Fish oil-based emulsion for the treatment of parenteral nutrition associated liver disease in an adult patient

Background & aims: Reversal of parenteral nutrition associated liver disease with fish oil emulsion (FO) has been reported in infants. We report a similar case in an adult patient. Methods: A 58 year-old female on home parenteral nutrition for a short bowel syndrome due to Crohn's disease, showed a progressive worsening of liver steatosis, and a persistent increase of the plasma liver function tests (LFTs). LFTs, serum alpha-tochopherol, red blood cell membrane fatty acids and liver histology were evaluated before and after an 8 month treatment with FO. Results: The patient's LFT's improved. There was an increase of the n-3 and a decrease of the n-6 series of fatty acids in erythrocyte membrane. There was an approximate 30% increase in vitamin E status. Before FO, liver histology showed a non-alcoholic steatohepatitis with grade 2 steatosis and inflammation and stage 3 fibrosis. After the treatment, steatosis and inflammation were grade 1, whereas fibrosis remained at stage 3. Conclusions: Infusion of FO was associated with consistent changes of cell membrane fatty acid structure and with mild improvement of vitamin E status. A potential role of FO in decreasing liver steatosis and inflammation with no change of liver fibrosis might be suggested. © 2010 European Society for Clinical Nutrition and Metabolism

Predictive factors for hepatocellular carcinoma recurrence after curative treatments

Hepatocellular carcinoma (HCC) is the fifth most common neoplasm worldwide. Recurrence of HCC after resection or loco-regional therapies represents an important clinical issue as it affects up to 70% of patients. This can be divided into early or late, if it occurs within or after 24 months after treatment, respectively. While the predictive factors for early recurrence are mainly related to tumour biology (local invasion and intrahepatic metastases), late recurrences are mainly related to de novo tumour formation. Thus, it is important to recognize these factors prior to any treatment in each patient, in order to optimize the treatment strategy and follow-up after treatment. The aim of this review is to summarize the current evidence available regarding predictive factors for the recurrence of HCC, according to the different therapeutic strategies available. In particular, we will discuss the role of new ultrasound-based techniques and biological features, such as tumor-related and circulating biomarkers, in predicting HCC recurrence. Recent advances in imaging-related parameters in computed-tomography scans and magnetic resonance imaging will also be discussed

Clinical presentation of celiac disease and diagnosis accuracy in a single-center european pediatric cohort over 10 years

(1) Background: Changes in the clinical presentation of celiac disease (CD) in children have been reported. The guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) allow esophagogastroduodenoscopy (EGD) with biopsies to be avoided under specific circumstances. We aimed to assess the clinical picture of pediatric CD patients at diagnosis and to validate ESPGHAN non-biopsy criteria. (2) Methods: Patients with suspected CD or undergoing screening from 2004 to 2014 at the University Hospital in Modena, Italy were enrolled. The accuracy of ESPGHAN non-biopsy criteria and modified versions were assessed. (3) Results: In total, 410 patients were enrolled, of whom 403 were considered for analysis. Of the patients considered, 45 were asymptomatic and diagnosed with CD (11.2%) while 358 patients (88.2%) were symptomatic, of whom 295 were diagnosed with CD. Among symptomatic CD patients, 57 (19.3%) had gastrointestinal symptoms, 98 (33%) had atypical symptoms and 140 (47.4%) had both. No difference was found for the presence of gastrointestinal symptoms at different ages. The non-biopsy ESPGHAN criteria yielded an accuracy of 59.4% with a positive predictive value (PPV) of 100%; 173 out of 308 EGD (56.2%) could have been avoided. The modified 7× and 5× upper limit of normal cut-offs for IgA anti tissue-transglutaminase reached 60.7% and 64.3% of EGD avoided, respectively. (4) Conclusions: Over 10 years, late age at diagnosis and increased rates of atypical CD presentation were found. ESPGHAN non-biopsy criteria are accurate for CD diagnosis and allow half of unneeded EGD to be avoided. Modified versions allowed sparing a greater number of EGD

A population-based approach to background discrimination in particle physics

Background properties in experimental particle physics are typically estimated using control samples corresponding to large numbers of events. This can provide precise knowledge of average background distributions, but typically does not consider the effect of fluctuations in a data set of interest. A novel approach based on mixture model decomposition is presented as a way to estimate the effect of fluctuations on the shapes of probability distributions in a given data set, with a view to improving on the knowledge of background distributions obtained from control samples. Events are treated as heterogeneous populations comprising particles originating from different processes, and individual particles are mapped to a process of interest on a probabilistic basis. The proposed approach makes it possible to extract from the data information about the effect of fluctuations that would otherwise be lost using traditional methods based on high-statistics control samples. A feasibility study on Monte Carlo is presented, together with a comparison with existing techniques. Finally, the prospects for the development of tools for intensive offline analysis of individual events at the Large Hadron Collider are discussed.Comment: Updated according to the version published in J. Phys.: Conf. Ser. Minor changes have been made to the text with respect to the published article with a view to improving readabilit

Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives

Creatine supplementation has been one of the most studied and useful ergogenic nutritional support for athletes to improve performance, strength, and muscular mass. Over time creatine has shown beneficial effects in several human disease conditions. This review aims to summarise the current evidence for creatine supplementation in advanced chronic liver disease and its complications, primarily in sarcopenic cirrhotic patients, because this condition is known to be associated with poor prognosis and outcomes. Although creatine supplementation in chronic liver disease seems to be barely investigated and not studied in human patients, its potential efficacy on chronic liver disease is indirectly highlighted in animal models of non-alcoholic fatty liver disease, bringing beneficial effects in the fatty liver. Similarly, encephalopathy and fatigue seem to have beneficial effects. Creatine supplementation has demonstrated effects in sarcopenia in the elderly with and without resistance training suggesting a potential role in improving this condition in patients with advanced chronic liver disease. Creatine supplementation could address several critical points of chronic liver disease and its complications. Further studies are needed to support the clinical burden of this hypothesis

Alterations of autophagy in the peripheral neuropathy Charcot-Marie-Tooth type 2B

Charcot-Marie-Tooth type 2B (CMT2B) disease is a dominant axonal peripheral neuropathy caused by 5 mutations in the RAB7A gene, a ubiquitously expressed GTPase controlling late endocytic trafficking. In neurons, RAB7A also controls neuronal-specific processes such as NTF (neurotrophin) trafficking and signaling, neurite outgrowth and neuronal migration. Given the involvement of macroautophagy/autophagy in several neurodegenerative diseases and considering that RAB7A is fundamental for autophagosome maturation, we investigated whether CMT2B-causing mutants affect the ability of this gene to regulate autophagy. In HeLa cells, we observed a reduced localization of all CMT2B-causing RAB7A mutants on autophagic compartments. Furthermore, compared to expression of RAB7AWT, expression of these mutants caused a reduced autophagic flux, similar to what happens in cells expressing the dominant negative RAB7AT22N mutant. Consistently, both basal and starvation-induced autophagy were strongly inhibited in skin fibroblasts from a CMT2B patient carrying the RAB7AV162M mutation, suggesting that alteration of the autophagic flux could be responsible for neurodegeneration.Peer reviewe

Effects of tillage systems in durum wheat under rainfed Mediterranean conditions

A 2-year conservation agriculture experiment was conducted in Southern Italy on durum wheat continuous cropping. Aim of the research was to assess the durum wheat productivity and grain quality in reduced soil tillage systems, according to conservation agriculture principles. The interactions among experimental treatments and climate revealed a close relationship among grain yield, grain quality and wheat growth conditions. Specifically, conventional tillage (CT, plowing and 2 disc harrowing) showed in the 2-year period higher grain production than reduced tillage treatments, minimum (MT, 1 disc harrowing) and No tillage (NT), especially for good crop water availability (3.29 t ha–1 of grain yield in CT, 2.67 in MT and 2.54 in NT). The amount of rainfall (above the average in both years) and its distribution in the growing seasons (more regular in the first year) strongly influenced wheat-grain quality indices (11.97% of protein content in the first year and 9.82% in the second one). Also, the wheat quality resulted more sensitive to the “Year × Tillage” interaction, with differences among tillages more evident in the second year and favourable to NT and MT. Spectral vegetation indexes (NDVI and TVI) measurements at flowering, have been shown to be useful to support farmers in N-late application for improving grain wheat quality. From this experiment carried out during the conversion period and in wet years, wheat managed with CT resulted in higher grain yield and quality, while only test weight showed a significant “Year × Tillage” interaction. Further indications emerged on the need to supply additional (10–20%) seed amount at sowing and crop nitrogen fertilizer in the first transition years in reduced tillage systems compared to conventional ones

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease

Chronic liver disease (CLD), including non-alcoholic fatty liver disease (NAFLD) and its advanced form, non-alcoholic steatohepatitis (NASH), affects a significant portion of the population worldwide. NAFLD is characterised by fat accumulation in the liver, while NASH is associated with inflammation and liver damage. Osteosarcopenia, which combines muscle and bone mass loss, is an emerging clinical problem in chronic liver disease that is often underappreciated. The reductions in muscle and bone mass share several common pathophysiological pathways; insulin resistance and chronic systemic inflammation are the most crucial predisposing factors and are related to the presence and gravity of NAFLD and to the worsening of the outcome of liver disease. This article explores the relationship between osteosarcopenia and NAFLD/MAFLD, focusing on the diagnosis, prevention and treatment of this condition in patients with CLD

Segmental Distribution of Hepatocellular Carcinoma in Cirrhotic Livers

Background: To evaluate the segmental distribution of hepatocellular carcinoma (HCC) according to Couinaud’s anatomical division in cirrhotic patients. Methods: Between 2020 and 2021, a total of 322 HCC nodules were diagnosed in 217 cirrhotic patients who underwent computed tomography (CT) or magnetic resonance imaging (MRI) for the evaluation of suspicious nodules (>1 cm) detected during ultrasound surveillance. For each patient, the segmental position of the HCC nodule was recorded according to Couinaud’s description. The clinical data and nodule characteristics were collected. Results: A total of 234 (72.7%) HCC nodules were situated in the right lobe whereas 79 (24.5%) were detected in the left lobe (p < 0.0001) and only 9 nodules were in the caudate lobe (2.8%). HCC was most common in segment 8 (n = 88, 27.4%) and least common in segment 1 (n = 9, 2.8%). No significant differences were found in the frequencies of segmental or lobar involvement considering patient demographic and clinical characteristics, nodule dimension, or disease appearance. Conclusions: The intrahepatic distribution of HCC differs among Couinaud’s segments, with segment 8 being the most common location and segment 1 being the least common. The segmental distribution of tumour location was similar to the normal liver volume distribution, supporting a possible correlation between HCC location and the volume of hepatic segments and/or the volumetric distribution of the portal blood flow