Nonalcoholic fatty liver disease and diabetes

Nonalcoholic fatty liver disease(NAFLD)is the most prevalent chronic liver disease in the world and represents a clinical-histopathologic entity where the steatosis component may vary in degree and may or may not have fibrotic progression.The key concept of NAFLD pathogenesis is excessive triglyceride hepatic accumulation because of an imbalance between free fatty acid influx and efflux.Strong epidemiological,biochemical,and therapeutic evidence supports the premise that the primary pathophysiological derangement in most patients with NAFLD is insulin resistance;thus the association between diabetes and NAFLD is widely recognized in the literature.Since NAFLD is the hepatic manifestation of a metabolic disease,it is also associated with a higher cardiovascular risk.Conventional B-mode ultrasound is widely adopted as a first-line imaging modality for hepatic steatosis,although magnetic resonance imaging represents the gold standard noninvasive modality for quantifying the amount of fat in these patients.Treatment of NAFLD patients depends on the disease severity,ranging from a more benign condition of nonalcoholic fatty liver to nonalcoholic steatohepatitis.Abstinence from alcohol,a Mediterranean diet,and modification of risk factors are recommended for patients suffering from NAFLD to avoid major cardiovascular events,as per all diabetic patients.In addition,weight loss induced by bariatric surgery seems to also be effective in improving liver features,together with the benefits for diabetes control or resolution,dyslipidemia,and hypertension.Finally,liver transplantation represents the ultimate treatment for severe nonalcoholic fatty liver disease and is growing rapidly as a main indication in Western countries.This review offers a comprehensive multidisciplinary approach to NAFLD,highlighting its connection with diabetes.

Laparoscopic appendectomy,stump closure and endoloops:A meta-analysis

BACKGROUND Acute appendicitis(AA)is one of the main indications for urgent surgery.Laparoscopic appendectomy(LA)has shown advantages in terms of clinical results and cost-effectiveness,even if there is still controversy about different devices to utilize,especially with regards to the endoloop(EL)vs endostapler(ES)when it comes to stump closure.AIM To compare safety and cost-effectiveness of EL vs ES.METHODS From a prospectively maintained database,data of 996 consecutive patients treated by LA with a 3 years-follow up in the department of Emergency General Surgery-St Orsola University Hospital,Bologna(Italy)were retrieved.A metaanalysis was performed in terms of surgical complications,in comparison to the international literature published from 1995 to 2021.RESULTS The meta-analysis showed no evidence regarding wound infections,abdominal abscesses,and total post-operative complications,in terms of superiority of a surgical technique for the stump closure in LA.CONCLUSION Even when AA is complicated,the routine use of EL is safe in most patients.