A risk score including body mass index, glycated haemoglobin and triglycerides predicts future glycaemic control in people with type 2 diabetes.

AIM: To identify, predict and validate distinct glycaemic trajectories among patients with newly diagnosed type 2 diabetes treated in primary care, as a first step towards more effective patient-centred care. METHODS: We conducted a retrospective study in two cohorts, using routinely collected individual patient data from primary care practices obtained from two large Dutch diabetes patient registries. Participants included adult patients newly diagnosed with type 2 diabetes between January 2006 and December 2014 (development cohort, n = 10 528; validation cohort, n = 3777). Latent growth mixture modelling identified distinct glycaemic 5-year trajectories. Machine learning models were built to predict the trajectories using easily obtainable patient characteristics in daily clinical practice. RESULTS: Three different glycaemic trajectories were identified: (1) stable, adequate glycaemic control (76.5% of patients); (2) improved glycaemic control (21.3% of patients); and (3) deteriorated glycaemic control (2.2% of patients). Similar trajectories could be discerned in the validation cohort. Body mass index and glycated haemoglobin and triglyceride levels were the most important predictors of trajectory membership. The predictive model, trained on the development cohort, had a receiver-operating characteristic area under the curve of 0.96 in the validation cohort, indicating excellent accuracy. CONCLUSIONS: The developed model can effectively explain heterogeneity in future glycaemic response of patients with type 2 diabetes. It can therefore be used in clinical practice as a quick and easy tool to provide tailored diabetes care.

The Importance of Microbiota and Fecal Microbiota Transplantation in Pancreatic Disorders.

The role of the intestinal microbiota in the diagnosis and treatment of pancreatic diseases is increasingly significant. Consequently, fecal microbiota transplantation (FMT) is emerging as a promising therapeutic avenue for various pancreatic disorders, including cancer, pancreatitis, and type 1 diabetes (T1D). This innovative procedure entails transferring gut microbiota from healthy donors to individuals affected by pancreatic ailments with the potential to restore intestinal balance and alleviate associated symptoms. FMT represents a pioneering approach to improve patient outcomes in pancreatic diseases, offering tailored treatments customized to individual microbiomes and specific conditions. Recent research highlights the therapeutic benefits of targeting the gut microbiota for personalized interventions in pancreatic disorders. However, a comprehensive understanding of the intricate interplay between gut microbiota and pancreatic physiology warrants further investigation. The necessity for additional studies and research endeavors remains crucial, especially in elucidating both adult and pediatric cases affected by pathological pancreatic conditions.

Assessing Lifestyle Patterns and Their Influence on Weight Status in Students from a High School in Sibiu, Romania: An Adaptation of ISCOLE Questionnaires and the Child Feeding Questionnaire.

The escalation of global obesity is driving research to understand environmental influences on this process, particularly during vulnerable developmental stages such as childhood and adolescence. Efforts include the development of various structured data collection tools. We aimed to adapt a series of previously validated questionnaires from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE), the Child Feeding Questionnaire, and elements from the World Health Organization Childhood Obesity Surveillance Initiative (COSI) in order to assess local lifestyle patterns among Romanian high school students and their families that may predispose them to obesity. To this goal, an expert committee was formed as part of a research partnership to oversee the questionnaire's translation and adaptation. It consisted of education and school management specialists, clinical research professionals, language experts, and public health experts. The adapted questionnaires were then applied to 114 students enrolled in the 9th and 10th grades attending a high school situated in Sibiu, and their parents. The variables measured were investigated for correlations with overweight and obesity and, as a secondary objective, academic performance. The study revealed several critical findings, including suboptimal sleep durations and physical activity levels among students, a significant amount of screen time, and correlations between weight status and physical activity, sedentary time, and maternal weight status and education levels. The adapted questionnaires proved to be effective tools in capturing the multifaceted factors implicated in adolescent obesity, providing a foundation for targeted interventions and broader public health strategies to address this issue.

Hepatic Involvement across the Metabolic Syndrome Spectrum: Non-Invasive Assessment and Risk Prediction Using Machine Learning.

Metabolic-dysfunction-associated steatotic liver disease (MASLD) and metabolic syndrome (MetS) are inextricably linked conditions, both of which are experiencing an upward trend in prevalence, thereby exerting a substantial clinical and economic burden. The presence of MetS should prompt the search for metabolic-associated liver disease. Liver fibrosis is the main predictor of liver-related morbidity and mortality. Non-invasive tests (NIT) such as the Fibrosis-4 index (FIB4), aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), hepatic steatosis index (HIS), transient elastography (TE), and combined scores (AGILE3+, AGILE4) facilitate the detection of liver fibrosis or steatosis. Our study enrolled 217 patients with suspected MASLD, 109 of whom were diagnosed with MetS. We implemented clinical and biological evaluations complemented by transient elastography (TE) to discern the most robust predictors for liver disease manifestation patterns. Patients with MetS had significantly higher values of FIB4, APRI, HSI, liver stiffness, and steatosis parameters measured by TE, as well as AGILE3+ and AGILE4 scores. Machine-learning algorithms enhanced our evaluation. A two-step cluster algorithm yielded three clusters with reliable model quality. Cluster 1 contained patients without significant fibrosis or steatosis, while clusters 2 and 3 showed a higher prevalence of significant liver fibrosis or at least moderate steatosis as measured by TE. A decision tree algorithm identified age, BMI, liver enzyme levels, and metabolic syndrome characteristics as significant factors in predicting cluster membership with an overall accuracy of 89.4%. Combining NITs improves the accuracy of detecting patterns of liver involvement in patients with suspected MASLD.

Interactions between Metabolic Syndrome, MASLD, and Arterial Stiffening: A Single-Center Cross-Sectional Study.

Metabolic-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), has emerged as a prominent global cause of chronic liver disease and is increasingly recognized as associated with atherosclerotic vascular illness, consolidating its position along traditional cardiovascular risk factors. Individuals with MASLD exhibit a combination of metabolic syndrome risk factors, carotid atherosclerosis, and increased arterial stiffness, hinting at shared pathogenesis. In this study, we aim to explore liver involvement and arterial stiffness within metabolic syndrome. We enrolled 75 patients (30 male and 45 female) with either liver steatosis on conventional ultrasound, altered liver function tests, or the presence of cardiometabolic risk factors after excluding liver pathology other than MASLD. Clinical evaluation, laboratory measurements, abdominal and carotid ultrasounds, vibration-controlled transient elastography (VCTE, Fibroscan), and assessment with the Arteriograph (Tensiomed) were performed. The 26 patients diagnosed with MetS had significantly higher liver involvement as quantified via the hepatic steatosis index (HSI), Fibrosis-4 (FIB4), aspartate aminotransferase to platelet ratio index (APRI) category, and VCTE measurements, as well as Agile 3+ and Agile 4 scores which use a combination of clinical and laboratory parameters together with results obtained from VCTE to reflect the probability of advanced liver fibrosis or cirrhosis. Patients with MetS also exhibited more pronounced vascular involvement as quantified via arterial stiffness measurements and CIMT (carotid intima-media thickness). We applied a two-step clustering algorithm to enhance our analysis, which gave us pertinent insight into the interplay between metabolic syndrome elements and typologies of hepatic steatosis and arterial stiffness degrees. Notably, of the three obtained clusters, the cluster showing increased levels of hepatic steatosis and arterial stiffness also exhibited the highest prevalence of metabolic syndrome and its constituting components. The results have significant clinical implications, advocating for a comprehensive diagnostic approach when MetS or MASLD is suspected.

Assessing Obesogenic School Environments in Sibiu County, Romania: Adapting the ISCOLE School Environment Questionnaire.

The impact of the school environment on childhood weight status has garnered significant attention in recent years. This study aimed to adapt and validate the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) School and Environment questionnaire in order to assess the potential obesogenic impact of school environments in Sibiu County, Romania. The ISCOLE questionnaire was chosen for its rigorous methodology. It was derived from a comprehensive study conducted across 12 countries which aimed to capture multifaceted influences on childhood weight while emphasizing educational settings in the collection of data. To guide the translation and adaptation of the questionnaire, a multidisciplinary committee was assembled which comprised experts in teaching and school administration to ensure target responder relevance, experts in clinical research to ensure methodological robustness, experts in language adaptation to preserve the original intent of the survey, and experts in public health to steer the interpretation of the results, with potential policy implications. The data were analyzed by distinguishing between urban and rural settings, and a two-step cluster analysis was implemented to identify potential intervention targets. To assess the validity of the adapted tool, the questionnaire's construct validity and internal consistency were explored. A response rate of 71.2% of the approached schools in Sibiu County was achieved. Of the 84 responding school representatives, 37 (44%) were from a rural setting. The rural schools had significantly more limited access to gymnasiums, secured lockers, showers, and bicycle racks, and exhibited more serious problems regarding the inadequate disposal of garbage in the school vicinity. A two-step cluster analysis revealed distinct school categories, providing opportunities for public policy interventions. One of these primarily concerned rural schools with limited infrastructure but with proactive practices and policies which were termed "unable but willing"; on the opposing spectrum, the category "able but unwilling" mainly comprised urban schools which had available facilities but lacked local proactive initiatives. The findings emphasize the urgent need for targeted measures to bridge these discrepancies by investing in infrastructure in rural schools and promoting active school practices and policies in urban settings. The assessment of obesogenic school environments in Sibiu County provides a pilot model for broader applications due to the diverse school landscape and supportive local authorities. The results, which were achieved using low-cost methods, can guide future educational policies, health promotion initiatives, and preventive interventions.

Dominant negative mutants of the murine cytomegalovirus M53 gene block nuclear egress and inhibit capsid maturation.

The alphaherpesvirus proteins UL31 and UL34 and their homologues in other herpesvirus subfamilies cooperate at the nuclear membrane in the export of nascent herpesvirus capsids. We studied the respective betaherpesvirus proteins M53 and M50 in mouse cytomegalovirus (MCMV). Recently, we established a random approach to identify dominant negative (DN) mutants of essential viral genes and isolated DN mutants of M50 (B. Rupp, Z. Ruzsics, C. Buser, B. Adler, P. Walther and U. H. Koszinowski, J. Virol 81:5508-5517). Here, we report the identification and phenotypic characterization of DN alleles of its partner, M53. While mutations in the middle of the M53 open reading frame (ORF) resulted in DN mutants inhibiting MCMV replication by approximately 100-fold, mutations at the C terminus resulted in up to 1,000,000-fold inhibition of virus production. C-terminal DN mutants affected nuclear distribution and steady-state levels of the nuclear egress complex and completely blocked export of viral capsids. In addition, they induced a marked maturation defect of viral capsids, resulting in the accumulation of nuclear capsids with aberrant morphology. This was associated with a two-thirds reduction in the total amount of unit length genomes, indicating an accessory role for M53 in DNA packaging.

ICT Services for Life Improvement for the Elderly.

Integrated care ICT Platform to support patients, care-givers and health/social professionals in the care of dementia and Parkinson's disease with training, empowerment, sensor-based data analysis and cooperation services based on user-friendly interfaces.

Investigation on Crude and High-Temperature Heated Coffee Oil by ATR-FTIR Spectroscopy along with Antioxidant and Antimicrobial Properties.

The coffee oil has a promising potential to be used in food industry, but an efficient use, especially in products that required high-temperature heating, depends on its chemical composition and the changes induced by processing. Since there is little information on this topic, the aim of our study was to investigate the crude green and roasted coffee oil (GCO, RCO) and heated (HGCO, HRCO) for 1 h at 200°C, by Fourier Transform Infrared (FTIR) spectroscopy and in terms of antioxidant and antimicrobial properties. The results of FTIR spectroscopy revealed that no statistically significant differences (one-way ANOVA, p>0.05) in the oxidative status of GCO and RCO were found. The coffee oils heating induced significant spectral changes in the regions 3100-3600 cm(-1), 2800-3050 cm(-1) and 1680-1780 cm(-1) proved by the differences in the absorbance ratios A 3009 cm(-1)/A 2922 cm(-1), A 3009 cm(-1)/A 2853 cm(-1), A 3009 cm(-1)/A 1744 cm(-1), A 1744 cm(-1)/A 2922 cm(-1). These alterations were related to the reduction of the unsaturation degree due to primary and secondary oxidation processes of the lipid fraction. The radical scavenging ability of oils investigated by 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay revealed that the IC50 value of GCO was significantly lower than of RCO (p<0.05). The IC50 values of crude coffee oils were lower than those of heated samples. The antioxidant activity of oils was attributed to both antioxidant compounds with free-radical scavenging capacity and to lipids oxidation products generated by heating. In the first 6 h of incubation, the inhibitory activity of crude oils against E. coli and E. faecalis was not significantly different to the control (p>0.05). Also, HGCO and HRCO showed significantly different inhibitory potential related to the control (p<0.05). The heating induced statistically significant decreases in the effectiveness of coffee oils against the tested bacteria. GCO proved to be the most effective among investigated coffee oils against the tested bacteria.

[The effects on growth velocity of inhaled corticosteroids therapy in children with asthma]. / Efectele glucocorticosteroizilor inhalatori administrati de durata asupra velocitatii cresterii la copiii cu astm bronsic persistent.

INTRODUCTION: Studies have demonstrated growth suppressive effects in case of use of inhaled corticosteroids therapy. OBJECTIVE: To assess growth velocity during 12 months of inhaled corticosteroids therapy in children with persistent asthma. METHODS: Measurements of height were performed in the study group including 109 children with mild and moderately severe, persistent asthma, after 12 month with low or medium doses of either beclomethasone dipropionate or fluticasone propionate. The results were compared with a control group including 71 children with asthma treated with montelukast or cromones. RESULTS: There were statistically significant differences between study group and controls concerning the growth velocity after 3 months of inhaled glucocorticoid therapy (GSI). CONCLUSIONS: The velocity of growth was decreased in the study group compared to controls after 3 months of treatment, but the differences become unsignificant after 12 months of therapy.

[Effectiveness of antireflux therapy in asthmatic children with gastroesophageal reflux disease]. / Eficienta terapiei antireflux la copiii astmatici cu boala de reflux gastroesofagian.

There is an increased interest within literature regarding the relationship between gastro-esophageal reflux disease and asthma. The study was performed to assess the efficiency of antireflux therapy in asthmatic children. In a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years) the pulmonary function tests were made by means of spirometry in those patients in which reflux disease was diagnosed by means of 24h esophageal pH-monitoring and upper digestive endoscopy. All these patients were reevaluated by means of spirometry 3 months after the antireflux therapy with ranitidine and cisapride added to antiasthmatic therapy. Three months later the results showed a significant decrease in frequency of asthma exacerbations from 3.18 +/- 4.86 to 0.45 +/- 0.80 (p = 0.016). There is also a significant increase of FEV1 (p = 0.04) and of FEV1/FVC (p = 0.018) in asthmatic patients with reflux disease and a positive symptomatic index, and of FEV1/FVC (p = 0.002) in all asthmatic children with abnormal gastro-esophageal reflux respectively. In conclusion, by adding antireflux therapy in asthmatic children there is a significant improvement in clinical and some of functional parameters.

[Gastroesophageal reflux in asthmatic children: prevalence and pathogenic role]. / Refluxul gastro-esofagian patologic la copii cu astm bronsic: prevalenta si rol patogenetic.

The relationship of gastroesophageal reflux disease and asthma is controversial. This study was performed to assess the prevalence of pathologic gastroesophageal reflux and its effect on pulmonary function tests in asthmatic children. The following study protocol was performed in a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years): diagnosis of pathologic gastroesophageal reflux by means of 24h esophageal pH-monitoring; diagnosis of reflux esophagitis by means of upper digestive endoscopy and pulmonary function tests by means of spirometry. The results show a high prevalence (87%) of pathologic gastroesophageal reflux in asthmatic children. Additionally, there is an inverse correlation (r = -0.67) between the severity of pathologic gastroesophageal reflux and FEV1/FVC. In conclusion, there is a high prevalence of pathologic gastro-esophageal reflux in asthmatic children, contributing to asthma severity.

[Prevalence of bronchial asthma in 7 years -old children in Cluj-Napoca, an ISAAC study]. / Prevalenta astmului bronsic la copiii de 7 ani din municipiul Cluj-Napoca. Studiu ISAAC.

The authors studied the prevalence of asthma in children of 7 years from Cluj Napoca and analyzed the possible risk factors. We used the questionnaire elaborated by International Study on Asthma and Allergic Diseases in Children (ISAAC) which allowed the comparison of our data with those from other countries. Anamnesis, functional tests and allergic skin tests were performed in children with positive answers for questionnaire. 1334 children completed the study, 52.5% being males. Prevalence of asthma diagnosed previous to the questionnaire was of 5.7%, and it was higher in males (6.1%). By anamnesis, functional and skin tests data the diagnosis of asthma was made in a total of 217 children, so that the real prevalence of asthma is of 16.3% in this age group. Maternal smoking during the first year of life was significantly higher in children with wheezing. The high number of respiratory tract infections in the first year of life could also play a role. In conclusion, prevalence of asthma diagnosed in children of 7 years of age from Cluj Napoca is of 5.7% with a real prevalence of disease that seems to be much higher, of 16.3%. Maternal smoking represents a risk factor correlated with wheezing.

[The effects of long-term inhaled glucocorticoids on children's bones]. / Efectele glucocorticoizilor administrati de durata, pe cale inhalatorie, la copil, asupra osului.

The authors study, by calcanean ultrasonographic method, the effects of inhaled steroids, administered for long term, on the bone status, in children with persistent asthma. The study group consisted in 33 children with persistent asthma, treated for 12 months with low or moderate doses of either beclomethasone dipropionate or fluticasone propionate. In all of them there were measured the main ultrasonographic parameters, before and after treatment. The results were compared with those recorded in a control group. The control group consisted in 16 children with asthma that did not receive long term inhaled steroids. In the study group the were no statistically significant differences between ultrasonographic parameters measured before and after steroids inhaled treatment. There were no statistically significant differences between ultrasonographic parameters measured after steroid treatment in the study group and the same parameters recorded in the control group. The results of our study reveal that long term inhaled steroids therapy do not influence the bone density at the calcanean level.

[Increase of the prevalence of bronchial asthma and related symptoms in students in Cluj-Napoca. Epidemiologic study with a five-years interval]. / Cresterea prevalentei astmului bronsic si simptomelor asociate la scolarul mare în Cluj-napoca. Studiu epidemiologic la 5 ani interval.

BACKGROUND: The prevalence of asthma is increasing in developed countries during the past decade. In Romania there are few studies on asthma epidemiology and no data on the trend of the prevalence. AIMS: The authors investigate the prevalence of asthma and associated symptoms in children and evaluate the trend of prevalence 5 years apart. METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children (ISAAC). The questionnaire was applied during 1995 in 2,866 children aged 13-14 years from a Romanian city, and during 2001 in 1,657 children from the same area. RESULTS: The prevalence of previous diagnosed asthma increased significant, from 3.3% in 1995 to 5.5% in 2001 (p = 0.0005). A higher percentage of pupils presented probable asthma (4.3% in 1995 and 13.6% in 2001; p < 0. 00001). Similar results were obtained regarding symptoms related to asthma like wheezing, cough during exercise and night cough. Previous diagnosed asthma was more frequent in boys, but probable asthma and symptoms related to asthma were more prevalent in girls both in 1995 and in 2001. The prevalence of asthma is similar with that reported in other central and eastern European countries that used the same core questionnaire provided by ISAAC. CONCLUSION: The prevalence of asthma and associated symptoms increased significantly during the past 5 years.