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BACKGROUND: Population-based studies of the natural course of chronic viral liver disease that consider comorbidity factors are lacking. Using data from the Dionysos Study, we quantified the burden of chronic viral liver disease and the role of alcohol intake to morbidity and mortality in a representative sample of subjects from the general population of two communities of Northern Italy. METHODS AND FINDINGS: We followed up 139 subjects with chronic hepatitis C virus (HCV) infection and 61 with chronic hepatitis B virus (HBV) infection for a median (IQR) time of 8.4 (1.0) and 8.3 (0.9) yr, respectively. Ethanol intake was evaluated using a food-frequency questionnaire, fatty liver (FL) was diagnosed by ultrasonography, and liver cirrhosis (LC) and hepatocarcinoma (HCC) were diagnosed by liver biopsy. Exact multivariable Poisson regression was performed to identify predictors of death. The incidence and remission rates of FL were 9.0 and 29.7 in the HCV cohort and 4.0 and 30.4 per 1,000 person-years (PY) in the HBV cohort. Progression to LC and HCC was more common in the HCV than in the HBV cohort (4.5 vs 2.0 and 2.7 vs 2.0 per 1,000 PY, respectively). Ethanol intake was an independent predictor of LC in the HCV cohort [rate ratio (RR) = 4.15 (95% CI 1.02–41.2) for every increase of 30 g/day of ethanol intake at baseline] and of death rate in both cohorts [RR = 8.53 (95% CI 1.40–24.61) and 3.56 (1.34 to 26.50) for every increase of 30 g/day of ethanol intake at baseline]. CONCLUSIONS: The morbidity and mortality rate of HBV and HCV infection in the general population is lower than that reported in secondary-care populations, blood donors, or clinical series. Ethanol intake is an independent predictor of LC in subjects with chronic HCV infection and an independent predictor of death in subjects with either HCV or HBV infection. [ABSTRACT FROM AUTHOR]

Aim : We evaluated the accuracy of body mass index (BMI) in detecting an elevated alanine aminotransferase (ALT) level in adolescents, taking into account the effects of gender, age, ethanol intake, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, and drug consumption. Subjects : A representative sample of 454 adolescents (11-17 years) from two cities in northern Italy was studied (the Dionysos Study). Methods : z -BMI was calculated as the z -score of BMI using national growth charts. Logistic regression was used to quantify the contribution of the variables of interest to an elevated ALT (>30 UL -1 ). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated, and areas under receiver-operator characteristic curves (AUC) were used to evaluate accuracy. Results : An elevated ALT was detected in 21 adolescents (4.6%). Among the studied variables, only male gender (OR = 6.7, 95% CI 2.0-23.2) and z -BMI (OR = 2.1, 95% CI 1.4-3.2) were significant predictors of elevated ALT. The accuracy of the prediction was 0.69 (95% CI 0.59-0.79) for gender and 0.71 (95% CI 0.59-0.81) for z -BMI. By combining gender and z -BMI, the accuracy rose to 0.80 (95% CI 0.71-0.89). Conclusion : BMI is a good predictor of elevated ALT in Italian adolescents and gender adds to the accuracy of the prediction. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between infection with specific strains of Helicobacter pylori and peptic ulcer in patients referred for upper gastrointestinal endoscopy. Methods: One thousand, six hundred and twenty-six consecutive dyspeptic patients, referred to one Endoscopy Unit in Bologna, Italy, were enrolled. For each participant, a blood sample was obtained for the measurement of distinct immunoglobulin G antibodies against H. pylori lysate and cytotoxin associated gene A (cagA). A case–control study included the whole series: patients diagnosed with duodenal (n =275) or gastric (n =71) ulcer were identified and independently compared with controls with non-ulcer dyspepsia (n =1280). Results: H. pylori seroprevalence (at least one positive marker) was associated with increasing age, male sex and a diagnosis of peptic ulcer. This association was stronger with duodenal ulcer (multivariate odds ratio (OR), 5.2; 95% confidence interval (CI), 3.5–7.9) than with gastric ulcer (OR, 2.3; 95% CI, 1.2–4.4). Further analyses showed that H. pylori lysate+/cagA- subjects had a moderately increased risk of duodenal (OR, 3.2), but not gastric (OR, 1.1), ulcer. When cagA+ subjects were separately compared with seronegative patients, there was a six-fold increased risk for duodenal ulcer and a three-fold increased risk for gastric ulcer. Conclusions: A strong positive association between infection with a cagA+ H. pylori strain and the presence of peptic disease was found. The seroprevalence of anti-cagA antibodies among patients with non-ulcer dyspepsia is so high (41%) to preclude its use as a pre-endoscopic screening test. [ABSTRACT FROM AUTHOR]

In 153 consecutive patients with cirrhosis we assessed: (1) the prevalence of IgG to Helicobacter pylori and compared it with that found in 1010 blood donors resident in the same area; and (2) the relationships of IgG to Helicobacter pylori with clinical and endoscopic features and with the risk of peptic ulcer. The IgG to Helicobacter pylori prevalence of cirrhotics was significantly higher than in blood donors (76.5% vs 41.8%; P < 0.0005) and was not associated with sex, cirrhosis etiology, Child class, gammaglobulins and hypertensive gastropathy. In both groups, the prevalence of IgG to Helicobacter pylori was significantly higher in subjects over 40. Among patients with cirrhosis a significantly higher prevalence of Helicobacter pylori was found in patients with previous hospital admission (P = 0.02) and/or upper gastrointestinal endoscopy (P = 0.01) and patients with peptic ulcer (P = 0.0004). Multivariate analysis identified increasing age and male sex as risk factors for a positive Helicobacter pylori serology and no independent risk factors for peptic ulcer. The high prevalence of Helicobacter pylori-positive serology found in the present series is related to age and sex and might also be explained by previous hospital admissions and/or upper gastrointestinal endoscopy. Our results do not confirm the role of Helicobacter pylori as risk factor for peptic ulcer in patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

In the framework of the building sector de-carbonization, the case of a new nearly zero-energy district, located in the Milan urban area (Italy), is presented. In particular, the scope of the work is to demonstrate that the proposed energy concept, based on the combination of low-energy building design and high-efficiency technical systems, allows the reduction of the final energy uses. After the evaluation of the energy needs, a low-temperature and small-size wood biomass district thermal plant was designed to be integrated with groundwater heat pumps (GWHP) and solar photovoltaic (PV) systems, taking up the challenge to design an almost full-renewable urban district by means of a Multi-Energy System. The core is a biomass boiler coupled with a small combined heat and power (CHP) unit with a twin-screw steam expander (TSSE). The heat produced by the CHP satisfies a consistent fraction of space heating and domestic hot water (DHW) needs during the winter season. GWHPs coupled with PV satisfy remaining thermal needs in winter and the entire thermal needs in mid-season and in the summer period. The obtained outcomes prove the benefits of the combination of a wood biomass CHP with GWHPs and PV with a significant share of renewable energies. • Provide an overview of the evolution of district heating networks. • Propose a solution for energy decarbonization of new settlements. • Show how biomass CHP, PV systems and heat pumps may be successfully integrated. • Propose an effective control strategy to enhance local-RES self-consumption. [ABSTRACT FROM AUTHOR]

In 2002, the Italian guidelines for eligibility of patients for intestinal transplantation (ITx) were defined as: life-threatening complications of home parenteral nutrition (HPN), lack of venous access for HPN, locally invasive tumors of the abdomen, Chronic intestinal failure (CIF) with a high risk of mortality, primary disease-related poor quality of life (QoL) despite optimal HPN. Our aim was to identify potential candidates for ITx according to these national guidelines among patients managed by a medical referral center for CIF. Records of patients who received HPN were reviewed. CIF was considered reversible or irreversible (energy by HPN <50% or >50% basal energy expenditure). Patients with irreversible CIF were considered eligible for ITx in the absence of a contraindication, as are used for solid organs Tx. From 1986 to 2003 among 64 patients who met the entry criteria 23 showed reversible and 41 irreversible, CIF. Twenty-one patients with irreversible CIF had an indication for ITx, but eight had also contraindications; thus 13 were eligible, including intestinal pseudo-obstruction (n = 6), mesenteric ischemia (n = 3), Crohn''s (n = 2), radiation enteritis (n = 1), and desmoid (n = 1). Indications for ITx included HPN liver failure (n = 2), lack of venous access (n = 2), CIF with high risk of mortality (n = 3), very poor QoL (n = 6 including 5 with pseudo-obstruction). According to the Italian guidelines for ITx, 31% of patients with irreversible CIF managed by a medical referral center were eligible for ITx. Primary disease-related poor QoL was the indication in half of them. Studies on the QoL after ITx are required to allow patients to make an educated decision. [Copyright &y& Elsevier]