Brain perfusion defects by SPET/CT and neurostat semi-quantitative analysis in two patients with congenital erythropoietic porphyria.

BACKGROUND: Congenital erythropoietic porphyria (CEP) is a rare autosomal recessively inherited disorder with chronic and relatively stable presentation. Till now brain blood flow derangements have been described only in acute hepatic porphyrias. We describe the first findings of brain perfusion defects, studied by single photon emission tomography/computed tomography (SPET/CT), in two patients affected by CEP, by using a semi-quantification anatomic-standardized voxel-based program compared with magnetic resonance imaging (MRI) results. SUBJECTS AND METHODS: Two Pakistanis brothers were investigated for CEP confirmed by a genetic test. The disease was severe with: skin burning, mood depression and haemolytic anemia. Considering depression, patients underwent brain SPET/CT and MRI. Single photon emission tomography/CT images were processed by neurostat semi-quantitative software. Data obtained were compared to a normal database and z-score images were generated. RESULTS: In both patients we found several perfusion defects evident in transaxial slices and in z-score images obtained by neurostat processing. Magnetic resonance imaging was negative in both patients. Biochemical mechanisms inducing localized brain hypoperfusion are uncertain. However, mismatch between SPET/CT data and MRI was probably due to absence of necrosis. CONCLUSION: In our opinion, SPET/CT could have a key role in this setting of patients due to its high sensitivity and reliability in mild-to-moderate brain perfusion defects detection. Moreover, the quantitative analysis by using neurostat may allow to recognize even mild brain perfusion alterations, difficult to detect only visually.

Multi-Criteria Decision Analysis (MCDA) for sustainability assessment in food sector. A systematic literature review on methods, indicators and tools.

In the last decades, several studies have highlighted the significant impacts of the food sector. Therefore, enhancing sustainability within this sector has become of paramount importance. A crucial step towards achieving this goal involves the definition and implementation of effective sustainability metric and measurements. In this regard, the adoption of multi-criteria decision analysis (MCDA) methods can be seen as one of the most suitable and promising approach to comprehensively capture the complex and broad-ranging effects of agricultural practices and food supply chains. In such context, a systematic review of the scientific literature on multi-criteria approaches and tools for measuring the sustainability of food supply chains (harvest and post-harvest stages) has been carried out, resulting in the selection and analysis of 42 articles. To delve into the selected articles, three main areas of focus have been identified. The first about MCDA methods and their features, revealing the most adopted methods for sustainability assessments of food supply chains. The second, focusing on the participatory approach, led to the definition of a stakeholder's engagement map, highlighting the typology of stakeholders involved, the reasons of their involvement and engagement methods. Lastly, the third focus is related to the analysis and classification of indicators adopted in each study and the sustainability dimensions to which they refer to. The results of the present review study provide a comprehensive overview of the essential aspects to be considered when developing a MCDA for sustainability assessment in the food sector, serving as a valuable resource for both scholars and practitioners.

Bioenergy from anaerobic digestion plants: Energy and environmental assessment of a wide sample of Italian plants.

This study assesses the energy and environmental performances of electricity produced from Italian anaerobic digestion coupled with combined heat and power plants. The Life Cycle Assessment methodology is applied to a set of plants characterised by different power sizes (from 100 to 999 kW) and feedstock compositions (variable rates of agricultural products and by-products). Then, the average eco-profile of the produced electricity is compared with electricity produced by the national grid and photovoltaic panels. The analysis allows detection of the combinations of size and feedstock with the lowest impacts. They correspond to small and medium plants mainly fed by organic by-products. In addition, compared to electricity from the grid, the average biogas electricity is characterised by the lowest contribution in impacts categories, such as abiotic depletion potential and ozone layer depletion potential, while largest in acidification and eutrophication. Focusing on global warming potential and cumulative energy demand fossil, the impacts of average biogas electricity (155 kgCO2eq/MWh and 172 MJ/MWh) are about 35 % and 38 % of that generated by the grid. Furthermore, it could generate 47 % less of the impact in the abiotic depletion elements category of the solar system. To enhance the farms' environmental and economic sustainability and balance the electric grid, these outcomes point out that biogas electricity produced from the agriculture and livestock sector can contribute to the decarbonisation and self-sufficiency of European countries. The results strictly depend on the operative conditions and can aid policymakers at the global level in improving the energy supply security and sustainability. Further, they provide reliable information to stakeholders to select the most sustainable solution, according to the feedstock type, power supply, and management.

Energy-environmental assessment of the UIA-OpenAgri case study as urban regeneration project through agriculture.

Sustainable agriculture is strongly promoted by Agenda 2030 and peri-urban agriculture is considered strategic for agri-food sustainability. Although, innovative farming practices are being implemented, the analysis of their impacts often does not reach the required depth. Within the EU project 'UIA-OpenAgri - New Skills for new Jobs in Peri-urban Agriculture', a regeneration process of a peri-urban area in Milan (Italy) was started, through the development of an innovative food hub. 28 innovative foodchains are assessed by a Life Cycle Assessment approach based on primary data collected from the involved start-ups. Non-Renewable Cumulative Energy Demand and the Global Warming Potential indicators are assessed and coupled with the productive land indicator. To effectively support involved operators in planning sustainable agriculture practices, the results are presented with GIS maps and insights for improving economic sustainability of involved start-ups are presented. The study shows that the impacts related to the practices implemented (i.e. organic agriculture, including intercropping, agroforestry, ancient grains, etc.) decrease by an average of 55% in energy consumption and 65% on Global Warming Potential if compared to conventional ones. Then, these practices can provide a positive contribution to the Agenda 2030 goal of ensuring sustainable farm production practices.

Energy and environmental life cycle assessment of an institutional catering service: An Italian case study.

Food production is recognised as one of the major drivers for global environmental pressure. In the last years, changes in consumption models result in an increasing population consuming food out of home that pose the catering service sector at the centre of the European Union policies aimed at improving the environmental sustainability of the food sector. In this framework, better technical knowledge on the environmental impacts of catering service is essential in order to identify potential actions towards a more sustainable food sector. This article presents an environmental assessment of a school catering service operating in Italy and delivering approximately 2,518,128 meals per year. Starting from primary data on the amount of each food consumed in the catering service examined, we perform an environmental analysis of an equivalent meal ready to be consumed in the schools canteens by using the Life Cycle Assessment methodology consistent with ISO 14040 standard. The system boundaries include food and tableware production, food transport, food storage and cooking and waste treatment. Due to a lack of primary data tableware production, food storage, cooking and waste treatment are modelled using literature data or models. The results of the analysis show that the food production phase is relevant to almost all assessed impact categories (contribution higher than 65%). The exception is represented by photochemical oxidation impact categories in which the larger impact is linked to the transportation phase. The environmental impacts associated to the tableware production, food storage and cooking are relevant to global warming and global energy requirement (contributions higher than 7%). The scenario analysis of potential actions aimed at reducing the environmental impacts of the catering service shows that, to obtain a more sustainable food sector, strategies must be implemented along the entire food supply chain and considering a wide range of environmental impact categories.

Endothelial function and cardiovascular risk in active inflammatory bowel diseases.

BACKGROUND: Endothelial dysfunction has been already reported in inflammatory bowel diseases (IBD). However, case series so far examined were rather heterogeneous as for disease severity and subsets investigated. OBJECTIVE: We evaluated endothelial dysfunction by brachial artery flow-mediated vasodilatation (FMD), and subclinical atherosclerosis by assessment of common carotid intima-media thickness (CCA-IMT) in a cohort of patients with Crohn's disease (CD) or Ulcerative colitis (UC) in active phase compared to healthy control subjects. METHODS: Forty-nine patients (mean age 41±16 years), 25 with CD and 23 with UC, and forty controls (mean age 45±15 years) were enrolled. Diagnosis was based on the standard clinical, endoscopic and histological criteria. Disease activity was assessed by Crohn's Disease Activity Index or Disease Activity Index. All patients, were under medical treatment as appropriate. RESULTS: FMD values were lower in IBD patients than controls (6.1±3.0 vs 8.2±3.4. p=0.003); no difference was seen between UC/CD groups (5.9±3.5 vs 6.3±2.6, p=0.67). No changes in statistical differences occurred after adjustment for age, gender, body mass index and family history of cardiovascular disease. Finally, no differences in IMT values were seen between IBD patients and controls. Disease duration and medical treatment did not affect endothelial function. CONCLUSIONS: Our study showed a lower FMD in IBD patients. Inflammation and immune response could explain endothelial dysfunction, which is the earliest stage of atherosclerotic process. IBD patients in active phase might therefore be at higher risk for atherosclerosis progression.

Cardiovascular Risk in Women With PCOS.

Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus , it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascular risk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascular risk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascular risk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients' health integrity.

Is there a correlation between OSAS duration/severity and carotid intima-media thickness?

BACKGROUND: Obstructive Sleep Apnea Syndrome (OSAS) is a common airways disease recognized as an independent cardiovascular risk factor. It is often associated with obesity, diabetes and dyslipidemia. Its pathophysiological consequences (hypoxia, hypercapnia, micro-arousals, sympathetic hyperactivity, oxidative stress, systemic inflammation and hyper-coagulability) are implicated in the development of hypertension, endothelial dysfunction and higher intima-media thickness (IMT) values, all elements known to lead to atherosclerosis. The study aim was to demonstrate a relationship between OSAS duration and IMT values and to confirm how OSAS severity could influence IMT (a marker of atherosclerosis). METHODS: We enrolled 156 patients (125 men, mean age: 60 ± 12 years) affected by OSAS of different severity: 111 (71%) were in CPAP therapy; some of the population were also affected by hypertension [102 (65%)], dyslipidemia [52 (33%)] and diabetes [38 (24%)]. Patients underwent evaluation of carotid artery IMT and answered a questionnaire investigating the time of onset (confirmed by a person aware of the patient's previous sleeping habits) and the duration of the disease. RESULTS: We found a statistically significant higher IMT value in patients with longer-lasting disease (OSAS duration in IMT < 0.9 mm: 120 (60-192) months versus OSAS duration in IMT ≥ 0.9 mm: 200 (120-310) months; p < 0.001). OSAS severity is positively related to IMT values. We found a positive relationship between IMT and OSAS duration [r = 0.34; p < 0.001] and between AHI and IMT [r = 0.51; p < 0.001]. CONCLUSIONS: Our study shows that the duration of OSAS and its severity are important factor related with higher values of IMT and hence with a higher risk of atherosclerosis.

Doppler ultrasound venous mapping of the lower limbs.

BACKGROUND: The study aim was to test the accuracy (intra and interobserver variability), sensitivity, and specificity of a simplified noninvasive ultrasound methodology for mapping superficial and deep veins of the lower limbs. METHODS: 62 consecutive patients, aged 62 ± 11 years, were enrolled. All underwent US-examinations, performed by two different investigators, of both legs, four anatomical parts, and 17 veins, to assess the interobserver variability of evaluation of superficial and deep veins of the lower limbs. RESULTS: Overall the agreement between the second versus the first operator was very high in detecting reflux (sensitivity 97.9, specificity 99.7, accuracy 99.5; P = 0.80 at McNemar test). The higher CEAP classification stages were significantly associated with reflux (odds ratio: 1.778, 95% confidence interval: 1.552-2.038; P < 0.001) as well as with thrombosis (odds ratio: 2.765, 95% confidence interval: 1.741-4.389; P < 0.001). Thus, our findings show a strict association between the symptoms of venous disorders and ultrasound evaluation results for thrombosis or reflux. CONCLUSION: This study demonstrated that our venous mapping protocol is a reliable method showing a very low interobserver variability, which makes it accurate and reproducible for the assessment of the morphofunctional status of the lower limb veins.

Carotenoids and cardiovascular risk.

Fruits and vegetables (typically associated with the Mediterranean diet) are very rich in carotenoids, i.e. fat-soluble pigments really important in human life. Structurally, carotenoids consists of eleven (beta-carotene, zeaxanthin, lycopene) or ten (alpha-carotene, lutein) conjugated double bonds, responsible for their antioxidant capability in agreement with their substituents. Low-Density Lipoprotein (LDL) particles oxidation process is the one of the most important first steps of atherosclerotic disease and, consequentially, the first pathogenetical step of cerebro- and cardiovascular events like myocardial infarction and stroke, which are the first cause of death in industrialized countries. Reactive oxygen species (ROS) also seem to be the target of Carotenoids main action, by scavenging singlet oxygen (1O2) and free radicals. Literature data showed that ROS increase atherosclerotic individual burden. The carotenoids scavenging action could reduce atherosclerosis progression partly due to such a decrease in ROS concentrations. Many studied demonstrated such a reduction by analyzing the relationship between carotenoids and Intima-Media Thickness of common carotid artery wall (CCA-IMT), [a well established marker of atherosclerosis evolution] reduction. Aim of this review is to evaluate actual knowledge about the importance of carotenoids molecules in slowing down the starting and the progression of atherosclerotic plaque, and to consider their implementation in everyone's diet as a tool to obtain a sharp decrease of LDL oxidation and their possible effect on endothelial function.