Technical aspects of the Koff procedure (urethral mobilization) in anterior hypospadias.

INTRODUCTION: In our center the level of division of the corpus spongiosum as the determinant to classifying hypospadias. The hypospadias with a distal division is less severe and they present a little curvature. MATERIAL AND METHODS: We present a case of distal hypospadias corrected by Koff technique and we showed our tricks for avoiding curvature. RESULTS: In this selected case a Koff procedure are preferred because it has the main advantage of exicing the dysplastic tissues and avoiding a urethroplasty using nonurethral tissues. Late penile curvature is a source of concerns for some, but in our experience no significant curvature was found at follow up. DISCUSSION: We believe that some tricks, showed in our video, are necessary to avoid iatrogenic curvature and to obtain a good cosmetic result. CONCLUSIONS: Koff technique is a good technique for hypospadias with distal division of corpus spongiosum, without significant curvature at follow up.

A Reusable Thermochromic Phantom for Testing High Intensity Focused Ultrasound Technologies.

High Intensity Focused Ultrasound (HIFU) surgery is a promising technology for the treatment of several pathologies, including cancer. Testing is a fundamental step for verifying treatment efficacy and safety. Ex-vivo tissues represent the most common solution for replicating the properties of human tissues in the HIFU operative scenario. However, they constitute an avoidable waste of resources. Thus, tissue mimicking phantoms have been investigated as a more sustainable and reliable alternative. In this scenario, we proposed a reusable silicone-based thermochromic phantom. It is cost-effective and can be rapidly fabricated. The acoustic, mechanical, and thermal characterization of the phantom are reported. The phantom usability was evaluated with a HIFU robotic platform. 18 different working conditions were tested by varying both sonication power and duration. Temperature and simulated lesions' size were quantified for all testing conditions. An accordance between temperature and lesion dimension trend over time was found. The proposed phantom results a valid alternative to ex-vivo tissues, especially in the early stages of developing novel HIFU treatment paradigms.

Cervical re-injection of indocyanine green to improve sentinel lymph node detection in endometrial cancer.

OBJECTIVES: To evaluate the role of cervical re-injection of indocyanine green (ICG) to increase the detection rate of sentinel lymph node (SLN) in patients with endometrial cancer (EC) who underwent robotic-assisted surgical staging. METHODS: We retrospectively identified consecutive EC patients undergoing robotic-assisted staging with SLN biopsy at our Institution between June 2016 and April 2020. Patients were excluded if they had open abdominal surgical approach, neoadjuvant chemotherapy, and advanced stage [International Federation of Gynecology and Obstetrics (FIGO) stage III-IV] at diagnosis. According to our SLN protocol, in case of either unilateral or no SLN detection, we performed an ipsilateral or bilateral cervical re-injection of ICG. RESULTS: In total, 251 patients meeting inclusion criteria were included in the analysis. At first injection, bilateral detection was achieved in 184 (73.3%), unilateral detection in 57 (22.7%), and no detection in 10 (4.0%) patients. Cervical re-injection was performed in 51 of 67 patients with failed bilateral mapping. After cervical re-injection, bilateral detection rate increased to 94.5% (222/235), while unilateral and no detection were 5.1% (12/235) and 0.4% (1/235), respectively. CONCLUSIONS: Our results suggest that cervical re-injection of ICG, in case of failed bilateral mapping of SLN, brings about a significant improvement in SLN detection rates, therefore reducing the number of side-specific required lymphadenectomies.

Pen sensor made with silver nanoparticles decorating graphite-polyurethane electrodes to detect bisphenol-A in tap and river water samples.

Rapid, on-site detection of emerging pollutants is critical for monitoring health threats and the environment, especially if performed through autonomous systems. In this paper, we report on a new design of a complete electrochemical system whose working (WE), auxiliary (AE) and reference (RE) electrodes were obtained on a pen (PEN Sensor) made with graphite:polyurethane (GPUE). Working electrodes were decorated with spherical, ca. 200 nm silver nanoparticles (AgNPs) reduced on graphite using the polyol method. Differential pulse voltammetry (DPV) was used to detect bisphenol-A (BPA) in a linear range from 2.5 to 15 µmol L-1 with detection limit of 0.24 µmol L-1. The PEN Sensor could also detect bisphenol-A in tap and river water samples, with satisfactory reproducibility and repeatability, while common interferents did not affect electrooxidation of bisphenol-A. The high sensitivity and rapid detection are suitable for real-time analysis and in loco monitoring of emerging pollutants. With their robustness and versatility, PEN Sensors such as those fabricated here may be integrated into futuristic smart robotic systems.

The NATO project: nanoparticle-based countermeasures for microgravity-induced osteoporosis.

Recent advances in nanotechnology applied to medicine and regenerative medicine have an enormous and unexploited potential for future space and terrestrial medical applications. The Nanoparticles and Osteoporosis (NATO) project aimed to develop innovative countermeasures for secondary osteoporosis affecting astronauts after prolonged periods in space microgravity. Calcium- and Strontium-containing hydroxyapatite nanoparticles (nCa-HAP and nSr-HAP, respectively) were previously developed and chemically characterized. This study constitutes the first investigation of the effect of the exogenous addition of nCa-HAP and nSr-HAP on bone remodeling in gravity (1 g), Random Positioning Machine (RPM) and onboard International Space Station (ISS) using human bone marrow mesenchymal stem cells (hBMMSCs). In 1 g conditions, nSr-HAP accelerated and improved the commitment of cells to differentiate towards osteoblasts, as shown by the augmented alkaline phosphatase (ALP) activity and the up-regulation of the expression of bone marker genes, supporting the increased extracellular bone matrix deposition and mineralization. The nSr-HAP treatment exerted a protective effect on the microgravity-induced reduction of ALP activity in RPM samples, and a promoting effect on the deposition of hydroxyapatite crystals in either ISS or 1 g samples. The results indicate the exogenous addition of nSr-HAP could be potentially used to deliver Sr to bone tissue and promote its regeneration, as component of bone substitute synthetic materials and additive for pharmaceutical preparation or food supplementary for systemic distribution.

Excitation Mechanism of Low-n Edge Harmonic Oscillations in Edge Localized Mode-Free, High Performance, Tokamak Plasmas.

The excitation mechanism for low-n edge harmonic oscillations in quiescent H-mode regimes is identified analytically. We show that the combined effect of diamagnetic and poloidal magnetohydrodynamic flows, with the constraint of a Doppler-like effect of the ion flow, leads to the stabilization of short wavelength modes, allowing low-n perturbation to grow. The analysis, performed in tokamak toroidal geometry, includes the effects of large edge pressure gradients, associated with the local flattening of the safety factor and diamagnetic flows, sheared parallel and E×B rotation, and a vacuum region between plasma and the ideal metallic wall. The separatrix also is modeled analytically.

Prediction of short-term surgical complications in women undergoing pelvic exenteration for gynecological malignancies.

OBJECTIVE: Pelvic exenteration (PE) is an extensive surgery associated with high rates of postoperative morbidity and mortality. The absence of well-defined preoperative selection criteria to identify patients eligible for PE prompted the assessment of pre-operative predictors of 30-day major surgical complications. METHODS: Demographics and surgical characteristics of patients undergoing PE for gynecologic cancer in a single institution between 01/2004-12/2016 were reviewed. Postoperative complications within 30 days following surgery were graded using the Accordion grading system. Logistic regression was used to analyze potential risk factors for severe postoperative complications. RESULTS: A total of 138 patients were included in the cohort. Forty-five patients underwent total PE, 52 anterior PE, and 41 posterior PE. Among the 137 patients with follow-up, a severe postoperative complication was experienced by 37 patients (27.0%) and 3 patients (2.2%) experienced death within 90 days. The most frequent grade 3 complications were complications of urinary reconstruction (n = 15), wound dehiscence (n = 9), and abdominal abscess requiring intervention with drain or return to the operating room (n = 6). On multivariable analysis, independent predictors of severe postoperative complications were anterior or total PE (adjusted odds ratio (aOR): 11.66, 95% CI 2.56-53.18), pre-operative hemoglobin ≤10 mg/dl (aOR 2.70, 95% CI 1.02-7.14) and presence of 3+ comorbidities (aOR: 2.76, 95% CI 1.07-7.10). CONCLUSIONS: Major complications after exenteration are common. Surgical complexity and patient selection play a considerable role in predicting complications. These data can be used to better risk stratify patients undergoing PE.

A Pilot Study for a Quantitative Evaluation of Acoustic Coupling in US-guided Focused Ultrasound Surgery.

In Ultrasound-guided High Intensity Focused Ultrasound (USgHIFU) surgery, the verification of the acoustic coupling correctness between the HIFU transducer and the patient's body is a fundamental step for an efficient and safe therapy. Nowadays, clinicians perform this check by qualitative inspecting Ultrasound images. The aim of this study is the introduction of an objective index to quantitively evaluate the coupling on the base of the radiofrequency echo signals acquired during a low-energy HIFU shot. The experimental session involved a tissue mimicking phantom and a robotic system composed by a HIFU therapeutic transducer and a 2D confocal Ultrasound probe. 15 different coupling conditions between the phantom and the transducer were tested: in each of them, the maximum absolute value of the Fourier Transform of the echo signals was computed and employed to determine an Acoustic Coupling (AC) coefficient.This metrics showed a sigmoidal trend between AC coefficient and coupling increase. This curve can be employed as a calibration tool to quantitatively assess the correctness of the therapeutic set-up before starting the HIFU treatment.

Mesenchymal stem cells encapsulated into biomimetic hydrogel scaffold gradually release CCL2 chemokine in situ preserving cytoarchitecture and promoting functional recovery in spinal cord injury.

Spinal cord injury (SCI) is an acute neurodegenerative disorder caused by traumatic damage of the spinal cord. The neuropathological evolution of the primary trauma involves multifactorial processes that exacerbate the pathology, worsening the neurodegeneration and limiting neuroregeneration. This complexity suggests that multi-therapeutic approaches, rather than any single treatment, might be more effective. Encouraging preclinical results indicate that stem cell-based treatments may improve the disease outcome due to their multi-therapeutic ability. Mesenchymal Stem Cells (MSCs) are currently considered one of the most promising approaches. Significant improvement in the behavioral outcome after MSC treatment sustained by hydrogel has been demonstrated. However, it is still not known how hydrogel contribute to the delivery of factors secreted from MSCs and what factors are released in situ. Among different mediators secreted by MSCs after seeding into hydrogel, we have found CCL2 chemokine, which could account for the neuroprotective mechanisms of these cells. CCL2 secreted from human MSCs is delivered efficaciously in the lesioned spinal cord acting not only on recruitment of macrophages, but driving also their conversion to an M2 neuroprotective phenotype. Surprisingly, human CCL2 delivered also plays a key role in preventing motor neuron degeneration in vitro and after spinal cord trauma in vivo, with a significant improvement of the motor performance of the rodent SCI models.

Skills improvement after observation or direct practice of a simulated laparoscopic intervention.

BACKGROUND: Laparoscopic skills are more and more often being learned on simulators. PURPOSE: To assess the respective roles of observation and direct practice in the retention of laparoscopic procedural skills. BASIC PROCEDURES: Twelve surgical residents were included in a two-session laparoscopic training course. During the first session (S1), one participant completed a cholecystectomy on the Simbionix LAPMentor™ and then observed his colleague carrying out a total hysterectomy and vice versa. During the second session (S2), each participant completed both interventions. Skills evaluation was assessed using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale and LAPMentor™ metrics. MAIN FINDINGS: Mean OSATS score during the first session was 19.3±5.1, and increased by 37% in the group of former observer students (S2O, P=0.003), and by 54% in the group of former practising students (S2A, P=0.001). Self- and peer-grading results were concordant with the supervisor's evaluation. Detailed analysis of LAPMentor™ metrics showed a trend toward more parameters being improved in group S2A as compared to group S2O on both interventions. The most significant improvements concerned the time of completion for the hysterectomy and the efficiency of cautery for the cholecystectomy. CONCLUSIONS: Observation of laparoscopic skills still allows for surgical improvement, but direct practice on a virtual reality trainer provides better results. Self- and peer-grading were concordant with the supervisor's evaluation. This work may advocate the integration of both personal training on simulators and surgical observation into residents' surgical curricula.

Vaginal vs. robotic hysterectomy for patients with endometrial cancer: A comparison of outcomes and cost of care.

OBJECTIVE: To compare outcomes and cost for patients with endometrial cancer undergoing vaginal hysterectomy (VH) or robotic hysterectomy (RH), with or without lymphadenectomy (LND). METHODS: Patients undergoing planned VH (and laparoscopic LND) or RH (and robotic LND) between January 2007 and November 2012 were reviewed. Patients with stage IV disease, synchronous cancer, synchronous surgery, or treated with palliative intent were excluded. Patients were objectively triaged to LND per institutional protocol based on frozen section. Outcomes were compared between VH and RH groups matched 1:1 on propensity scores. RESULTS: VH was planned in 153 patients; 60 (39%) had concurrent LND while 93 (61%) were low risk and did not require LND. RH was planned in 398 patients; 225 (56%) required concurrent LND and 173 (44%) did not. Among 50 PS-matched pairs without LND, there was no significant difference in complications, length of stay, readmission, or progression free survival. However, median operative time was 1.3h longer and median 30-day cost $3150 higher for RH compared to VH (both p<0.001). Among patients requiring LND, 42 PS-matched pairs were identified. Median operative time was not different when pelvic and para-aortic LND was performed, and 12min longer in the VH group for pelvic LND alone (p=0.03). Median 30-day cost was $921 higher for RH compared to VH when LND was required (p=0.08). CONCLUSION: Utilization of vaginal hysterectomy for endometrial cancer results in similar surgical and oncologic outcomes and lower costs compared to RH and should be considered for appropriate patients with a low risk of requiring LND.

ß-Cyclodextrin-based supramolecular poly(N-isopropylacrylamide) hydrogels prepared by frontal polymerization.

Frontal polymerization (FP) was successfully applied to the synthesis of poly(N-isopropylacrylamide)-grafted-acryloyl-ß-cyclodextrin supramolecularly crosslinked hydrogels. It was established that acryloyl-ß-cyclodextrin (AßCD) allowed performing successful frontal polymerizations with N-isopropylacrylamide even in the absence of any covalent crosslinker, which is something generally required. It was found that the swelling properties of the resulting hydrogels can be tuned by varying the amount of AßCD. Namely, when little amounts of this non-covalent crosslinker were used, superabsorbent hydrogels were obtained. Hydrogels containing also a covalent crosslinker were also prepared for comparison. These latter exhibited swelling ratios that are much lower than the others.

Water and hexane in an ionic liquid: computational evidence of association under high pressure.

High pressures may strongly affect the mesoscopic structure of some ionic liquids. In particular, the so called sponge-like structure is gradually destroyed when an increasing pressure is applied. Here we show how a polar solute, an apolar solute or a mixture thereof behave in the ionic liquid trihexyl, tetradecylphosphonium bis (trifluoromethyl-sulfonyl) imide when the pressure is raised up to 10 kbar. Our calculations clearly show an association between molecules that would not interact in ordinary conditions.

Papillary cannulation and sphincterotomy techniques at ERCP: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It provides practical advice on how to achieve successful cannulation and sphincterotomy at minimum risk to the patient. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence. Main recommendations 1 ESGE suggests that difficult biliary cannulation is defined by the presence of one or more of the following: more than 5 contacts with the papilla whilst attempting to cannulate; more than 5 minutes spent attempting to cannulate following visualization of the papilla; more than one unintended pancreatic duct cannulation or opacification (low quality evidence, weak recommendation). 2 ESGE recommends the guidewire-assisted technique for primary biliary cannulation, since it reduces the risk of post-ERCP pancreatitis (moderate quality evidence, strong recommendation). 3 ESGE recommends using pancreatic guidewire (PGW)-assisted biliary cannulation in patients where biliary cannulation is difficult and repeated unintentional access to the main pancreatic duct occurs (moderate quality evidence, strong recommendation). ESGE recommends attempting prophylactic pancreatic stenting in all patients with PGW-assisted attempts at biliary cannulation (moderate quality evidence, strong recommendation). 4 ESGE recommends needle-knife fistulotomy as the preferred technique for precutting (moderate quality evidence, strong recommendation). ESGE suggests that precutting should be used only by endoscopists who achieve selective biliary cannulation in more than 80 % of cases using standard cannulation techniques (low quality evidence, weak recommendation). When access to the pancreatic duct is easy to obtain, ESGE suggests placement of a pancreatic stent prior to precutting (moderate quality evidence, weak recommendation). 5 ESGE recommends that in patients with a small papilla that is difficult to cannulate, transpancreatic biliary sphincterotomy should be considered if unintentional insertion of a guidewire into the pancreatic duct occurs (moderate quality evidence, strong recommendation).In patients who have had transpancreatic sphincterotomy, ESGE suggests prophylactic pancreatic stenting (moderate quality evidence, strong recommendation). 6 ESGE recommends that mixed current is used for sphincterotomy rather than pure cut current alone, as there is a decreased risk of mild bleeding with the former (moderate quality evidence, strong recommendation). 7 ESGE suggests endoscopic papillary balloon dilation (EPBD) as an alternative to endoscopic sphincterotomy (EST) for extracting CBD stones < 8 mm in patients without anatomical or clinical contraindications, especially in the presence of coagulopathy or altered anatomy (moderate quality evidence, strong recommendation). 8 ESGE does not recommend routine biliary sphincterotomy for patients undergoing pancreatic sphincterotomy, and suggests that it is reserved for patients in whom there is evidence of coexisting bile duct obstruction or biliary sphincter of Oddi dysfunction (moderate quality evidence, weak recommendation). 9 In patients with periampullary diverticulum (PAD) and difficult cannulation, ESGE suggests that pancreatic duct stent placement followed by precut sphincterotomy or needle-knife fistulotomy are suitable options to achieve cannulation (low quality evidence, weak recommendation).ESGE suggests that EST is safe in patients with PAD. In cases where EST is technically difficult to complete as a result of a PAD, large stone removal can be facilitated by a small EST combined with EPBD or use of EPBD alone (low quality evidence, weak recommendation). 10 For cannulation of the minor papilla, ESGE suggests using wire-guided cannulation, with or without contrast, and sphincterotomy with a pull-type sphincterotome or a needle-knife over a plastic stent (low quality evidence, weak recommendation).When cannulation of the minor papilla is difficult, ESGE suggests secretin injection, which can be preceded by methylene blue spray in the duodenum (low quality evidence, weak recommendation). 11 In patients with choledocholithiasis who are scheduled for elective cholecystectomy, ESGE suggests intraoperative ERCP with laparoendoscopic rendezvous (moderate quality evidence, weak recommendation). ESGE suggests that when biliary cannulation is unsuccessful with a standard retrograde approach, anterograde guidewire insertion either by a percutaneous or endoscopic ultrasound (EUS)-guided approach can be used to achieve biliary access (low quality evidence, weak recommendation). 12 ESGE suggests that in patients with Billroth II gastrectomy ERCP should be performed in referral centers, with the side-viewing endoscope as a first option; forward-viewing endoscopes are the second choice in cases of failure (low quality evidence, weak recommendation). A straight standard ERCP catheter or an inverted sphincterotome, with or without the guidewire, is recommended by ESGE for biliopancreatic cannulation in patients who have undergone Billroth II gastrectomy (low quality evidence, strong recommendation). Endoscopic papillary ballon dilation (EPBD) is suggested as an alternative to sphincterotomy for stone extraction in the setting of patients with Billroth II gastrectomy (low quality evidence, weak recommendation).In patients with complex post-surgical anatomy ESGE suggests referral to a center where device-assisted enteroscopy techniques are available (very low quality evidence, weak recommendation).

Management of endometrial cancer: issues and controversies.

Although endometrial cancer (EC) is the most common gynecologic cancer in developed countries, several aspects of its management are still controversial. In particular, the need to perform lymphadenectomy represents an important matter of discussion. Because of the discordant results in the literature, it is still not possible to draft any definitive conclusions regarding the therapeutic value of lymph node dissection. The present review discusses the role of lymphadenectomy in the setting of EC, risk factors for lymphatic spread, identification of patients at risk for lymph node dissemination, and the current evidence for adjuvant therapies in patients with positive nodes. Reasons for the difficulty in demonstrating any therapeutic value of pelvic and para-aortic lymphadenectomy are also discussed.

Dual Kidney Transplantation: Evaluation of Recipient Selection Criteria at Niguarda Hospital.

BACKGROUND: Dual kidney transplantation (DKT) is a largely accepted strategy to enlarge the donor pool. Niguarda Hospital started this program in December 2010, and 38 DKT have been performed. In our series, we included recipients older than those in the other series published in literature. The aim of this study was to know if our recipient selection criteria for DKT are safe. METHODS: We reviewed our data base of DKT and analyzed recipients' medical history, surgical technique, post-operative complications, graft survival, morbidity, and mortality. We then compared our results with the literature. RESULTS: From December 2010 to April 2015, 38 DKT were performed in Niguarda Hospital. Delayed graft function was present in 21 recipients. Explantation of both kidneys was performed in 1 patient and explantation of 1 kidney in 6 patients. Post-operative complications were present in 8 patients. Five patients returned to hemodialysis after DKT. One recipient died of medical post-operative sepsis. The mean follow-up was 24 months. Graft survival and patient survival were 86.84% and 97.93%, respectively. Compared with the literature, our series had similar mortality and morbidity rates, even if recipients' age was higher than in other series. CONCLUSIONS: The strategy of DKT allocation in elderly recipients is safe. Further studies have to be performed to optimized selection of the recipients for DKT not to disadvantage younger patients in the transplant waiting list and to improve the technique of organ evaluation and preservation to refine graft allocation.

Do Older Liver Grafts Have Worse Survival? The Niguarda Experience.

BACKGROUND: Elderly donor livers are thought to be marginal graft. In the present study, we aimed to identify an age threshold to consider a graft as elderly to identify the trend (if any) of the donor age in our series and to identify an efficient allocation criteria for elderly grafts. METHODS: We reviewed in a retrospective manner our series of 1520 liver transplants, comparing graft survival under and over a certain age. On the basis of the results of this analysis, we identified a threshold of 70 years to define a graft as old. The donor age trend analysis showed an increasing rate of transplants from elderly donors. RESULTS: To identify efficient allocation criteria for elderly graft, we stratified the series by the disease of the recipient: 556 patients underwent transplants for hepatocellular carcinoma (HCC+ group) and 964 for other diseases (HCC- group). Two hundred twenty-one patients of 556 of the HCC+ group were hepatitis c virus (HCV) negative (HCC+/HCV- group), and 312 of 964 of the HCC- group were HCV positive (HCC-/HCV+). The survival analysis showed no significant differences in comparing the outcome for elderly and young grafts in the HCC+ (P = .135) and HCC- (P = .055) groups. CONCLUSIONS: When comparing the survival of old and young livers in the HCC+/HCV- group, the elderly livers appear to have a better outcome (P = .05); on the other hand, the same analysis in the HCC-/HCV+ group shows a worse outcome for old-aged grafts (P = .026). Therefore, the present study suggests that elderly livers should be allocated to hepatocellular carcinoma (HCC) patients and should be avoided in HCV+ recipients.

Nutritional information and health warnings on wine labels: Exploring consumer interest and preferences.

This paper aims to contribute to the current debate on the inclusion of nutritional information and health warnings on wine labels, exploring consumers' interest and preferences. The results of a survey conducted on a sample of Italian wine consumers (N = 300) show the strong interest of respondents in the inclusion of such information on the label. Conjoint analysis reveals that consumers assign greater utility to health warnings, followed by nutritional information. Cluster analysis shows the existence of three different consumer segments. The first cluster, which included mainly female consumers (over 55) and those with high wine involvement, revealed greater awareness of the links between wine and health and better knowledge of wine nutritional properties, preferring a more detailed nutritional label, such as a panel with GDA%. By contrast, the other two clusters, consisting of individuals who generally find it more difficult to understand nutritional labels, preferred the less detailed label of a glass showing calories. The second and largest cluster comprising mainly younger men (under 44), showed the highest interest in health warnings while the third cluster - with a relatively low level of education - preferred the specification of the number of glasses not to exceed. Our results support the idea that the policy maker should consider introducing a mandatory nutritional label in the easier-to-implement and not-too-costly form of a glass with calories, rotating health warnings and the maximum number of glasses not to exceed.

Pressure-induced mesoscopic disorder in protic ionic liquids: first computational study.

It has been recently shown that pressure may affect the mesoscopic heterogeneity in aprotic ionic liquids, owing to the long alkyl chain folding on itself. Here we explore protic ionic liquids, using classical molecular dynamics. These compounds have shorter and stiffer alkyl chains, harder to fold. We observed that high pressure affects the mesoscopic structure of the studied chemicals and, indeed, the effect may be ascribed to chain folding.