Effects of different dietary interventions on non-alcoholic fatty liver disease.

Many nutrients and the overall dietary composition can influence liver function. In fact, an excessive intake of refined carbohydrate and saturated fats, an increased consumption of fructose and other simple sugars, and the spread of high-calorie Western diets have been associated with a dramatic increase in overweight/obesity and insulin resistance and, more recently, also with non-alcoholic fatty liver disease (NAFLD). Noteworthy, the excess of adiposity, in particular abdominal adiposity, and insulin resistance are the major contributors to the development of several cardiometabolic abnormalities strictly related to the increased risk of cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM). Recently, considerable interest has been placed on the possible beneficial effect of some dietary components on NAFLD. Generally, hypercaloric diets, especially rich in trans/saturated fat and cholesterol, high consumption of red and processed meat, and fructose-sweetened beverages seem to increase the risk of NAFLD development, whereas a high consumption of foods or beverages rich in bioactive compounds of plant origin, such as whole grains, legumes, fruits, vegetables, nuts, coffee and tea, have shown preventive and therapeutic effects on NAFLD. The relationship between the intake of some dietary components and the improvement in NAFLD could be related, at least in part, to some bioactive compounds able to improve glucose and lipid metabolism, insulin resistance, hepatic fat content, sub-clinical inflammatory status, and oxidative stress. Consequently, it is conceivable that the combination of these foods in a dietary model such as a "Portfolio diet", inspired to a Mediterranean Diet model in which more beneficial dietary component are included – i.e. low glycemic index (GI) carbohydrates, vegetable fiber, monounsaturated fatty acids (MUFA), n-6 and n-3 polyunsaturated fatty acids (PUFA), polyphenols, and vitamins – could maximize the impact on prevention and treatment of NAFLD. In this scenario, it is important to define which dietary components are able to prevent and treat NAFLD to design dietary interventions to test. Therefore, the present project was designed to assess: (1) the relationships between liver fat content and metabolic, inflammatory and nutritional factors in a homogeneous cohort of individuals at high cardio-metabolic risk; (2) the effects of fructose intake on liver fat content and other cardiometabolic risk factors in a large cohort of abdominally obese men; (3) the effects of a Portfolio diet versus an isoenergetic diet rich in MUFA on liver fat content in patients with T2DM

Oncological, Vascular, and Spinal Uses of Contrast-Enhanced Ultrasound in Neurosurgery

Contrast-enhanced ultrasound (CEUS) is a real-time, feasible technique. Both intraoperatively and bedside, it satisfies the need for serial assessment and easy performability. Initially employed in neuro-oncology, it has recently overcome this first application. The chapter aims to give a comprehensive view of its use in oncological, vascular, and spinal neurosurgery. CEUS versatility across the aforementioned areas is analyzed, underlining its complementarity to other well-settled imaging techniques. Its major oncological (both cerebral and spinal) and vascular (including aneurysms, AVMs, dAVFs, carotid plaques, and stroke) application and state of the art are discussed. The chapter is focused on reporting CEUS advantages and disadvantages, giving an insight to future perspectives and applications

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

Background: Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide. Objectives: The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS. Methods: Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated. Results: Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS. Conclusions: The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS

New Perspective to Improve Care of Patients with Infected Diabetic Foot Ulcer: Early Economic Impact of the Use of Photodynamic Therapy with RLP068 (Based) System

Objective: To perform an early economic evaluation of a system based on photodynamic advanced adjuvant therapy with photosensitizer RLP068/CI to facilitate the healing process of foot/leg skin lesions/ulcers with an excellent safety profile.Design: An early short-term (10 weeks) cost-effectiveness and a budget impact analysis (over 5 years) comparing photodynamic therapy with photosensitizer RLP068/CI based (PDT-RLP068) system added to Standard of Care (SoC) vs SoC alone.Setting: The Italian National Healthcare System perspective considering both the outpatient and the day-hospital regimen.Participants: Hypothetical patients with diabetic foot infection (DFI) grades I/IIB.Interventions: The PDT-RLP068 system as an add-on to Standard of Care (SoC) vs SoC alone as the first-line treatment for the management of DFIs.Main Outcomes: Days within which the clinical target was achieved and direct health costs for patients' management.Results: Additional costs generated by the use of the PDT-RLP068 system progressively decreased as time to reach the target induced by the novel system decreased. In the outpatient regimen, when time to reach clinical target decreased in the range 7-28 days, ICERs varied from about 1 to 70 for each additional day gained with clinical target achieved. The system was dominant when halving time to reach the target in the outpatient regimen and even for modest reduction of time in day-hospital regimen. In terms of budget impact, when considering day-hospital regimen, if the PDT-RLP068 based system allowed a shortened duration to reach the clinical target of between 7-28 days, BI was 8,100,000 to 700,000, with saving less than 2,000,000 with 50% reduction of time. Considering the inpatient setting, the use of the PDT-RLP068 system would result in saving even with the modest impact on the time needed to activate the healing process.Conclusion: The early economic evaluation performed suggested that, if the claimed effectiveness of the technology demonstrated in case reports and in preliminary clinical studies can be confirmed in larger population studies, and allowing for shortening of the time needed to activate the healing process, the PDT-RLP068 system could offer the chance to improve care for DFI patients without compromising the sustainability of the system

Dietary fibre as a unifying remedy for the whole spectrum of obesity-associated cardiovascular risk

Obesity is a pandemic carrying the heavy burden of multiple and serious co-morbidities including metabolic syndrome, type 2 diabetes and cardiovascular diseases. The pathophysiological processes leading to the accumulation of body fat slowly evolve to fat accumulation in other body compartments than subcutaneous tissue. This abnormal fat deposition determines insulin resistance which in turn causes blood glucose and lipid metabolism derangement, non-alcoholic fatty liver disease, hypertension, and metabolic syndrome. All these conditions contribute to increase the cardiovascular risk of obese people. Several randomized clinical trials demonstrated that moderate weight loss (5–10%) in obese patients improves obesity-related metabolic risk factors and coexisting disorders. Therefore, nutritional strategies able to facilitate weight management, and in the meantime positively influence obesity-associated cardiovascular risk factors, should be implemented. To this aim, a suitable option could be dietary fibres that may also act independently of weight loss. The present narrative review summarizes the current evidence about the effects of dietary fibres on weight management in obese people. Moreover, all of the different cardiovascular risk factors are individually considered and evidence on cardiovascular outcomes is summarized. We also describe the plausible mechanisms by which different dietary fibres could modulate cardio-metabolic risk factors. Overall, despite both epidemiological and intervention studies on weight loss that show statistically significant but negligible clinical effects, dietary fibres seem to have a beneficial impact on main pathophysiological pathways involved in cardiovascular risk (i.e., insulin resistance, renin-angiotensin, and sympathetic nervous systems). Although the evidence is not conclusive, this suggests that fibre would be a suitable option to counteract obesity-related cardio-metabolic diseases also independently of weight loss. However, evidence is not consistent for the different risk factors, with clear beneficial effects shown on blood glucose metabolism and Low Density Lipoprotein (LDL) cholesterol while there is fewer, and less consistent data shown on plasma triglyceride and blood pressure. Ascribing the beneficial effect of some foods (i.e., fruits and vegetables) solely to their fibre content requires more investigation on the pathophysiological role of other dietary components, such as polyphenols