International Journal of Immunopathology and Pharmacology, 2010
Helicobacter pylori is one of the most common infections found in humans. It was first identified... more Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and seq...
OBJECTIVE To evaluate the relationship between remnant cholesterol and carotid intima-media thick... more OBJECTIVE To evaluate the relationship between remnant cholesterol and carotid intima-media thickness (cIMT), a surrogate marker for atherosclerosis, in children and adolescents. STUDY DESIGN Anthropometric, laboratory, liver and carotid ultrasonographic data were obtained from 767 youths (594, overweight/obese; 173, normal weight). Fasting RC was calculated from the standard lipid profile. cIMT ≥ 0.56 mm (corresponding to the 90th percentile of values observed in normal-weight children) was chosen to define elevated cIMT. Logistic regression analysis was used to estimate the risk of elevated cIMT according to tertiles of RC levels. RESULTS In the entire cohort, the mean concentration of RC was 17.9±10.3 mg/dl and mean cIMT value was 0.51±0.8 mm. Remnant cholesterol significantly correlated with age, sex, body mass index (BMI), waist circumference, blood pressure, lipids, liver enzymes, and insulin resistance (HOMA-IR). cIMT value increased progressively with rising RC tertiles (Pfor trend<0.001). Compared with subjects in the lowest RC tertile, those in the middle and highest RC tertiles had a 2.3- and 2.4-fold increased risk of elevated cIMT, independently of age, sex, pubertal stage, BMI and apolipoprotein B (all Padj≤0.003). When the effects of overweight/obesity on the association between RC and cIMT were determined, normal-weight as well as overweight/obese subjects in the highest RC tertile had a 3.8- and 2.3-fold increased risk to have elevated cIMT compared with the respective study groups in the lowest tertile, after adjustment for conventional risk factors (Padj=0.038 and Padj=0.003, respectively). CONCLUSION In youths elevated levels of remnant cholesterol might represent a marker of early atherosclerotic damage.
sepsis by using the upper limits (or 97.5th percentile) of the referficity of procalcitonin for s... more sepsis by using the upper limits (or 97.5th percentile) of the referficity of procalcitonin for sepsis diagnosis in premature infants. Lancet ence sample for the first 48 hours of life as a cutoff point. Our 1998; 351:1211-2. method also contrasts markedly with that used by Lapillonne et 4. Nylen ES, O'Neil W, Jordan MH, et al. Late pulmonary sequela following al. to assess procalcitonin specificity for the diagnosis of neonatal burns: persistence of hypercalcitoninemia using a 1-57 amino acid Nsepsis [8]. In that study, uninfected neonates (mean postnatal age, terminal flanking peptide assay. Respir Med 1995; 89:41-6. 2.3 days) were deemed to have high serum procalcitonin concentrations on the basis of a surrogate cutoff level originally established
Nutrition, Metabolism and Cardiovascular Diseases, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
A commercially available selective group A streptococcal agar (ssA) was evaluated for the recover... more A commercially available selective group A streptococcal agar (ssA) was evaluated for the recovery of group A streptococci (GAS) in comparison with recovery from simultaneous cultures on conventional sheep blood agar (SBA). Both sets of plates were incubated in air, 5% CO2, and anaerobically for 48 h, with a first reading taken at 24 h. A total of 402 (67.0%) GAS were isolated from the 600 specimens that were submitted. Recovery of GAS was significantly greater after 48 h of incubation than after 24 h of incubation for each medium-atmosphere combination. After 48 h of incubation, the sensitivities of GAS detection obtained by each culture technique were as follows: ssA-anaerobic atmosphere, 98.5%; SBA-anaerobic atmosphere, 89.5%; ssA-CO2 atmosphere, 88.0%; SBA-air, 86.5%; SBA-CO2 atmosphere, 82.0%; and ssA-air, 74.6%. There were no cultures positive in air or CO2 which were not positive anaerobically on either medium. The increased sensitivity of detecting positive GAS cultures when...
Letter to the Editor Isolation of Yersinia enterocolitica Serogroup 0:8, Biogroup 1B We are writi... more Letter to the Editor Isolation of Yersinia enterocolitica Serogroup 0:8, Biogroup 1B We are writing in response to the article by Ichinohe et al. (2) concerning the first isolation of Yersinia enterocolitica serogroup 0:8, biogroup 1B (formerly biogroup 1 esculin and salicin negative), from a child with acute enteritis in Japan. The authors state that this is the first case of human infection due to this pathogenic bio-serogroup outside of North America. That is simply not true. In 1987, a report by our National Center for Yersiniosis showed the remarkable isolation of pathogenic "North American" strains of Y. enterocolitica from four children with acute enteritis in Italy during an 8-year period (1). Over the next 4 years, only one additional child suffering from acute enteritis due to this phenotype of Y. enterocolitica has been observed by investigators in Italy (3). Thus, our current level of knowledge and experience with human yersiniosis indicates that the occasional introduction of the pathogenic North American strains into Italy does not have an important epidemiologic impact. In contrast to our observations, Ichinohe et al. (2) concluded that their case report does "show that Y. enterocolitica serotype 0:8 is gradually spreading around the world." We are concerned that the authors may have drawn a conclusion not justified by the data that they presented.
Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblasti... more Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblastic leukemia, who were on maintenance cancer chemotherapy, were examined weekly for the presence of Clostridium difficile and its toxin. Four out of 15 patients were positive for C. difficile: three patients had stool specimens that did not contain toxin, but cultures yielded growth of toxigenic C. difficile on only one occasion. The fourth patient, who had a recent history of hospitalization, particularly aggressive cancer chemotherapy, neutropenia, and antibiotic therapy, excreted both C. difficile and its toxin for at least 1 month. All children were asymptomatic at the time of positive cultures. This preliminary study reveals a low rate of C. difficile colonization in leukemic children on maintenance cancer chemotherapy.
1. Clin Infect Dis. 1994 Nov;19(5):980-1. Elevated white blood cell counts associated with Ureapl... more 1. Clin Infect Dis. 1994 Nov;19(5):980-1. Elevated white blood cell counts associated with Ureaplasma urealyticum colonization in preterm neonates. Panero A, Pacifico L, Rossi N, Bucci G, Chiesa C. Comment on: Clin Infect Dis. 1993 Aug;17 Suppl 1:S144-7. ...
In the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of ch... more In the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide, primarily as a result of the epidemic of obesity. NAFLD is strongly associated with insulin resistance, glucose intolerance, and dyslipidemia and is currently regarded as the liver manifestation of the metabolic syndrome, a highly atherogenic condition even at a very early age. Patients with NAFLD including pediatric subjects have a higher prevalence of subclinical atherosclerosis, as shown by impaired flow-mediated vasodilation, increased carotid artery intima-media thickness, and arterial stiffness, which are independent of obesity and other established risk factors. More recent work has identified NAFLD as a risk factor not only for premature coronary heart disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Thus, we conducted a systematic review and meta-analysis to test the hypothesis th...
Endothelial dysfunction is recognized as an early sign of systemic atherosclerosis, and it repres... more Endothelial dysfunction is recognized as an early sign of systemic atherosclerosis, and it represents a therapeutic target to prevent long-term cardiovascular (CV) consequences. Alpha-lipoic acid (ALA) is a commonly used dietary supplement exerting anti-oxidant and anti-inflammatory effects. We investigated whether a three-month treatment with ALA improves endothelial function, as assessed by flow-mediated dilation (FMD) of the brachial artery, and clinical and metabolic risk factors in overweight/obese youths. We enrolled 67 overweight/obese children, and 22 normal-weight metabolically healthy controls. Overweight/obese youths were randomly allocated in a double-blinded manner to receive ALA (n = 34) or placebo (n = 33). Of these, 64 (32 ALA, 32 placebo) completed the follow-up. At baseline, in ALA and placebo groups, FMD was similar, but lower as compared with that in controls (p = 0.045). At three months, within the ALA and placebo groups, FMD did not change significantly. Howeve...
Celiac Disease and Non-Celiac Gluten Sensitivity, Jun 7, 2017
Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolam... more Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolamins in genetically susceptible individuals, characterized by the presence of a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. Hepatitis B virus (HBV) infection is an important global public health problem that can cause chronic liver disease, and it is associated to a high risk of death from cirrhosis and hepatocellular carcinoma. Since 1982, a safe and effective HBV vaccine has been available, and recommendation for HBV vaccination has been extended to all infants to achieve protection against HBV infection. HBV vaccination is highly effective in eliciting a sustained immune response in immune-competent individuals. However, research papers have suggested that celiac patients may have low rate of protective antibodies after HBV vaccination. The failure of CD subjects to respond to HBV vaccination has great importance for public health policies as the nonresponders could be regarded as a reservoir for HBV. The aim of our work is to revise and to discuss the scarce literature on this field in order to provide clinical practice guidelines to establish the best surveillance program of response to HBV vaccine in CD pediatric patient.
Background: The reported sensitivities and specificities of procalcitonin (PCT) concentrations fo... more Background: The reported sensitivities and specificities of procalcitonin (PCT) concentrations for the diagnosis of neonatal infection vary widely. A postnatal increase of PCT has been observed in healthy term newborns with a peak at ≈24 h of age, and many questions remain regarding maternal and perinatal factors that may influence the normal PCT kinetics during the immediate postnatal period. Methods: We prospectively investigated the association between the serum PCT values obtained from 121 mothers at delivery and serum PCT in their healthy, term offspring at birth as well as at 24 and 48 h of age. We also analyzed whether obstetric and perinatal factors would alter maternal and neonatal PCT response. Results: PCT concentrations in the babies at birth were significantly higher than in the mothers (P <0.0001), with even larger differences at 24 and 48 h of age. None of the variables identified from maternal and perinatal histories had a significant effect on maternal PCT respon...
Background: There is a wide range of reported sensitivities and specificities for C-reactive prot... more Background: There is a wide range of reported sensitivities and specificities for C-reactive protein (CRP) and interleukin-6 (IL-6) in the detection of early-onset neonatal infection. This prompted us to assess reference intervals for CRP and IL-6 during the 48-h period immediately after birth and to identify maternal and perinatal factors that may affect them. Methods: CRP and IL-6 values were prospectively obtained for 148 healthy babies (113 term, 35 near-term) at birth and at 24 and 48 h of life, and from their mothers at delivery. Results: Upper reference limits for CRP at each neonatal age were established. At birth, CRP was significantly lower than at 24 and 48 h of life. Rupture of membranes ≥18 h, perinatal distress, and gestational hypertension significantly affected the neonatal CRP dynamics, but at specific ages. There was no correlation between CRP concentrations in mothers and their offspring at birth. The IL-6 values observed in the delivering mothers and in their bab...
Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease... more Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease affecting not only the liver but also extrahepatic organs. Aim: To investigate whether in youths NAFLD is associated with extrahepatic complications such as subclinical atherosclerosis, cardiac abnormalities, hypertension, type 2 diabetes, decreased bone mineral density, renal dysfunction, obstructive sleep apnea, and polycystic ovary syndrome. Methods: We systematically reviewed PubMed; Scopus; Embase; and the Cochrane Library databases up to 28 February 2019 and assessed the quality of studies using the Newcastle-Ottawa Scale. Results: Thirty-five articles were selected for this systematic review: fifteen (4627 participants) evaluated the association of NAFLD with subclinical atherosclerosis; four (969 participants) with cardiac abnormalities; two (550 participants) with hypertension; four (1328 participants) with diabetes; six (523 participants) with low bone mineral density; two (86...
Probiotics and Prebiotics in Human Nutrition and Health, 2016
Celiac disease (CD) is an autoimmune enteropathy induced by gluten ingestion in genetically susce... more Celiac disease (CD) is an autoimmune enteropathy induced by gluten ingestion in genetically susceptible individuals. Genetic predisposition plays an important role in the development of CD, but it is not sufficient by itself for the disease development. Although gluten proteins are the main environmental factor involved in CD pathogenesis and ingestion of gluten is necessary to manifest the disease, recent studies have suggested that alteration of the microbiota could be involved and, in particular, the interplay between gut microbiota and the mucosal immune system. Dysbiosis, the alteration of the microbiota, has been associated with a variety of intestinal pathologies including Crohn disease and CD. Most observational studies in children and adults with CD have shown alterations in the intestinal microbiota composition compared to control subjects, which is only partially recovered after treatment with a gluten-free diet (GFD). At this time, the only treatment for CD is lifelong adherence to a GFD, which involves the elimination of grains containing gluten, wheat, rye, and barley. However, it is difficult for many patients to follow a GFD. Abnormalities in the gut microbiome in CD patients have led to the use of probiotics as a promising alternative as a therapeutic or preventative approach.
To perform a systematic review assessing accuracy and completeness of diagnostic studies of proca... more To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS.We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies.We found 18 articles (1998...
The mechanisms initiating, regulating and sustaining the systemic stress response to a surgical i... more The mechanisms initiating, regulating and sustaining the systemic stress response to a surgical injury have not all been identified yet. Recent studies point to the adipose tissue as a major endocrine system, the hormones of which influence energy homeostasis, glucose and lipid metabolism, vascular homeostasis, and immune response. Essential elements of this control system are leptin and ghrelin. The purpose of the present study was to compare the patterns of leptin and ghrelin secretion in different perioperative periods in patients undergoing elective cholecystectomy, and to relate the changes in circulating leptin or ghrelin to concomitantly occurring changes in glucose, insulin, C-peptide, growth hormone (GH), insulin-like growth factor (IGF)-1, total cortisol, free cortisol index, and interleukin-6, and other clinical parameters. Thirty patients were included in the study. Blood was sampled at seven time points between one hour prior to the induction of anesthesia (first observation) to approximately 24 hours later. Both leptin and ghrelin displayed a parallel decrease in concentrations from baseline in the intra-and postoperative periods, with a parallel return to baseline on the morning of the first postoperative day. However, at each perioperative period the leptin trend was not associated with that of other substances(including ghrelin).Likewise, the ghrelin time trend was independent of other study variables (including leptin). What triggers this response remains unknown but this study implies that it is unlikely to be the hypothalamicpituitary-adrenocortical, GH/IGF-1, or glucose homeostatic axis, or proinflammatory cytokines.
International Journal of Immunopathology and Pharmacology, 2010
Helicobacter pylori is one of the most common infections found in humans. It was first identified... more Helicobacter pylori is one of the most common infections found in humans. It was first identified in 1982 and by 1989 had been associated with gastric inflammation and ulcers in adults and children. During the 1990's evidence emerged of its etiologic role in stomach cancers in adults. That the infection is common and may have serious consequences, has led to an avalanche of research during the last twenty years. During this time, there have been many studies on children which have sought an effective and safe treatment to eradicate the infection, but as yet, no therapy regimen has been found which is always effective and safe. This article provides information, from a pediatric point of view, on the major developments in the therapeutics and therapy of H. pylori infection. It examines first-line treatment regimens, evaluates the efficacy of the main drugs used in the management of (primary) H. pylori infection in children, assesses the potential for the use of probiotics and seq...
OBJECTIVE To evaluate the relationship between remnant cholesterol and carotid intima-media thick... more OBJECTIVE To evaluate the relationship between remnant cholesterol and carotid intima-media thickness (cIMT), a surrogate marker for atherosclerosis, in children and adolescents. STUDY DESIGN Anthropometric, laboratory, liver and carotid ultrasonographic data were obtained from 767 youths (594, overweight/obese; 173, normal weight). Fasting RC was calculated from the standard lipid profile. cIMT ≥ 0.56 mm (corresponding to the 90th percentile of values observed in normal-weight children) was chosen to define elevated cIMT. Logistic regression analysis was used to estimate the risk of elevated cIMT according to tertiles of RC levels. RESULTS In the entire cohort, the mean concentration of RC was 17.9±10.3 mg/dl and mean cIMT value was 0.51±0.8 mm. Remnant cholesterol significantly correlated with age, sex, body mass index (BMI), waist circumference, blood pressure, lipids, liver enzymes, and insulin resistance (HOMA-IR). cIMT value increased progressively with rising RC tertiles (Pfor trend<0.001). Compared with subjects in the lowest RC tertile, those in the middle and highest RC tertiles had a 2.3- and 2.4-fold increased risk of elevated cIMT, independently of age, sex, pubertal stage, BMI and apolipoprotein B (all Padj≤0.003). When the effects of overweight/obesity on the association between RC and cIMT were determined, normal-weight as well as overweight/obese subjects in the highest RC tertile had a 3.8- and 2.3-fold increased risk to have elevated cIMT compared with the respective study groups in the lowest tertile, after adjustment for conventional risk factors (Padj=0.038 and Padj=0.003, respectively). CONCLUSION In youths elevated levels of remnant cholesterol might represent a marker of early atherosclerotic damage.
sepsis by using the upper limits (or 97.5th percentile) of the referficity of procalcitonin for s... more sepsis by using the upper limits (or 97.5th percentile) of the referficity of procalcitonin for sepsis diagnosis in premature infants. Lancet ence sample for the first 48 hours of life as a cutoff point. Our 1998; 351:1211-2. method also contrasts markedly with that used by Lapillonne et 4. Nylen ES, O'Neil W, Jordan MH, et al. Late pulmonary sequela following al. to assess procalcitonin specificity for the diagnosis of neonatal burns: persistence of hypercalcitoninemia using a 1-57 amino acid Nsepsis [8]. In that study, uninfected neonates (mean postnatal age, terminal flanking peptide assay. Respir Med 1995; 89:41-6. 2.3 days) were deemed to have high serum procalcitonin concentrations on the basis of a surrogate cutoff level originally established
Nutrition, Metabolism and Cardiovascular Diseases, 2021
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
A commercially available selective group A streptococcal agar (ssA) was evaluated for the recover... more A commercially available selective group A streptococcal agar (ssA) was evaluated for the recovery of group A streptococci (GAS) in comparison with recovery from simultaneous cultures on conventional sheep blood agar (SBA). Both sets of plates were incubated in air, 5% CO2, and anaerobically for 48 h, with a first reading taken at 24 h. A total of 402 (67.0%) GAS were isolated from the 600 specimens that were submitted. Recovery of GAS was significantly greater after 48 h of incubation than after 24 h of incubation for each medium-atmosphere combination. After 48 h of incubation, the sensitivities of GAS detection obtained by each culture technique were as follows: ssA-anaerobic atmosphere, 98.5%; SBA-anaerobic atmosphere, 89.5%; ssA-CO2 atmosphere, 88.0%; SBA-air, 86.5%; SBA-CO2 atmosphere, 82.0%; and ssA-air, 74.6%. There were no cultures positive in air or CO2 which were not positive anaerobically on either medium. The increased sensitivity of detecting positive GAS cultures when...
Letter to the Editor Isolation of Yersinia enterocolitica Serogroup 0:8, Biogroup 1B We are writi... more Letter to the Editor Isolation of Yersinia enterocolitica Serogroup 0:8, Biogroup 1B We are writing in response to the article by Ichinohe et al. (2) concerning the first isolation of Yersinia enterocolitica serogroup 0:8, biogroup 1B (formerly biogroup 1 esculin and salicin negative), from a child with acute enteritis in Japan. The authors state that this is the first case of human infection due to this pathogenic bio-serogroup outside of North America. That is simply not true. In 1987, a report by our National Center for Yersiniosis showed the remarkable isolation of pathogenic "North American" strains of Y. enterocolitica from four children with acute enteritis in Italy during an 8-year period (1). Over the next 4 years, only one additional child suffering from acute enteritis due to this phenotype of Y. enterocolitica has been observed by investigators in Italy (3). Thus, our current level of knowledge and experience with human yersiniosis indicates that the occasional introduction of the pathogenic North American strains into Italy does not have an important epidemiologic impact. In contrast to our observations, Ichinohe et al. (2) concluded that their case report does "show that Y. enterocolitica serotype 0:8 is gradually spreading around the world." We are concerned that the authors may have drawn a conclusion not justified by the data that they presented.
Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblasti... more Between December 1982 and November 1983, stool specimens from 15 children with acute lymphoblastic leukemia, who were on maintenance cancer chemotherapy, were examined weekly for the presence of Clostridium difficile and its toxin. Four out of 15 patients were positive for C. difficile: three patients had stool specimens that did not contain toxin, but cultures yielded growth of toxigenic C. difficile on only one occasion. The fourth patient, who had a recent history of hospitalization, particularly aggressive cancer chemotherapy, neutropenia, and antibiotic therapy, excreted both C. difficile and its toxin for at least 1 month. All children were asymptomatic at the time of positive cultures. This preliminary study reveals a low rate of C. difficile colonization in leukemic children on maintenance cancer chemotherapy.
1. Clin Infect Dis. 1994 Nov;19(5):980-1. Elevated white blood cell counts associated with Ureapl... more 1. Clin Infect Dis. 1994 Nov;19(5):980-1. Elevated white blood cell counts associated with Ureaplasma urealyticum colonization in preterm neonates. Panero A, Pacifico L, Rossi N, Bucci G, Chiesa C. Comment on: Clin Infect Dis. 1993 Aug;17 Suppl 1:S144-7. ...
In the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of ch... more In the last 20 years, nonalcoholic fatty liver disease (NAFLD) has become the leading cause of chronic liver disease worldwide, primarily as a result of the epidemic of obesity. NAFLD is strongly associated with insulin resistance, glucose intolerance, and dyslipidemia and is currently regarded as the liver manifestation of the metabolic syndrome, a highly atherogenic condition even at a very early age. Patients with NAFLD including pediatric subjects have a higher prevalence of subclinical atherosclerosis, as shown by impaired flow-mediated vasodilation, increased carotid artery intima-media thickness, and arterial stiffness, which are independent of obesity and other established risk factors. More recent work has identified NAFLD as a risk factor not only for premature coronary heart disease and cardiovascular events, but also for early subclinical abnormalities in myocardial structure and function. Thus, we conducted a systematic review and meta-analysis to test the hypothesis th...
Endothelial dysfunction is recognized as an early sign of systemic atherosclerosis, and it repres... more Endothelial dysfunction is recognized as an early sign of systemic atherosclerosis, and it represents a therapeutic target to prevent long-term cardiovascular (CV) consequences. Alpha-lipoic acid (ALA) is a commonly used dietary supplement exerting anti-oxidant and anti-inflammatory effects. We investigated whether a three-month treatment with ALA improves endothelial function, as assessed by flow-mediated dilation (FMD) of the brachial artery, and clinical and metabolic risk factors in overweight/obese youths. We enrolled 67 overweight/obese children, and 22 normal-weight metabolically healthy controls. Overweight/obese youths were randomly allocated in a double-blinded manner to receive ALA (n = 34) or placebo (n = 33). Of these, 64 (32 ALA, 32 placebo) completed the follow-up. At baseline, in ALA and placebo groups, FMD was similar, but lower as compared with that in controls (p = 0.045). At three months, within the ALA and placebo groups, FMD did not change significantly. Howeve...
Celiac Disease and Non-Celiac Gluten Sensitivity, Jun 7, 2017
Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolam... more Celiac disease (CD) is an immune-mediated systemic disorder elicited by gluten and related prolamins in genetically susceptible individuals, characterized by the presence of a variable combination of gluten-dependent clinical manifestations, CD-specific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. Hepatitis B virus (HBV) infection is an important global public health problem that can cause chronic liver disease, and it is associated to a high risk of death from cirrhosis and hepatocellular carcinoma. Since 1982, a safe and effective HBV vaccine has been available, and recommendation for HBV vaccination has been extended to all infants to achieve protection against HBV infection. HBV vaccination is highly effective in eliciting a sustained immune response in immune-competent individuals. However, research papers have suggested that celiac patients may have low rate of protective antibodies after HBV vaccination. The failure of CD subjects to respond to HBV vaccination has great importance for public health policies as the nonresponders could be regarded as a reservoir for HBV. The aim of our work is to revise and to discuss the scarce literature on this field in order to provide clinical practice guidelines to establish the best surveillance program of response to HBV vaccine in CD pediatric patient.
Background: The reported sensitivities and specificities of procalcitonin (PCT) concentrations fo... more Background: The reported sensitivities and specificities of procalcitonin (PCT) concentrations for the diagnosis of neonatal infection vary widely. A postnatal increase of PCT has been observed in healthy term newborns with a peak at ≈24 h of age, and many questions remain regarding maternal and perinatal factors that may influence the normal PCT kinetics during the immediate postnatal period. Methods: We prospectively investigated the association between the serum PCT values obtained from 121 mothers at delivery and serum PCT in their healthy, term offspring at birth as well as at 24 and 48 h of age. We also analyzed whether obstetric and perinatal factors would alter maternal and neonatal PCT response. Results: PCT concentrations in the babies at birth were significantly higher than in the mothers (P <0.0001), with even larger differences at 24 and 48 h of age. None of the variables identified from maternal and perinatal histories had a significant effect on maternal PCT respon...
Background: There is a wide range of reported sensitivities and specificities for C-reactive prot... more Background: There is a wide range of reported sensitivities and specificities for C-reactive protein (CRP) and interleukin-6 (IL-6) in the detection of early-onset neonatal infection. This prompted us to assess reference intervals for CRP and IL-6 during the 48-h period immediately after birth and to identify maternal and perinatal factors that may affect them. Methods: CRP and IL-6 values were prospectively obtained for 148 healthy babies (113 term, 35 near-term) at birth and at 24 and 48 h of life, and from their mothers at delivery. Results: Upper reference limits for CRP at each neonatal age were established. At birth, CRP was significantly lower than at 24 and 48 h of life. Rupture of membranes ≥18 h, perinatal distress, and gestational hypertension significantly affected the neonatal CRP dynamics, but at specific ages. There was no correlation between CRP concentrations in mothers and their offspring at birth. The IL-6 values observed in the delivering mothers and in their bab...
Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease... more Background: There is growing evidence that non-alcoholic fatty liver disease (NAFLD) is a disease affecting not only the liver but also extrahepatic organs. Aim: To investigate whether in youths NAFLD is associated with extrahepatic complications such as subclinical atherosclerosis, cardiac abnormalities, hypertension, type 2 diabetes, decreased bone mineral density, renal dysfunction, obstructive sleep apnea, and polycystic ovary syndrome. Methods: We systematically reviewed PubMed; Scopus; Embase; and the Cochrane Library databases up to 28 February 2019 and assessed the quality of studies using the Newcastle-Ottawa Scale. Results: Thirty-five articles were selected for this systematic review: fifteen (4627 participants) evaluated the association of NAFLD with subclinical atherosclerosis; four (969 participants) with cardiac abnormalities; two (550 participants) with hypertension; four (1328 participants) with diabetes; six (523 participants) with low bone mineral density; two (86...
Probiotics and Prebiotics in Human Nutrition and Health, 2016
Celiac disease (CD) is an autoimmune enteropathy induced by gluten ingestion in genetically susce... more Celiac disease (CD) is an autoimmune enteropathy induced by gluten ingestion in genetically susceptible individuals. Genetic predisposition plays an important role in the development of CD, but it is not sufficient by itself for the disease development. Although gluten proteins are the main environmental factor involved in CD pathogenesis and ingestion of gluten is necessary to manifest the disease, recent studies have suggested that alteration of the microbiota could be involved and, in particular, the interplay between gut microbiota and the mucosal immune system. Dysbiosis, the alteration of the microbiota, has been associated with a variety of intestinal pathologies including Crohn disease and CD. Most observational studies in children and adults with CD have shown alterations in the intestinal microbiota composition compared to control subjects, which is only partially recovered after treatment with a gluten-free diet (GFD). At this time, the only treatment for CD is lifelong adherence to a GFD, which involves the elimination of grains containing gluten, wheat, rye, and barley. However, it is difficult for many patients to follow a GFD. Abnormalities in the gut microbiome in CD patients have led to the use of probiotics as a promising alternative as a therapeutic or preventative approach.
To perform a systematic review assessing accuracy and completeness of diagnostic studies of proca... more To perform a systematic review assessing accuracy and completeness of diagnostic studies of procalcitonin (PCT) for early-onset neonatal sepsis (EONS) using the Standards for Reporting of Diagnostic Accuracy (STARD) initiative.EONS, diagnosed during the first 3 days of life, remains a common and serious problem. Increased PCT is a potentially useful diagnostic marker of EONS, but reports in the literature are contradictory. There are several possible explanations for the divergent results including the quality of studies reporting the clinical usefulness of PCT in ruling in or ruling out EONS.We systematically reviewed PubMed, Scopus, and the Cochrane Library databases up to October 1, 2014. Studies were eligible for inclusion in our review if they provided measures of PCT accuracy for diagnosing EONS. A data extraction form based on the STARD checklist and adapted for neonates with EONS was used to appraise the quality of the reporting of included studies.We found 18 articles (1998...
The mechanisms initiating, regulating and sustaining the systemic stress response to a surgical i... more The mechanisms initiating, regulating and sustaining the systemic stress response to a surgical injury have not all been identified yet. Recent studies point to the adipose tissue as a major endocrine system, the hormones of which influence energy homeostasis, glucose and lipid metabolism, vascular homeostasis, and immune response. Essential elements of this control system are leptin and ghrelin. The purpose of the present study was to compare the patterns of leptin and ghrelin secretion in different perioperative periods in patients undergoing elective cholecystectomy, and to relate the changes in circulating leptin or ghrelin to concomitantly occurring changes in glucose, insulin, C-peptide, growth hormone (GH), insulin-like growth factor (IGF)-1, total cortisol, free cortisol index, and interleukin-6, and other clinical parameters. Thirty patients were included in the study. Blood was sampled at seven time points between one hour prior to the induction of anesthesia (first observation) to approximately 24 hours later. Both leptin and ghrelin displayed a parallel decrease in concentrations from baseline in the intra-and postoperative periods, with a parallel return to baseline on the morning of the first postoperative day. However, at each perioperative period the leptin trend was not associated with that of other substances(including ghrelin).Likewise, the ghrelin time trend was independent of other study variables (including leptin). What triggers this response remains unknown but this study implies that it is unlikely to be the hypothalamicpituitary-adrenocortical, GH/IGF-1, or glucose homeostatic axis, or proinflammatory cytokines.
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Papers by Lucia Pacifico