Exercise for hepatic fat accumulation in type 2 diabetic subjects

Type 2 diabetes is characterized by frequent ectopic fat accumulation in several tissues and organs. In particular, a number of studies showed that these subjects frequently have hepatic fat accumulation, which may play a role in the metabolic abnormalities typical of diabetes and has been also linked to increased risk for cardiovascular disease. In the last decade, the effect of exercise on ectopic fat content of type 2 diabetic patients has raised growing interest. However, there are only a few small randomized controlled trialson this topic. Results from these intervention studies indicate that exercise training, independent of dietary modifications, may reduce hepatic fat content and serum transaminases in these patients, suggesting that exercise per se may be an effective strategy to be combined with the traditional dietary interventions. As regards the different training modalities, there is recent evidence that both aerobic and resistance exercisemay equally reduce hepatic fat accumulation in type 2 diabetic subjects. However, information regarding the effect of exercise on liver histology and fat accumulation in other ectopic sites is still very limited

Influence of Acute Bouts of Exercise on Blood Glucose in Type 2 Diabetic patients, as Measured by Continuous Glucose Monitoring Systems

Literature data indicate that the effect on blood glucose levels of a single bout of exercise may persist up to 48-h after cessation of exercise. Regular exercise improves insulin sensitivity and blood glucose control in subjects with type 2 diabetes and is considered a key element in the management of this condition. However, adaptive responses to exercise are altered in diabetic subjects and medications used in these patients may cause inappropriate insulin levels for the concurrent blood glucose concentrations, with a possible increase in risk for hypoglycaemia. Recently, the development and clinical availability of systems for the continuous monitoring of glucose (continuous glucose monitoring system, CGMS), have made it possible to continuously record blood glucose levels for several days in real life conditions, showing that possible differences in blood glucose levels of these individuals may occur during and after a single bout of exercise, depending on the characteristics of the physical activity. In particular, differences between aerobic vs resistance exercise and between low-intensity vs high-intensity exercise have been reported. However, there are only a few, small heterogeneous studies on this topic, and results are to some extent discordant, limiting any conclusions. Further research on this issue is needed before we can reach clear conclusions. In particular, the role of differences in frequency, duration, intensity, type and timing of exercise needs to be carefully investigated. Hopefully, this information will assist clinicians and exercise specialists in designing personalized exercise programmes and strategies aimed at optimally improving glucose control of type 2 diabetic patients, also limiting the risk for hypoglycaemia. In this article, we review the literature regarding the acute effect of different types of exercise on glucose levels, as measured by CGMS, in subjects with type 2 diabetes

Sex differences in the association of psychological status with measures of physical activity and sedentary behaviour in adults with type 2 diabetes

Aim – To assess the association of psychological variables on leisure time physical activity and sedentary time in men and women with type 2 diabetes mellitus (T2D). Methods – In this cross-sectional study, we evaluated 163 patients with T2D, consecutively recruited at the Diabetes Centre of the Verona General Hospital. Scores on depression and anxiety symptoms, psychosocial factors (including self-efficacy, perceived interference, perceived severity, social support, misguided support behaviour, spouse’s positive behaviour), physical activity and time spent sitting were ascertained using questionnaires responses to the Beck Depression Inventory-II, Beck Anxiety Inventory, Multidimensional Diabetes Questionnaire, International Physical Activity Questionnaire. Results – Physical activity was significantly associated with higher social support in women, and with increased self-efficacy in men. Sedentary time was significantly associated with higher perceived interference, anxiety and depressive symptoms, and with reduced diabetes self-efficacy in women, while it was associated solely with anxiety in men. Depressive symptoms and self-efficacy in women and anxiety symptoms in men were independent predictors of sedentary time when entered in a multivariable regression model also including age, BMI, hemoglobin A1c, diabetes duration, perceived interference and self-efficacy as covariates. Conclusions – Lower self-efficacy and higher symptoms of depression were closely associated with increased sedentary time in women, but not in men, with T2D. It is possible that individualized behavioral interventions designed to reduce depressive symptoms and to improve diabetes self-efficacy would ultimately reduce sedentary behaviours, particularly in women with T2D

Trimester-specific reference intervals for thyroid function parameters in pregnant Caucasian women using Roche platforms: a prospective study

Background: Standard thyroid function parameters reference intervals (RI) are unsuitable during pregnancy, potentially resulting in incongruous treatments that may cause adverse effects on pregnancy outcomes. We aimed at defining trimester-specific TSH, FT4 and FT3 RI, using samples longitudinally collected from healthy Caucasian women. Materials and methods: Blood samples from 150 healthy Caucasian women, who had a physiological gestation and a healthy newborn at term, were collected in each trimester and at around six months post-partum. They showed mild iodine deficiency. After excluding women with overt TSH abnormalities (> 10 mU/L) and/or TPO antibodies, data from 139 pregnant women were analyzed by means of widely used Roche platforms, and TSH, FT4 and FT3 trimester-specific RI were calculated. Post-partum data were available for 55 subjects. Results: Serum TSH RI were 0.34-3.81 mU/L in the first trimester, and changed slightly to 0.68-4.07 U/L and 0.63-4.00 mU/L in the second and third trimester, respectively. Conversely, both FT4 and FT3 concentrations progressively decreased during pregnancy, the median values in the third trimester being 14.8% and 13.2% lower, respectively, than in the first trimester. Thyroid function parameters in the first trimester were similar to those measured after the end of pregnancy. Conclusions: This study calculates trimester-specific RI for thyroid function parameters in pregnancy, and proposes the reference limits that should be adopted when using Roche platforms in Caucasian women

Serum HMGB1 levels are independently associated with glucose clamp-derived measures of insulin resistance in women with PCOS

Purpose: PCOS is associated with low grade inflammation which could play a role in insulin resistance and ovarian dysfunction. Preliminary findings suggested that serum levels of HMGB1, a cytokine involved in inflammation, might be altered in women with PCOS. Primary aim of this study was to assess whether HMGB1 serum concentrations are associated with PCOS and with the state of insulin resistance of these women. Methods: Sixty women with PCOS, selected to have a similar proportion of subjects with altered or normal insulin sensitivity, and 29 healthy controls were studied. Serum HMGB1 levels were compared in subgroups of PCOS women and controls. In PCOS women, insulin sensitivity was assessed by the glucose clamp technique and HMGB1 was measured at baseline and after acute hyperinsulinemia. Results: HMGB1 levels were similar in women with PCOS and controls and no elements used for diagnosing PCOS were associated with serum HMGB1. However, HMGB1 concentrations were higher in insulin-resistant vs insulin-sensitive PCOS women (p = 0.017), and inversely associated with insulin-induced total and non-oxidative glucose metabolism. In both subgroups of PCOS women, serum HMBG1 levels significantly increased after acute hyperinsulinemia. Conclusions: These data suggest that HMGB1 levels are not associated with PCOS per se, but with insulin resistance. Further research should establish the underlying nature of this relationship, and whether this protein might play a role in the metabolic complications of PCOS

PRIMO SPORT Surroundings and activities just right for growing up well

Concept and "how to use" of a playground designed for improving modor development in 0-6 y old children. To be used by parent and educators looking for information and recommendation from international health agencies and from scientific publication

PRIMO SPORT L’ambiente e il movimento ideali per crescere sani

Necessità per un sano sviluppo nell'infanzia, linee guida, raccomandazioni e dati della ricerca scientifica internazionale per genitori e educatori. Concept e utilizzo del nuovo parco PrimoSport 024

Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society

Background: Hirsutism, defined by the presence of excessive terminal hair in androgen-sensitive areas of the female body, is one of the most common disorders in women during reproductive age.Methods: We conducted a systematic review and critical assessment of the available evidence pertaining to the epidemiology, pathophysiology, diagnosis and management of hirsutism.Results: The prevalence of hirsutism is about 10% in most populations, with the important exception of Far-East Asian women who present hirsutism less frequently. Although usually caused by relatively benign functional conditions, with the polycystic ovary syndrome leading the list of the most frequent etiologies, hirsutism may be the presenting symptom of a life-threatening tumor requiring immediate intervention.Conclusions: Following evidence-based diagnostic and treatment strategies that address not only the amelioration of hirsutism butalso the treatment of the underlying etiology is essential for the proper management of affected women, especially considering that hirsutismis, in most cases, a chronic disorder needing long-term follow-up. Accordingly, we provide evidence-based guidelines for the etiological diagnosis and for the management of this frequent medical complaint

Enhanced follicular delivery of finasteride to human scalp skin using heat and chemical penetration enhancers

© The Author(s) 2020. This article is an open access publication. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Purpose The aim of this work was to evaluate whether improved topical delivery of finasteride, focussed to the hair follicles of human scalp skin could be achieved with application of short durations of heat and use of specific chemical penetration enhancers. Methods Franz cell experiments with human scalp skin were performed with a range of chemical penetration enhancers at 32°C and 45°C to simulate normal and heated conditions. Selected chemical penetration enhancers were taken forward for finite dose Franz cell studies which examined the effect of heat produced by a prototype external heating system that supplied either 20 or 30 min of additional heat over both a 24 h and a 1 h time period. Results Short durations of externally applied heat significantly increased finasteride penetration into human scalp skin after 24 h. Analysis of drug distribution in the skin after 1 h and 24 h indicated that both heat and chemical penetration enhancer selection influenced drug delivery to the hair follicles. Conclusion The use of short durations of heat in combination with specific chemical penetration enhancers was able to increase the delivery of finasteride to human scalp skin and provide focussed drug delivery to the hair follicles.Peer reviewe

Effect of Testosterone on Insulin Stimulated IRS1 Ser Phosphorylation in Primary Rat Myotubes—A Potential Model for PCOS-Related Insulin Resistance

Polycystic ovary syndrome (PCOS) is characterized by a hyperandrogenic state and frequently develops skeletal muscle insulin resistance. We determined whether testosterone adversely affects insulin action by increasing serine phosphorylation of IRS-1(636/639) in differentiated rat skeletal muscle myotubes. The phosphorylation of Akt, mTOR, and S6K, downstream targets of the PI3-kinase-IRS-1 complex were also studied.Primary differentiated rat skeletal muscle myotubes were subjected to insulin for 30 min after 16-hour pre-exposure to either low (20 ng/ml) or high (200 ng/ml) doses of testosterone. Protein phosphorylation of IRS-1 Ser(636/639), Akt Ser(473), mTOR-Ser(2448), and S6K-Thr(389) were measured by Western blot with signal intensity measured by immunofluorescence.Cells exposed to 100 nM of insulin had increased IRS-1 Ser(636/639) and Akt Ser(473) phosphorylation. Cells pre-exposed to low-dose testosterone had significantly increased insulin-induced mTOR-Ser(2448) and S6K-Thr(389) phosphorylation (p<0.05), and further increased insulin-induced IRS-1 Ser(636/639) phosphorylation (p = 0.042) compared to control cells. High-dose testosterone pre-exposure attenuated the insulin-induced mTOR-Ser(2448) and S6K-Thr(389) phosphorylation.The data demonstrated an interaction between testosterone and insulin on phosphorylation of intracellular signaling proteins, and suggests a link between a hyperandrogenic, hyperinsulinemic environment and the development of insulin resistance involving serine phosphorylation of IRS-1 Ser(636/639). These results may guide further investigations of potential mechanisms of PCOS-related insulin resistance