Metabolic Medicine

Modena, Italy

Metabolic Medicine

Modena, Italy

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Petta S.,University of Palermo | Valenti L.,University of Milan | Bugianesi E.,University of Turin | Targher G.,University of Verona | And 23 more authors.
Digestive and Liver Disease | Year: 2016

The prevalence of fatty liver (steatosis) in the general population is rapidly increasing worldwide. The progress of knowledge in the physiopathology of fatty liver is based on the systems biology approach to studying the complex interactions among different physiological systems. Similarly, translational and clinical research should address the complex interplay between these systems impacting on fatty liver. The clinical needs drive the applications of systems medicine to re-define clinical phenotypes, assessing the multiple nature of disease susceptibility and progression (e.g. the definition of risk, prognosis, diagnosis criteria, and new endpoints of clinical trials). Based on this premise and in light of recent findings, the complex mechanisms involved in the pathology of fatty liver and their impact on the short- and long-term clinical outcomes of cardiovascular, metabolic liver diseases associated with steatosis are presented in this review using a new "systems medicine" approach. A new data set is proposed for studying the impairments of different physiological systems that have an impact on fatty liver in different subsets of subjects and patients. © 2015 Editrice Gastroenterologica Italiana S.r.l.


Ng J.M.,Diabetes Center | Mellor D.D.,Diabetes Center | Narayanan D.,Metabolic Medicine | Atkin S.L.,Diabetes | And 2 more authors.
Journal of Diabetes Nursing | Year: 2010

Malnutrition remains a significant problem in people admitted to hospital; to tackle this issue the NHS Institute of Innovation and Improvement have introduced a protected mealtimes (PRMT) initiative to provide patients with adequate nutrition. While PRMT is laudable, it does not specifically address the needs of people with diabetes admitted to hospital. This article describes a study that investigated the effect of implementation of PRMT on glycaemic control in people with diabetes on a specialist diabetes ward. The results showed that PRMT did not improve glycaemic control in this group of inpatients with diabetes; these key findings warrant provision of a model of care aimed at targeting glycaemic control, particularly in relation to the key principles of ThinkGlucose (NHS Institute for Innovation and Improvement, 2010).


Salerno A.,Clinical Cardiology Heart Failure Clinic | Fragasso G.,Clinical Cardiology Heart Failure Clinic | Esposito A.,Diagnostic Radiology | Esposito A.,Vita-Salute San Raffaele University | And 11 more authors.
Acta Diabetologica | Year: 2015

Background and aims: We wanted to assess the effects of short-term changes in serum free fatty acids (FFAs) on left ventricular (LV) energy metabolism and function in patients with heart failure and whether they correlated with circulating markers of inflammation. Methods and results: LV function and phosphocreatine (PCr)/ATP ratio were assessed using MR imaging (MRI) and 31P magnetic resonance spectroscopy (MRS) in 11 men with chronic heart failure in two experimental conditions 7 days apart. Study 1: MRI and 31P-MRS were performed before and 3–4 h after i.v. bolus + continuous heparin infusion titrated to achieve a serum FFA concentration of 1.20 mM. Study 2: The same protocol was performed before and after the oral administration of acipimox titrated to achieve a serum FFA concentration of 0.20 mM. Serum concentrations of IL6, TNF-α, PAI-1, resistin, visfatin and leptin were simultaneously assessed. Serum glucose and insulin concentrations were not different between studies. The PCr/ATP ratio (percent change from baseline: +6.0 ± 16.9 and −16.6 ± 16.1 % in Study 1 and Study 2, respectively; p = 0.005) and the LV ejection fraction (−1.5 ± 4.0 and −6.9 ± 6.3 % in Study 1 and Study 2, respectively; p = 0.044) were reduced during low FFA when compared to high FFA. Serum resistin was higher during Study 1 than in Study 2 (p < 0.05 repeated measures ANOVA); meanwhile, the other adipocytokines were not different. Conclusion: FFA deprivation, but not excess, impaired LV energy metabolism and function within hours. Cautions should be used when sudden iatrogenic modulation of energy substrates may take place in vulnerable patients. © 2014, Springer-Verlag Italia.


Giovanardi P.,Internal Cardiovascular Medicine | Stefanelli G.,Hesperia Hospital | Turrini F.,Internal Cardiovascular Medicine | Sarti L.,Internal Cardiovascular Medicine | And 5 more authors.
Minerva Cardioangiologica | Year: 2014

Aim. Aim of this study was to better understand interactions between left ventricular (LV) and right ventricular (RV) systolic and diastolic function echocardiographic indexes in stable cardiovascular diseased patients and in subjects with cardiovascular risk factors. Methods. The study enrolled 683 stable patients who were submitted to standard transthoracic echocardiography with evaluation of left ventricular ejection fraction (LVEF) (Simpson biplane method), LV and RV systolic peak on Doppler tissue imaging (LVSys and RVSys), tricuspid annulus plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP), and multiparameter evaluation of LV and RV diastolic function utilizing E and A peak, their ratio, E peak deceleration time, E′ and A′ peak on Doppler tissue imaging, their ratio, and E/E′ ratio. Results. Part of the considered indexes had interactions but only LVEF and TAPSE were related to all the others (LVEF P<0.001 with all the considered parameters; TAPSE P<0.001 with all parameters except with PASP=0.003). Unexpectedly TAPSE seems to have, such as LVEF, a pivotal position among LV and RV function. Conclusion. The study demonstrates the existence of interactions between LV and RV function indexes; these results may be considered as a piece of evidence in favor of heart seen as a single structure.

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