ORE identifies extreme expression effects enriched for rare variants.

MOTIVATION: Non-coding rare variants (RVs) may contribute to Mendelian disorders but have been challenging to study due to small sample sizes, genetic heterogeneity and uncertainty about relevant non-coding features. Previous studies identified RVs associated with expression outliers, but varying outlier definitions were employed and no comprehensive open-source software was developed. RESULTS: We developed Outlier-RV Enrichment (ORE) to identify biologically-meaningful non-coding RVs. We implemented ORE combining whole-genome sequencing and cardiac RNAseq from congenital heart defect patients from the Pediatric Cardiac Genomics Consortium and deceased adults from Genotype-Tissue Expression. Use of rank-based outliers maximized sensitivity while a most extreme outlier approach maximized specificity. Rarer variants had stronger associations, suggesting they are under negative selective pressure and providing a basis for investigating their contribution to Mendelian disorders. AVAILABILITY AND IMPLEMENTATION: ORE, source code, and documentation are available at https://pypi.python.org/pypi/ore under the MIT license. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Crotoxin down-modulates pro-inflammatory cells and alleviates pain on the MOG35-55-induced experimental autoimmune encephalomyelitis, an animal model of multiple sclerosis.

Multiple sclerosis (MS) is a Central Nervous System inflammatory demyelinating disease that has as primary symptoms losses of sensory and motor functions, including chronic pain. To date, however, few studies have investigated the mechanisms of chronic pain in animal models of MS since locomotor impairments render difficult its evaluation. It was previously demonstrated that in the MOG35-55-induced EAE, an animal model of MS, the hypernociception appears before the onset of motor disability, allowing for the study of these two phenomena separately. Here, we evaluated the effect of crotoxin (CTX), a neurotoxin isolated from the Crotalus durissus terrificus snake venom that displays, at non-toxic dose, antinociceptive, anti-inflammatory and immunomodulatory effects, in the pain and in symptoms progression of EAE. The pain threshold of female C57BL/6 mice decreased at the 4th day after immunization, while the first sign of disease appeared around the 11st-12nd days, coinciding with the onset of motor abnormalities. CTX (40 µg/kg, s.c.) administered in a single dose on the 5th day after immunization, induced a long-lasting analgesic effect (5 days), without interfering with the clinical signs of the disease. On the other hand, when crotoxin was administered for 5 consecutive days, from 5th-9th day after immunization, it induced analgesia and also reduced EAE progression. The antinociceptive effect of crotoxin was blocked by Boc-2 (0.5 mg/kg, i.p.), a selective antagonist of formyl peptide receptors, by NDGA (30 µg/kg, i.p.), a lipoxygenase inhibitor and by atropine sulfate (10 mg/kg, i.p.), an antagonist of muscarinic receptors, administered 30 min before CTX. CTX was also effective in decreasing EAE clinical signs even when administered after its onset. Regarding the interactions between neurons and immunocompetent cells, CTX, in vitro, was able to reduce T cell proliferation, decreasing Th1 and Th17 and increasing Treg cell differentiation. Furthermore, in EAE model, the treatment with 5 consecutive doses of CTX inhibited IFN-γ-producing T cells, GM-CSF-producing T cells, reduced the frequency of activated microglia/macrophages within the CNS and decreased the number of migrating cell to spinal cord and cerebellum at the peak of the disease. These results suggest that CTX is a potential treatment not only for pain alteration but also for clinical progression induced by the disease as well as an useful tool for the development of new therapeutic approaches for the multiple sclerosis control.

Oral propranolol in the treatment of proliferating infantile haemangiomas: British Society for Paediatric Dermatology consensus guidelines.

BACKGROUND: Infantile haemangiomas (IH) are the most common vascular tumours of infancy. Despite their frequency and potential complications, there are currently no unified U.K. guidelines for the treatment of IH with propranolol. There are still uncertainties and diverse opinions regarding indications, pretreatment investigations, its use in PHACES (posterior fossa malformations-haemangiomas-arterial anomalies-cardiac defects-eye abnormalities-sternal cleft and supraumbilical raphe) syndrome and cessation of treatment. OBJECTIVES: To provide unified guidelines for the treatment of IH with propranolol. METHODS: This study used a modified Delphi technique, which involved an international treatment survey, a systematic evidence review of the literature, a face-to-face multidisciplinary panel meeting and anonymous voting. RESULTS: The expert panel achieved consensus on 47 statements in eight categories, including indications and contraindications for starting propranolol, pretreatment investigations, starting and target dose, monitoring of adverse effects, the use of propranolol in PHACES syndrome and how to stop treatment. CONCLUSIONS: These consensus guidelines will help to standardize and simplify the treatment of IH with oral propranolol across the U.K. and assist in clinical decision-making.

Linking the Psychosocial Impact of Assistive Devices Scale (PIADS) to the International Classification of Functioning, Disability, and Health.

PURPOSE: Assistive technologies are widely implemented in clinical and research settings. Despite their dissemination, the psychosocial impact of their adoption still deserves further consideration. The aim of the present study is to determine the degree of compatibility between the Psychosocial Impact of Assistive Devices Scale (PIADS) and the International Classification of Functioning, Disability, and Health (ICF). METHODS: Six health professionals (two neurologists, one neuro-rehabilitation technician, two psychologists, one university professor of rehabilitation) created a technical board to discuss upon the PIADS-ICF linking. The standardized linking methodology was applied, and a Delphi technique was used to examine consensus. RESULTS: Five Delphi sessions were required to reach 100% of consensus and to finalize the procedure. Of the 26 PIADS' items, 23 were linked to an ICF category: 9 items were endorsed at the 3rd ICF level, and 14 items at the 2nd ICF level. Two items were classified as "not defined" and 1 item as "not covered". CONCLUSION: The study highlighted the conceptual connection between the PIADS and the ICF framework and set a bio-psychosocial standpoint by which accounting the role of assistive devices in rehabilitation settings.

Antibacterial activity and immunomodulatory effects on a bovine mammary epithelial cell line exerted by nisin A-producing Lactococcus lactis strains.

Twenty-nine strains of mastitis pathogens were used to study the antibacterial activity of the cell-free supernatants (CFS) of 25 strains of Lactococcus lactis ssp. lactis. Out of the tested strains, only the CFS of L. lactis LL11 and SL153 were active, inhibiting and killing most of the pathogens. By means of ultra-performance liquid chromatography/high resolution mass spectrometry, they were shown to produce nisin A, a class I bacteriocin. A variable sensitivity to nisin A-containing CFS was observed among Streptococcus uberis and Enterococcus faecalis strains. Nonetheless, Streptococcus agalactiae, Strep. uberis, and E. faecalis displayed high minimum inhibitory concentration values, reaching 384 arbitrary units/mL. Interestingly, the minimum inhibitory values and the bactericidal concentrations were almost identical among them for each of the 2 stains, LL11 and SL153. Staphylococci were, on average, less sensitive than streptococci, but the 2 CFS inhibited and killed, at different dilutions, strains of methicillin-resistant Staphylococcus aureus. The immune response to nisin A-containing CFS was tested using the bovine mammary epithelial cell line BME-UV1. Application of CFS did not damage epithelial integrity, as demonstrated by the higher activity of N-acetyl-ß-d-glucosaminidase (NAGase) and lysozyme inside the cells, in both treated and control samples. On the other hand, the increase of released NAGase after 15 to 24h of treatment with LL11 or SL153 live cultures demonstrated an inflammatory response of epithelial cells. Similarly, a significantly higher lysozyme activity was detected in the cells treated with LL11 live culture confirming the stimulation of lysosomal activity. The treatment of epithelial cells with SL153 live culture induced a significant tumor necrosis factor-α downregulation in the cells, but did not influence IL-8 expression. The control of tumor necrosis factor-α release could be an interesting approach to reduce the symptoms linked to clinical intramammary infections. Due to their antibacterial activity and to the stimulation of lysosomal activity of mammary epithelial cells, the L. lactis strains SL153 and LL11 could be of interest for the development of alternative intramammary treatments to control cow mastitis.

Semi-supine exercise stress echocardiography in children and adolescents: feasibility and safety.

Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497-0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782-0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (≥30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress.

Egg quality and productive performance of laying hens fed different levels of skimmed milk powder added to a diet containing Lactobacillus acidophilus.

The current trial was carried out on a commercial poultry farm to study the effect of skim milk powder (SMP) added to a diet containing Lactobacillus acidophilus on performance and egg quality of laying hens from 20 to 49 wk of age. A total of 2,400 Hy-Line W-36 laying hens were housed in 600 unenriched cages (4 hens each) located over 4 tier levels. Animals were assigned to 1 of 3 experimental treatments (0, 3, and 4). The laying hens assigned to treatments 3 and 4 received a diet enriched respectively with 3 and 4% SMP, whereas the animals in treatment 0 were fed a diet without SMP. All diets, moreover, were supplemented with L. acidophilus D2/CSL. Hen performance was determined throughout the experimental period and egg quality was measured on 30 eggs per treatment every week. Results showed that productive performance in terms of egg production, egg weight, and feed conversion ratio was not influenced by SMP at 3 or 4% of the diet. Egg quality was significantly affected by SMP included at 3 or 4% of the diet. Eggs from treatments 3 and 4, in fact, displayed higher shell thickness than those from treatment 0 (P < 0.0001). Likewise, specific gravity, Haugh unit, and shell percentage were significantly affected by the addition of SMP. In conclusion, in our study, SMP added to a diet containing L. acidophilus had no significant effects on the productive parameters of hens during the laying period, whereas significant improvements were found in certain egg quality characteristics.

Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions.

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group. Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary. Data sources: Articles published between January 2010-March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults. Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems. Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no "gold standard" is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.

Carpal tunnel sonography.

Carpal tunnel syndrome (CTS) is the most frequent entrapment neuropathy of peripheral nerves, with an incidence of 1-3 patients in 1000. CTS typically occurs between 45 and 60 years of age, and it is more frequent in women than in men. The main cause of CTS is chronic compression of the median nerve and ischemic suffering secondary to increased pressure in the carpal tunnel. There are many possible causes of CTS, which can be differentiated into idiopathic causes, which include most cases, and secondary causes. Classical CTS diagnosis is based on the patient's clinical examination and electrophysiological tests, such as electromyography and nerve conduction studies. The latter are helpful for determining the site of nerve compression, assessing its severity, monitoring the course of the disease after therapy, and excluding other causes of median nerve pain, such as cervical radiculopathies, brachial plexopathies, polyneuropathy, or other forms of mononeuropathies. However, clinical examination and electrophysiological tests are not able to differentiate idiopathic forms from secondary forms of CTS, and discrepancies are possible between clinical examination and electrophysiological tests (false negatives). Ultrasound examination is able to recognize most of the secondary forms of CTS. It can evaluate the morphological alterations of the nerve and correlate them with the severity of nerve suffering in all cases, even idiopathic ones, with a sensitivity and specificity equal to those of electrophysiological tests. It can also highlight some anatomical predisposing variants or conditions that may represent contraindications to minimally invasive treatments. Ultrasound examination also plays a fundamental role in evaluating patients with an unfavorable outcome after surgical treatment.

Medication adherence in the older adults with chronic multimorbidity: a systematic review of qualitative studies on patient's experience.

PURPOSE: Medication non-adherence represents a socially relevant challenge, particularly when interlinked to multiple chronic diseases and polypharmacy. Non-adherence rates affect treatment efficacy and increase health care costs. The aim of the study was to identify factors influencing medication adherence in the older adults through a systematic review of qualitative studies on patients' experience. METHODS: Two electronic databases were searched for qualitative studies on medication adherence in chronic diseases (hypertension, heart disease, COPD, asthma) involving people aged 65 + . The systematic review was performed according to the PRISMA statement guidelines, employing theoretical frameworks of the ABC Taxonomy of patient adherence and Three Factor model of determinants of behaviour. RESULTS: The initial database search identified 1234 records, of which 39 studies were considered eligible. Most of the studies focused on hypertension and were conducted in English-speaking countries. According to the ABC Taxonomy, Persistence and Implementation were the most often considered phases. Considering the Three Factor model, the most often reported themes were Information and Strategies upon being adherent. Stemming from the review findings and the patients' narratives, a new integrated model was proposed. It reports the patient's decisional flowchart describing barriers and facilitators (personal, social and environmental) to adherence. CONCLUSION: Medication adherence is a complex and multifaceted process. The implementation of theoretical frameworks along with a patient-centred perspective may provide clinicians with useful suggestions for clinical practice, enhancing the patient's ability to adhere.

NFKF is a synthetic fragment derived from rat hemopressin that protects mice from neurodegeneration.

Previous studies suggested the pharmacological potential of rat hemopressin (PVNFKFLSH) and its shorter synthetic peptide NFKF, to protect from pilocarpine-induced seizures in mice. Orally administered NFKF was shown to be hundred times more potent than cannabidiol in delaying the first seizure induced by pilocarpine in mice. Here, using an experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis we have shown that C57BL/6 J mice orally administrated with NFKF (500 µg/kg) presented better EAE clinical scores and improved locomotor activity compared to saline administrated control mice. NFKF blocked the production of IL-1beta and IL-6, and has high scores binding cannabinoid type 2 receptors. Therefore, NFKF is an exciting new possibility to neurodegenerative diseases therapeutics.

Introgression from modern hybrid varieties into landrace populations of maize (Zea mays ssp. mays L.) in central Italy.

Landraces are domesticated local plant varieties that did not experience a deliberate and intensive selection during a formal breeding programme. In Europe, maize landraces are still cultivated, particularly in marginal areas where traditional farming is often practiced. Here, we have studied the evolution of flint maize landraces from central Italy over 50 years of on-farm cultivation, when dent hybrid varieties were introduced and their use was widespread. We have compared an 'old' collection, obtained during the 1950s, before the introduction of hybrids, and a recent collection of maize landraces. For comparison, a sample of maize landraces from north Italy, and of improved germplasm, including hybrids and inbred lines were also used. A total of 296 genotypes were analysed using 21 microsatellites. Our results show that the maize landraces collected in the last 5-10 years have evolved directly from the flint landrace gene pool cultivated in central Italy before the introduction of modern hybrids. The population structure, diversity and linkage disequilibrium analyses indicate a significant amount of introgression from hybrid varieties into the recent landrace populations. No evidence of genetic erosion of the maize landraces was seen, suggesting that in situ conservation of landraces is an efficient strategy for preserving genetic diversity. Finally, the level of introgression detected was very variable among recent landraces, with most of them showing a low level of introgression; this suggests that coexistence between different types of agriculture is possible, with the adoption of correct practices that are aimed at avoiding introgression from undesired genetic sources.

Synthesis of Graphite and Hydrocarbons by Reaction between Calcite and Hydrogen.

The reaction of calcite with hydrogen was investigated over a range of pressure, temperature, and time. The reaction initiates at about 500 degrees C. Its primarily temperature-dependent rateproceeds in a crystallographically anisotropic manner, and reaction products are CaO, Ca(OH)(2), H(2)O, CO, CH(4), C2H(6), and C (graphite), plus a black solid residue that may be hydrocarbon.

Enantioselective HF loss promoted by resonant two-photon ionization of supersonically expanded (R)-1-phenyl-2,2,2-trifluoroethanol clusters.

(R)-1-phenyl-2,2,2-trifluoroethanol and its hydrogen bonded adducts with achiral (water, tetrahydrofuran) and chiral solvent molecules ((R)- and (S)-butan-2-ol, (R)- and (S)-3-hydroxy-tetrahydrofuran) have been ionized by resonant two-photon absorption. The presence of photofragments, attributable to the occurrence of a hydrogen fluoride loss reaction, has been interpreted with the aid of theoretical predictions at the DFT level of theory with the inclusion of dispersive terms. The HF elimination process takes place by a mechanism involving the preliminary C(alpha)-H hydrogen transfer to an hydroxyl oxygen assisted by the solvent molecule which is followed by extrusion of the HF molecule. The calculated energy barriers depend on the type of solvent as well as on its configuration and are consistent with the observed fragmentation ratios.

An Italian experience in the ICF implementation in rehabilitation: preliminary theoretical and practical considerations.

PURPOSE: The International Classification of Functioning, Disability and Health (ICF) in its complete form cannot be adopted in clinical rehabilitative practice due to its complexity and size. Ongoing international research is aimed at validating and verifying the reliability of simplified instruments derived from the ICF (ICF Core Sets). An Italian multicentre study was recently conducted with these aims. The purpose of this article is to present some qualitative considerations on ICF Core Sets implementation. METHOD: A brief schedule purposely built to assess the difficulties encountered by the health professionals who administered the ICF Core Sets were sent them via e-mail. Due to the small size of the sample, a qualitative analysis was performed. RESULT: The main difficulties which emerged were: (i) To clearly translate the ICF categories' contents in a language easily understandable especially by patients with low education and concrete cognitive style, (ii) the process of assigning the qualifier to the given category, particularly with the 'Activity and Participation' and 'Environmental factors' components, and (iii) the influence of evaluators' different professional backgrounds on interview performance. CONCLUSION: Since the classification was designed to uniform language and to promote homogeneous ways of evaluation in extremely different healthcare and social contexts, more studies are necessary to improve reliability and to identify the best methods of using the ICF in daily clinical practice.

[Contribution to the Italian validation of the IPQ-R]. / Contributo alla validazione italiana dell'IPQ-R.

Knowledge of patients' opinions and beliefs about their illness is fundamental in interdisciplinary health care interventions. The IPQ and its revised version (IPQ-R) are questionnaires designed to assess components of the mental representation of illness described in Leventhal's self-regulation model. To validate the IPQ-R in the Italian population, verifying its psychometric properties and focusing on Part II of the instrument (opinions about disease), we enrolled 277 inpatients (216 males and 61 females) affected by myocardial infarction (n=70), coronary artery by-pass graft surgery (n=52), chronic heart failure (n=47), valve replacement (n=20), obstructive sleep apnoea syndrome associated to obesity (n=53) and respiratory failure (n=35). All patients completed the Italian version of the IPQ-R obtained by means of 3 translations and a back version. IPQ-R scores were compared to patients' scores on the SF-36 and AD schedule (on anxiety and depression). Structural validity and reliability (both internal and test-retest) of the Italian IPQ-R were assessed. The validity of Part II of the IPQ-R was confirmed. As in the original version, 7 factors were extracted. ANOVA revealed statistically significant differences between the different diseases. Correlations between IPQ-R and, respectively, the SF-36 and AD schedule were statistically significant and coherent with the constructs analyzed. Finally statistically significant correlations emerged between the IPQ-R factors. The test-retest reliability and internal consistency of the questionnaire were confirmed. The psychometric properties of the Italian version of the IPQ-R were demonstrated to be robust. Hence, the Italian version of the IPQ-R, which resulted homogeneous with the original version, could be useful in assessing the cognitive factors involved in patients' adjustment to various chronic illnesses.

Adherence to treatment: assessment of an unmet need in asthma.

BACKGROUND: In asthma, as in other chronic conditions, poor adherence to treatment and to medical advice is common and contributes to substantial worsening of the disease and increased health care costs. OBJECTIVE: The aim of the present study was to evaluate patients' self-reported adherence to asthma medication regimens and to identify possible correlations between treatment adherence and depression, anxiety, and coping strategies. METHODS: Sixty-three asthmatic outpatients (27 men and 36 women; mean age +/- SD, 38.5 +/- 14.1) were consecutively enrolled during their routine control visit. Patients were asked to complete 3 different questionnaires: the Adherence Schedule in Asthma, the Hospital Anxiety and Depression Scale, and the Coping Orientations to Problem Experienced questionnaires. RESULTS: Depression was detected in 32.3% of patients and anxiety in 34.9%. A negative correlation was found between older age and perception of family support (rho = -0.33). The presence of anxiety displayed a positive correlation with difficulty in accepting the illness (rho = 0.33) and a negative correlation with acceptance of illness limitations (p = -0.30); it was also positively correlated with fear of the side effects of medication (rho = 0.37). The presence of depression was negatively correlated with acceptance of illness limitations (rho = -0.32), knowledge of the illness (p = -0.29), and with ability to identify worsening signs (rho = -0.31). CONCLUSION: This study shows how different factors may modulate adherence to asthma treatment. The opportunity to identify reasons for nonadherence through a simple assessment will allow a tailored intervention to be planned for each patient.

Impact of children's respiratory allergies on caregivers.

BACKGROUND: Despite the great attention that has been paid to HRQoL in children with respiratory allergy, few studies have addressed this aspect in relation to caregivers. The aim of our study was to evaluate the impact of childhood respiratory allergies on caregivers by means of a new method. METHODS: 119 parents of children suffering from allergies (75 suffering from asthma and 44 suffering from rhinitis) were recruited from three Italian Allergy Units. Parents were asked to complete the Disease Impact On Caregiver (DIOC), a new non disease specific questionnaire, validated on the Italian population. The questionnaire consists of 31 items grouped in four factors (Performance, Personal gratification, Psychophysical endurance, Socio-emotional domain) and covers the life aspects that could be affected by the assistance duties towards an ill family member. RESULTS: Child's asthma resulted to have a worse impact on many aspects of a parents' life than rhinitis. Differences resulted to be statistically significant in 19 aspects out of the 31 assessed. The worse impact of asthma versus rhinitis was confirmed in the following domains: Performance (24.0 +/- 18.2 vs 11.5 +/- 17.8), Personal gratification (26.3 +/- 20.5 vs 12.1 +/- 16.5) and Psychophysical endurance (35.0 +/- 24.8 vs 18.8 +/- 21.7). In the Socio-emotional domain no difference emerged. CONCLUSIONS: Compared to parents of rhinitics, parents of asthmatic children appear to be more compromised in their resistance to stress, mood, emotional stability, amount of spare time and leisure activities. Our results suggest the need of giving the due attention to these problems both in clinical practice and in research, in order to avoid possible interferences of the caregiver's distress in the optimization of treatment outcome.

Diabetes Management in End of Life: A Preliminary Report Stemming From Clinical Experience.

The increasing coexistence of cancer and diabetes within the elderly population requires specific palliative care skills on diabetes treatment. We report our experience of diabetes management in a palliative care setting. In our retrospective 3-year activity sample (n = 563), 27.2% of patients have a diagnosis of diabetes mellitus: 80% have cancer whereas 20% have a main diagnosis of other severe chronic diseases. As to the presence/absence of diabetes, no differences emerge in the examined clinical indicators and global survival, with the exception of body mass index and days of hospitalization. At lifetime analysis, Barthel index and palliative prognostic index are the only parameters significantly related to death. Even if diabetes seems not to modify the prognosis, it significantly influences the health care burden and the team engagement.