Nonalcoholic fatty liver disease: Evolving paradigms

In the last years new evidence has accumulated on nonalcoholic fatty liver disease (NAFLD) challenging the paradigms that had been holding the scene over the previous 30 years. NAFLD has such an epidemic prevalence as to make it impossible to screen general population looking for NAFLD cases. Conversely, focusing on those cohorts of individuals exposed to the highest risk of NAFLD could be a more rational approach. NAFLD, which can be diagnosed with either non-invasive strategies or through liver biopsy, is a pathogenically complex and clinically heterogeneous disease. The existence of metabolic as opposed to genetic-associated disease, notably including "lean NAFLD" has recently been recognized. Moreover, NAFLD is a systemic condition, featuring metabolic, cardiovascular and (hepatic/extrahepatic) cancer risk. Among the clinico-laboratory features of NAFLD we discuss hyperuricemia, insulin resistance, atherosclerosis, gallstones, psoriasis and selected endocrine derangements. NAFLD is a precursor of type 2 diabetes (T2D) and metabolic syndrome and progressive liver disease develops in T2D patients in whom the course of disease is worsened by NAFLD. Finally, lifestyle changes and drug treatment options to be implemented in the individual patient are also critically discussed. In conclusion, this review emphasizes the new concepts on clinical and pathogenic heterogeneity of NAFLD, a systemic disorder with a multifactorial pathogenesis and protean clinical manifestations. It is highly prevalent in certain cohorts of individuals who are thus potentially amenable to selective screening strategies, intensive follow-up schedules for early identification of liver-related and extrahepatic complications and in whom earlier and more aggressive treatment schedules should be carried out whenever possible

Annali storici di Principato Citra, A. 6, n. 2.2 (2008)

A. 6, n. 2.2 (2008): G. Guardia, Editoriale, P. 3 ; A. Trezza, Il Cilento in semiotica del paesaggio: testo della cultura e testo paesaggistico, P. 5 ; M.L. Mautone, Un cofanetto nuziale della bottega degli Embrachi al Museo Diocesano di Vallo della Lucania, P. 35 ; E. Granito, Lotte operaie nel Salernitano dall’Unità all’Età Giolittiana. Menechella la scapricciata e i suoi compagni, P. 48 ; A. Gargano, Affreschi oligarchici: lettere anonime, ricorsi e inchieste prefettizie nella vita socio-amministrativa di Pagani nel tardo Ottocento, P. 69 ; E. Bianco, L’incastellamento medievale nel Cilento interno: il borgo murato di Stio (XI-XVI sec.). Prime indagini, P. 96 ; E. Frescani, L’arte di imparare. Note sull’apprendistato nella valle dell’Irno nel XVII secolo, P. 109 ; E. Catone, I marchesi Forcella a Buccino. Brevi note genealogiche, P. 114 ; G. Pepe, Francesco Durelli: uno storico ignorato, P. 124 ; A. La Greca, “In diem Christi conscientiam onerantes”. L’atto di rifondazione della confraternita del SS. Rosario di Montecorice e del suo trasferimento dalla cappella di S. Sofia alla nuova chiesa parrocchiale di S. Biagio (6 febbraio 1589), P. 139 ; A. Capano, Note di toponomastica in margine al Catasto provvisorio di San Giovanni a Piro (1815) e di Bosco sua frazione (20 sett. 1828), P. 146 ; Nota di Redazione, Pioppi: « culla » della Dieta Mediterranea. Celebrati i 25 anni di “Cronache Cilentane” e la XVIII Edizione degli “Incontri Mediterranei”, P. 180 ; M. Serra, Un’avvincente iniziativa editoriale del Centro di Promozione Culturale per il Cilento, P. 183 ; G. De Vita, “Oltre la torre d’avorio”. Un libro degli allievi per i sessant’anni del prof. Luigi Rossi, P. 188

"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 ± 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Biomass and Methane Production in Double Cereal Cropping Systems with Different Winter Cereal and Maize Plant Densities

The biogas supply chain requires a correct combination of crops to maximize the methane yield per hectare. Field trials were carried out in North Italy over three growing seasons, according to a factorial combination of four cropping systems (maize as a sole-crop or after hybrid barley, triticale and wheat) and two maize plant densities (standard, 7.5 plants m−2 and high, 10 plants m−2) with the plants harvested as whole-crop silage. The specific methane production per ton was measured through the biochemical methane potential (BMP) method, while the methane yield per hectare was calculated on the basis of the BMP results and considering the biomass yield. The average methane yield of wheat resulted to be equal to 4550 Nm3 ha−1, and +17% and +28% higher than triticale and barley, respectively, according to the biomass yield. A delay in maize sowing reduced the yield potential of this crop; the biomass of maize grown after barley, triticale and wheat was 20%, 33% and 47% lower, respectively, than maize cultivated as a single crop. The high plant population increased the biomass yield in the sole-crop maize (+23%) and in the maize grown after barley (+20%), compared to the standard density. The highest biomass (32 t ha−1 DM) and methane yield (9971 Nm3 ha−1) within the cropping systems were obtained for barley followed by maize at a high plant density. This cropping system increased the methane yield by 46% and 18%, respectively, compared to the sole-crop maize or maize after triticale at a standard density. The smaller amount of available solar radiation, resulting from the later sowing of maize, reduced the advantage related to the application of a high plant density

Multi-Mycotoxin Long-Term Monitoring Survey on North-Italian Maize over an 11-Year Period (2011–2021): The Co-Occurrence of Regulated, Masked and Emerging Mycotoxins and Fungal Metabolites

Maize is considered one of the most susceptible crops to mycotoxin-producing fungi throughout the world, mainly belonging to the Fusarium spp. and Aspergillus spp. Maize is mainly used as animal feeds in Italy, as well as for human consumption, being essential for all the protected designation of origin (DOP) products. Our study investigated the occurrence of regulated mycotoxins in 3769 maize grain samples collected from 88 storage centers by the National Monitoring Network over an 11-year period (2011–2021). Moreover, an in-depth survey over a 4-year period, characterized by extremely different meteorological conditions, was conducted to investigate the co-occurrence of regulated, masked, and emerging mycotoxins. The survey confirmed that Fusarium spp. was the most frequent fungi and fumonisins were the main mycotoxins that were constantly detected in the different years and areas. Moreover, the areas characterized by high fumonisin levels were also the most prone to contamination by emerging mycotoxins produced by the same Fusarium species of the Liseola section. On the other hand, as a result of climatic changes, maize grains have also been affected by the increased frequency of aflatoxin accumulation. Deoxynivalenol, zearalenone, and other emerging mycotoxins produced by the same Fusarium species as the Discolor section occurred more abundantly in some areas in Northern Italy and in years characterized by predisposing meteorological conditions

Correction: Quarantine and Appendicitis: A Macro-Area Experience

quarantine offer new aspects about incidence of appendicitis especially in our macroare

Pathogenesis and significance of hepatitis C virus steatosis: An update on survival strategy of a successful pathogen

Hepatitis C virus (HCV) is a successful pathogen on the grounds that it exploits its host's metabolism to build up viral particles; moreover it favours its own survival by inducing chronic disease and the development of specific anatomic changes in the infected organ. Steatosis, therefore, is associated with HCV infection by necessity rather than by chance alone. Approximately 6% of HCV patients have steatohepatitis. Interestingly, HCV steatosis occurs in the setting of multiple metabolic abnormalities (hyperuricemia, reversible hypocholesterolemia, insulin resistance, arterial hypertension and expansion of visceral adipose tissue) collectively referred to as "hepatitis C-associated dysmetabolic syndrome" (HCADS). General, nonalcoholic fatty liver disease (NAFLD)-like, mechanisms of steatogenesis (including increased availability of lipogenic substrates and de novo lipogenesis; decreased oxidation of fatty substrates and export of fatty substrates) are shared by all HCV genotypes. However, genotype 3 seemingly amplifies such steatogenic molecular mechanisms reported to occur in NAFLD via more profound changes in microsomal triglyceride transfer protein; peroxisome proliferator-activated receptor alpha; sterol regulatory element-binding proteins and phosphatase and tensin homologue. HCV steatosis has a remarkable clinical impact in as much as it is an acknowledged risk factor for accelerated fibrogenesis; for impaired treatment response to interferon and ribavirin; and development of hepatocellular carcinoma. Recent data, moreover, suggest that HCV-steatosis contributes to premature atherogenesis via both direct and indirect mechanisms. In conclusion, HCV steatosis fulfills all expected requirements necessary to perpetuate the HCV life cycle. A better understanding of the physiology of HCADS will likely result in a more successful handling of disease with improved antiviral success rates. © 2014 Baishideng Publishing Group Inc. All rights reserved

Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis

AIM To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis. METHODS A prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age-and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression. RESULTS At the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A. CONCLUSION Undiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer