Therapeutic Contract in Adolescents Using Hybrid Closed Loop System

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The effects of ecolabels on environmentally- and health-friendly cars : an online survey and two experimental studies

Purpose: Given the increasing importance of political decision-making to reduce emission targets, the main purpose of the current paper is to identify and test the considerations that would nudge consumers towards an environmentally and health-friendly motor vehicle. Methods: An online survey was conducted to assess public responses and the role of public authorities to a voluntary emission standard for passenger cars. In addition, two online experiments were conducted to test incentives in the design of ecolabels (e.g. price, safety, performance) for optimization. A random sample of 6400 individuals was drawn from eight countries: Germany, Ireland, Italy, the Netherlands, Spain, UK, Czech Republic and Lithuania. An online survey was conducted among 3200 respondents, 400 in each of the 8 countries, and 2 online experiments with 3200 subjects, 400 in each of the 8 countries, allowing for 200 respondents for each experiment in each country. Results and discussion: The survey shows that Europeans are aware of the health and environmental impact of cars. The findings also confirm the gap between self-reported attitudes/intentions and actual behaviours. In influencing car purchase decisions, health and environmental concerns are less important than other attributes such as price, safety and performance. The experiments show that all these attributes have a significant effect on consumers\u2019 choices. However, message content was found to have the strongest effect. Respondents are more likely to choose European Union Low Emitting carS (EULES)-friendly cars when the label shows information on lower costs or lower taxes and less likely to be influenced by health-related benefits, convenient parking or access fees. Finally, combinations of one message with other elements\u2014EULES logo, CO2 logo or both\u2014within the same label have a small but positive effect on respondents\u2019 choices. Conclusions: The findings of this study assist governmental decision-making processes by identifying those issues that have the greatest impact on consumers\u2019 car purchasing decisions. Furthermore, the results will help to guide environmentally conscious customers towards the purchase of vehicles with clean emission profiles

“CoVidentary”: An online exercise training program to reduce sedentary behaviours in children with type 1 diabetes during the COVID-19 pandemic

Aim: We explored the physical activity (PA) level and the variation in glycaemic control in children with type 1 diabetes (T1D) before and during the lockdown. Then, we proposed an online training program supported by sport-science specialists. Methods: Parents of children with T1D (<18 years) filled out an online survey. Anthropometric characteristics, PA, play, sport and sedentary time and the medical related outcomes were recorded. An adapted online program “Covidentary” was proposed through full-training (FT) and active breaks (AB) modality. Results: 280 youth (11.8 ± 3.3 years) were included in the analysis. We reported a decline in sport (-2.1 ± 2.1 h/week) and outdoor-plays (-73.9 ± 93.6 min/day). Moreover, we found an increase in sedentary time (+144.7 ± 147.8 min/day), in mean glycaemic values (+25.4 ± 33.4 mg/dL) and insulin delivery (71.8% of patients). 37% of invited patients attended the training program, 46% took part in AB and 54% in FT. The AB was carried out for 90% of the total duration, while the FT for 31%. Both types of training were perceived as moderate intensity effort. Conclusion: A decline of participation in sport activities and a subsequent increase of sedentary time influence the management of T1D of children, increasing the risk of acute/long-term complications. Online exercise program may contrast the pandemic's sedentary lifestyle

Dor versus Toupet fundoplication after Laparoscopic Heller Myotomy: Systematic review and Bayesian meta-analysis of randomized controlled trials

Laparoscopic Heller Myotomy (LHM) with partial fundoplication has become the treatment of choice for esophageal achalasia. However, the choice of the partial fundoplication is debated. The aim of this study was to compare outcomes for Dor and Toupet fundoplication after LHM. A systematic search of randomized controlled trials comparing Dor and Toupet fundoplication was performed using PubMed, EMBASE and Web of Science. Three studies met the inclusion criteria. Overall, 174 patients were included in the analysis. The postoperative abnormal acid reflux [pooled Risk Ratio 0.98 (95% HPD 0.54-1.80)] and dysphagia [pooled Risk Ratio 1.03 (95% HPD 0.51-2.05)] were similar comparing Dor and Toupet fundoplication. The % total time pH  64 4 [estimated pooled mean difference -0.08 (95% HPD -1.04-0.90)] and DeMeester score [estimated pooled mean difference 0.51 (95% HPD -0.90-1.94)] were comparable. Additionally, the operative time [estimated pooled mean difference 0.02 (95% HPD -0.53-0.52)] and iatrogenic esophageal perforation [pooled Risk Ratio 1.05 (95% HPD 0.52-2.10)] were similar in the two groups. Dor and Toupet fundoplication after laparoscopic Heller myotomy seem comparable in term of postoperative abnormal acid exposure and dysphagia. The choice of the partial fundoplication should be left to surgeon experience and tailored on each patient

Modulation by chronic stress and ketamine of ionotropic AMPA/NMDA and metabotropic glutamate receptors in the rat hippocampus

Converging clinical and preclinical evidence has shown that dysfunction of the glutamate system is a core feature of major depressive disorder. In this context, the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has raised growing interest as fast acting antidepressant. Using the chronic mild stress (CMS) rat model of depression, performed in male rats, we aimed at analyzing whether hippocampal specific changes in subunit expression and regulation of \u3b1-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) or NMDA ionotropic receptors and in metabotropic glutamate receptors could be associated with behavioral vulnerability/resilience to CMS. We also assessed whether acute ketamine (10 mg/kg) was able to dampen the alterations in CMS vulnerable animals. Although chronic stress and ketamine had no effect on ionotropic glutamate receptors mRNAs (expression, RNA editing and splicing), we found selective modulations in their protein expression, phosphorylation and localization at synaptic membranes. AMPA GluA2 expression at synaptic membranes was significantly increased only in CMS resilient rats (although a trend was found also in vulnerable animals), while its phosphorylation at Ser880 was higher in both CMS resilient and vulnerable rats, a change partially dampened by ketamine. In the hippocampus from all stressed groups, despite NMDA receptor expression levels were reduced in total extract, the levels of GluN2B-containing NMDA receptors were remarkably increased in synaptic membranes. Finally, mGlu2 underwent a selective downregulation in stress vulnerable animals, which was completely restored by acute ketamine. Overall, these results are in line with a hypofunction of activity-dependent glutamatergic synaptic transmission induced by chronic stress exposure in all the animals, as suggested by the alterations of ionotropic glutamate receptors expression and localization at synaptic level. At the same time, the selective modulation of mGlu2 receptor, confirms its previously hypothesized functional role in regulating stress vulnerability and, for the first time here, suggests a mGlu2 involvement in the fast antidepressant effect of ketamine

Elevated blood pressure, cardiometabolic risk and target organ damage in youth with overweight and obesity

Background and aim: To compare cardiometabolic risk profile and preclinical signs of target organ damage in youth with normal and elevated blood pressure (BP), according to the American Academy of Pediatrics (AAP) guidelines. Methods and results: This cross-sectional multicenter study included 2739 youth (5-17 year-old; 170 normal-weight, 610 overweight and 1959 with obesity) defined non hypertensive by the AAP guidelines. Anthropometric, biochemical and liver ultrasound data were available in the whole population; carotid artery ultrasound and echocardiographic assessments were available respectively in 427 and 264 youth. Elevated BP was defined as BP 65 90th to <95th percentile for age, gender and height in children or BP 65 120/80 to <130/80 in adolescents. The overall prevalence of elevated BP was 18.3%, and significantly increased from normal-weight to obese youth. Young people with elevated BP showed higher levels of body mass index (BMI), insulin resistance and a higher prevalence of liver steatosis (45% vs 36%, p < 0.0001) than normotensive youth, whilst they did not differ for the other cardiometabolic risk factors, neither for carotid intima media thickness or left ventricular mass. Compared with normotensive youth, individuals with elevated BP had an odds ratio (95%Cl) of 3.60 (2.00\u20136.46) for overweight/obesity, 1.46 (1.19\u20131.78) for insulin-resistance and 1.45 (1.19\u20131.77) for liver steatosis, controlling for centers, age and prepubertal stage. The odds for insulin resistance and liver steatosis persisted elevated after correction for BMI-SDS. Conclusion: Compared to normotensive youth, elevated BP is associated with increased BMI, insulin resistance and liver steatosis, without significant target organ damage

Time-dependent changes induced by acute stress in function and architecture of excitatory synapses in prefrontal and frontal cortex

Stressful life events impact on brain and bodily function and represent major risk factors for stress-related neuropsychiatric disorders. The response to stressful events can promote adaptive plasticity and improved cognition, when the physiological stress response is efficiently activated and inactivated in due time, or maladaptive and harmful effects, when the response is overused or dysregulated. In turn, the outcome of a maladaptive stress response can be associated with the triggering of brain, systemic and metabolic disorders. Chronic stress has been shown to induce reduction of density of synapses and dendrites in prefrontal and frontal cortex (PFC/FC), with concomitant impairments in neuronal activity and cognitive functions. Instead, the early and rapid effects of acute stress on synaptic function and plasticity are often opposite, with enhancement of glutamate release/transmission, increased number of spines and synapses, enhancement of synaptic strength. However, the delayed effects of acute stress have not been investigated, although this could give crucial information on the time- dependent changes in the brain stress response. We have previously characterized the synaptic effects of acute footshock (FS)-stress, which induces enhancement of glutamate release/transmission in PFC/FC, due to the increase of the readily releasable pool (RRP), in turn mediated by rapid non-genomic corticosterone action at synapses (Mol. Psy., 19:433-443, 2014). Here we have analyzed the effects of acute FS-stress in the PFC/FC of rats at different times after completion of the stress protocol. We found that acute stress induced early and sustained increase of RRP over time in excitatory perforated synapses, while the number of non-perforated and axo-spinous synapses was increased (without changes in vesicle pools). The total number of synaptic spines was increased up to 24 h, while apical dendrites showed decreased density 2 weeks after acute stress (with no significant changes at earlier times). In behavioral tests for working memory, FS-stress improved performance 2 h after stress and impaired it after 24 h. Changes in glutamate release, RRP, number of synapses and spines are blocked or attenuated by prior chronic treatment with the antidepressant desipramine. The different glutamatergic modifications in functional and morphological plasticity suggest a bi-phasic process, during which the stress response in PFC/FC may turn from early increased excitatory activation into its opposite. The identification of these points and the players involved in the switch are crucial for the understanding of the dynamics of stress-related pathology