inactivation. This could be appreciated at the molecular (cytokine expression, amyloid production, plaque deposition) as well as behavioral levels (memory impairment). We here describe a previously unknown link between the endocannabinoid system and interleukin-1ß in the context of Alzheimer's disease that open new possibilities for the development of novel therapeutics.

Cannabinoid CB2 receptors in the mouse brain: relevance for Alzheimer's disease.

BACKGROUND: Because of their low levels of expression and the inadequacy of current research tools, CB2 cannabinoid receptors (CB2R) have been difficult to study, particularly in the brain. This receptor is especially relevant in the context of neuroinflammation, so novel tools are needed to unveil its pathophysiological role(s). METHODS: We have generated a transgenic mouse model in which the expression of enhanced green fluorescent protein (EGFP) is under the control of the cnr2 gene promoter through the insertion of an Internal Ribosomal Entry Site followed by the EGFP coding region immediately 3' of the cnr2 gene and crossed these mice with mice expressing five familial Alzheimer's disease (AD) mutations (5xFAD). RESULTS: Expression of EGFP in control mice was below the level of detection in all regions of the central nervous system (CNS) that we examined. CB2R-dependent-EGFP expression was detected in the CNS of 3-month-old AD mice in areas of intense inflammation and amyloid deposition; expression was coincident with the appearance of plaques in the cortex, hippocampus, brain stem, and thalamus. The expression of EGFP increased as a function of plaque formation and subsequent microgliosis and was restricted to microglial cells located in close proximity to neuritic plaques. AD mice with CB2R deletion exhibited decreased neuritic plaques with no changes in IL1ß expression. CONCLUSIONS: Using a novel reporter mouse line, we found no evidence for CB2R expression in the healthy CNS but clear up-regulation in the context of amyloid-triggered neuroinflammation. Data from CB2R null mice indicate that they play a complex role in the response to plaque formation.

Amplitude and phase modulation in microwave ring resonators by doped CVD graphene.

In this paper, we numerically and experimentally demonstrate how to modulate the amplitude and phase of a microwave ring resonator by means of few-layers chemical vapour deposition graphene. In particular, both numerical and experimental results show a modulation of about 10 dB and a 90 degrees-shift (quadrature phase shift) when the graphene sheet-resistance is varied. These findings prove once again that graphene could be efficiently exploited for the dynamically tuning and modulation of microwave devices fostering the realization of (i) innovative beam-steering and beam-forming systems and (ii) graphene-based sensors.

Transperineal rectocele repair with biomesh: updating of a tertiary refer center prospective study.

PURPOSE: Symptomatic rectocele results in obstructed defecation and constipation. Surgical repair may provide symptomatic relief. A variety of surgical procedures have been used in the rectocele repair to enhance anatomical and functional results and to improve long-term outcomes. METHODS: In this prospective study, we treated 25 selected women suffering from simple symptomatic rectocele with transperineal repair using porcine dermal acellular collagen matrix Biomesh (Permacol®). Watson score and SF-36 questionnaire were used to evaluate postoperative outcomes and quality of life. RESULTS: Follow-up ranged from 12 to 24 months, the mean total Watson score was significantly lower than the preoperative score (P < 0.001), and every patient has improved functional outcomes. There were no major intraoperative or postoperative complications. Two cases of urinary infection and 4 patients delayed wound healing were reported. Those patients who were sexually active prior to surgery have not experienced problems with sexual function or dyspareunia. CONCLUSIONS: Despite lack of comparative study in literature, rectocele repair with Permacol® by the transperineal approach seems an effective and safe procedure that avoids some of the complications associated with synthetic mesh use.