What the fish? Tracing the geographical origin of fish using NIR spectroscopy.

Food authentication is a growing concern with rising complexities of the food supply network, with fish being an easy target of food fraud. In this regard, NIR spectroscopy has been used as an efficient tool for food authentication. This article reviews the latest research advances on NIR based fish authentication. The process from sampling/sample preparation to data analysis has been covered. Special attention was given to NIR spectra pre-processing and its unsupervised and supervised analysis. Sampling is an important aspect of traceability study and samples chosen ought to be a true representative of the population. NIR spectra acquired is often laden with overlapping bands, scattering and highly multicollinear. It needs adequate pre-processing to remove all undesirable features. The pre-processing technique can make or break a model and thus need a trial-and-error approach to find the best fit. As for spectral analysis and modelling, multicollinear nature of NIR spectra demands unsupervised analysis (PCA) to compact the features before application of supervised multivariate techniques such as LDA, PLS-DA, QDA etc. Machine learning approach of modelling has shown promising result in food authentication modelling and negates the need for unsupervised analysis before modelling.

Strontium isotope signature of the PGI lemons Limone Costa d'Amalfi and Limone di Sorrento, and of the orchard soils from Sorrento peninsula.

The Limone Costa d'Amalfi and Limone di Sorrento lemons from the Sorrento Peninsula have Protected Geographical Indication (PGI) and are subject to origin fraud. The 87Sr/86Sr ratio (SrIR) signature of lemons and soils was investigated to verify its reliability to trace the PGI lemons and to highlight environmental factors responsible of the lemon SrIRs. The SrIR ranges of each PGI lemon were not discriminating as they overlapped with each other and some non-PGI lemon SrIRs fell within these ranges. The lemon SrIRs were generally not correlated with bulk and bioavailable soil SrIRs, rather, they were the result of plant Sr uptake with different SrIRs depending on interaction between water supplied to soil and soil with different chemical and physical characteristics. The study of lemon SrIRs and the causes of their origin and variability provides a reliable forecast reference for the other PGI agri-food products in the study area.

Suspected stenosis in Caroli syndrome: when cholangioscopy can be the game changer.

Video 1Cholangioscopy performed during ERCP.

Upper Esophageal Sphincter Metrics across Eosinophilic Esophagitis, Gastroesophageal Reflux Disease and Functional Dysphagia: A Pilot Study.

BACKGROUND: Recent studies have evaluated the upper esophageal sphincter (UES) with high-resolution manometry (HRM) in some esophageal diseases, but not eosinophilic esophagitis (EoE). The aim of our study was to evaluate the function of the UES across EoE, gastroesophageal reflux disease (GERD), functional dysphagia (FD), and the relationship with esophageal symptoms, esophageal body contraction, and esophagogastric junction (EGJ) metrics. METHODS: HRM was performed on 30 EoE, 18 GERD, and 29 FD patients according to the Chicago Classification 3.0. The study data were exported to the online analysis platform Swallow Gateway. The UES was assessed in terms of UES Resting Pressure (UES-RP), UES Basal Pressure (UES-BP), UES Integrated Relaxation Pressure (UES-IRP), UES Relaxation Time (UES-RT), Basal UES Contractile Integral (Basal UES-CI), Post-Deglutitive UES Contractile Integral (Post-Deglutitive UES-CI), and Proximal Contractile Integral (PCI). RESULTS: ANOVA analysis showed significantly higher values of Post-Deglutitive UES-CI in EoE patients compared with FD patients (p = 0.001). Basal UES-CI and UES-RP showed significantly higher values in EoE (p = 0.002, p = 0.038) and GERD (p < 0.001, p = 0.001) patients compared with FD patients. Correlations between LES-CI and Post-Deglutitive UES-CI, Basal UES-CI, and UES-RP (p ≤ 0.001, p = 0.027, p = 0.017, respectively), and between LES-BP and Post-Deglutitive UES-CI (p = 0.019), independent of diagnosis, were shown. No correlations have been demonstrated between the UES, EGJ metrics, and esophageal symptoms. CONCLUSIONS: Some differences in UES metrics in the three different diseases were found. Further studies are needed to confirm the results of our pilot study and possible applications in clinical practice.

One-Day versus Three-Day Low-Residue Diet and Bowel Preparation Quality before Colonoscopy: A Multicenter, Randomized, Controlled Trial.

BACKGROUND: One-day low-residue diet (LRD) is recommended before colonoscopy, but only three single-center trials compared the 1-day versus 3-day LRD. The aim of this multicenter study was to compare the impact of a 3-day versus 1-day LRD on its ability to adequately and successfully prepare the bowel of outpatients that require a colonoscopy. The outpatients' tolerance and adherence to the LRD were also considered. METHODS: Consecutive outpatients were randomized to 1-day versus 3-day LRD at three open-access endoscopy units. The primary endpoint consisted of the proportion of patients with a satisfactory degree of bowel cleanliness (Score 2-3 on the Boston Bowel Preparation Scale [BBPS] in each segment). Secondary endpoints were patients' tolerance and adherence to the prescribed diet evaluated by a standardized questionnaire. RESULTS: 289 patients were included in the study (1-day LRD arm = 143, 3-day LRD arm = 146). BBPS ≥2 was not significantly different in the two dietary regimens in any of the three colonic segments (71% vs. 72%, p = 0.9). The percentage of patients with incomplete preparation was similar in the two arms (9% vs. 9%; p = 1.0). No significant differences were found among colonoscopy findings in terms of abnormalities (81% vs. 84%, p = 0.8). Both groups scored similarly in overall tolerance to LRD (48% vs. 49%, p = 1.0) and also in whether they would have adopted a different dietary regimen (p = 0.3). CONCLUSION: Our multicenter randomized study confirmed that optimal bowel cleansing is reached through a 1-day LRD.

Perception of the COVID-19 pandemic in patients with achalasia and its impact on gastrointestinal symptoms: a proof-of-concept study.

Background: Currently, no data are available on COVID-19 pandemic perception in patients with achalasia. We evaluated how the COVID-19 lockdown was perceived by these patients and its impact on their upper gastrointestinal symptoms. Methods: COVID-19 perception was assessed in 64 patients with achalasia using a previously published survey. Upper gastrointestinal symptoms were assessed using a standardized questionnaire and the results were compared to those obtained before the COVID-19 pandemic. All questionnaires were administered by telephone/video calls during the second Italian lockdown. Results: Fifty-one patients (79.7%) responded to the survey. For the question "On a 0-100 scale, how worried are you about the COVID-19 pandemic?" the mean score was 72.8±27.1, and 64.7% of patients with achalasia gave a score >60 on a visual analog scale of 0-100. In addition, those who considered themselves more vulnerable or anxious about contracting the infection than the general population, showed a significantly higher score for COVID-19 fear compared to those who felt less vulnerable or anxious (79.7±27.6 vs. 62.5±23.6, P=0.027; 80.9±19.6 vs. 57.1±33.1, P=0.002, respectively). The selected patients (n=29), who had not undergone any change in medical/surgical treatment for at least one year before the COVID-19 pandemic, had a significant worsening of the intensity-frequency score of regurgitation, heartburn, odynophagia, water brash, and epigastric burning during the lockdown (P<0.05). Finally, 75% of the patients were very interested in using Telemedicine. Conclusions: The COVID-19 lockdown had a significant impact on the psychological aspects and upper gastrointestinal symptoms of patients with achalasia. Telemedicine might represent a follow-up strategy.

Gerd symptoms after laparoscopic Roux-en-Y gastric bypass: an emerging scenario.

Laparoscopic Roux-en-Y gastric bypass (RYGB) is the second most performed bariatric procedure and it is considered the procedure of choice to treat patients with severe obesity and gastroesophageal reflux disease (GERD). However, some authors described the new onset or the recurrence of GERD symptoms after RYGB, and data at follow-up were scanty. In our center, we evaluated trend in weight, GERD symptoms and obesity-related comorbidities in 45 patients undergone RYGB at least 60 months before (mean follow-up 99.9 ± 22.9 months). At RYGB 51.1% patients referred preoperative GERD symptoms; among them, 47.8% showed an intraoperative hiatal hernia (HH). At medium-term follow-up mean BMI was significantly lower compared to baseline (p < 0.001). Among patients with preoperative GERD, 69.6% had GERD resolution and 30.4% reported postoperative GERD symptoms. Furthermore, 18.2% without preoperative GERD referred postoperative GERD new onset. We confirmed that RYGB as primary intervention provides satisfactory weight loss and a high percentage of GERD symptoms resolution. However, about 24.4% of patients complained of GERD symptoms at medium-term follow-up. The pathophysiology of GERD after RYGB, de novo or persistence, is not completely understood and several hypotheses could be drawn; however, further studies focusing the pathophysiology of these symptoms are needed.

Use of near-infrared spectroscopy combined with chemometrics for authentication and traceability of intact lemon fruits.

The reflectance NIR spectroscopy and chemometric data treatment on mature intact lemons, Limone di Sorrento PGI (cv Ovale di Sorrento) and Limone Costa D'Amalfi PGI (cv Sfusato Amalfitano) from Campania region, collected in 2018 and 2019, were used to predict properties, and discriminate cultivar and geographical provenance. By PCA, lemon NIR spectra grouped for production years due to the year variation of lemon properties attributable to annual climatic differences, homogeneous in all sites. This agrees with lemon chemical and physical differences by production year. Consequently, the relationship of NIR spectra with lemon quality properties by MLR and the cultivar and provenances discrimination by LDA were affected by year climatic difference; therefore, better model reliability was for single production year. NIR detectability of lemon properties did not appear beyond lemon thick peels, therefore the measured properties of lemon juices could derive from measurable properties of peel correlating with pulp properties.

Provenance discrimination of Sorrento lemon with Protected Geographical indication (PGI) by multi-elemental fingerprinting.

Multielement analysis and chemometric methods were proposed to discriminate the Sorrento lemon (PGI) juices according to geographical origin. In 2018 and 2019, 169 fruits from three farms in PGI area and two in not-PGI area were collected and analysed for essential and not-essential elements by ICP-MS. The PCA of multielement fingerprinting grouped lemon juices from PGI farms revealing a strong differentiation at small geographical scale. The S-LDA discriminated lemon juices for Mo, Ba, Rb, Mg, Co, Ca, Fe, Sr on the two production years, giving 97.7% correct classification, 98.5% accuracy and 93.8% external validation. The good correlation lemon juice vs cultivation soil and the soil discrimination by not-essential elements suggested the use of these elements as reliable indicators of lemon juice provenances. Despite lowering the number of variables, constituted by not-essential elements Ba, Rb, Ti, Co, the use of S-QDA discriminated the lemons juices with 87.5% accuracy and 83.9% validation.

Impact of COVID-19 lockdown on symptoms in patients with functional gastrointestinal disorders: Relationship with anxiety and perceived stress.

BACKGROUND: Psychological stress and anxiety, such those generated by forced quarantine, affect gastrointestinal symptoms course in patients with functional gastrointestinal disorders. Thus, our aim was to assess, in a cohort of patients regularly followed up in a devoted outpatient clinic of Southern Italy, the association between their gastrointestinal symptoms changes, stress, and anxiety reported during the Italian lockdown. METHODS: We recruited patients from the outpatient clinic of the University of Salerno, devoted to functional gastrointestinal disorders, selecting only patients for whom an evaluation was available in the last 6 months before the lockdown. Gastrointestinal symptoms were evaluated at each visit through standardized questionnaire and pooled in a database. On 45th days from the beginning of the lockdown, patients were re-assessed by phone with the same questionnaire. Anxiety and stress levels were assessed through a self-administered online questionnaire based on Generalized Anxiety Disorder 7 test and Perceived Stress Scale 10 test. KEY RESULTS: The intensity-frequency scores of several upper gastrointestinal symptoms improved (Wilcoxon test <0.05). Higher anxiety levels had a higher risk of worsening chest pain (OR 1.3 [1.1-1.7]), waterbrash (OR 1.3 [1.0-1.7]), epigastric burning (OR 1.3 [1.0-1.6]), and abdominal pain (OR 1.6 [1.0-2.3]). When compared to the interval preceding the outbreak, half of the patients declared their symptoms remained unchanged, 13.6% worsened, and 36.4% improved. CONCLUSIONS AND INFERENCES: During the COVID-19 quarantine, there was an improvement of the majority of upper gastrointestinal symptoms in our patients, and anxiety seems an important risk of worsening few of them.

Decreased hemoglobin levels are associated with higher plasma level of fibrinogen, irrespective of age.

BACKGROUND: Increased plasma levels of fibrinogen are been associated with an increased risk of cardiovascular accident. We aimed at verifying whether the changes of fibrinogen levels are associated with red blood cell (and/or hemoglobin) concentration. METHODS: A group of 381 carefully selected healthy volunteers (219 male and 162 female), aged from 18 to 101 years, were enrolled in this study. Fasting blood samples were taken and all measurements (fibrinogen plasma level, whole blood viscosity, hemoglobin concentration, hematocrit value, red blood cell and white blood cell count, platelet count, glucose, total cholesterol and triglycerides plasma concentration, and C-reactive protein level) were obtained with standardized methodology using appropriate equipment, procedures, and controls. RESULTS AND CONCLUSIONS: In the male but not in the female group, plasma fibrinogen concentration inversely correlated with hemoglobin (P < 0.0001) and hematocrit value (P < 0.01). In a post hoc analysis, plasma fibrinogen level inversely correlated with hemoglobin in the subgroup of the 93 premenopausal women and directly correlated with age and inversely correlated with platelet count in the subgroup of the 69 postmenopausal women. Results of multiple regression analysis revealed that in all the subjects, except in the postmenopausal women, hemoglobin level is an independent predictor of fibrinogen plasma level. Considering the physiopathologic role of increased plasma fibrinogen concentration and the scarcity of pharmacologic approaches to decrease its level, these findings could be important in designing a preventive therapy of cardiovascular disease.

Ozonized autohemotransfusion does not affect arterial vasodilation in patients with peripheral arterial disease.

Ozonized autohemotransfusion has been used as a complementary therapy in patients with peripheral arterial disease (PAD). To determine whether ozone therapy could acutely modify artery vasodilatory capacity, a flow-mediated dilation test was performed at the brachial artery level before and after an ozonized autohemotransfusion in 16 patients with PAD, mean (± SD) age 55±1.8 years, and 14 healthy volunteers matched for age, sex and body mass index. Before ozonized autohemotransfusion, the mean baseline diameter of the brachial artery was higher in PAD patients than in healthy subjects (4.6±0.54 mm versus 3.6±0.54 mm, P<0.001) while mean flow-mediated brachial artery dilation and percentage of increase in flow were significantly lower in PAD patients than in controls (6.3±6.1% versus 11.8±2.4%, P<0.02; 433±61% versus 580±46%, P<0.02, respectively). No significant changes were observed after ozonized autohemotransfusion, indicating that ozonized autohemotransfusion does not modify endothelium-dependent ischemia-induced vascular reactivity.