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Tirzepatide (TZP) is a new anti-obesity drug, and little is currently known about its effect on body composition (BC) in people with overweight or obesity. The aim of this study is to conduct a systematic review on the impact of TZP on BC compartments in this population during weight loss programs. Literature searches, study selection, method development, and quality appraisal were performed. The data were synthesized using a narrative approach, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of the 1379 papers retrieved, 6 randomized controlled trials met the inclusion criteria and were reviewed, revealing the following findings. Firstly, TZP was shown to result in a significant reduction in total fat mass (FM), visceral adipose tissue (VAT) and waist circumference (WC) between baseline and short as well as intermediate follow-ups. Compared to other anti-obesity medications (e.g., dulaglutide and semaglutide) taken over the same duration, TZP showed a superior decrease in body fat compartments (i.e., total FM, VAT and WC). Finally, the effect of TZP on fat-free mass (FFM) is still uncertain because the findings remain inconclusive. In conclusion, TZP appears to be an effective strategy for achieving significant improvements in body fat and its distribution, but additional investigations are still needed to determine the impact of TZP on lean mass in this population.

The COVID-19 pandemic caused abrupt and profound changes to teaching and learning. The present study seeks to understand adolescents' experiences of the emergency adoption of online school learning (OSL) during the first national lockdown in Italy. Sixty-four students in their final two years of high school were interviewed and content analysis was performed. The findings describe students' views of the changes related to OSL according to structural, individual and relational dimensions. Schools' lack of organization, overwhelming demands, as well as experience of difficulties in concentration, stress and inhibited relationships with teachers and classmates were among the challenges evidenced in the transition. OSL, however, has also made it possible to experience a new flexibility and autonomy in the organization of learning. The study stresses the importance of fostering adaptation of teacher-student relationships and collaborative learning in order to improve schools' preparedness for digital transitions in and out of emergencies., Author(s): Iana Tzankova [sup.1] , Christian Compare [sup.1] , Daniela Marzana [sup.2] [sup.3] , Antonella Guarino [sup.1] , Immacolata Di Napoli [sup.4] , Alessia Rochira [sup.5] , Emanuela Calandri [sup.6] [...]

The SS precursor signals are a powerful tool for mapping topography of mantle discontinuities, which are sensitive to the thermal and compositional structure of the mantle. The depth of mantle discontinuities is usually estimated using the differential travel time between the main arrival and its precursor. However, this method ignores potential travel path deviations that influence the travel time of precursor signals. Here, we use an approach that considers directivity information as well as travel‐time measurements. Applying seismic array techniques, we measure slowness, back azimuth, and travel time of the signals, and use this information to backproject to the point of reflection. In our test dataset, we observe deviations from the predicted values in slowness and back azimuth in the range of 0.1–2.3 s/° and 1–20°, respectively. These values lead to reflection locations that can differ considerably from theoretical reflection points calculated with great circle plane paths as well as depths different from the depth calculated for in‐plane propagation, with differences up to ∼150 km. Our results indicate that the travel‐path deviations should be considered to avoid misinterpretation of mantle discontinuities and potentially reduce previously observed scatter in discontinuity depth.

A 44-year-old athletic man presented in 2009 with severe low back pain. Dual-energy x-ray absorptiometry revealed severe osteoporosis; serum testosterone was 189 ng/dL while serum estradiol (E2) measured by liquid chromatography/ mass spectrometry was 8 pg/mL. DNA was extracted and sequenced from a blood sample from the patient since his maternal first cousin also had low bone mass and both patients were screened for aromatase dysfunction by PCR analysis for the CYP19A1 gene, which encodes aromatase. No known pathologic mutations were observed in the coding exons, but novel single nucleotide polymorphisms were detected both in the proband and in his cousin. Treatment with topical testosterone started in August 2010. Over the next 8 years, testosterone dosage was varied and switched from topical gel to injections and maintained on depo-injections of testosterone at about 60 mg once per week. Re-examination in March 2012 included a brain MRI to exclude pituitary lesions; hyperparathyroidism was ruled out (normal serum parathyroid hormone, calcium, and calcium to phosphorous ratio) and celiac disease was excluded (negative transglutaminase antibodies). Follow-up in October 2018 showed improved bone mineral density of the lumbar spine by 29% and of the left femoral hip by 15% compared to baseline measurements. This reveals the importance of measuring serum E2 for making the correct diagnosis, as well as for monitoring a therapeutic effect. Herein, we propose treatment of male osteoporosis where serum E2 levels are below about 20 pg/mL with testosterone to reverse osteoporosis.

ObjectiveThe serum calcium (Ca)–to–phosphorus (P) ratio has been proposed to identify patients with primary hyperparathyroidism and chronic hypoparathyroidism (HPT), but it has never been tested in pseudohypoparathyroidism (PHP). The aim of this study was to test the performance of Ca/P ratio in PHP diagnosis compared with that in healthy subjects and patients with HPT for differential diagnosis.DesignA retrospective, cross-sectional, and observational study was carried out.MethodsSerum Ca, P, creatinine, parathyroid hormone (PTH), and albumin were collected. Ca and P were expressed in mmol/L. Ca/P diagnostic performance was evaluated by receiver operating characteristic curve, sensitivity, specificity, and accuracy.ResultsA total of 60 patients with PHP, 60 patients with HPT, and 120 controls were enrolled. The Ca/P ratio was lower in patients with PHP and HPT than that in controls (p < 0.0001). The cutoff of 1.78 (2.32 if Ca and P measured in mg/dL) for Ca/P ratio could identify patients with PHP and HPT among the entire cohort (sensitivity and specificity of 76%). No valid cutoff of Ca/P was found to distinguish patients with PHP from patients with HPT; in this case, PTH above 53.0 ng/dL identified patients with PHP (sensitivity and specificity of 100%). The index (Ca/P × PTH) above 116 ng/L recognized patients with PHP from controls (sensitivity of 84.7% and specificity of 87.4%), whereas (Ca/P × PTH) below 34 ng/L recognized patients with HPT from controls (sensitivity of 88.9% and specificity of 90.8%).ConclusionsThe Ca/P ratio below 1.78 (2.32 CU) is highly accurate to identify patients with PHP and HPT, although it is not reliable to differentiate these two conditions. The index (Ca/P × PTH) is excellent to specifically recognize PHP or HPT from healthy subjects.

Background Data about classification of hypogonadism and estrogen deficiency in male people living with HIV (PLWH) are scanty. Aim To investigate the prevalence and characterization of biochemical hypogonadism and relative estrogen deficiency in male PLWH aged < 50 comparing liquid chromatography-tandem mass spectrometry (LC-MS/MS) with chemiluminescent immunoassay (CI), and combining gonadotropin, sex hormone-binding globulin (SHBG) and serum estradiol (E2) measurements. Methods Prospective, cross-sectional, observational study. Serum total testosterone (TT), E2, gonadotropins, SHBG were measured by CI. TT and E2 were also assessed by LC-MS/MS. Free testosterone (cFT) was calculated by Vermeulen equation. Results A total of 316 PLWH (45.3 ± 5.3 years) were enrolled. TT and cFT by LC-MS/MS were lower compared to CI (p

Hypogonadism is a frequent finding among men living with HIV (MLWH) and it seems to occur earlier in comparison with the general male population. Although the prevalence of hypogonadism in MLWH has significantly lowered thanks to advancements in medical management, it remains high if compared with age-matched HIV-uninfected men, ranging from 13% to 40% in the age group of 20-60 years. Signs and symptoms of low serum testosterone (T) in MLWH are cause of concern since they are non-specific, of mild-to-moderate degree, and often overlapping with those of infection per se. For these reasons, hypogonadism can be underestimated in the absence of targeted laboratory blood examinations. With regard to the etiological factors involved in the T decrease, emerging evidence has suggested the functional nature of hypogonadism in MLWH, pointing out the mutual relationship between sex steroids, health status, comorbidities, and HIV-related factors. In agreement with this hypothesis, a therapeutic approach aiming at improving or reversing concomitant diseases through lifestyle changes (e.g. physical activity) rather than pharmacological T treatment should be theoretically considered. However, considering both patient’s barriers to lifestyle changes to be maintained overtime and the lack of evidence-based data on the efficacy of lifestyle changes in normalizing serum T in MLWH, T therapy remains an option when other non-pharmacological interventions are ineffective as well as for all other functional forms of hypogonadism. From this perspective, the traditional therapeutic management of male hypogonadism in MLWH, especially the role of T supplementation, should be revised in the light of the probable functional nature of hypogonadism by considering a good balance between benefits and harmful. This narrative review presents an overview of current knowledge on hypogonadism in MLWH, deepening the factors driving and taking part in T decrease, providing advice for the clinical approach, and underlining the importance of individualized treatment aiming at optimizing non-gonadal comorbidities and thus avoiding over-, or even unnecessary, treatment with T.

As immigration is one of the dominant issues in contemporary public discourse, it is important to explain the mechanism of prejudice against immigrants from a cultural psychology perspective. Several studies in the literature have confirmed a significant relationship between perceptions of the estimated size of the immigrant population and negative attitudes towards them. This study aims to investigate whether this relationship is moderated by symbolic universes, i.e., affect-laden generalized worldviews. The study involves a representative sample of 3020 Italians who participated in a computer-assisted web survey and completed a questionnaire containing items measuring their estimates of the size of the migrant population in Italy, political orientation, cultural worldviews (symbolic universes), and the perceived threat posed by migrants. The results confirm that the relationship between the estimated size of the migrant population and the perceived threat is moderated by symbolic universes, being stronger for participants who hold both pessimistic and idealizing symbolic universes. The results are interpreted within the framework of semiotic cultural psychology theory.

Objective: The objectives of this study were to describe the trajectories of bone mineral density (BMD) and trabecular bone score (TBS) changes throughout pre-menopause (reproductive phase and menopausal transition) and post-menopause (early and late menopause) in women with HIV (WWH) undergoing different antiretroviral therapies (ARTs) and explore the risk factors associated with those changes. Methods: This was an observational longitudinal retrospective study in WWH with a minimum of two DEXA evaluations comprising BMD and TBS measurements, both in the pre-menopausal and post-menopausal periods. Menopause was determined according to the STRAW+10 criteria, comprising four periods: the reproductive period, menopausal transition, and early- and late-menopausal periods. Mixed-effects models were fitted to estimate the trajectories of the two outcomes (BMD and TBS) over time. Annualized lumbar BMD and TBS absolute and percentage changes were calculated in each STRAW+10 time window. A backward elimination procedure was applied to obtain the final model, including the predictors that affected the trajectories of BMD or TBS over time. Results: A total of 202 WWH, all Caucasian, were included. In detail, 1954 BMD and 195 TBS data were analyzed. The median number of DEXA evaluations per woman was 10 (IQR: 7, 12). The median observation periods per patient were 12.0 years (IQR = 8.9–14.4) for BMD and 6.0 years (IQR: 4.3, 7.9) for TBS. The prevalence of osteopenia (63% vs. 76%; p < 0.001) and osteoporosis (16% vs. 36%; p < 0.001) increased significantly between the pre-menopausal and post-menopausal periods. Both BMD (1.03 (±0.14) vs. 0.92 (±0.12) g/cm2; p < 0.001) and TBS (1.41 (IQR: 1.35, 1.45) vs. 1.32 (IQR: 1.28, 1.39); p < 0.001) decreased significantly between the two periods. The trend in BMD decreased across the four STRAW+10 periods, with a slight attenuation only in the late-menopausal period when compared with the other intervals. The TBS slope did not significantly change throughout menopause. The delta mean values of TBS in WWH were lower between the menopausal transition and reproductive period compared with the difference between menopause and menopausal transition. Conclusions: Both BMD and TBS significantly decreased over time. The slope of the change in BMD and TBS significantly decreased in the menopausal transition, suggesting that this period should be considered by clinicians as a key time during which to assess bone health and modifiable risk factors in WWH.

The COVID-19 pandemic experience had a major impact on adolescents' relational lives. The abrupt change in habits led adolescents to revise their relationships with respect to family, friends, and school; they suffered greatly because of this but, at the same time, were able to discover new resources and possibilities. The present paper aims to give adolescents a voice by exploring their experiences of the change that the pandemic period brought about in their life and significant relationships as well as by examining whether quarantine and social isolation provided opportunities for personal growth and transformation. The participants were 66 adolescents (between 16 and 19 years old). A qualitative method was adopted with a semi-structured interview that investigated changes in the main relational areas. The results offer an insight into the lives of adolescents during the lockdown in Italy, allowing us to "hear their voice." The results highlight the adolescents' struggle to cope with the change, suffering from the many limitations but also experiencing increased self-awareness, reflectivity, and responsibility. [ABSTRACT FROM AUTHOR]

To identify and confirm patterns of relationships connecting sense of community (SOC) and individual resilience with psychological well‐being, via the mediation of coronavirus disease 2019 (COVID‐19) impacts on life domains. An online survey was conducted with a sample of adults (n = 650) 1 year after the COVID‐19 outbreak in Italy and the United States (April–December 2021). Utilizing a Structural Equation Model, we tested a mediation model (n = 563) to identify the associations between SOC and individual resilience and the perceived impacts of the emergency situation and psychological well‐being. Results revealed that during the crisis, SOC had an influence on psychological well‐being, but only by mediating the effects of COVID‐19 impacts on life domains. Independently, individual resilience had a direct influence on psychological well‐being. The findings support the importance of the interaction of individual and collective variables that played different roles at different phases of the pandemic. The findings suggest for possible interventions to enhance well‐being during crises. [ABSTRACT FROM AUTHOR]

Tirzepatide (TZP) is a new anti-obesity drug, and little is currently known about its effect on body composition (BC) in people with overweight or obesity. The aim of this study is to conduct a systematic review on the impact of TZP on BC compartments in this population during weight loss programs. Literature searches, study selection, method development, and quality appraisal were performed. The data were synthesized using a narrative approach, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Of the 1379 papers retrieved, 6 randomized controlled trials met the inclusion criteria and were reviewed, revealing the following findings. Firstly, TZP was shown to result in a significant reduction in total fat mass (FM), visceral adipose tissue (VAT) and waist circumference (WC) between baseline and short as well as intermediate follow-ups. Compared to other anti-obesity medications (e.g., dulaglutide and semaglutide) taken over the same duration, TZP showed a superior decrease in body fat compartments (i.e., total FM, VAT and WC). Finally, the effect of TZP on fat-free mass (FFM) is still uncertain because the findings remain inconclusive. In conclusion, TZP appears to be an effective strategy for achieving significant improvements in body fat and its distribution, but additional investigations are still needed to determine the impact of TZP on lean mass in this population. [ABSTRACT FROM AUTHOR]

AF is a highly prevalent disease, often requiring long-term oral anticoagulation to prevent stroke or systemic embolism. Coronary artery disease, which is common among AF patients, is often referred for myocardial revascularisation by percutaneous coronary intervention (PCI), which requires dual antiplatelet therapy to minimise the risk of stent-related complications. The overlap of AF and PCI is a clinical conundrum, especially in the early post-procedural period, when both long-term oral anticoagulation and dual antiplatelet therapy are theoretically indicated as a triple antithrombotic therapy. However, stacking drugs is not a desirable option because of the increased bleeding risk. Several strategies have been investigated to mitigate this concern, including shortening triple antithrombotic therapy duration and switching to a dual antithrombotic regimen. This review analyses the mechanisms underlying thrombotic complications in AF-PCI, summarises evidence surrounding antithrombotic therapy regimens and reports and comments on the latest European guidelines.