AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these res...AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels.METHODS: One hundred and forty patients (50 HCV-related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated.RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids.Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test.CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients.展开更多
AIM: To investigate the safety and efficacy of long-term combination therapy with alpha interferon and lamivudine in non-responsive patients with anti-HBe-positive chronic hepatitis B.METHODS: 34 patients received com...AIM: To investigate the safety and efficacy of long-term combination therapy with alpha interferon and lamivudine in non-responsive patients with anti-HBe-positive chronic hepatitis B.METHODS: 34 patients received combination treatment (1 month lamivudine, 12 month lamivudine+interferon, 6month lamivudine), 24 received lamivudine (12 months),24 received interferon (12 months). Interferon was administered at 6 MU tiw and lamivudine at 100 mg orally once daily. Patients were followed up for 6 months after treatment.RESULTS: At the end of treatment, HBV DNA negativity rates were 88 % with lamivudine+interferon, 99 % with lamivudine and 55 % with interferon, (P=0.004, combination therapy vs. interferon, and P=0.001 lamivudine vs.interferon), and serum transaminase normalization rates were 84 %, 91% and 53 % (P=0.01 combination therapy vs. interferon, and P=0.012 lamivudine vs. interferon). Six months later, HBV DNA negativity rates were 44 % with lamivudine+interferon, 33 % with lamivudine and 25 % with interferon, and serum transaminase normalization rates were 61%, 42 % and 45 %, respectively, without statistical significance. No YMDD variants were observed with lamivudine+interferon (vs. 12 % with lamivudine). The combination therapy appeared to be safe. CONCLUSION: Although viral clearance and transaminase normalization are slower with long-term lamivudine+interferon than that with lamivudine alone, the combination regimen seems to provide more lasting benefits and to protect against the appearance of YMDD variants. Studies with other regimens regarding sequence and duration are needed.展开更多
Diverticular disease of the colon is a common disease worldwide. Although the disease is asymptomatic in about 70-80 % of patients, it represents, at least in Western countries, one of the most important gastrointesti...Diverticular disease of the colon is a common disease worldwide. Although the disease is asymptomatic in about 70-80 % of patients, it represents, at least in Western countries, one of the most important gastrointestinal diseases in terms of direct and indirect health costs. Pathocenesis of the disease is still unknown. However, it is the result of complex interactions between colonic structure, intestinal motility, diet and genetic factors. Whilst efficacious preventive strategies remain to be identified, fibre supplementation in the diet is recommended. Why symptoms develop is still unclear. Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa, induced by changes in bacterial microflora,could affect the enteric nervous system, which is crucial for normal gut function, thus favouring symptom development.This hypothesis could be extrapolated also for diverticular disease, since bacterial overgrowth is present, at least in a subgroup of patients. These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.展开更多
Background:Core affect is defined as the most general affective construct consciously accessible that is experienced constantly.It can be experienced as free-floating(mood)or related to prototypical emotional episodes...Background:Core affect is defined as the most general affective construct consciously accessible that is experienced constantly.It can be experienced as free-floating(mood)or related to prototypical emotional episodes.The aim of this study was to examine the influence of pleasant and unpleasant core affect on cyclo-ergometer endurance performance.Specifically,we considered the influence of pleasant and unpleasant core affect on performance outcomes(i.e.,time to task completion)and rate of perceived exertion(RPE;Borg Scale,category ratio-10)collected during the task.Methods:Thirty-one participants aged 20-28 years were recruited.Core affect was randomly elicited by 2 sets of pleasant and unpleasant pictures chosen from the international affective picture system.Pictures were displayed to participants during a cyclo-ergometer performance in 2 days in a counterbalanced order.RPE was collected every minute to detect volunteers’exhaustion.Results:The study sample was split into 2 groups.Group 1 comprised participants who performed better with pleasant core affect,whereas Group 2 included participants who performed better with unpleasant core affect.Mixed between-within subjects analysis of variance revealed a significant 2(group)×2(condition)×5(isotime)interaction(p=0.002,ηp^2=0.158).Post hoc comparisons showed that participants who obtained better performance with pleasant core affect(pleasant pictures;Group 1)reported lower RPE values at 75%of time to exhaustion in a pleasant core affect condition compared to an unpleasant core affect condition.On the other hand,participants who obtained better performance with unpleasant core affect(unpleasant pictures;Group 2)reported lower RPE values at 75%and 100%of time to exhaustion in an unpleasant core affect condition.Conclusion:Findings suggest differential effects of pleasant and unpleasant core affect on performance.Moreover,core affect was found to influence perceived exertion and performance according to participants’preferences for pleasant or unpleasant core affect.展开更多
AIM:To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively,...AIM:To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identifi ed as risk factors in men while, in females, the only risk factors were increasing age and a high BMI.Increasing age and pain in the right hypocondrium in men and increasing age in females were identifi ed as predictors of gallstones. Pain in the epigastrium/ right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION:Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confi rmed as the only symptom related to gallstones.展开更多
AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophage...AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated en-doscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn andregurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.展开更多
Coronavirus disease 2019(COVID-19)is,at present,one of the most relevant global health problems.In the literature hepatic alterations have been described in COVID-19 patients,and they are mainly represented by worseni...Coronavirus disease 2019(COVID-19)is,at present,one of the most relevant global health problems.In the literature hepatic alterations have been described in COVID-19 patients,and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality.Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)to cause liver damage have been hypothesized.COVID-19 primary liver injury is less common than secondary liver injury.Most of the available data demonstrate how liver damage in SARSCo V-2 infection is likely due to systemic inflammation,and it is less likely mediated by a cytopathic effect directed on liver cells.Moreover,liver alterations could be caused by hypoxic injury and drugs(antibiotics and non-steroidal antiinflammatory drugs,remdesivir,tocilizumab,tofacitinib and dexamethasone).SARS-Co V-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral,coronary and peripheral vascular beds.Data in the literature highlight how the virus triggers an exaggerated immune response,which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis.This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms,especially in central,lobar or segmental pulmonary arteries,in COVID-19.There are currently fewer data for arterial thrombosis,while myocardial injury was identified in 7%-17%of patients hospitalized with SARS-Co V-2 infection and 22%-31%in the intensive care unit setting.Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COVID-19 patients.Hemostasis dysregulation is observed during the COVID-19 course.Lower platelet count,mildly increased prothrombin time and increased Ddimer are typical laboratory features of patients with severe SARS-Co V-2 infection,described as“COVID-19 associated coagulopathy.”These alterations are correlated to poor outcomes.Moreover,patients with severe SARS-Co V-2 infection are characterized by high levels of von Willebrand factor with subsequent ADAMTS13 deficiency and impaired fibrinolysis.Platelet hyperreactivity,hypercoagulability and hypofibrinolysis during SARS-Co V-2 infection induce a pathological state named as“immuno-thromboinflammation.”Finally,liver dysfunction and coagulopathy are often observed at the same time in patients with COVID-19.The hypothesis that liver dysfunction could be mediated by microvascular thrombosis has been supported by postmortem findings and extensive vascular portal and sinusoidal thrombosis observation.Other evidence has shown a correlation between coagulation and liver damage in COVID-19,underlined by the transaminase association with coagulopathy,identified through laboratory markers such as prothrombin time,international normalized ratio,fibrinogen,D-dimer,fibrin/fibrinogen degradation products and platelet count.Other possible mechanisms like immunogenesis of COVID-19 damage or massive pericyte activation with consequent vessel wall fibrosis have been suggested.展开更多
AIM: To explore the prevalence of autoimmune gastritis in chronic hepatitis C virus (HCV) patients and the influence of α-intefferon (IFN) treatment on autoimmune gastritis.METHODS: We performed a prospective study o...AIM: To explore the prevalence of autoimmune gastritis in chronic hepatitis C virus (HCV) patients and the influence of α-intefferon (IFN) treatment on autoimmune gastritis.METHODS: We performed a prospective study on 189patients with positive anti-HCV and viral RNA enrolled in a 12-month IFN protocol. We evaluated: a) the baseline prevalence of autoimmune gastritis, b) the impact of IFN treatment on development of biochemical signs of autoimmune gastritis (at 3, 6 and 12 months), c) the evolution after IFN withdrawal (12 months) in terms of anti-gastric-parietal-cell antibodies (APCA), gastrin, anti-thyroid, and anti-non-organ-specific antibodies.RESULTS: APCA positivity and 3-fold gastrin levels were detected in 3 (1.6 %) and 9 (5 %) patients, respectively, at baseline, in 25 (13 %) and 31 (16 %) patients at the end of treatment (both P＜0.001, vs baseline), and in 7 (4 %) and 14 (7 %) patients 12 months after withdrawal (P=0.002and ,P=0.01 respectively, vs baseline; P=not significant vs end of treatment). The development of autoimmune gastritis was strictly associated with the presence of autoimmune thyroiditis (P =0.0001), no relationship was found with other markers of autoimmunity.CONCLUSION: In HCV patients, IFN frequently precipitates latent autoimmune gastritis, particularly in females. Following our 12-month protocol, the phenomenon generally regressed. Since APCA positivity and high gastrin levels are associated with the presence of antithyroid antibodies,development of autoimmune thyroiditis during IFN treatment may provide a surrogate preliminary indicator of possible autoimmune gastritis to limit the need for invasive examinations.展开更多
Hepatitis C is a major cause of liver-related morbidity and mortality worldwide. In fact, chronic hepatitis C is considered as one of the primary causes of chronic liver disease, cirrhosis and hepatocellular carcinoma...Hepatitis C is a major cause of liver-related morbidity and mortality worldwide. In fact, chronic hepatitis C is considered as one of the primary causes of chronic liver disease, cirrhosis and hepatocellular carcinoma, and is the most common reason for liver transplantation. The primary objectives for the treatment of HCV-related chronic hepatitis is to eradicat einfection and prevent progression of the disease. The treatment has evolved from the use of m-interferon (IFNα) alone to the combination of IFNα plus ribavirin, with a significant improvement in the overall efficacy, and to the newer PEG-IFNs which have further increased the virological response, used either alone or in combination with ribavirin. Despite these positive results, in terms of efficacy, concerns are related to the safety and adverse events. Many patients must reduce the dose of PEG-IFN or ribavirin, others must stop the treatment and a variable percentage of subjectsare not suitable owing to intolerance toward drugs. IFNβ represents a potential therapeutic alternative for the treatment of chronic viral hepatitis and in some countries it plays an important role in therapeutic protocols. Aim of the present paper was to review available data on the safety ofIFNβ treatment in HCV-related chronic hepatitis. The rates of treatment discontinuation and/or dose modification due to the appearance of severe side effects during IFNβ are generally low and in several clinical studies no requirements for treatment discontinuation and/or dose modifications have been reported. The most frequent side effects experienced during IFNβ treatment are flu-like syndromes, fever, fatigue and injection-site reactions. No differences in terms of side-effect frequency and severity between responders and non-responders have been reported.A more recent study, performed to compare IFNβ alone or in combination with ribavirin, confirmed the good safety profile of both treatments. Similar trends of adverse event frequency have been observed in subpopulations such as patients with genotype-lb HCV hepatitis unresponsive to IFNα treatment or with HCV-related cirrhosis and patients with acute viral hepatitis. If further studies will confirm the efficacy of combined IFNβ and ribavirin treatment, this regimen could represent a safe and alternative therapeutic option in selected patients.展开更多
Background: Obesity, type II Diabetes mellitus (DMII) and vascular damage could be implicated in prostate cancer (PCa) nevertheless no clear results has been reached. The aim of the research was to investigate the ass...Background: Obesity, type II Diabetes mellitus (DMII) and vascular damage could be implicated in prostate cancer (PCa) nevertheless no clear results has been reached. The aim of the research was to investigate the association of these alterations with PCa at initial diagnosis, without the influence of hormone therapy or chemotherapy. Methods: Retrospective analysis of 400 patients undergoing prostate biopsy at our institution between 2005 and 2012 was conducted. We examined associations of obesity, DMII and vascular damage in 200 patients with PCa diagnosis versus 200 age-matched controls. Men with history of hormone therapy or chemotherapy, prostate or bladder surgery were excluded. Results: Obesity was significantly associated (OR 2.10, p < 0.05) with aggressive PCa (Gleason Score 8 - 10). DMII was significantly associated to aggressive PCa but only in obese cases (OR 4.25). Carotid vascular disease (CVD) and coronary artery disease (CAD) were significantly linked to PCa in all cases versus controls (OR 1.88, p < 0.05). Conclusions: In our study, obesity, particularly in combination with DMII, was significantly associated with aggressive PCa. Moreover, a significant relation was found between vascular disease and PCa hormone-naive at initial diagnosis. The metabolic derangements associated to obesity and DMII may increase oxidative stress and cause a permanent pro-inflammatory state that predisposes to vascular disease and PCa.展开更多
In the pathophysiology of neurodegenerative disorders,the role of misfolded protein deposition leading to neurodegeneration has been primarily discussed.In the last decade,however,it has been proposed a parallel invol...In the pathophysiology of neurodegenerative disorders,the role of misfolded protein deposition leading to neurodegeneration has been primarily discussed.In the last decade,however,it has been proposed a parallel involvement of innate immune activation,chronic inflammation and adaptive immunity in the neurodegeneration mechanisms triggered by proteinopathies.New insights in the neurodegenerative field strongly suggest a role for the immune system in the pathophysiology of neurodegenerative disorders.Therefore,the hypothesis underlining the modulation of the innate and the adaptive immune system in the events linked to brain deposition of misfolded proteins could open new perspectives in the setting of specific immunotherapeutic strategies for the treatment of neurodegenerative diseases.Therefore,we have reviewed the pathogenic hypothesis in neurodegenerative pathologies,underling the links between the deposition of misfolded protein mechanisms and the immune activation.展开更多
PURPOSE:To describe the microscopic corneal and conjunctival findings in patients with Fabry disease(FD)related keratopathy by using in vivo confocal microscopy.DESIGN:Prospective observational case series.METHODS:Twe...PURPOSE:To describe the microscopic corneal and conjunctival findings in patients with Fabry disease(FD)related keratopathy by using in vivo confocal microscopy.DESIGN:Prospective observational case series.METHODS:Twelve eyes of six patients affected by Fabry disease,belonging to two different families,underwent in vivo confocal microscopic examination.Corneal and conjunctival morphology were assessed by means of a scanning slit corneal confocal whitelight microscopy and confocal laser-scanning microscope.RESULTS:Confocal microscopy examination evidenced two different types of corneal epithelial changes.The three hemizygous patients presented bright hyper-reflective intracellular inclusions located within the basal epithelial cells,while the three heterozygous patients showed fine diffusion of reflective substance at the level of superficial,basal epithelial cells and basal membrane,in all eyes.The complex basal-Bowman’ s membrane appeared irregular,distorted,and nonhomogeneous in all subjects.Stromal increased reflectivity attributable to haze and epithelial ingrowth with bright intracellular inclusions was noticed in one hemizygous patient.In all patients,conjunctival epithelial involvement represented by bright roundish intracellular inclusions was evidenced,appearing more pronounced in tarsal than in bulbar conjunctiva.CONCLUSIONS:Although FD-related cornea verticillata attributable to glycosphingolipids accumulation is considered to be primarily a corneal disease,in vivo confocal microscopy demonstrated structural alterations throughout the entire ocular surface epithelia.It is still unclear whether the different type of corneal epithelial lesions observed for hemizygous and heterozygous patients is related to different physiopathological mechanisms.Confocal microscopy may assist ophthalmologists in the diagnosis of FD-related ocular surface and corneal manifestations.展开更多
文摘AIM: To evaluate and compare the clinical usefulness of 13C-phenylalanine and 13C-methacetin breath tests in quantitating functional hepatic mass in patients with chronic liver disease and to further compare these results with those of conventional tests, Child-Pugh score and serum bile acid levels.METHODS: One hundred and forty patients (50 HCV-related chronic hepatitis, 90 liver cirrhosis patients) and 40 matched healthy controls were studied. Both breath test and routine liver test, serum levels of cholic and chenodeoxycholic acid conjugates were evaluated.RESULTS: Methacetin breath test, expressed as 60 min cumulative percent of oxidation, discriminated the hepatic functional capacity not only between controls and liver disease patients, but also between different categories of chronic liver disease patients. Methacetin breath test was correlated with liver function tests and serum bile acids.Furthermore, methacetin breath test, as well as serum bile acids, were highly predictive of Child-Pugh scores. The diagnostic power of phenylalanine breath test was always less than that of methacetin breath test.CONCLUSION: Methacetin breath test represents a safe and accurate diagnostic tool in the evaluation of hepatic functional mass in chronic liver disease patients.
文摘AIM: To investigate the safety and efficacy of long-term combination therapy with alpha interferon and lamivudine in non-responsive patients with anti-HBe-positive chronic hepatitis B.METHODS: 34 patients received combination treatment (1 month lamivudine, 12 month lamivudine+interferon, 6month lamivudine), 24 received lamivudine (12 months),24 received interferon (12 months). Interferon was administered at 6 MU tiw and lamivudine at 100 mg orally once daily. Patients were followed up for 6 months after treatment.RESULTS: At the end of treatment, HBV DNA negativity rates were 88 % with lamivudine+interferon, 99 % with lamivudine and 55 % with interferon, (P=0.004, combination therapy vs. interferon, and P=0.001 lamivudine vs.interferon), and serum transaminase normalization rates were 84 %, 91% and 53 % (P=0.01 combination therapy vs. interferon, and P=0.012 lamivudine vs. interferon). Six months later, HBV DNA negativity rates were 44 % with lamivudine+interferon, 33 % with lamivudine and 25 % with interferon, and serum transaminase normalization rates were 61%, 42 % and 45 %, respectively, without statistical significance. No YMDD variants were observed with lamivudine+interferon (vs. 12 % with lamivudine). The combination therapy appeared to be safe. CONCLUSION: Although viral clearance and transaminase normalization are slower with long-term lamivudine+interferon than that with lamivudine alone, the combination regimen seems to provide more lasting benefits and to protect against the appearance of YMDD variants. Studies with other regimens regarding sequence and duration are needed.
文摘Diverticular disease of the colon is a common disease worldwide. Although the disease is asymptomatic in about 70-80 % of patients, it represents, at least in Western countries, one of the most important gastrointestinal diseases in terms of direct and indirect health costs. Pathocenesis of the disease is still unknown. However, it is the result of complex interactions between colonic structure, intestinal motility, diet and genetic factors. Whilst efficacious preventive strategies remain to be identified, fibre supplementation in the diet is recommended. Why symptoms develop is still unclear. Results of recent experimental studies on irritable bowel syndrome speculated that low grade inflammation of colonic mucosa, induced by changes in bacterial microflora,could affect the enteric nervous system, which is crucial for normal gut function, thus favouring symptom development.This hypothesis could be extrapolated also for diverticular disease, since bacterial overgrowth is present, at least in a subgroup of patients. These perspectives on symptom development are reviewed and new therapeutic approaches are hypothesized.
基金This study was part of a Ph.D.program funded by University“G.d’Annunzio”of Chieti-Pescara,Italy.
文摘Background:Core affect is defined as the most general affective construct consciously accessible that is experienced constantly.It can be experienced as free-floating(mood)or related to prototypical emotional episodes.The aim of this study was to examine the influence of pleasant and unpleasant core affect on cyclo-ergometer endurance performance.Specifically,we considered the influence of pleasant and unpleasant core affect on performance outcomes(i.e.,time to task completion)and rate of perceived exertion(RPE;Borg Scale,category ratio-10)collected during the task.Methods:Thirty-one participants aged 20-28 years were recruited.Core affect was randomly elicited by 2 sets of pleasant and unpleasant pictures chosen from the international affective picture system.Pictures were displayed to participants during a cyclo-ergometer performance in 2 days in a counterbalanced order.RPE was collected every minute to detect volunteers’exhaustion.Results:The study sample was split into 2 groups.Group 1 comprised participants who performed better with pleasant core affect,whereas Group 2 included participants who performed better with unpleasant core affect.Mixed between-within subjects analysis of variance revealed a significant 2(group)×2(condition)×5(isotime)interaction(p=0.002,ηp^2=0.158).Post hoc comparisons showed that participants who obtained better performance with pleasant core affect(pleasant pictures;Group 1)reported lower RPE values at 75%of time to exhaustion in a pleasant core affect condition compared to an unpleasant core affect condition.On the other hand,participants who obtained better performance with unpleasant core affect(unpleasant pictures;Group 2)reported lower RPE values at 75%and 100%of time to exhaustion in an unpleasant core affect condition.Conclusion:Findings suggest differential effects of pleasant and unpleasant core affect on performance.Moreover,core affect was found to influence perceived exertion and performance according to participants’preferences for pleasant or unpleasant core affect.
文摘AIM:To evaluate gallstone incidence and risk factors in a large population-based study. METHODS: Gallstone incidence and risk factors, were evaluated by structured questionnaire and physical examination, respectively, in 9611 of 11 109 (86.5%) subjects who were gallstone-free at the cross-sectional study. RESULTS: Six centers throughout Italy enrolled 9611 subjects (5477 males, 4134 females, aged 30-79 years), 9517 of whom were included into analysis: 424 subjects (4.4%) had gallstones and 61 (0.6%) had been cholecystectomized yielding a cumulative incidence of 0.67% per year (0.66% in males, 0.81% in females). Increasing age, a high body mass index (BMI), a history of diabetes, peptic ulcer and angina, and low cholesterol and high triglyceride levels were identifi ed as risk factors in men while, in females, the only risk factors were increasing age and a high BMI.Increasing age and pain in the right hypocondrium in men and increasing age in females were identifi ed as predictors of gallstones. Pain in the epigastrium/ right hypocondrium was the only symptom related to gallstones; furthermore, some characteristics of pain (forcing to rest, not relieved by bowel movements) were significantly associated with gallstones. No correlation was found between gallstone characteristics and clinical manifestations, while increasing age in men and increasing age and BMI in females were predictors of pain. CONCLUSION:Increasing age and BMI represent true risk factors for gallstone disease (GD); pain in the right hypocondrium and/or epigastrium is confi rmed as the only symptom related to gallstones.
文摘AIM: To assess the management and outcome of nonerosive gastro-esophageal reflux disease (NERD) patients who were identified retrospectively, after a 5-year follow-up.METHODS: We included patients with gastro-esophageal reflux disease (GERD) symptoms who had a negative endoscopy result and pathological 24-h esophageal pH-monitoring while off therapy. We interviewed them after an average period of 5 years (range 3.5-7 years) by means of a structured questionnaire to assess presence of GERD symptoms, related therapy, updated en-doscopic data and other features. We assessed predictors of esophagitis development by means of univariate and multivariate statistical analysis.RESULTS: 260 patients (137 women) were included. Predominant GERD symptoms were heartburn andregurgitation in 103/260 (40%). 70% received a maintenance treatment, which was proton pump inhibitor (PPI) in 55% of cases. An average number of 1.5 symptomatic relapses per patient/year of follow-up were observed. A progression to erosive gastro-esophageal reflux disease (ERD) was found in 58/193 (30.0%) of patients undergoing repeat endoscopy; 72% of these were Los Angeles grade A-B. CONCLUSION: This study shows that progression to ERD occurs in about 5% of NERD cases per year, despite therapy. Only two factors consistently and independently influence progression: smoking and absence of PPI therapy.
文摘Coronavirus disease 2019(COVID-19)is,at present,one of the most relevant global health problems.In the literature hepatic alterations have been described in COVID-19 patients,and they are mainly represented by worsening of underlying chronic liver disease leading to hepatic decompensation and liver failure with higher mortality.Several potential mechanisms used by severe acute respiratory syndrome coronavirus 2(SARS-Co V-2)to cause liver damage have been hypothesized.COVID-19 primary liver injury is less common than secondary liver injury.Most of the available data demonstrate how liver damage in SARSCo V-2 infection is likely due to systemic inflammation,and it is less likely mediated by a cytopathic effect directed on liver cells.Moreover,liver alterations could be caused by hypoxic injury and drugs(antibiotics and non-steroidal antiinflammatory drugs,remdesivir,tocilizumab,tofacitinib and dexamethasone).SARS-Co V-2 infection can induce multiple vascular district atherothrombosis by affecting simultaneously cerebral,coronary and peripheral vascular beds.Data in the literature highlight how the virus triggers an exaggerated immune response,which added to the cytopathic effect of the virus can induce endothelial damage and a prothrombotic dysregulation of hemostasis.This leads to a higher incidence of symptomatic and confirmed venous thrombosis and of pulmonary embolisms,especially in central,lobar or segmental pulmonary arteries,in COVID-19.There are currently fewer data for arterial thrombosis,while myocardial injury was identified in 7%-17%of patients hospitalized with SARS-Co V-2 infection and 22%-31%in the intensive care unit setting.Available data also revealed a higher occurrence of stroke and more serious forms of peripheral arterial disease in COVID-19 patients.Hemostasis dysregulation is observed during the COVID-19 course.Lower platelet count,mildly increased prothrombin time and increased Ddimer are typical laboratory features of patients with severe SARS-Co V-2 infection,described as“COVID-19 associated coagulopathy.”These alterations are correlated to poor outcomes.Moreover,patients with severe SARS-Co V-2 infection are characterized by high levels of von Willebrand factor with subsequent ADAMTS13 deficiency and impaired fibrinolysis.Platelet hyperreactivity,hypercoagulability and hypofibrinolysis during SARS-Co V-2 infection induce a pathological state named as“immuno-thromboinflammation.”Finally,liver dysfunction and coagulopathy are often observed at the same time in patients with COVID-19.The hypothesis that liver dysfunction could be mediated by microvascular thrombosis has been supported by postmortem findings and extensive vascular portal and sinusoidal thrombosis observation.Other evidence has shown a correlation between coagulation and liver damage in COVID-19,underlined by the transaminase association with coagulopathy,identified through laboratory markers such as prothrombin time,international normalized ratio,fibrinogen,D-dimer,fibrin/fibrinogen degradation products and platelet count.Other possible mechanisms like immunogenesis of COVID-19 damage or massive pericyte activation with consequent vessel wall fibrosis have been suggested.
文摘AIM: To explore the prevalence of autoimmune gastritis in chronic hepatitis C virus (HCV) patients and the influence of α-intefferon (IFN) treatment on autoimmune gastritis.METHODS: We performed a prospective study on 189patients with positive anti-HCV and viral RNA enrolled in a 12-month IFN protocol. We evaluated: a) the baseline prevalence of autoimmune gastritis, b) the impact of IFN treatment on development of biochemical signs of autoimmune gastritis (at 3, 6 and 12 months), c) the evolution after IFN withdrawal (12 months) in terms of anti-gastric-parietal-cell antibodies (APCA), gastrin, anti-thyroid, and anti-non-organ-specific antibodies.RESULTS: APCA positivity and 3-fold gastrin levels were detected in 3 (1.6 %) and 9 (5 %) patients, respectively, at baseline, in 25 (13 %) and 31 (16 %) patients at the end of treatment (both P＜0.001, vs baseline), and in 7 (4 %) and 14 (7 %) patients 12 months after withdrawal (P=0.002and ,P=0.01 respectively, vs baseline; P=not significant vs end of treatment). The development of autoimmune gastritis was strictly associated with the presence of autoimmune thyroiditis (P =0.0001), no relationship was found with other markers of autoimmunity.CONCLUSION: In HCV patients, IFN frequently precipitates latent autoimmune gastritis, particularly in females. Following our 12-month protocol, the phenomenon generally regressed. Since APCA positivity and high gastrin levels are associated with the presence of antithyroid antibodies,development of autoimmune thyroiditis during IFN treatment may provide a surrogate preliminary indicator of possible autoimmune gastritis to limit the need for invasive examinations.
文摘Hepatitis C is a major cause of liver-related morbidity and mortality worldwide. In fact, chronic hepatitis C is considered as one of the primary causes of chronic liver disease, cirrhosis and hepatocellular carcinoma, and is the most common reason for liver transplantation. The primary objectives for the treatment of HCV-related chronic hepatitis is to eradicat einfection and prevent progression of the disease. The treatment has evolved from the use of m-interferon (IFNα) alone to the combination of IFNα plus ribavirin, with a significant improvement in the overall efficacy, and to the newer PEG-IFNs which have further increased the virological response, used either alone or in combination with ribavirin. Despite these positive results, in terms of efficacy, concerns are related to the safety and adverse events. Many patients must reduce the dose of PEG-IFN or ribavirin, others must stop the treatment and a variable percentage of subjectsare not suitable owing to intolerance toward drugs. IFNβ represents a potential therapeutic alternative for the treatment of chronic viral hepatitis and in some countries it plays an important role in therapeutic protocols. Aim of the present paper was to review available data on the safety ofIFNβ treatment in HCV-related chronic hepatitis. The rates of treatment discontinuation and/or dose modification due to the appearance of severe side effects during IFNβ are generally low and in several clinical studies no requirements for treatment discontinuation and/or dose modifications have been reported. The most frequent side effects experienced during IFNβ treatment are flu-like syndromes, fever, fatigue and injection-site reactions. No differences in terms of side-effect frequency and severity between responders and non-responders have been reported.A more recent study, performed to compare IFNβ alone or in combination with ribavirin, confirmed the good safety profile of both treatments. Similar trends of adverse event frequency have been observed in subpopulations such as patients with genotype-lb HCV hepatitis unresponsive to IFNα treatment or with HCV-related cirrhosis and patients with acute viral hepatitis. If further studies will confirm the efficacy of combined IFNβ and ribavirin treatment, this regimen could represent a safe and alternative therapeutic option in selected patients.
文摘Background: Obesity, type II Diabetes mellitus (DMII) and vascular damage could be implicated in prostate cancer (PCa) nevertheless no clear results has been reached. The aim of the research was to investigate the association of these alterations with PCa at initial diagnosis, without the influence of hormone therapy or chemotherapy. Methods: Retrospective analysis of 400 patients undergoing prostate biopsy at our institution between 2005 and 2012 was conducted. We examined associations of obesity, DMII and vascular damage in 200 patients with PCa diagnosis versus 200 age-matched controls. Men with history of hormone therapy or chemotherapy, prostate or bladder surgery were excluded. Results: Obesity was significantly associated (OR 2.10, p < 0.05) with aggressive PCa (Gleason Score 8 - 10). DMII was significantly associated to aggressive PCa but only in obese cases (OR 4.25). Carotid vascular disease (CVD) and coronary artery disease (CAD) were significantly linked to PCa in all cases versus controls (OR 1.88, p < 0.05). Conclusions: In our study, obesity, particularly in combination with DMII, was significantly associated with aggressive PCa. Moreover, a significant relation was found between vascular disease and PCa hormone-naive at initial diagnosis. The metabolic derangements associated to obesity and DMII may increase oxidative stress and cause a permanent pro-inflammatory state that predisposes to vascular disease and PCa.
文摘In the pathophysiology of neurodegenerative disorders,the role of misfolded protein deposition leading to neurodegeneration has been primarily discussed.In the last decade,however,it has been proposed a parallel involvement of innate immune activation,chronic inflammation and adaptive immunity in the neurodegeneration mechanisms triggered by proteinopathies.New insights in the neurodegenerative field strongly suggest a role for the immune system in the pathophysiology of neurodegenerative disorders.Therefore,the hypothesis underlining the modulation of the innate and the adaptive immune system in the events linked to brain deposition of misfolded proteins could open new perspectives in the setting of specific immunotherapeutic strategies for the treatment of neurodegenerative diseases.Therefore,we have reviewed the pathogenic hypothesis in neurodegenerative pathologies,underling the links between the deposition of misfolded protein mechanisms and the immune activation.
文摘PURPOSE:To describe the microscopic corneal and conjunctival findings in patients with Fabry disease(FD)related keratopathy by using in vivo confocal microscopy.DESIGN:Prospective observational case series.METHODS:Twelve eyes of six patients affected by Fabry disease,belonging to two different families,underwent in vivo confocal microscopic examination.Corneal and conjunctival morphology were assessed by means of a scanning slit corneal confocal whitelight microscopy and confocal laser-scanning microscope.RESULTS:Confocal microscopy examination evidenced two different types of corneal epithelial changes.The three hemizygous patients presented bright hyper-reflective intracellular inclusions located within the basal epithelial cells,while the three heterozygous patients showed fine diffusion of reflective substance at the level of superficial,basal epithelial cells and basal membrane,in all eyes.The complex basal-Bowman’ s membrane appeared irregular,distorted,and nonhomogeneous in all subjects.Stromal increased reflectivity attributable to haze and epithelial ingrowth with bright intracellular inclusions was noticed in one hemizygous patient.In all patients,conjunctival epithelial involvement represented by bright roundish intracellular inclusions was evidenced,appearing more pronounced in tarsal than in bulbar conjunctiva.CONCLUSIONS:Although FD-related cornea verticillata attributable to glycosphingolipids accumulation is considered to be primarily a corneal disease,in vivo confocal microscopy demonstrated structural alterations throughout the entire ocular surface epithelia.It is still unclear whether the different type of corneal epithelial lesions observed for hemizygous and heterozygous patients is related to different physiopathological mechanisms.Confocal microscopy may assist ophthalmologists in the diagnosis of FD-related ocular surface and corneal manifestations.
