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Here, we analyze future projections of cyclone activity in the Mediterranean region at the end of the twenty-first century based on an ensemble of state-of-the-art fully-coupled Regional Climate System Models (RCSMs) from the Med-CORDEX initiative under the Representative Concentration Pathway (RCP) 8.5. Despite some noticeable biases, all the RCSMs capture spatial patterns and cyclone activity key characteristics in the region and thus all of them can be considered as plausible representations of the future evolution of Mediterranean cyclones. In general, the RCSMs show at the end of the twenty-first century a decrease in the number and an overall weakening of cyclones moving across the Mediterranean. Five out of seven RCSMs simulate also a decrease of the mean size of the systems. Moreover, in agreement with what already observed in CMIP5 projections for the area, the models suggest an increase in the Central part of the Mediterranean region and a decrease in the South-eastern part of the region in the cyclone-related wind speed and precipitation rate. These rather two opposite tendencies observed in the precipitation should compensate and amplify, respectively, the effect of the overall reduction of the frequency of cyclones on the water budget over the Central and South-eastern part of the region. A pronounced inter-model spread among the RCSMs emerges for the projected changes in the cyclone adjusted deepening rate, seasonal cycle occurrence and associated precipitation and wind patterns over some areas of the basin such as Ionian Sea and Iberian Peninsula. The differences observed appear to be determined by the driving Global Circulation Model (GCM) and influenced by the RCSM physics and internal variability. These results point to the importance of (1) better characterizing the range of plausible futures by relying on ensembles of models that explore well the existing diversity of GCMs and RCSMs as well as the climate natural variability and (2) better understanding the driving mechanisms of the future evolution of Mediterranean cyclones properties. [ABSTRACT FROM AUTHOR]

Background: The optimal management of duodenal neuroendocrine neoplasms (dNENs) is unclear, and endoscopic resection is increasingly performed instead of surgery.Methods: This is a retrospective analysis of patients with histologically confirmed diagnosis of dNENs, managed at five Italian tertiary referral Centers in Italy.Results: From 2000 to 2017, 108 patients (69 males, 39 females, median age 59.5 years) were included in this study. Seventy-one patients had G1, 21 G2, 4 G3 dNENs (12 Ki-67 not available). Fifty-four patients showed metastases at diagnosis, and 20 patients developed metachronous metastases. Thirty patients had a functioning dNEN (14 metastatic). Fifty-seven patients had the dNEN surgically resected, 16 endoscopically, 23 metastatic, received medical therapy + surgery or endoscopy. Seven patients underwent liver-directed therapies, and one patient had PRRT. Median OS was 187 months. During a median follow-up of 76 months, 20 patients died (19 of disease-related causes). At Cox’s multivariate proportional hazard regression, grading and age were the only variables independently related to OS. Median PFS was 170 months. Grading and staging at the initial diagnosis were independently related to PFS. No differences in terms of OS and PFS were observed between patients treated surgically or endoscopically.Conclusions: dNENs prognosis may be highly variable. These tumors can be metastatic in up to 50% of cases at the time of first diagnosis and can develop metastases thereafter. Functioning neoplasms express high metastatic potential. Nuclear imaging should be performed to exclude distant metastases in all dNENs. Endoscopy and surgery play a primary role in the management of the disease. Further prospective studies are needed. [ABSTRACT FROM AUTHOR]

This study aims to assess the skill of regional climate models (RCMs) at reproducing the climatology of Mediterranean cyclones. Seven RCMs are considered, five of which were also coupled with an oceanic model. All simulations were forced at the lateral boundaries by the ERA-Interim reanalysis for a common 20-year period (1989-2008). Six different cyclone tracking methods have been applied to all twelve RCM simulations and to the ERA-Interim reanalysis in order to assess the RCMs from the perspective of different cyclone definitions. All RCMs reproduce the main areas of high cyclone occurrence in the region south of the Alps, in the Adriatic, Ionian and Aegean Seas, as well as in the areas close to Cyprus and to Atlas mountains. The RCMs tend to underestimate intense cyclone occurrences over the Mediterranean Sea and reproduce 24-40 % of these systems, as identified in the reanalysis. The use of grid nudging in one of the RCMs is shown to be beneficial, reproducing about 60 % of the intense cyclones and keeping a better track of the seasonal cycle of intense cyclogenesis. Finally, the most intense cyclones tend to be similarly reproduced in coupled and uncoupled model simulations, suggesting that modeling atmosphere-ocean coupled processes has only a weak impact on the climatology and intensity of Mediterranean cyclones. [ABSTRACT FROM AUTHOR]

Exploiting the added value of the ensemble of high-resolution model simulations provided by the Med-CORDEX coordinated initiative, an updated assessment of Mediterranean extreme precipitation events as represented in different observational, reanalysis and modelling datasets is presented. A spatiotemporal characterisation of the long-term statistics of extreme precipitation is performed, using a number of different diagnostic indices. Employing a novel approach based on the timing of extreme precipitation events a number of physically consistent subregions are defined. The comparison of different diagnostics over the Mediterranean domain and physically homogeneous sub-domains is presented and discussed, focussing on the relative impact of several model configuration features (resolution, coupling, physical parameterisations) on the performance in reproducing extreme precipitation events. It is found that the agreement between the observed and modelled long-term statistics of extreme precipitation is more sensitive to the model physics, in particular convective parameterisation, than to other model configurations such as resolution and coupling. [ABSTRACT FROM AUTHOR]

In this study we investigate the scaling of precipitation extremes with temperature in the Mediterranean region by assessing against observations the present day and future regional climate simulations performed in the frame of the HyMeX and MED-CORDEX programs. Over the 1979-2008 period, despite differences in quantitative precipitation simulation across the various models, the change in precipitation extremes with respect to temperature is robust and consistent. The spatial variability of the temperature-precipitation extremes relationship displays a hook shape across the Mediterranean, with negative slope at high temperatures and a slope following Clausius-Clapeyron (CC)-scaling at low temperatures. The temperature at which the slope of the temperature-precipitation extreme relation sharply changes (or temperature break), ranges from about 20 °C in the western Mediterranean to <10 °C in Greece. In addition, this slope is always negative in the arid regions of the Mediterranean. The scaling of the simulated precipitation extremes is insensitive to ocean-atmosphere coupling, while it depends very weakly on the resolution at high temperatures for short precipitation accumulation times. In future climate scenario simulations covering the 2070-2100 period, the temperature break shifts to higher temperatures by a value which is on average the mean regional temperature change due to global warming. The slope of the simulated future temperature-precipitation extremes relationship is close to CC-scaling at temperatures below the temperature break, while at high temperatures, the negative slope is close, but somewhat flatter or steeper, than in the current climate depending on the model. Overall, models predict more intense precipitation extremes in the future. Adjusting the temperature-precipitation extremes relationship in the present climate using the CC law and the temperature shift in the future allows the recovery of the temperature-precipitation extremes relationship in the future climate. This implies negligible regional changes of relative humidity in the future despite the large warming and drying over the Mediterranean. This suggests that the Mediterranean Sea is the primary source of moisture which counteracts the drying and warming impacts on relative humidity in parts of the Mediterranean region. [ABSTRACT FROM AUTHOR]

The Mistral and Tramontane are important wind phenomena that occur over southern France and the northwestern Mediterranean Sea. Both winds travel through constricting valleys before flowing out towards the Mediterranean Sea. The Mistral and Tramontane are thus interesting phenomena, and represent an opportunity to study channeling effects, as well as the interactions between the atmosphere and land/ocean surfaces. This study investigates Mistral and Tramontane simulations using five regional climate models with grid spacing of about 50 km and smaller. All simulations are driven by ERA-Interim reanalysis data. Spatial patterns of surface wind, as well as wind development and error propagation along the wind tracks from inland France to offshore during Mistral and Tramontane events, are presented and discussed. To disentangle the results from large-scale error sources in Mistral and Tramontane simulations, only days with well simulated large-scale sea level pressure field patterns are evaluated. Comparisons with the observations show that the large-scale pressure patterns are well simulated by the considered models, but the orographic modifications to the wind systems are not well simulated by the coarse-grid simulations (with a grid spacing of about 50 km), and are reproduced slightly better by the higher resolution simulations. On days with Mistral and/or Tramontane events, most simulations underestimate (by 13 % on average) the wind speed over the Mediterranean Sea. This effect is strongest at the lateral borders of the main flow—the flow width is underestimated. All simulations of this study show a clockwise wind direction bias over the sea during Mistral and Tramontane events. Simulations with smaller grid spacing show smaller biases than their coarse-grid counterparts. [ABSTRACT FROM AUTHOR]

The characteristics of the mesoscale Mistral and Tramontane winds under changing climate conditions are of great interest for risk assessments. In this study, a classification algorithm is applied to identify Mistral and Tramontane-permitting sea-level pressure patterns, thus allowing for estimates of their future characteristics. Five simulations with three regional climate models on a 0.44 $$^\circ$$ grid and five global circulation models are assessed for the representative concentration pathways (RCPs) 4.5 and 8.5. Regional climate simulations driven by ERA-Interim are used to test the classification algorithm and to estimate its accuracy. The derived Mistral and Tramontane time series are discussed. The results for the ERA-Interim period show that the classification algorithm and the regional climate models work well in terms of the number of Mistral and Tramontane days per year, but the results overestimate the average length of such events. For both the RCPs, only small changes in Mistral frequency were found in both regional and global climate simulations. Most simulations show a decrease in Tramontane frequencies and average period lengths during the 21st century. Regional climate simulations using RCP8.5 show fewer Tramontane events than those using RCP4.5. [ABSTRACT FROM AUTHOR]

Purpose: Small-intestine neuroendocrine neoplasms are heterogeneous neoplasms arising from endocrine cells of the intestinal mucosa. Ki-67 is the main determinant of prognosis in neuroendocrine neoplasms. However, the search for new prognostic makers represents a key point with regard to small-intestine neuroendocrine neoplasms. The oncofetal protein IMP3 plays a role in cell growth and its expression has a prognostic value in lung neoplasms. Methods: From January 1998 to August 2015, all the consecutive small-intestine neuroendocrine neoplasms patients suitable for surgery were included: 51 patients (32 males, median age 68 years) had small-intestine neuroendocrine neoplasms classified according to the WHO 2010 classification. In all the cases IMP3 expression was evaluated on primary tumors and, when available, on nodal and distant metastases. The medical records and pathological slides of these patients were used to determine the clinical characteristics, pathological diagnoses, and outcome information. Results: The overall 5-year and 10-year survival rate were 53.9 and 42% respectively. At Cox proportional hazards regression grading was the major factor influencing both OS and progression-free survival at univariate ( p = 0.0002 and 0.0051, respectively) and multivariate analysis ( p = 0.0004 and 0.0043, respectively). Also IMP3 expression at the nodal metastases resulted a factor significantly associated with progression-free survival at both univariate ( p = 0.0066) and multivariate analysis ( p = 0.0059, HR 3.58). IMP3 expression did not correlate with the Ki-67 ( p = n.s.). Conclusions: In this study, IMP3 at the nodal site resulted to be associated with low progression-free survival in small-intestine neuroendocrine neoplasms, independently of the Ki-67 index. We suggest that the integration of IMP3 and Ki-67 would help better stratify the risk of progression in small-intestine neuroendocrine neoplasms. [ABSTRACT FROM AUTHOR]

The potential impact of climate change on port operations and infrastructures has received much less attention than the corresponding impact for beach systems. However, ports have always been vulnerable to weather extremes and climate change could enhance such occurrences at timescales comparable to the design lifetime of harbour engineering structures. The analysis in this paper starts with the main climatic variables affecting harbour engineering and exploitation. It continues with a review of the available projections for such variables first at global scale and then at a regional scale (Catalan coast in the western Mediterranean) as a study case for similar environments in the planet. The detailed assessment of impacts starts from downscaled projections for mean sea level and wave storms (wind not considered in the paper). This is followed by an analysis of the port operations and infrastructure performance that are relevant from a climate perspective. The key climatic factors here considered are relative sea level, wave storm features (height, period, direction and duration) and their combined effect, which is expected to produce the highest impacts. The paper ends with a discussion and some examples of analyses aiming at port adaptation to future climate change. [ABSTRACT FROM AUTHOR]

Background: The addition of impedance to 24-h pH monitoring has allowed detection of weakly acidic reflux, but the extent to which pH-impedance (pH-MII) monitoring improves outcomes is unknown.Methods: This was a prospective observational study. Patients referred for pH or pH-MII monitoring completed a standardized questionnaire on improvement in the dominant symptom, their satisfaction, and treatment at 3 and 12 months after the test during a telephone interview.Results: A total of 184 patients (mean age, 52 years, range, 19-82 years; 35 % with typical symptoms; and 89 % tested off therapy) completed pH (n = 92) or pH-MII monitoring (n = 92) over a period of 15 months. The two arms were similar in terms of demographic, clinical, and endoscopic variables. Ten patients in the pH-MII arm showed evidence of weakly acidic reflux disease. There was no difference in the percentage of patients in the pH and pH-MII monitoring arms who experienced improvement in their dominant symptom after 3 (58 vs. 63 %; p = 0.621) or 12 months (66 vs. 70 %; p = 0.234), and the same was true for patient satisfaction. There were also no between-group difference in the use of proton pump inhibitors (PPIs) after 3 (63 vs. 68.5 %; p = 0.437) or 12 months (47 vs. 60.5 %; p = 0.051). PPIs were prescribed more frequently after a positive test (p < 0.001) although they were used by 45.6 % of the negative patients. Only one patient underwent fundoplication.Conclusions: Two-thirds of patients undergoing pH-MII monitoring experience a positive outcome, similarly to what occurs after traditional pH monitoring. Physicians often pay little attention to the test results, especially if they are negative. [ABSTRACT FROM AUTHOR]

Present case report refers to a 48-year-old man with genetic haemochromatosis (C282Y mut/mut) diagnosed at the age of 26. After aggressive iron depleting regimen carried out up to normalization of iron-related indexes, he received a maintenance regimen based on regular phlebotomies for about 20 years. In 2014, a marked reduction of both serum ferritin and transferrin saturation percent, without concomitant anaemia, was noted on two different occasions at 5-month interval. An obscure occult GI bleeding was suspected, but both upper and lower GI tract endoscopy were negative for abnormal findings, as also was a detailed abdominal US scan. The persistence of low iron-related indexes prompted the physicians to perform a videocapsule endoscopy, which showed an ulcerative bleeding lesion in the small bowel, not confirmed however by both anterograde and retrograde double-balloon enteroscopy. Further MRI and PET allowed the identification of a 3.5 cm large lesion, located outside the small bowel wall, suspected to be a gastrointestinal stromal tumour (GIST). A further laparoscopic procedure allowed the resection of 10 cm of midileum, which included the mass, fully consistent with GIST at pathology. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Antibiotic-associated diarrhea (AAD) and Clostridium difficile-associated diarrhea (CDAD) are common complications of antibiotic use. Probiotics were effective in preventing AAD and CDAD in several randomized controlled trials. This study was aimed at testing the effect of Saccharomyces boulardii on the occurrence of AAD and CDAD in hospitalized patients.METHODS:A single-center, randomized, double-blind, placebo-controlled, parallel-group trial was performed. Patients being prescribed antibiotics or on antibiotic therapy for <48 h were eligible. Exclusion criteria were ongoing diarrhea, recent assumption of probiotics, lack of informed consent, inability to ingest capsules, and severe pancreatitis. Patients received a capsule containing S. boulardii or an indistinguishable placebo twice daily within 48 h of beginning antibiotic therapy, continued treatment for 7 days after antibiotic withdrawal, and were followed for 12 weeks after ending antibiotic treatment.RESULTS:Of 562 consecutive eligible patients, 275 patients aged 79.2±9.8 years (134 on placebo) were randomized and 204 aged 78.4±10.0 years (98 on placebo) completed the follow-up. AAD developed in 13.3% (13/98) of the patients receiving placebo and in 15.1% (16/106) of those receiving S. boulardii (odds ratio for S. boulardii vs. placebo, 1.16; 95% confidence interval (CI), 0.53-2.56). Five cases of CDAD occurred, 2 in the placebo group (2.0%) and 3 in the probiotic group (2.8%; odds ratio for S. boulardii vs. placebo, 1.40; 95% CI, 0.23-8.55). There was no difference in mortality rates (12.7% vs. 15.6%, P=0.60).CONCLUSIONS:In elderly hospitalized patients, S. boulardii was not effective in preventing the development of AAD. [ABSTRACT FROM AUTHOR]

Background: Hereditary hemorrhagic telangiectasia is a genetic disease characterized by teleangiectasias involving virtually every organ. There are limited data in the literature regarding the natural history of liver vascular malformations in hemorrhagic telangiectasia and their associated morbidity and mortality.Aim: This prospective cohort study sought to assess the outcome of liver involvement in hereditary hemorrhagic telangiectasia patients.Methods: We analyzed 16 years of surveillance data from a tertiary hereditary hemorrhagic telangiectasia referral center in Italy. We considered for inclusion in this study 502 consecutive Italian patients at risk of hereditary hemorrhagic telangiectasia who presented at the hereditary hemorrhagic telangiectasia referral center and underwent a multidisciplinary screening protocol for the diagnosis of hereditary hemorrhagic telangiectasia. Of the 502 individuals assessed in the center, 154 had hepatic vascular malformations and were the subject of the study; 198 patients with hereditary hemorrhagic telangiectasia and without hepatic vascular malformations were the controls. Additionally, we report the response to treatment of patients with complicated hepatic vascular malformations.Results: The 154 patients were included and followed for a median period of 44 months (range 12-181); of these, eight (5.2%) died from VM-related complications and 39 (25.3%) experienced complications. The average incidence rates of death and complications were 1.1 and 3.6 per 100 person-years, respectively. The median overall survival and event-free survival after diagnosis were 175 and 90 months, respectively. The rate of complete response to therapy was 63%.Conclusions: This study shows that substantial morbidity and mortality are associated with liver vascular malformations in hereditary hemorrhagic telangiectasia patients. [ABSTRACT FROM AUTHOR]

OBJECTIVES:Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) expressing somatostatin receptors may be treated with somatostatin analogs (SSAs). Selection criteria are a positive Octreoscan or a >50% hormone level decrease after octreotide subcutaneous (s.c.) injection (octreotide test) (OT). Plasma chromogranin A (CgA) is the best general GEP-NET marker, but data on CgA response to OT are scanty. Thus, we evaluated whether plasma CgA response to OT could predict the clinical response to SSAs.METHODS:At diagnosis, 38 GEP-NET patients received octreotide 200 μg s.c., with plasma CgA determination at 0, 3, and 6 h. Long-term SSA treatment was then given by monitoring symptomatic, biochemical, and objective responses, and survival.RESULTS:Basal plasma CgA levels were significantly higher in patients with functioning than non-functioning tumors (median (range): 220 (18–2,230) vs. 46 (25–8,610) U/l, P=0.03) and in those with than without metastases (171 (18–8,610) vs. 43 (28–220) U/l, P=0.04). CgA levels significantly correlated with WHO classification, clinical TNM staging, and Ki-67 proliferative index. After OT, CgA levels decreased from 146 (18–8,610) to 61 (10–8,535) U/l (basal and nadir values), P<0.001. In patients responsive to OT, a successful objective response occurred in 21/31 patients (68%). Successful symptomatic response occurred in 13/18 patients (72%), biochemical response in 25/31 (81%), and objective response in 21/31 (68%). In the remaining seven unresponsive cases, with CgA decrement <30%, disease progressed to death in six (86%). Median survival from enrollment was 48 months (6–138) in responsive and 6 (6–30) in unresponsive patients (P=0.0005).CONCLUSIONS:In GEP-NETs, plasma CgA is a reliable marker, and a >30% decrease after OT has a relevant prognostic meaning allowing the identification of the subgroup of patients most likely to be responsive to chronic SSAs. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Assessment of the activity of perianal fistulas may be of clinical relevance in patients with Crohn's disease. Fistula activity is currently evaluated by means of magnetic resonance imaging; anal ultrasound can also be used, but its diagnostic performance in this setting remains to be defined. Our aims were to evaluate the agreement between clinical examination, magnetic resonance imaging, and anal ultrasound in assessing perianal fistula activity, and to apply computerized analysis to improve the assessment of ultrasound images. METHODS: Thirty-one consecutive patients with Crohn's perianal fistulas underwent clinical examination, and magnetic resonance and anal ultrasound imaging. Active fistulas were defined as the presence of active drainage or signs of local inflammation on clinical examination, and the definition was confirmed by surgical examination. Activity was assessed on the basis of T2 hyperintensity on magnetic resonance imaging and the degree of hypoechogenicity on anal ultrasound; the anal ultrasound images were also analyzed using dedicated computer image-analysis software. RESULTS: Twenty-five patients had an active fistula at clinical examination. The agreement between clinical examination and magnetic resonance imaging was good ( k-value = 0.739), whereas that with anal ultrasound was only fair ( k-value = 0.266–0.294); computer-assisted analysis of the anal ultrasound images improved the agreement from fair to good ( k-value = 0.608–0.670). CONCLUSIONS: Anal ultrasound can be used to assess fistula track activity in patients with Crohn's disease. The diagnostic performance of the technique can be improved to values comparable with those of magnetic resonance imaging by using a computer-assisted evaluation of the anal ultrasound images. [ABSTRACT FROM AUTHOR]

BACKGROUND AND AIM: In patients with chronic liver disease, the accuracy of ultrasound scan (US), spiral computed tomography (CT), magnetic resonance imaging (MRI), and alpha-fetoprotein (AFP) in diagnosing hepatocellular carcinoma (HCC) has never been systematically assessed, and present systematic review was aimed at this issue. METHODS: Pertinent cross-sectional studies having as a reference standard pathological examinations of the explanted liver or resected segment(s), biopsies of focal lesion(s), and/or a period of follow-up, were identified using MEDLINE, EMBASE, Cochrane Library, and CancerLit. Pooled sensitivity, specificity, and likelihood ratios (LR) were calculated using the random effect model. Summary receiver operating characteristic (SROC) curve and predefined subgroup analyses were made when indicated. RESULTS: The pooled estimates of the 14 US studies were 60% (95% CI 44–76) for sensitivity, 97% (95% CI 95–98) for specificity, 18 (95% CI 8–37) for LR+, and 0.5 (95% CI 0.4–0.6) for LR−; for the 10 CT studies sensitivity was 68% (95% CI 55–80), specificity 93% (95% CI 89–96), LR+ 6 (95% CI 3–12),and LR− 0.4 (95% CI 0.3–0.6); for the nine MRI studies sensitivity was 81% (95% CI 70–91), specificity 85% (95%CI 77–93), LR+ 3.9 (95%CI 2–7), and LR− 0.3 (95% CI 0.2–0.5). The sensitivity and specificity of AFP varied widely, and this could not be entirely attributed to the threshold effect of the different cutoff levels used. CONCLUSIONS: US is highly specific but insufficiently sensitive to detect HCC in many cirrhotics or to support an effective surveillance program. The operative characteristics of CT are comparable, whereas MRI is more sensitive. High-quality prospective studies are needed to define the actual diagnostic role of AFP. [ABSTRACT FROM AUTHOR]

Computed tomography (CT) findings in acute alcoholic hepatitis (AAH) have not been investigated and a“pseudotumoral aspect” of the liver parenchyma has rarely been reported as an exceedingly unusual finding. We observed 11 patients with AAH over a 1-yr period, five of whom underwent CT for concomitant clinical reasons. Arterial enhancement indicated areas of hypervascularized tissue in all cases, and the histological findings were fully consistent with AAH without any sign of malignancy. The present findings suggest that the above pattern is not uncommon in AAH and should be carefully considered in order to avoid diagnostic errors.(Am J Gastroenterol 2005;100:1-6) [ABSTRACT FROM AUTHOR]

: ObjectiveGhrelin, the gut–brain peptide, recently identified as the natural endogenous ligand for growth hormone secretagogue receptors, exerts various endocrine and nonendocrine effects, including the control of energy homeostasis and food intake, but its possible relevance in malabsorption syndromes is unknown. Therefore, the aim of this study was to evaluate circulating ghrelin levels in adults with untreated and treated celiac disease (CD) and, for comparison, in healthy subjects.: MethodsFasting serum ghrelin levels were measured in 30 consecutive patients with newly diagnosed CD, 13 celiac patients successfully treated with a gluten-free diet (GFD), and 30 healthy controls.: ResultsGhrelin levels were abnormally high in patients with active CD compared with controls (297 ± 17.6 vs 218 ± 15.2 pmol/L, p < 0.01) and correlated positively with intestinal mucosal lesion severity (rs = 0.444, p < 0.02). In the successfully GFD-treated patients, ghrelin values were normal compared with controls (233 ± 22.0 vs 218 ± 15.2 pmol/L, ns) and, moreover, correlated negatively with body mass index (r = −0.632, p = 0.02), unlike in the untreated patient group (r = −0.263, ns).: ConclusionHigh ghrelin levels characterized our series of adult patients with newly diagnosed CD and correlated significantly with the degree of severity of intestinal mucosal lesions. This is the first evidence of a relationship between ghrelin and inflammatory processes, but the mechanisms involved are still unclear. Furthermore, our findings suggest that an interplay of hormonal, metabolic, and nutritional factors could influence ghrelin secretion under pathophysiological circumstances. [Copyright &y& Elsevier]

OBJECTIVE:For celiac disease (CD), screening a trend has recently emerged to measure tissue transglutaminase antibodies (tTGA) by immunoassays instead of the more laborious endomysial antibodies (EmA), as they recognize the same target, tissue transglutaminase (tTG). However, a high rate of false-positive results has been reported in some patient series with diseases known to be associated with CD. Moreover, tTG is a ubiquitous, multifunctional enzyme, overexpressed in experimental models of heart failure. Therefore, we assessed the specificity of tTGA assays in a large series of EmA-negative patients with end-stage heart failure.METHODS:We studied 288 patients with end-stage heart failure and 60 blood donors. No subject had clinical evidence of CD or IgA deficiency, and all were EmA negative. Serum IgA and IgG tTGA were measured by means of commercial kits using as substrate, either guinea pig or recombinant human tTG. Blocking studies and Western blots were also performed using recombinant human tTG.RESULTS:All blood donor sera were IgA tTGA negative. IgA tTGA positivity was observed in 47.6% and 49.1% of patients with heart failure using, respectively, guinea pig tTG and recombinant human tTG as substrates. Preincubation of positive sera with recombinant human tTG resulted in 81% blocking of IgA tTGA in immunoassay. Western blot analysis confirmed the presence of antibodies against recombinant human tTG. IgA tTGA-positive sera were also IgG tTGA positive.CONCLUSIONS:IgA and IgG tTGA occur in a large number of EmA-negative patients with end-stage heart failure, and their presence is unlikely to be caused by concomitant CD. [Copyright &y& Elsevier]

Investigates gallbladder emptying and cholecystokinin and somatostatin plasma levels in response to a fatty meal in patients with celiac disease by researchers from Milan, Italy. Correlation of gallbladder hypomotility in celiac disease to decreased cholecystokinin secretion; Use of ultrasonography and radioimmunoassay to measure gallbladder volume and plasma levels of cholecystokinin and somatostatin; Indications using gluten-free diet to reverse these abnormalities.

Biochemical indexes of bone metabolism, bone mineral density, and histomorphometry were evaluated in 14 male patients with noncholestatic cirrhosis due to primary hemochromatosis (six cases) or to chronic alcohol abuse (eight cases), and in 30 male controls of similar age. Alkaline phosphatase in alcoholic patients was significantly higher than in controls (mean ± SD 50.4 ± 33.7 vs 33.0 ± 7.1 U/L, p < 0.01), as was urinary hydroxyproline in both hemochromatotics and alcoholics (mean ± SD, 44.3 ± 8.4 and 40.4 ± 16.8, respectively, vs 30.1 ± 4.5 mg/g, p < 0.001 and p < 0.005). Bone mineral density was significantly lower in hemochromatotics than in alcoholics and controls (mean ± SD, 591 ± 90 vs 765 ± 87 and 759 ± 34 mg/cm², respectively, p < 0.005 and p < 0.001). At bone biopsy, trabecular osteoporosis was observed in two hemochromatotics and four alcoholics, and osteomalacia was seen in another alcoholic. Overall densitometric and histomorphometric findings indicate a derangement of trabecular bone in both alcoholic and hemochromatotic cirrhosis, whereas cortical osteoporosis seems limited to hemochromatotic patients. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which describes the association and contribution of TMPRSS6 RS855791 polymorphism to iron deficiency in treated celiac disease (CD).

OBJECTIVE: The aim of this study was to investigate the role of genetic factors and the characteristics of five monozygous twin pairs with at least one member affected by gluten sensitivity. METHODS: Five pairs of monozygous female twins, of whom one or both were affected by gluten sensitivity (i.e., celiac disease or dermatitis herpetiformis), were followed-up for 11 -23 yr. RESULTS: Three pairs were concordant for celiac disease: the onset was comparable and synchronous in two pairs; in the third, one member presented an overt malabsorption syndrome, and the other developed iron deficiency anemia 10 yr later. Discordance for gluten sensitivity was found in the remaining two pairs, one of whose members was diagnosed as having, respectively, celiac disease and dermatitis herpetiformis. CONCLUSIONS: As no environmental factors were found to affect the phenotypic expression of the disease, genetic factors seem to play a major role. The presence of overt or latent celiac disease in three of the four siblings of the three concordant twins, and the association with cystic fibrosis in all three siblings of one of these families, further supports this hypothesis. [ABSTRACT FROM AUTHOR]

Background: An association between celiac disease and primary biliary cirrhosis has been reported in a few cases, mainly as individual case reports. Objectives: To screen adult patients with celiac disease for primary biliary cirrhosis and patients with primary biliary cirrhosis for intestinal celiac involvement. Methods: The celiac group consisted of 336 adults (218 women and 118 men; mean age, 36 yr; range 18-74 yr) with celiac disease diagnosed by serological and histological tests, 38 with newly diagnosed celiac disease and 298 with previously diagnosed celiac disease who were consuming a gluten-free diet. The mean follow-up period was 6 yr (range, 1-16 yr). Liver function parameters and autoantibody levels were determined, and, when indicated, histological tests were performed. The biliary cirrhosis group consisted of 65 subjects (58 women and seven men) (mean age, 59 yr; range, 35-67 yr) with primary biliary cirrhosis diagnosed 1-17 years previously (mean, 7 yr) on the basis of the usual biochemical, serological, and histological criteria. Antigliadin and antiendomysium antibody levels were determined, and two biopsy specimens from the distal duodenum obtained during endoscopy were evaluated. Results: In patients with celiac disease, impairment of liver function was frequently found at diagnosis (16 of 38, or 44%), but primary biliary cirrhosis was diagnosed in only one case. In patients with primary biliary cirrhosis, no cases of celiac disease, as currently defined, were found. Conclusions: Our findings indicate that celiac disease and primary biliary cirrhosis are rarely associated and support the hypothesis that the intestinal lesions per se are not responsible for the liver disease. [ABSTRACT FROM AUTHOR]

Six men and one woman with mild anemia due to β-thalassemia trait and major iron overload attributable to concomitant primary hemochromatosis were treated by erythrocytapheresis to remove iron, combined with subcutaneous desferrioxamine in the four cases with greater iron load. Depletion was achieved by iron removal of 4.5-15.1 g after 9-24 months' treatment. No side effects were observed, suggesting that such a regimen is effective and safe in this particular subgroup of hemochromatotics. [ABSTRACT FROM AUTHOR]

Somatostatin (4 µg/min, cyclic form) was infused for 24 h on six occasions in four patients with carcinoid ileal tumor and multiple liver metastases. During infusion, spontaneous flushes and/or diarrhea were markedly reduced with a return to the pretreatment pattern on the next day. Urinary 5-hydroxyindole acetic acid excretion and plasma gastrin were not significantly changed, whereas plasma insulin presented the expected decrease and rebound. These results confirm that carcinoid symptoms are somatostatin-sensitive but do not provide evidence that serotonin or gastrin play a major role in inducing these symptoms. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Funding may influence trial results examining probiotics and Clostridium difficile diarrhea rates?" by M.R. Kolber and colleagues in the July 2014 issue.

A response by Pietro Pozzoni, Dario Conte and Agostino Colli to a letter to the editor about their article "Saccharomyces boulardii for the preventionof antibiotic-associated diarrhea in adult hospitalized patients: a single-center, randomized, double-blind, placebocontrolled trial" is presented.

A response by Sara Massironi and colleagues to a letter to the editor about their article " Plasma chromogranin A response to octreotide test: prognostic value for clinical outcome in endocrine digestive tumors" in the 2010 issue is presented.

A letter to the editor is presented commenting on a study concerning patients with hepatocellular carcinoma.

Presents a letter to the editor in response to the article "Prevalence of Celiac Disease and Its Endoscopic Markers Among Patients Having Routine Gastrointestinal Endoscopy," by William Dickey and D. Hughes in a 1999 issue.