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Additional file 1: Table S1. Persons with diabetes per country in various years. Table S2. Persons with type 1 diabetes per country in various years. Absolute prevalence. Table S3. Glucagon sales (any type, millions of units) in 2019-2021 in countries where new ready-to-use glucagons were or were not available in 2019-2021. Only retail data are considered. Totals and mean ± SD are reported. On the left: sales in countries where new drugs were (Group A) or were not (Group B) available in 2019-2021. On the right: sales in the same countries when new drugs are not considered. Table S4. Glucagon units (any type) by country. Totals and mean ± SD. Retail and hospital sales are considered together. Table S5. Commercial sales of glucagon formulations (any type) by country. Retail and hospital sales are considered together. Figure S1. Persons with type 1 diabetes and glucagon sales (any type, millions of units) in years 2014-2019.Figure S2. Persons with type 1 diabetes and glucagon sales (any type, millions of units) in year 2021; comparison between data on prevalence of type 1 diabetes according to IDF Atlas and to the recent paper (Lancet Diabetes Endocrinol 2022; 10:741).

Physisorption of hydrogen in nanoporous materials offers an efficient and competitive alternative for hydrogen storage. At low temperatures (e.g. 77 K) and moderate pressures (below 100 bar) molecular H2 adsorbs reversibly, with very fast kinetics, at high density on the inner surfaces of materials such as zeolites, activated carbons and metal–organic frameworks (MOFs). This review, by experts of Task 40 ‘Energy Storage and Conversion based on Hydrogen’ of the Hydrogen Technology Collaboration Programme of the International Energy Agency, covers the fundamentals of H2 adsorption in nanoporous materials and assessment of their storage performance. The discussion includes recent work on H2 adsorption at both low temperature and high pressure, new findings on the assessment of the hydrogen storage performance of materials, the correlation of volumetric and gravimetric H2 storage capacities, usable capacity, and optimum operating temperature. The application of neutron scattering as an ideal tool for characterising H2 adsorption is summarised and state-of-the-art computational methods, such as machine learning, are considered for the discovery of new MOFs for H2 storage applications, as well as the modelling of flexible porous networks for optimised H2 delivery. The discussion focuses moreover on additional important issues, such as sustainable materials synthesis and improved reproducibility of experimental H2 adsorption isotherm data by interlaboratory exercises and reference materials.

Purpose: Bariatric surgery (BS) is considered the most efficient treatment for severe obesity. International guidelines recommend multidisciplinary approach to BS (general practitioners, endocrinologists, surgeons, psychologists, or psychiatrists), and access to BS should be the final part of a protocol of treatment of obesity. However, there are indications that general practitioners (GPs) are not fully aware of the possible benefits of BS, that specialty physicians are reluctant to refer their patients to surgeons, and that patients with obesity choose self-management of their own obesity, including internet-based choices. There are no data on the pathways chosen by physicians and patients to undergo BS in the real world in Italy. Methods: An exploratory exam was performed for 6 months in three pilot regions (Lombardy, Lazio, Campania) in twenty-three tertiary centers for the treatment of morbid obesity, to describe the real pathways to BS in Italy. Results: Charts of 2686 patients (788 men and 1895 women, 75.5% in the age range 30–59 years) were evaluated by physicians and surgeons of the participating centers. A chronic condition of obesity was evident for the majority of patients, as indicated by duration of obesity, by presence of several associated medical problems, and by frequency of previous dietary attempts to weight loss. The vast majority (75.8%) patients were self-presenting or referred by bariatric surgeons, 24.2% patients referred by GPs and other specialists. Self-presenting patients were younger, more educated, more professional, and more mobile than patients referred by other physicians. Patients above the age of 40 years or with a duration of obesity greater than 10 years had a higher prevalence of all associated medical problems. Conclusions: The majority of patients referred to a tertiary center for the treatment of morbid obesity have a valid indication for BS. Most patients self-refer to the centers, with a minority referred by a GP or by specialists. Self-presenting patients are younger, more educated, more professional, and more mobile than patients referred by other physicians. Older patients and with a longer duration of obesity are probably representative of the conservative approach to BS, often regarded as the last resort in an endless story. Graphical abstract: [Figure not available: see fulltext.]

Aims Bariatric surgeries induce profound weight loss (decrease in body mass index, BMI), through a decrease in fat mass (FM) and to a much lesser degree of fat-free mass (FFM). Some reports indicate that the weight which is lost after gastric bypass (RYGB) and sleeve gastrectomy (SG) is at least partially regained 2 years after surgery. Here we compare changes in BMI and body composition induced by four bariatric procedures in a 5 years follow-up study. Methods We analyzed retrospectively modifications in BMI, FM and FFM obtained through Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD) and a long common limb revisional biliopancreatic diversion (reduction of the gastric pouch and long common limb; BPD + LCL−R). Patients were evaluated at baseline and yearly for 5 years. Of the whole cohort of 565 patients, a subset of 180 patients had all yearly evaluations, while the remaining had incomplete evaluations. Setting University Hospital. Results In a total of 180 patients evaluated yearly for 5 years, decrease in BMI and FM up to 2 years was more rapid with RYGB and SG than BPD and BPD + LCL−R; with RYGB and SG both BMI and FM slightly increased in the years 3–5. At 5 years, the differences were not significant. When analysing the differences between 2 and 5 years, BPD + LCL−R showed a somewhat greater effect on BMI and FM than RYGB, BPD and SG. Superimposable results were obtained when the whole cohort of 565 patients with incomplete evaluation was considered. Conclusions All surgeries were highly effective in reducing BMI and fat mass at around 2 years; with RYGB and SG both BMI and FM slightly increased in the years 3–5, while BPD and BPD + LCL−R showed a slight further decreases in the same time interval.

Severe COVID-19 is characterized by overproduction of immune mediators, but the role of interferons (IFNs) of the type I (IFN-I) or type III (IFN-III) families remains debated. We scrutinized the production of IFNs along the respiratory tract of COVID-19 patients and found that high levels of IFN-III, and to a lesser extent IFN-I, characterize the upper airways of patients with high viral burden but reduced disease risk or severity. Production of specific IFN-III, but not IFN-I, members, denotes patients with a mild pathology and efficiently drives the transcription of genes that protect against SARS-CoV-2. In contrast, compared to subjects with other infectious or non-infectious lung pathologies, IFNs are over-represented in the lower airways of patients with severe COVID-19 that exhibit gene pathways associated with increased apoptosis and decreased proliferation. Our data demonstrate a dynamic production of IFNs in SARS-CoV-2-infected patients and show IFNs play opposing roles at distinct anatomical sites., An in-depth analysis of interferons in COVID-19 reveals differences in their roles based on anatomical location, viral load, age and disease severity. In the upper respiratory tract, high levels of IFN-III are protective and result in mild disease in spite of higher SARS-CoV-2 viral burden while the lower airways of patients with severe COVID-19 demonstrate elevated IFN-I and III, cell death and a reduction in interferon stimulated genes.

A 53–year–old woman presented herself at our center for the appearance of oppressive chest pain radiating to the upper limbs associated with cold sweat, which arose in resting conditions. The patient had as cardiovascular risk factors tobacco habits and an important family history of cardiovascular diseases (father died of AMI at a young age) and had entered menopause for some months. The ECG showed signs of anterior transmural ischemia (Figure 1a) with corresponding echocardiographic kinetic abnormalities of the cardiac apex (EF 40%). The patient underwent an emergency coronary angiography documenting an intramyocardial bridge with evident systolic squeezing of the vessel in the proximal–middle section of the anterior descending artery and normal appearance of the remaining coronary tree (Figure 2). She was subjected to infusion of intracoronary nitrates with improvement of the instrumental picture and on that occasion it was opted for medical therapy alone with double antiplatelet therapy and low–dose calcium antagonist. On the second day after the diagnostic procedure, there was a recurrence of anginal symptoms with evidence on the ECG of anterolaterally reversed T waves (figure 1b). The patient underwent a new coronary angiography, IVUS–guided, with documentation of probable intramural hematoma in the absence of non–flow–limiting dissection image with an area of 7 mm² (Figure 3). During the subsequent hospitalization, the patient remained asymptomatic with stable ECG tracing, but telemetry revealed ventricular tachyarrhythmias for which beta–blocker therapy was optimized with improvement of the arrhythmic burden. The pre–discharge echocardiogram showed improvement of cardiac kinesis with resumption of systolic function (EF 48%). The patient was discharged stable and asymptomatic with follow–up at our dedicated ischemic heart disease clinic. This case report is an example of an infrequent cause of acute coronary syndrome, of non–atherosclerotic origin, to be considered in clinical practice.

Medium-temperature fluoroalkylation of microporous activated carbons (ACs) with 1,1,1,2-tetrafluoroethane is presented. Supercapacitor (SC) electrodes based on the fluoroalkylated ACs showed enhanced specific capacitance and high specific energy in electrolytes, either aqueous potassium hydroxide solution or tetraethylammonium tetrafluoroborate-acetonitrile solution. We found the largest increase in the specific capacitance, up to 89 F g–1, and in the specific energy, up to 7.5 Wh kg–1, at the voltage of 1.5 V. The specific capacitance of the SC electrode based on the sample prepared at 350 °C increases by a factor of ~ 2–3 × for certain scan rates in the organic electrolyte. The fluoroalkylated ACs have good electrochemical stability in the tested model systems. We associate the registered enhanced SC parameters with an increase in the total fluorine content and high specific surface areas of the carbon electrode materials. The surface “isolated fluorine” formed during fluoroalkylation at 300–400 °C ensures the production of improved electrode materials for SC applications. Fluoroalkylation is a simple and cost-effective method of improving the specific capacitance of carbon-based SC electrodes.

The prevalence of heart failure in the population and the COVID pandemic have rendered increasingly necessary the integration of remote monitoring with cardiology teleconsultation. A patient with dilated cardimiopathy was subjected to ICD implantation (Boston Scientific Perciva DR) with remote monitoring (LatitudeTM). One month after implant, remote monitoring recorded an increase in the HeartLogicTM heart failure index, a decrease of right ventricular and atrial sensing, contextually to fluctuations of the impedance values of the two leads (Fig. 1). The patient reported having performed shoulder’s rehabilitation therapy with probable manipulation of the ICD pocket. Chest X–ray showed dislocation of both leads with distal end of right atrial catheter in superior vena cava and distal end of right ventricular catheter in right atrium (Fig. 2A) and kinking of proximal segments (Fig. 2B), a picture compatible with diagnosis of Twiddler‘s syndrome. Implant revision confirmed lead kinking in the subcutaneous pocket (Fig. 3A). The atrial catheter, given the amount of tissue deposited at its distal end (Fig.3B) which prevented its active fixation, was replaced. Following discharge, an increase in the HeartLogicTM Heart Failure Index was detected. The outpatient visit showed the presence of pleural effusion and medical therapy was therefore optimized. In order to avoid frequent ambulatory visits to the patient, a cardiology teleconsultation was planned, which enabled to verify the clinical benefit of therapy’s variation. Remote device monitoring confirmed HeartLogicTM Heart Failure Index normalization. In conclusion, the integration of remote monitoring with cardiology teleconsultation, enables to timely detect device malfunctions and prevent episodes of heart failure, avoiding further hospitalizations. This integration is even more useful and necessary in geographically disadvantaged areas, strengthening the link between the territory and the hospital, improving patients compliance and therapeutic adherence and thus allowing a progressive improvement of the symptoms and quality of life of heart failure patients.

Compared to medical treatment, bariatric surgery reduces long-term mortality in persons with obesity. Some studies indicate that the effect only applies to patients above median age of cohorts, not to younger patients. Our objective was to assess the role of age in the reduction of mortality (global mortality and mortality for specific causes) through bariatric surgery. Data sources: PubMed, Cochrane Library, MEDLINE, and Embase. Study selection: studies reporting mortality in relation to median age of patients. Data extraction and synthesis: pooled random effects of estimates of the risk of mortality in participants undergoing surgery compared with controls, as function of median age. Mortality was lower in patients undergoing surgery than in controls (OR = 0.29, 95% CI 0.17–0.49). Below median age, the difference between surgery patients and controls was nonsignificant (OR = 0.78, 95% CI 0.57–1.06). Above median age, the difference was significant (OR = 0.23, 95% CI 0.12–0.44). In a subset of 5 studies, deaths due to various causes were less, and external causes-related deaths were more frequent in surgery than in controls. Below median age, deaths due to CVD were less frequent in surgery than in controls. Above median age, total deaths and deaths due to various causes (cardiovascular, diabetes, cancer, and other causes) were less in surgery than in controls. Publication bias was absent. Compared with controls, bariatric surgery reduces long-term global mortality only above median age, not below median age. Also mortality due to specific causes is mainly reduced in persons above median age.

Glucagon is used to resolve severe hypoglycemia in unconscious patients with diabetes, requiring third-party assistance. A few studies have shown that intranasal (IN) glucagon causes resolution of hypoglycemia in insulin-treated patients with type 1 (T1DM) diabetes. This systematic review and meta-analysis updates the comparison of the effectiveness of IN glucagon with injected intramuscular/subcutaneous (IM/SC) glucagon in treatment of hypoglycemia in T1DM. Controlled randomized studies were considered; eight studies, published in English, were included in a meta-analysis (random-effects model). Intervention effect (resolution of hypoglycemia) was expressed as odds ratio (OR), with 95% confidence intervals. Meta-regression was employed to correlate the effect with size of studies, age of patients, basal blood glucose levels. In a total of 467 treatments in 269 patients with IN and IM/SC glucagon, the OR IN versus IM/SC was 0.61 (CI 0.13–2.82); since four of eight studies showed 100% effectiveness, a simulation was made with 1 failure for each treatment; in this simulation analysis, the OR was 0.80 (95% CI 0.28–2.32). Heterogeneity was low and not statistically significant. Publication bias was absent, and quality of papers was high. At meta-regression, no correlation was found between the effect and number of patients in each study, age of patients, basal blood glucose levels. No study formally compared IN versus IM/SC in unconscious patients. This meta-analysis indicates that in conscious T1DM patients IN glucagon and IM/SC glucagon are equally effective in resolution of hypoglycemia.

Thermal exfoliation of graphite oxide is a scalable way to produce macroscopic amount of defective graphene-based compounds with high specific surface area, ideal as electrode materials in high-performance electrochemical supercapacitors. In order to increase the stored energy, defective graphene has been decorated with Ni nanoparticles without exposing the system to air. During the first charge cycle in an aqueous electrolyte (KOH 3.5M), Ni anchored to graphene proved to easily convert to Ni(OH)2 at the nanoscale and hence to reversibly assume Ni2+ and Ni3+ valence during cyclic voltammetry, through its conversion to NiOOH. Such reversible faradaic mechanism led to a one order of magnitude increase of the specific capacitance of electrodes, reaching up to 1900 F/g at 2 mV/s in KOH 3.5M. An asymmetric supercapacitor was obtained by coupling a pure graphene negative electrode with a Ni decorated graphene positive one. The supercapacitor, operating with aqueous electrolyte, was successfully cycled in the 0-1.5 V voltage range, reaching a maximum specific energy of 37 Wh/kg and a maximum specific power of 5 kW/kg. The devices displayed good reversibility and retained 72 % of the specific energy over 10 thousand of cycles. Such promising results disclose to possible industrial implementation of graphene-based supercapacitors, for a wide range of energetic application.

In this work, we prepared biochar from rice husks (RH) by pyrolysis and subsequently we activated it by chemical treatment with a KOH ratio of 2: 1. The samples were characterized by Thermogravimetric Analysis (TGA), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), Scanning Electron Microscopy (SEM), Energy-dispersive X-ray (EDX) spectroscopy, and porosimetry by Brunauer, Emmett and Teller method (BET). The results revealed that RH biochar activated by KOH had a considerable increase in specific surface area and pore volume suitable for hydrogen storage. It is interesting to note that the hydrogen storage capacity of 2.3 wt.% was observed at 77K/6 bars. As a result, activated carbon derived from RH can be used in hydrogen storage, and therefore RH can be converted into a high value-added product in the energy storage field., Proceedings of the 30th European Biomass Conference and Exhibition, 9-12 May 2022, Online, pp. 895-901

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Background. Overweight and obesity are associated with atrial fibrillation (AF), and bariatric surgery (BS), able to induce sustained and prolonged weight loss, might represent the ideal treatment in the prevention of AF. Previous studies could not definitely establish a role for weight loss and BS in preventing incident AF so far. During the last few years, several studies on the effect of bariatric surgery on cardiovascular diseases have been published, and we performed a systematic review and meta-analysis to evaluate the role of weight loss through BS in the prevention of incident AF in obesity. Methods. This meta-analysis followed the PRISMA guideline. Eligible studies were controlled trials evaluating the appearance of atrial fibrillation in patients undergoing weight loss through BS as compared with patients receiving medical treatment. Quality of studies was assessed according to the Newcastle-Ottawa Quality Assessment Scale, and risk-of-bias was evaluated employing the Egger’s test. All analyses were run by a random-effects model according to Hartung and Knapp and sensitivity analyses were performed. Heterogeneity was assessed through Q and I2 statistics for each comparison, and potential publication bias was formally investigated. Results. Ten studies were included in the meta-analysis, and the overall result was statistically significant [OR = 0.665 (0.475–0.929), p = 0.017], with significant heterogeneity (Q = 48.98, p < 0.001; I2 = 81.6%), but with no publication bias. In sensitivity analyses, the amount of weight loss, percentage of patients with diabetes and value of the Newcastle-Ottawa Quality Assessment Scale, were all associated with significance of effect. Since age was different in one study, a sensitivity analysis was performed by excluding this study; OR was similar [OR = 0.608 (0.454–0.814), p < 0.001]; heterogeneity was reduced but still significant (Q = 35.74, p < 0.001, I2 = 77.6%) and again no publication bias was detected. Conclusions. Bariatric surgery as compared to medical treatment is associated with reduced appearance of incident AF.