Vitamin E as a Treatment for Nonalcoholic Fatty Liver Disease: Reality or Myth?

Obesity is one of the major epidemics of this millennium, and its incidence is growing worldwide. Following the epidemics of obesity, nonalcoholic fatty liver disease (NAFLD) has become a disease of increasing prevalence and a leading cause of morbidity and mortality closely related to cardiovascular disease, malignancies, and cirrhosis. It is believed that oxidative stress is a main player in the development and progression of NAFLD. Currently, a pharmacological approach has become necessary in NAFLD because of a failure to modify lifestyle and dietary habits in most patients. Vitamin E is a potent antioxidant that has been shown to reduce oxidative stress in NAFLD. This review summarizes the biological activities of vitamin E, with a primary focus on its therapeutic efficacy in NAFLD

Infrapatellar Fat Pad Features In Osteoartrhitis: A Histopathological And Molecular Study

Background and aims: Knee osteoarthritis (KOA) is a common cause of disability and pain in adults. Obesity is increasingly recognized as the primary modifiable risk factor for the onset and progression of KOA. The mechanisms that link the two conditions are still not fully clarified but recent data suggest an important role mediated by the infrapatellar fat pad (IFP). Accordingly, we aimed to determine the histomorphological characteristics of IFP in individuals affected by KOA and compare them to those obtained from lean healthy individuals using a histological scoring system. Moreover, we determined the expression of certain adipocytokines in IFP of KOA subjects. Materials and Methods: We enrolled 28 subjects (BMI 35.5±5 kg/m2) undergoing total knee replacement for OA. The controls were represented by IFP and adjacent synovial membrane specimens sampled from bodies or bodies part of 8 healthy subjects without history of osteoarthritis involved in the Body Donation Program ‘Donation to Science’ held by the University of Padova. The microscopic anatomy of IFP was analyzed through histological and morphometrical methods. The histology of the synovial membrane adjacent to the IFP was also analyzed. We determined mRNA expression using Quantitative real time PCR for adipokines (leptin, adiponectin, Peroxisome proliferator-activated receptor gamm, fatty acid binding protein4) and cytokines (Interleukin 6 [IL-6], Tumor necrosis factor alfa[TNF-α], Monocyte chemoattractant protein-1[MCP-1], Vascular endothelial growth factor [VEGF]) in the IFP specimens of KOA subjects. Results: All the evaluated IFPs showed microscopical characteristics similar to white adipose tissue. IFPs were organized in adipose lobuli separated by fibrous septa. No differences were detected in the mean diameter of the adipose lobuli of the IFP in KOA patients and controls. Mononuclear infiltration was present in 22 KOA patients while it was not observed in any of the IFP used as control (p = 0.001). The average number of vessels and the thickness of interlobular septa were significantly higher in KOA patients compared to controls (p < 0.0001 and p = 0.004 respectively). BMI correlated positively with the thickness of the interlobular septa in IFP (p= 0.02, r= 0.42). Concerning synovial membrane, the presence of lymphocytic infiltration and hyperplasia was statistically higher in KOA compared to controls (p <0.001 and p = 0.001 respectively) and it was more vascularized and fibrotic compared to controls (p <0.001 and p = 0.002 respectively). Furthermore, in IFP samples it was noticed an expression of genes typical of inflammed adipose tissue such as IL-6, TNF-α, MCP-1 and VEGF. Moreover, we observed a positive correlation between the number of blood vessels of KOA synovial membrane and mRNA expression of VEGF in IFP (p=0.04). Conclusion: Our study describes for the first time the histopathological characteristics of IFP in a large cohort of patients with KOA. IFP showed pathologic structural changes in the lobule dimension, interlobular septa, vascularization and inflammatory infiltrate. These changes were associated with synovial inflammation. Moreover, we added evidence about the existence of a probable crosstalk between cytokines produced by IFP and the synovial membrane

Relationship between Heart Disease and Liver Disease: A Two-Way Street

In clinical practice, combined heart and liver dysfunctions coexist in the setting of the main heart and liver diseases because of complex cardiohepatic interactions. It is becoming increasingly crucial to identify these interactions between heart and liver in order to ensure an effective management of patients with heart or liver disease to provide an improvement in overall prognosis and therapy. In this review, we aim to summarize the cross-talk between heart and liver in the setting of the main pathologic conditions affecting these organs. Accordingly, we present the clinical manifestation, biochemical profiles, and histological findings of cardiogenic ischemic hepatitis and congestive hepatopathy due to acute and chronic heart failure, respectively. In addition, we discuss the main features of cardiac dysfunction in the setting of liver cirrhosis, nonalcoholic fatty liver disease, and those following liver transplantation

Chemical Composition, Antioxidant and Antibacterial Activities of Thymus broussonetii Boiss and Thymus capitatus (L.) Hoffmann and Link Essential Oils

Thymus capitatus and Thymus broussonnetii are two Moroccan endemic medicinal plants used traditionally by the local population. The present study aims to investigate their essential oil chemical composition, antioxidant and antibacterial activities. The chemical composition of the essential oils was determined using the GC-MS analysis, the antioxidant activity assessed using DPPH and FRAP methods while the antimicrobial activity was evaluated against nine bacteria species tested (Enterococcus faecalis, Serratia fonticola, Acinetobacter baumannii, Klebsiella oxytoca, sensitive Klebsiella pneumoniae, sensitive Escherichia coli, resistant Escherichia coli, resistant Staphylococcus aureus and Enterobacter aerogenes). The major identified compounds of T. capitatus essential oil where carvacrol (75%) and p-cymene (10.58%) while carvacrol (60.79%), thymol (12.9%), p-cymene (6.21%) and γ-terpinene (4.47%) are the main compounds in T. broussonnetii essential oil. The bioactivity of the essential oils of the two species of thyme was explained by their richness in oxygenated monoterpenes known for their great effectiveness with an IC50 of 3.48 ± 0.05 and 4.88 ± 0.04 μL/mL and EC50 of 0.12 ± 0.01 and 0.20 ± 0.02 μL/mL in the DPPH and FRAP assays, respectively, with an important antibacterial activity. These results encourage the use of these plants as a source of natural antioxidants, and antibacterial additives, to protect food from oxidative damage and to eliminate bacteria that are responsible for nosocomial infections

Chemical Composition, Antioxidant and Antibacterial Activities of Thymus broussonetii Boiss and Thymus capitatus (L.) Hoffmann and Link Essential Oils

Thymus capitatus and Thymus broussonnetii are two Moroccan endemic medicinal plants used traditionally by the local population. The present study aims to investigate their essential oil chemical composition, antioxidant and antibacterial activities. The chemical composition of the essential oils was determined using the GC-MS analysis, the antioxidant activity assessed using DPPH and FRAP methods while the antimicrobial activity was evaluated against nine bacteria species tested (Enterococcus faecalis, Serratia fonticola, Acinetobacter baumannii, Klebsiella oxytoca, sensitive Klebsiella pneumoniae, sensitive Escherichia coli, resistant Escherichia coli, resistant Staphylococcus aureus and Enterobacter aerogenes). The major identified compounds of T. capitatus essential oil where carvacrol (75%) and p-cymene (10.58%) while carvacrol (60.79%), thymol (12.9%), p-cymene (6.21%) and γ-terpinene (4.47%) are the main compounds in T. broussonnetii essential oil. The bioactivity of the essential oils of the two species of thyme was explained by their richness in oxygenated monoterpenes known for their great effectiveness with an IC50 of 3.48 ± 0.05 and 4.88 ± 0.04 μL/mL and EC50 of 0.12 ± 0.01 and 0.20 ± 0.02 μL/mL in the DPPH and FRAP assays, respectively, with an important antibacterial activity. These results encourage the use of these plants as a source of natural antioxidants, and antibacterial additives, to protect food from oxidative damage and to eliminate bacteria that are responsible for nosocomial infections

Chemical Composition, Antioxidant and Antibacterial Activities of Thymus broussonetii Boiss and Thymus capitatus (L.) Hoffmann and Link Essential Oils

Thymus capitatus and Thymus broussonnetii are two Moroccan endemic medicinal plants used traditionally by the local population. The present study aims to investigate their essential oil chemical composition, antioxidant and antibacterial activities. The chemical composition of the essential oils was determined using the GC-MS analysis, the antioxidant activity assessed using DPPH and FRAP methods while the antimicrobial activity was evaluated against nine bacteria species tested (Enterococcus faecalis, Serratia fonticola, Acinetobacter baumannii, Klebsiella oxytoca, sensitive Klebsiella pneumoniae, sensitive Escherichia coli, resistant Escherichia coli, resistant Staphylococcus aureus and Enterobacter aerogenes). The major identified compounds of T. capitatus essential oil where carvacrol (75%) and p-cymene (10.58%) while carvacrol (60.79%), thymol (12.9%), p-cymene (6.21%) and gamma-terpinene (4.47%) are the main compounds in T. broussonnetii essential oil. The bioactivity of the essential oils of the two species of thyme was explained by their richness in oxygenated monoterpenes known for their great effectiveness with an IC50 of 3.48 +/- 0.05 and 4.88 +/- 0.04 mu L/mL and EC50 of 0.12 +/- 0.01 and 0.20 +/- 0.02 mu L/mL in the DPPH and FRAP assays, respectively, with an important antibacterial activity. These results encourage the use of these plants as a source of natural antioxidants, and antibacterial additives, to protect food from oxidative damage and to eliminate bacteria that are responsible for nosocomial infections.Peer reviewe

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Infrapatellar Fat Pad Features In Osteoartrhitis: A Histopathological And Molecular Study

Background and aims: Knee osteoarthritis (KOA) is a common cause of disability and pain in adults. Obesity is increasingly recognized as the primary modifiable risk factor for the onset and progression of KOA. The mechanisms that link the two conditions are still not fully clarified but recent data suggest an important role mediated by the infrapatellar fat pad (IFP). Accordingly, we aimed to determine the histomorphological characteristics of IFP in individuals affected by KOA and compare them to those obtained from lean healthy individuals using a histological scoring system. Moreover, we determined the expression of certain adipocytokines in IFP of KOA subjects. Materials and Methods: We enrolled 28 subjects (BMI 35.5±5 kg/m2) undergoing total knee replacement for OA. The controls were represented by IFP and adjacent synovial membrane specimens sampled from bodies or bodies part of 8 healthy subjects without history of osteoarthritis involved in the Body Donation Program ‘Donation to Science’ held by the University of Padova. The microscopic anatomy of IFP was analyzed through histological and morphometrical methods. The histology of the synovial membrane adjacent to the IFP was also analyzed. We determined mRNA expression using Quantitative real time PCR for adipokines (leptin, adiponectin, Peroxisome proliferator-activated receptor gamm, fatty acid binding protein4) and cytokines (Interleukin 6 [IL-6], Tumor necrosis factor alfa[TNF-α], Monocyte chemoattractant protein-1[MCP-1], Vascular endothelial growth factor [VEGF]) in the IFP specimens of KOA subjects. Results: All the evaluated IFPs showed microscopical characteristics similar to white adipose tissue. IFPs were organized in adipose lobuli separated by fibrous septa. No differences were detected in the mean diameter of the adipose lobuli of the IFP in KOA patients and controls. Mononuclear infiltration was present in 22 KOA patients while it was not observed in any of the IFP used as control (p = 0.001). The average number of vessels and the thickness of interlobular septa were significantly higher in KOA patients compared to controls (p < 0.0001 and p = 0.004 respectively). BMI correlated positively with the thickness of the interlobular septa in IFP (p= 0.02, r= 0.42). Concerning synovial membrane, the presence of lymphocytic infiltration and hyperplasia was statistically higher in KOA compared to controls (p <0.001 and p = 0.001 respectively) and it was more vascularized and fibrotic compared to controls (p <0.001 and p = 0.002 respectively). Furthermore, in IFP samples it was noticed an expression of genes typical of inflammed adipose tissue such as IL-6, TNF-α, MCP-1 and VEGF. Moreover, we observed a positive correlation between the number of blood vessels of KOA synovial membrane and mRNA expression of VEGF in IFP (p=0.04). Conclusion: Our study describes for the first time the histopathological characteristics of IFP in a large cohort of patients with KOA. IFP showed pathologic structural changes in the lobule dimension, interlobular septa, vascularization and inflammatory infiltrate. These changes were associated with synovial inflammation. Moreover, we added evidence about the existence of a probable crosstalk between cytokines produced by IFP and the synovial membrane.Introduzione e scopo dello studio: L’osteoartrosi del ginocchio (KOA) è la maggiore causa di disabilità e dolore nella popolazione anziana. L'obesità è considerata il fattore di rischio modificabile più comune per l'insorgenza e la progressione della KOA. Sebbene i meccanismi che collegano le due patologie sono poco chiari, dati recenti suggeriscono un ruolo significativo mediato dal tessuto adiposo infrapatellare (IFP). Lo scopo di questo lavoro è quello di descrivere le caratteristiche istomorofologiche dell’ IFP in soggetti affetti da KOA e confrontarle con quelle ottenute da soggetti sani, utilizzando un sistema di ‘score’ istologico. Inoltre, abbiamo valutato l'espressione dei varie adipocitochine nell’ IFP di soggetti con KOA. Materiali e Metodi: Sono stati arruolati 28 soggetti (BMI 35,5 ± 5 kg / m2) sottoposti a sostituzione totale del ginocchio per KOA. Sono stati utilizzati come controlli, campioni di IFP con membrana sinoviale adiacente prelevati da 8 donatori del programma “Donarsi alla Scienza” dell’Istituto di Anatomia Umana presso l'Università di Padova. L'aspetto microscopico dell’ IFP è stato analizzato con metodi istologici e morfometrici. E’ stato anche effettuato l'esame istologico della membrana sinoviale adiacente all’IFP. Abbiamo determinato l'espressione di mRNA utilizzando real time PCR quantitativa per le seguenti adipochine (leptina, adiponectina, Peroxisome proliferator-activated receptor gamma, Fatty acids binding protein 4) e citochine (interleuchina 6 [IL-6], fattore di necrosi tumorale alfa [TNF-α], Monocyte chemoattractant protein-1 [MCP-1], vascular endothelial growth factor [VEGF]) nei campioni dell’IFP dei soggetti affetti da KOA. Risultati:I campioni di IFP hanno evidenziato caratteristiche microscopiche simili al tessuto adiposo bianco. L’IFP è organizzato in lobuli adiposi separati da setti fibrosi. Non sono state rilevate differenze nel diametro medio del lobulo adiposo dell’IFP sia nei soggetti affetti da KOA che nei controlli. L’ infiltrazione Mononucleare è presente in 22 soggetti con KOA, mentre non è stata osservata in nessun IFP dei controlli (p = 0.001). Il numero medio dei vasi e lo spessore dei setti interlobulari sono significativamente più alti nei soggetti con KOA rispetto ai controlli (p <0.0001 e p = 0,004 rispettivamente). Il BMI correlava positivamente con lo spessore dei setti interlobulari nell’ IFP (p = 0.02, r = 0.42). Inoltre, l’infiltrazione linfocitaria e l’iperplasia sinoviale erano più accentuate nel KOA rispetto ai controlli (p <0.001 e p = 0.001 rispettivamente). La membrana sinoviale era anche più vascolarizzata e fibrotica rispetto ai controlli (p <0.001 e p = 0.002 rispettivamente).Per quanto riguarda l’analisi molecolari, l’ IFP mostrava un espressione dei geni tipiche del tessuto adiposo infiammato come IL-6, TNF-α, MCP-1 e VEGF. Inoltre, abbiamo osservato una correlazione positiva tra l’angiogenesi sinoviale e l’ espressione genica del VEGF nell’ IFP (p = 0.04). Conclusione: Il nostro studio è il primo che descrive le caratteristiche istopatologiche dell’ IFP in soggetti prevalentemente sovrappeso/obesi affetti da KOA. L’IFP aveva un fenotipo patologico caratterizzato dall’alterazione a livello della dimensione del lobulo, dello spessore dei setti interlobulari, del grado di vascolarizzazione ed dell’infiltrato infiammatorio. Queste alterazioni strutturali sono state associate ad un’infiammazione a livello della membrana sinoviale adiacente. Inoltre, abbiamo aggiunto un’altra prova dell'esistenza di una probabile crosstalk tra citochine prodotte dall’ IFP e la membrana sinoviale

Hypertrophic, Dilated, and Arrhythmogenic Cardiomyopathy: Where Are We?

Cardiomyopathies are a heterogeneous group of structural, mechanical, and electrical heart muscle disorders which often correlate with life-threatening arrhythmias and progressive heart failure accounting for significant cardiovascular morbidity and mortality. Currently, cardiomyopathies still represent a leading reason for heart transplantation worldwide. The last years have brought remarkable advances in the field of cardiomyopathies especially in terms of understanding the molecular basis as well as the diagnostic evaluation and management. Although most cardiomyopathy treatments had long focused on symptom management, much of the current research efforts aim to identify and act on the disease-driving mechanisms. Regarding risk assessment and primary prevention of sudden cardiac death, additional data are still pending in order to pave the way for a more refined and early patient selection for defibrillator implantation. This review summarizes the current knowledge of hypertrophic, dilated and arrhythmogenic cardiomyopathy with a particular emphasis on their pathophysiology, clinical features, and diagnostic approach. Furthermore, the relevant ongoing studies investigating novel management approaches and main gaps in knowledge are highlighted