Subnormothermic machine perfusion protects steatotic livers against preservation injury: a potential for donor pool increase?

We tested whether rat liver preservation performed by machine perfusion (MP) at 20 degrees C can enhance the functional integrity of steatotic livers versus simple cold storage. We also compared MP at 20 degrees C with hypothermic MP at 8 degrees C, and 4 degrees C. Obese and lean male Zucker rats were used as liver donors. MP was performed for 6 hours with a glucose and N-acetylcysteine-supplemented Krebs-Henseleit solution. Both MP and cold storage preserved livers were reperfused with Krebs-Henseleit solution (2 hours at 37 degrees C). MP at 4 degrees C and 8 degrees C reduced the fatty liver necrosis compared with cold storage but we further protected the organs using MP at 20 degrees C. Necrosis did not differ in livers from lean animals submitted to the different procedures; the enzymes released in steatotic livers preserved by MP at 20 degrees C were similar to those showed in nonsteatotic organs. The adenosine triphosphate/adenosine diphosphate ratio and bile production were higher and the oxidative stress and biliary enzymes were lower in steatotic livers preserved by MP at 20 degrees C as compared with cold storage. In livers from lean rats, the adenosine triphosphate/adenosine diphosphate ratio appears better conserved by MP at 20 degrees C as compared with cold storage. In steatotic livers preserved by cold storage, a 2-fold increase in tumor necrosis factor-alpha levels and caspase-3 activity was observed as compared with organs preserved by MP at 20 degrees C. These data are substantiated by better morphology, higher glycogen content, and lower reactive oxygen species production by sinusoidal cells in steatotic liver submitted to MP at 20 degrees C versus cold storage. MP at 20 degrees C improves cell survival and leads to a marked improvement in hepatic preservation of steatotic livers as compared with cold storage.

[Clinical phytotherapy: opportunities and problematics]. / Fitoterapia clinica: opportunita e problematiche.

In every country traditional medicines find foundation in magical or religious beliefs, or popular experience. The World Health Organization is engaged to establish guidelines for methodology of clinical research and the appraisal of effectiveness of traditional medicine. In Italy it has been adopted the term non-conventional medicines in order to group one series of therapies and medicines which are radically different one from the other. Phytotherapy uses medicinal plants prepared by means of adapted extractive technologies and proper pharmacological preparations, purified and standardized in their chemical principles. As for any shape of therapy there are possible side effects, contraindications, pharmacological interactions. It is deemed necessary that a basic knowledge of the pharmacological aspects of phytotherapy be included in the regular Course of Medicine.

[Flavonoids: risks or therapeutic opportunities?]. / Flavonoidi: rischi o opportunità terapeutiche?

Flavonoids are polyphenolic compounds that occur ubiquitously in fruits and vegetables. Over 4,000 different flavonoids have been described, and they are categorized into flavonols, flavones, catechins, flavanones, anthocyanidins and isoflavonoids. Flavonoids have many different biological effects in numerous mammalian cell systems, showed both in vitro and in vivo. Recently, much attention has been paid to their antioxidant properties and to their inhibitory role in various stages of tumour development in animal studies. In epidemiological studies the intake of flavonoids was inversely associated with subsequent coronary heart disease and cancer. Soy, St. John's Wort, Silybum marianum, Ginkgo biloba, Citrus species, Vaccinum mirtillus, Hawthorn and tea are medicinal plants containing flavonoids whose efficacy in the treatment of a variety of diseases has been demonstrated in numerous clinical studies. The main question that has not been answered satisfactorily deal with the triad absorption/metabolism/efficacy of flavonoids and is actually an important unsolved problem in judging their many alleged health effects. The aim of this review is based on providing by means of experimental and clinical studies information about efficacy and toxicity of flavonoids, especially focusing on infantile leukaemia for which there has been an international warning without sufficient and affordable scientific data.

Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: a controlled clinical trial.

Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P <.05). The treatment of group A proved to be safer also than treatment of group B. Patients randomized in group B showed a higher prevalence of infections (90.0% of cases versus 55.5% of cases; P <.01) mainly because of bacterial (80.0% versus 50.0%; P <.05) and viral (50.0% versus 16.6%; P <.05) agents. In conclusion, the study shows that intravenous administration of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d is more effective and safer than intravenous dose of 1,000 mg of methylprednisolone for three consecutive days in the treatment of acute cellular rejection in patients with liver transplantation.