Catalytic Cleavage of the 9-Fluorenylmethoxycarbonyl (Fmoc) Protecting Group under Neat Conditions

This work reports the first solvent-free catalytic approach for the cleavage of the fluorenylmethoxycarbonyl (Fmoc) protecting group from amine and alcohol functionalities. Various saccharide, peptide, and glyco-amino acid substrates were efficiently deprotected by simple treatment with 20 mol % neat 4-dimethylaminopyridine (DMAP) (one of the effective base catalysts found), without any solvent or stoichiometric additives. Small model structures were finally assembled through one-pot, base-catalyzed, solvent-free multistep sequences combining the Fmoc cleavage with esterification, amidation, and/or glycosylation steps.

IELSG30 phase 2 trial: intravenous and intrathecal CNS prophylaxis in primary testicular diffuse large B-cell lymphoma

ABSTRACT

Primary testicular diffuse large B-cell lymphoma (PTL) is characterized by high risk of contralateral testis and central nervous system (CNS) relapse. Chemoimmunotherapy with intrathecal (IT) CNS prophylaxis and contralateral testis irradiation eliminates contralateral recurrences and reduces CNS relapses. The IELSG30 phase 2 study investigated feasibility and activity of an intensified IT and IV CNS prophylaxis. Patients with stage I/II PTL who had not received treatment received 2 cycles of IV high-dose methotrexate (MTX) (1.5 g/m2) after 6 cycles of the R-CHOP regimen (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, every 21 days). IT liposomal cytarabine was administered on day 0 of cycles 2 to 5 of 21-day R-CHOP regimen. Contralateral testis radiotherapy (25-30 Gy) was recommended. Fifty-four patients (median age: 66 years) with stage I (n = 32) or II (n = 22) disease were treated with R-CHOP, 53 received at least 3 doses of IT cytarabine, 48 received at least 1 dose of IV MTX, and 50 received prophylactic radiotherapy. No unexpected toxicity occurred. At a median follow-up of 6 years, there was no CNS relapse; 7 patients progressed, and 8 died, with 5-year progression-free and overall survival rates of 91% (95% confidence interval [CI], 79-96) and 92% (95% CI, 81-97), respectively. Extranodal recurrence was documented in 6 patients (in 2 without nodal involvement). In 4 cases, the relapse occurred >6 years after treatment. Causes of death were lymphoma (n = 4), second primary malignancy (n = 1), cerebral vasculopathy (n = 1), unknown (n = 2). Intensive prophylaxis was feasible and effective in preventing CNS relapses. Late relapses, mainly at extranodal sites, represented the most relevant pattern of failure. This trial was registered at www.clinicaltrials.gov as #NCT00945724.

Multi-step semi-synthesis, structural characterization and growth factor interaction study of regiochemically sulfated diabolican polysaccharides

Diabolican is an exopolysaccharide (EPS) produced by Vibrio diabolicus HE800, a mesophilic bacterium firstly isolated from a deep-sea hydrothermal field. Its glycosaminoglycan (GAG)-like structure, consisting of a tetrasaccharide repeating unit composed of two aminosugars (N-acetyl-glucosamine and N-acetyl-galactosamine) and two glucuronic acid units, suggested to subject it to regioselective sulfation processes, in order to obtain some sulfated derivatives potentially acting as GAG mimics. To this aim, a multi-step semi-synthetic approach, relying upon tailored sequence of regioselective protection, sulfation and deprotection steps, was employed in this work. The chemical structure of the obtained sulfated diabolican derivatives was characterized by a multi-technique analytic approach, in order to define both degree of sulfation (DS) and sulfation pattern within the polysaccharide repeating unit, above all. Finally, binding affinity for some growth factors relevant for biomedical applications was measured for both starting diabolican and sulfated derivatives thereof. Collected data suggested that sulfation pattern could be a key structural element for the selective interaction with signaling proteins not only in the case of native GAGs, as already known, but also for GAG-like structures obtained by regioselective sulfation of naturally unsulfated polysaccharides.

CT Images in Follicular Lymphoma: Changes after Treatment Are Predictive of Cardiac Toxicity in Patients Treated with Anthracycline-Based or R-B Regimens

The aim of this study is to evaluate changes in epicardial adipose tissue (EAT) and cardiac extracellular volume (ECV) in patients with follicular lymphoma (FL) treated with R-CHOP-like regimens or R-bendamustine. We included 80 patients with FL between the ages of 60 and 80 and, using computed tomography (CT) performed at onset and at the end of treatment, we assessed changes in EAT by measuring tissue density at the level of the cardiac apex, anterior interventricular sulcus and posterior interventricular sulcus of the heart. EAT is known to be associated with metabolic syndrome, increased calcium in the coronary arteries and therefore increased risk of coronary artery disease. We also evaluated changes in ECV, which can be used as an early imaging marker of cardiac fibrosis and thus myocardial damage. The R-CHOP-like regimen was associated with lower EAT values (p < 0.001), indicative of a less active metabolism and more adipose tissue, and an increase in ECV (p < 0.001). Furthermore, in patients treated with anthracyclines and steroids (R-CHOP-like) there is a greater decrease in ejection fraction (EF p < 0.001) than in the R-B group. EAT and ECV may represent early biomarkers of cardiological damage, and this may be considered, to our knowledge, the first study investigating radiological and cardiological parameters in patients with FL.

Towards the semi-synthesis of phosphorylated mimics of glycosaminoglycans: Screening of methods for the regioselective phosphorylation of chondroitin

Glycosaminoglycan (GAG) mimics carrying phosphate rather than sulfate anionic groups have been poorly investigated, in spite of their interesting perspectives. While some GAG-mimicking phosphorylated polymers have been reported, to the best of our knowledge no phosphorylated polysaccharides having the same backbone of natural sulfated GAGs have been accessed yet. To fill this gap, in this work two standard phosphorylation protocols and two recently reported procedures have been screened on a set of polysaccharide species composed by microbial sourced chondroitin and three partially protected, semi-synthetic derivatives thereof. A detailed structural characterization by 1H, 13C and 31P NMR spectroscopy revealed the higher versatility of the innovative, biomimetic reaction employing monopotassium salt of phosphoenolpyruvate (PEPK) with respect to standard phosphorylating agents (phosphoric acid or phosphorus oxychloride). Indeed, PEP-K and H3PO4 gave similar results in the regioselective phosphorylation of the primary hydroxyls of unprotected chondroitin, while only the former reacted on partially protected chondroitin derivatives in a controlled, regioselective fashion, affording chondroitin phosphate (CP) polysaccharides with different derivatization patterns. The reported results represent the first, key steps towards the systematic semi-synthesis of phosphorylated GAGs as a new class of GAG mimics and to the evaluation of their biological activities in comparison with native sulfated GAGs.

CT-based body composition in diffuse large B cell lymphoma patients: changes after treatment and association with survival

PURPOSE

Primary purpose was to assess changes of bone mineral density (BMD) in diffuse large B cell lymphoma (DLBCL) patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone R-CHOP (like) chemotherapy regimen. Secondary purposes were to assess other body composition features changes and to assess the association of pre-therapy values and their changes over time with survival.

MATERIAL AND METHODS

Patients selected underwent R-CHOP(like) regimen for DLBCL, and underwent PET-CT before and after treatment. Main clinical data collected included body mass index, date of last follow-up, date of progression, and date of death. From the low-dose CT images, BMD was assessed at the L1 level; the other body composition values, including muscle and fat distribution, were assessed at the L3 level by using a dedicated software. Descriptive statistics were reported as median and interquartile range, or frequencies and percentages. Statistical comparisons of body composition variables between pre- and post-treatment assessments were performed using the Wilcoxon matched pairs signed rank test. Non-normal distribution of variables was tested with the Shapiro-Wilk test. For qualitative variables, the Fisher exact test was used. Log rank test was used to compare survival between different subgroups of the study population defined by specific body composition cutoffs. The significance level was set at p < 0.05.

RESULTS

Eighty-two patients were included. The mean follow-up was 37.5 ± 21.4 months. A significant difference was found in mean BMD before and after R-CHOP(like) treatment (p < 0.0001). The same trend was observed for mean skeletal muscle area (SMA) (p = 0.004) and mean skeletal muscle index (SMI) (p = 0.006). No significant association was demonstrated between body composition variables, PFS and OS.

CONCLUSION

R-CHOP(like) treatment in DLBCL patients was associated with significant reduction of BMD, SMA and SMI.

Built-in tensile strain dependence on the lateral size of monolayer MoS2 synthesized by liquid precursor chemical vapor deposition

Strain engineering is an efficient tool to tune and tailor the electrical and optical properties of 2D materials. The built-in strain can be tuned during the synthesis process of a two-dimensional semiconductor, such as molybdenum disulfide, by employing different growth substrates with peculiar thermal properties. In this work, we demonstrate that the built-in strain of MoS2 monolayers, grown on a SiO2/Si substrate by liquid precursor chemical vapor deposition, is mainly dependent on the size of the monolayer. In fact, we identify a critical size equal to 20 μm, from which the built-in strain increases drastically. The built-in strain is the maximum for a 60 μm sized monolayer, leading to 1.2% tensile strain with a partial release of strain close to the monolayer triangular vertexes due to the formation of nanocracks. These findings also imply that the standard method for evaluation of the number of layers based on the Raman mode separation can become unreliable for highly strained monolayers with a lateral size above 20 μm.

Serum Paraprotein Is Associated with Adverse Prognostic Factors and Outcome, across Different Subtypes of Mature B-Cell Malignancies-A Systematic Review

The presence of a serum paraprotein (PP) is usually associated with plasma-cell dyscrasias, Waldenstrom Macroglobulinemia/lymphoplasmacytic lymphoma, and cryoglobulinemia. However, PP is also often reported in other high- and low-grade B-cell malignancies. As these reports are sparse and heterogeneous, an overall view on this topic is lacking, Therefore, we carried out a complete literature review to detail the characteristics, and highlight differences and similarities among lymphoma entities associated with PP. In these settings, IgM and IgG are the prevalent PP subtypes, and their serum concentration is often low or even undetectable without immunofixation. The relevance of paraproteinemia and its prevalence, as well as the impact of IgG vs. IgM PP, seems to differ within B-NHL subtypes and CLL. Nonetheless, paraproteinemia is almost always associated with advanced disease, as well as with immunophenotypic, genetic, and clinical features, impacting prognosis. In fact, PP is reported as an independent prognostic marker of poor outcome. All the above call for implementing clinical practice, with the assessment of paraproteinemia, in patients' work-up. Indeed, more studies are needed to shed light on the biological mechanism causing more aggressive disease. Furthermore, the significance of paraproteinemia, in the era of targeted therapies, should be assessed in prospective trials.

Multi-step Strategies Toward Regioselectively Sulfated M-Rich Alginates

Sulfated alginates (ASs), as well as several artificially sulfated polysaccharides, show interesting bioactivities. The key factors for structure-activity relationships studies are the degree of sulfation and the distribution of the sulfate groups along the polysaccharide backbone (sulfation pattern). The former parameter can often be controlled through stoichiometry, while the latter requires the development of suitable chemical or enzymatic, regioselective methods and is still missing for ASs. In this work, a study on the regioselective installation of several different protecting groups on a d-mannuronic acid enriched (M-rich) alginate is reported in order to develop a semi-synthetic access to regioselectively sulfated AS derivatives. A detailed structural characterization of the obtained ASs revealed that the regioselective sulfation could be achieved complementarily at the O-2 or O-3 positions of M units through multi-step sequences relying upon a silylating or benzoylating reagent for the regioselective protection of M-rich alginic acid, followed by sulfation and deprotection.

Role of Neutrophil-to-Lymphocyte Ratio (NLR) in Patients with Mycosis Fungoides

BACKGROUND

The neutrophil/lymphocyte ratio (NLR) at baseline has been demonstrated to correlate with higher stages of disease and to be a prognostic factor in numerous cancers. However, its function as a prognostic factor for mycosis fungoides (MF) has not been yet clarified.

OBJECTIVE

Our work aimed to assess the association of the NLR with different stages of MF and to outline whether higher values of this marker are related to a more aggressive MF.

METHODS

We retrospectively calculated the NLRs in 302 MF patients at the moment of diagnosis. The NLR was obtained using the complete blood count values.

RESULTS

The median NLR among patients with early stage disease (low-grade IA-IB-IIA) was 1.88, while the median NLR for patients with high-grade MF (IIB-IIIA-IIIB) was 2.64. Statistical analysis showed positive associations of advanced MF stages with NLRs higher than 2.3.

CONCLUSIONS

Our analysis demonstrates that the NLR represents a cheap and easily available parameter functioning as a marker for advanced MF. This might guide physicians in recognizing patients with advanced stages of disease requiring a strict follow-up or an early treatment.

Adaptation of Zemplén's conditions for a simple and highly selective approach to methyl 1,2-trans glycosides

1,2-trans methyl glycosides can be readily obtained from peracetylated sugars through their initial conversion into glycosyl iodide donors and subsequent exposure of these latter to a slight excess of sodium methoxide in methanol. Under these conditions a varied set of mono- and disaccharide precursors afforded the corresponding 1,2-trans glycosides with concomitant de-O-acetylation in satisfying yields (in the range 59-81%). A similar approach also proved effective when using GlcNAc glycosyl chloride as the donor.

Glycosaminoglycan Mimetics Obtained by Microwave-Assisted Sulfation of Marine Bacterium Sourced Infernan Exopolysaccharide

Sulfated glycosaminoglycans (GAGs) are fundamental constituents of both the cell surface and extracellular matrix. By playing a key role in cell-cell and cell-matrix interactions, GAGs are involved in many physiological and pathological processes. To design GAG mimetics with similar therapeutic potential as the natural ones, the specific structural features, among them sulfate content, sulfation pattern, and chain length, should be considered. In the present study, we describe a sulfation method based on microwave radiation to obtain highly sulfated derivatives as GAG mimetics. The starting low-molecular-weight (LMW) derivative was prepared from the infernan exopolysaccharide, a highly branched naturally slightly sulfated heteropolysaccharide synthesized by the deep-sea hydrothermal vent bacterium Alteromonas infernus. LMW highly sulfated infernan derivatives obtained by conventional heating sulfation have already been shown to display GAG-mimetic properties. Here, the potential of microwave-assisted sulfation versus that of the conventional method to obtain GAG mimetics was explored. Structural analysis by NMR revealed that highly sulfated derivatives from the two methods shared similar structural features, emphasizing that microwave-assisted sulfation with a 12-fold shorter reaction time is as efficient as the classical one.

Validation and application of a SEC-HPLC method for the determination of total protein in therapeutic immunoglobulins as an alternative to the European Pharmacopoeia methods

Several analytical procedures are described in the European Pharmacopoeia (Ph. Eur.) to determine total protein content. However, the method for the determination of protein content in therapeutic immunoglobulins prescribed in the Ph. Eur. monographs is the Kjeldahl method. The Kjeldahl method is time-consuming and requires the use of large amounts of hazardous reagents, which also results in the production of a large amount of hazardous chemical waste. The purpose of this work was to validate an alternative chromatographic method that requires no hazardous reagents and saves time, using the same instrumental conditions specified in the Ph. Eur. for the human immunoglobulin size-exclusion high-performance liquid chromatography (SEC-HPLC) molecular-size distribution assay. The chromatographic separation was achieved with a TSKgel G3000SW (600 × 7.5 mm, 10 µm) column, using an isocratic elution, with detection at 280 nm wavelength. The mobile phase consisted of an aqueous solution of 0.03 M disodium hydrogen phosphate dehydrate, 0.01 M sodium dihydrogen phosphate monohydrate, 0.2 M sodium chloride and 1 mM sodium azide. The protein content of the test samples was determined referring to a standard with a known protein concentration (i.e. Human immunoglobulin (molecular size) Biological Reference Preparation). The method was validated evaluating the characteristics precision and trueness according to the ICH Q2 guideline, and the goodness of linear fit for the signal response was assessed (given for information only). In addition, the equivalence of methods was evaluated with two one-sided t-tests (TOST) analysis with the Kjeldahl method mentioned in Ph. Eur. monographs on therapeutic immunoglobulins, and with Bland-Altman analysis of SEC-HPLC and manufacturers' data (Kjeldahl and biuret methods). The uncertainty of measurement was also calculated in order to evaluate the accuracy and quality of the results, thus facilitating a reliable compliance/non-compliance decision. Based on the outcome, the method is proposed as a suitable and convenient alternative for the determination of protein content in human immunoglobulins.

IELSG40/CLEO phase II trial of clarithromycin and lenalidomide in relapsed/refractory extranodal marginal zone lymphoma

Not available.

The impact of the SARS-CoV-2 pandemic on cause-specific- mortality: a systematic literature review

Background

Although investigating the patterns of COVID-19 excess mortality (EM) is relevant, understanding the effects of the pandemic on cause-specific mortality is even crucial and should also be assessed, as this metric allows for a more detailed analysis of the true impact of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon.

Methods

We searched MEDLINE to identify studies that reported cause-specific mortality during the COVID-19 pandemic. We adopted several inclusion criteria: original article; assessed at least one cause-specific mortality during the pandemic; assessed causes of deaths using the ICD-10 classification; reporting of at least one of the following outcomes: cause-specific mortality estimates or cause-specific EM; full-length articles. Several relevant data were extracted (e.g. publication year, data stratification, territory, country income level, all-cause EM, and cause-specific mortality, etc.).

Results

The search identified 548 articles. After title, abstract and full-text screening, we extracted relevant data from the final set of 14 articles. Cause-specific mortality was reported using different units of measurement. Only 9 studies reported the statistical significance and/or confidence intervals. The most frequently analyzed causes of death were cardiovascular diseases (n = 11), cancer (n = 7), diabetes (n = 6), and suicide (n = 5). We found very heterogeneous patterns of cause-specific mortality, for all the specific causes of deaths, except for suicide and road accident.

Conclusions

The impact of the pandemic on cause-specific deaths has been very heterogeneous and the analyses conducted so far are not exhaustive. We advocate for the urgent need to find a consensus to define uniform methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality.

Key messages

• We reviewed the body of literature to estimate the impact of the COVID-19 pandemic on different causes of death, and to provide a quantitative and qualitative analysis of the phenomenon.

• We did not identify unique patterns of cause-specific mortality due to too varied approaches in terms of disease classification and coding, and methodologies used for estimating mortality.

Perceived quality and willingness to continue using telemedicine services in patients with diabetes

Background

Plenty of literature reported the applicability and usefulness of telemedicine and teleassistance (TMTA) services in the management of diabetes and other chronic conditions. Specifically, TMTA proved to be effective for conditions that require radical lifestyle modifications, tailored pharmacological interventions, and periodic monitoring of clinical health status. The purpose of this study is to investigate the individual and contextual determinants of the perceived quality (PQ) of the telemedicine and teleassistance (TMTA) services and the willingness to continue (WC) with them among patients with diabetes using TMTA during the COVID-19 pandemic in one large region of Italy (Emilia-Romagna).

Methods

A structured survey was administered to patients with type 1 and 2 diabetes who used TMTA services during the first wave of the COVID-19 pandemic. The questionnaire was comprised of questions on TMTA service experience and participants’ socio-demographic characteristics. Multiple regression models investigated the independent factors associated with PQ (score 1-100) and WC (yes/no).

Results

The final analysis included 569 patients with diabetes (54.7% female), with an average age of 58.1 years. TMTA services’ PQ and WC were high. A higher education (OR = 1.83; 95%CI 1.04, 3.31) and being unemployed (OR = 2.57; 95%CI 1.17, 6.02) were factors associated with an increased WC. Older age was negatively related to PQ (b = −3.6; 95%CI −6.8, −0.29). Perceived support from TMTA service was positively associated with PQ (b = 10.1; 95%CI 5.1, 15) and WC (OR = 2.03; 95%CI 1.07, 3.85). Perceived increase in disease self-management was positively associated with PQ (b = 5.3; 95%CI 0.24, 10) and WC (OR = 7.11; 95%CI 4.04, 12.8).

Conclusions

Our study identified several determinants of PQ and WC. These socio-demographic and patient-perception related factors should be considered in the implementation of care pathways integrating in-person visits with TMTA services.

Key messages

• Socio-demographic factors play a crucial role in TMTA acceptance and should be taken into due consideration when implementing health pathways integrating in-person visits with TMTA services.

• Health workers should always try to improve patients’ self-management skills and should always make patients feel supported. This is also true in the digital health era.

Thalamo-hippocampal pathway regulates incidental memory capacity in mice

Incidental memory can be challenged by increasing either the retention delay or the memory load. The dorsal hippocampus (dHP) appears to help with both consolidation from short-term (STM) to long-term memory (LTM), and higher memory loads, but the mechanism is not fully understood. Here we find that female mice, despite having the same STM capacity of 6 objects and higher resistance to distraction in our different object recognition task (DOT), when tested over 1 h or 24 h delays appear to transfer to LTM only 4 objects, whereas male mice have an STM capacity of 6 objects in this task. In male mice the dHP shows greater activation (as measured by c-Fos expression), whereas female mice show greater activation of the ventral midline thalamus (VMT). Optogenetic inhibition of the VMT-dHP pathway during off-line memory consolidation enables 6-object LTM retention in females, while chemogenetic VMT-activation impairs it in males. Thus, removing or enhancing sub-cortical inhibitory control over the hippocampus leads to differences in incidental memory.

Incidental memory is affected by retention delay, and by memory load. Here the authors show that female and male mice process high memory load through different activation of thalamic-cortical pathways, that makes their incidental memory resistant to distraction and to memory decay, respectively.

P-327 The impact of chronic endometritis disease on endometrial receptivity gene expression in women with repeated implantation failure

Study question

Does chronic endometritis (CE) have an impact on the expression of the genes involved in the embryo implantation?

Summary answer

The mRNA expression of genes involved in embryo implantation (HOXA10, HOXA11, BTEB1 and LIF) does not change in patients with and without CE.

What is known already

CE is an inflammatory disorder of the endometrium with a detrimental effect on embryo implantation and its prevalence in women with repeated implantation failure (RIF) is up to 30%. During the implantation window, the expression of some genes plays a key role in determining the success of embryo implantation. The homeobox genes HOXA10, HOXA11 and the basic transcriptional element binding protein 1 (BTEB1) gene are essential for endometrial cells growth regulation and for embryonic development and the leukaemia inhibitory factor (LIF) has a role in the embryo–endometrium interaction.

Study design, size, duration

A single centre-prospective case-control study was conducted at the Women’s and Children’s Health Department at Padua University, on infertile women with RIF from June 2020 to November 2021. 29 women with RIF were prospectively enrolled.

Participants/materials, setting, methods

An endometrial biopsy using a Novak curette was performed for each patient and the obtained tissue samples were divided in two aliquots, one for immunohistochemistry for histological examination (endometrial dating and CE diagnosis) and one for RNA extraction and gene expression analysis that has been performed using RT-PCR. Sample of patients with and without CE were compared using non-parametric Mann–Whitney U-test. A p-value &lt;.05 was considered as statistically significant.

Main results and the role of chance

Enrolled women were divided in two groups according to the histological diagnosis of CE: 13 patients with CE, 16 without CE. In all samples, appropriate histological dating (WOI) was evaluated according to Noyes criteria. After the comparison of all investigated genes (HOXA10, HOXA11, BTEB1 and LIF), no significant difference in mRNA expression was detected between women with and without CE (p value &gt;.05). In the literature, defective endometrial expression of HOXA10, HOXA11 and LIF genes has been associated with abnormal implantation and the reduced expression of BTEB1 gene results in subfertility and progesterone resistance. Although the negative role of CE in altering embryo implantation is known, our results suggest that the CE has no effect on the expression of HOXA10, HOXA11, BTEB1 and LIF genes. Probably the detrimental effect of CE on embryo implantation does not act through HOXA10, HOXA11, BTEB1 and LIF gene expression.

Limitations, reasons for caution

This is a non-randomized observational study with a limited number of patients. Further studies are needed to confirm our data with immunohistochemistry evaluation to define the protein expression levels of the investigated genes.

Wider implications of the findings

Understanding the pathogenic mechanism of CE on endometrial receptivity is crucial for identifying markers that best correlate with possible implantation failure and for identifying the appropriate therapy to treat the disease and restore the embryo implantation capacity.

Trial registration number

not applicable

Chemical Composition of Essential Oil from Four Sympatric Orchids in NW-Italy

Orchidaceae is a flowering plant family worldwide distributed known for producing volatile organic compounds (VOCs) which can act as olfactory signals for pollinators. Despite the importance of VOCs in the different reproductive strategies, in the literature there are only a few publications on the characterization of orchids' volatile profiles. In this study, the essential oils from fresh inflorescences of sympatric orchids Anacamptis morio, Himantoglossum robertianum, Ophrys sphegodes and Orchis purpurea, naturally growing in Piedmont (Italy) were isolated by steam distillation and characterized by GC/FID and GC/MS. A number of compounds were identified, with a peculiar distribution in the species: alcohols (range 16.93-50.60%), from which p-cresol (range 12.75-38.10%) was the most representative compound; saturated hydrocarbons (range 5.81-59.29%), represented by pentacosane (range 2.22-40.17%) and tricosane (range 0.78-27.48%); long-chain monounsaturated hydrocarbons (range 0.29-5.20%) represented by 9-pentacosene, 11-tricosene, and 1-heneicosene. The structure of positional isomers in linear alkenes was elucidated by derivatization with dimethyl disulfide and MS fragmentation patterns. Coumarin (68.84%) was the dominant compound in O. purpurea and was detected in lower concentrations (range 0.21-0.26%) in the other taxa. These volatile compounds may represent a particular feature of these plant species and play an essential role in pollinator interaction.

Integration of Baseline Metabolic Parameters and Mutational Profiles Predicts Long-Term Response to First-Line Therapy in DLBCL Patients: A Post Hoc Analysis of the SAKK38/07 Study

Accurate estimation of the progression risk after first-line therapy represents an unmet clinical need in diffuse large B-cell lymphoma (DLBCL). Baseline (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) parameters, together with genetic analysis of lymphoma cells, could refine the prediction of treatment failure. We evaluated the combined impact of mutation profiling and baseline PET/CT functional parameters on the outcome of DLBCL patients treated with the R-CHOP14 regimen in the SAKK38/07 clinical trial (NCT00544219). The concomitant presence of mutated SOCS1 with wild-type CREBBP and EP300 defined a group of patients with a favorable prognosis and 2-year progression-free survival (PFS) of 100%. Using an unsupervised recursive partitioning approach, we generated a classification-tree algorithm that predicts treatment outcomes. Patients with elevated metabolic tumor volume (MTV) and high metabolic heterogeneity (MH) (15%) had the highest risk of relapse. Patients with low MTV and favorable mutational profile (9%) had the lowest risk, while the remaining patients constituted the intermediate-risk group (76%). The resulting model stratified patients among three groups with 2-year PFS of 100%, 82%, and 42%, respectively (p < 0.001).

Burden of rare coding variants in an Italian cohort of familial multiple sclerosis

BACKGROUND

Multiple Sclerosis (MS) is a chronic inflammatory and neurodegenerative demyelinating disease of the central nervous system. It is a complex and heterogeneous disease caused by a combination of genetic and environmental factors, and it can cluster in families.

OBJECTIVE

to evaluate at gene-level the aggregate contribution of predicted damaging low-frequency and rare variants to MS risk in multiplex families.

METHODS

We performed whole exome sequencing (WES) in 28 multiplex MS families with at least 3 MS cases (81 affected and 42 unaffected relatives) and 38 unrelated healthy controls. A gene-based burden test was then performed, focusing on two sets of candidate genes: i) literature-driven selection and ii) data-driven selection.

RESULTS

We identified 11 genes enriched with predicted damaging low-frequency and rare variants in MS compared to healthy individuals. Among them, UBR2 and DST were the two genes with the strongest enrichment (p = 5 × 10^-4 and 3 × 10^-4, respectively); interestingly enough the association signal in UBR2 is driven by rs62414610, which was present in 25% of analysed families.

CONCLUSION

Despite limitations, this is one of the first studies evaluating the aggregate contribution of predicted damaging low-frequency and rare variants in MS families using WES data. A replication effort in independent cohorts is warranted to validate our findings and to evaluate the role of identified genes in MS pathogenesis.

Magnetic resonance T1w/T2w ratio and voxel-based morphometry in multiple system atrophy

Diagnosis of multiple system atrophy (MSA) may be improved by using multimodal imaging approaches. We investigated the use of T1-weighted/T2-weighted (T1w/T2w) images ratio combined with voxel-based morphometry to evaluate brain tissue integrity in MSA compared to Parkinson’s disease (PD) and healthy controls (HC). Twenty-six patients with MSA, 43 patients with PD and 56 HC were enrolled. Whole brain voxel-based and local regional analyses were performed to evaluate gray and white matter (GM and WM) tissue integrity and mean regional values were used for patients classification using logistic regression. Increased mean regional values of T1w/T2w in bilateral putamen were detected in MSA-P compared to PD and HC. The combined use of regional GM and T1w/T2w values in the right and left putamen showed the highest accuracy in discriminating MSA-P from PD and good accuracy in discriminating MSA from PD and HC. A good accuracy was also found in discriminating MSA from PD and HC by either combining regional GM and T1w/T2w values in the cerebellum or regional WM and T1w/T2w in the cerebellum and brainstem. The T1w/T2w image ratio alone or combined with validated MRI parameters can be further considered as a potential candidate biomarker for differential diagnosis of MSA.

Generation and validation of a PET radiomics model that predicts survival in diffuse large B cell lymphoma treated with R-CHOP14: A SAKK 38/07 trial post-hoc analysis

Functional parameters from positron emission tomography (PET) seem promising biomarkers in various lymphoma subtypes. This study investigated the prognostic value of PET radiomics in diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP given either every 14 (testing set) or 21 days (validation set). Using the PyRadiomics Python package, 107 radiomics features were extracted from baseline PET scans of 133 patients enrolled in the Swiss Group for Clinical Cancer Research 38/07 prospective clinical trial (SAKK 38/07) [ClinicalTrial.gov identifier: NCT00544219]. The international prognostic indices, the main clinical parameters and standard PET metrics, together with 52 radiomics uncorrelated features (selected using the Spearman correlation test) were included in a least absolute shrinkage and selection operator (LASSO) Cox regression to assess their impact on progression-free (PFS), cause-specific (CSS), and overall survival (OS). A linear combination of the resulting parameters generated a prognostic radiomics score (RS) whose area under the curve (AUC) was calculated by receiver operating characteristic analysis. The RS efficacy was validated in an independent cohort of 107 DLBCL patients. LASSO Cox regression identified four radiomics features predicting PFS in SAKK 38/07. The derived RS showed a significant capability to foresee PFS in both testing (AUC, 0.709; p < 0.001) and validation (AUC, 0.706; p < 0.001) sets. RS was significantly associated also with CSS and OS in testing (CSS: AUC, 0.721; p < 0.001; OS: AUC, 0.740; p < 0.001) and validation (CSS: AUC, 0.763; p < 0.0001; OS: AUC, 0.703; p = 0.004) sets. The RS allowed risk classification of patients with significantly different PFS, CSS, and OS in both cohorts showing better predictive accuracy respect to clinical international indices. PET-derived radiomics may improve the prediction of outcome in DLBCL patients.

Parents’ perception of overweight-obese children Quality of Life in different settings

Background

Children's Health-Related Quality of Life (HRQoL) has been frequently investigated, in particular among individuals affected by chronic diseases. It is reported that agreement between child and parent ratings regarding the child's HRQoL is strongly influenced by the latter's health status. To our knowledge, there is no evidence of how this agreement is related to different healthcare settings. Thus, our study aims to examine the relationship between child's and parent-proxy reported HRQoL of similar overweight/obese children according to the recruitment setting.

Methods

A cross-sectional study was conducted among 68 overweight/obese children, aged 6-10, recruited in a primary school (Group1, G1) and in a hospital outpatient clinic (Group2, G2) of Imola (Italy) in 2019. HRQoL was assessed using Italian version 4.0 of the Pediatric Quality of Life (PedsQL) questionnaire. For each child, we obtained self-reported children's and parents' perceived children's HRQoL total score (5 questions investigating Physical Health domain and 10 questions investigating Psychosocial Health domain divided in Emotional, Social and School Functioning).

Results

In G1 there were n = 42 overweight/obese children and in G2 n = 26. The correlation between children's reported and parents' perceived HRQoL scores is lower in G1 (Physical Health: r=-0,17; Psychosocial Health: r = 0.38) compared to G2 (Physical Health: r = 0.80; Psychosocial Health: r = 0.66). Notably, in G1, parents tend to overestimate their children's HRQoL, specifically in the Physical Health domain.

Conclusions

Correlation between children's and parents' HRQoL scores is higher in the clinical setting compared to the school setting. Implementing this questionnaire on a large scale would allow us to identify settings which need awareness-raising initiatives to improve parents' knowledge about their children's health.

Key messages

Parents’ overestimate children’s HRQoL in the school setting, particularly in the Physical Health domain. Children’s HRQoL misinterpretation might determine less targeted actions to improve their wellbeing and highlights the need for raising parents’ awareness about obesity and its effects on children.

Association between economic growth, mortality and healthcare spending in 31 high-income countries

Background

During the last decades, countries' healthcare spending has grown continuously, becoming a major expenditure item and threatening the overall sustainability of healthcare systems. Plenty of literature shows conflicting evidence about the relationship between economic variations and measurable health outcomes. This study aims to investigate the association between GDP, population mortality and healthcare spending in OECD high-income countries.

Methods

We conducted a cross-sectional study using panel data across 31 high-income countries from 2000 to 2017. Socioeconomic data for every year and each country were extracted from WHO and OECD Database. The association between current healthcare expenditure (CHE), GDP and mortality rate (MR) was investigated through a random-effects model. To control for possible reverse causality, we adopted a test of Granger causality for heterogeneous panel data models.

Results

The results of the random-effects model show that the MR has no statistically significant effect on CHE. We found no statistically significant association between countries' MR and GDP when the latter is the dependent variable. Our results show that an increase in GDP is associated with a significant increase of CHE (b = 0.066, p &lt; 0.001) and CHE is significantly associated with an increase in GDP (b = 3.188, p &lt; 0.001). The Granger causality analysis shows a unidirectional association between MR and CHE, with MR influencing CHE, albeit with a small statistical significance (p = 0.045). Between GDP and CHE, the causality is bidirectional, while between GDP and MR we found no causality.

Conclusions

In this study, we found a strong two-way relationship between GDP and CHE, both in the causality analysis and in the random-effect panel model. Our analysis highlights the economic multiplier effect of CHE. In the debate on the optimal allocation of resources often resulting from economic crises, this evidence should be taken into due consideration.

Key messages

Policymakers worldwide need to recognize the economic impact of healthcare spending when allocating financial resources. Spending on health leads to economic growth. In light of the current health-economy dichotomy, it is important to produce robust scientific evidence supporting healthcare spending.

Exploring children breakfast habits using Zoom8-questionnaire: Results from the I-MOVE Study

Background

Scientific evidence widely argues that consuming breakfast daily is considered a good habit which positively affects health and academic performance, especially in children. In order to be adequate, according to national requirements, breakfast should include a portion of milk or yogurt and one grain based product, providing about 15-20% of the daily recommended energy intake. The aim of this study was to analyse breakfast habits in a convenience sample of primary school children inside the Imola Active Breaks Study.

Methods

A cross-sectional study was conducted in a sample of children, aged 6-10, recruited in a primary school of Imola (Emilia Romagna region, Italy). The Zoom8 self-reported questionnaire, which investigates dietary habits and lifestyle aspects were administered to parents to explore the children's breakfast habits.

Results

A total of 155 children were recruited in November 2019. Breakfast was consumed daily by 117 children (75%), 4-6 times/week by 12 (7%), 2-4 times/week by 4 (3%), and 22 (14%) did not answer. Concerning dairy products' consumption: 50 (32%) children reported milk or yogurt, 47 (30%) milk, 6 (4%) yogurt, 9 (6%) neither of them and 43 (28%) gave no answer. Mostly all the children consumed at least one of these products: biscuits, cakes, croissants, industrial snacks or cereals. 108 children (70%) recognised that the consumption of a dairy and a carbohydrate product represent an adequate breakfast.

Conclusions

The findings suggested that the majority of children consumed one grain based product for breakfast, but most of them were high in sugar and fat content (industrial snacks and croissants). Still not every child had breakfast daily nor had a portion of a dairy product. Measurements should be taken to avoid skipping breakfast and to promote a more balanced breakfast. It would be advisable to analyse in detail the frequency of consumption of each food group and their energy intake.

Key messages

Breakfast consumption positively affects children’s health and academic performance. Health Promotion should stimulate daily consumption of breakfast and improve its quality and energy intake.

Foraging Behavior and Pollen Transport by Flower Visitors of the Madeira Island Endemic Echium candicans

Simple Summary

The successful conservation of many endangered island plants depends on the pollination services provided by animals. In this study, we identify the flower visitors of Echium candicans, a charismatic plant exclusive to the island of Madeira, and also evaluate their performance as pollinators by analyzing their behavior on the flowers and the pollen they transport on their body. We found that many different animals visit this plant’s flowers, from insects to reptiles, but bees were the most frequent visitors. Large bees visited more flowers and transported more pollen of Echium candicans compared to other pollinators, like butterflies and hoverflies. However, by visiting many flowers in the same plant large bees might contribute to inbreeding, whilst the other animals visited fewer flowers in each plant favoring outcrossing. We conclude that the different flower visitors of Echium candicans provide complementary services as pollinators and highlight the importance of having diverse communities of pollinators to ensure successful pollination in many island plants.

Abstract

The study of flower visitor behavior and pollen transport dynamics within and between plants can be of great importance, especially for threatened or rare plant species. In this work, we aim to assess the flower visitor assemblage of the Madeiran endemic Echium candicans and evaluate the performance of the most common visitors through the analysis of their foraging behavior and pollen loads. The flower visitor assemblage of E. candicans is diverse, including several insect groups and the endemic lizard Teira dugesii, but bees are the most common visitors. In general, large bees (Amegilla quadrifasciata, Apis mellifera, and Bombus spp.) had the highest average visitation rates (>18 flowers/min) and their pollen loads had higher percentages of homospecific pollen (>66%) when compared with butterflies and hoverflies. The honeybee (Apis mellifera) and two bumblebees (Bombus terrestris and B. ruderatus) were the most efficient flower visitors of E. candicans, but their foraging behavior seems to favor geitonogamy. Other visitors, such as butterflies and the small bee Lasioglossum wollastoni, may have a complementary role to the honeybee and bumblebee species, as their high mobility is associated with fewer flower visits on each plant and may promote xenogamy. Two non-native bees (A. mellifera and B. ruderatus) are important flower visitors of E. candicans and may contribute mostly to self-pollination rendering the endemic plant more vulnerable to inbreeding effects.

Identification of differential DNA methylation associated with multiple sclerosis: A family-based study

Multiple Sclerosis (MS) is caused by a still unknown interplay between genetic and environmental factors. Epigenetics, including DNA methylation, represents a model for environmental factors to influence MS risk. Twenty-six affected and 26 unaffected relatives from 8 MS multiplex families were analysed in a multicentric Italian study using MeDIP-Seq, followed by technical validation and biological replication in two additional families of differentially methylated regions (DMRs) using SeqCap Epi Choice Enrichment kit (Roche®). Associations from MeDIP-Seq across families were combined with aggregation statistics, yielding 162 DMRs at FDR ≤ 0.1. Technical validation and biological replication led to 2 hypo-methylated regions, which point to NTM and BAI3 genes, and to 2 hyper-methylated regions in PIK3R1 and CAPN13. These 4 novel regions contain genes of potential interest that need to be tested in larger cohorts of patients.

Periodic Bedrock Ridges at the ExoMars 2022 Landing Site: Evidence for a Changing Wind Regime

Wind-formed features are abundant in Oxia Planum (Mars), the landing site of the 2022 ExoMars mission, which shows geological evidence for a past wet environment. Studies of aeolian bedforms at the landing site were focused on assessing the risk for rover trafficability, however their potential in recording climatic fluctuations has not been explored. Here we show that the landing site experienced multiple climatic changes in the Amazonian, which are recorded by an intriguing set of ridges that we interpret as Periodic Bedrock Ridges (PBRs). Clues for a PBR origin result from ridge regularity, defect terminations, and the presence of preserved megaripples detaching from the PBRs. PBR orientation differs from superimposed transverse aeolian ridges pointing toward a major change in wind regime. Our results provide constrains on PBR formation mechanisms and offer indications on paleo winds that will be crucial for understanding the landing site geology.

Hypervirulent and hypermucoviscous extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Klebsiella variicola in Chile

Convergence of virulence and antibiotic-resistance has been reported in Klebsiella pneumoniae, but not in Klebsiella variicola. We, hereby, report the detection and genomic characterization of hypervirulent and hypermucoviscous K. pneumoniae and K.variicola recovered in Chile from health-care associated infections, which displayed resistance to broad-spectrum cephalosporins. One hundred forty-six K. pneumoniae complex isolates were screened by hypermucoviscosity by the “string test.” Two hypermucoid isolates, one hypermucoviscous K. pneumoniae (hmKp) and one K. variicola (hmKv), were further investigated by whole-genome sequencing. In vivo virulence was analyzed by the Galleria mellonella killing assay. In silico analysis of hmKp UCO-494 and hmKv UCO-495 revealed the presence of multiple antibiotic-resistance genes, such as bla_CTX-M-1, bla_DHA-1 and bla_LEN-25 among others clinically relevant resistance determinants, including mutations in a two-component regulatory system related to colistin resistance. These genetic features confer a multidrug-resistant (MDR) phenotype in both strains. Moreover, virulome in silico analysis confirmed the presence of the aerobactin gene iutA, in addition to yersiniabactin and/or colicin V encoding genes, which are normally associated to high virulence in humans. Furthermore, both isolates were able to kill G. mellonella and displayed higher virulence in comparison with the control strain. In summary, the convergence of virulence and the MDR-phenotype in K. pneumoniae complex members is reported for the first time in Chile, denoting a clinical problem that deserves special attention and continuous surveillance in South America.

Use of dual layered stents in endovascular treatment of extracranial stenosis of the internal carotid artery: one year results of a patient-based meta-analysis of 4 clinical studies

Background

Small sized clinical studies evaluating one year outcomes of CAS performed with two available DLS, Roadsaver® (RS) and CGuard® (CG), have been published.

Purpose

To evaluate one year safety and efficacy of dual layered mesh covered carotid stent systems (DLS) for carotid artery stenting (CAS).

Methods

We performed an individual patient-level meta-analysis including studies enrolling more than 100 CAS with DLS. Primary endpoint was the death and stroke rate; secondary endpoints were restenosis and in-stent thrombosis rates at one year.

Results

Patients were divided in two groups according to DLS (RS N=250; CG N=306). At one year, 11 patients died (1.97%), 7 patients in the group RS (2.8%) and 4 patients in the CG one (1.31%), 10 strokes occurred, 4 in the group RS (1.6%) and 6 in the CG one (1.96%). Overall death and stroke rate was 3.77% (N=21), 11 events in the group RS (4.4%) and 10 in the CG group (3.27%). Symptomatic status was the only predictor of death and or stroke.

At one year restenosis occurred in 12 patients (2.1%), 10 in the group RS (4%) and 2 in the CG one (0.65%) (p=0.007). In stent thrombosis occurred in 1 patient (0.18%) of the group CG (0.32%). RS use was the only independent restenosis predictor.

Conclusions

This study suggests that DLS use for CAS is associated to a low one year death and stroke rate and specific DLS stent use could affect restenosis rate.

Funding Acknowledgement

Type of funding source: None

Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association

AIM

It is not known whether patients with obstructive left colon cancer (OLCC) with caecal ischaemia or diastatic perforation (defined as a blowout of the caecal wall related to colonic overdistension) should undergo a (sub)total colectomy (STC) or an ileo-caecal resection with double-barrelled ileo-colostomy. We aimed to compare the results of these two strategies.

METHOD

From 2000 to 2015, 1220 patients with OLCC underwent surgery by clinicians who were members of the French Surgical Association. Of these cases, 201 (16%) were found to have caecal ischaemia or diastatic perforation intra-operatively: 174 patients (87%) underwent a STC (extended colectomy group) and 27 (13%) an ileo-caecal resection with double-end stoma (colon-sparing group). Outcomes were compared retrospectively.

RESULTS

In the extended colectomy group, 95 patients (55%) had primary anastomosis and 79 (45%) had a STC with an end ileostomy. In the colon-sparing group, 10 patients (37%) had simultaneous resection of their primary tumour with segmental colectomy and an anastomosis which was protected by a double-barrelled ileo-colostomy. The demographic data for the two groups were comparable. Median operative time was longer in the STC group (P = 0.0044). There was a decrease in postoperative mortality (7% vs 12%, P = 0.75) and overall morbidity (56% vs 67%, P = 0.37) including surgical (30% vs 40%, P = 0.29) and severe complications (17% vs 27%, P = 0.29) in the colon-sparing group, although these differences did not reach statistical significance. Cumulative morbidity included all surgical stages and the rate of permanent stoma was 66% and 37%, respectively, with no significant difference between the two groups. Overall survival and disease-free survival were similar between the two groups.

CONCLUSION

The colon-sparing strategy may represent a valid and safe alternative to STC in OLCC patients with caecal ischaemia or diastatic perforation.

Concordance between child’s and parents’- reported Health-related quality of life and overweight

Background

Health-related quality of life (HRQoL) of children is an important health outcome which has frequently been investigated regarding children's chronicle illnesses using parents proxy-reported HRQoL. Obesity is an increasingly frequent condition in children, for which the evidence about perceived quality of life is lacking. The aim of our study is to examine the concordance between child's and parents'- reported HRQoL according to children's weight status.

Methods

A cross-sectional study was conducted in 2019 among 128 children, aged 6-10, recruited in a primary school of Imola (Italy). Children were divided in Group1 (G1: normal-underweight) and Group2 (G2: overweight-obese) using the International Obesity Task Force cut points. HRQoL was assessed using the Italian version 4.0 of Paediatric Quality of Life (PedsQL) questionnaire. We obtained self-reported children's HRQoL total score and the parents' perceived children's HRQoL total score. Each score had two subscales: one for physical health and one for emotional, social and school functioning.

Results

In G1 there were 86 children and in G2 42. The correlation between the children's and parents' HRQoL scores is low in G1 (physical health: 0.24; emotional, social and school functioning: 0.15). Children in G2 and their and parents' perception of physical health are poorly correlated (r=-0.09) and those of emotional, social and school functioning are well correlated (r = 0.43).We observed that in case of discordant HRQoL results, parents usually overestimate their children's HRQoL.

Conclusions

Correlation between the children's and parents' HRQoL scores is low in G1. In G2 children's and parents' perception are concordant for emotional, social and school functioning and unrelated for physical health. It would be useful to investigate whether these results depend from lack of communication between parents and children or lack of parents' awareness of health-related problems with obesity.

Key messages

Parents and children have a discordant perception of physical health quality of life. Further studies should investigate the reasons why these results are discordant.

Scientific literature response in Pubmed for the novel Coronavirus outbreak: a literature analysis

Background

Recent events highlight how emerging and re-emerging pathogens are actually becoming global challenges for public health. In December 2019, a novel coronavirus (SARS-CoV-2) has emerged. This has suddenly turned out into a global health concern which has led to a very high number of papers published in the scientific literature. Aim of this research is to focus on the bibliometric aspects in order to give researchers a glimpse on what is published in the first 30-days of a global epidemic outbreak.

Methods

We searched MEDLINE (PubMed) electronic database in order to find all relevant studies in the first 30-days from the first publication (which appeared on Pubmed at 14/01/2020), meaning the period 15/01/2020-13/02/2020. We used the following search string: coronavirus* OR Pneumonia of Unknown Etiology OR Covid-19 OR nCoV. We placed a language restriction for English, but no publication status or study design limit was put in place for our search.

Results

From the initial 462 identified articles, 234 articles were found as pertinent and read in extenso in order to classify them. The vast majority of papers come from China, UK and USA. 66.2% of the papers were Editorials, comments, letters or other kind of mainly reported data. 10.7% of papers were secondary literature papers (mainly narrative reviews). The remaining 23.1% were original primary studies. Only 17.5% of the sources used data which were directly collected on the field.

Conclusions

Almost all of data came from China. Even if some preferential channels were guaranteed for publishing those results in the most important journals, it appears that the vast majority of publication in scientific literature in the first 30-days of an epidemic outbreak is based more on reported data and comments, and only a small fraction of the papers have primary data collected in the field. Nevertheless the whole international literature depends on that type of data sources in the early days of the epidemic.

Key messages

This is the first bibliometric research in Pubmed Database on the first 30 days of publications regarding the novel Coronavirus (2019-nCoV) outbreak of 2019.

The vast majority of publication in the first 30-days of an epidemic outbreak are reported data or comments, and only a small fraction of the papers has directly collected data.

Comparison between health-related quality of life in normal-weight and overweight-obese children

Background

In Italy 32% of 6-10 aged children were overweight in 2017-2018. Measures of Health-Related Quality of Life (HRQoL) assess important aspects of health daily activities, physical symptoms, social interactions and emotional well-being. It is suggested that HRQoL is influenced by children's weight status. The aim of the study is to compare HRQoL among normal-underweight and overweight-obese children in an Italian sample.

Methods

A cross-sectional study was conducted in 2019 among 144 children, aged 6-10, recruited in a primary school in Bologna (Italy). Children were divided in Group1 (G1: normal-underweight) and Group2 (G2: overweight-obese) using the International Obesity Task Force cut points. HRQoL was assessed using 4.0 Italian version of PedsQL questionnaire. We obtained summary scores for children's total HRQoL and two subscales: one for physical health and one for emotional, social and school functioning.

Results

Of 144 children, 98 (68%) and 46 (32%) were respectively in G1 and G2. HRQoL total scores were 73.10±1.30 in G1 and 69.28±1.96 in G2 (p = 0.051). We analysed separately children in Grade 1 and Grade 3-4. In Grade 1, there were 68 children: 48 (71%) in G1 and 20 (29%) in G2. In grade 3-4 there were 76 children: 50 (66%) in G1 and 26 (34%) in G2. HRQoL total scores in grade 3-4 were: 73.28±1.63 in G1 and 72.66±2.32 in G2 (p = 0.41). In Grade 1, HRQoL total scores were 72.92±2.05 in G1 and 64.89±3.15 in G2 (p = 0.02); at subscale levels, means for physical health were 77.73±1.92 in G1 and 72.5±3.58 in G2 (p = 0.08) and means for emotional, social and school functioning were 70.35±2.48 in G1 and 60.83±4.04 in G2 (p = 0.02).

Conclusions

The effects of child overweight and obesity on health-related QOL was more evident in children aged 6-7, especially regarding emotional, social and school functioning. Prevention of childhood overweight and obesity is important not only to avoid health consequences of weight but also to improve children' quality of life.

Key messages

Overweight is a public health problem in Italy not only among adults, but even among children. Overweight has a negative impact on quality of life, therefore a healthy lifestyle should be promoted.