BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiologica...BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiological examinations,a few conditions,such as Wernicke encephalopathy(WE),may present a particular diagnostic difficulty.WE is a neurological disorder caused by deficiency of thiamine(B1 vitamin),most often resulting from alcoholism,malnutrition,hyperemesis gravidarum or bariatric surgery.The diagnosis of WE in a certain historical,clinical setting is easily suggested,but in a few cases presenting with acute neurological deficits,it can be particularly challenging.CASE SUMMARY We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities,dizziness and a confusional state,which had lasted for approximately 30 minutes.The patient had a similar episode of a confusional state approximately two months earlier;at that time,a transient ischemic attack was suspected and he was started on aspirin.The initial clinical evaluation and imaging findings were unremarkable for stroke,but the patient’s symptoms,history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE.Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.CONCLUSION Through this case report,we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke,especially when the presentation is atypical or when risk factors for thiamine deficiency are present.Since intravenous thiamine significantly improves outcomes,delayed recognition and treatment in some cases might be deleterious.展开更多
The assessment of the fibrotic evolution of chronic hepatitis has always been a challenge for the clinical hepatologist. Over the past decade, various noninvasive methods have been proposed to detect the presence of f...The assessment of the fibrotic evolution of chronic hepatitis has always been a challenge for the clinical hepatologist. Over the past decade, various noninvasive methods have been proposed to detect the presence of fibrosis, including the elastometric measure of stiffness, panels of clinical and biochemical parameters, and combinations of both methods. The aim of this review is to analyse the most recent data on non-invasive techniques for the evaluation of hepatic fibrosis with particular attention to costeffectiveness. We searched for relevant studies published in English using the Pub Med database from 2009 to the present. A large number of studies have suggested that elastography and serum markers are useful techniques for diagnosing severe fibrosis and cirrhosis and for excluding significant fibrosis in hepatitis C virus patients. In addition, hepatic stiffness may also help to prognosticate treatment response to antiviral therapy. It has also been shown that magnetic resonance elastography has a high accuracy for staging and differentiating liver fibrosis. Finally, studies have shown that non-invasive methods are becoming increasingly precise in either positively identifying or excluding liver fibrosis, thus reducing the need for liver biopsy. However, both serum markers and transient elastography still have "grey area" values of lower accuracy. In this case, liver biopsy is still required to properly assess liver fibrosis. Recently, the guidelines produced by the World Health Organization have suggested that the AST-to-platelet ratio index or FIB-4 test could be utilised for the evaluation of liver fibrosis rather than other, more expensive non-invasive tests, such as elastography or Fibro Test.展开更多
Transient elastography and the acoustic radiation force impulse techniques may play a pivotal role in the study of liver fibrosis. Some studies have shown that elastography can detect both the progression and regressi...Transient elastography and the acoustic radiation force impulse techniques may play a pivotal role in the study of liver fibrosis. Some studies have shown that elastography can detect both the progression and regression of fibrosis. Similarly, research results have been analysed and direct and indirect serum markers of hepatic fibrosis have shown high diagnostic accuracy for advanced fibrosis/cirrhosis. The prognosis of different stages of cirrhosis is well established and various staging systems have been proposed, largely based on clinical data. However, it is still unknown if either noninvasive markers of liver fibrosis or elastography may contribute to a more accurate staging of liver cirrhosis, in terms of prognosis and fibrosis regression after effective therapy. In fact, not enough studies have shown both the fibrosis regression in different cirrhosis stages and the point beyond which the prognosis does not change- even in the event of fibrosis regression. Therefore, future studies are needed to validate noninvasive methods in predicting the different phases of liver cirrhosis.展开更多
In clinical practice obesity is primarily diagnosed through the body mass index. In order to characterize patients affected by obesity the use of traditional anthropometric measures appears misleading. Beyond the body...In clinical practice obesity is primarily diagnosed through the body mass index. In order to characterize patients affected by obesity the use of traditional anthropometric measures appears misleading. Beyond the body mass index, there are overwhelming evidences towards the relevance of a more detailed description of the individual phenotype by characterizing the main body componentsas free-fat mass, muscle mass, and fat mass. Among the numerous techniques actually available, bioelectrical impedance analysis seems to be the most suitable in a clinical setting because it is simple, inexpensive, noninvasive, and highly reproducible. To date, there is no consensus concerning the use of one preferred equation for the resting energy expenditure in overweight and/or obese population. Energy restriction alone is an effective strategy to achieve an early and significant weight loss, however it results in a reduction of both fat and lean mass therefore promoting or aggravating an unfavourable body composition(as sarcobesity) in terms of mortality and comorbidities. Therefore the implementation of daily levels of physical activity should be simultaneously promoted. The major role of muscle mass in the energy balance has been recently established by the rising prevalence of the combination of two condition as sarcopenia and obesity. Physical exercise stimulates energy expenditure, thereby directly improving energy balance, and also promotes adaptations such as fiber type, mitochondrial biogenesis, improvement of insulin resistance, and release of myokines, which may influence different tissues, including muscle.展开更多
BACKGROUND An altered (dysbiosis) and unhealthy status of the gut microbiota is usually responsible for a reduction of short chain fatty acids (SCFAs) concentration. SCFAs obtained from the carbohydrate fermentation p...BACKGROUND An altered (dysbiosis) and unhealthy status of the gut microbiota is usually responsible for a reduction of short chain fatty acids (SCFAs) concentration. SCFAs obtained from the carbohydrate fermentation processes are crucial in maintaining gut homeostasis and their determination in stool samples could provide a faster, reliable and cheaper method to highlight the presence of an intestinal dysbiosis and a biomarker for various gut diseases. We hypothesize that different intestinal diseases, such as celiac disease (CD), adenomatous polyposis (AP) and colorectal cancer (CRC) could display a particular fecal SCFAs’ signature. AIM To compare the fecal SCFAs’ profiles of CD, AP, CRC patients and healthy controls, using the same analytical method. METHODS In this cross-sectional study, we defined and compared the SCFAs’ concentration in fecal samples of 9 AP, 16 CD, 19 CRC patients and 16 healthy controls (HC). The SCFAs’ analysis were performed using a gas-chromatography coupled with mass spectrometry method. Data analysis was carried out using Wilcoxon ranksum test to assess pairwise differences of SCFAs’ profiles, partial least squaresdiscriminate analysis (PLS-DA) to determine the status membership based on distinct SCFAs’ profiles, and Dirichlet regression to determine factors influencing concentration levels of SCFAs. RESULTS We have not observed any difference in the SCFAs’ amount and composition between CD and healthy control. On the contrary, the total amount of SCFAs was significantly lower in CRC patients compared to HC (P = 0.044) and CD (P = 0.005). Moreover, the SCFAs’ percentage composition was different in CRC and AP compared to HC. In detail, HC displayed higher percentage of acetic acid (P value = 1.3 × 10-6) and a lower amount of butyric (P value = 0.02192), isobutyric (P value = 7.4 × 10-5), isovaleric (P value = 0.00012) and valeric (P value = 0.00014) acids compared to CRC patients. AP showed a lower abundance of acetic acid (P value = 0.00062) and higher percentages of propionic (P value = 0.00433) and isovaleric (P value = 0.00433) acids compared to HC. Moreover, AP showed higher levels of propionic acid (P value = 0.03251) and a lower level of isobutyric acid (P value = 0.00427) in comparison to CRC. The PLS-DA model demonstrated a significant separation of CRC and AP groups from HC, although some degree of overlap was observed between CRC and AP. CONCLUSION Analysis of fecal SCFAs shows the potential to provide a non-invasive means of diagnosis to detect patients with CRC and AP, while CD patients cannot be discriminated from healthy subjects.展开更多
BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging dat...BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio<1(immunological non-responders[INRs])and CD4/CD8>1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and butyric acids.Contemporarily,a reduction of serum IP-10 and an increase of IL-8 levels were detected in the viral suppression condition.In addition,the same components were compared between IRs and INRs.Concerning the microflora population,we detected a reduction of Faecalibacterium and an increase of Alistipes in INRs.Simultaneously,fecal isobutyric,isovaleric,and 2-methylbutyric acids were also increased in INRs.CONCLUSION Our results provided an additional perspective about the impact of HIV infection,ART,and immune recovery on the"microbiome-immunity axis"at the metabolism level.These factors can act as indicators of the active processes occurring in the gastrointestinal tract.Individuals with HIV-1 infection,before ART and after reaching virological suppression with 24 wk of ART,displayed a microbiota with unchanged overall bacterial diversity;moreover,their systemic inflammatory status seems not to be completely restored.In addition,we confirmed the role of the GM metabolites in immune reconstitution.展开更多
Objective:Acupuncture is considered an important part of the alternative medical treatment of tumors.However,it is still unclear whether acupuncture has a direct effect on inhibition of tumor growth.The purpose of thi...Objective:Acupuncture is considered an important part of the alternative medical treatment of tumors.However,it is still unclear whether acupuncture has a direct effect on inhibition of tumor growth.The purpose of this study was to evaluate the effects of acupuncture treatment on tumors in BALB/c mice that were or were not administered cyclophosphamide.Methods:A 4T1 breast carcinoma mouse model for this study was established.When the mice developed 5 mm × 5 mm visible subcutaneous tumors,they were subjected to acupuncture and/or cyclophosphamide (CTX) treatment for 15 days.Results:Acupuncture and CTX treatment both reduced the size of the solid tumors.When used in conjunction,the tumor size reduction was even more obvious.Hematoxylin and eosin staining showed that acupuncture had a significant effect on induction of tumor cell necrosis and inhibition of angiogenesis.Immunohistochemistry showed that the expression of CD34 and matrix metalloproteinase-9 (MMP-9),which were related to angiogenesis,decreased after treatment with either acupuncture or CTX.However,when the two treatments were used in conjunction,they showed a synergistic effect on inhibiting the expression of CD34.However,the synergistic effect was not observed onMvMP-9 expression.Conclusion:Acupuncture plays an important role in improving the effect of chemotherapy by inhibiting angiogenesis.展开更多
HIV-associated dementia(HAD)is a public health problem and is particularly prevalent in drug abusers.The neuropathogenesis of human immunodeficiency virus(HIV)infection involves a complex cascade of inflammatory event...HIV-associated dementia(HAD)is a public health problem and is particularly prevalent in drug abusers.The neuropathogenesis of human immunodeficiency virus(HIV)infection involves a complex cascade of inflammatory events,including monocyte/macrophage infiltration in the brain,glial immune activation and release of neurotoxic substances.In these events,astrocytic-derived monocyte chemoattractant protein-1(MCP-1)plays an important role,whose release is elevated by HIV transactivator of transcription(HIV tat)and could be further elevated by opiates.This review will also consider some critical factors and events in MCP-1 enhancement induced by the interactions of opiate and HIV tat,including the mediating role of mu opioid receptor(MOR)and CCR2 as well as the possible signal transduction pathways within the cells.Finally,it will make some future perspectives on the exact pathways,new receptors and target cells,and the vulnerability to neurodegeneration with HIV and opiates.展开更多
BACKGROUND Fibromyalgia(FM)syndrome is mainly characterized by widespread pain,sleeping disorders,fatigue,and cognitive dysfunction.In many cases,gastrointestinal distress is also reported,suggesting the potential pat...BACKGROUND Fibromyalgia(FM)syndrome is mainly characterized by widespread pain,sleeping disorders,fatigue,and cognitive dysfunction.In many cases,gastrointestinal distress is also reported,suggesting the potential pathogenic role of the gut microbiota(GM).The GM is deeply influenced by several environmental factors,especially the diet,and recent findings highlighted significant symptom improvement in FM patients following various nutritional interventions such as vegetarian diet,low-fermentable oligosaccharides,disaccharides,monosaccharides,and polyols based diets,gluten-free diet,and especially an ancient grain supplementation.In particular,a recent study reported that a replacement diet with ancient Khorasan wheat led to an overall improvement in symptom severity of FM patients.AIM To examine the effects of ancient Khorasan wheat on the GM,inflammation,and short-chain fatty acid production in FM patients.METHODS After a 2-wk run-in period,20 FM patients were enrolled in this randomized,double-blind crossover trial.In detail,they were assigned to consume either Khorasan or control wheat products for 8 wk and then,following an 8-wk washout period,crossed.Before and after treatments,GM characterization was performed by 16S rRNA sequencing while the fecal molecular inflammatory response and the short-chain fatty acids(SCFAs)were respectively determined with the Luminex MAGPIX detection system and a mass chromatography-mass spectrometry method.RESULTS The Khorasan wheat replacement diet,in comparison with the control wheat diet,had more positive effects on intestinal microbiota composition and on both the fecal immune and SCFAs profiles such as the significant increase of butyric acid levels(P=0.054),candidatus Saccharibacteria(P=9.95e-06)and Actinobacteria,and the reduction of Enterococcaceae(P=4.97e-04).Moreover,the improvement of various FM symptoms along with the variation of some gut bacteria after the Khorasan wheat diet have been documented;in fact we reported positive correlations between Actinobacteria and both Tiredness Symptoms Scale(P<0.001)and Functional Outcome of Sleep Questionnaire(P<0.05)scores,between Verrucomicrobiae and both Widespread Pain Index(WPI)+Symptom Severity scale(SS)(P<0.05)and WPI(P<0.05)scores,between candidatus Saccharibacteria and SS score(P<0.05),and between Bacteroidales and Sleep-Related and Safety Behaviour Questionnaire score(P<0.05).CONCLUSION The replacement diet based on ancient Khorasan wheat results in beneficial GM compositional and functional modifications that positively correlate with an improvement of FM symptomatology.展开更多
Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance.Although pain is a common complaint among psychiatric patients,clinicians generally separate its presence from ...Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance.Although pain is a common complaint among psychiatric patients,clinicians generally separate its presence from the background mental disorder and downplay its importance,trying primarily to control the psychiatric symptomatology.As a sensory modality,the presence of pain and its importance account for an impressive body of scholarly research.Cartesian methodology considered sensations of all modalities in a mechanistic form,which actually sounds obsolete.However,authors have continuously been faced with the same dilemmas plaguing scholars for centuries.We assume that a large portion of the sensory inputs might be generators of distorted perceptions,which subsequently lead to psychopathology.Auditory and visual hallucinations are incontestable examples.Somaesthetic hallucinations also exist,but pain hardly deserves such a denomination.Nevertheless,chronic pain and psychiatric comorbidity is a reality that needs explanation.Painkillers are not effective in treating psychiatric disorders,and antipsychotics do very little,perhaps nothing,to relieve pain.The pharmacological approach opens one door on the horizon and closes many others,while clinicians continue to face a high prevalence of comorbid pain and mental health issues.However,attempts to correlate altered body schemata(as distorted as it may be,for example,in phantom limb pain) with somatic delusions can simplify all these dilemmas,and the basket of psychophysiology,in fact,might be bigger than presumed.展开更多
Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning ...Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning of obese subjects and the influence of psychological factors on treatment outcome. The aim of the present narrative review is to critically analyze the current literature, in order to point out the most common psychological constructs studied in obesity and to give an overview of the main existing tools investigating psychological features which have been considered significant for the prediction of success in weight loss and maintenance programs in obese patients. In this framework, the most common psychological constructs studied are: self-motivation, self-efficacy, locus of control, health related quality of life, self-esteem, self-control, concerns about body image, outcome expectations, and personality traits. These features have been explored through a wide variety of psychometric instruments. However, as an overall, studies evaluating the association between psychological features and treatment outcome failed to give consistent results. A possible explanation may consist on the fact that many tools widely used to explore psychological features were not specifically designed for obese patients and none of them was comprehensive of all possible psychological features involved. The identification of well-defined subgroups of patients and the validation of more reliable and comprehensive tools, specifically designed for obese subjects, should be forecasted in order to reach a better knowledge of psychological functioning of obese individuals and to improve the outcome of weight loss programs.展开更多
AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral response.METHODS:LS was measured in all patients before treatment was administered.The therapeutic a...AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral response.METHODS:LS was measured in all patients before treatment was administered.The therapeutic approach was based on hepatic,virological,and immunological evaluations and considered the fact that patients with severe fibrosis(F3)or compensated cirrhosis(F4)in Child-Pugh class A are the primary candidates for triple therapy.In total,65 hepatitis C virus(HCV)patients were treated with Peg-interferon/ribavirin(Peg-IFN/RBV);24patients were classified as genotypes 1/4(36.92%),and41 patients were classified as genotypes 2/3(63.08%)(dual therapy).In addition,20 HCV treatment-experienced genotype 1 patients were treated with Peg IFN-RBV and boceprevir(triple therapy).Wilcoxon rank-sum tests were used to compare the groups.RESULTS:LS significantly differed between dual therapy and triple therapy(P=0.002).The mean LS value before dual therapy treatment was 8.61±5.79k Pa and was significantly different between patients achieving a sustained virologic response(SVR)24weeks after therapy and those who did not(7.23±5.18 k Pa vs 11.72±5.99 k Pa,respectively,P=0.0003).The relative risk of non-response to therapy was 4.45(95%CI:2.32-8.55).The attributable risk of non-response to therapy was 49%.The mean LSvalue before triple therapy treatment was 13.29±8.57k Pa and was significantly different between patients achieving and not achieving SVR24(9.41±5.05 vs19.11±9.74,respectively;P=0.008).The relative risk of non-response to therapy was 5.57%(95%CI:1.50-20.65).The attributable risk of non-response to therapy(70%)was increased compared with dual therapy patients.Pre-treatment stiffness>12 k Pa was significantly associated with non-SVR(P<0.025)in both groups.CONCLUSION:Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.展开更多
Forensic psychiatrists routinely appear in courts for crimes that have been perpetrated by mentally ill patients or when the defendant is suffering from a major psychiatric disorder.However,committing crimes under the...Forensic psychiatrists routinely appear in courts for crimes that have been perpetrated by mentally ill patients or when the defendant is suffering from a major psychiatric disorder.However,committing crimes under the presumed effects of magic and witchcraft is uncommon.A variety of delusional thoughts and personality disorders have been imputed in aggressive behaviour that might culminate in homicide.The patterns of a premeditated homicide,as well as the aberrations of the interpersonal relations,as a rule require long-term and close contact.As such,the family is a setting where such occurrences have been reported.We describe a case of first-degree murder by a woman who killed her mother-in-law after accusing her repeatedly of sorcery and witchcraft.Such complicated cases cannot be resolved without the help of forensic experts,whose role remains multifaceted and of particular importance.展开更多
The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients.The potential role of psychological trauma in the ear...The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients.The potential role of psychological trauma in the early developmental stages,and even the existence of adverse childhood experiences,is important to prove,yet it is difficult to do so.A diverse range of methods have been applied,all of which presumably benchmark a big therapeutic step;however,these enthusiastic methods frequently do not last for long.While hypnosis supporters,Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories,modern psychiatry relies mostly on diversely structured interviews.Functional magnetic resonance and its related subtleties might help,but the questions that remain unanswered are numerous and confusing.Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual’s growth trajectory;thus,it remains an intriguing issue.展开更多
文摘BACKGROUND Several conditions may present with acute neurological symptoms,thus mimicking the presentation of stroke.Although the underlying disorder can be diagnosed after careful medical,neurological,and radiological examinations,a few conditions,such as Wernicke encephalopathy(WE),may present a particular diagnostic difficulty.WE is a neurological disorder caused by deficiency of thiamine(B1 vitamin),most often resulting from alcoholism,malnutrition,hyperemesis gravidarum or bariatric surgery.The diagnosis of WE in a certain historical,clinical setting is easily suggested,but in a few cases presenting with acute neurological deficits,it can be particularly challenging.CASE SUMMARY We present the case of a 63-year-old man who was brought to the emergency department after developing weakness of the left extremities,dizziness and a confusional state,which had lasted for approximately 30 minutes.The patient had a similar episode of a confusional state approximately two months earlier;at that time,a transient ischemic attack was suspected and he was started on aspirin.The initial clinical evaluation and imaging findings were unremarkable for stroke,but the patient’s symptoms,history of chronic alcohol abuse and abnormal liver function tests prompted the consideration of WE.Magnetic resonance imaging findings in subthalamic areas and electroencephalogram data of diffuse delta activity supported this diagnosis.CONCLUSION Through this case report,we aim to underscore the importance of considering WE as a differential diagnosis in patients presenting with symptoms suggestive of stroke,especially when the presentation is atypical or when risk factors for thiamine deficiency are present.Since intravenous thiamine significantly improves outcomes,delayed recognition and treatment in some cases might be deleterious.
文摘The assessment of the fibrotic evolution of chronic hepatitis has always been a challenge for the clinical hepatologist. Over the past decade, various noninvasive methods have been proposed to detect the presence of fibrosis, including the elastometric measure of stiffness, panels of clinical and biochemical parameters, and combinations of both methods. The aim of this review is to analyse the most recent data on non-invasive techniques for the evaluation of hepatic fibrosis with particular attention to costeffectiveness. We searched for relevant studies published in English using the Pub Med database from 2009 to the present. A large number of studies have suggested that elastography and serum markers are useful techniques for diagnosing severe fibrosis and cirrhosis and for excluding significant fibrosis in hepatitis C virus patients. In addition, hepatic stiffness may also help to prognosticate treatment response to antiviral therapy. It has also been shown that magnetic resonance elastography has a high accuracy for staging and differentiating liver fibrosis. Finally, studies have shown that non-invasive methods are becoming increasingly precise in either positively identifying or excluding liver fibrosis, thus reducing the need for liver biopsy. However, both serum markers and transient elastography still have "grey area" values of lower accuracy. In this case, liver biopsy is still required to properly assess liver fibrosis. Recently, the guidelines produced by the World Health Organization have suggested that the AST-to-platelet ratio index or FIB-4 test could be utilised for the evaluation of liver fibrosis rather than other, more expensive non-invasive tests, such as elastography or Fibro Test.
文摘Transient elastography and the acoustic radiation force impulse techniques may play a pivotal role in the study of liver fibrosis. Some studies have shown that elastography can detect both the progression and regression of fibrosis. Similarly, research results have been analysed and direct and indirect serum markers of hepatic fibrosis have shown high diagnostic accuracy for advanced fibrosis/cirrhosis. The prognosis of different stages of cirrhosis is well established and various staging systems have been proposed, largely based on clinical data. However, it is still unknown if either noninvasive markers of liver fibrosis or elastography may contribute to a more accurate staging of liver cirrhosis, in terms of prognosis and fibrosis regression after effective therapy. In fact, not enough studies have shown both the fibrosis regression in different cirrhosis stages and the point beyond which the prognosis does not change- even in the event of fibrosis regression. Therefore, future studies are needed to validate noninvasive methods in predicting the different phases of liver cirrhosis.
文摘In clinical practice obesity is primarily diagnosed through the body mass index. In order to characterize patients affected by obesity the use of traditional anthropometric measures appears misleading. Beyond the body mass index, there are overwhelming evidences towards the relevance of a more detailed description of the individual phenotype by characterizing the main body componentsas free-fat mass, muscle mass, and fat mass. Among the numerous techniques actually available, bioelectrical impedance analysis seems to be the most suitable in a clinical setting because it is simple, inexpensive, noninvasive, and highly reproducible. To date, there is no consensus concerning the use of one preferred equation for the resting energy expenditure in overweight and/or obese population. Energy restriction alone is an effective strategy to achieve an early and significant weight loss, however it results in a reduction of both fat and lean mass therefore promoting or aggravating an unfavourable body composition(as sarcobesity) in terms of mortality and comorbidities. Therefore the implementation of daily levels of physical activity should be simultaneously promoted. The major role of muscle mass in the energy balance has been recently established by the rising prevalence of the combination of two condition as sarcopenia and obesity. Physical exercise stimulates energy expenditure, thereby directly improving energy balance, and also promotes adaptations such as fiber type, mitochondrial biogenesis, improvement of insulin resistance, and release of myokines, which may influence different tissues, including muscle.
基金Supported by Italian Society for Celiac Disease and Foundation for Celicac Disease,No.007_FC_2016Regione Toscana(The Programma Attuativo Regionale Toscana funded by FAS),No.MICp ROBIMM
文摘BACKGROUND An altered (dysbiosis) and unhealthy status of the gut microbiota is usually responsible for a reduction of short chain fatty acids (SCFAs) concentration. SCFAs obtained from the carbohydrate fermentation processes are crucial in maintaining gut homeostasis and their determination in stool samples could provide a faster, reliable and cheaper method to highlight the presence of an intestinal dysbiosis and a biomarker for various gut diseases. We hypothesize that different intestinal diseases, such as celiac disease (CD), adenomatous polyposis (AP) and colorectal cancer (CRC) could display a particular fecal SCFAs’ signature. AIM To compare the fecal SCFAs’ profiles of CD, AP, CRC patients and healthy controls, using the same analytical method. METHODS In this cross-sectional study, we defined and compared the SCFAs’ concentration in fecal samples of 9 AP, 16 CD, 19 CRC patients and 16 healthy controls (HC). The SCFAs’ analysis were performed using a gas-chromatography coupled with mass spectrometry method. Data analysis was carried out using Wilcoxon ranksum test to assess pairwise differences of SCFAs’ profiles, partial least squaresdiscriminate analysis (PLS-DA) to determine the status membership based on distinct SCFAs’ profiles, and Dirichlet regression to determine factors influencing concentration levels of SCFAs. RESULTS We have not observed any difference in the SCFAs’ amount and composition between CD and healthy control. On the contrary, the total amount of SCFAs was significantly lower in CRC patients compared to HC (P = 0.044) and CD (P = 0.005). Moreover, the SCFAs’ percentage composition was different in CRC and AP compared to HC. In detail, HC displayed higher percentage of acetic acid (P value = 1.3 × 10-6) and a lower amount of butyric (P value = 0.02192), isobutyric (P value = 7.4 × 10-5), isovaleric (P value = 0.00012) and valeric (P value = 0.00014) acids compared to CRC patients. AP showed a lower abundance of acetic acid (P value = 0.00062) and higher percentages of propionic (P value = 0.00433) and isovaleric (P value = 0.00433) acids compared to HC. Moreover, AP showed higher levels of propionic acid (P value = 0.03251) and a lower level of isobutyric acid (P value = 0.00427) in comparison to CRC. The PLS-DA model demonstrated a significant separation of CRC and AP groups from HC, although some degree of overlap was observed between CRC and AP. CONCLUSION Analysis of fecal SCFAs shows the potential to provide a non-invasive means of diagnosis to detect patients with CRC and AP, while CD patients cannot be discriminated from healthy subjects.
基金Supported by University of Florence,No.XXXV PhD Program。
文摘BACKGROUND Human immunodeficiency virus type 1(HIV-1)infection is characterized by persistent systemic inflammation and immune activation,even in patients receiving effective antiretroviral therapy(ART).Converging data from many cross-sectional studies suggest that gut microbiota(GM)changes can occur throughout including human immunodeficiency virus(HIV)infection,treated by ART;however,the results are contrasting.For the first time,we compared the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression,after 24 wk of ART therapy.In addition,we compared the microbiota composition,microbial metabolites,and cytokine profile of patients with CD4/CD8 ratio<1(immunological non-responders[INRs])and CD4/CD8>1(immunological responders[IRs]),after 24 wk of ART therapy.AIM To compare for the first time the fecal microbial composition,serum and fecal microbial metabolites,and serum cytokine profile of treatment-na?ve patients before starting ART and after reaching virological suppression(HIV RNA<50 copies/m L)after 24 wk of ART.METHODS We enrolled 12 treatment-na?ve HIV-infected patients receiving ART(mainly based on integrase inhibitors).Fecal microbiota composition was assessed through next generation sequencing.In addition,a comprehensive analysis of a blood broad-spectrum cytokine panel was performed through a multiplex approach.At the same time,serum free fatty acid(FFA)and fecal short chain fatty acid levels were obtained through gas chromatography-mass spectrometry.RESULTS We first compared microbiota signatures,FFA levels,and cytokine profile before starting ART and after reaching virological suppression.Modest alterations were observed in microbiota composition,in particular in the viral suppression condition,we detected an increase of Ruminococcus and Succinivibrio and a decrease of Intestinibacter.Moreover,in the same condition,we also observed augmented levels of serum propionic and butyric acids.Contemporarily,a reduction of serum IP-10 and an increase of IL-8 levels were detected in the viral suppression condition.In addition,the same components were compared between IRs and INRs.Concerning the microflora population,we detected a reduction of Faecalibacterium and an increase of Alistipes in INRs.Simultaneously,fecal isobutyric,isovaleric,and 2-methylbutyric acids were also increased in INRs.CONCLUSION Our results provided an additional perspective about the impact of HIV infection,ART,and immune recovery on the"microbiome-immunity axis"at the metabolism level.These factors can act as indicators of the active processes occurring in the gastrointestinal tract.Individuals with HIV-1 infection,before ART and after reaching virological suppression with 24 wk of ART,displayed a microbiota with unchanged overall bacterial diversity;moreover,their systemic inflammatory status seems not to be completely restored.In addition,we confirmed the role of the GM metabolites in immune reconstitution.
文摘Objective:Acupuncture is considered an important part of the alternative medical treatment of tumors.However,it is still unclear whether acupuncture has a direct effect on inhibition of tumor growth.The purpose of this study was to evaluate the effects of acupuncture treatment on tumors in BALB/c mice that were or were not administered cyclophosphamide.Methods:A 4T1 breast carcinoma mouse model for this study was established.When the mice developed 5 mm × 5 mm visible subcutaneous tumors,they were subjected to acupuncture and/or cyclophosphamide (CTX) treatment for 15 days.Results:Acupuncture and CTX treatment both reduced the size of the solid tumors.When used in conjunction,the tumor size reduction was even more obvious.Hematoxylin and eosin staining showed that acupuncture had a significant effect on induction of tumor cell necrosis and inhibition of angiogenesis.Immunohistochemistry showed that the expression of CD34 and matrix metalloproteinase-9 (MMP-9),which were related to angiogenesis,decreased after treatment with either acupuncture or CTX.However,when the two treatments were used in conjunction,they showed a synergistic effect on inhibiting the expression of CD34.However,the synergistic effect was not observed onMvMP-9 expression.Conclusion:Acupuncture plays an important role in improving the effect of chemotherapy by inhibiting angiogenesis.
基金supported by the National Natural Science Foundation of China(No.30671856 and No.30772536)
文摘HIV-associated dementia(HAD)is a public health problem and is particularly prevalent in drug abusers.The neuropathogenesis of human immunodeficiency virus(HIV)infection involves a complex cascade of inflammatory events,including monocyte/macrophage infiltration in the brain,glial immune activation and release of neurotoxic substances.In these events,astrocytic-derived monocyte chemoattractant protein-1(MCP-1)plays an important role,whose release is elevated by HIV transactivator of transcription(HIV tat)and could be further elevated by opiates.This review will also consider some critical factors and events in MCP-1 enhancement induced by the interactions of opiate and HIV tat,including the mediating role of mu opioid receptor(MOR)and CCR2 as well as the possible signal transduction pathways within the cells.Finally,it will make some future perspectives on the exact pathways,new receptors and target cells,and the vulnerability to neurodegeneration with HIV and opiates.
文摘BACKGROUND Fibromyalgia(FM)syndrome is mainly characterized by widespread pain,sleeping disorders,fatigue,and cognitive dysfunction.In many cases,gastrointestinal distress is also reported,suggesting the potential pathogenic role of the gut microbiota(GM).The GM is deeply influenced by several environmental factors,especially the diet,and recent findings highlighted significant symptom improvement in FM patients following various nutritional interventions such as vegetarian diet,low-fermentable oligosaccharides,disaccharides,monosaccharides,and polyols based diets,gluten-free diet,and especially an ancient grain supplementation.In particular,a recent study reported that a replacement diet with ancient Khorasan wheat led to an overall improvement in symptom severity of FM patients.AIM To examine the effects of ancient Khorasan wheat on the GM,inflammation,and short-chain fatty acid production in FM patients.METHODS After a 2-wk run-in period,20 FM patients were enrolled in this randomized,double-blind crossover trial.In detail,they were assigned to consume either Khorasan or control wheat products for 8 wk and then,following an 8-wk washout period,crossed.Before and after treatments,GM characterization was performed by 16S rRNA sequencing while the fecal molecular inflammatory response and the short-chain fatty acids(SCFAs)were respectively determined with the Luminex MAGPIX detection system and a mass chromatography-mass spectrometry method.RESULTS The Khorasan wheat replacement diet,in comparison with the control wheat diet,had more positive effects on intestinal microbiota composition and on both the fecal immune and SCFAs profiles such as the significant increase of butyric acid levels(P=0.054),candidatus Saccharibacteria(P=9.95e-06)and Actinobacteria,and the reduction of Enterococcaceae(P=4.97e-04).Moreover,the improvement of various FM symptoms along with the variation of some gut bacteria after the Khorasan wheat diet have been documented;in fact we reported positive correlations between Actinobacteria and both Tiredness Symptoms Scale(P<0.001)and Functional Outcome of Sleep Questionnaire(P<0.05)scores,between Verrucomicrobiae and both Widespread Pain Index(WPI)+Symptom Severity scale(SS)(P<0.05)and WPI(P<0.05)scores,between candidatus Saccharibacteria and SS score(P<0.05),and between Bacteroidales and Sleep-Related and Safety Behaviour Questionnaire score(P<0.05).CONCLUSION The replacement diet based on ancient Khorasan wheat results in beneficial GM compositional and functional modifications that positively correlate with an improvement of FM symptomatology.
文摘Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance.Although pain is a common complaint among psychiatric patients,clinicians generally separate its presence from the background mental disorder and downplay its importance,trying primarily to control the psychiatric symptomatology.As a sensory modality,the presence of pain and its importance account for an impressive body of scholarly research.Cartesian methodology considered sensations of all modalities in a mechanistic form,which actually sounds obsolete.However,authors have continuously been faced with the same dilemmas plaguing scholars for centuries.We assume that a large portion of the sensory inputs might be generators of distorted perceptions,which subsequently lead to psychopathology.Auditory and visual hallucinations are incontestable examples.Somaesthetic hallucinations also exist,but pain hardly deserves such a denomination.Nevertheless,chronic pain and psychiatric comorbidity is a reality that needs explanation.Painkillers are not effective in treating psychiatric disorders,and antipsychotics do very little,perhaps nothing,to relieve pain.The pharmacological approach opens one door on the horizon and closes many others,while clinicians continue to face a high prevalence of comorbid pain and mental health issues.However,attempts to correlate altered body schemata(as distorted as it may be,for example,in phantom limb pain) with somatic delusions can simplify all these dilemmas,and the basket of psychophysiology,in fact,might be bigger than presumed.
文摘Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning of obese subjects and the influence of psychological factors on treatment outcome. The aim of the present narrative review is to critically analyze the current literature, in order to point out the most common psychological constructs studied in obesity and to give an overview of the main existing tools investigating psychological features which have been considered significant for the prediction of success in weight loss and maintenance programs in obese patients. In this framework, the most common psychological constructs studied are: self-motivation, self-efficacy, locus of control, health related quality of life, self-esteem, self-control, concerns about body image, outcome expectations, and personality traits. These features have been explored through a wide variety of psychometric instruments. However, as an overall, studies evaluating the association between psychological features and treatment outcome failed to give consistent results. A possible explanation may consist on the fact that many tools widely used to explore psychological features were not specifically designed for obese patients and none of them was comprehensive of all possible psychological features involved. The identification of well-defined subgroups of patients and the validation of more reliable and comprehensive tools, specifically designed for obese subjects, should be forecasted in order to reach a better knowledge of psychological functioning of obese individuals and to improve the outcome of weight loss programs.
文摘AIM:To evaluate the association between liver stiffness(LS) prior to the initiation of dual/triple therapy and viral response.METHODS:LS was measured in all patients before treatment was administered.The therapeutic approach was based on hepatic,virological,and immunological evaluations and considered the fact that patients with severe fibrosis(F3)or compensated cirrhosis(F4)in Child-Pugh class A are the primary candidates for triple therapy.In total,65 hepatitis C virus(HCV)patients were treated with Peg-interferon/ribavirin(Peg-IFN/RBV);24patients were classified as genotypes 1/4(36.92%),and41 patients were classified as genotypes 2/3(63.08%)(dual therapy).In addition,20 HCV treatment-experienced genotype 1 patients were treated with Peg IFN-RBV and boceprevir(triple therapy).Wilcoxon rank-sum tests were used to compare the groups.RESULTS:LS significantly differed between dual therapy and triple therapy(P=0.002).The mean LS value before dual therapy treatment was 8.61±5.79k Pa and was significantly different between patients achieving a sustained virologic response(SVR)24weeks after therapy and those who did not(7.23±5.18 k Pa vs 11.72±5.99 k Pa,respectively,P=0.0003).The relative risk of non-response to therapy was 4.45(95%CI:2.32-8.55).The attributable risk of non-response to therapy was 49%.The mean LSvalue before triple therapy treatment was 13.29±8.57k Pa and was significantly different between patients achieving and not achieving SVR24(9.41±5.05 vs19.11±9.74,respectively;P=0.008).The relative risk of non-response to therapy was 5.57%(95%CI:1.50-20.65).The attributable risk of non-response to therapy(70%)was increased compared with dual therapy patients.Pre-treatment stiffness>12 k Pa was significantly associated with non-SVR(P<0.025)in both groups.CONCLUSION:Pre-treatment liver stiffness may be useful for predicting the response to treatment in patients treated with either dual or triple anti-HCV therapy.
文摘Forensic psychiatrists routinely appear in courts for crimes that have been perpetrated by mentally ill patients or when the defendant is suffering from a major psychiatric disorder.However,committing crimes under the presumed effects of magic and witchcraft is uncommon.A variety of delusional thoughts and personality disorders have been imputed in aggressive behaviour that might culminate in homicide.The patterns of a premeditated homicide,as well as the aberrations of the interpersonal relations,as a rule require long-term and close contact.As such,the family is a setting where such occurrences have been reported.We describe a case of first-degree murder by a woman who killed her mother-in-law after accusing her repeatedly of sorcery and witchcraft.Such complicated cases cannot be resolved without the help of forensic experts,whose role remains multifaceted and of particular importance.
文摘The documentation of psychological trauma is obviously a challenge to clinicians while they are diving deep into remote events related to their clients or patients.The potential role of psychological trauma in the early developmental stages,and even the existence of adverse childhood experiences,is important to prove,yet it is difficult to do so.A diverse range of methods have been applied,all of which presumably benchmark a big therapeutic step;however,these enthusiastic methods frequently do not last for long.While hypnosis supporters,Freudian and Neo-Freudian disciples can be acute enough to enhance and uncover suppressed memories,modern psychiatry relies mostly on diversely structured interviews.Functional magnetic resonance and its related subtleties might help,but the questions that remain unanswered are numerous and confusing.Connecting early experiences with long-term memory while identifying psychological trauma its importance for the individual’s growth trajectory;thus,it remains an intriguing issue.
