Background: In the past, most people sought medical information by consulting heath care professionals. Nowadays, many people started to use online resources to access medical information. Objective: The study aims to investigate whether YouTube videos on hemorrhoids and hemorrhoid surgery can be a useful e-learning source for the general population, surgical trainees and specialists. Methods: A YouTube search was performed in October 2019 using the keywords “hemorrhoids” and “hemorrhoid surgery”, and the videos were divided into 2 groups according to the keywords. Three independent researchers assessed the metadata and classified them according to the level of accuracy (hemorrhoid group) and to the level of usefulness (hemorrhoid surgery group). Cohen’s test and Kappa (K) value was used to evaluate the inter-investigators agreement. Results: A total of 200 videos were analyzed, 100 for each keyword. Regarding hemorrhoid group, 43 videos (48.3%) were misleading, 9 were accurate (10.1%), 18 were approximate (20.2%), and 19 were considered a personal experience (21.4%). Regarding hemorrhoid surgery group, around 60% of the videos were lacking clear explanation, while about 16% were inaccurate. Only the remaining 24% were considered useful for teaching. Conclusion: Around half of the YouTube videos regarding hemorrhoids topic are misleading or inaccurate and present a risk of harmful consequences. Credible videos with accurate information need to be uploaded by medical professionals and medical institutions and some sort of filtering using categories by the staff of YouTube appear to be necessary. Care must be taken to produce clear highquality operative clips with generous scientific commentary.

The study aimed to assess the long-term results of the stapled hemorrhoidopexy (SH) using high-volume devices equipped with innovative technology, evaluating recurrence rate, complications rate, and patients' satisfaction. Methods: All the patients who underwent SH using high-volume devices (TST Starr plus, Touchstone International Medical Science Corp., Ltd.) for II to IV symptomatic hemorrhoidal disease from November 2012 to December 2014 were enrolled. Between December 2019 and January 2020, all of them were phone called to come to undergo a proctological reevaluation and asked to fill some questionnaires about hemorrhoidal prolapse recurrence, symptoms recurrence, and surgery satisfaction. Results: Fifty-nine patients with a mean age of 47 years completely answered the questionnaires. Twenty-two of them accepted to come to undergo a proctological reevaluation while 27 preferred to answer only by phone due to their referred wellbeing. The median follow-up was 70.5 months (range, 60-84 months). The recurrence rate was 5.1% with a mean satisfaction level after surgery was 9.1 (range, 0-10) and 84.7% of patients whose satisfaction scored ≥ 8. The mean value of Cleveland Global Quality of Life assessment was 0.79 (range, 0.71-0.93). There were no cases of new onset of impaired anal continence after surgery. Conclusion: The new generation high-volume devices to perform SH resulted to be safe and effective for II to IV degree hemorrhoidal prolapse leading to a lower long-term recurrence rate with an evident reduction of postoperative complications in comparison with the low-volume SH.

Background: In this review an overview of the development of omics studies in recent years were considered. The bottom-up and top-down approaches on system biology were discussed and some of the recent tools that integrate multiomics data on system biology studies were discussed. The improvements on omics applications from genomics to metabolomics was inspected in the light of breast cancer biomarker discovery. Results: It is known that genome or proteome analysis alone is not sufficient to elucidate the molecular mechanism of any disease, but instead, a holistic evaluation including metabolomics studies is rational and gives definite results. This review focused to present the studies performed on breast cancer biomarker development. Breast cancer markers approved in the beginning of the millennium encouraged researchers to search for diagnostic and prognostic biomarkers with the improvements of advanced analytical strategies. The recent developments on omics techniques and tools to process multi omics data are capable of presenting valuable scientific information better than ever before. Conclusion: The clinical perspective of the researches using omics techniques might be supported with the integration of multiomics data to validate the results and to understand the molecular pathway interacted in the biological system.

Introduction Gallstones' color is usually yellow, brown, black or more commonly a mixture of two or more of these colors in different proportions, depending on their composition, with yellow being the most commonly encountered color. Pearl-white gallstones are a very rare entity that has not been studied and reported sufficiently. Case presentation Our patient is a 44-year-old lady who was suffering from recurrent attacks of epigastric and right hypochondrial abdominal pain that was aggravated by consumption of fatty meals. Ultrasound Imaging revealed multiple gallbladder stones. After an elective cholecystectomy unusual pearl-white gallstones were found inside a distended gallbladder filled with transparent thick fluid. Chemical analysis To evaluate the chemical composition of these stones Fourier-transform infrared (FTIR) spectroscopy and X-Ray Diffraction (XRD) tests were performed and revealed that these stones are composed of cholesterol (99.6%) and calcium carbonate (0.4%). Discussion Gallstones are bile depositions of a solid consistency formed inside the gallbladder. Cholesterol, bilirubin, and other substances are involved in the composition of different kinds of gallstones. The presence of gallstones alone inside the gallbladder is usually presented as colicky abdominal pain. Cholecystectomy is a simple surgical removal of the gallbladder from it bed and is the definitive treatment of gallstone disease. Conclusion Pearl-white gallstones are rarely encountered and lack information about their pathogenesis, thus prompting further evaluation and studying.

BACKGROUND Xanthogranulomatous Cholecystitis is a rare inflammatory disease of the gallbladder characterised by a focal or diffuse destructive inflammatory process with accumulation of lipid laden macrophages, fibrous tissue and acute and chronic inflammatory cells. Its importance lies in the fact that it is a benign condition that may be confused with carcinoma of the gallbladder, which is associated with a poor prognosis. It was initially described as a variant of chronic cholecystitis; it has an active destructive process that can lead to significant morbidity as the inflammatory process usually extends into the gallbladder wall and adjacent structures. [1]