Histological recovery and gluten-free diet adherence: a prospective 1-year follow-up study of adult patients with coeliac disease

BACKGROUND

Adequate gluten-free diet (GFD) is the only treatment for coeliac disease (CD). However, no agreement has been reached on either how and when to assess patient adherence to GFD or its effectiveness on villous atrophy.

AIM

To assess, in a prospective study, patient adherence to and efficacy of GFD on histological recovery after 1-year of GFD.

METHODS

Between 2009 and 2012, we enrolled 65 consecutive newly-diagnosed adult patients (median age 38 years, 18-70) with biopsy-proven atrophic CD. Patients were re-evaluated after 1 year of GFD with duodenal histology, serological assays, symptoms and a dietary interview based on a validated questionnaire. Complete histological recovery was defined as the absence of villous atrophy and ≤30/100 intraepithelial lymphocytes.

RESULTS

Overall, 81.5% of patients had adequate adherence (ADA) to GFD, whereas 18.5% had an inadequate adherence (IADA); 66% of ADA patients and no IADA patients achieved complete histological recovery (P < 0.00001). Among ADA patients, antibody seroconversion and symptoms were not significantly different between patients who achieved complete histological recovery and those who achieved partial histological recovery with P = 0.309 and P = 0.197, respectively. Multivariate analysis showed that Marsh 3C was a risk factor for incomplete histological recovery in ADA patients (OR 8.74, 95% CI: 1.87-40.83).

CONCLUSIONS

This study shows that complete histological recovery after 1-year of GFD in adult patients, who are assessed as adherent to the GFD, can be obtained in 66% of patients. Patients with severe histological damage at diagnosis are at risk for incomplete histological recovery 1 year later.

Management of in-stent restenosis in peripheral arteries: are DEBs sufficient as stand-alone treatment for femoro-popliteal in-stent restenosis?

The treatment of in-stent restenosis (ISR) in the femoro-popliteal artery (FPA) is one of the major challenges of endovascular therapy, occurring in up to 40% of femoro-popliteal lesions treated with bare-metal stents within 1 year of treatment. Drug-eluting technologies, involving local delivery of paclitaxel, are providing a new paradigm for the treatment of ISR. Preliminary experience shows promising results compared to other techniques such as cutting balloon angioplasty and debulking strategies. Based on available data, drug-eluting balloons (DEBs) seem sufficient as stand-alone treatment of FPA-ISR. However, larger evidence from randomized studies is warranted to identify the clinical and/or anatomical setting in which they could fail.

New perspectives for transcatheter aortic valve implantation: more than a "simple" alternative to surgery

To date, the gold standard of aortic stenosis treatment is surgical valve replacement. However, in inoperable or high risk patients a valid alternative is transcatheter aortic valve implantation (TAVI). Several trials showed feasibility, efficacy and safety of TAVI, with a tailored strategy for these patients on the basis of their clinical and anatomical conditions. The selection of valve type (CoreValve® or Edwards Sapien®) and transcatheter approach (transfemoral, transapical, subclavian or direct aortic approach) is an important step in the management of aortic stenosis. However, mortality is high and it is mainly related to non-cardiac reasons, given the high clinical risk profile of these patients. Moreover, the less invasive approach, the faster recovery, the reduced morbidity and the improved psychological tolerance, typical of TAVI, suggest that this technique could be used in a broader spectrum of cases, becoming a valid therapeutic alternative even in patients with severe aortic stenosis with a low surgical risk or asymptomatics. The identification of aortic stenosis patients by the medical community and their assessment over time, before they become candidates only for "extreme" strategies, remains the main challenge.

Fatty acid and sensory profiles of Caciocavallo cheese as affected by management system

The effect of season of the year associated with changes in feeding and management system (pasture-based vs. confinement) on milk and cheese fatty acid profile and on sensory properties of Caciocavallo cheese was evaluated on 3 mountain dairy farms. Each farm used a pasture-based feeding system from April to June and from September to October (PS), and a confinement system for the rest of the year (CS). As a consequence of grazing, PS milk showed higher percentages of C18:3, cis-9,trans-11 conjugated linoleic acid, and trans-11 C18:1, and a reduced percentage of C16:0. The fatty acid profile of cheese largely reflected that of the corresponding raw milk from which cheese was made. This led to a significant decrease of atherogenic index in cheeses produced from cows on pasture. Based on sensory analysis, cheese from animals kept on pasture was more yellow and had a lower intensity of butter and smoked odors than did CS cheese. In addition, grazing induced a lower intensity of bitter and a higher intensity of spicy flavors compared with cheese from CS animals. In regard to texture, pasture feeding resulted in higher intensity of friability and graininess. All cheeses performed well in consumer tests; the panel found all samples more than acceptable for overall liking, and for liking according to appearance, taste/flavor, and texture. Overall liking of Caciocavallo cheese, as assessed by slope analysis, was affected primarily by taste/flavor (raw slope k=0.88) and texture (k=0.97), whereas appearance had a lesser effect (k=0.72). The acidic and sensory profiles of cheese were well discriminated, with healthier cheeses produced by grazing cows. Therefore, wider use of pasture should be promoted to accentuate this favorable feature. Based on the specific nutritional and sensory characteristics of mountain Caciocavallo cheese, particularly that obtained from grazing animals, efforts should be made to indicate the quality of this cheese to the consumer and improve product recognition.

Transcriptional profile characterization for the identification of peripheral blood biomarkers in patients with cerebral aneurysms

We tried to identify molecular markers in peripheral blood to predict high risk of aneurysm rupture. Extraction of the total population of peripheral blood mononuclear cell (PBMC) from total blood volume, total RNA extraction from PBMC and Agilent One Color Gene-expression Oligo-Microarray were performed on peripheral venous blood samples from 45 patients with ruptured, unruptured cerebral aneurysms and control group (15). Mean foreground/ background signal intensities and A (log2(R*G)/2) values were calculated for each spot. Genes with absolute fold change (FC) greater than or equal to plus or minus 1.5 and p-value less than 0.05 were considered differentially expressed in the 3 groups (Student T-test). Genes coding for MMPs were strongly underexpressed in ruptured aneurysms group, suggesting a possible role in aneurysms development more than their rupture. Genes coding for adhesine proteins of the extracellular matrix (ICAM1) and cytoskeleton (WIPF1,TUBA4A) were underexpressed in ruptured aneurysms. Genes coding proteins involved in the regulation of apoptotic processes may be important in aneurysm development and rupture, resulting into an increased rate of remodeling processes in the arterial wall. Fas coding gene, SUMO1, ZFAT, BCL2, CCR5 genes were all over-represented in unruptured aneurysms. The coexisting over-representation of pro-apoptotic genes and the underexpression of cytoskeleton and extracellular matrix genes confirms that aneurysms development and evolution are part of a degenerative process of the arterial wall not involved in aneurysms rupture. MMPs may be involved in repairing chronic damages to the arterial walls and preventing SAH. Unexpectedly, Heat Shock Proteins (HSP90AA1, HSPA1A, HSPB1), G and RAS proteins, generally activated by stress situations were under-represented in aneurysmal walls. Further PCR and Western Blotting studies are needed to confirm such findings and to identify diagnostic and prognostic markers in order to define screening protocols for intracranial aneurysms.

Biological inverse fluidized-bed reactors for the treatment of low pH- and sulphate-containing wastewaters under different COD/SO4(2-) conditions

The feasibility of removing sulphate using low-density polypropylene pellets as carrier material in two lactate-fed sulphidogenic inverse fluidized-bed reactors was investigated. Two different COD/sulphate ratios and two different feed-sulphate concentrations were used for the operation of the reactors. During the 242 days of operation, the robustness of the system was studied by suddenly decreasing the feed pH to 3.00. A 10% fluidization degree was used since the carrier material adopted showed not to be adequate to attain a satisfactory immobilization of the biomass with higher fluidization degrees. This resulted in a failure of the process when the feed pH was intentionally decreased to 3.00 in reactor 2, operated with a COD/sulphate ratio of 4.00. On the contrary, when a slightly acidic feed solution was fed to reactor 2, a 97% sulphate reduction efficiency was obtained. In reactor 1, operated with a COD/sulphate ratio of 0.67 throughout the experiment, COD removal and sulphate reduction efficiencies reached the highest values of 75% and 35%, respectively. Higher efficiencies were not achieved also due to the accumulation of acetate and the most likely presence of microbial competition between sulphate reducers and other microorganisms.