Clinical implications of the hyperdynamic syndrome in cirrhosis.

The hyperdynamic syndrome is a late consequence of portal hypertension in cirrhosis. The principal hemodynamic manifestations of the hyperdynamic syndrome are high cardiac output, and increased heart rate and total blood volume, accompanied by reduced total systemic vascular resistance. Pathophysiology involves a complex of humoral and neural mechanisms that can determine hemodynamic changes, and lead to hyperdynamic circulation. In this review we focus our attention on the manifestations of the hyperdynamic syndrome. Some of these are well described and directly related to portal hypertension (varices, ascites, hepatic encephalopathy, and hepatorenal syndrome), while others, such as hepatopulmonary syndrome, portopulmonary hypertension, and cirrhotic cardiomyopathy, are less known as clinical manifestations related to cirrhosis and, therefore, merit further investigation

Clinical course and management of acute and chronic viral hepatitis during pregnancy.

Pregnancy is a para-physiologic condition, which usually evolves without any complications in the majority of women, even if in some circumstances moderate or severe clinical problems can also occur. Among complications occurring during the second and the third trimester very important are those considered as concurrent to pregnancy such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, HELLP syndrome and acute fatty liver of pregnancy. The liver diseases concurrent to pregnancy typically occur at specific times during the gestation and they may lead to significant maternal and foetal morbidity and mortality. Commonly, delivery of the foetus, even preterm, usually terminates the progression of these disorders. All chronic liver diseases, such as chronic viral hepatitis, autoimmune hepatitis, Wilson's disease, and cirrhosis of different aetiologies may cause liver damage, independently from pregnancy. In this review we will also comment the clinical implications of pregnancies occurring in women who received a orthotopic liver transplantation (OLT) Therefore, the management of immunosuppressive therapy before and after the delivery in women who received liver transplant is becoming a relevant clinical issue. Finally, we will focus on acute and chronic viral hepatitis occurring during pregnancy, on management of advanced liver disease and we will review the literature on the challenging issue regarding pregnancy and OLT

Credenze metacognitive e propensione al bere negli adolescenti

Secondo il modello della funzione autoregolatoria del bere problematico (Spada e Wells, 2009), le credenze meta-cognitive sono una specifica forma di aspettative circa gli effetti benefici dell’alcol sul funzionamento cognitivo ed emotivo (meta-credenze positive) o circa i danni e l’incontrollabilità del bere (meta-credenze negative). Queste meta-credenze predicono il consumo alcolico in adulti dipendenti e universitari binge drinkers (Clark et al., 2012). Scopo della ricerca è provare l’ipotesi che gli adolescenti a rischio alcolico evidenziano livelli maggiori di meta-credenze positive e negative sull’alcol e indagare il peso di alcune caratteristiche individuali e di contesto (coetanei e famiglia) nel predirne il consumo. Gli adolescenti hanno compilato la Positive Alcohol Metacognitions Scale e la Negative Alcohol Metacognitions Scale (Spada e Wells, 2008), l’AUDIT-C per il rischio alcolico, alcuni item inerenti fattori di rischio/protezione di tipo individuale, familiare e dei pari (Bonino et al., 2007). Gli adolescenti a rischio (25.4%) presentano maggiori meta-credenze positive, frequentano coetanei più propensi al consumo di alcolici, vivono con genitori che ne approvavano l’assunzione. Soltanto le ragazze non a rischio hanno maggiori meta-credenze negative e più fattori individuali di protezione. Le meta-credenze positive risultano il più forte predittore del consumo alcolico per entrambi i generi. Solo per le ragazze le meta-credenze negative intervengono come predittore negativo. Le meta-credenze positive, pertanto, si confermano anche in adolescenza un fattore di rischio del bere problematico. A differenza di quanto osservato in individui di età maggiore, sembra che in questa fase evolutiva le meta-credenze negative per le ragazze siano un fattore di protezione

Effect of high, medium, and low molecular weight hyaluronan on inflammation and oxidative stress in an in vitro model of human nasal epithelial cells

IL-17A is involved in the activation of oxidative stress and inflammation in nasal epithelial cells. Hyaluronan (HA) in its high molecular weight form (HMW-HA) shows anti-inflammatory responses in contrast to low and medium molecular weight HA (LMW-HA and MMW-HA). The aim of this study was to investigate the pro- or anti-inflammatory biologic function of HA at different molecular weight in an in vitro model of nasal inflammation IL-17A mediated. We evaluated the ERK1/2 and IκBα phosphorylation, NF-κB signal pathway activation, ROS production, IL-8 and NOX-4 protein, and mRNA levels, in nasal epithelial cells RPMI 2650 stimulated with recombinant human (rh) IL-17A. Furthermore, the cells were treated with HMW-HA, MMW-HA, LMW-HA, and U0126. Our results showed that rhIL-17A increased the ERK1/2, IκBα phosphorylation and NF-κB signal pathway activation, ROS production, IL-8 and NOX-4 proteins, and mRNA levels. The addiction of HMW-HA or U0126 showed a significant downregulatory effect on inflammation due to the rhIL-17A stimulation in nasal epithelial cells. IL-17A is able to generate oxidative stress and inflammation via the activation of ERK1/2/NF-κB pathway in nasal epithelial cells. The HMW-HA might represent a coadjuvant of the classic anti-inflammatory/antioxidative treatment of nasal epithelial cells during IL-17A nasal inflammation