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

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

Increased leptin/leptin receptor pathway affects systemic and airway inflammation in COPD former smokers

Background: Leptin, a hormone produced mainly by adipose tissue, regulates food intake and energy expenditure. It is involved in inflammatory diseases such as chronic obstructive pulmonary disease (COPD) and its deficiency is associated with increased susceptibility to the infection. The leptin receptor is expressed in the lung and in the neutrophils. Methods: We measured the levels of leptin, tumor necrosis factor alpha (TNF-a) and soluble form of intercellular adhesion molecule-1 (sICAM-1) in sputum and plasma from 27 smoker and former smoker patients with stable COPD using ELISA methods. Further we analyzed leptin and its receptor expression in sputum cells from 16 COPD patients using immunocytochemistry. Results: In plasma of COPD patients, leptin was inversely correlated with TNF-a and positively correlated with the patient weight, whereas the levels of sICAM-1 were positively correlated with TNF-a. In sputum of COPD patients leptin levels were correlated with forced expiratory volume in 1 second/forced vitality capacity. Additionally, increased levels of sputum leptin and TNF-a were observed in COPD former smokers rather than smokers. Further the expression of leptin receptor in sputum neutrophils was significantly higher in COPD former smokers than in smokers, and the expression of leptin and its receptor was positively correlated in neutrophils of COPD former smokers. Conclusion: Our findings suggest a role of leptin in the local and systemic inflammation of COPD and, taking into account the involvement of neutrophils in this inflammatory disease, describe a novel aspect of the leptin/leptin receptor pathway in the regulation of host defense after smoking cessation

Frequency and clinical aspects of neurological and psychiatric symptoms in patients with non-celiac wheat sensitivity

Background: Non-Celiac Wheat Sensitivity (NCWS) is characterized by both intestinal and extra-intestinal symptoms. The study aims to investigate the frequency of neuropsychiatric manifestations in NCWS patients and identify their clinical and demographic characteristics. Methods: 278 clinical records of NCWS patients, diagnosed by a double-blind placebo-controlled wheat challenge between 2006 and 2020, were retrospectively revised. Fifty-two patients with Celiac Disease (CD) and 54 patients with Irritable Bowel Syndrome (IBS) served as controls. Results: 87% of the NCWS patients had an IBS-like clinical presentation. The NCWS group showed a longer duration of symptoms, a higher frequency of positive serum anti-nuclear antibodies than CD and IBS patients, and a higher frequency of DQ2/DQ8 haplotypes and duodenal mucosa lymphocytosis than IBS controls. In addition, 50% of NCWS patients showed neuropsychiatric manifestations, while lower percentages were observed in CD (25%) and IBS (28%) controls. Neuropsychiatric symptoms in NCWS were more frequently associated with the male sex, longer duration of symptoms, and IBS-diarrhea-like clinical presentation. Conclusions: Our data suggest that in patients with IBS-like symptoms and neuropsychiatric manifestations of unknown cause, it could be useful to investigate a correlation of these symptoms with wheat ingestion to identify NCWS patients with this ‘atypical’ manifestation

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

MODIFICAZIONI ECOGRAFICHE DELLA LINFADENOPATIA DELL’ILO EPATICO DOPO ERADICAZIONE DELL’HCV CON DIRECT-ACTING ANTIVIRALS

A) Valutare le modificazioni ecografiche (US) dei linfonodi (LN) dell’ilo epatico in pazienti con epatopatia cronica (EC) correlata al virus dell’epatite C (HCV) e Sustained Virological Responders (SVR) alla terapia con i Direct-Acting Antivirals (DAAs); B) rilevare i fattori predittivi correlati con la scomparsa di LN. Abbiamo studiato 177 pazienti, trattati con DAAs, arruolati consecutivamente tra il Gennaio 2015 e il Dicembre 2016, con un follow-up dell’SVR di 24 mesi (SVR24) a Dicembre 2018; erano esclusi i pazienti con storia o insorgenza di epatocarcinoma nel follow-up. I LN erano definiti ingranditi (LN+) se il diametro maggiore era >1 cm. Al baseline (BL) registravamo: età, sesso, BMI, markers HBV, HCV e genotipo, uso di alcol; valutavamo al BL, a 12 mesi (SVR12) e a 24 mesi: test di funzione epatica, HCV-RNA, liver stiffness (Fibroscan), diametri US di vena porta e milza. La prevalenza di LN+ al BL era 49.8%, il diametro 2.1±0.6 cm, in LN+ vs LN- le transaminasi erano più elevate (P<0.05). A SVR12 la prevalenza di LN+ era 32.2 %; in LN+ vs LNs (pazienti in cui erano scomparsi) dei parametri studiati solo l’età era maggiore (P<0.05). Il diametro dei LN+ a SVR12 era 1.8±0.4 cm, ridotto rispetto al BL (P<0.05). A SVR24 la prevalenza di LN+ era 29.3 % inferiore vs BL (P<0.001), solo l’età si confermava maggiore vs LNs (P<0.03). Il diametro di LN+ era 1.7±0.5 minore che al BL (P<0.05), sovrapponibile a SVR12 (P=ns). Nelle EC da HCV è frequente il rilievo US di LN all’ilo epatico, considerati indice di grading e staging istologici epatici più severi ed espressione del linfotropismo virale. Alla luce di questi presupposti i LN dovrebbero scomparire dopo l’eradicazione dell’infezione HCV, a questo proposito gli studi dopo terapia con Interferone sono contrastanti. Nel nostro studio LN+ al BL correla con AST e ALT confermando la relazione con l’attività necro-infiammatoria epatica. A SVR24 la prevalenza di LN+ è del 29.4% significativamente ridotta che al BL. IL diametro dei LN+ residui diminuisce a SVR12 per poi stabilizzarsi. La causa della persistenza di LN è controversa, l’assenza di relazione tra LN+ residui ed indici di funzione e fibrosi epatica ci fa ipotizzare che non dipenda più dall’attività della malattia epatica, ma da altre variabili, una potrebbe essere la diversa attività immunologica instauratasi dopo l’eradicazione virale, a conferma di ciò va ricordato che nel 20 % dei soggetti sani è possibile rilevare LN all’ilo epatico (J.Hepatol.2003;39:807), dato questo simile al nostro 29.4 %

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

PRESENTAZIONE ECOGRAFICA DELL’EPATOCARCINOMA: ESPERIENZA DI UN SINGOLO CENTRO NELL’ARCO DI TRE DECENNI

Valutare i cambiamenti della presentazione ecografica (US) degli epatocarcinomi (HCC) diagnosticati presso la nostra UO di Medicina Interna in tre periodi:1993-98, 2003-2008,2013-18. Il Gruppo 1 (G1) (1993-1998) comprendeva 174 HCC, il Gruppo 2 (G2) (2003-08) 96, il Gruppo 3 (G3) (2013-2018) 102. Sono stati registrati età, sesso, markers HBV, HCV, uso di alcol, alfafetoproteina (AFP), test di funzionalità epatica, autoanticorpi, ferritinemia. La diagnosi di HCC in G2 e G3 è stata posta secondo le linee guida EASL, in G1 con istologia o citologia nel 40%, nel resto con multiple tecniche di imaging concordanti (ecografia, TC, TC con lipiodol, angiografia), livelli sierici di AFP>200 ng/ml. La presentazione US veniva classificata secondo Otho in: Singolo, Multipli, Diffusi (Dig. Liv. Dis. 43 (2011) 875–880). Nel gruppo 1: 11.5% dei pazienti risultava in sorveglianza, meno che nel G2 (66%) e nel G3 (76.4%) (p<0.0001), G2 vs G3 (P=ns). L’età media aumentava progressivamente da G1 a G3 (rho=0.45; P<0.0001), gli HCC Singoli erano più frequenti in G2 (63.5%) e in G3 (65.6 %) vs G1 (40 %) (P<0.0001), G2 vs G3 P=ns. La frequenza dei Multipli era maggiore in G1 (50 %) vs G2 (34.4%) e G3 (33.3%) (entrambi P<0.02), G2 vs G3 P=ns. Il Diffuso prevaleva in G1 (16 %) vs G2 (2 %) e G3 (1 %), (entrambi P<0.001), G2 vs G3 P=ns. L’ecostruttura nei tre periodi era sovrapponibile, risultava maggiore l’ipocogena (50-70%), la meno frequente l’isoecogena (7-12%). L’eziologia più frequente nei tre G era HCV, la post Non Alcoholic Steatohepatitis/ criptogenetica (NASH/C) nel G3 era significativamente maggiore vs G2 e vs G1 (entrambi P<0.05). Nel G3 gli HCC-NASH/C vs i virali avevano una severità secondo Otho maggiore (rho=0.3, P<0.02) e il diametro dei noduli neoplastici era più grande (P<0.0001). I programmi di vaccinazione contro l’HBV, le terapie antivirali, l’aumentata prevalenza della cirrosi postNASH, la sorveglianza US, hanno modificato il ruolo dei fattori di rischio e la severità dell’epatocarcinoma (HCC) al momento della diagnosi. I nostri risultati confermano che la presentazione US dell’HCC negli anni è diventata meno severa, effetto della sorveglianza ecografica semestrale. I nostri dati mostrano inoltre nel G3 un aumento della prevalenza degli HCC-postNASH/C, questi alla diagnosi hanno una presentazione più severa se confrontati con i virali, probabilmente conseguenza di un ritardo diagnostico, infatti pochi pazienti (6/14) erano in sorveglianza US. Sono necessari ulteriori studi per definire le politiche di sorveglianza ecografica per gli HCC nella NASH

GaSb-based solar cells for multi-junction integration on Si substrates

We report on the first single-junction GaSb solar cell epitaxially grown on a Si substrate. A control stand-alone GaSb solar cell was primarily fabricated, which demonstrated a 5.90% efficiency (AM1.5G). The preparation, growth and manufacturing procedures were then adapted to create the GaSb-on-Si solar cell. The hybrid device resulted in a degraded efficiency for which comparison between experimental and simulated data revealed dominant non-radiative recombination processes. Material and electrical characterization also highlighted the impact of anti-phase domains and boundaries and threading dislocation density on the shunt resistance of the cell. Nevertheless, the GaSb-on-Si cell performance is close to recent results on the integration of GaSb solar cells on GaAs, despite a much larger lattice mismatch (12% vs 8%). Routes for improvement, concerning the material quality and cell structure, are proposed. This work lays the foundations of a GaSb-based multi-junction solar cell monolithically integrated on Si