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Policaptil Gel Retard® (PGR), is a new macromolecule complex based on polysaccharides slowing the rate of carbohydrate and fat absorption. It proved to significantly reduce body weight, acanthosis nigricans expression, HbA1c levels, and glucose metabolism abnormalities in obese, hyper-insulinemic adolescents. No such data are available for adults. to compare the effects of PGR vs. metformin in adult subjects with the Metabolic Syndrome (MS) and T2DM on a Low Glycemic Index diet. This spontaneous clinical, longitudinal, single-blind, randomized study based on a per-protocol analysis enrolled 100 outpatients with MS and T2DM consecutively referring to our clinic for three months, and randomly assigned to either the active treatment (Group A :, 6 tablets/day) or the comparator (Group B : Metformin tablets, 1500–2000 mg/day in two divided doses during the two main meals, to minimize side effects) to be taken 30 min before each main meal in equally divided doses. Serum lipid profile, anthropometry, HOMA-IR index, and tolerability parameters were evaluated before and after a 6-month follow-up period. all parameters improved at a similar rate in both groups but for the lipid profile, which got even better in Group A. Group A also experienced less prominent gastrointestinal side effects than its counterpart. For the first time, we showed the non-inferiority of PGR compared to metformin in obese adult subjects with the MS and T2DM as for glycemic control and a clear-cut superiority of PGR in terms of both serum lipid-lowering capacity and tolerability. • Treatment of metabolic syndrome needs more drugs this makes adherence to treatment worse. • Metformin is the most widely used drug for glycemic control but its gastrointestinal side effects are well known. • Policaptil gel retard is a medical device made of substances (MDMS), reducing plasma glucose and body weight. • Policaptil gel retard is proposed as a useful alternative to metformin in the treatment of metabolic syndrome. [ABSTRACT FROM AUTHOR]

Belief, according to many philosophers, aims at truth. In this paper I discuss in what measure a pluralist conception of truth is compatible with this claim. In particular, I argue that if the idea is understood according to a teleological account, alethic pluralism can be adopted also in a strong form. I contend that while the teleological account of belief requires a generic concept of truth, it poses a few constraints on the property (or the properties) of truth. By contrast, at least a moderate version of alethic pluralism is commanded by a normativist interpretation of the aim. [ABSTRACT FROM AUTHOR]

Italian coastal urban development is a problem which requires measures to contain land consumption and a continuous monitoring action on the phenomenon, especially in those areas where the tendency to consume land is high. Two of the major limitation in achieving full awareness of the phenomenon are the lack of common European policies and land consumption definition issues In this study the aim is to analyse the evolution of land consumption occurred in the Italian coastline on a diachronic basis (2012- 2018). We used the National Land Consumption Map, produced by ISPRA yearly covering all the Italian territory, adopting a proper definition of what is meant to be consumed. Moreover, the phenomenon is assessed showing its relation to the distance from the coastline, morphological typologies, administrative boundaries and protected areas, in order to identify consumption patterns and highlight particular areas most frequently affected by land consumption. This study finds consumed land is increasingly distributed within 100 meters from the coastline, with different peaks and trends. At the same time new changes increase proportionally to the distancing from the coast. This is partially argued with the saturation, already built, of the territory between 0 and 200 meters, that constitutes a major spatial constraint. The relationship between the phenomenon and the distance from the coastline, connotes a characteristic feature at regional level Through a set of finalised indicators, distinctive pattern of the evolution occurred have been analytically highlighted, showing that density of changes is more intense between 300 and 500 meters, in the first unrestricted portion of land. The level of detail allows to provide a useful database as an effective support for territorial policies and planning, with the aim of preserving the coastal landscape and increasing awareness of the finiteness of the soil resource, a true challenge, that in a medium-long term, with required organized and coordinated interregional policies can be tackled in its various issues. [ABSTRACT FROM AUTHOR]

Our recent data document that a low glycemic index (LGI) Neapolitan pizza prepared with a mix of Kamut and whole wheat flours plus Glucomannan, (i) has a lower impact on postprandial hyperglycemic spikes than pizza made of whole wheat flour, (ii) is pleasant and appreciated as traditional one and (iii) does not cause any gastro-intestinal troubles. The aim of our study was to describe the validation process underlying the identification of the right mix of those elements for a LGI pizza preventing gastro-intestinal disturbances. we described all procedures followed to make good products with different combinations of the three components and a series of tests made by four well-experienced professional pasta-making masters, one nutritionist, five diabetologists, one nurse and twenty volunteers with T1DM. we could identify the best workable and most suitable flour mix to achieve both pleasant taste and low glycemic impact proving to be efficient in real-life twin paper providing results from diabetic patients. this kind of food will certainly help people with diabetes eat pizza without risking any serious deterioration of their own glucose control while fully enjoying socially active life. • Widespread pizza consumption causes sustained hyperglycemia in people with diabetes (DM). • Low glycaemic index (LGI) flour pizzas proposed so far to overcome this problem taste bad. • The LGI pizza we developed could encourage DM patients to enjoy both socialization and taste. • We provide details on how to successfully prepare it from a mix of flours and glucomannan. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Due to the risk of hypoglycennia-related incapacitation, diabetic pilots requiring insulin are assessed as unfit according to the International Civil Aviation Organization and most national authorities. Some authorities, such as those from Canada, the United Kingdom, and the United States, permit selected insulin-treated pilots (ITDM-pilots) to fly subject to a protocol requiring pre-and in-flight capillary glucose measurements to show/safe levels (>100-<300 mg⋅dl-1). Critics of such permission question the practicability of these in-flight measurements and whether clinically desired glycemic targets can be achieved while keeping glucose levels in the safe range. Subcutaneous continuous glucose monitoring (CGM) has recently been approved by the FDA as a stand-alone method to provide accurate glucose levels and treatment decision guidance in patients. This commentary considers that use of CGM by ITDM pilots facilitates practicability and recording of in-flight glucose measurements and facilitates achievement of clinically desired glycemic targets without increasing hypoglycemia risks. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus (DM) is the most common cause of renal failure and ESRD all over the world, and often requires an individualized insulin treatment regimen. Malnutrition, depression-related eating behavior changes, high on-off-dialysis day-to-day glycemic variability and frequent hypoglycemic events occurring during or immediately after dialysis make it hard to identify best insulin dosage in hemodialyzed patients. This suggests a prudent attitude including non-stringent control, despite which repeated hypoglycemia quite often occurs in such patients. When looking for possible sources of hypoglycemia, health professionals too often overlook the identification of skin lipodystrophy (LD) due to an incorrect insulin injection technique. This mini-review focuses on the high frequency (57%) of LD in a cohort of 1004 insulin-treated people with DM on dialysis consecutively referring to our joint medical centers, and on its relationship with hypoglycemia and glycemic control/variability. When taking on such patients, care team members accept to face a complex disease burdened with several risk factors requiring high professional skills, and have to keep in mind also the possible presence of any LD areas eventually interfering with expected results. A timely educational intervention on the correct injection technique can help reduce the high risk of hypoglycemia and large glycemic variability in dialysed people with DM. [ABSTRACT FROM AUTHOR]

• Exercise improves diabetes mellitus (DM) outcomes not only in terms of metabolic control but also of chronic complication management and patients' quality of life. • Most doctors lack education on the effects of exercise features on glucose metabolism and can therefore lend their patients poor specifìc support. • International guidelines stick to a prudent attitude as well, by suggesting people with diabetes to adopt a "trial and error" method. • Research progress and our own personal long-lasting experience prompted us to define exercise related care pathways suited to separately analyzed T1DM and T2DM. • Our aim is to provide both specialists and patients with a handy personalized therapeutic exercise realization-verification toolbox. [ABSTRACT FROM AUTHOR]

Abstract Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is unrecognized in as high as 80% of patients before surgery. When untreated, OSA increases a surgical patient's propensity for airway collapse and sleep deprivation lending to a higher risk for emergent re-intubation, prolonged recovery time, escalation of care, hospital readmission, and longer length of stay. We have reviewed the evidence regarding diagnostic performance of OSA screening methods and the impact of perioperative management strategies on postoperative complications among patients with diagnosed or suspected OSA who are undergoing orthopedic surgery. We then integrated the data and recommendations from professional society guidelines to develop an evidence-based clinical care pathway to optimize the perioperative management of this surgical population. Successful management of patients with diagnosed or suspected OSA encompass five facets of care: screening, education, airway management, medications, and monitoring. This narrative review revealed two gaps in the evidence to inform management of patients undergoing orthopedic surgery 1) during the perioperative setting to include evidence-based interventions that reduce postoperative complications and 2) after discharge to an unmonitored environment. The clinical care pathway as well as perspectives for future research are discussed. [ABSTRACT FROM AUTHOR]

Il «confinamento» con o senza isolamento, specie quando le esigenze dei nuovi programmi comporteranno praticamente un aumento della durata dei voli spaziali, rappresenta uno dei fattori suscettibili di influenzare l'efficienza e l'integrità del cosmonauta alla stregua delle accelerazioni, della subgravità, delle radiazioni nocive, per due principali motivi:— la ristrettezza dell'abitacolo riservato all'uomo;- l'allontanamento dal globo terrestre.Tali ragioni hanno suggerito il ricorso alla preliminare sperimentazione onde poter documentare obiettivamente le possibilità ed i limiti di tolleranza umana nonché mettere in evidenza e studiare le preminenti caratteristiche che favoriscono una maggiore adattabilità.A tale scopo l'A. ha condotto, presso il Centro Studi e Ricerche di Med. Aer. e Sp. di Roma, due gruppi di indagini, uno precedente e l'altro successivo all'Aprile 1961, momento cioè che inaugura il vero volo spaziale umano.Servendosi nel primo gruppo di 10 volontari, per una durata massima di 2 giorni, e nel secondo di 70 non volontari, per una durata massima di 6 ore, egli ha studiato, con particolari accorgimenti tecnici, le manifestazioni del comportamento e i tratti della personalità.

Opposed to whole wheat (WWP), traditional pizza (TP) is loved by patients with type 1 diabetes mellitus (T1DM) despite causing hyperglycemia. 50 well-trained T1DM patients had higher glucose levels after TP than after WWP or mixed flour pizza, which however was tasty, digestible and metabolically appropriate to break diet monotony. Image 1 • Consumption of traditional pizza causes high post meal glucose levels in patients with diabetes, especially those with type 1 disease. • Traditional pizza causes high post meal glucose levels in type 1 diabetes disease. 50 patients with type 1 diabetes, we compared effects of refined (traditional), whole wheat and mixed flour pizzas. • The latter two varieties cause lower glucose post meal hyperglycemia, and also have a pleasant taste. [ABSTRACT FROM AUTHOR]

Lipohypertophy (LH) is the most common skin complication of incorrect injection technique which does not only represent an aesthetic defect but also severely disrupts insulin pharmacokinetics/pharmacodynamics. As a consequence of that, hormone release is delayed and unexplained/unpredictable hypoglycemia occurs, both deteriorating metabolic control while negatively affecting adherence to treatment and quality of life. The economic burden due to unwanted intra-LH injections is accounted for by inappropriately high insulin requirements, increased emergency-related hospitalizations, and loss of work days. Greater attention has to be paid by diabetes care teams to education programs with periodic refreshers to achieve better metabolic control and reduce the economic burden of diabetes. [ABSTRACT FROM AUTHOR]

We are hereby reporting on a woman with type 1 diabetes getting insulin, 4 shots a day, and referring to us for an episode of severe hypoglycemia occurred after vigorously rubbing a lipo-hypertrophy (LH). She had always injected insulin into an abdominal LH area but had never suffered from any hypoglycemic event (Hypo) during the last period. Nevertheless her history included frequent Hypos, mostly mild-to-moderate but sometimes severe and eventually ending into unconsciousness and her glycemic control was poor (HbA1c 8.3%, mean FPG 161 ± 22 mg/dl, mean PPG 218 ± 51 mg/dl, glycemic variability (106 ± 44 mg/dl). In fact, all of a sudden she rubbed vigorously the LH area trying to get rid of the abdominal skin thickening and soon after a severe Hypo occurred causing her to need for emergency medical assistance. When back at home, she corrected her technique and carefully refrained from inject insulin into the LH so that after six months the lesion disappeared, glycemic control improved and no Hypo occurred any more. Based on the recent publication reporting on a woman with a large LH consisting of thickened skin surrounding some fluid containing insulin at concentrations 13 fold those in blood, we hypothesize that such severe depended on massive insulin release from rubbed skin stores into the blood stream. [ABSTRACT FROM AUTHOR]

• Immune checkpoint inhibitors (ICIs) are correlated with immune-related adverse events (irAEs) that may potentially affect all host tissues. • The effects of ICIs on the skeleton are poorly investigated, thus we evaluated the changes of specific markers of bone resorption and formation. • We found an increase of type I collagen C-terminal telopeptide (CTX-I) levels after 3 months of ICIs treatment with a concomitant reduction of N -terminal propeptide of type I procollagen (PINP) levels with a trend toward statistical significance. • CTX-I increase was also associated with poor prognosis in terms of treatment response and survival. Immune checkpoint inhibitors (ICIs) has revolutionized the treatment of different advanced solid tumors, but most patients develop severe immune-related adverse events (irAEs). Although a bi-directional crosstalk between bone and immune systems is widely described, the effect of ICIs on the skeleton is poorly investigated. Here, we analyze the changes in plasma levels of type I collagen C-terminal telopeptide (CTX-I) and N -terminal propeptide of type I procollagen (PINP), reference makers of bone turnover, in patients treated with ICIs and their association with clinical outcome. A series of 44 patients affected by advanced non-small cell lung cancer or renal cell carcinoma, without bone metastases, and treated with ICIs as monotherapy were enrolled. CTX-I and PINP plasma levels were assessed at baseline and after 3 months of ICIs treatment by ELISA kits. A significant increase of CTX-I with a concomitant decreasing trend towards the reduction of PINP was observed after 3 months of treatment. Intriguingly, CTX-I increase was associated with poor prognosis in terms of treatment response and survival. These data suggest a direct relationship between ICIs treatment, increased osteoclast activity and potential fracture risk. Overall, this study reveals that ICIs may act as triggers for skeletal events, and if confirmed in larger prospective studies, it would identify a new class of skeletal-related irAEs. [ABSTRACT FROM AUTHOR]

Unstable (cyclical alternating pattern, or CAP) sleep is associated with surges of sympathetic nervous system activity, increased blood pressure and vasoconstriction, heightened baroreflex sensitivity, and unstable heart rhythm and breathing. In susceptible persons, CAP sleep provokes clinically significant events, including hypertensive crises, sleep-disordered breathing, and cardiac arrhythmias. Here we explore the neurophysiology of CAP sleep and its impact on cardiovascular and respiratory functions. We show that: (i) an increase in neurophysiological recovery rate can explain the emergence of slow, self-sustained, hypersynchronized A1 CAP-sleep pattern and its transition to the faster A2-A3 CAP-sleep patterns; (ii) in a two-dimensional, continuous model of cardiac tissue with heterogeneous action potential duration (APD) distribution, heart rate accelerations during CAP sleep may encounter incompletely recovered electrical excitability in cell clusters with longer APD. If the interaction between short cycle length and incomplete, spatially heterogeneous repolarization persists over multiple cycles, irregularities and asymmetry of depolarization front may accumulate and ultimately lead to a conduction block, retrograde conduction, breakup of activation waves, reentrant activity, and arrhythmias; and (iii) these modeling results are consistent with the nighttime data obtained from patients with structural heart disease (N=13) that show clusters of atrial and ventricular premature beats occurring during the periods of unstable heart rhythm and respiration that accompany CAP sleep. In these patients, CAP sleep is also accompanied by delayed adaptation of QT intervals and T-wave alternans. [ABSTRACT FROM AUTHOR]