Nuove strategie endoscopiche e mininvasive nel trattamento delle fistole anastomotiche pouch-anali e colorettali : endoluminal vacuum-assisted therapy (Endosponge®) first stage vs second stage treatment

La fistola anastomotica è una delle complicanze più temute nella chirurgia colo-rettale. Le anastomosi colo-rettali basse , le colo-anali e le pouch anali hanno un rischio più elevato di sviluppare una fistola anastomotica . La terapia endoluminale a pressione negativa (Endosponge®) è stata proposta come strategia di trattamento, tuttavia, la tempistica migliore in cui attuare la procedura rimane ancora poco definita. Lo scopo dello studio è confrontare i risultati ottenuti con l'Endosponge® come trattamento di prima linea rispetto a quelli in cui è stato applicato a seguito del fallimento di ulteriori trattamenti. Lo studio retrospettivo monocentrico ha incluso pazienti con fistola anastomotica trattati con Endosponge® in un periodo di tempo compreso tra novembre 2019 e novembre 2022. L'Endosponge® è stato applicato come prima linea o come salvataggio. Il dispositivo è stato applicato nella sede della deiscenza e periodicamente sostituito fino alla guarigione. La risoluzione del leak anastomotico è stata confermata con esame endoscopico. Dei 25 pazienti inclusi, 9 sono stati sottoposti a Endosponge® come trattamento di prima linea, mentre 16 sono stati sottoposti a Endosponge® di salvataggio. La deiscenza anastomotica è stata diagnosticata dopo un intervallo di tempo mediano di 14 giorni (range 10-413) nel primo gruppo e di 38 giorni (range 11-362) nel secondo (p=0,82). L'Endosponge® è stato applicato dopo 7 giorni (range 1-60) dalla diagnosi di fistola anastomotica nel primo gruppo e dopo 76 giorni (range 6-780) nel secondo gruppo (p=0,058). La risoluzione della fistola anastomotica è stata ottenuta in una percentuale di casi maggiore nel primo gruppo rispetto al secondo 88,9% vs 37,6% (p =0,033). Lo studio conferma l'efficacia dell'Endosponge® nel trattamento delle fistole anastomotiche colorettali basse quando utilizzato precocemente e come trattamento di prima linea.

Knots and links in lens spaces

The aim of this dissertation is to improve the knowledge of knots and links in lens spaces. If the lens space L(p,q) is defined as a 3-ball with suitable boundary identifications, then a link in L(p,q) can be represented by a disk diagram, i.e. a regular projection of the link on a disk. In this contest, we obtain a complete finite set of Reidemeister-type moves establishing equivalence, up to ambient isotopy. Moreover, the connections of this new diagram with both grid and band diagrams for links in lens spaces are shown. A Wirtinger-type presentation for the group of the link and a diagrammatic method giving the first homology group are described. A class of twisted Alexander polynomials for links in lens spaces is computed, showing its correlation with Reidemeister torsion. One of the most important geometric invariants of links in lens spaces is the lift in 3-sphere of a link L in L(p,q), that is the counterimage of L under the universal covering of L(p,q). Starting from the disk diagram of the link, we obtain a diagram of the lift in the 3-sphere. Using this construction it is possible to find different knots and links in L(p,q) having equivalent lifts, hence we cannot distinguish different links in lens spaces only from their lift. The two final chapters investigate whether several existing invariants for links in lens spaces are essential, i.e. whether they may assume different values on links with equivalent lift. Namely, we consider the fundamental quandle, the group of the link, the twisted Alexander polynomials, the Kauffman Bracket Skein Module and an HOMFLY-PT-type invariant.

The Role of Multiple Social Categorisation in Promoting the Inclusion in the Human Group of Outgroup Members

Analysis of Two Component Systems in Group B Streptococcus Shows that RgfAC and the Novel FspSR Modulate Virulence and Bacterial Fitness

Group B Streptococcus (GBS), in its transition from commensal to pathogen, will encounter diverse host environments and thus require coordinately controlling its transcriptional responses to these changes. This work was aimed at better understanding the role of two component signal transduction systems (TCS) in GBS pathophysiology through a systematic screening procedure. We first performed a complete inventory and sensory mechanism classification of all putative GBS TCS by genomic analysis. Five TCS were further investigated by the generation of knock-out strains, and in vitro transcriptome analysis identified genes regulated by these systems, ranging from 0.1-3% of the genome. Interestingly, two sugar phosphotransferase systems appeared differently regulated in the knock-out mutant of TCS-16, suggesting an involvement in monitoring carbon source availability. High throughput analysis of bacterial growth on different carbon sources showed that TCS-16 was necessary for growth of GBS on fructose-6-phosphate. Additional transcriptional analysis provided further evidence for a stimulus-response circuit where extracellular fructose-6-phosphate leads to autoinduction of TCS-16 with concomitant dramatic up-regulation of the adjacent operon encoding a phosphotransferase system. The TCS-16-deficient strain exhibited decreased persistence in a model of vaginal colonization and impaired growth/survival in the presence of vaginal mucoid components. All mutant strains were also characterized in a murine model of systemic infection, and inactivation of TCS-17 (also known as RgfAC) resulted in hypervirulence. Our data suggest a role for the previously unknown TCS-16, here named FspSR, in bacterial fitness and carbon metabolism during host colonization, and also provide experimental evidence for TCS-17/RgfAC involvement in virulence.

Polymerizing activity and regulation of group B Streptococcus pilus 2a sortase C1

Group B Streptococcus [GBS; Streptococcus agalactiae] is the leading cause of life-threatening diseases in newborn and is also becoming a common cause of invasive diseases in non-pregnant, elderly and immune-compromised adults. Pili, long filamentous fibers protruding from the bacterial surface, have been discovered in GBS, as important virulence factors and vaccine candidates. Gram-positive bacteria build pili on their cell surface via a class C sortase-catalyzed transpeptidation mechanism from pilin protein substrates. Despite the availability of several crystal structures, pilus-related C sortases remain poorly characterized to date and their mechanisms of transpeptidation and regulation need to be further investigated. The available three-dimensional structures of these enzymes reveal a typical sortase fold except for the presence of a unique feature represented by an N-terminal highly flexible loop, known as the “lid”. This region interacts with the residues composing the catalytic triad and covers the active site, thus maintaining the enzyme in an auto-inhibited state and preventing the accessibility to the substrate. It is believed that enzyme activation may occur only after lid displacement from the catalytic domain. In this work we provide the first direct evidence of the regulatory role of the lid, demonstrating that it is possible to obtain in vitro an efficient polymerization of pilin subunits using an active C sortase lid mutant carrying a single residue mutation in the lid region. Moreover, biochemical analyses of this recombinant mutant reveal that the lid confers thermodynamic and proteolytic stability to the enzyme. A further characterization of this sortase active mutant showed promiscuity in the substrate recognition, as it is able to polymerize different LPXTG-proteins in vitro.

Numerical invariants for measurable cocycles

The theory of numerical invariants for representations can be generalized to measurable cocycles. This provides a natural notion of maximality for cocycles associated to complex hyperbolic lattices with values in groups of Hermitian type. Among maximal cocycles, the class of Zariski dense ones turns out to have a rigid behavior. An alternative implementation of numerical invariants can be given by using equivariant maps at the level of boundaries and by exploiting the Burger-Monod approach to bounded cohomology. Due to their crucial role in this theory, we prove existence results in two different contexts. Precisely, we construct boundary maps for non-elementary cocycles into the isometry group of CAT(0)-spaces of finite telescopic dimension and for Zariski dense cocycles into simple Lie groups. Then we approach numerical invariants. Our first goal is to study cocycles from complex hyperbolic lattices into the Hermitian group SU(p,q). Following the theory recently developed by Moraschini and Savini, we define the Toledo invariant by using the pullback along cocycles, also by involving boundary maps. For cocycles Γ × X → SU(p,q) with 1group. As a consequence, there is no Zariski dense such cocycle when 1cohomology, their image is contained in a finite dimensional algebraic subgroup of PU(p,∞). Finally, we classify Zariski dense measurable cocycles Γ × X → G from finitely generated groups into Hermitian groups not of tube-type. Precisely, we show that the pullback of the Kahler class completely determines the cohomology class of such cocycles.

Finite group lattice gauge theories for quantum simulation

The present manuscript focuses on Lattice Gauge Theories based on finite groups. For the purpose of Quantum Simulation, the Hamiltonian approach is considered, while the finite group serves as a discretization scheme for the degrees of freedom of the gauge fields. Several aspects of these models are studied. First, we investigate dualities in Abelian models with a restricted geometry, using a systematic approach. This leads to a rich phase diagram dependent on the super-selection sectors. Second, we construct a family of lattice Hamiltonians for gauge theories with a finite group, either Abelian or non-Abelian. We show that is possible to express the electric term as a natural graph Laplacian, and that the physical Hilbert space can be explicitly built using spin network states. In both cases we perform numerical simulations in order to establish the correctness of the theoretical results and further investigate the models.