Adding a Leafy Vegetable Fraction to Diets Decreases the Risk of Red Meat Mortality in MASLD Subjects: Results from the MICOL Cohort

BACKGROUND

Dietary guidelines recommend limiting red meat intake because it has been amply associated with increased cancer mortality, particularly in patients with liver conditions, such as metabolic dysfunction-associated fatty liver disease (MASLD). MASLD is the leading cause of liver dysfunction in the world today, and no specific treatment other than lifestyle correction has yet been established. The aim of this study was to explore the protective role of leafy vegetables when associated with high red meat consumption.

METHODS

The study cohort included 1646 participants assessed during the fourth recall of the MICOL study, subdivided into two groups based on red meat intake (≤50 g/die vs. >50 g/die), in order to conduct a cancer mortality analysis. The prevalence of subjects that consumed >50 g/die was only 15.73%. Leafy vegetable intake was categorized based on median g/die consumption, and it was combined with red meat intake.

CONCLUSIONS

This is the first study to demonstrate that the consumption of about 30 g/die of leafy vegetables reduces the risk of mortality. A strong association with mortality was observed in subjects with MASLD, and the protective role of vegetables was demonstrated.

Additional booster doses in patients with chronic lymphocytic leukemia induce humoral and cellular immune responses to SARS-CoV-2 similar to natural infection regardless ongoing treatments: A study by ERIC, the European Research Initiative on CLL

Profound immune dysregulation and impaired response to the SARS-CoV-2 vaccine put patients with chronic lymphocytic leukemia (CLL) at risk of severe COVID-19. We compared humoral memory and T-cell responses after booster dose vaccination or breakthrough infection. (Green) Quantitative determination of anti-Spike specific antibodies. Booster doses increased seroconversion rate and antibody titers in all patient categories, ultimately generating humoral responses similar to those observed in the postinfection cohort. In detail, humoral response with overscale median antibody titers arose in >80% of patients in watch and wait, off-therapy in remission, or under treatment with venetoclax single-agent. Anti-CD20 antibodies and active treatment with BTK inhibitors (BTKi) represent limiting factors of humoral response, still memory mounted in ~40% of cases following booster doses or infection. (Blue) Evaluation of SARS-CoV-2-specific T-cell responses. Number of T-cell functional activation markers documented in each patient. The vast majority of patients, including those seronegative, developed T-cell responses, qualitatively similar between treatment groups or between vaccination alone and infection cases. These data highlight the efficacy of booster doses in eliciting T-cell immunity independently of treatment status and support the use of additional vaccination boosters to stimulate humoral immunity in patients on active CLL-directed treatments.

Development and Internal Validation of a Model for Predicting Overall Survival in Subjects with MAFLD: A Cohort Study

Background & Aims: Fatty liver disease with metabolic dysfunction (MAFLD) is a new concept proposed to replace the previous concept of Non-Alcoholic Hepatic Steatosis (NAFLD). We developed and internally validated a prognostic model to predict the likelihood of death in a cohort of subjects with MAFLD. Methods: Our work involved two steps: the first was the construction of a bootstrapped multivariable Cox model for mortality risk prognosis and the second was its validation. Results: The study cohort included 1506 subjects, of which 907 were used for internal validation. Discriminant measures for the final model were R2D 0.6845 and Harrell's C 0.8422 in the development and R2D 0.6930 and Harrell's C 0.8465 in the validation. We used the nine independent prognostic factors selected by the LASSO Cox procedure and fitted by the bootstrap Cox survival model, and observed β were: Gender 0.356 1.42 (p < 0.008), Age 0.146 (p < 0.001), Glycemia 0.004 (p < 0.002), Total Cholesterol -0.0040 (p < 0.009), Gamma Glutamyl Transpeptidase 0.009 (p < 0.001), SBP 0.009 (p < 0.036), DBP -0.016 (p < 0.041), ALP 0.008 (p < 0.071) and Widowhood 0.550 (p < 0.001). Conclusions: We produced and validated a model to estimate the probability of death in subjects with MAFLD. The instruments we used showed satisfactory predictive capabilities.

Protective Role of Lycopene in Subjects with Liver Disease: NUTRIHEP Study

BACKGROUND

Liver diseases are constantly increasing throughout the world and are often associated with other diseases, but above all they are caused by improper diet. Adherence to a diet with abundant vegetables has now been widely demonstrated to be important in combating this pathological condition. The aim of this study was to explore the protective role of lycopene (LYC) extracts from cooked and fresh tomato.

METHODS

The study cohort included 969 participants assessed in the NUTRIHEP cohort (2005-2006) and the associated follow-up (2014-2016), divided into two groups, based on liver condition: NAFLD, or AFLD and FLD.

RESULTS

The results indicated a statistical significance of LYC consumption, showing a protective role against liver disease, the best concentration being 9.50 mg/die, with an RR value of 0.59, p = 0.01, 0.39 to 0.90 at 95% C.I., and RRR = 0.40, p = 0.002, 0.22 to 0.71 at 95% C.I.

CONCLUSIONS

The protective role of LYC extracts from tomato has not been amply demonstrated in humans. We conclude that this is one of the few papers in the literature to evaluate the protective effect of LYC against liver disease, as well as how this molecule could be used in future possible treatments. Utilizing lycopene as a supplement alone or in combination with other foods could be useful for developing treatments with reduced contraindications.

Effects of Egg Consumption on Subjects with SLD or Hypertension: A MICOL Study

BACKGROUND

Steatotic liver disease (SLD) is defined as a fat accumulation in more than 5% of hepatocytes; it can progress to non-alcoholic steatohepatitis (NASH), associated with an increased state of inflammation. The aim of this study was to explore the protective effects of eating eggs and any association with SLD and hypertension (HTN).

METHODS

The study cohort included 908 participants assessed in the fourth recall of the MICOL study, grouped into four groups, based on NALFD and/or HTN.

RESULTS

The prevalence of HTN and SLD among participants was 31.61%. Overall, the results indicated a statistical significance of egg consumption, showing a protective role against the two disease conditions, in both the raw and adjusted models (RRR = 0.34, p = 0.009, 0.15 to 0.76 95% C.I.).

CONCLUSIONS

Many differences were found among the groups, and the protective role of eating eggs was amply demonstrated. We can conclude that it is unwise to demonize the intake of this food and its nutritional properties, in contrast with previous reports in the literature.

High Adherence to a Mediterranean Alcohol-Drinking Pattern and Mediterranean Diet Can Mitigate the Harmful Effect of Alcohol on Mortality Risk

BACKGROUND

Alcohol is a psychoactive substance with deleterious effects on human health and mortality. This study aims to investigate the joint associations between the Mediterranean Diet (MedDiet), alcohol- consumption patterns and mortality from the following: all causes, cardiovascular, neoplastic, the digestive system, and other causes.

METHODS

A sample of 3411 alcohol consumers aged ≥18 years was selected from two prospective cohort studies: the MICOL and NUTRIHEP Study. Cohorts were enrolled in 2005-2006, and followed up until December 2022, capturing data on alcohol consumption, diet, and mortality. Adherence to the MedDiet was measured by the relative Mediterranean score (rMED), and alcohol consumption by the Mediterranean Alcohol-drinking Pattern index (MADP). Statistical analyses included flexible parametric survival models and subdistribution hazard ratios, to consider different causes of death.

RESULTS

a significant increase in digestive-system (SHR 2.77, 95% CI 1.16; 63) and cancer mortality risk (SHR 2.25, 95% CI 1.08; 4.70) was observed among individuals with low adherence to the MADP. Low adherence to the Mediterranean pattern of alcohol consumption, combined with low adherence to the MedDiet, was associated with higher overall mortality (HR 2.29, 95% CI 1.04, 5.04), and, in particular, with higher mortality from digestive system diseases (SHR 4.38, 95% CI 1.22, 15.8).

CONCLUSIONS

This study suggests that deleterious effects of alcohol on mortality vary, depending on alcohol consumption patterns and dietary context. Higher adherence to the MedDiet appears to mitigate the adverse effects of moderate alcohol consumption, particularly for wine drinkers.

Effect of Intake of Extra Virgin Olive Oil on Mortality in a South Italian Cohort with and without NAFLD

BACKGROUND

Extra-virgin olive oil (EVOO) is the main source of seasoning fat in the Mediterranean diet and it is one of the components with known protective factors on chronic-degenerative disease. We aimed to evaluate the effect of a medium-high level of oil consumption on mortality in a cohort with good adherence to the Mediterranean diet.

METHODS

A total of 2754 subjects who had completed the food questionnaire in the Multicenter Italian study on Cholelithiasis (MICOL) cohort were included in the study. EVOO consumption was categorized in four levels (<20 g/die, 21-30 g/die, 31-40 g/die, >40 g/die). We performed a flexible parametric survival model to assess mortality by EVOO consumption level adjusted for some covariates. We also performed the analysis on subjects with and without non-alcoholic fatty liver disease (NAFLD) to evaluate the effects of oil in this more fragile sub-cohort.

RESULTS

We found a statistically significant negative effect on mortality for the whole sample when EVOO consumption was used, both as a continuous variable and when categorized. The protective effect was stronger in the sub-cohort with NAFLD, especially for the highest levels of EVOO consumption (HR = 0.58 with p < 0.05).

CONCLUSIONS

Our study has shown a protective effect of EVOO consumption towards all causes of mortality. Despite the higher caloric intake, the protective power is greater for a consumption >40 g/day in both the overall cohort and the sub-cohorts with and without NAFLD.

Enhanced Physical Capacity and Gastrointestinal Symptom Improvement in Southern Italian IBS Patients following Three Months of Moderate Aerobic Exercise

Moderate-intensity aerobic exercise improves gastrointestinal (GI) health and alleviates irritable bowel syndrome (IBS) symptoms. This study explored its effects on physical capacity (PC) and IBS symptoms in 40 patients from Southern Italy (11 males, 29 females; 52.10 ± 7.72 years). The exercise program involved moderate-intensity aerobic exercise (60/75% of HRmax) for at least 180 min per week. Before and after the intervention, participants completed the IBS-SSS questionnaire to assess IBS symptoms, reported their physical activity levels, and underwent field tests to evaluate PC. PC was quantified as the Global Physical Capacity Score (GPCS). A total of 38 subjects (21 males, 17 females; 53.71 ± 7.27 years) without lower GI symptoms served as a No IBS group. No significant differences were found between IBS patients and No IBS subjects, except for the symptom score, as expected. After the exercise, all participants experienced significant improvements in both IBS symptoms and PC. Higher PC levels correlated with greater benefits in IBS symptomatology, especially with GPCS reaching above-average values. Engaging in moderate-intensity aerobic exercise for at least 180 min per week positively impacts IBS symptoms and PC. Monitoring GPCS in IBS patients provides insights into the connection between physical activity and symptom severity, aiding healthcare professionals in tailoring effective treatment plans.

The Impact of a Twelve-Week Moderate Aerobic Exercise Program on Gastrointestinal Symptom Profile and Psychological Well-Being of Irritable Bowel Syndrome Patients: Preliminary Data from a Southern Italy Cohort

Walking is popular moderate-intensity aerobic exercise that improves mental and gastrointestinal (GI) health. It can relieve symptoms associated with irritable bowel syndrome (IBS), e.g., intestinal gas, abdominal distension, and bowel disturbances. This study examined the impact of a moderate-intensity aerobic exercise program on the clinical and psychological parameters of IBS patients. In total, 40 IBS patients (11 males and 29 females; mean age 51.9 ± 7.8 years) participated in a 12-week aerobic exercise program. Participants completed questionnaires assessing GI symptoms, psychological profiles, and quality of life (QoL) before and after the intervention. Field tests, anthropometric measurements, and bioimpedance assessments were also conducted. The present findings confirmed a significant improvement in IBS symptoms after the aerobic exercise program. Bloating was the most common symptom and, together with abdominal pain, was significantly reduced after treatment. Psychological and QoL questionnaires indicated decreased anxiety, depression, somatization, and stress levels. Correlations were found between anxiety/depression and the severity of abdominal pain as well as between stress and the severity of abdominal distension. Moderate-intensity aerobic exercise positively impacted GI symptoms and psychological well-being, complementing dietary and psychological support as a non-pharmacological therapy for the management of IBS. These findings emphasize the importance of alternative approaches for IBS treatment.

Lifestyle Modification: Evaluation of the Effects of Physical Activity and Low-Glycemic-Index Mediterranean Diet on Fibrosis Score

BACKGROUND

Non-Alcoholic Fatty Liver Disease (NAFLD) is one the most prevalent causes of chronic liver disease worldwide. In the absence of an approved drug treatment, lifestyle modification is the first intervention strategy. This study aimed to estimate the main effect of two different physical activity (PA) programs, and a Low-Glycemic-Index Mediterranean Diet (LGIMD), or their combined effect on liver fibrosis parameters in subjects with NAFLD.

METHODS

Subjects with moderate or severe NAFLD grade of severity (n = 144) were randomly assigned to six intervention arms for three months: LGIMD, PA programs, and their combination. Data were collected at baseline, 45 days, and 90 days. Transient elastography was performed to assess the outcome.

RESULTS

at 90 days, a statistically significant reduction in kPa was found among subjects following LGMID (-2.85, 95% CI -5.24, -0.45) and those following an LGIMD plus PA1 (-2.37, 95% CI -4.39, -0.35) and LGIMD plus Pa2 (-2.21, 95% CI -4.10, -0.32). The contrast between time 2 and time 1 of the LGIMD plus PA2 treatment showed a statistically significant increase, and vice versa: the contrast between time 3 and time 2 of the same treatment showed a statistically significant reduction. The PA1 and PA2 arms also showed reduced kPa, although the results did not reach statistical significance.

CONCLUSIONS

The intervention arms, LGIMD, LGIMD+PA1, and LGIMD+PA2, reduced the fibrosis score.

Synergistic Effect of Diet and Physical Activity on a NAFLD Cohort: Metabolomics Profile and Clinical Variable Evaluation

Together with its comorbidities, nonalcoholic fatty liver disease (NAFLD) is likely to rise further with the obesity epidemic. However, the literature's evidence shows how its progression can be reduced by the administration of calorie-restrictive dietary interventions and physical activity regimens. The liver function and the gut microbiota have been demonstrated to be closely related. With the aim of ascertaining the impact of a treatment based on the combination of diet and physical activity (versus physical activity alone), we recruited 46 NAFLD patients who were divided into two groups. As a result, we traced the connection between volatile organic compounds (VOCs) from fecal metabolomics and a set of statistically filtered clinical variables. Additionally, we identified the relative abundances of gut microbiota taxa obtained from 16S rRNA gene sequencing. Statistically significant correlations emerged between VOCs and clinical parameters, as well as between VOCs and gut microbiota taxa. In comparison with a physical activity regimen alone, we disclose how ethyl valerate and pentanoic acid butyl ester, methyl valerate, and 5-hepten-2-one, 6-methyl changed because of the positive synergistic effect exerted by the combination of the Mediterranean diet and physical activity regimens. Moreover, 5-hepten-2-one, 6-methyl positively correlated with Sanguinobacteroides, as well as the two genera Oscillospiraceae-UCG002 and Ruminococcaceae UCG010 genera.

Diet and Exercise Exert a Differential Effect on Glucose Metabolism Markers According to the Degree of NAFLD Severity

BACKGROUND

Non-Alcoholic Fatty Liver Disease (NAFLD) and Type 2 Diabetes (T2D) are highly prevalent diseases worldwide. Insulin Resistance (IR) is the common denominator of the two conditions even if the precise timing of onset is unknown. Lifestyle change remains the most effective treatment to manage NAFLD. This study aimed to estimate the effect of the Low Glycemic Index Mediterranean Diet (LGIMD) and exercise (aerobic and resistance) over a one-year period on the longitudinal trajectories of glucose metabolism regulatory pathways.

MATERIALS AND METHODS

In this observational study, 58 subjects (aged 18-65) with different degrees of NAFLD severity were enrolled by the National Institute of Gastroenterology-IRCCS "S. de Bellis", to follow a 12-month program of combined exercise and diet.

RESULTS

The mean age was 55 ± 7 years old. Gender was equally distributed among NAFLD categories. There was a statistically significant main effect of time for glycosylated hemoglobin (Hb1Ac) over the whole period (-5.41, 95% CI: -7.51; -3.32). There was a steady, statistically significant decrease of HbA1c in participants with moderate and severe NAFLD whereas this effect was observed after the 9th month in those with mild NAFLD.

CONCLUSIONS

The proposed program significantly improves glucose metabolism parameters, especially HbA1c.

Modified WCRF/AICR Score and All-Cause, Digestive System, Cardiovascular, Cancer and Other-Cause-Related Mortality: A Competing Risk Analysis of Two Cohort Studies Conducted in Southern Italy

Background: In real life, nutrition goes beyond purely biological domains. Primary prevention is the most efficient approach for reducing the risk of mortality. We aimed to study the association of lifestyle, as measured by a modified World Cancer Research Fund/American Institute for Cancer Research (mWCRF/AICR) scoring system with all-cause, digestive system disease-related (DSD-related), cardiovascular disease-related (CVD-related), cancer–related and other cause-related mortality using data from two population-based cohort studies conducted in Southern Italy. Methods: A random sample of 5271 subjects aged 18 years or older was enrolled in 2005–2006 and followed up until 2020. Usual food intakes were estimated using a validated dietary questionnaire. Competing risks survival models were applied. Results: High adherence to the mWCRF/AICR score was found to be statistically significant and negatively associated with all-cause mortality (HR 0.56, 95%CI 0.39; 0.82), DSD-related mortality (SHR 0.38, 95%CI 0.15; 0.97) and cancer-related mortality (SHR 0.43, 95%CI 0.19; 0.97) in the male sub-cohort and other-cause mortality (SHR 0.43, 95%CI 0.21; 0.88) only in the female group. Conclusions: This mWCRF/AICR score can be seen as a simple, easy tool for use in clinical practice to evaluate both qualitative and quantitative aspects of the diet.

Development and validation of a neural network for NAFLD diagnosis

Non-Alcoholic Fatty Liver Disease (NAFLD) affects about 20–30% of the adult population in developed countries and is an increasingly important cause of hepatocellular carcinoma. Liver ultrasound (US) is widely used as a noninvasive method to diagnose NAFLD. However, the intensive use of US is not cost-effective and increases the burden on the healthcare system. Electronic medical records facilitate large-scale epidemiological studies and, existing NAFLD scores often require clinical and anthropometric parameters that may not be captured in those databases. Our goal was to develop and validate a simple Neural Network (NN)-based web app that could be used to predict NAFLD particularly its absence. The study included 2970 subjects; training and testing of the neural network using a train–test-split approach was done on 2869 of them. From another population consisting of 2301 subjects, a further 100 subjects were randomly extracted to test the web app. A search was made to find the best parameters for the NN and then this NN was exported for incorporation into a local web app. The percentage of accuracy, area under the ROC curve, confusion matrix, Positive (PPV) and Negative Predicted Value (NPV) values, precision, recall and f1-score were verified. After that, Explainability (XAI) was analyzed to understand the diagnostic reasoning of the NN. Finally, in the local web app, the specificity and sensitivity values were checked. The NN achieved a percentage of accuracy during testing of 77.0%, with an area under the ROC curve value of 0.82. Thus, in the web app the NN evidenced to achieve good results, with a specificity of 1.00 and sensitivity of 0.73. The described approach can be used to support NAFLD diagnosis, reducing healthcare costs. The NN-based web app is easy to apply and the required parameters are easily found in healthcare databases.

The effect of the Mediterranean Diet on lifespan: a treatment-effect survival analysis of a population-based prospective cohort study in Southern Italy

BACKGROUND

The Mediterranean diet (MedDiet) is associated with good health. We aimed to estimate the effect of levels of adherence to the MedDiet on lifespan by performing treatment effects survival analysis.

METHODS

A sample of 5250 subjects aged ≥18 years were randomly selected from the electoral list of Castellana Grotte and Putignano (Apulian Region, Italy). Cohorts were enrolled in 2005-06 and followed-up until December 2018. The adherence to the MedDiet was measured by the relative Mediterranean score (rMED) and categorized as high, medium and low. Time-to-death (all-causes) as estimated by average treatment effect on the treated (ATET), potential outcome mean (POM) and relative efficiency of exposure were the outcomes.

RESULTS

A total of 4896 subjects were included. The median follow-up time was 12.82 (inter quartile range (IQR) 12.22-13.05), 12.91 (IQR 12.21-13.27) and 12.84 (IQR 12.19-13.03) years for high, medium and low rMED subjects respectively. By December 2018, 453 (9.25%) had died. There was a strong effect of medium and low rMED {ATET, -5.10 [95% confidence interval (CI) -9.39, -0.80] and -8.91 (95%CI -13.37, -4.45), respectively}. High rMED has an important effect on mean age at death [POM 90.16 (95% CI 86.06, 94.25)]. The relative effect size for medium and low rMED subjects was a lower lifespan of 5.62% (95% CI 1.01, 10.3) and 9.90% (95% CI 5.30, 5.30), respectively.

CONCLUSIONS

We observed an important benefit in additional years of survival from adherence to MedDiet in this southern Italian cohort. Further investigation corroborating our findings in other population groups in other geographic regions will be an important contribution to promoting health and longevity.

Decreased levels of physical activity: results from a cross-sectional study in southern Italy during the COVID-19 lockdown

BACKGROUND

During the COVID-19 pandemic, the Italian government took security measures to try to limit infections. Restrictive measures included social distancing, home confinement and the closure of all public structures like gyms and swimming pools. The impact of these limitations on health and lifestyle was inevitably negative. The purpose of this study was to establish the level of physical activity (PA), expressed as energy expenditure (MET-minute/week) in a Southern Italian population before and during the COVID-19 lockdown.

METHODS

An adapted version of the International Physical Activity Questionnaire-short form (IPAQ-SF) was published on the official website of the National Institute of Gastroenterology IRCCS S. de Bellis, Castellana Grotte, Bari, Italy and on several social media in May 2020.

RESULTS

Three hundred ten replies (72% women) from Apulia (60%), Calabria (28%), Campania (11%) and Sicily (1%) were included in the study. The COVID-19 lockdown had a negative effect on the vigorous PA intensity level and on walking, but not on the moderate PA intensity level. Additionally, daily time spent sitting down increased by more than 12% during the COVID-19 lockdown.

CONCLUSIONS

Isolation changed PA behaviors. The decreased energy expenditure (MET-minute/week) during the lockdown had a negative impact in both genders, especially on the young adults and adults' groups.

Remnant cholesterol as a risk factor for cardiovascular, cancer or other causes mortality: A competing risks analysis

BACKGROUND AND AIMS

Cardiovascular diseases (CVDis) are leading causes of morbidity and mortality. Even after the introduction of pharmacological therapy to lower Cholesterol, there is still a residual risk that may be ascribed to remnant cholesterol (RC). We aimed, by analyzing two prospective cohort studies, to estimate the effect of RC on risk and hazard of cardiovascular deaths (CVDs), while accounting for competing risks such as cancer (CDs) and other-causes deaths (OCDs).

METHODS AND RESULTS

Cohorts were enrolled in 1992 and 2005. Personal data history was recorded. A fasting venous blood sample was obtained, and RC was calculated at baseline. Cause of Death was coded by using ICD-10th version. Follow-up ended on December 31, 2017. Flexible parametric competing-risks models were applied, with age at death as time-axis. In total, 5729 subjects were enrolled. There were 861 (15.1%) deaths: 234 CVDs (27.2%), 245 CDs (28.5%), 271 OCDs (31.5%) and 111 unknown causes of death (12.8%). RC exposure was a strong risk factor only for CVDs (Risk 2.54, 95% Confidence Interval 1.21; 5.34; Trend 1.26 (1.00; 1.58) for ≥1.29 mmol/L).

CONCLUSIONS

RC is a strong independent risk factor for cardiovascular mortality. Competing risk analysis is demonstrably a useful tool to disentangle associations among different competing events with a common risk factor.

Selecting the best machine learning algorithm to support the diagnosis of Non-Alcoholic Fatty Liver Disease: A meta learner study

Background & aims

Liver ultrasound scan (US) use in diagnosing Non-Alcoholic Fatty Liver Disease (NAFLD) causes costs and waiting lists overloads. We aimed to compare various Machine learning algorithms with a Meta learner approach to find the best of these as a predictor of NAFLD.

Methods

The study included 2970 subjects, 2920 constituting the training set and 50, randomly selected, used in the test phase, performing cross-validation. The best predictors were combined to create three models: 1) FLI plus GLUCOSE plus SEX plus AGE, 2) AVI plus GLUCOSE plus GGT plus SEX plus AGE, 3) BRI plus GLUCOSE plus GGT plus SEX plus AGE. Eight machine learning algorithms were trained with the predictors of each of the three models created. For these algorithms, the percent accuracy, variance and percent weight were compared.

Results

The SVM algorithm performed better with all models. Model 1 had 68% accuracy, with 1% variance and an algorithm weight of 27.35; Model 2 had 68% accuracy, with 1% variance and an algorithm weight of 33.62 and Model 3 had 77% accuracy, with 1% variance and an algorithm weight of 34.70. Model 2 was the most performing, composed of AVI plus GLUCOSE plus GGT plus SEX plus AGE, despite a lower percentage of accuracy.

Conclusion

A Machine Learning approach can support NAFLD diagnosis and reduce health costs. The SVM algorithm is easy to apply and the necessary parameters are easily retrieved in databases.

SARS-CoV-2: Sanitize a hospital

Issue

During the SARS-CoV-2 pandemic, several critical issues emerged. One of these was to identify which was the best terminal disinfection strategy for hospital rooms of a COVID-19. Description of the problem. Our University Hospital adopted ozone disinfection two years ago, recognized internationally as a 'safe gas' and is an excellent disinfectant for its characteristics of attacking and oxidizing each type of organic and inorganic compound and specifically also works against SARS-CoV-2.

Results

23 ozone generators were purchased, 20 ozonizers were assigned to departments with high environmental sanitation needs, 3 ozonizers supplied to the ozonator team. For the correct use of the equipment, 200 operators were trained in a certified way. The rooms are ozonated with pre-established frequency and whenever a COVID-19 patient is cared for. The ozonation team sanitizes rooms in wards that are not equipped but that may have hosted patients with carriers. Indications have been given in all the wards to create the ozonation room, that can be used as an ozone disinfection chamber, where it is possible to place garrisons and furnishings, even large-sized, that cannot be disinfected in other ways (in addition to sanitization with hypochlorite). The team also provides for the ozonation of ambulances with a predetermined periodicity or in the case of transport of patient carrying SARS-CoV-2. All activities are monitored with a special traceability card.

Lessons

Terminal disinfection of environments that have hosted patients with COVID-19. Terminal disinfection of the devices used on patients with COVID-19. Increased safety for operators carrying out environmental sanitation.

Key messages

Fight SARS-COV-2 with ozone.

Disinfecting with ozone is safety for everyone.

The Effect of Three Mediterranean Diets on Remnant Cholesterol and Non-Alcoholic Fatty Liver Disease: A Secondary Analysis

BACKGROUND

Elevated fasting remnant cholesterol (REM-C) levels have been associated with an increased cardiovascular risk in patients with metabolic syndrome (Mets) and Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to estimate the effect of different diets on REM-C levels in patients with MetS, as well as the association between NAFLD and REM-C.

METHODS

This is a secondary analysis of the MEDIDIET study, a parallel-arm Randomized Clinical Trial (RCT). We examined 237 people with MetS who underwent Liver Ultrasound (LUS) to assess the NAFLD score at baseline, 3-, and 6-months follow-up. Subjects were randomly assigned to the Mediterranean diet (MD), Low Glycemic Index diet (LGID), or Low Glycemic Index Mediterranean diet (LGIMD). REM-C was calculated as [total cholesterol-low density lipoprotein cholesterol (LDL-C)-high density lipoprotein cholesterol (HDL-C)].

RESULTS

REM-C levels were higher in subjects with moderate or severe NAFLD than in mild or absent ones. All diets had a direct effect in lowering the levels of REM-C after 3 and 6 months of intervention. In adherents subjects, this effect was stronger among LGIMD as compared to the control group. There was also a significant increase in REM-C levels among Severe NAFLD subjects at 3 months and a decrease at 6 months.

CONCLUSIONS

fasting REM-C level is independently associated with the grade of severity of NAFLD. LGIMD adherence directly reduced the fasting REM-C in patients with MetS.

Reducing NAFLD-screening time: A comparative study of eight diagnostic methods offering an alternative to ultrasound scans

BACKGROUND & AIMS

The use of ultrasound scan (US) in non-alcoholic fatty liver disease (NAFLD) screening overloads US waiting lists. We hypothesized and tested a hybrid two-step method, consisting of applying a formula, to exclude subjects at low risk, before US.

METHODS

The sample included 2970 males and females (937 with NAFLD) diagnosed by US. We selected eight formulas: Fatty Liver Index (FLI), Hepatic Steatosis Index (HIS), body mass index (BMI), waist circumference (WC), Abdominal Volume Index (AVI), waist-to-height ratio (WHtR), waist/height^0.5 (WHT.5R) and Body Roundness Index (BRI), and calculated their performance in the two-step method evaluating percentage reduction of the number of liver US (US reduction percentage), percentage of false negative and percentage of NAFLD identified.

RESULTS

The US reductions percentage were 52.2% (WHtR), 52.1% (HIS), 51.8% (FLI), 50.8% (BRI), 50.7% (BMI and WHt_5R), 46.5% (WC) and 45.2% (AVI). The false negative percentage were 8.5% (WHtR), 7.9% (BRI), 7.3% (WHt_5R), 7.2% (BMI), 6.7% (HIS), 6.6% (FLI), 5.6% (WC) and 5.2% (AVI). The best percentage of NALFD identified was obtained using AVI (83.6%) before US, then WC (82.2%), FLI (79%), HIS (78.9%), BMI (77.3%), WHt_5R (76.9%), BRI (74.8%) and WHtR (73%).

CONCLUSION

The best formula to use in two-step diagnostic NAFLD screening was AVI, which showed a low false negative rate and a higher percentage of identified NAFLD. Other studies evaluating the economic advantages of this screening method are warranted.

Potato Consumption Is not Associated with Higher Risk of Mortality: A Longitudinal Study among Southern Italian Older Adults

OBJECTIVE

The consumption of potatoes is increasing worldwide, but few studies have assessed the association between potato consumption and mortality, particularly in Mediterranean countries. We therefore investigated whether potato consumption is associated with higher risk of death in a large cohort of people living in South Italy.

DESIGN

Longitudinal.

SETTING

Community-dwelling.

MEASUREMENTS

2,442 participants coming from MICOL and NUTRIHEP studies aged more than 50 years at baseline were followed-up for 11 years. Dietary intake was assessed by means of a Food Frequency Questionnaire. Potato consumption was categorized in quintiles according to their daily consumption (< 3.95, 3.96-8.55, 8.56-15.67, 15.68-22.0, and > 22.0 g/day). Mortality was ascertained through validated cases of death. The association between potato consumption and mortality was assessed through Cox's regression models, adjusted for potential confounders, and reporting the data as hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

The 2,442 eligible participants were prevalently males (54.6%) and aged a mean of 64.3±9.3 years. During the 11-year follow-up, 396 (=16.2%) participants died. After adjusting for 12 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not have an increased overall mortality risk (HR=0.75; 95%CI: 0.53-1.07). Modelling the potato consumption as continuous (i.e. as increase in 10 g/day) did not substantially change our findings (fully-adjusted HR=0.93; 95%CI: 0.84-1.02).

CONCLUSION

Overall potato consumption was not associated with higher risk of death in older people living in a Mediterranean area. Future studies are warranted to elucidate the role of potato consumption on all-cause and cause-specific mortality.

Multi-stage freezing of HEUR polymer networks with magnetite nanoparticles

We observe a change in the segmental dynamics of hydrogels based on hydrophobically modified ethoxylated urethanes (HEUR) when hydrophobic magnetite nanoparticles (MNPs) are embedded in the hydrogels. The dynamics of the nanocomposite hydrogels is investigated using dielectric relaxation spectroscopy (DRS) and neutron spin echo (NSE) spectroscopy. The magnetic nanoparticles within the hydrophobic domains of the HEUR polymer network increase the size of these domains and their distance. The size increase leads to a dilution of the polymers close to the hydrophobic domain, allowing higher mobility of the smallest polymer blobs close to the "center". This is reflected in the decrease of the activation energy of the β-process detected in the DRS data. The increase in distance leads to an increase of the size of the largest hydrophilic polymer blobs. Therefore, the segmental dynamics of the largest blobs is slowed down. At short time scales, i.e. 10(-9) s < τ < 10(-3) s, the suppression of the segmental dynamics is reflected in the α-relaxation processes detected in the DRS data and in the decrease of the relaxation rate Γ of the segmental motion in the NSE data with increasing concentration of magnetic nanoparticles. The stepwise (multi-stage) freezing of the small blobs is only visible for the pure hydrogel at low temperatures. On the other hand, the glass transition temperature (Tg) decreases upon increasing the MNP loading, indicating an acceleration of the segmental dynamics at long time scales (τ∼ 100 s). Therefore, it would be possible to tune the Tg of the hydrogels by varying the MNP concentration. The contribution of the static inhomogeneities to the total scattering function Sst(q) is extracted from the NSE data, revealing a more ordered gel structure than the one giving rise to the total scattering function S(q), with a relaxed correlation length ξNSE = (43 ± 5) Å which is larger than the fluctuating correlation length from a static investigation ξSANS = (17.2 ± 0.3) Å.

Two-stage treatment of a secondary aortoesophageal fistula after thoracic endovascular aneurysm repair

Secondary aortoesophageal fistula is a relatively rare but very often lethal complication that may develop after thoracic endovascular aneurysm repair (TEVAR). The clinical syndrome is well explained by the Chiari triad: midthoracic pain and/or dysphagia, and sentinel minor hematemesis followed by massive hematemesis. The incidence of this serious complication has increased with the growing number of patients undergoing TEVAR. This case report describes a patient who was seen in the emergency department at this hospital because of fever, sepsis and thoracic pain radiating to the back and unresponsive to drug therapy, diagnosed with a secondary aortoesophageal fistula and subsequently treated with a two stage surgical procedure.

Allergy and multiple sclerosis: a population-based case-control study

BACKGROUND

Epidemiological studies on the association between allergic disorders, T-helper type 2 (Th2) mediated, and multiple sclerosis (MS), a T-helper type 1 (Th1)/Th17-mediated disease, provided conflicting results.

OBJECTIVE

The aim of this study was to further examine the association between allergic disorders and MS.

METHODS

The association between MS and previous medical history of any type of allergy has been investigated in a population-based case-control study conducted in Northern Italy, based on telephone interviews to 423 cases and 643 population controls (refusal rates 3.7% and 9.4%, respectively). Controls were a random sample of the general population.

RESULTS

A history of atopic allergies seems to confer protection against MS (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.38-0.89; P = 0.012). In particular, the prevalence of allergic asthma was 4.9% in people with MS and 12% in control subjects (OR = 0.38; 95% CI 0.22-0.66, P < 0.01). No association was found between MS and nonatopic allergies.

CONCLUSIONS

Our findings are confirmatory of the putative protective effect of Th2-mediated disorders on Th1 immune responses associated with MS. A unifying theory on the mechanisms by which previous history of atopic allergies may modify the risk of MS is still lacking.

Nipple reconstruction by local flaps: a long-term comparative study between star and skate techniques

Nipple reconstruction often gives the highest satisfaction to the patient despite being just a minor procedure. During the last 50 years, many techniques have been described in order to improve the cosmetic appearance. Star and skate flaps are two of the most frequently reported procedures. The aim of this study was to compare the personal experience of two plastic surgery departments that have been using these two different methods. Thirty patients have been included in this study. Nipple projection and cosmetic appearance have been evaluated by both patients and surgeons. Follow-up ranged between 1 and 5 years. Results have been compared. Both techniques proved to be versatile and valid. The skate flap seemed to keep projection for a longer time, while the star technique gave a better cosmetic appearance.

A new mutation (G51C) in the iron-responsive element (IRE) of L-ferritin associated with hyperferritinaemia-cataract syndrome decreases the binding affinity of the mutated IRE for iron-regulatory proteins

Hereditary hyperferritinaemia-cataract syndrome is an autosomal dominant disorder characterized by a constitutively increased synthesis of L-ferritin in the absence of iron overload. The disorder is associated with point mutations in the iron-responsive element (IRE) of L-ferritin mRNA. We report a new mutation, G51C, identified in two members of a Canadian family, presenting a moderate increase in serum ferritin and a clinically silent bilateral cataract. Gel retardation assays showed that the binding of the mutated IRE to iron-regulatory proteins (IRPs) was reduced compared with the wild type. Structural modelling predicted that the G51C induces a rearrangement of base pairing at the lateral bulge of the IRE structure which is likely to modify IRE conformation.

Expression of Bcl-2, p53, c-jun and c-fos protooncogenes in keloids and hypertrophic scars

Keloids and hypertrophic scars represent a model of altered wound healing characterized by overproduction of extracellular matrix and dermal fibroblasts with high mitotic rate. Alteration of apoptosis and cell proliferation has been implicated in the etiology of keloids. The bcl-2 protooncogene encodes a protein that protects cells from programmed cell death while p53 protein functions as negative regulator of cell proliferation. Both protooncogenes have been shown to play a role in tissue homeostasis as apoptotic regulatory genes. The c-jun and c-fos protooncogenes are transactivating factors also involved in fibroblast proliferation. In our study we investigated, by immunohistochemistry, skin specimens from three clinically active hypertrophic scars and keloids, two resting keloids and two early phase morphea to detect both bcl-2 and p53 protein expression, in order to evaluate these apoptotic regulatory genes in different fibrotic conditions. The c-jun and c-fos, at protein and mRNA level, and Ki67 nuclear antigen expression were also investigated. In hypertrophic scars and active keloids we could detect intense Bcl-2 staining in basal keratinocytes and in scattered fibroblast-like and perivascular spindle-shaped cells, while no p53 expression could be demonstrated. The c-jun and c-fos mRNA and protein expression was mainly found in dermal fibroblast-like cells and elongated perivascular cells in all skin biopsies, and similar immunostaining pattern was observed for Ki67 antigen. No protooncogene expression in morphea patients and normal skin, unless Bcl-2 staining in the basal layer of normal epidermis, was documented. Our results suggest that Bcl-2, c-jun and c-fos protein expression and lack of p53 detection in fibroblast-like and perivascular spindle cells are related to increased fibroblast proliferation, confirmed by Ki67 positivity, probably due to alteration of these regulatory apoptotic genes resulting in pathological scarring.

Motor evoked potentials in the post-surgical follow-up of cervical spondylotic myelopathy

Eighteen patients (6 female, 12 male; average age 51 years, range 37-79) with clinical and radiological evidence (MRI) of cervical spondylotic myelopathy (CSM) were examined. The subjects were divided into two groups depending on whether radiology indicated single level (9 patients) or multilevel (9 patients) compression of the cervical cord. All of the patients underwent surgical decompression. Seriate exam with trans-cranial magnetic stimulation was performed in double session before surgery, and 3 and 12 months after surgery. The follow-up study of these patients revealed a statistically significant neurophysiological improvement only in those patients with single-level compression. In these cases, the cervical cord pathology revealed by MRI signal hyperintensity in T2 may at least partially consist of an edematous component and/or an initial demyelinization that has still a chance of recovery. In patients with multilevel damage, the compression may cause irreversible lesions.

Coexistence of haemophilia A and von Willebrand's disease in the same kindred

A clinical and laboratory investigation of a kindred in which haemophilia A and autosomal recessive von Willebrand's disease (VWD) were concomitantly present is described. 3 male patients were shown to be hemizygotes for moderate haemophilia A, one female appeared to be haemophilia A carrier and 3 males showed laboratory findings consistent with heterozygosity for autosomal recessive VWD. In one woman, the pedigree and laboratory findings suggest the possibility of double heterozygosity.