Single-row versus transosseous technique in the arthroscopic treatment of rotator cuff tears: a meta-analysis.

PURPOSE: This study aims to compare single-row suture-anchors (SA) versus transosseous arthroscopic (TO) technique in the treatment of patients with rotator cuff tears in terms of clinical structural outcomes at atleast 24 months of follow-up. METHODS: The systematic review was performed according to "PRISMA guidelines" (Preferred Reporting Items for Systematic Reviews and Meta-analyses), in order to identify all the studies comparing clinical, both subjective and objective, outcomes with 24 months follow-up minimum in patients undergoing arthroscopic RC repair with the SR and TO technique. OVID-MEDLINE®, Cochrane, SCOPUS and PubMed were searched from January 2010 to October 2022 to identify relevant studies, using the following key words, that were combined together to achieve maximum search strategy sensitivity: "Rotator cuff tear" OR "repair" OR "shoulder" OR "reconstruction" OR "suture" OR "arthroscopic" OR "single-row" OR "transosseous". RESULTS: Six papers were finally analyzed in this meta-analysis. The weighted mean difference on Constant scores and for ASES for studies considering suture-anchors (SA) group showed good outcomes. The weighted mean difference of Constant scores and of ASES for TO (transosseous) group showed good outcomes. The weighted mean difference of CONSTANT for TO versus SA groups showed no differences in the outcomes of SA and TO techniques for the repair of Rotator Cuff Tears at minimum 24 months follow-up. CONCLUSIONS: The Arthroscopic transosseous rotator cuff repair technique and SA (suture-anchor) technique both lead to significant short-term improvement and satisfactory subjective outcome scores with low complication/failure rates. No differences were found in the final outcome between the two techniques.

Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization.

BACKGROUND: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking. METHODS: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively. RESULTS: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively. LIMITATIONS: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems. CONCLUSION: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.

Arthroscopic transosseous versus suture anchor repair: clinical outcomes in patients with bilateral rotator cuff tears.

The aim of our study was to define if Arthroscopic Transosseous Rotator Cuff Techniques should have comparable results to those of the suture-anchors technique in a single row configuration. We reported the preliminary results of a consecutive population of 22 patients who underwent a rotator cuff treatment on the left and right sides for average medium-sized thickness tears with minimal fatty infiltration with the two different techniques: transosseous rotator cuff repair technique on one side and single row with suture-anchors on the other side, in different times. Subjective evaluation with DASH questionnaires, Constant Scores and Numerical Rating Scale (NRS) for pain evaluation, have been submitted pre and postoperatively after both operations. A statistical analysis was performed to assess the superiority of one technique and to compare pre and postoperative ROM data and clinical outcomes. A transosseous rotator cuff repair was performed in 7 patients on the dominant arm, while the other 15 patients had dominant arm cuff tear lesions repaired by using suture-anchors technique. At last follow-up a significant improvement, in shoulder pain and function, was referred at both sides. Also, DASH, Constant Scores and NRS for pain evaluation improved with both techniques, but no statistical difference was found between them. Arthroscopic transosseous rotator cuff repair technique shows comparable results to those of the suture-anchors technique in a single row configuration.

Inter-rater reliability of classification systems of scapular dyskinesis.

Prevalence of scapular dyskinesis varies across records, with overhead athletes being more frequently affected than non-overhead athletes A number of methods have been described to evaluate scapular kinematics and scapular dyskinesis. The "yes/no" and the "4-type" classification systems are widely accepted and diffusely used among orthopaedics and physical therapists. The inter-rater reliability for both the "yes/no" and the "4-type" classification systems may be different. Moreover, differences between physical therapists and orthopaedic surgeons may exist. Seven examiners (2 orthopaedic surgeons and 5 physical therapists) were asked to evaluate a mixed sequence of video recordings of healthy subjects and patients affected by shoulder, scapular or clavicular disorders and to assess scapular dyskinesis using the "yes/no" and the "4-type" classification systems. Cohen's kappa coefficient (κ) and weighted kappa were used to measure inter-rater reliability. Twenty-four subjects were enrolled. In general, the "4- type" system has higher κ values than ''yes/no'' classification system and orthopaedic surgeons achieve higher reliability than physical therapists for both systems. The clinical evaluation of active shoulder movements permits reproducible assessment and classification of scapular dyskinesis, in particular for the "4-type" classification system. The "4-type" classification system can be used to assess and classify scapular dyskinesis, especially among orthopaedic surgeons.

Do radiolucent lines and stress shielding of the humeral shaft really matter in shoulder arthroplasty?

The purpose of this study is to evaluate at a mid-term follow up, the radiological survival of an uncemented humeral stem in shoulder arthroplasty. One hundred and twenty-six replacements including hemi (HA), total (TSA) and reverse (RSA) implanted from 1999 to 2008 were reviewed at a mean follow up of 7.2 years (48-144 months). The same uncemented triconical stem (SMR, Lima Corporate) was implanted. There were: 23 HSA, 43 TSA, 60 RSA. An independent observer evaluated all the patients with Constant Score. A radiologic analysis by an expert radiologist and an orthopaedic surgeon was performed: humeral component-bone interface was divided in seven zones. They judged a mobilisation if a migration or tilt of the humeral implant or if≥ 2 mm radiolucent line in at least three zones was present. Chi-squared test, Fisher test and analysis of variance were performed and a p<0.05 was considered statistically significant. No major radiological signs of loosening and no tilt or migration of the humeral component were found. Only 23 (18.2%) patients had no RL around the humeral implant. In the remaining 103 (81.7%) implants: 96 (76.1%) presented RL less than 2 mm, particularly 75 (59.5%) in less than 3 zones and 21 (16.6%) in more than 3 zones. Of the remaining 7 (5.5%) implants the presence of RL of 2 mm or greater in only one zone was seen. Apart from sepsis no revision was performed for humeral component loosening. Although a high rate of RL, uncemented humeral stem has an excellent survivorship at a mid-term follow up. Relationship between presence, position and depth of RL and internal stress shielding is commonly observed but does not appear to compromise quality of fixation or clinical outcomes in shoulder arthroplasty.

Real-world effectiveness of long acting aripiprazole: Treatment persistence and its correlates in the Italian clinical practice.

OBJECTIVES: To identify the variables that are associated with persistence to Aripiprazole-Long Acting (A-LAI), in adult patients with schizophrenia. METHODS: Observational, retrospective, non-interventional study involving 261 patients with schizophrenia. RESULTS: Eighty-six percent of study subjects were persistent for at least 6 months. All subjects with baseline CGI-S of 1 or 2, 95% of subjects with CGI-S of 3, 86% with CGI-S of 4, 82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7 were persistent. A-LAI treatment continuation rate was higher in patients with: 1) baseline CGI score ≤ 4; 2) schizophrenia dimension (LDPS) mania score ≤ 5; 3) psychotic spectrum schizoid score ≤ 11. CONCLUSIONS: A relatively high number of patients (n = 225, 86%) were persistent to A-LAI for at least 6 months. Not surprisingly, very severe patients were more unlikely to be persistent. However, it is noteworthy that a large number of subjects with high CGI score at the time when A-LAI was started (82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7) were persistent. Larger, controlled, prospective and longer studies are warranted.

Primary sedimentation as a sustainability measure for newly built municipal wastewater treatment plants: too expensive?

A study was performed based on the design of a new wastewater treatment plant (WWTP) to be built in Weesp, The Netherlands (about 46,000 Population Equivalents (PE)). The conventional activated sludge plant was considered among the alternatives, with and without primary sedimentation. This pre-treatment technique is considered a sustainability measure as it improves the energy balance of the WWTP. However, at the same time, the question arose about the cost effectiveness of this measure. The scope of the study was to assess whether other sustainability measures (like solar panels) can realise the same level of sustainability with lower costs. The outcome of the study indeed shows that, for a new WWTP, it is considerably cheaper to avoid primary sedimentation and focus on other measures like solar panels instead. This appeared not only to be the case for the scale of WWTP Weesp, but also for WWTPs with capacities higher than 500,000 PE. For existing WWTPs with primary sedimentation, the choice can be different as customisation is necessary.

Survey on Energy Drinks consumption and related lifestyle among students of two Italian high schools.

BACKGROUND: The European Food Safety Authority (EFSA) has identified some risk factors for the occurrence of side effects linked to energy drinks (EDs) consumption by young people. EDs consumption has been evaluated in a sample of students in Italy together with some aspects of their lifestyle. METHODS: The survey was performed in two high schools from September 2016 to June 2017. 583 students between 14 to 18 years were recruited and a standard questionnaire (EFSA checklist) was used to collect information on responders characteristics, beverages consumption, EDs with alcohol, and EDs and sports. RESULTS: Despite 350 out of 583 responders (60%) consumed EDs, only 146 out of 583 (25%) were EDs-alcohol consumers. Moreover, 208 out of 379 (55%) of all physically active adolescents reported frequent EDs consumption before sport trainings. CONCLUSIONS: Study results highlight the need for primary prevention measures in communication campaigns and training delivered by school to limit potential health threats related to excess of EDs consumption.

Rate of Legionella pneumophila colonization in hospital hot water network after time flow taps installation.

In hospital water systems legionellae may be resistant to disinfectants in pipework, which is a problem particularly in areas where there is low flow or stagnation of water. We evaluated legionella colonization of a water network of an Italian hospital after time flow taps (TFTs) installation in proximity to dead legs. The water volume flushed was 64 L/day from May 2016, and 192 L/day from December 2016. Before TFTs installation, Legionella pneumophila sg2-14 was detected in all points (4 × 104 ± 3.1 × 104 cfu/L). All sites remained positive (2.9 × 104 ± 1.9 × 104 cfu/L) through November 2016. From December 2016 legionella persisted in one point only (2 × 102 to 6.8 × 103 cfu/L). TFTs with chemical disinfection may reduce legionella colonization associated with dead legs.

Evaluation and control of microbial and chemical contamination in dialysis water plants of Italian nephrology wards.

BACKGROUND: Patients receiving haemodialysis are exposed to a large volume of dialysis fluid. The Italian Society of Nephrology (ISN) has published guidelines and microbial quality standards on dialysis water (DW) and solutions to ensure patient safety. AIM: To identify microbial and chemical hazards, and evaluate the quality of disinfection treatment in DW plants. METHODS: In 2015 and 2016, water networks and DW plants (closed loop and online monitors) of nine dialysis wards of Italian hospitals, hosting 162 dialysis beds overall, were sampled on a monthly basis to determine the parameters provided by ISN guidelines. Chlorinated drinking water was desalinated by reverse osmosis and distributed to the closed loop which feeds all online monitors. Disinfection with peracetic acid was performed in all DW plants on a monthly basis. FINDINGS: Over the 24-month study period, seven out of nine DW plants (78%) recorded negative results for all investigated parameters. Closed loop contamination with Burkholderia cepacia was detected in a DW plant from January 2015 to March 2015. Pseudomonas aeruginosa was isolated from March 2016 to May 2016 in the closed loop of another DW plant. These microbial contaminations were eradicated by shock disinfection with sodium hypochlorite and peracetic acid, followed by water flushing. CONCLUSION: These results highlight the importance of chemical and physical methods of DW disinfection. The maintenance of control measures in water plants hosted in dialysis wards ensures a microbial risk reduction for all dialysis patients.

Thyroid and shoulder diseases: the bases of a linked channel.

The association between thyroid disorders and musculoskeletal diseases has long been suspected, but it is still debated whether they have a role in the pathogenesis of shoulder diseases. In vivo and in vitro studies describe the role of thyroid hormones in bone, cartilage and tendon biology. Retrospective studies and case reports suggest that thyroid diseases should be considered as risk factors and hold prognostic value in some of the most common causes of shoulder pain. Thus, it is advisable to search for underlying thyroid disorders in these patients. The pathophysiologic mechanisms by which thyroid hormone imbalance affects the onset, progression and response to treatment of these diseases are yet to be thoroughly defined and demand further studies.

Patellar Tendon Rupture after Lateral Release without Predisposing Systemic Disease or Steroid Use.

Arthroscopic technique for lateral release is the most widely used procedure for the correction of recurrent dislocations of the patella. In the relevant literature, several complications of lateral release are described, but the spontaneous patellar tendon rupture has never been suggested as a possible complication of this surgical procedure. Patellar tendon rupture is a rather infrequent and often unilateral lesion. Nevertheless, in case of systemic diseases (LES, rheumatoid arthritis, and chronic renal insufficiency) that can weaken collagen structures, bilateral patellar tendon ruptures are described. We report a case of a 24-year-old girl with spontaneous rupture of patellar tendon who, at the age of 16, underwent an arthroscopic lateral release for recurrent dislocation of the patella. This is the first case of described spontaneous patellar tendon rupture that occurred some years after an arthroscopic lateral release.

Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery?

OBJECTIVE: The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis. METHODS: This is a retrospective observational study according to SOSORT and SRS (Scoliosis Research Society) recommendations involving 48 girls with documented progressive idiopathic scoliosis, treated with Chêneau brace. A statistical analysis was performed with STATA MP11.2 to validate the obtained results. RESULTS: No patient needed surgery. The average curve angle measured in Cobb degrees passed from 27° ± 6.7° at the beginning (T0), to 7.6° ± 7.4° in brace (T1) (72 % of correction), to 8.5° ± 8.6° (69 % of correction) at the end of treatment (T2), to 11.0° ± 7.4° (59.3 % of correction) at final follow-up (mean 5 years and 5 months) (T3). CONCLUSION: Conservative treatment with Chêneau brace and physiotherapy was effective in our hands for halting scoliosis progression in 100 % of patients.

Polyneuropathy in cerebrotendinous xanthomatosis and response to treatment with chenodeoxycholic acid.

Polyneuropathy has been reported in cerebrotendinous xanthomatosis (CTX), although its nature and possible association with certain genotypes and phenotypes are unclear. The effect of chronic administration of chenodeoxycholic acid (CDCA) on peripheral nerve conduction parameters is still debated. We report clinical, laboratory, and electrophysiological findings in 35 CTX patients. Twenty-six subjects (74.2 %) showed peripheral nerve abnormalities. Polyneuropathy was predominantly axonal (76.9 % of patients) and generally mild. No correlation was found between its presence and clinical or biochemical data. In polyneuropathic patients, CDCA treatment improved electrophysiological conduction parameters, irrespective of the duration of therapy. Improvement mainly concerned nerve conduction velocities, whereas most nerve amplitudes remained unchanged. This means that CDCA treatment did not influence the number of axons activated by maximum electrical stimulation but increased the conduction of the still-excitable fibers. Our findings may suggest that CDCA treatment promotes myelin synthesis in nerve fibers with residual unaffected axons. The effect of therapy may therefore depend largely on the extent of irreversible structural damage to axons.

Vertebral body reconstruction system B-Twin® versus corset following non-osteoporotic Magerl A1.2 thoracic and lumbar fracture. Functional and radiological outcome at 12 month follow-up in a prospective randomized series of 50 patients.

INTRODUCTION: Kyphoplasty and percutaneous vertebroplasty are two effective procedures for osteoporotic vertebral compression fractures, but there have been few publications on their use in non-osteoporotic forms. B-Twin(®) vertebral body reconstruction is a new minimally invasive vertebral body reconstruction technique developed for non-osteoporotic vertebral compression fractures of the thoracolumbar junction and lumbar spine. OBJECTIVES: The present study describes this novel technique and assessed efficacy compared to a conservative method. PATIENTS AND METHODS: Inclusion criteria were: Magerl type A1.2 non-osteoporotic thoracolumbar or lumbar spinal compression fractures in patients aged over 18 years, free of neurologic compromise. Patients were randomized to management by corset (group 1) or by the B-Twin(®) spacer (group 2). Follow-up used a visual analog scale (VAS) to assess pain, the Oswestry Disability Index (ODI) and, on radiology, the vertebral (VK) and regional (RK) kyphosis angles and anterior and medial height indices at baseline, 3 months and 12 months. RESULTS: Group 1 comprised 26 patients; group 2 comprised 24 patients, with 44 implants. In group 1, mean VK was 10.7° (± 1.73°) at baseline, 11.9° (± 1.56°) at 3 months and 12.3° (± 1.6°) at 12 months. Mean RK was respectively 9.7° (± 0.97°), 11.10° (± 1.07°) and 11.8° (± 1.27). Mean medial height (medial-to-posterior [MH/PH] height ratio was respectively 0.75 [±0.05], 0.70 [±0.06] and 0.65 [±0.04]). Mean anterior height (anterior-to-posterior [AH/PH] height ratio) was respectively 0.79 [± 0.06], 0.76 [± 0.05] and 0.73 [± 0.05]). Mean VAS score was respectively 8.6 (± 0.52), 3.8 (± 0.82) and 2.3 (± 0.83). In group 2, mean VK was 13.8° (± 0.47°) at baseline, 4.88° (± 0.65°) at 3 months and 4.88° (± 0.65°). Mean RK was respectively 9.82° (± 1.67°), 4.47° (± 0.86°) and 4.82° (± 0.98°). Mean MH/PH ratio was respectively 0.69 (± 0.05), 0.86 (± 0.03) and 0.86 (± 0.03). Mean AH/PH ratio was respectively 0.73 (± 0.04), 0.90 (± 0.03) and 0.90 (± 0.03). Mean VAS score was 8.88 (± 0.47) at baseline, 2 (± 1) at 1-day post-surgery, 1.71 (± 0.88) at 3 months and 1.12 (± 0.23) at 12 months. The increase in vertebral body height in patients managed by B-Twin(®) was maintained at 6 and 12 months (P<0.0001). The study showed better results with the vertebral spacer than on conservative treatment, with a 95% reduction in bed-rest: 4-6 weeks in the conservative group vs. 2-3 days in the surgical group. CONCLUSIONS: The vertebral body reconstruction technique provided anatomic vertebral body reconstruction and quick return to household activity without resort to a corset. Deformity was durably reduced. At 12-month follow-up, pain reduction and stasis were achieved. The risk of injected cement leakage was slight.

Cotrel-Dubousset instrumentation in neuromuscular scoliosis.

The study design is retrospective. The aim is to describe our experience about the treatment of patients with neuromuscular scoliosis (NMS) using Cotrel-Dubousset instrumentation. Neuromuscular scoliosis are difficult deformities to treat. A careful assessment and an understanding of the primary disease and its prognosis are essential for planning treatment which is aimed at maximizing function. These patients may have pelvic obliquity, dislocation of the hip, limited balance or ability to sit, back pain, and, in some cases, a serious decrease in pulmonary function. Spinal deformity is difficult to control with a brace, and it may progress even after skeletal maturity has been reached. Surgery is the main stay of treatment for selected patients. The goals of surgery are to correct the deformity producing a balanced spine with a level pelvis and a solid spinal fusion to prevent or delay secondary respiratory complications. The instrumented spinal fusion (ISF) with second-generation instrumentation (e.g., Luque-Galveston and unit rod constructs), are until 1990s considered the gold standard surgical technique for neuromuscular scoliosis (NMS). Still in 2008 Tsirikos et al. said that "the Unit rod instrumentation is a common standard technique and the primary instrumentation system for the treatment of pediatric patients with cerebral palsy and neuromuscular scoliosis because it is simple to use, it is considerably less expensive than most other systems, and can achieve good deformity correction with a low loss of correction, as well as a low prevalence of associated complications and a low reoperation rate." In spite of the Cotrel-Dubousset (CD) surgical technique, used since the beginning of the mid 1980s, being already considered the highest level achieved in correction of scoliosis by a posterior approach, Teli et al., in 2006, said that reports are lacking on the results of third-generation instrumentation for the treatment of NMS. Patients with neuromuscular disease and spinal deformity treated between 1984 and 2008 consecutively by the senior author (G.D.G.) with Cotrel-Dubousset instrumentation and minimum 36 months follow-up were reviewed, evaluating correction of coronal deformity, sagittal balance and pelvic obliquity, and rate of complications. 24 patients (Friedreich's ataxia, 1; cerebral palsy, 14; muscular dystrophy, 2; polio, 2; syringomyelia, 3; spinal atrophy, 2) were included. According the evidence that the study period is too long (1984-2008) and that in more than 20 years many things changed in surgical strategy and techniques, all patients were divided in two groups: only hooks (8 patients) or hybrid construct (16 patients). Mean age was 18.1 years at surgery (range 11 years 7 months-max 31 years; in 17 cases the age at surgery time was between 10 and 20 years old; in 6 cases it was between 20 and 30 and only in 1 case was over 30 years old). Mean follow-up was 142 months (range 36-279). The most frequent patterns of scoliosis were thoracic (10 cases) and thoracolumbar (9 cases). In 8 cases we had hypokyphosis, in 6 normal kyphosis and in 9 hyperkyphosis. In 8 cases we had a normal lordosis, in 11 a hypolordosis and in 4 a hyperlordosis. In 1 case we had global T4-L4 kyphosis. In 8 cases there were also a thoracolumbar kyphosis (mean value 24°, min 20°-max 35°). The mean fusion area included 13 vertebrae (range 6-19); in 17 cases the upper end vertebra was over T4 and in 11 cases the lower end vertebra was over L4 or L5. In 7 cases the lower end vertebra was S1 to correct the pelvic obliquity. In 5 cases the severity of the deformity (mean Cobb's angle 84.2°) imposed a preoperative halo traction treatment. There were 5 anteroposterior and 19 posterior-only procedures. In 10 cases, with low bone quality, the arthrodesis was performed using iliac grafting technique while in the other (14 cases) using autologous bone graft obtained in situ from vertebral arches and spinous processes (in all 7 cases with fusion extended until S1, it was augmented with calcium phosphate). The mean correction of coronal deformity and pelvic obliquity averaged, respectively, 57.2% (min 31.8%; max 84.8%) and 58.9% (mean value preoperative, 18.43°; mean value postoperative, 7.57°; mean value at last follow-up, 7.57°). The sagittal balance was always restored, reducing hypo or hyperkyphosis and hypo or hyperlordosis. Also in presence of a global kyphosis, we observed a very good restoration (preoperatory, 65°; postoperatory, 18° kyphosis and 30° lordosis, unmodified at last f.u.). The thoracolumbar kyphosis, when present (33.3% of our group) was always corrected to physiological values (mean 2°, min 0°-max 5°). The mean intraoperative blood lost were 2,100 cc (min 1,400, max 5,350). Major complications affected 8.3% of patients, and included 1 postoperative death and 1 deep infection. Minor complications affected none of patients. CD technique provides lasting correction of spinal deformity in patients with neuromuscular scoliosis, with a lower complications rate compared to reports on second-generation instrumented spinal fusion.

Prevalence of obesity in 6- and 9-year-old children living in Central-North Italy. Analysis of determinants and indicators of risk of overweight.

The objective of our article is to survey the prevalence of overweight and obesity among 6- and 9-year-old children in Emilia-Romagna, a region of Central-North Italy, and to study the eating habits and behaviours of these children and their families. During 2003 and 2005, we analysed a stratified sample of the general population of children attending pre-school (2681 children aged 6 years) and primary school (2955 children aged 9 years). Their height and weight were measured by healthcare workers. In the 6-year-old children, information concerning their eating habits was collected by means of a questionnaire completed by their parents. The prevalence of overweight was 16.5% in 6-year-old children and 20.6% in 9-year-old children. The increase of overweight from 6- to 9-year-old children was observed in males (13.5% in 6-year-old/21.3% in 9-year-old boys), but not in females. The prevalence of obesity was 8.9% in children aged 6 years and 9.0% in those aged 9 years, and it was higher in comparison with Italian surveys carried out in 1993 and in 2001: 7.5% in 6-year-old and 7.8% in 9-year-old children in 1993, and 6.6% in 6-year-old and 7.2% in 9-year-old children in 2001. In pre-school children, overweight and obesity were closely influenced by the education level, occupation and nutritional status of the parents.

Noradrenaline and angiotensin II modify vascular prostanoid release in fructose-fed hypertensive rats.

1 A fructose-enriched diet induces hypertension, metabolic alterations and insulin resistance in rats, resembling human metabolic syndrome. Previously, we found that prostanoid production was altered in fructose-fed rats. 2 This study analysed the effects of incubation with noradrenaline (NA) and angiotensin II (Ang II) on prostanoid release in mesenteric vascular beds from control and fructose-fed rats. Animals which received fructose solution (10% w/v) for 22 weeks showed higher systolic blood pressure and triglyceridaemia. 3 In controls, NA increased 6-keto-prostaglandin (PG) F(1)alpha (prostacyclin metabolite) and thromboxane (TX) production. Ang II increased only TX release. In fructose-fed animals, NA increased 6-keto-PG F(1)alpha and TX. PGF(2)alpha (vasoconstrictor) was also elevated. Ang II also increased PGF(2)alpha and PGE(2) levels. 4 In conclusion, in fructose rats Ang II in vitro stimulates a vasoconstrictor prostanoid not stimulated in controls. This could be related to the observed in vivo blood pressure increase. In fructose-fed animals, NA and Ang II also augment vasodilator prostanoids, suggesting a compensatory mechanism because of long-term hypertension.