Project for the prevention of caries in the developmental age: Experience in kindergartens of Northern Italy

AbstractIntroduction: Caries is one of the most widespread chronic diseases in the world and in Italy, only 78.4% of the 4 years children are caries free. Caries is defined as an infectious multifactorial pathology and between the etiological factors that contribute to its developing we find excessive sugar consumption. Correct behaviours adopted since the pediatric age will allow the child to learn how to improve their lifestyle, thus protecting health. Parents must therefore be properly educated to transmit healthy habits to their children from the early years. The main goal of our project is the prevention of caries in the developmental age by means of educational interventions on parents of children in the kindergarten (0–3 years). The study assesses the oral hygiene and food habits of the child and caregiver at baseline and after 3 months from the interventions (follow-up).Materials and Methods: We have used a questionnaire to collect the oral hygiene and food habits of parents and children. Next, dental hygienists and nutritionists organized training sessions for parents about correct oral hygiene and eating habits (in particular to reduce the sugar consumption). After 3 months from the training, the same questionnaires reconfirmed to evaluate the improvement of family habits.Results: The number of participants was reduce from 99 to 68 at the follow-up. With regards to eating habits, after training, almost the whole of the sample began to practice breakfast, indicating that the actual importance of this meal was understood. The habit of morning and afternoon snack, essential for a growing child, has increased (from 84% at baseline to 94% at follow-up and from 92% to 97% respectively). The bad habit of the after dinner snack, often even after teeth brushing, has decreased consistently (32% to 22%).The most significant advances in oral hygiene are those concerning tooth washing (86% to 97%), the average daily washing (1.27/die to 1.57/die), self-washing (33% to 30%), the use of toothpaste (85% to 90%) and fluoridated toothpaste (48% to 62%).Discussion: Starting from the data obtained from our pilot study, we think that it is essential to intervene already in the first years of life, when the subject is still "plastic" and can be trained to perform correct eating habits and oral hygiene. Furthermore, reducing the consumption of foods rich in sugar does not have a positive effect only on the onset of caries but also on the health of the individual

Bioengineering thymus organoids to restore thymic function and induce donor-specific immune tolerance to allografts

One of the major obstacles in organ transplantation is to establish immune tolerance of allografts. Although immunosuppressive drugs can prevent graft rejection to a certain degree, their efficacies are limited, transient, and associated with severe side effects. Induction of thymic central tolerance to allografts remains challenging, largely because of the difficulty of maintaining donor thymic epithelial cells in vitro to allow successful bioengineering. Here, the authors show that three-dimensional scaffolds generated from decellularized mouse thymus can support thymic epithelial cell survival in culture and maintain their unique molecular properties. When transplanted into athymic nude mice, the bioengineered thymus organoids effectively promoted homing of lymphocyte progenitors and supported thymopoiesis. Nude mice transplanted with thymus organoids promptly rejected skin allografts and were able to mount antigen-specific humoral responses against ovalbumin on immunization. Notably, tolerance to skin allografts was achieved by transplanting thymus organoids constructed with either thymic epithelial cells coexpressing both syngeneic and allogenic major histocompatibility complexes, or mixtures of donor and recipient thymic epithelial cells. Our results demonstrate the technical feasibility of restoring thymic function with bioengineered thymus organoids and highlight the clinical implications of this thymus reconstruction technique in organ transplantation and regenerative medicine

Effectiveness of lithium in subjects with treatment-resistant depression and suicide risk: results and lessons of an underpowered randomised clinical trial

BACKGROUND: As lithium treatment might be effective in reducing the risk of deliberate self-harm (DSH) in adult patients with unipolar affective disorders, we designed a pragmatic randomised trial to assess its efficacy in more than 200 patients with treatment-resistant depression. However, we randomised 56 patients only. The aim of this report is therefore twofold: first, to disseminate the results of this underpowered study which may be incorporated into future meta-analytical reviews; second, to analyse some critical aspects of the study which might explain failure to reach the target sample size.METHODS: We carried out a randomised, parallel group, assessor-blinded superiority clinical trial. Adults with a diagnosis of major depression, an episode of DSH in the previous 12 months and inadequate response to at least two antidepressants given sequentially at an adequate dose for an adequate time for the current depressive episode were allocated to add lithium to usual care (intervention arm) versus usual care alone (control arm). Suicide completion and acts of DSH during the 12 months of follow-up constituted the composite primary outcome.RESULTS: Of 58 patients screened for inclusion, 29 were allocated to lithium plus usual care and 27 were assigned to usual care without lithium. Six patients in the lithium plus usual care group and seven in the usual care group committed acts of DSH during the follow-up phase. The survival probability did not differ between the two treatment arms (Chi2 = 0.17, p =0.676). With regard to changes in the severity of depressive symptomatology from baseline to endpoint, no significant differences were detected.CONCLUSIONS: The present study failed to achieve the minimum sample size needed to detect a clinically meaningful difference between the two treatment arms. Consequently, the finding that lithium, in addition to usual care, did not exert a positive effect in terms of reduction of DSH after 12 months of follow-up is likely due to the lack of sufficient statistical power to detect a difference, if a difference existed. The dissemination of the results of this underpowered study will inform future meta-analytical reviews on lithium and suicide-related outcomes.TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00927550

Production of He-4 and (4) in Pb-Pb collisions at root(NN)-N-S=2.76 TeV at the LHC

Results on the production of He-4 and (4) nuclei in Pb-Pb collisions at root(NN)-N-S = 2.76 TeV in the rapidity range vertical bar y vertical bar <1, using the ALICE detector, are presented in this paper. The rapidity densities corresponding to 0-10% central events are found to be dN/dy4(He) = (0.8 +/- 0.4 (stat) +/- 0.3 (syst)) x 10(-6) and dN/dy4 = (1.1 +/- 0.4 (stat) +/- 0.2 (syst)) x 10(-6), respectively. This is in agreement with the statistical thermal model expectation assuming the same chemical freeze-out temperature (T-chem = 156 MeV) as for light hadrons. The measured ratio of (4)/He-4 is 1.4 +/- 0.8 (stat) +/- 0.5 (syst). (C) 2018 Published by Elsevier B.V.Peer reviewe

Analysis of dietary habits and health status in a court of young athletes in Northern Italy practicing Athletic disciplines

AbstractIntroduction:A balanced diet is a fundamental component of athletes' health, training and performance. WHO dietary guidelines highlight the importance of maintaining a normal BMI, limiting the intake of sugars (especially sweetened foods and beverages), eating at least 5 portions of fruits and vegetables per day, drink lots of clean water (at least 2 L per day for children older than 13 and for adults). HBSC-Italy study reveals that children have frequently bad eating habits, such as consuming sweetened drinks and not enough fruits and vegetables. Indeed, 21.3% of Italian children are overweight and 9.3% are obese. The purpose of this study is to evaluate nutritional and health status of a population of Northern Italy children and adolescents practicing Athletics, investigating for both endurance and not endurance disciplines. Data obtained are a starting point for focused food education interventions aimed at improving health and sport performance.Materials and Methods:A cohort of 125 athletes (12–25 years, 42.4% male, 57.6% female). Two groups were created: children (12–17 years) and adults (18–25 years). Weight, height, waist circumference, triceps and subscapularis skinfolds were measured in order to calculate BMI, Waist-to-Height ratio (WtHr), body adiposity and muscle mass. At baseline and after 1 year (follow-up) from a nutritional educational intervention, the anthropometric measures and dietary habits were tested with a validated dietary screening survey, considering food quality, portions and frequencies of consumption, were taken.Results:At Baseline, more than 85% of athletes were found to be normal weight with WHtR < 0.5. All the athletes showed body adiposity in the normal range. Regarding food habits, most athletes do not take the recommended daily fruit and vegetable servings follow Italian trend. Only about 20% of children athletes assumes the water daily intake. On the contrary, about 50% of athletes in every group drink sweetened beverages every day. The data collection after the personalized food education meetings will be collected in May 2019.Discussion:The athletes of cohort shows a good health status but nutritional habits present critical issue. For this reasons, there is a need of nutritional education for improving healthy eating habits in young athletes in order to impact positively on future health status and on sport performance

Salt and Sugar: Two Enemies of Healthy Blood Pressure in Children

The prevalence of essential arterial hypertension in children and adolescents has grown considerably in the last few decades, making this disease a major clinical problem in the pediatric age. The pathogenesis of arterial hypertension is multifactorial, with one of the components being represented by incorrect eating habits. In particular, excessive salt and sugar intake can contribute to the onset of hypertension in children, particularly in subjects with excess weight. Babies have an innate predisposition for sweet taste, while that for salty taste manifests after a few weeks. The recent modification of dietary styles and the current very wide availability of salt and sugar has led to an exponential increase in the consumption of these two nutrients. The dietary intake of salt and sugar in children is in fact much higher than that recommended by health agencies. The purpose of this review is to explore the mechanisms via which an excessive dietary intake of salt and sugar can contribute to the onset of arterial hypertension in children and to show the most important clinical studies that demonstrate the association between these two nutrients and arterial hypertension in pediatric age. Correct eating habits are essential for the prevention and nondrug treatment of essential hypertension in children and adolescents

Hypertension in Children: Role of Obesity, Simple Carbohydrates, and Uric Acid

Over the past 60 years there has been a dramatic increase in the prevalence of overweight in children and adolescents, ranging from 4% in 1975 to 18% in 2016. Recent estimates indicate that overweight or obese children and adolescents are more than 340 million. Obesity is often associated with hypertension, which is an important cardiovascular risk factor. Recent studies show that the presence of hypertension is a frequent finding in the pediatric age. Hypertensive children easily become hypertensive adults. This phenomenon contributes to increasing cardiovascular risk in adulthood. Primary hypertension is a growing problem especially in children and adolescents of western countries, largely because of its association with the ongoing obesity epidemic. Recently, it has been hypothesized that a dietary link between obesity and elevated blood pressure (BP) values could be simple carbohydrate consumption, particularly fructose, both in adults and in children. Excessive intake of fructose leads to increased serum uric acid (SUA) and high SUA values are independently associated with the presence of hypertension and weaken the efficacy of lifestyle modifications in children. The present review intends to provide an update of existing data regarding the relationship between BP, simple carbohydrates (particularly fructose), and uric acid in pediatric age. In addition, we analyze the national policies that have been carried out over the last few years, in order to identify the best practices to limit the socio-economic impact of the effects of excessive sugar consumption in children

Relationship between endothelin and nitric oxide pathways in the onset and maintenance of hypertension in children and adolescents

The mechanisms that regulate blood pressure are numerous and complex; one mechanism that plays an important role in this scenario is represented by the balance between the vasoconstrictor effect of endothelin-1 and the vasodilator effect of nitric oxide. While there is agreement on the fact that increased endothelin-1 activity and decreased nitric oxide bioavailability are present in hypertensive adults, the situation is less clear in children and adolescents. Not all studies agree on the finding of an increase in plasma endothelin-1 levels in hypertensive children and adolescents; in addition, the picture is often confused by the concomitant presence of obesity, a condition that stimulates the production of endothelin-1. Furthermore, there is recent evidence that, in younger obese and hypertensive subjects, there is an overproduction of nitric oxide, rather than a reduction. This condition may change over time, causing endothelial dysfunction due to a reduced availability of nitric oxide in hypertensive adolescents. The purpose of this review is to address the main biochemical and pathophysiological aspects of endothelin and nitric oxide involvement in hypertension and to summarize the available scientific evidence on their role in the onset and maintenance of high blood pressure in children and adolescents

Impact of Lifestyle Modifications on Alterations in Lipid and Glycemic Profiles and Uric Acid Values in a Pediatric Population

Cardiometabolic risk factors are frequent in children and adolescents with excess weight. The aim of this study was to evaluate the effects of lifestyle modifications on alterations in lipid and glycemic profiles and uric acid values in a pediatric population at increased cardiovascular risk. The study involved 276 subjects with a mean age of 10.6 (2.3) years. Body mass index (BMI) z-score and biochemical parameters (serum low-density lipoprotein (LDL) cholesterol, triglycerides and uric acid and homeostasis model assessment to quantify insulin resistance (HOMA index)) were assessed at baseline and at the end of a median follow-up of 14.7 (12.4, 19.3) months. Throughout follow-up, all children received a non-pharmacological treatment based on increased physical activity, reduced sedentary activity and administration of a personalized, healthy and balanced diet. All children attended periodic quarterly control visits during follow-up. Multivariable statistical analyses showed that each BMI z-score point reduction at follow-up was associated with an 8.9 (95% CI −14.2; −3.6) mg/dL decrease in LDL cholesterol (p = 0.001), 20.4 (95% CI −30.0; −10.7) mg/dL in triglycerides (p p p = 0.001) values. At each reduction of the BMI z-score by one point, the odds of presenting with insulin resistance and hyperuricemia at follow-up significantly decreased (OR 0.23, 95% CI 0.10–0.50, and OR 0.32, 95% CI 0.10–0.95, p p < 0.05, respectively). Improvement of dietary habits and lifestyles may improve lipid and glycemic profiles and serum uric acid values in a pediatric population