Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass.

Osteoporosis is a health issue in postmenopausal women. Physical activity is recommended in these subjects, since it has positive effects on bone mass. Cellular mechanisms underlying this effect are still unclear. Osteogenic cells, released after physical exertion, could be a key factor in exercise-induced bone formation. INTRODUCTION: The aim of our research was to explore if a weight-bearing and resistance exercise program could positively affect circulating osteogenic cells (OCs), markers of bone formation and quality of life (QoL) in osteopenic postmenopausal women. METHODS: We recruited 33 postmenopausal women with a T-score at lumbar spine or femoral neck between - 1 and - 2.5 SD. Anthropometric and fitness parameters, bone-remodeling markers, OCs, and QoL were evaluated at the time of enrolment, after 1-month run-in period, and after 3 months of weight-bearing and resistance exercise. RESULTS: After 3 months of training, the pro-collagen type 1 N-terminal peptide (P1NP) and the number of OCs were significantly increased, with no significant increase of the type 1 collagen cross-linked C-telopeptide (sCTX). We also observed a significant increase in body height, one-repetition maximum (1RM) on the pull-down lat machine and leg press, and mean VO2max. The increase of immature circulating OCs was significantly correlated with the improvement of 1RM both of the upper and lower limbs. Moreover, QoL was significantly improved with regard to pain, physical function, mental function, and general QoL. The improvement in QoL, namely in the overall score and in the pain score, was significantly correlated with the increase in height. CONCLUSIONS: The exercise program we trialed is able to increase the markers of bone formation and the commitment of immature OCs with no significant increase in the markers of bone resorption. Our results confirm that combined weight-bearing and resistance physical activity is an effective tool to improve QoL of postmenopausal women with low bone mass. TRIAL REGISTRATION: NCT03195517.

Is telephone follow-up really effective in early diagnosis of inflammatory complications after tooth extraction?

BACKGROUND: To establish whether telephone follow-up is really able to intercept post-extraction complications and to evaluate the degree of patient satisfaction with this kind of post-surgical monitoring. MATERIAL AND METHODS: six hundred and thirty-eight patients were enrolled and randomly assigned to a test or control group. Test group patients were monitored by telephone follow-up 24 and 72 hours after surgery to investigate the presence of local symptoms that are frequently associated with surgical wound infection and inflammation. Both test and control group patients were examined 7 days at suture removal. Patients with systemic diseases, those in which intra-operative accidents occurred during surgery and those for whom extraction suture was not required, were excluded. RESULTS: At least one complication among alveolar osteitis, alveolar inflammation, alveolar infection and dehiscence involved 15.70% of the patients in the test group and 30.70% of the patients in the control group and telephone follow-up proved to be useful in early identification of anomalies in the post-extraction wound healing process. Comparable results were recorded in all extraction subgroups divided according to the type (surgical and non-surgical) and the number (single and multiple) of extractions performed in the same session. Telephone follow-up showed an 8.60 ± 1.17 (0 to 10 score scale) average acceptance. All cases of alveolar osteitis and infection occurred in patients who underwent antibiotic prophylaxis. CONCLUSIONS: Telephone follow-up seems to allow early detection of any possible wound healing complications, it is widely accepted by patients and it could therefore be considered a valid method for wound healing monitoring after tooth extractions, due to its effectiveness, feasibility and low costs.

Intensive lifestyle intervention is particularly advantageous in poorly controlled type 2 diabetes.

BACKGROUND AND AIMS: It is unknown whether lifestyle change is effective in people with type 2 diabetes with inadequate glucose control. The aim of this study was to asses, in a group of people with type 2 diabetes, the impact of baseline values of glycosylated haemoglobin (HbA1c) on the effects of an intensive lifestyle intervention on metabolic, clinical and strength parameters. METHODS AND RESULTS: 222 people with type 2 diabetes with mean ± standard deviation baseline HBA1c of 7.50% ± 1.27 (range 5.1-12.7%), were enrolled in a 3-month structured multidisciplinary lifestyle intervention. Anthropometric, biochemical, clinical and fitness measurements were collected at baseline, at the end of the lifestyle intervention program and at two-year follow-up visit. Significant improvements in glycometabolic control (HbA1c: p ≤ 0.0001); anthropometric parameters (BMI p ≤ 0.0001; waist circumference: p ≤ 0.0001); and systemic blood pressure (p ≤ 0.0001) were observed both at the end of the three month intensive lifestyle program and at the two-year follow up visit. In addition, defined daily doses of hypoglycaemic treatment significantly decreased (p = 0.001). Fitness measures exhibited significant increments in the whole sample at the end of the intensive intervention program (p ≤ 0.0001). When patients were divided into tertiles considering the baseline value of HbA1c, the most marked improvements in HbA1c, blood glucose and triglycerides were observed in the group with inadequate glucose control (Hba1c ≥ 7.71%), both at the three-month and two-year follow-ups. CONCLUSION: These results demonstrate that an intensive lifestyle intervention should be recommended for people with type 2 diabetes, particularly those with the most inadequate glycaemic control. REGISTRATION NUMBER: CURIAMO trial was registered in the Australian New Zealand Clinical Trials Registry, (ACTRN12611000255987).

Antibiotic prophylaxis for infective endocarditis: some rarely addressed issues.

Although quite consistent indications on antibiotic prophylaxis for infective endocarditis (IE) have been reported internationally, several common dental practice issues are still not clear: which dental procedures require antibiotic prophylaxis? In the case of multiple procedures can the same antibiotic be used? How can dentists identify high-risk conditions for IE? Do dentists verify patient antibiotic intake? What are the requirements of antibiotic prophylaxis in cases of coexistence of diseases which involve host defence impairment? What are the modalities of second choice drug administration? And finally, are chlorhexidine mouthwashes before dental procedures combined with antibiotics useful or not? Uncertainty also persists as far as the real need for prophylaxis is concerned and although several sources have suggested that a wide prospective randomised controlled study may be the definitive solution, problems exist in performing such a study.

Psychological disorders and oral lichen planus: matched case-control study and literature review.

OBJECTIVE: Oral lichen planus (OLP) may be linked to psychological disorders. This study investigated psychological factors associated with OLP. METHODS: A case-control study with incident OLP case patients and age-gender-socio-economic status-matched controls, recruited from among relatives, accompanying persons, and departmental staff, investigated psychological traits using the Psychological General Well-Being Index-Short form. Common factor analysis was used to generate a set of psychological dimensions. The association between these dimensions and OLP adjusted for confounders (education, number of lifetime sexual partners, drinking-smoking) and interactions was assessed through conditional logistic regression and odds ratios (OR) were estimated. RESULTS: A total of 67 case-control pairs were recruited. Psychological dimensions generated were: dimension-1 (anxiety, low vitality), dimension-2 (negative well-being, low vitality), dimension-3 (depressed mood, low self-control). The ORs for OLP were, dimension-1, 1.0 (95% confidence interval -95CI, 0.3-2.6); dimension-2, 0.5 (95CI, 0.2-1.2); dimension-3, 4.8 (95CI, 1.8-12.9). Dimension-3 was highly associated with mild, but not associated with severe, OLP. Literature searching provided 21 studies, with anxiety and depression principally associated with OLP. CONCLUSIONS: Depressed mood and low self-control were highly associated with OLP, particularly the reticular-papular forms. These traits could have a causative role in OLP development-progression, but further investigations are necessary.

A multivariate statistical analysis on variables affecting inferior alveolar nerve damage during third molar surgery.

AIM: The risk factors associated with inferior alveolar nerve damage during third molar surgery were investigated. MATERIAL AND METHODS: Surgeries performed during a period of 50 months by a single expert surgeon were reviewed. Only those surgeries that met the selected inclusion criteria were considered for this study. The following tests were applied for the statistical analysis: the Kolmogorov-Smirnov test, the principal components analysis, the Mann-Whitney U test, the two-tailed exact Fisher test and the Bonferroni sequential correction. RESULTS: The surgical difficulty index, multi-rooted third molars and changes in the inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage. CONCLUSIONS: Computed tomography is mandatory when the nerve is superimposed on the tooth root on the ortopantomography. SCIENTIFIC RATIONALE FOR STUDY: Lower third molar extraction is one of the most common procedures in oral and maxillofacial surgery, and it is burdened by the risk of inferior alveolar nerve damage. Understanding which factors are able to predict this complication is therefore essential in correctly programming surgery. PRINCIPAL FINDINGS: Surgical difficulty index, multi-rooted third molars and changes in inferior alveolar nerve running in relation to the tooth roots are predictors of nerve damage. PRACTICAL IMPLICATIONS: If, on the orthopantomography, the nerve is superimposed on the tooth root, a computed tomography is mandatory to define all of these variables.

Diurnal trajectories of salivary cortisol, salivary α-amylase and psychological profiles in oral lichen planus patients.

Although many reports have been published on the link between oral lichen planus (OLP) and the stress-related neuro-psycho-endocrine clinical features of the disease over the last 20 years, the data still remain controversial. Therefore, the aim of this study was to explore the personality traits of OLP subjects and assess the subjects' capability of coping with stress challenges. Cortisol and alpha-amylase were measured as reliable markers of the hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS) activities in salivary samples collected by the participants at their home during the sampling day (07:30, 12:00, and 19:30). Compared with the healthy controls, the OLP patients demonstrated a less effective coping ability, had higher scores in stress perception and loneliness, and had no significant variation in their anxiety and depressive symptoms. The OLP patients also showed dysregulation of the HPA axis activity with a significant reduction of diurnal salivary cortisol production, which was particularly significant in the morning hours. No significant variation was found in the OLP salivary alpha-amylase diurnal fluctuation and production, which was measured at the same time point as that for cortisol. In conclusion, we report that OLP subjects had a reduced capability of coping with stress events and presented a dysregulation of HPA axis activity with hypocortisolism detected in the morning hours.

A consensus conference on management of the lower third molar. Italian Society of Odontostomatological Surgery.

During the first Congress of the Italian University Schools of Oral Surgery, held in Rome on 18-20th February, 2010, a task force was convened by the Italian Society of Odontostomatological Surgery (SIdCO) to summarize the data collected from the current literature on selected aspects relating to the mandibular third molar and its removal. The task of the Conference Participants was to review and analyze the pertinent literature and to elaborate conclusive recommendations for the management of the lower third molar. The statements made and the recommendations presented represent the consensus of the Conference, which can be considered the official statement of the SIdCO.

[An experimental model for assessing the risk factors for work-related stress in four Italian universities]. / Un modello sperimentale di valutazione del rischio stress lavoro-correlato: risultati ottenuti in ambito universitario.

This study, a collaborative effort among the Local Health Authority 2 of Perugia, Italy, the National Coordination of Worker's Safety Representatives for University and Research Institutions and the National Coordination for Protection and Prevention Services for Universities and Research Institutions, describes the results of a method used to evaluate work-related stress. Personnel from four Italian universities, which we call University I, II, III and IV geographically distributed in nord (1), center (2) and south (1) of Italy, responded to a questionnaire regarding risk evaluation of work-related stress in response to the Italian Law 81/2008. The methodology includes a preliminary analysis of the physical/technological and organizational/relational aspects of the company in order to determine a risk factor of work-related stress. This is followed by an evaluation by agencies competent in the areas of prevention and protection, (Administrative personnel of the company, Medical support persons, heads of the Prevention and Protection Service, employee representatives, and others) that apply a specific algorithm and by the employees through the completion of a questionnaire. The employees, mostly men, of the various universities, completed 510 questionnaires. Based on the results of the questionnaires and on a comparison between the expectations of the administration and the employees, the preventative measures that need to be adopted were identified. The results of this study show that there is not complete agreement between the administration and the employees regarding the work-related expectations. This difference in viewpoints could be a source of work-related stress. Some aspects of the study were shown to be of common concern in the various universities, while for other aspects, there were significantly different perceptions between male and female employees. An immediate response is needed with respect to some aspects in the work context and to plan further investigations where the results are not clear. The method used provides an adequate response to the legislative requirements and labor principles, in evaluating the risk of work related stress. In addition the method allows employees to contribute directly to the evaluation process.

An innovative model for changing the lifestyles of persons with obesity and/or Type 2 diabetes mellitus.

AIM: To describe the multidisciplinary lifestyle intervention model used in an experimental CURIAMO (Centro Universitario Ricerca Interdipartimentale Attività Motoria) project designed to validate the short- and long-term efficacy of the model in obesity and Type 2 diabetes. RESEARCH DESIGN AND METHODS: Over a 3-yr period, about 1000 adults (70% diabetes-free and overweight or obese; 30% with Type 2 diabetes and overweight or obese). INCLUSION CRITERIA: Age range 18-80 yr, body mass index >27 kg/m2 with or without Type 2 diabetes mellitus; participants will be divided into three age groups (18-45, 45-65, 65-80 yr). The study duration will be from 5 to 6 yr: 1 yr of intervention followed by a mean follow-up period of 4 yr. In the first years, after a 4- month intensive lifestyle intervention, subjects will follow a maintenance programme. The intervention, which includes seven steps, involves the following experts: endocrinologists, sport medicine doctors or cardiologists, psychologists, dietitians, educators, nurses, exercise physiologists, and promoters of outdoor activities. RESULTS: The main endpoint of the study is to measure the efficacy of the lifestyle improvement intervention, defined as a loss of at least 7% of body weight combined with an increase of at least 10 MET/h-1·week-1 of energy expenditure by physical activity, after 1 yr and during the follow-up. A cost/utility analysis of the model will be made in participants with diabetes. CONCLUSIONS: We expect that the CURIAMO model will be highly effective, and that the aim of the intervention will be achieved in more than 70% of cases.

A sixteen year sample of surgically treated supernumerary teeth.

AIM: Supernumerary teeth represent a numerical dental anomaly in which more teeth than the norm are present in the dentition. A sixteen year sample of supernumerary teeth has been reviewed in order to analyse epidemiological data, morphological and topographic features of these teeth, especially of those located in the praemaxillary region. MATERIALS AND METHODS: All cases in which supernumerary teeth were surgically treated from 1991 to 2006 at the Oral Surgery Unit of the Sapienza University of Rome have been reviewed. RESULTS: 118 Caucasian subjects with supernumerary teeth have been reviewed in the range of age comprised between 5 and 42 years: 191 SNTs were collected, 136 from the upper jaw and 55 from the mandible. In the maxilla the incisor region was more frequently involved (67.65%), while in the mandible the one most frequently involved was the premolar region (69.1%). Conoid was the most frequent type of supernumerary teeth. Uneruption of the contiguous permanent teeth was the most commonly associated pathological condition, found in 81 out of the 191 cases of supernumerary teeth (40 patients, 42.4%). Tuberculated, infundibuliform and incisiform-shaped teeth caused uneruption of permanent teeth more frequently than the other morphological types of supernumerary teeth. CONCLUSION: In the upper incisor area, the extraction of SNT is mandatory as early as they are diagnosed, especially if they are tuberculated, infundibuliform and incisiform-shaped, if they are located palatally or just in the middle of the ridge and when more than one SNT is present.

Two weekly sessions of combined aerobic and resistance exercise are sufficient to provide beneficial effects in subjects with Type 2 diabetes mellitus and metabolic syndrome.

This study was performed to establish whether only 2 sessions per week of combined aerobic and resistance exercise are enough to reduce glycated hemoglobin (HbA(1c)) and to induce changes in skeletal muscle gene expression in Type 2 diabetes mellitus (DM2) subjects with metabolic syndrome. Eight DM2 subjects underwent a 1-yr exercise program consisting of 2 weekly sessions of 140 min that combined aerobic [at 55-70% of maximal oxygen uptake (VO(2max))] and resistance circuit training [at 60-80% of 1 repetition maximum (RM)]. The training significantly improved VO(2max) (from 33.5+/-3.8 ml/kg/min to 38.2+/-3.5 ml/kg/min, p=0.0085) and muscle strength (p<0.05). Changes over baseline were significant for HbA(1c), reduced by 0.45% (p=0.0084), fasting blood glucose (from 8.8+/-1.5 to 6.9+/-2.2 mmol/l, p=0.0132), waist circumference (from 98.9+/-4.8 to 95.9+/-4.6 cm, p=0.0054), body weight (from 87.5+/-10.7 to 85.7+/-10.1 kg, p=0.0375), systolic blood pressure (from 137+/-15 to 126+/-8 mmHg, p=0.0455), total cholesterol (from 220+/-24 to 184+/-13 mg/dl, p=0.0057), and LDL-cholesterol (from 150+/-16 to 105+/-15 mg/dl, p=0.0004). Mitochondrial DNA/nuclear DNA ratio at 6 and 12 months did not change. There was a significant increase of mRNA of peroxisome proliferator- activated receptor (PPAR)-gamma after 6 months of train - ing (p=0.024); PPARalpha mRNA levels were significantly increased at 6 (p=0.035) and 12 months (p=0.044). The mRNA quantification of other genes measured [mitochondrially encoded cytochrome c oxidase subunit II (MTCO2), cytochrome c oxidase subunit Vb (COX5b), PPARgamma coactivator 1alpha (PGC- 1alpha), glucose transporter 4 (GLUT 4), forkhead transcription factor BOX O1 (FOXO-1), carnitine palmitoyltransferase 1 (CPT-1), lipoprotein lipase (LPL), and insulin receptor substrate 1 (IRS-1)] did not show significant changes at 6 and 12 months. This study suggests that a twice-per-week frequency of exercise is sufficient to improve glucose control and the expression of skeletal muscle PPARgamma and PPARalpha in DM2 subjects with metabolic syndrome.

Benign odontogenic tumours: Clinical, epidemiological and therapeutic aspects of a sixteen years sample.

AIM: An original sample of benign odontogenic tumours collected over a period of 16 years has been evaluated as to its clinical, epidemiological and therapeutic aspects. METHODS: Data collection included a retrospective study from January 1, 1987 to December 31, 1999 and a prospective study from January 1, 2000 to December 1, 2002. RESULTS: A total number of 53 benign odontogenic tumours were collected; 9 different types of tumours were found with a slight prevalence in males rather than in females (1.2:1). The medium age of the patients at the time of diagnosis was 28.6 years. Odontomas represented the most frequent tumour, about 53% of the sample. The mandible was more interested (71%) than the maxillary bones and in only 63.5% of the sample symptoms or signs were present at the discovery time. The surgical treatment was almost always conservative with enucleation of the pathological tissue and the curettage of the residual bone cavity. CONCLUSIONS: Odontogenic tumours are more frequently diagnosed in the first three decades of life and therefore they can interfere with the physiological growth of the dento-skeletal apparatus. An early radiographic screening is therefore important to reveal these tumours at an initial stage of their development, when clinical signs or symptoms are not yet present. Due to the usual small size and the benign behaviour of these tumours, a conservative surgical approach is almost always effective in their treatment.

Early detection of insulin deprivation in continuous subcutaneous insulin infusion-treated patients with type 1 diabetes.

BACKGROUND: This study was performed to define the clinical relevance of early changes of capillary 3beta-hydroxybutyrate (3betaOHB), for detection of metabolic deterioration before occurrence of overt diabetic ketoacidosis following interruption of continuous subcutaneous insulin infusion (CSII). METHODS: An open clinical trial was performed with eight patients with type 1 diabetes on CSII therapy. After an overnight fast, at 8 a.m. (T0) CSII was interrupted for 4 h. At noon (T240) CSII was re-established, and at 4 p.m. (T480) the study was ended. Blood glucose (BG) and capillary and plasma 3betaOHB were measured at 30-min intervals, plasma insulin at 60-min intervals, and urinary ketones at 120-min intervals. RESULTS: After CSII interruption mean BG increased from 149.8+/-54.4 mg/dL at T0 to 224.8+/-56.2 mg/dL at T240 (P<0.05), and mean capillary 3betaOHB increased from 0.1+/-0.1 mmol/L at T0 to 0.9+/-0.6 mmol/L at T240 (P<0.001). The rate of increase of capillary 3betaOHB was faster and significantly more relevant than that of BG (P<0.05). The restoration of CSII produced a significant reduction of mean BG and capillary 3betaOHB (T480, 119.5+/-24 mg/dL and 0.2+/-0.2 mmol/L, respectively; P<0.05 for both vs. T240). The recovery of capillary 3betaOHB was significantly faster than that of BG (P=0.03). CONCLUSIONS: The dynamic evaluation of changes of capillary 3betaOHB levels can represent a useful support to home BG monitoring in the event of CSII interruption, providing faster information on early metabolic deterioration due to insulin deprivation and allowing preventative action for avoiding the evolution towards overt diabetic ketoacidosis. After reintroduction of insulin infusion the monitoring of the faster recovery of 3betaOHB relative to BG can provide useful information for the prevention of late hypoglycemia due to insulin overinfusion.

Technical notes about soft tissues biopsies of the oral cavity.

Oral mucosa biopsy is a simple surgical procedure in common dental practice; however, to obtain the best results from its use, it should be performed in the respect of some specific rules concerning indications, techniques, drawing sites, surgical steps and specimen management. The main purpose of biopsy, indeed, is the histopathological diagnosis and, therefore, the specimen should be suitable in size and clinical expressivity and free from artifacts. The availability of the proper instruments, the correct performance of all surgical steps and the suitable treatment of the specimen before it is processed by the pathologist are all essential means to avoid microscopic misinterpretations. The relationship between surgeon or dentist and pathologist is also an important aspect to be considered in the management of the biopsied patient. Complete clinical information should be provided to the pathologist; on the other hand, a clear microscopic response should be supplied to the clinician. Finally, when an excisional biopsy is performed, some surgical expediencies have to be carried out to guarantee the best aesthetic and functional results.

Extraoral extraction: a very rare surgical approach to tooth impaction. A case report.

Extraoral route of access is usually not considered in surgical extraction of teeth because of technical difficulties and above all because of scar resulting from surgical skin wound healing. Some specific conditions, however, should suggest the use of this kind of access. A case of an impacted transmigrated right mandibular canine in an 18-year-old girl is reported. A CT examination has been carried out to evaluate the anatomy of the impacted toot as well as its relationship with the neighbouring structures. Extraoral surgical technique is then detaily described: skin incision, muscular dissection, ostectomy, tooth extraction and suture. Esthetical result was also reevaluated after 10 years. Advantages and drawbacks of intraoral and extraoral routes of access to mandibular tooth impaction are discussed and all anatomic and topographic factors related to the present impacted canine are examined. In conclusion, it is possible to confirm that extraoral access is indicated when a tooth is superficially impacted, in the molar-premolar region, toward the lingual aspect and near the lower border of the mandible.

A clinical radiographic and histologic revaluation of a 10 years sample of surgically treated cysts of the jaws, with special emphasis on keratocysts.

AIM: The aim of this study was to compare the histologic features of the cysts as regards their radiographic and clinical aspects, in order to assess the accuracy of the diagnosis, the appropriateness of the treatment and the reliability of the follow-up. METHODS: A sample of 173 cysts of the jaws was reviewed in accordance with the 1992 WHO histological classification. RESULTS: Of these cysts, 77.44% were inflammatory, 12.71% follicular and 8.67% keratocysts. The cysts were slightly more frequently located in the mandible (52.60%) than in the maxilla (47.39%) and they affected men more frequently (60.11%) than women (39.88%). However keratocysts and nasopalatine cysts were twice as frequent in women than in men. No recurrence of keratocysts was found, either in those correctly diagnosed at the moment of the first histologic examination, or in those firstly erroneously diagnosed as an other type of cysts. CONCLUSION: On the basis of the fairly high percentage of non-inflammatory cysts in adult patients, it can be suggested to perform an orthopantomography as a preventive measure, every 5 years, particularly when impaired teeth are present.

Periapical cemental (fibrous) dysplasia. Clinical, radiographic and pathologic aspects in 7 reported cases.

AIM: Periapical cemental dysplasia (PCD) is a relatively common, well-defined pathology. Because of the structural similarities existing in the group of the so-called "fibro-(cemento)-osseus lesions" of the jaws, to which PCD belongs, clinical and radiographic findings are probably more diagnostic than histology. The aim of the present paper is to analyse some new cases of PCD and to compare their clinical, radiographic and histologic features to those reported by the international literature. METHODS: Seven new cases of PCD are presented here; they were observed in a 12-year period of time. All the patients are white women and 6 lesions exceeded 1 cm in diameter. Only 2 patients were surgically treated, but all of them are still today clinically and radiographically followed. RESULTS: Clinical, radiographic and histologic data of our cases are generally in agreement with those provided by the international literature. CONCLUSION: Finally, stress is laid on the existing difficulty, at present as well as in the past, of establishing definitive classification criteria for all fibro-cemento-osseous lesions of the jaws.

Prevalence of carotid stenosis in type 2 diabetic patients asymptomatic for cerebrovascular disease.

Stroke, with an incidence of 2.5 x 10(3) yr(-1) (95% CI, 2.3-2.8 x 10(3) yr(-1)), is the third most frequent cause of death and the first cause of disability in western society. Diabetes is an important risk factor for ischaemic stroke, second only to hypertension, whereas it does not seem to be associated with an increased risk of haemorrhagic stroke. The incidence of stroke in men and women between 45 and 74 yr has been found to be 2.5 and 3.5 times higher in diabetics than in non-diabetic subjects, with a relative risk higher in females than in males with diabetes and greater in both sexes in the 50-to-60-yr age group but decreased in subjects who were 70 and above. It is known that there is an association between ischaemic stroke and carotid stenosis. However, the prevalence of carotid stenosis in Type 2 diabetes mellitus (T2DM) patients has not been well investigated, mainly in the Italian diabetic population. Therefore, the aim of this study was to evaluate the prevalence of carotid artery stenosis in a population of T2DM patients asymptomatic for cerebrovascular disease selected from the files of the Diabetes Clinics, and from the computerised files of General Practitioners (GPs). Three hundred and sixty-five subjects were examined: 187 were non-diabetic (89 males, 98 females) and 178 were T2DM patients (82 males, 96 females). The mean age of all the subjects was 67 +/- 7.8 yr; 66 +/- 7.9 for the non-diabetic subjects and 67 +/- 7.5 yr in the diabetic subjects. In the echo-Doppler examination of the carotid, a degree of stenosis ranging 10-99% was recorded in 143/365 subjects (39.1%), 49/187 non-diabetics (26.2%) and 94/178 diabetics (52.8%). The differences were highly significant (p < 0.001). Severe stenosis was recorded in 17/143 subjects (12%); 12 of these were diabetic (70%) and 5 non-diabetic (30%). The diabetics were three times more likely to develop carotid stenosis than the non-diabetics with an odds ratio of 3.152, (95% CI, 2.032-4.889).

Circulating ghrelin levels of visceral obese men are not modified by a short-term treatment with very low doses of GH replacement.

Ghrelin, the endogenous ligand for the GH secretagogue-receptor (GHS-R), in addition to its GH-releasing action, has orexigenic and adipogenic properties. These characteristics make ghrelin a potential hormone involved in the pathogenesis of obesity. Ghrelin levels are decreased in obese humans and it is unknown whether this decrease is responsible for the blunted GH secretion reported in visceral obesity. Since only few data are available on the potential feedback regulation by GH on systemic ghrelin concentrations, it remains to be established whether the correction of circulating GH concentrations in obese individuals affects ghrelin concentrations. To answer this question, we measured plasma ghrelin levels after a week of administration of low doses of recombinant human GH (rhGH) in a randomized, double-blind, placebo (PL)-controlled trial. This study was originally designed to evaluate the effects of GH replacement on lipid kinetics in visceral obese men. Six adult men with abdominal/visceral obesity (age 42+/-3 yr, body weight 107 +/- 10 kg, BMI 33 +/- 1 kg/m2, waist circumference 111 +/- 3 cm, mean +/- SE) were evaluated in the basal state (BS) and after one week of treatment with subcutaneous bedtime injections of either PL, 2.5 (GH2.5) or 3.3 (GH3.3) pg/kg/die of rhGH. In comparison to BS either PL, GH2.5 or GH3.3 did not significantly modify circulating ghrelin concentrations (p = 0.77). In contrast, a significant increase of serum GH (p = 0.0028), IGF-I (p = 0.0033) and whole body rate of lipolysis (p = 0.038, GH2.5; p = 0.009, GH3.3) occurred, in comparison to BS or PL, after GH2.5 and GH3.3, without differences between the two treatments. These data demonstrate that in abdominal/visceral obese men a short-term treatment with very low doses of rhGH replacement, sufficient to augment the rate of lipolysis, do not modify circulating ghrelin levels.