The role of vitamin deficiency in liver disease: To supplement or not supplement?

Over the past few years, growing interest has been shown for the impact of dietary requirements and nutritional factors on chronic diseases. As a result, nutritional programs have been reinforced by public health policies. The precise role of micronutrients in chronic liver disease is currently receiving particular attention since abnormalities in vitamin levels are often detected. At present, treatment programs are focused on correcting vitamin deficiencies, which are frequently correlated to higher rates of comorbidities with poor outcomes. The literature reviewed here indicates that liver diseases are often related to vitamin disorders, due to both liver impairment and abnormal intake. More specific knowledge about the role of vitamins in liver disease is currently emerging from various results and recent evidence. The most significant benefits in this area may be observed when improved vitamin intake is combined with a pharmacological treatment that may also affect the progression of the liver disease, especially in the case of liver tumors. However, further studies are needed

New endoscopic over-the-scope clip system for closure of a chronic tracheoesophageal fistula

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Photo Thermal Effect Graphene Detector Featuring 105 Gbit s-1 NRZ and 120 Gbit s-1 PAM4 Direct Detection

The challenge of next generation datacom and telecom communication is to increase the available bandwidth while reducing the size, cost and power consumption of photonic integrated circuits. Silicon (Si) photonics has emerged as a viable solution to reach these objectives. Graphene, a single-atom thick layer of carbon5, has been recently proposed to be integrated with Si photonics because of its very high mobility, fast carrier dynamics and ultra-broadband optical properties. Here, we focus on graphene photodetectors for high speed datacom and telecom applications. High speed graphene photodetectors have been demonstrated so far, however the most are based on the photo-bolometric (PB) or photo-conductive (PC) effect. These devices are characterized by large dark current, in the order of milli-Amperes , which is an impairment in photo-receivers design, Photo-thermo-electric (PTE) effect has been identified as an alternative phenomenon for light detection. The main advantages of PTE-based photodetectors are the optical power to voltage conversion, zero-bias operation and ultra-fast response. Graphene PTE-based photodetectors have been reported in literature, however high-speed optical signal detection has not been shown. Here, we report on an optimized graphene PTE-based photodetector with flat frequency response up to 65 GHz. Thanks to the optimized design we demonstrate a system test leading to direct detection of 105 Gbit s-1 non-return to zero (NRZ) and 120 Gbit s-1 4-level pulse amplitude modulation (PAM) optical signal

Can Baseline IL-6 Levels Predict Long COVID in Subjects Hospitalized for SARS-CoV-2 Disease?

The immune response to infection plays a crucial role in the pathogenesis of COVID-19, but several patients develop a wide range of persistent symptoms, which is becoming a major global health and economic burden. However, reliable indicators are not yet available to predict the persistence of symptoms typical of the so-called long COVID. Our study aims to explore an eventual role of IL-6 levels as a marker of long COVID. Altogether, 184 patients admitted to the COVID Medicine Unit of the University Hospital in Palermo, Italy, from the 1st of September 2020, were analyzed. Patients were divided into two groups according to the IL-6 serum levels (normal or elevated), considering the serum IL-6 levels measured during the first four days of hospitalization. In our study, higher serum IL-6 levels were associated with a doubled higher risk of long COVID (OR = 2.05; 95% CI: 1.04–4.50) and, in particular, they were associated with a higher incidence of mobility decline (OR = 2.55; 95% CI: 1.08–9.40) and PTSD (OR = 2.38; 95% CI: 1.06–8.61). The analysis of our case series confirmed the prominent role of IL-6 levels in response to SARS-CoV-2 infection, as predictors not only of COVID-19 disease severity and unfavorable outcomes, but also long COVID development trends

The Prevalence of NAFLD and Fibrosis in Bariatric Surgery Patients and the Reliability of Noninvasive Diagnostic Methods

Background: Bariatric surgery patients have a higher prevalence of nonalcoholic fatty liver (NAFL) than the general population; however, its assessment and the accurate staging of fibrosis are often complicated because noninvasive tests are not very accurate in patients with morbid obesity, and liver biopsy cannot be performed as a routine exam. The aim of this study was to evaluate (A) the histological prevalence of NAFL, nonalcoholic steatohepatitis (NASH), and fibrosis in patients undergoing bariatric surgery; (B) the reliability of ultrasound (US) in diagnosing NAFL; and (C) the reliability of various fibrosis scoring systems for defining fibrosis. Methods: US and intraoperative liver biopsy results were reviewed in 57 bariatric surgery patients. NAFL, NASH, and fibrosis were diagnosed according to the Kleiner scoring system. US diagnosis of liver steatosis was based on the bright liver. Fibrosis scores used were (i) the BMI, AST/ALT Ratio, Diabetes (BARD) scoring system; (ii) the nonalcoholic fatty liver disease (NAFLD) fibrosis score; and (iii) the fibrosis-4 (FIB-4) index. Results: The prevalence of NAFL was 81%, NASH 61.4%, and fibrosis 94% (F3 5.7%, cirrhosis 2.8%). The sensitivity of US was 95%, specificity 50%, and likelihood ratio (LR+, LR-) 1.91 and 0.1. The reliability of fibrosis scores for F ≥ 2 were as follows: BARD score: sensitivity 46%, specificity 54%, and area under the receiver-operating characteristics (AUROC) curve 0.5; NAFLD score: sensitivity 30%, specificity 89%, and AUROC 0.5; and FIB-4: sensitivity 68%, specificity 67%, and AUROC 0.7. Conclusions: In bariatric surgery patients, the prevalence of NAFL was 81%, NASH 61.4%, and fibrosis 94%. US is able to rule out the presence of NAFL, while the commonly used scores may be inaccurate in defining fibrosis in patients with morbid obesity

Antiendomysium antibodies assay in the culture medium of intestinal mucosa: an accurate method for celiac disease diagnosis

Background Celiac disease (CD) diagnosis is becoming more difficult as patients with no intestinal histology lesions may also be suffering from CD. Aim To evaluate the diagnostic accuracy of antiendomysium (EmA) assay in the culture medium of intestinal biopsies for CD diagnosis. Patients and methods The clinical charts of 418 patients with CD and 705 non-CD controls who had all undergone EmA assay in the culture medium were reviewed. Results EmA assay in the culture medium had a higher sensitivity (98 vs. 80%) and specificity (99 vs. 95%) than serum EmA/antibodies to tissue transglutaminase (anti-tTG) assay. All patients with CD who were tested as false-negatives for serum EmA and/or anti-tTG (32 adults and 39 children) carried the human leukocyte antigen alleles associated to CD. Furthermore, during the follow-up, four patients with negative-serum EmA/anti-tTG, normal villi architecture, and positive-EmAs in the culture medium, developed villous atrophy and underwent gluten-free diet with consequent resolution of the symptoms and complete intestinal histology recovery. Conclusion EmA assay in the culture medium should be included in the diagnostic criteria for CD diagnosis in 'seronegative' patients. Eur J Gastroenterol Hepatol 23:1018-1023 (C) 2011 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Dispositional optimism as a correlate of decision-making styles in adolescence

Despite the numerous psychological areas in which optimism has been studied, including career planning, only a small amount of research has been done to investigate the relationship between optimism and decision-making styles. Consequently, we have investigated the role of dispositional optimism as a correlate of different decision-making styles, in particular, positive for effective styles and negative for ineffective ones (doubtfulness, procrastination, and delegation). Data were gathered through questionnaires administered to 803 Italian adolescents in their last 2 years of high schools with different fields of study, each at the beginning stages of planning for their professional future. A paper questionnaire was completed containing measures of dispositional optimism and career-related decision styles, during a vocational guidance intervention conducted at school. Data were analyzed using stepwise multiple regression. Results supported the proposed model by showing optimism to be a strong correlate of decision-making styles, thereby offering important intervention guidelines aimed at modifying unrealistically negative expectations regarding their future and helping students learn adaptive decision-making skills