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Role of non-steroidal anti-inflammatory drugs on intestinal permeability and nonalcoholic fatty liver disease

World Journal of Gastroenterology 2017年第22期23卷 3954-3963页

作者： erika utzeri paolo usai department of medical sciences university of cagliari

The use of non-steroidal anti-inflammatory drugs(NSAIDs) is widespread worldwide thanks to their analgesic, anti-inflammatory and antipyretic effects. However, even more attention is placed upon the recurrence of digestive system complications in the course of their use. Recent data suggests that the complications of the lower gastro-intestinal tract may be as frequent and severe as those of the upper tract. NSAIDs enteropathy is due to enterohepatic recycling of the drugs resulting in a prolonged and repeated exposure of the intestinal mucosa to the compound and its metabolites. Thus leading to so-called topical effects, which, in turn, lead to an impairment of the intestinal barrier. This process determines bacterial translocation and toxic substances of intestinal origin in the portal circulation, leading to an endotoxaemia. This condition could determine a liver inflammatory response and might promote the development of nonalcoholic steatohepatitis, mostly in patients with risk factors such as obesity, metabolic syndrome and a high fat diet, which may induce a small intestinal bacterial overgrowth and dysbiosis. This alteration of gut microbiota may contribute to nonalcoholic fatty liver disease and its related disorders in two ways: firstly causing a malfunction of the tight junctions that play a critical role in the increase of intestinal permeability, and then secondly leading to the development of insulin resistance, body weight gain, lipogenesis, fibrogenesis and hepatic oxidative stress.

关键词： Non-steroidal anti-inflammatory drugs Intestinal barrier Intestinal permeability Non-steroidal anti-inflammatory drugs - enteropathy Nonalcoholic fatty liver disease Nonalcoholic steatohepatitis Microbiota Metabolic syndrome Proton pump inhibitors Endotoxaemia

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Gastroparesis:New insights into an old disease

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World Journal of Gastroenterology 2020年第19期26卷 2333-2348页

作者： paolo usai-Satta Massimo Bellini Olivia Morelli Francesca Geri Mariantonia Lai Gabrio Bassotti Department of Internal Medicine Division of GastroenterologyBrotzu HospitalCagliari 09124Italy Gastrointestinal Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56122Italy Gastroenterology and Hepatology Section Department of MedicineUniversity of Perugia Medical SchoolPerugia 06123Italy Gastroenterology Unit University of CagliariMonserrato 09042Italy

Gastroparesis(Gp)is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical *** this condition has been reported in the literature since the mid-1900s,only recently has there been renewed clinical and scientific interest in this disease,which has a potentially great impact on the quality of *** aim of this review is to explore the pathophysiological,diagnostic and therapeutical aspects of Gp according to the most recent evidence.A comprehensive online search for Gp was carried out using MEDLINE and *** is the result of neuromuscular abnormalities of the gastric motor *** is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or *** regards diagnostic approach,99-Technetium scintigraphy is currently considered to be the gold standard for *** limits are a lack of standardization and a mild risk of radiation *** C13 breath testing is a valid and safe alternative method.13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic *** wireless motility capsule is a promising technique,but its use is limited by costs and scarce availability in many ***,therapeutic strategies are related to the clinical severity of *** mild and moderate Gp,dietary modification and prokinetic agents are generally *** is the only drug approved by the Food and Drug Administration for ***,other older and new prokinetics and antiemetics can be *** a second-line therapy,tricyclic antidepressants and cannabinoids have been *** severe cases the normal nutritional approach can be compromised and artificial nutrition may be *** drug-unresponsive Gp patients some alternative strategies(endoscopic,electric stimulation or surgery)are available.

关键词： Gastroparesis Delayed gastric emptying Gastric Scintigraphy 13C breath testing Wireless motility capsule Prokinetics Antiemetic drugs Gastric-per-oral endoscopic myotomy Gastric electrical stimulation

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Irritable bowel syndrome: a disease still searching for pathogenesis, diagnosis and therapy

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World Journal of Gastroenterology 2014年第27期20卷 8807-8820页

作者： Massimo Bellini Dario Gambaccini Cristina Stasi Maria Teresa Urbano Santino Marchi paolo usai-Satta Gastrointestinal Unit Department of Gastroenterology University of Pisa 56124 Pisa Italy Department of Experimental and Clinical Medicine University of Florence 50134 Florence Italy Epidemiological Observatory Health Agency of Tuscany 50141 Florence Italy Gastrointestinal Unit P. Brotzu Hospital09124 Cagliari Italy

Irritable bowel syndrome (IBS) is the most frequently diagnosed functional gastrointestinal disorder in primary and secondary care. It is characterised by abdominal discomfort, pain and changes in bowel habits that can have a serious impact on the patient’s quality of life. The pathophysiology of IBS is not yet completely clear. Genetic, immune, environmental, inflammatory, neurological and psychological factors, in addition to visceral hypersensitivity, can all play an important role, one that most likely involves the complex interactions between the gut and the brain (gut-brain axis). The diagnosis of IBS can only be made on the basis of the symptoms of the Rome III criteria. Because the probability of organic disease in patients fulfilling the IBS criteria is very low, a careful medical history is critical and should pay particular attention to the possible comorbidities. Nevertheless, the severity of the patient’s symptoms or concerns sometimes compels the physician to perform useless and/or expensive diagnostic tests, transforming IBS into a diagnosis of exclusion. The presence of alarming symptoms (fever, weight loss, rectal bleeding, significant changes in blood chemistry), the presence of palpable abdominal masses, any recent onset of symptoms in patient aged over 50 years, the presence of symptoms at night, and a familial history of celiac disease, colorectal cancer and/or inflammatory bowel diseases all warrant investigation. Treatment strategies are based on the nature and severity of the symptoms, the degree of functional impairment of the bowel habits, and the presence of psychosocial disorders. This review examines and discusses the pathophysiological aspects and the diagnostic and therapeutic approaches available for patients with symptoms possibly related to IBS, pointing out controversial issues and the strengths and weaknesses of the current knowledge.

关键词： Irritable bowel syndrome Pathogenesis Diagnosis Therapy

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Nonalcoholic fatty liver disease in patients with inflammatory bowel disease: Beyond the natural history

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World Journal of Gastroenterology 2019年第37期25卷 5676-5686页

作者： Salvatore Magrì Danilo Paduano Fabio Chicco Arianna Cingolani Cristiana Farris Giovanna Delogu Francesca Tumbarello Mariantonia Lai Alessandro Melis Laura Casula Massimo C Fantini paolo usai Department of Medical Sciences and Public Health University of CagliariMonserrato 09042Italy Department of Systems Medicine University of Rome"Tor Vergata"Rome 00133Italy

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is a frequently reported condition in patients with inflammatory bowel disease(IBD).Both intestinal inflammation and metabolic factors are believed to contribute to the pathogenesis of IBDassociated *** To evaluate the prevalence of steatosis and liver fibrosis(LF)in a cohort of IBD patients and the identification of metabolic-and IBD-related risk factors for NAFLD and *** IBD patients were consecutively enrolled from December 2016 to January ***,anthropometric and biochemical data were collected so as eating *** ultrasound and transient elastography were performed to evaluate the presence of NAFLD and LF *** A total of 178 consecutive patients were enrolled and included in the analysis(95 Ulcerative colitis,83 Crohn’s disease).NAFLD was detected by imaging in 72(40.4%)*** between patients with and without NAFLD showed no significant differences in terms of IBD severity,disease duration,location/extension,use of IBD-related medications(i.e.,steroids,anti-TNFs,and immunomodulators)and *** was significantly associated with the presence of metabolic syndrome[MetS;odds ratio(OR):4.13,P=0.001]and obesity defined by body mass index(OR:9.21,P=0.0002).IBD patients with NAFLD showed higher caloric intake and lipid consumption than those without NAFLD,regardless disease *** the multivariate analysis,male sex,advanced age and high lipid consumption were independent risk factors for the development of *** increased liver stiffness was detected in 21 patients(16%)and the presence of MetS was the only relevant factor associated to LF(OR:3.40,P=0.01).CONCLUSION In this study,we demonstrate that risk factors for NAFLD and LF in the IBD population do not differ from those in the general population.

关键词： Nonalcoholic fatty liver disease Liver fibrosis Inflammatory bowel disease Risk factors Dietary habits

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Lactose malabsorption and intolerance: What should be the best clinical management?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2012年第3期3卷 29-33页

作者： paolo usai-Satta Mariella Scarpa Francesco Oppia Francesco Cabras Gastroenterology Unit Brotzu Hospital

Lactose malabsorption (LM) is the incomplete hydrolysis of lactose due to lactase deficiency, which may occur as a primary disorder or secondary to other intestinal diseases. Primary adult-type hypolactasia is an autosomal recessive condition resulting from the physiological decline of lactase activity. Different methods have been used to diagnose LM. Lactose breath test represents the most reliable technique. A recent consensus conference has proposed the more physiological dosage of 25 g of lactose and a standardized procedure for breath testing. Recently a new genetic test, based on C/T13910 polymorphism, has been proposed for the diagnosis of adult-type hypolactasia, complementing the role of breath testing. LM represents a wellknown cause of abdominal symptoms although only some lactose malabsorbers are also intolerants. Diagnosing lactose intolerance is not straightforward. Many non-malabsorber subjects diagnose themselves as being lactose intolerant. Blind lactose challenge studies should be recommended to obtain objective results. Besides several studies indicate that subjects with lactose intolerance can ingest up to 15 g of lactose with no or minor symptoms. Therefore a therapeutic strategy consists of a lactose restricted diet avoiding the nutritional disadvantages of reduced calcium and vitamin intake. Various pharmacological options are also available. Unfortunately there is insufficient evidence that these therapies are effective. Further double-blind studies are needed to demonstrate treatment effectiveness in lactose intolerance.

关键词： Lactose malabsorption Lactose intolerance Therapeutic options

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Irritable bowel syndrome and chronic constipation: Fact and fiction

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World Journal of Gastroenterology 2015年第40期21卷 11362-11370页

作者： Massimo Bellini Dario Gambaccini paolo usai-Satta Nicola De Bortoli Lorenzo Bertani Santino Marchi Cristina Stasi Gastrointestinal Unit Department of GastroenterologyUniversity of Pisa Gastrointestinal Unit P. Brotzu Hospital Department of Experimental and Clinical Medicine University of Florence Epidemiological Observatory Regional Health Agency of Tuscany

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.

关键词： Irritable bowel syndrome Chronic constipation Func

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Clinical and epidemiological features of ulcerative colitis patients in Sardinia,Italy:Results from a multicenter study

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World Journal of Clinical Cases 2022年第30期10卷 10921-10930页

作者： Salvatore Magrì Mauro Demurtas Maria Francesca Onidi Marcello Picchio Walter Elisei Manuela Marzo Federica Miculan Roberto Manca Maria Pina Dore Bianca Maria Quarta Colosso Antonio Cicu Luigi Cugia Monica Carta Laura Binaghi paolo usai Mariantonia Lai Fabio Chicco Massimo Claudio Fantini Alessandro Armuzzi Giammarco Mocci Department of Medical Sciences and Public Health University of CagliariMonserrato 09042Italy Endoscopy Unit Humanitas Istituto Clinico CataneseCatania 95045Italy Endoscopy Unit San Martino HospitalOristano 09170Italy Gastroenterology Unit Brotzu HospitalCagliari 09121Italy Division of General Surgery Ospedale Civile P ColomboVelletri 00049Italy Gastroenterology Unit San Camillo Forlanini HospitalRome 00152Italy Internal Medicine and Gastroenterology Department Cardinale Panico HospitalTricase 73039Italy Department of Surgery San Martino HospitalOristano 09170Italy Division of Gastroenterology Santissima TrinitàHospitalCagliari 09121Italy Dipartimento di Medicina Clinica e Sperimentale University of SassariSassari 07100Italy Department of Medical Science and Public Health University of SassariSassari 07100Italy Unit of Gastroenterology ASL SassariSassari 07100Italy Gastroenterology Unit Santissima Annunziata HospitalSassari 07100Italy Medical Science and Public Health University of CagliariCagliari 09042Italy Medical Sciences and Public health Presidio Policlinico of MonserratoCagliariMonserrato 09042CagliariItaly Department of Internal Medicine University of Rome Tor VergataRome 00133Italy IBD Unit Policlinico Universitario GemelliRome 00168Italy

BACKGROUND There are little data on the epidemiological and clinical features of adult patients with ulcerative colitis(UC) in the different Italian regions,mainly derived from the absence of a national *** prevents correct interpretation of the disease *** To assess the main clinical and epidemiological features of adult patients diagnosed with UC in Sardinia,*** We performed a multicenter,observational,cross-sectional study that included adult patients with UC enrolled in seven gastroenterology unit centers in *** were obtained from the patients’ medical records and from a questionnaire administered at the inclusion *** Four hundred and forty-two patients with UC were *** median age at diagnosis was 39years(interquartile range 28-48).After a median disease duration of 10 years,53 patients experienced proximal extension of proctitis or left-sided ***-five patients developed extraintestinal *** patients(4.3%) developed cancer:two with colorectal cancer and seventeen with extracolonic ***(5-ASA) remains the mainstay of treatment for ***,95 patients(21.5%) were treated with one or more biologic agents,whereas 15 patients(3.4%) underwent surgery,mostly *** Our results provide important insights into the clinical and epidemiological features of patients with UC,and while waiting for a national Italian registry,present eligible data on the UC population in Sardinia.

关键词： Inflammatory bowel disease-basic Inflammatory bowel disease-clinical Ulcerative colitis Epidemiology Natural history Treatment

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Experimental evaluation of mechanical compression of lattice trusses made with Ti6Al4V for aerospace use

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Chinese Journal of Aeronautics 2024年第5期37卷 520-532页

作者： Carlo Giovanni FERRO Sara VARETTI paolo MAGGIORE Department of Mechanical and Aerospace Engineering Politecnico di TorinoCorso Duca degli AbruzziTorino 10124Italy

Lattice structures are three-dimensional structures composed of repeated geometrical shapes with multiple interconnected nodes,providing high strength-to-weight ratios,customizable properties,and efficient use of materials.A smart use of materials leads to reduced fuel consumption and lower operating costs,making them highly desirable for aircraft ***,the customizable properties of lattice structures allow for tailoring to specific design requirements,leading to improved performance and safety for *** advantages make lattice structures an important focus for research and development in the aviation *** paper presents an experimental evaluation of the mechanical compression properties of lattice trusses made with Ti6Al4V,designed for use in an anti-ice *** truss structures were manufactured using additive manufacturing techniques and tested under compressive loads to determine mechanical *** showed that lattice trusses exhibited high levels of compressive strength,making them suitable for use in applications where mechanical resistance and durability are critical,such as in anti-ice *** also highlight the potential of additive manufacturing techniques for the fabrication of lattice trusses with tailored mechanical *** study provides valuable insights into the mechanical behavior of Ti6Al4V lattice trusses and their potential applications in anti-ice systems,as well as other areas where high strength-to-weight ratios are *** results of this research contribute to the development of lightweight,efficient,and durable anti-ice systems for use in aviation and other industries.

关键词： Additive Manufacturing(AM) Selective Laser Sintering(SLM) Anti ice systems Lattice structures Aircraft on board systems Design of Experiments(DOE)

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Friction and wear performance of polyether ether ketone(PEEK)polymers in three lubrication regimes

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Friction 2024年第4期12卷 670-682页

作者： Davide MASSOCCHI Nora LECIS Marco LATTUADA Davide SCAGLIA Steven CHATTERTON paolo PENNACCHI Department of Mechanical Engineering Politecnico di MilanoMilan 20156Italy Eni SpA Downstream product R&DLombardia 20097Italy Eurobearings S.R.L. Lombardia 29016Italy

This experimental study investigates the friction and wear of three coatings commonly used in industrial applications,particularly in hydrodynamic *** three materials under investigation were Babbitt,polyether ether ketone(PEEK)reinforced with 15%carbon fibers,and PEEK reinforced with 20%carbon *** first polymer material was extruded,while the other was produced by fused deposition modelling(FDM).The materials were subjected to sliding tests in a pin-on-disc configuration,with a steel ball serving as the counter *** tests were conducted at room temperature,with a load of 10 N and under three different lubrication conditions:dry,grease,and *** linear speed was set at 0.3 m/s for the dry and semi-solid lubrication tests,while for the oil tests,the speed was set at 0.25 m/*** greases used had consistency grades of NGLI 000 and NGLI *** ISO VG 68 circulation oil was used for the oil lubrication ***,thermodynamic analyses were performed under the most severe conditions(i.e.,dry)to investigate the steel-Babbitt and steel-PEEK contact.

关键词： hydrodynamic bearings polyether ether ketone(PEEK)polymers additive manufacturing grease lubrication sliding oil lubrication ball-on-disk tribology

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Double-nylon purse-string suture technique: Another addition to the endoscopist's toolbox for full-thickness defect closure

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World Journal of Gastroenterology 2024年第25期30卷 3152-3154页

作者： Angad Walia Roberto paolo Trasolini Neal Shahidi Department of Medicine University of British ColumbiaVancouver V6Z2K5BCCanada

Iatrogenic perforation is the most feared adverse event in *** the expansion of interventional endoscopy in favor of traditional surgery,it is now more crucial than ever to develop effective defect closure *** has culminated in the dissemination of multiple novel closure technologies,including through-the-scope clips,over-the-scope clips,through-the-scope suturing and over-the-scope suturing *** this editorial,we comment on the recent publication by Wang and colleagues discussing the performance of the double-nylon purse-string suture technique in the closure of large(>3 cm)gastric full-thickness *** technique offers a promising,practical and cost-effective approach to closure of large full-thickness defects that can be readily imple-mented across diverse healthcare settings.

关键词： Cancer Endoscopy Endoscopic full-thickness resection Perforation

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