Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis

The current epidemic of non-alcoholic fatty liver disease (NAFLD) is reshaping the field of hepatology all around the world. The widespread diffusion of metabolic risk factors such as obesity, type2-diabetes mellitus, and dyslipidemia has led to a worldwide diffusion of NAFLD. In parallel to the increased availability of effective anti-viral agents, NAFLD is rapidly becoming the most common cause of chronic liver disease in Western Countries, and a similar trend is expected in Eastern Countries in the next years. This epidemic and its consequences have prompted experts from all over the word in identifying effective strategies for the diagnosis, management, and treatment of NAFLD. Different scientific societies from Europe, America, and Asia-Pacific regions have proposed guidelines based on the most recent evidence about NAFLD. These guidelines are consistent with the key elements in the management of NAFLD, but still, show significant difference about some critical points. We reviewed the current literature in English language to identify the most recent scientific guidelines about NAFLD with the aim to find and critically analyse the main differences. We distinguished guidelines from 5 different scientific societies whose reputation is worldwide recognised and who are representative of the clinical practice in different geographical regions. Differences were noted in: the definition of NAFLD, the opportunity of NAFLD screening in high-risk patients, the noninvasive test proposed for the diagnosis of NAFLD and the identification of NAFLD patients with advanced fibrosis, in the follow-up protocols and, finally, in the treatment strategy (especially in the proposed pharmacological management). These difference have been discussed in the light of the possible evolution of the scenario of NAFLD in the next years

Bioactive Compounds in Goat Milk and Cheese: The Role of Feeding System and Breed

This chapter provides an introductory overview of some bioactive compounds in goat milk, presenting a selection of key results from literature. The aim of the chapter is to review the effects of the feeding system and of the breed on goat milk and cheese fine quality in order to identify management options aimed at improving the nutraceutical characteristics of milk and dairy products. We will discuss a series of case studies focused on the assessment of the effects of feeding system and breed and their interaction on specific health-promoting bioactive compounds: (i) fatty acid (FA) profile, (ii) antioxidant compounds and (iii) oligosaccharides (OS). Experimental data will be discussed highlighting the potential role of local Mediterranean breeds for the production of functional dairy products

Bioactivity of Different Chemotypes of Oregano Essential Oil against the Blowfly Calliphora vomitoria Vector of Foodborne Pathogens

Blowflies play a substantial role as vectors of microorganisms, including human pathogens. The control of these insect pests is an important aspect of the prevention of foodborne diseases, which represent a significant public health threat worldwide. Among aromatic plants, spices essential oils (EOs) are the most suitable to protect food from insect pests. In this study, we determined the chemical composition of three oregano EOs and assessed their toxicity and deterrence to oviposition against the blowfly Calliphora vomitoria L. The chemical analyses showed that the EOs belonged to three chemotypes: one with a prevalence of carvacrol, the carvacrol chemotype (CC; carvacrol, 81.5%), and two with a prevalence of thymol, the thymol/p-cymene and thymol/-terpinene chemotypes(TCC and TTC; thymol, 43.8, and 36.7%, respectively). The bioassays showed that although all the three EOs chemotypes are able to exert a toxic activity against C. vomitoria adults (LD50 from 0.14 to 0.31 L insect1) and eggs (LC50 from 0.008 to 0.038 L cm2) as well as deter the oviposition (Oviposition Activity Index, OAI, from 0.40 0.04 to 0.87 0.02), the bioactivity of oregano EOs significantly varies among the chemotypes, with the thymol-rich EOs (TCC and TTC) overall demonstrating more effectiveness than the carvacrol-rich (CC) EO

Comparison of cheeses from goats fed 7 forages based on a new health index.

This study proposed the General Health Index of Cheese (GHIC) as an indicator for the presence of health-promoting compounds in cheese and compared the antioxidant capacity and phenolic and fatty acid contents of cheeses from goats consuming 7 forage species. Ninety-one homogeneous Red Syrian goats were randomly assigned to 1 of 7 feeding treatments (Festuca arundinacea, Hordeum vulgare, Triticosecale, Pisum sativum, Trifolium alexandrinum, Vicia sativa, and Vicia faba minor). The housed goat groups received the scheduled forage ad libitum. Forage species affected the antioxidant capacity, the phenolic and fatty acid contents, the Health Promoting Index, and the GHIC. Trifolium alexandrinum, Triticosecale, and Hordeum vulgare showed a clear advantage in terms of beneficial fatty acids content in goat cheese. Cheese from the Triticosecale group also showed a high antioxidant capacity value even if its polyphenol content was intermediate compared with others. Trifolium alexandrinum and Triticosecale had the highest value of the new index GHIC. This comparison suggests that there are important differences in fatty acid profile and polyphenol content among cheeses from goats fed grasses and legumes commonly used in the Mediterranean area. In this first approach, GHIC index, which combines the positive components found in cheese, seems to be a useful tool to provide an indication concerning the general health value of the product

Insights into the safety and versatility of 4D printed intravesical drug delivery systems

This paper focuses on recent advancements in the development of 4D printed drug delivery systems (DDSs) for the intravesical administration of drugs. By coupling the effectiveness of local treatments with major compliance and long-lasting performance, they would represent a promising innovation for the current treatment of bladder pathologies. Being based on a shape-memory pharmaceutical-grade polyvinyl alcohol (PVA), these DDSs are manufactured in a bulky shape, can be programmed to take on a collapsed one suitable for insertion into a catheter and re-expand inside the target organ, following exposure to biological fluids at body temperature, while releasing their content. The biocompatibility of prototypes made of PVAs of different molecular weight, either uncoated or coated with Eudragit®-based formulations, was assessed by excluding relevant in vitro toxicity and inflammatory response using bladder cancer and human monocytic cell lines. Moreover, the feasibility of a novel configuration was preliminarily investigated, targeting the development of prototypes provided with inner reservoirs to be filled with different drug-containing formulations. Samples entailing two cavities, filled during the printing process, were successfully fabricated and showed, in simulated urine at body temperature, potential for controlled release, while maintaining the ability to recover about 70% of their original shape within 3 min

Acute Liver Failure Caused by Amanita phalloides

Mushroom poisoning is a relatively rare cause of acute liver failure (ALF). The present paper analyzes the pathogenesis, clinical features, prognostic indicators, and therapeutic strategies of ALF secondary to ingestion of Amanita phalloides, which represents the most common and deadly cause of mushroom poisoning. Liver damage from Amanita phalloides is related to the amanitins, powerful toxins that inhibit RNA polymerase II resulting in a deficient protein synthesis and cell necrosis. After an asymptomatic lag phase, the clinical picture is characterized by gastrointestinal symptoms, followed by the liver and kidney involvement. Amatoxin poisoning may progress into ALF and eventually death if liver transplantation is not performed. The mortality rate after Amanita phalloides poisoning ranges from 10 to 20%. The management of amatoxin poisoning consists of preliminary medical care, supportive measures, detoxification therapies, and orthotopic liver transplantation. The clinical efficacy of any modality of treatment is difficult to demonstrate since randomized, controlled clinical trials have not been reported. The use of extracorporeal liver assist devices as well as auxiliary liver transplantation may represent additional therapeutic options