THE COMPLEX INTERPLAY BETWEEN VITAMIN D DEFICIENCY AND DIABETES

It has been recently highlighted the link between vitamin D and metabolic and immunological pro- cesses, which established its role as an essential component of human health preservation. Vitamin D has been defined as natural immune modulators, and through the activation of its receptors (VDRs), it regulates calcium metabolism, cellular growth, proliferation and apoptosis, and other immunological functions. In this setting, vita- min D has also been reported to influence glucose regulation via effects on insulin secretion and action. Vitamin D deficiency is strongly associated with obesity mostly due to the storage of vitamin D in adipose tissue because of its lipophilic properties. The decrease in vitamin D levels may occur through several mechanisms such as a decrease in the calcium concentration, an increase in PTH, or a direct effect of vitamin D on worsening insulin resistance and secretion, augmenting the risk of developing type 2 diabetes. On the other hand, retrospective analysis and observational studies demonstrated high prevalence of vitamin D deficiency in patients with type 1 diabetes and suggested a contributory role in the pathogenesis of type 1 diabetes, specially with certain allelic variations of the VDR. Vitamin D supplementation during pregnancy and early childhood decreased the risk of autoimmune dia- betes and perhaps, even after the onset of diabetes, it may improve glycemic control. In addition, in subjects that are affected by a high risk of developing diabetes (impaired fasting glucose and/or glucose tolerance, possibly without obesity) vitamin D supplementation could be helpful on the prevention of type 2 diabete

Toward the strengthening of enabling technologies in Italy: results of the second survey on Procurement 4.0

Purpose of the paper: This paper presents the results of the second survey on Procurement 4.0 in Italy, focusing on the skills needed for digital transformation. Methodology: The study is conducted through an online questionnaire (CAWI), transmitted by ADACI via email to its members. The results are presented in a comparative format relative to the first survey developed in 2018. Results: The survey suggests that enabling technologies have evolved, at least in the larger companies, from an infancy phase to a real introduction phase with greater involvement of the procurement function, called to act as a gateway for innovation. Limitations: Our second survey has a low participation, though higher than the first. As with the COVID-19 pandemic, the role of enabling technologies in ensuring business continuity has been pushed to the fore, we hope that the third wave of the survey will involve more enterprises. Practical implications: This study provides useful information to researchers, policymakers, and practitioners also suggesting the most appropriate skills to invest in. The findings indicate a strong need for a new training paradigm toward a new integrated mindset. Originality of the paper: The surveys carried out in the framework of this research project are the first to be developed in Italy on Procurement 4.0. The results contribute to illuminating a phenomenon that remains underexplored. Through a university-business partnership, the study can feed decision-making processes at different levels to support the digital transformation of the Italian economic system

Injections Site Reactions and Biologics for Psoriasis: A Questionnaire Based Real Life Study

Background: Biologic selection for psoriasis treatment should take into account numerous factors including injection site reactions (ISRs) such as swelling at the injection site, pain, burning, erythema, all possibly reducing patient adherence. Methods: A 6-months observational real life study was performed involving psoriasis patients. Inclusion criteria were age ≥ 18 years, moderate-to-severe psoriasis diagnosis since at least 1 year, patients being on biologic treatment for psoriasis ≥ 6 months. A 14-item questionnaire was administered to all patients enrolled to assess whether the patient ever experienced ISRs after the injection of the biologic drug. Results: 234 patients were included: 32.5% received an anti-TNF-alpha drug, 9.4% received anti-IL12/23, 32.5% received an anti-IL17, 25.6% received an anti-IL23. 51.2% of study population reported at least one symptom related to ISR. 35.9% of patients experienced pain, 31.6% swelling, 28.2% burning sensation and 17.9% erythema. 3.4% of the surveyed population experienced anxiety or fear of the biologic injection due to ISRs symptoms. The greater incidence of pain was registered in anti-TNF-alpha and anti-IL17 groups (47.4% and 42.1%, p<0.01). Ixekizumab proved to be the drug with the highest rate of patients experiencing pain (72.2%), burning (77.7%) and swelling (83.3%). No patients reported biologics discontinuation or delay for ISRs symptoms. Conclusion: Our study highlighted that each different class of biologics for psoriasis was linked to ISRs. These events are more frequently reported with anti-TNF-alpha and anti-IL17

The Stromboli geophysical experiment. Preliminary report on wide angle refraction seismics and morphobathymetry of Stromboli island (Southern Tyrrhenian sea, Italy)based on integrated offshore-onshore data acquisition (cruise STRO-06 R/V Urania)

The Stromboli geophysical experiment, performed to acquire onshore and offshore seismic data through a combined on-land and marine network, was finalized to reconstruct the seismic tomography of the volcano and to investigate the deep structures and the location of magma chambers. A detailed swath bathymetry around the volcano has also been acquired by the R/V Urania Multibeam. In particular, high resolution bathymetry of the ’Sciara del Fuoco’ area allows to image the present-day seafloor setting of the area involved by the submarine slide of 2002-12-30. During the experiment wide angle refraction seismics was performed all around the Stromboli volcano by a 4 GI-GUN tuned array. The data were recorded by the permanent seismic network of the INGV and 20 temporary stations and 10 OBS deployed on the SE, SW and NE submerged flanks of the volcano after detailed morpho-bathymetric analysis

Intragastric balloon or diet alone? A retrospective evaluation

Background Very few studies have reported results of the BioEnterics Intragastnic Balloon (BIB (R)) at >= 12 months follow-up. The aim of this study is the retrospective evaluation of the results of BIB placement compared to diet regimen alone. Methods From January 2005 to June 2006, 130 outpatients, underwent a structured diet plan with simple behavioral modification at Our institutions. Controls (n=130) were selected from the charts of patients who, during the same period, underwent BIB treatment. Patients in the outpatient group were given a structured balanced diet with a caloric intake between 1,000 and 1,200. The approximate macronutrient distribution, according the "Mediterranean diet," was 25% protein (at least 60 g/day), 20-25% lipids, and 50-55%, carbohydrates. In the BIB group, patients received generic Counseling for eating behavior. In both groups, We considered weight loss parameters (kilograms, percentage of excess weight loss [%EWL], body mass index [BMI], percentage of excess BMI loss [%EBL]) at 6 and 24 months from baseline and comorbidities at baseline and after 24 months. Results are expressed as mean standard deviation. Statistical analysis was done by Student's t-test and chi(2)- test or Fisher's exact test. p <.05 was considered significant. Results At the time of BIB removal (6 months), significantly better results in terms of weight loss in kilograms (16.7 +/- 4.7 vs. 6.6 +/- 2.6; p < 0.01), BMI (35.4 +/- 11.2 vs. 38.9 +/- 12.1; p < 0.01), %EBL (38.5 +/- 16.1 Vs 18.6 +/- 14.3; p < 0.01), and %EWL (33.9 +/- 18 vs. 24.3 +/- 17.0; p < 0.01) were observed in patients treated by intragastric balloon as compared to diet-treated patients. At 24 months from baseline, patient dropout was 1/130 (0.7%) and 25/130 (19.2%) in the BIB and diet groups, respectively (p < 0.001). At this tirne, patients treated with intragastric balloon have tended to regain weight, whereas diet-treated patients have already regained most of lost weight. Conclusions Although the strength of this study may be limited by its retrospective design, the results indicate that, in the short-to-medium term, BIB is significantly superior to diet in terms of weight loss

Efficacy and safety of biologics and small molecules for psoriasis in pediatric and geriatric populations. Part II: focus on elderly patients

Introduction: The management of moderate-to-severe forms of psoriasis is becoming a frequent concern in geriatric age due to the higher risk to develop treatment adverse events, logistic issues, vulnerability to immune-related diseases and cancer, presence of comorbidities and the risk of drug interactions. In this context, traditional systemic treatments are often contraindicated, and biologic drugs and small molecules seem to be a valuable option. However, data on their effectiveness and safety in elderly patients are scant. Areas covered: The aim of this review is to analyze the current literature in order to point out data on the efficacy and safety of biologic drugs and small molecules for the management of psoriasis in elderly patients in order to put the basis for universally shared treatment algorithm following available evidence. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used for the literature research. Expert opinion/commentary: Our review suggests biologics and small molecules as an effective and safe option for the management of moderate-to-severe forms of psoriasis in elderly patients