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Non-Alcoholic Fatty Liver Disease (NAFLD) is currently the most common form of liver disease worldwide affecting all ages and ethnic groups and it has become a consistent threat even in young people. Our aim was to estimate the effect of a Low Glycemic Index Mediterranean Diet (LGIMD) on the NAFLD score as measured by a Liver Ultrasonography (LUS). NUTRIzione in EPAtologia (NUTRIEPA) is a population-based Double-Blind RCT. Data were collected in 2011 and analyzed in 2013-14. 98 men and women coming from Putignano (Puglia, Southern Italy) were drawn from a previous randomly sampled population-based study and identified as having moderate or severe NAFLD. The intervention strategy was the assignment of a LGIMD or a control diet. The main outcome measure was NAFLD score, defined by LUS. After randomization, 50 subjects were assigned to a LGIMD and 48 to a control diet. The study lasted six months and all participants were subject to monthly controls/checks. Adherence to the LGIMD as measured by Mediterranean Adequacy Index (MAI) showed a median of 10.1. A negative interaction between time and LGIMD on the NAFLD score (-4.14, 95% CI -6.78,-1.49) was observed, and became more evident at the sixth month (-4.43, 95%CI -7.15, -1.71). A positive effect of the interaction among LGIMD, time and age (Third month: 0.07, 95% CI 0.02, 0.12; Sixth month: 0.08, 95% CI 0.03,0.13) was also observed. LGIMD was found to decrease the NAFLD score in a relatively short time. Encouraging those subjects who do not seek medical attention but still have NAFLD to follow a LGIMD and other life-style interventions, may reduce the degree of severity of the disease. Dietary intervention of this kind, could also form the cornerstone of primary prevention of Type 2 Diabetes Mellitus (T2DM) and cardiovascular disease.

Context: Endocannabinoids control food intake via both central and peripheral mechanisms, and cannabinoid type-1 receptor (CB1) modulates lipogenesis in primary adipocyte cell cultures and in animal models of obesity. Objectives: We aimed to evaluate, at the population level, the frequency of a genetic polymorphism of CB1 and to study its correlation with body mass index. Design, setting and participants: Healthy subjects from a population survey carried out in southern Italy examined in 1992-1993 and older than 65 years (n=419, M=237, F=182) were divided into quintiles by body mass index (BMI). Two hundred and ten subjects were randomly sampled from the first, third and fifth quintile of BMI (BMI, respectively: 16.2-23.8=normal, 26.7-28.4=overweight, 31.6-49.7=obese) to reach a total of 70 per quintile. Their serum and white cells from the biological bank were used to measure the genotype and the blood variables for the study. Measurements: Anthropometric parameters, blood pressure, serum glucose and lipid levels were measured with standard methods; genotyping for the CB1 1359G/A polymorphism was performed using multiplex PCR. Statistical methods included chi2 for trend, binomial and multinomial multiple logistic regression to model BMI on the genotype, controlling for potential confounders. Results: We found a clear trend of increasing relative frequency of the CB1 wild-type genotype with the increase of BMI (P=0.03) and, using a multiple logistic regression model, wild-type genotype, female gender, age, glycaemia and triglycerides were directly associated with both overweight (third quintile of BMI) and obesity (fifth quintile of BMI). Conclusions: Although performed in a limited number of subjects, our results show that the presence of the CB1 polymorphic allele was significantly associated with a lower BMI.

The consumption of potatoes is increasing worldwide, but few studies have assessed the association between potato consumption and mortality, particularly in Mediterranean countries. We therefore investigated whether potato consumption is associated with higher risk of death in a large cohort of people living in South Italy. Longitudinal. Community-dwelling. 2,442 participants coming from MICOL and NUTRIHEP studies aged more than 50 years at baseline were followed-up for 11 years. Dietary intake was assessed by means of a Food Frequency Questionnaire. Potato consumption was categorized in quintiles according to their daily consumption (< 3.95, 3.96-8.55, 8.56-15.67, 15.68-22.0, and > 22.0 g/day). Mortality was ascertained through validated cases of death. The association between potato consumption and mortality was assessed through Cox's regression models, adjusted for potential confounders, and reporting the data as hazard ratios (HRs) with 95% confidence intervals (CIs). The 2,442 eligible participants were prevalently males (54.6%) and aged a mean of 64.3±9.3 years. During the 11-year follow-up, 396 (=16.2%) participants died. After adjusting for 12 potential baseline confounders, and taking those with the lowest consumption of potatoes as the reference group, participants with the highest consumption of potatoes did not have an increased overall mortality risk (HR=0.75; 95%CI: 0.53-1.07). Modelling the potato consumption as continuous (i.e. as increase in 10 g/day) did not substantially change our findings (fully-adjusted HR=0.93; 95%CI: 0.84-1.02). Overall potato consumption was not associated with higher risk of death in older people living in a Mediterranean area. Future studies are warranted to elucidate the role of potato consumption on all-cause and cause-specific mortality.

Abstract Rationale Sepsis is a major cause of mortality among critically ill patients with cancer. Information about clinical outcomes and factors associated with increased risk of death in these patients is necessary to help physicians recognize those patients who are most likely to benefit from ICU therapy and identify possible targets for intervention. Objectives In this study, we evaluated cancer patients with sepsis chosen from a multicenter prospective study to characterize their clinical characteristics and to identify independent risk factors associated with hospital mortality. Methods Subgroup analysis of a multicenter prospective cohort study conducted in 28 Brazilian intensive care units (ICUs) to evaluate adult cancer patients with severe sepsis and septic shock. We used logistic regression to identify variables associated with hospital mortality. Measurements and Main Results Of the 717 patients admitted to the participating ICUs, 268 (37%) had severe sepsis (n = 142, 53%) or septic shock (n = 126, 47%). These patients comprised the population of the present study. The mean score on the third version of the Simplified Acute Physiology Score was 62.9 ± 17.7 points, and the median Sequential Organ Failure Assessment score was 9 (7–12) points. The most frequent sites of infection were the lungs (48%), intraabdominal region (25%), bloodstream as primary infection (19%), and urinary tract (17%). Half of the patients had microbiologically proven infections, and Gram-negative bacteria were the most common pathogens causing sepsis (31%). ICU and hospital mortality rates were 42% and 56%, respectively. In multivariable analysis, the number of acute organ dysfunctions (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16–1.87), hematological malignancies (OR, 2.57; 95% CI, 1.05–6.27), performance status 2–4 (OR, 2.53; 95% CI, 1.44–4.43), and polymicrobial infections (OR, 3.74; 95% CI, 1.52–9.21) were associated with hospital mortality. Conclusions Sepsis is a common cause of critical illness in patients with cancer and remains associated with high mortality. Variables related to underlying malignancy, sepsis severity, and characteristics of infection are associated with a grim prognosis.

ObjectivesTo stress the need of routine use of US imaging in treat to target strategies aiming to achieve remission in early rheumatoid arthritis.Methods72 patients consecutive with early rheumatoid arthritis (ERA,50 pts) or undifferentiated arthritis (UA, 22 pts) diagnosed according to 2010 ACR/EULAR criteria were enrolled in a single center from november 2012 to June 2014. Demographic (age, gender, disease duration, body mass index - BMI-), clinical (total swollen and tender joints count, DAS28, CDAI, SDAI, Health Assessment Questionnaire, EULAR response), serological (eritrocyte sedimentation rate, C reactive protein, rheumatoid factor -RF-, antibodies anti-cyclic citrullinated peptide -CCP-) data was collected at baseline and at 6 months follow-up. Ultrasonographic (US) hand (MCP joints, PIP joints and DIP joints), wrists (intercarpic and radiocarpic joints) and feet (MTP joints, PIP and DIP joints as well as ankle joints) evaluation was performed according to OMERACT recommendations at baseline and 6 months.ResultsAt baseline examination the mean disease duration was 15,5±7,8 weeks (min – max 4 - 24), 33/72 (45.91%) were RF positive and 32/72 (43.1%) were ACPA positive. Sixty-four patients were treated with DMARDs (62.5% MTX, 25% HCQ, 13% others) and 57 patients received corticosteroids. Ten out of 72 patients (13.9%) showed radiographic erosions at baseline evaluation. At 6 months clinical evaluation 23 pts were in remission according to DAS28 criteria, 14 pts were in low disease activity, 23 in moderate disease activity and 10 pts still in high disease activity. Comparing US evaluation in the different level of disease acitivity only joint synovial PD showed a statistical significant difference (table1).Table 1.Clinical and US features at 6 months evaluationEULAR DASUS FeaturesSynovial hypertrophySynovial Power-DopplerJoints erosionsTenosynovitisAt least one US alterationno. of pts (%)no. of pts (%)no. of pts (%)no. of pts (%)(%)Remission, no. of pts (%) (A)17/23 (73.9)11/23 (47.8)5/23 (21.7)11/23 (47.8%)19/23 (82.6)LDA, no. of pts (%) (B)14/14 (100)11/14 (78.6)5/14 (35.7)6/14 (42.9%)14/14 (100)MDA, no. of pts (%) (C)22/23 (95.7)19/23 (82.6)7/23 (30.4)11/23 (47.8%)22/23 (95.7)HDA, no. of pts (%) (D)9/10 (90)9/10 (90)3/7 (30)7/10 (70)10/10 (100)P valuens0.021nsnsnsP value (A+B vs C+D)ns0.013nsnsnsConclusionsAt 6- months US joint and tendon examination of a consecutive series of patients with early RA only the presence of synovial joint PD were significantly reduced in patients with disease remission as compared to patients with more active disease.Disclosure of InterestNone declared

Lippia alba is popularly known as lemon balm, with its essential oil (EO) cited for displaying antimicrobial, sedative, and vasorelaxant effects. Yet, its action on isolated human vessels has not been described in the literature. Thus, we evaluated the vasorelaxant effect of essential oil of L. alba (EOLa) on human umbilical arteries (HUA) isolated in organ baths. HUA rings were isolated, subjected to contractions induced by potassium chloride (KCl), serotonin (5-HT), or histamine (HIST) to record the isometric tension, and then treated with EOLa (30–1000 µg/mL). The EOLa showed a more prominent inhibitory effect on the pharmacomechanical coupling contraction via HIST with an EC50 value of 277.1 ± 8.5 µg/mL and maximum relaxant effect at 600 µg/mL. The addition of tetraethylammonium (TEA) or 4-aminopyridine (4-AP) in HUA preparations did not inhibit EOLa total relaxant effect at 1000 µg/mL. In the presence of gliblenclamide (GLI), the oil relaxed the HUA rings by 90.8% at maximum concentration. The EOLa was also investigated for its effects on voltage-operated calcium channels (VOCCs), where the HUA preincubation with this oil at 1000 μg/mL inhibited BaCl2 (0.1–30 mM)-induced contractions. This study demonstrates for the first time that EOla has a vasorelaxant effect on HUA and its particular blockade of VOCCs.

Objective: To assess the accuracy of prenatal diagnosis, the incidence of extracardiac and chromosomal anomalies, and the perinatal outcome in a population of fetuses with common arterial trunk (CAT). Design: Observational study of 23 fetuses from three referral centres with a confirmed diagnosis of CAT. All underwent fetal echocardiography, detailed anatomical scanning, and karyotyping. In 19 cases, FISH analysis was done to detect 22q11 microdeletion. The following variables were evaluated: gestational age at diagnosis, anatomical variants of the CAT, presence of extracardiac and chromosomal anomalies, pregnancy, and fetal–neonatal outcome. Necropsy reports and postnatal files were available for confirmation of the prenatal diagnosis in all cases. Results: The prenatal diagnosis proved correct in 23 of 24 cases, the last being pulmonary atresia with ventricular septal defect (PAVSD). A second cardiovascular anomaly was present in eight cases (34.8%); extracardiac anomalies were found in 10 (43.4%). FISH analysis showed 22q11 microdeletion in six of 19 cases (31.6%). Outcomes were as follows: eight terminations of pregnancy (34.8%), two intrauterine deaths (8.7%), five postnatal deaths (before or after surgery) (21.7%); the remaining eight neonates (34.8%) are alive and thriving after surgery (six) or awaiting surgery (two). Conclusions: CAT can be reliably diagnosed and characterised in prenatal life, although differentiation from PAVSD may be challenging. The association with chromosomal anomalies is consistent (8.7%), but there is a higher risk of 22q11 microdeletion (31.6%), in agreement with postnatal studies. The relatively poor survival rate (34.8%) reflects the high rate of terminations and the unfavourable cardiac anatomy in some cases.

Background The classic histological appearance of inflamed temporal arteries (TA) in giant cell arteritis (GCA) is transmural cell infiltration. However, periadventitial small vessel vasculitis (SVV) surrounding uninflamed TA and/or isolated vasculitis of the TA vasa vasorum (VVV) is found in a minority of patients with GCA. These patients have less frequently cranial manifestations and lower inflammatory markers at diagnosis compared to the patients with classic GCA, whereas the frequency of cranial ischemic events is similar (1). Color-doppler-sonography (CDS) can demonstrate a hypoechogenic (inflammatory) halo in the TA from patients with GCA in approximately 70% of cases. A study found a correlation between positive CDS findings and transmural inflammatory cell infiltration in GCA (2). There are no data on the performance of CDS in the diagnosis of SVV and/or VVV. Objectives The aim of this study was to evaluate the prevalence of the characteristic halo sign in the TA from patients with SVV and/or VVV and to compare it with that found in patients with classic GCA. Methods 30 consecutive patients with biopsy-proven SVV and/or VVV GCA who underwent CDS of the TA before TA biopsy were analyzed. Of this 30 patients, 16 had SVV, 11 isolated VVV, and 3 associated SVV and VVV. The identified patients were randomly matched to 30 biopsy-proven classic GCA patients. SVV was defined as aggregates of mononuclear inflammatory cells around capillaries located in the connective tissue surrounding the adventitia. VVV was defined as isolated vasculitis of TA vasa vasorum. A hypoechoic halo >0.4 mm around the TA lumen on CDS was considered diagnostic of GCA. For GCA categorization using the 1990 ACR criteria, SVV or isolated VVV were not considered to represent a positive TA biopsy. Results Of the 30 patients with SVV and/or VVV-GCA 14 (46.6%) satisfied the ACR criteria for the classification of GCA. Table 1 shows the comparisons between the patients with SVV/VVV and classic GCA. Table 1. Characteristics of the patients with SVV and/or VVV versus those with classic GCA SVV and/or VVV (N=30)Classic GCA (N=30)P Halo on CDS (%)6/30 (20%)23/30 (76.6%)0,0001 Bilateral Halo on CDS (%)1/6 (16.7%)15/23 (65.2%)0,064 Abnormalities of TA at physical examination (%)8/24 (33.3%)18/30 (60%)0,061 Conclusions The prevalence of the halo sign on CDS of the TA is significantly lower in patients with SVV/VVV-GCA compared with those with classic GCA. These results suggest that CDS does not perform well in these two subsets of GCA. TA biopsy is required to confirm the diagnosis of GCA in patients with SVV- and VVV-GCA. References Restuccia G et al. Small-vessel vasculitis surrounding an uninflamed temporal artery and isolated vasa vasorum vasculits of the temporal artery: two subsets of giant cell arteritis. Arthritis Rheum. 2011 Sep 27. Schmidt D et al. Comparison between color duplex ultrasonography and histology of the temporal artery in cranial arteritis (giant cell arteritis). Eur J Med Res. 2003 Jan 28;8(1):1-7. Disclosure of Interest None Declared

Scombroid syndrome is a fish poisoning characterised by the onset of symptoms compatible with a pseudoallergic reaction; it is rarely also responsible of signs and symptoms of acute coronary syndromes, as demonstrated in this case report.

In March 2013, the Nemo Phase-2 tower was successfully deployed at 80 km off-shore Capo Passero (Italy) at 3500 m depth. The tower operated continuously until August 2014. We present the results of the atmospheric muon analysis from the data collected in 411 days of live time. The zenith-angle distribution of atmospheric muons was measured and results compared with Monte Carlo simulations. The associated depth intensity relation was then measured and compared with previous measurements and theoretical predictions.