Cerebral Microdialysis: Going Deep into Brain Biochemistry for a Better Understanding of Pathomechanisms of Acute Brain Injury

AbstractPatients with traumatic brain injury (TBI) have variable outcomes subject to intracranial hypertension, ischemia, hypotension, and various biochemical alterations. Multimodality neurointensive monitoring is standard of care for decision making in all severe TBI cases at present in most neurotrauma units. Neuromonitoring tools, such as cerebral microdialysis, may contribute to understanding the pathomechanisms of acute brain injury, provide an early warning of secondary cerebral deterioration (therapeutic window of opportunity), and help in selecting the patients most suitable to benefit from this very invasive surgical rescue therapy. Cerebral microdialysis can be used as a measure of the effect of decompressive craniectomy on neurochemistry derangement and brain energy crisis jeopardizing the injured brain. Present review discusses the cerebral microdialysis, its usefulness, and role in prognostication of severe TBIs, especially in patients post-decompressive craniectomy. The authors also discuss the current consensus guidelines on usage of cerebral microdialysis in TBI patients

Nutritional evaluation of the gluten free diet

Attualmente l’unico trattamento previsto per la malattia celiaca è una rigorosa e permanente eliminazione del glutine dalla dieta. Nella comunità scientifica esiste ancora incertezza riguardo l’adeguatezza e la qualità nutrizionale di tale regime alimentare, poiché gli studi presenti al riguardo sono abbastanza contrastanti rendendo pertanto complicato trarre delle conclusioni definitive. I limitati dati esistenti sulla composizione nutrizionale dei prodotti senza glutine potrebbero in parte spiegare i risultati contrastanti emersi tra gli studi. Inoltre, nonostante negli ultimi anni si sta assistendo a un miglioramento delle qualità dei prodotti senza glutine, scarsa attenzione, in ambito scientifico, è stata rivolta alla percezione edonistica e sensoriale che questi prodotti generano nei bambini celiaci. Con lo scopo di valutare l’adeguatezza nutrizionale della dieta senza glutine, questa tesi di dottorato si è focalizzata principalmente sulla stima delle abitudini alimentari di 60 soggetti celiaci italiani e sul confronto con un gruppo di controllo sano, opportunamente selezionato. Per la realizzazione di questo obiettivo è stato necessario costruire preliminarmente una banca dati di composizione nutrizionale degli alimenti senza glutine più rappresentativi della dieta celiaca italiana. Lo sviluppo di una banca dati di composizione dei prodotti senza glutine rappresenta il primo strumento utile per le indagini nutrizionali sulla popolazione celiaca. Dalla stima della composizione nutrizionale dei prodotti senza glutine si è osservato che questi ultimi sono caratterizzati da una minore quantità di carboidrati e proteine e da un più alto contenuto di lipidi e sodio rispetto ai prodotti analoghi convenzionali contenenti glutine. Diversamente, la maggior parte dei prodotti senza glutine considerati nello studio è caratterizzata da un elevato contenuto di fibra (> 3 g/100 g). I risultati ottenuti dell’indagine nutrizionale su soggetti celiaci hanno dimostrato che questi, pur introducendo la stessa energia del gruppo di controllo, assumevano più energia da grassi totali e saturi, ma meno da carboidrati e proteine. Inoltre, i pazienti celiaci hanno introdotto più vitamina C, vitamina E e potassio rispetto al gruppo sano. In termini di categorie alimentari, i soggetti celiaci hanno consumato significativamente più farine, altri cereali e dolci, ma meno pane dei controlli. In generale, rispetto alle raccomandazioni di energia e nutrienti della popolazione italiana (LARN, 2012), i risultati ottenuti mostrano una qualità della dieta simile nei due gruppi caratterizzata da un elevato consumo di grassi totali, ma da basse introduzioni di fibra, calcio, ferro e folati. Ulteriore obiettivo di questa tesi di dottorato è stato quello di determinare la qualità sensoriale, intesa come gradimento apparente e gustativo, di 3 tipologie di alimenti commerciali senza glutine (biscotti frollini, biscotti al cioccolato e grissini) in 30 bambini celiaci di età compresa tra i 6 e i 12 anni. Dal punto di vista sensoriale, nessuno dei prodotti testati ha raggiunto il massimo gradimento e nella maggior parte dei casi il gradimento visivo ha prevalso su quello gustativo. I risultati di questo studio rappresentano un primo contributo per approfondire gli aspetti sensoriali legati ai prodotti alimentari destinati ai consumatori celiaci. In conclusione, i risultati ottenuti suggeriscono che la dieta senza glutine non risulta bilanciata dal punto di vista nutrizionale. Al fine di raggiungere un adeguato apporto di macro- e micro-nutrienti risulta importante e necessaria l’educazione alimentare di questi soggetti. I risultati sulla percezione sensoriale dei prodotti senza glutine forniscono un'indicazione importante, soprattutto per le aziende manifatturiere che dovrebbero sviluppare nuove formulazioni di prodotti senza glutine con migliori proprietà organolettiche e nutrizionali.Nowadays, the only treatment for celiac disease is represented by a strict and permanent elimination of the gluten from the diet. In the scientific community there is still uncertainty about the nutritional adequacy of the gluten free diet since the studies concerning the adequacy of macro- and micro-nutrient intake of celiac subjects have presented conflicting results. The discrepancy among the studies could be partly linked to the limited data of gluten free foods in the food databases. In recent years, despite the development of the gluten free products is increased, very poor attention has been given to the hedonistic and sensory perception that these products generate in the celiac children. With the aim to assess the nutritional adequacy of the gluten-free diet, this thesis is mainly focused on the evaluation of the dietary habits of 60 Italian celiac patients and the comparison with a matched group of healthy subjects. For this aim, it was necessary firstly to develop a food composition database of gluten free foods more representative of the Italian celiac diet. A further objective of this thesis was to determine the sensory quality, in terms of visual and taste liking, of 3 commercial gluten free foods (i.e., chocolate biscuit, breakfast biscuit and breadstick) in a group of 30 celiac children, aged between 6 and 12 years. The development of the nutrient composition database of gluten free products provides a first useful tool for nutritional surveys on dietary habits of celiac people. The estimated nutritional composition of gluten free products demonstrated that these products generally provide lower amounts of carbohydrates and proteins but a higher content of lipids and sodium than their gluten-containing counterpart. On the contrary, the majority of gluten free products considered contained a high amount of fiber (>3 g/100 g). other cereals (i.e. buckwheat and quinoa) and sweets but the consumption of breads in celiac patients was significant lower than controls The results of nutritional survey on celiac subjects show that although celiac patients observed the same energy as controls, they have a significant higher intake of total and saturated fats, energy from total and saturated fats, vitamin C, vitamin E and potassium than controls. Conversely celiac subjects reported a significant lower intake of energy from carbohydrate and protein than healthy peers. In terms of food categories celiac subjects consumed significantly a higher amounts of flours, other cereals (i.e. buckwheat and quinoa) and sweets but the consumption of breads in celiac patients was significant lower than controls. In relation to recommended intakes this study reveals inadequate intakes of total fats, fiber, calcium, iron, and folate in both groups studied (LARN, 2012). From sensory point of view, the results showed that the gluten free snacks tested do not fully satisfy the taste of celiac children and the majority of children appreciated more the appearance than the taste of all the gluten free products analyzed. The results of this study are a contribution to further investigate the underestimated sensory aspects associated to food products designed for celiac consumers diet. In conclusion, the result of this study suggest that the gluten free diet is not adequate from nutritional point of view. Dietary education should address the achievement of adequate macro and micro-nutrient intake. The results on sensory perception of gluten free products give an important indication, mainly for manufacturing companies that need to offer and propose new GF product formulations with better organoleptic and nutritional properties

Il trattamento del gozzo immerso. La nostra esperienza

Gli Autori, dopo avere accennato alla storia naturale del gozzo immerso, riferiscono la loro esperienza di tale patologia maturata negli ultimi 5 anni, sottolineando i caratteri della complessa sintoma - tologia osservata nei vari casi, la condotta terapeutica seguìta, i buoni risultati ottenuti. Si soffermano quindi ad elencare le molteplici classificazioni, via via proposte. Illustrano le complesse situazioni sia di ordine emodina - mico che respiratorio di particolare interesse anestesiologico. Discutono, infine, sulla diagnostica e soprattutto sul corretto atteggiamento terapeutico il cui obiettivo è duplice: risolvere la sinto - matologia prodotta dalla massa mediastinica ed escludere la possibi - lità di recidiv

Compositional study and antioxidant potential of Ipomoea hederacea Jacq. and Lepidium sativum L. seeds

The present investigation has been carried out to find the proximate composition, amino acids, metal contents, oil composition as well as the antioxidant capacity of the seeds of Ipomoea hederacea Jacq. and Lepidium sativum L. Proximate composition indicated a great difference in oil (14.09\ub10.66, 28.03\ub11.05) and fibre (16.55\ub10.31, 6.75\ub11.20) contents for I. hederacea and L. sativum, respectively. Fatty acid profile indicated that oleic acid (19.50 \ub1 0.37, 30.50 \ub1 0.16) and linoleic acid (52.09 \ub1 0.48, 8.60 \ub1 0.38) are major fatty acids. \u3b3-Tocopheol and alfa-tocopheol (28.70 \ub1 0.14, 111.56 \ub1 0.37) were the most abundant in the seed oil of I. hederacea and L. sativum, respectively. Results of antioxidant assays like TEAC, FRAP and TRAP indicated that L. sativum has much greater antioxidant potential than I. hederacea

Are treated celiac patients at risk for mycotoxins? An Italian case-study

Urinary biomarkers of mycotoxin exposure were evaluated in a group of celiac patients (n = 55) and in a control group of healthy subjects (n = 50) following their habitual diet. Deoxynivalenol (DON), zearalenone (ZEN), and fumonisin B1 (FB1) were monitored in 105 urinary samples collected from the two groups. Dietary habits were also recorded through compilation of a seven-day weighed dietary diary. Biomarkers of mycotoxin exposure were detected in 21 celiac patients and in 15 control subjects, corresponding to about 34% of total participants. In particular, ZEN was the most detected mycotoxin among all the studied subjects with a total of 19 positive cases. Results did not show a statistically significant difference in mycotoxin exposure between the two groups, and the presence of specific mycotoxins was not related to the intake of any particular food category. Our findings suggest little urgency of specific regulation for gluten free products, although the prevalence of exposure observed in free-living diets of both celiac and healthy subjects underlines the need of a constant surveillance on mycotoxins occurrence at large

Phenolic profile and antioxidant potential of selected plants of Pakistan

Antioxidants play an important role in inhibiting and scavenging radicals, thus providing protection to humans against infectious and degenerative diseases. Literature shows that the antioxidant activity is high in medicinal plants. Realizing the fact that, this investigation was carried out to evaluate the in vitro antioxidant capacity of methanolic extracts of Acacia leucophloea (bark), Albizia lebbeck (bark, flower, seed), Capparis decidua (root), Cicer arietinum (seeds) and Grewia asiatica (leaves). Barks showed the highest phenolic content as compared to seeds, leaves and roots and the order observed was A. lebbeck bark> A. leucophloea bark> G. asiatica leaves> C. decidua root >A. lebbeck flowers> A. lebbeck seeds> C. arietinum seeds. Phenolic compounds were identified based on their mass spectral characteristics in each extract. Antioxidant capacity measured by three commonly-benched methods, TEAC, FRAP and TRAP assays indicated that all extracts are a good source of natural antioxidants. Investigated extracts appeared to have potential as a health supplement rich in natural antioxidants and merits further intensive study. The results of this study will promote the reasonable usage of these plants in food and pharmacy industries as well as in alternative medicine and natural therapy

Effects of different maturity stages on antioxidant content of Ivorian Gnagnan (Solanum indicum L.) berries

Gnagnan (Solanum indicum L.) is a spontaneous plant widely distributed in Ivory Coast. During ripening stages, Solanum indicum L. presents different colours (green, yellow and red) and is reported to contain several albeit poorly characterized antioxidant compounds. This paper describes in detail the antioxidant profile (ascorbic acid, carotenoids and polyphenols), antioxidant capacity (FRAP test and Folin-Ciocalteau assay) and the colour changes of Gnagnan berries at different ripening levels. Ascorbic acid content was similar in green and yellow berries, but significantly lower in red ones. Red berries showed a higher content of carotenoids compared to green and yellow ones. Regarding polyphenols, several phenolic acids and flavonoids were found in all berries. The content of caffeoylquinic acids, caffeic acid, flavonol glycosides and naringenin was higher in red berries, while the content of p-coumaric acid and feruloylquinic acids was similar among the three colours. The FRAP assay increased with the ripening process, whereas total polyphenols were similar among berries. Significant differences were found for the colorimetric indexes among products of different degrees of ripening. The present results show the important role of the ripening stage in increasing the antioxidant content of Gnagnan berrie

A 15-year consolidated overview of data in over 6000 patients from the Transthyretin Amyloidosis Outcomes Survey (THAOS)

Background Transthyretin amyloidosis (ATTR amyloidosis) is a progressive, multisystemic, life-threatening disease resulting from the deposition of variant or wild-type (ATTRwt amyloidosis) transthyretin amyloid fibrils in various tissues and organs.Methods Established in 2007, the Transthyretin Amyloidosis Outcomes Survey (THAOS) is the largest ongoing, global, longitudinal, observational study of patients with ATTR amyloidosis, including both hereditary and wild-type disease, and asymptomatic carriers of pathogenic TTR mutations. This analysis describes the baseline characteristics of symptomatic patients and asymptomatic gene carriers enrolled in THAOS since its inception in 2007 (data cutoff: August 1, 2022), providing a consolidated overview of 15-year data from the THAOS registry.Results This analysis included 4428 symptomatic patients and 1707 asymptomatic gene carriers. The majority of symptomatic patients were male (70.8%) with a mean (standard deviation [SD]) age at symptom onset of 56.6 (17.9) years. Compared with the 14-year analysis, V30M remained the most prevalent genotype in Europe (62.2%), South America (78.6%), and Japan (74.2%) and ATTRwt remained most common in North America (56.2%). Relative to the 14-year analysis, there was an increase of mixed phenotype (from 16.6 to 24.5%) and a reduction of predominantly cardiac phenotype (from 40.7 to 31.9%). The proportion of patients with predominantly neurologic phenotype remained stable (from 40.1 to 38.7%). Asymptomatic gene carriers were 58.5% female with a mean age at enrollment of 41.9 years (SD 15.5).Conclusions This overview of > 6000 patients enrolled over 15 years in THAOS represents the largest registry analysis of ATTR amyloidosis to date and continues to emphasize the genotypic and phenotypic heterogeneity of the disease. Nearly a quarter of the symptomatic population within THAOS was mixed phenotype, underscoring the need for multidisciplinary management of ATTR amyloidosis.Trial registrationClinicalTrials.gov Identifier: NCT00628745

Long-term efficacy and safety of inotersen for hereditary transthyretin amyloidosis: NEURO-TTR open-label extension 3-year update

© The Author(s) 2022 Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/Background: Hereditary transthyretin amyloidosis (hATTR/ATTRv) results from the deposition of misfolded transthyretin (TTR) throughout the body, including peripheral nerves. Inotersen, an antisense oligonucleotide inhibitor of hepatic TTR production, demonstrated a favorable efficacy and safety profile in patients with the polyneuropathy associated with hATTR in the NEURO-TTR (NCT01737398) study. We report longer-term efficacy and safety data for inotersen, with a median treatment exposure of 3 years. Methods: Patients who satisfactorily completed NEURO-TTR were enrolled in its open-label extension (OLE) study. Efficacy assessments included the modified Neuropathy Impairment Score + 7 (mNIS + 7), Norfolk Quality of Life-Diabetic Neuropathy (Norfolk QoL-DN) questionnaire total score, and the Short Form 36 (SF-36v2) Health Survey Physical Component Summary score. Safety and tolerability were also assessed. Efficacy is reported for patients living in Europe and North America (this cohort completed the study approximately 9 months before the remaining group of patients outside these regions); safety is reported for the full safety dataset, comprising patients living in Europe, North America, and Latin America/Australasia. This study is registered with ClinicalTrials.gov, identifier NCT02175004. Results: In the Europe and North America cohort of the NEURO-TTR study, 113/141 patients (80.1%) completed the study, and 109 patients participated in the OLE study. A total of 70 patients continued to receive inotersen (inotersen-inotersen) and 39 switched from placebo to inotersen (placebo-inotersen). The placebo-inotersen group demonstrated sustained improvement in neurological disease progression as measured by mNIS + 7, compared with predicted worsening based on projection of the NEURO-TTR placebo data (estimated natural history). The inotersen-inotersen group demonstrated sustained benefit, as measured by mNIS + 7, Norfolk QoL-DN, and SF-36v2, compared with estimated natural history as well as compared with the placebo-inotersen group. With a maximum exposure of 6.2 years, inotersen was not associated with any additional safety concerns or increased toxicity in the OLE study. Platelet and renal monitoring were effective in reducing the risk of severe adverse events in the OLE study. Conclusion: Inotersen treatment for > 3 years slowed progression of the polyneuropathy associated with hATTR, and no new safety signals were observed.info:eu-repo/semantics/publishedVersio