13 research outputs found
Human lung fibroblasts present bacterial antigen to autologous lung T helper cells
No full textLung fibroblasts are key structural cells that reside in the submucosa where they are in contact with large numbers of CD4+ T helper cells. During severe viral infection and chronic inflammation the submucosa is susceptible to bacterial invasion by lung microbiota such as Nontypeable Haemophilus influenzae (NTHi). Given their proximity in tissue, we hypothesised that human lung fibroblasts play an important role in modulating T helper cell responses to NTHi. We demonstrate that fibroblasts express the critical CD4+ T cell antigen-presentation molecule HLA-DR within the human lung, and that this expression can be recapitulated in vitro in response to interferon (IFN)?. Furthermore, we observed that cultured lung fibroblasts could internalize live NTHi. While unable to express CD80 and CD86 in response to stimulation, fibroblasts expressed the co-stimulatory molecules 4-1BBL, OX-40L and CD70, all of which are related to memory T cell activation and maintenance. CD4+ T cells isolated from the lung were predominantly (mean 97.5%) CD45RO+ memory cells. Finally, cultured fibroblasts activated IFN? and IL-17A cytokine production by autologous, NTHi-specific lung CD4+ T cells, and cytokine production was inhibited by a HLA-DR blocking antibody. These results indicate a novel role for human lung fibroblasts in contributing to responses against bacterial infection through activation of bacteria-specific CD4+ T cells
Towards an artificial human lung: modelling organ-like complexity to aid mechanistic understanding
No full textRespiratory diseases account for over 5 million deaths yearly and are a huge burden to health-care systems worldwide. Murine models have been of paramount importance to decode human lung biology in vivo, but their genetic, anatomical, physiological and immunological differences with humans significantly hamper successful translation of research into clinical practice. Thus, to clearly understand human lung physiology, development, homeostasis and mechanistic dysregulation that may lead to disease, it is essential to develop models that accurately recreate the extraordinary complexity of the human pulmonary architecture and biology. Recent advances in micro-engineering technology and tissue engineering have allowed the development of more sophisticated models intending to bridge the gap between the native lung and its replicates in vitro Alongside advanced culture techniques, remarkable technological growth in downstream analyses has significantly increased the predictive power of human biology-based in vitro models by allowing capture and quantification of complex signals. Refined integrated multi-omics readouts could lead to an acceleration of the translational pipeline from in vitro experimental settings to drug development and clinical testing in the future. This review highlights the range and complexity of state-of-the-art lung models for different areas of the respiratory system, from nasal to large airways, small airways, and alveoli, with consideration of various aspects of disease states and their potential applications, including pre-clinical drug testing. We explore how development of optimised physiologically relevant in vitro human lung models could accelerate the identification of novel therapeutics with increased potential to translate successfully from the bench to the patient's bedside.</p
Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)
No full textPurpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure. Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications. Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications. Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care
Outcomes of loop ileostomy after rectal resection for cancer: A prospective observational multicenter snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)
No full textBackground: Diverting ileostomy is a common procedure in rectal cancer surgery, but it is sometimes associated with a nonnegligible rate of complications. The primary aim of this study was to analyze the incidence and types of stoma-related complications for ileostomy creation after rectal cancer resection. The secondary aims were to report the indications, the technical details, and the efficacy of stoma care provided by ostomy nurses. Methods: From 15 February to 31 December 2022, consecutive patients who underwent protective ileostomy after anterior rectal cancer resection were enrolled for prospective data collection at 45 Italian colorectal surgery centers. Univariate and multivariate analyses were performed to evaluate factors that influenced the occurrence of stoma-related complications. Results: In all, 287 patients were enrolled in the analysis. The short- and long-term postoperative stoma-related morbidity rates were 33.8% and 29.62%, respectively. The most frequent complications were dehydration (17.77%), peristomal skin dermatitis (13.59%), mucocutaneous separation (8.36%), and stoma retraction (4.18%). At the end of follow-up (median time 9 months), the overall stoma closure rate was 83.97% (241 patients), with a median time to stoma closure of 146 days (range 9–483 days). On multivariate analysis, the presence of a stoma nurse was a significant protective factor against stoma-related complications. Conclusions: This study demonstrated that the creation of a protective ileostomy is associated to a nonnegligible rate of short-term and long-term postoperative stoma-related morbidity, higher than 25%. The most frequent complication is dehydration, and the presence of stoma-specialized nurses seems to be a protective factor for stoma-related complications. Moreover, more than 15% of protective stomas were not closed at the end of follow-up
Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)
No full textPurpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure. Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications. Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146 days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score > 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications. Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care
Current state-of-the-art of adrenal surgery in Italy: the cancer risk in surgical adrenal lesions (CRISAL) survey
No full textAdrenalectomies are growing worldwide because of the frequent diagnosis of incidentaloma and the use of minimally invasive surgery (MIS). The factors used to identify a malignant lesion and the best surgical technique are uncertain. In this context, the definition of high-volume center and expert surgeon is under debate. The Italian Society of Endoscopic Surgery and New Technologies (SICE) developed a nationwide survey to investigate the state-of-the-art of adrenal surgery in Italy. A web-based survey comprising 37 questions was developed and distributed to Italian surgeons involved in adrenal surgery. Two hundred forty-eight answers were analyzed. Consensus was reached among the survey participants regarding local infiltration (83%) and rapid growth of the lesion (81%) as markers of malignancy. Nearly 30% of the participants used MIS in case of malignant adrenal lesions. The lateral (50%) and anterior transperitoneal (44%) approaches were the most common among Italian surgeons. Approximately 40% of participants believe that 20–40 adrenalectomies/year are needed to define an expert surgeon and at least 20 procedures/year to define a high-volume center. Approximately half of participants performed < 10 adrenalectomies/year in centers with a median volume < 10 procedures/year. Based on participant feedback, this survey highlights local infiltration and rapid growth as the most significant markers of malignant adrenal lesions. While open adrenalectomy remains the gold standard for suspected malignant lesions, nearly 30% of the participants practice MIS even in these cases. The lateral and anterior transperitoneal approaches emerge as the most familiar for Italian surgeons. A substantial proportion of Italian patients with adrenal lesions undergo surgery performed by surgeons with an annual case volume < 10 procedures, at centers with a low annual volume of adrenalectomies. Moreover, there is a lack of standardized definitions for ‘expert surgeon’ and ‘high-volume center’ in this context
Long term morphotectonic evolution of the Southern Apennines
No full textABSTRACT
The main goal of this work is the study of the morphological and morphometrical features of the Southern Apennines thrust belt – foredeep system, carrying out both a large scale and a small scale analyses of areas of high relevance, with the aim to determine new morphological and morphometrical constraints to the reconstruction of the main morphotectonic events that have interested the chain. This type of research has been based on the idea to compare such data with new thermochronological data that have been produced in many areas of the chain (Aldega et al., 2003; Mazzoli et al., 2006; Mazzoli et al., 2008), which highlighted the role of the exhumation processes in the evolution of the thrust belt. The thermochronological data indicate that the exhumation processes started about 10Ma and they have been active since recent time (in the last million years), resulting contemporary to the main morphogenetic events responsible of the actual morphostructural setting of the chain.
The Southern Apennines chain formed has a consequence of the Neogene collision of the African (and in particular, the Adria microplate) and Euroasiatic plates, with the subduction of the Adria microplate beneath the Euroasiatic plate. The morphostructural setting of the Southern Apennines has been determined by its complex tectonic history (with the occurrence of both thrust faults and normal faults) and by the erosional processes that have sculptured the topography, also considering that the landforms are strongly influenced by the rock type too.
In the last years the development of new techniques of analysis has provided new constraints useful to the reconstruction of the morphotectonic history of the Southern Apennines. This techniques are based on thermochronological analysis, and in particular on the Apatite Fission Tracks, the Ur-Th-He series, the Vitrinite Reflectance, the Clay Mineralogy and the Fluid Inclusions. These data, that have been extensively produced in the whole chain, have pointed out the attention on tectonic exhumation processes (we mean by rock exhumation a variation of the position of a rock in relation to the air-topograhy interface), which have determined rock uplift of thousands of meters in the last 2-3Ma (Aldega et al., 2003; Mazzoli et al., 2006; Mazzoli et al., 2008). The individuation of so enhanced vertical and horizontal tectonic motions in recent times has expected to have interacted with the processes responsible of the exogenic modelling of the topography, and they have probably played an important role in the morphotectonic evolution of the chain, leaving their signature in the topography.
The research has been based on large scale geomorphological and morphometrical techniques of analysis, that have been used with the aim to describe the main morphological and morphometrical features of the chain, to compare the features of the Tyrrhenian, Adriatic and Ionian slopes of the Southern Apennines, and to relate these features with the proposed morphotectonic events. The large scale analysis has been accompanied by the small scale analysis of a selected transect namely the Noce-Sirino-Alpi-Sant’Arcangelo transect. This transect has been chosen because of the particular features that make this area one of the most relevant portion of the chain in order to reconstruct the morphotectonic evolution of the Southern Apennines, and in particular, to investigate the role played by the rock exhumation processes in the evolution of the relief. This transect assumes a high relevance because:
- it includes tectonic units which have been exhumed in recent times;
- it preserves a stratigraphical and morpho-stratigraphical record which is almost continuous both temporally (from the Middle Pliocene to the whole Quaternary) and spatially (from the Tyrrhenian to the Adriatic coasts);
- the topography, in this portion of the Southern Apennines, has been only slightly dismembered by the post-orogenic extensional tectonic, and may be considered resulting by the major geodynamic processes (shortening, thrusting, extension and exhumation).
One of the main parameters that can influence the geomorphological and morphometrical features of a determined region is the lithology, or more correctly the bedrock resistance to erosion. In fact, parameters such as the elevation, local relief, steepness, presence of knickpoints are strongly controlled by bedrock erodibility. As a result, the first step in the analysis of the landscape is represented by a clear depiction of the space distribution of the rock types with different erodibility. For the above mentioned reason, a “Map of the Morphostructural Units of the Southern Apennines” has been created. This map is a simplification of the “Geological Map of the Southern Apennines” in scale 1:250000, in fact the 81 formations distinguished in the “Geological Map of the Southern Apennines” have been reduced into the 20 morphostructural units which have been grouped based on the estimation of erodibility of each rock type relative to other rock types. The erodibility degree was basically assigned by the observations of the features (e.g. steepness, degree of development of the upper convexity/basal concavity of hillslopes, average elevation, etc.) associated with the various bedrocks. As regards the Quaternary deposits, these were grouped based on different criteria. Taking into account the main goal of this study, which consists in the reconstruction of the Plio-Quaternary relative/absolute vertical motions of the Southern Apennines, the grouping of the different Quaternary stratigraphical units was based on the depositional environment (marine vs continental), degree of correlation of the different units with the original depositional environment (i.e. whether and to what degree they are displaced/dissected), and tectonic context (e.g. peri-tyrrhenian grabens, foredeep and intramontane basins deposits).
The large scale geomorphological analysis of the Southern Apennines has been based on the determination of the following parameters: elevation map and the derived maximum, medium and minimum elevation maps, swath profiles and the derived relief curves, analysis of the river long profiles and the derived parameters (drainage area vs distance, Stream Gradient Index, steepness (ks) and concavity (Q) indexes, slope of the first order channels). This type of analysis enhance a series of particular feature of the Southern Apennines that can be summarized as follows:
- the minimum elevation map can be separated in two different sector, respectively located north and south of the hereinafter named “Sele-Ofanto line”: the north sector is characterized by the coincidence of the highest values with the apenninic divide, while the southern sector is characterized by the presence of a wide area with high values in the minimum elevations, which moves from the apenninic divide to the east, involving the foredeep (and the Lavello high) and the Murge-Salento area ;
- this data regarding the minimum elevation map is very interesting in particular when compared with the “Map of the Morphostructural Units of the Southern Apennines”: this comparison show that the valleys on the Adriatic flank are higher than the valleys on the Tyrrhenian flank despite the Adriatic flank is characterized by the outcropping of very weak lithologies (external flyschs and Quaternary filling of the foredeep);
- the minimum elevation map could be so considered a good representation of the differential uplift at the orogen scale; this fact let the maximum elevation map to play a less relevant role when we want to interpret it in terms of uplift, and it can be more correctly considered as a good representation of the distribution of the tectonic Quaternary lows;
- the medium elevation map clearly enhance the presence of the hard carbonatic highs on the Tyrrhenian slope respect to more eroded surrounding areas where weaker lithologies crop out. This means that the Tyrrhenian slope has experienced a more intense erosion, or even that it is experiencing erosion since older times than the Adriatic flank (where the same weak lithologies crop out), and that the amount of eroded rock volumes is higher on the Tyrrhenian flank than on the Adriatic flank. If this two sectors were experiencing erosion since the same time, than we cannot explain why the external flank of the chain is higher than its inner flank despite this two sectors are characterized by the same rock-type;
- the analysis of the maximum, medium and minimum elevation maps suggests that the Adriatic flank of the Southern Apennines has experienced more enhanced uplift in recent times than the Tyrrhenian flank;
- the Tyrrhenian and the Adriatic flanks of the chain have also other different morphological and morphometrical features, in particular the Tyrrhenian flank becomes steeper than the Adriatic flank as we move to the south, giving the typical asymmetrical feature to the Southern Apennine;
- this asymmetrical feature of the chain is clearly showed by the envelop of the minimum elevation line of the five swath profiles, which enhance the presence of a Tyrrhenian steep slope and of an Adriatic gentle slope;
- there is an important difference regarding the elevation of the valleys on Tyrrhenian and the Adriatic flanks, with a mean gradient that bring the valleys to reach elevations a.s.l. higher on both the flanks as we move to the south, but in general the valleys on the Tyrrhenian flank are always lower than the valleys on the Adriatica flank: such a difference suggest a more recent uplift on the Adriatic flank than on the Tyrrhenian one;
The analysis of the river system shows how there is a spatial variations of the morphological and morphometrical features of the Southern Apennine rivers. If we consider the shape of the river long profiles we notice that the Tyrrhenian rivers have a clear concave-up shape with no important knickpoints, while the Adriatic rivers show a more rectilinear shape and the Ionian rivers show a less evident concave-up shape, in same cases close to the rectilinear, with evident knickpoints along the profiles. The Q (concavity index) values show a difference among the three sectors, with the Tyrrhenian rivers showing the highest value (Q=0.52), the Adriatic rivers showing a lower value (Q=0.45) and with the Ionian rivers showing the lowest value (Q=0.43). This data confirm what we noticed by the analysis of the river long profiles, in particular the Tyrrhenian rivers have a more evident concave-up shape and the Ionian rivers the less evident concave-up shape. The clear concave up shape of the Tyrrhenian rivers can be related to a more enhanced uplift on the Adriatic and Ionian slopes than on the Tyrrhenian slope. If we consider the Ks (steepness index) values, we suggest that in a geological setting such as the Southern Apennines, that is characterized by important lithological variations also in very close areas, the Ks index seems to reflect such variations more than recent rock uplift
The geomorphological, morphometrical and sedimentological analysis of the Noce-Sirino-Alpi-Sant’Arcangelo transect allowed the individuation of two low relief landforms which are located on the western sector of the Sant’Arcangelo basin (700-900m a.s.l.) and in the area between the north side of Mt. Sirino, Mt. Raparo and Mt. Alpi (1200-1400m a.s.l.). The lowest surface (700-900m a.s.l.) corresponds to the eroded depositional surface of the Serracorneta Conglomerate, so it is temporally constrained at about 0.6Ma. The morphological relationships among this lower paleosurface and the highest one are not clear, we can anyway affirm that it is recognized in the area north of the Mt. Sirino and it involves both carbonates units than Lagonegro Units, so its modelling took place after the exhumation of the Mt. Sirino ended and so, considering the data we are going to talk about soon, it could temporally constrained in the Middle-Late Lower Pleistocene, and in particular between 1.5-0.6Ma.
The field analysis let us to recognize the oldest units of the Qquaternary filling of the Sant’Arcangelo basin that contains clasts of the Lagonegro Units coming from the Mt. Sirino area: this unit is the subsynthem A2a (Benvenuti et al., 2006) which should be not older than 1.5Ma, so this means that at this time the Mt. Sirino was already a morphostructural highs that was experiencing erosion. This data agrees with the thermochronological analysis, which suggested that the rock exhumation of the Mt. Sirino started since 2.5Ma, and it has allowed us to give a lower temporal limit to the formation of the highest paleosurface.
The analysis of the “map of the slope of the 1st order channels”, carried out within the Sant’Arcangelo basin, suggests that the area comprised between the Serrapotamo and the Sarmento river shows the highest values: these high slope values could be related to a more enhanced uplift that this area has experienced respect to the rest of the Sant’Arcangelo basin. If we combine this data with the uplift data obtained by the analysis of the marine terraces on the Ionian coast (Amato, 2000), we have that the southwestern portion of the Sant’Arcangelo basin seems to be aligned with the southernmost Ionian coast, that is the portion of the Ionian coast which has experienced a more enhanced uplift: this data could suggest a connection between these two sectors, highlighting the presence of this NW-SE oriented portion of the Southern Apennines that has been strongly uplifted.
The analysis of the river terraces inside the Sinni valley has allowed the individuation of 7 orders of river terraces. The highest order, the 7th, doesn’t correspond to a real river terrace but it corresponds with the eroded depositional surface of the Serracorneta Conglomerates, whose age is of about 0.6Ma (Benvenuti et al., 2006). To date the lowest terraces we can try to correlate them with the dated marine terraces on the Ionian coast (Amato, 2000), this analysis let us to propose a late Upper Pleistocene for the 1st order terraces of the Sinni valley Considering the age of the highest river terraces and the actual elevation of the Sinni valley it is also possible to establish an incision rate of about 1mm/yr: the incision rate is always greater or equal to the uplift rate, so we can say that the uplift rate of the Sinni valley since 0.6Ma doesn’t exceed 1mm/yr. This uplift rate agrees with the uplift rate that have been proposed by Amato (2000) for the marine terraces on the Ionian coast, where the author proposed an uplift rate comprised between 0.3-1.6mm/yr.
The analysis of the Noce valley river terraces has allowed the grouping of the several mapped fluvial terraces into three main orders: pre-lake, syn-lake and post-lake terraces. There are no absolute date available to date the lake time, so the age of the syn-lake terraces has been obtained using methods of relative chronology, by trying to correlate such terraces with dated marine terraces on the Tyrrhenian coast at the mouth of the Noce river: an Emilian-Sicilian age is proposed for the highest marine terraces at 170m and 140m a.s.l., while a Middle Pleistocene age is proposed for the 80m a.s.l. marine terrace. The oldest marine terraces are extended inside the Noce valley, so it means that at that time the Noce valley was already individuated. In addiction to this we have to consider that, on the basis of morphometrical considerations, such marine terraces are correlable with the river terraces at about 200m a.s.l. individuated in locality Feliceta, inside the Noce valley, and that are referred to the post-lake river terraces. Another important issue is given by the presence of Lagonegro clasts into this marine deposits and, considering that the only area from which these clasts could come from is Mt. Sirino, this data suggests that at the time of the formation of the oldest marine terraces (about 1Ma), Mt. Sirino was already experiencing erosion, so it was very close to the actual morphostructural setting.
The combination of the sedimentological data of the SAnt’Arcagenlo basin and the analysis of the Noce river terraces allowed us to affirm that about 1.5-1Ma Mt. Sirino was already a morphological high which was experiencing erosion, so it means that the rock exhumation processes was finished: the comparison of these data with the thermochronological data suggest that in the period between 2.5Ma and 1.5-1Ma Mt. Sirino has experienced an enhanced rock exhumation that has brought it from an initial situation where it was covered by about 4km of rocks (2.5Ma) to a final situation where it outcrops on the Earth surface and it was subject to the exogenic processes (1.5-1Ma).
This study has highlighted the importance of the morphotectonic approach in the reconstruction of the tectonic events occurred either at a regional scale or at a local scale. In particular, the numerical analysis of digital topographic data has been very useful to the large scale characterization of the Southern Apennines chain landscape. Furthermore, the integration of data provided by the digital analysis technique (e.g. swath profiles, river long profiles and the derived metrics), with the data obtained through the “classical” geomorphological approach, based on morphostructural and morphostratigraphical analyses, has provided new constraints to the reconstruction of the vertical motions which affected the entire chain during the Quaternary.
The main results of this study can be summarized as follows:
- long profiles, elevation of the valley bottoms and the minimum elevation map show that the outer portion of the Southern Apennines (Adriatic and Ionian slopes) has been uplifted more recently and with higher rates than its inner side (Tyrrhenian slope). These data agree with data provided by the analysis of the shorelines, marine terraces and coastal deposits observed on the Ionian belt (Amato, 2000) and the Tyrrhenian margin (Romano, 1992; Caiazzo et al., 2006), which indicate that the Ionian flank has experienced larger uplift, since the Middle Pleistocene, than the Tyrrhenian flank;
- the Ionian rivers show a very steep long profile when they flow into the Sant’Arcangelo basin. This suggests that the post-orogenic uplift recognized by the marine terraces in the foredeep affected also the outer portion of the chain, involving at least the Sant’Arcangelo area;
- by the comparison of the Agri and the Sinni long profile, by the map of the gradient of the first order channel, and by the Ks values (which are higher on the southern portion of the Sant’Arcangelo basin and that decrease moving towards its northern portion) it appears that the uplift in the Sant’Arcangelo area follows a N-S trend. However, further studies are necessary to discern about the reason of such different uplift;
- as regards to the Middle Pleistocene to Present uplift trend, the above observations indicate that the uplift increases towards the west, probably reaching the chain axis. Coeval uplift in the Tyrrhenian margin (as estimated by elevation of Middle to Late Pleistocene marine terraces shorelines; Romano, 1992; Caiazzo et al., 2006; Filocamo, 2006) was much lower, not exceeding about 100 m. These evidences suggest that the uplift trend of the outer flank of the chain is not recognizable in the whole orogen. The western boundary of the more rapidly uplifting belt can be tentatively located in correspondence to the deep-seated normal faults that have formed the several Quaternary intramontane basins;
- the stronger post-orogenic uplift occurred on the outer side of the chain since the Middle Pleistocene has determined a minor ability of the Adriatic and Ionian rivers (which experienced a continuous downcutting) to compete with the Tyrrhenian rivers. This fact is enhanced by the comparison of the valley bottoms, which are higher for the rivers flowing on the outer flank than for the rivers flowing on the inner flank of the chain. This has probably contributed, together with regressive river erosion due to the extensional tectonics on the Tyrrhenian margin (see sec. 3.5), in the decoupling between the maximum elevation line and the main divide, which is one of the peculiar features of the Southern Apennines chain;
- the combination of the field analysis together with the morphological and morphometrical analysis of the Noce-Sirino-Alpi-Sant’Arcangelo transect allowed us to affirm that during the late Lower Pleistocene Mt. Sirino was already a morphological high which was experiencing erosion, so it means that the rock exhumation processes was finished;
- this data is confirmed by the analysis of the river terraces of the Noce valley: the lacustrine conditions have been dated (by methods of relative chronology on the basis of the morphological relationships among the fluvial terraces of the Noce valley and dated marine terraces on the Tyrrhenian coast close to the Noce mouth) to the middle Lower Pleistocene, and the recognition of Lagonegro clasts inside the oldest marine deposits (Lower Pleistocene) suggests that at that time there was an active drainage from Mt. Sirino to the south, and so Mt. Sirino was already a morphological high subject to the erosional processes and able to produce debris, and the lake didn’t exist anymore;
- in addiction to this, we have to consider that since its exhumation, Mt. Sirino corresponds to the location of the Apennine divide, representing one of the few portion of the Southern Apennines where there is a coincidence between the maximum elevation line and the divide location. This situation is partly recognized also in Monti Picentini area, where the two lines (divide and maximum elevation lines) are very close. The Sirino and the Picentini ridge are two areas t
Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)
No full textAcute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula
Diagnosis and management of caustic ingestion: an interdisciplinary nationwide cross-sectional survey from the Italian society of endoscopic surgery and new technologies (SICE), the Italian society of digestive endoscopy (SIED), the world society of emergency surgery-Italy chapter (WSESit), and the Italian society of surgical endoscopy and digestive diseases (ISSE)
No full textCaustic ingestion (CI) in adults represents a potentially life-threatening condition. Diagnosis and management of CI in real life remain challenging. The aim of the survey is to evaluate on a national scale the multidisciplinary management of these patients. 24-item online Survey was sent to the mailing lists and social media of Italian Society of Endoscopic Surgery and New Technologies, Italian Society of Digestive Endoscopy, World Society of Emergency Surgery-Italy Chapter, and Italian Society of Surgical Endoscopy and Digestive Diseases. Overall, 240 subjects answered to the survey, corresponding to 22.1% of the total members of the scientific societies involved. 131 (54.5%) respondents evaluated fewer than ten CI patients per year. The recommendations provided by the WSES and SIED guidelines were followed by 133 (55.2%) and 83 (34.4%) participants, respectively. Emergency surgery was advocated by 180 (77.6%) of the respondents for patients with transmural necrosis or signs of perforation, using minimally invasive surgery in 47% of the cases and considering initial esophagojejunal anastomosis as safe in 33 (14.2%) of the responses. Our study is the first to provide real-life data on how the management of CI varies across Italian physicians, according to regional, institutional, and specialty-related factors. This survey highlights the need for standardized and uniform guidelines
Surgeons’ practice and preferences for the anal fissure treatment: results from an international survey
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