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05). Adjusted correlations were significant for RANTES and z-BMI (r = 0.26; p less then 0.05) and for MIG with z-BMI (r = -0.26; p less then 0.05) and with NEFA (r = 0.27; p less then 0.05). Conclusion GH was not associated with higher chemokine levels in prepubertal children with OW/OB. Decreased rather than elevated GFR values were correlated with obesity and worse metabolic profiles. Chemokines levels in children with severe OB suggest a regulation of the immune response. Follow-up studies are needed to address the clinical implications of these findings.Background and aims The metabolic syndrome has been reported by cross-sectional studies to have an association with skeletal muscle quality and quantity. Using a longitudinal study design, this study aimed to explicate the association between muscle characteristics assessed with computed tomography (CT) and the incidence and progression of metabolic syndrome. Methods and results In this retrospective study on a cohort of employees undergoing annual physical examinations, we evaluated data from 554 participants without metabolic syndrome. The cross-sectional skeletal muscle area was determined based on CT data at the level of the third lumbar vertebra, and the skeletal muscle density (SMD) and skeletal muscle index (SMI) were measured. The participants were divided into four study groups according to the sex-specific median values for SMI and SMD. We followed the participants for a mean period of 3.1 years. In the sex- and age-adjusted model, SMI and SMD had an interaction effect on the longitudinal change in number of metabolic syndrome components (β = -0.074, p = 0.0727). Multiple regression analyses revealed that both low SMI and SMD was significantly associated with the change (β = 0.131, p = 0.0281), whereas the low SMI and high SMD, and high SMI and low SMD were not. Both low SMI and SMD (hazard ratio (HR), 2.42; 95% confidence interval, 1.28-4.78) showed an increased adjusted HR for incident metabolic syndrome. Conclusion The participants with both low quality and quantity of skeletal muscles were associated with the incidence and progression of metabolic syndrome, whereas those with only low quantity or quality of skeletal muscles were not.Background and aim Lifestyle factors heavily influence the development of cardiovascular disease (CVD); therefore, interventions delivering adequate lifestyle changes may improve the prognosis among patients at cardiovascular (CV) risk. Recently published research on the effectiveness of dietary and exercise intervention programmes, alone or combined, on reducing risk factors associated with CVD as well as preventing CV events have been now assessed. Methods and results Using the Medline database via PubMed, we searched for prospective studies published between January 2000 and January 2020 assessing the efficacy of dietary interventions alone or in combination with exercise on reducing CV risk factors or events in human adults at risk. Study quality was assessed using the American Dietetic Association Quality Criteria Checklist. From 934 articles, 21 prospective experimental design studies (15 randomized controlled trials (RCTs), one cluster RCT, and five quasi-experimental intervention studies with a control group) met inclusion and exclusion criteria. Most interventions improved at least some markers of CV risk and the most improvement was time devoted to physical activity increased. A low-fat intervention diet seemed to be effective only when coupled with moderate intensity exercise and weight loss, while a Mediterranean diet (MedDiet) intervention without physical activity, decreased both systolic and diastolic blood pressure, major CV events rate and risk of developing type 2 diabetes. Conclusion The MedDiet appears to have the most beneficial effect on CV events and increased hours of physical training are strongly related to greater improvement of risk factors; nevertheless, adherence to intervention is fundamental as it directly relates to health outcomes.Background and aims Glucagon-like Peptide 1 Receptor Agonists (GLP1-RA) has been associated with a reduction of major cardiovascular events (MACE) and mortality on the basis of the results of cardiovascular outcome trials (CVOT). Several meta-analyses on this issue have been recently published; however, they were all restricted to CVOT, with the exclusion of all studies designed for other endpoints; moreover, other cardiovascular endpoints, such as atrial fibrillation and heart failure have not been fully explored. Methods and results A Medline search for GLP-1 receptor agonists (exenatide, liraglutide, lixisenatide, albiglutide, dulaglutide, or semaglutide) was performed, collecting all randomized clinical trials with a duration ≥52 weeks, enrolling patients with type 2 diabetes, and comparing a GLP-1 receptor agonist with placebo or any other non-GLP-1 receptor agonist drug. We included 43 trials, enrolling 63,134 patients. A significant reduction of MACE (MH-OR 0.87 [0.83, 0.92]), all-cause mortality (MH-OR 0.89 [0.83, 0.96]), and a nonstatistical trend toward reduction of heart failure (MH-OR 0.93 [0.85, 1.01]) was observed - GLP1-RA did not increase the risk of atrial fibrillation (MH-OR 0.94 [0.84, 1.04]). Conclusion The present meta-analysis confirms the favorable effects of glucagon-like peptide-1 receptor agonists on major cardiovascular events, cardiovascular and all-cause mortality, stroke, and possibly myocardial infarction. Conversely, the effects on heart failure remain uncertain. Available data on atrial fibrillation seems to exclude any major safety issues in this respect. Registration number (prospero) CRD42018115577.A 58-year-old female patient presented with a single-digit clubbing on the second finger of her right hand two years previously. After investigation with imaging and incisional biopsy, superficial acral fibromyxoma was diagnosed. A brief review on single-digit clubbing and its causes is presented, focusing on superficial acral fibromyxoma.Objective To investigate the effect of a reduction of approximately 25% in total sleep time (TST) on sleep parameters, sleepiness and reaction time (RT) in short, long and intermediate sleepers. Design Twenty healthy young men with a TST of ≤6 h (n = 6), between 6 h and 8 h (n = 7) and > 8 h (n = 7), respectively considered as short, intermediate and long sleepers, underwent 5 consecutive nights with an approximately 25% reduction in TST, produced by delaying their usual bedtimes. All participants were subjected to 6 consecutive nights of polysomnography and assessments of sleep, sleepiness and RT at pre- and post-sleep time. The Linear Mixed Model (LMM) was mainly used to assess the effect of the group, time, and their interaction on the main outcomes. Results Long and short sleepers showed the most significant changes regarding sleep parameters and sleepiness. However, short sleepers showed more lapses and more sleepiness. Conclusions We report novel evidence of the association between cognitive function (assessed via reaction time) and sleep restriction-related risks based on real-life since individual sleep schedules were personally determined. Both long and short sleepers showed the most significant alterations of delaying bedtime regarding sleep parameters and sleepiness. However, the short sleepers showed more sleepiness, attention lapses and increased reaction times.Objectives To assess the benefits of training in mindfulness-based stress reduction (MBSR) or moderate intensity exercise (EX) for improving sleep quality. Design Randomized controlled trial. Setting Outpatient, community-based. Mito-TEMPO manufacturer Participants Healthy adults (n = 413) aged 30-69 who did not regularly exercise or practice meditation, and who had no known prior sleep problems. Interventions 1) 8-weeks of MBSR training; 2) matched EX training; or 3) wait-list control. Measurements The Pittsburgh Sleep Quality Index (PSQI) was administered at baseline and at 1, 3, 5, and 7-month follow-up visits. Analysis Total PSQI scores and three PSQI factors (perceived sleep quality; daily disturbances, sleep efficiency) were assessed using linear mixed effects regression models for longitudinal data. Results Compared to controls, PSQI global scores improved significantly for EX (mean change -0.98 points [95% CI -1.56, -0.41] p = 0.001) and marginally for MBSR (-0.53 [-1.10, 0.04] p = 0.07). The perceived sleep quality factor improved for both EX (-0.18 [-0.30, -0.07] p = 0.002) and MBSR (-0.12 [-0.24, -0.01] p = 0.035). The daily disturbances factor improved slightly more for MBSR (-0.13 [-0.22, -0.033] p = 0.008) than EX (-0.09 [-0.19, 0.004] p = 0.06). The sleep efficiency factor did not improve after MBSR (0.08 [-0.045, 0.21] p = 0.2) or EX (-0.07 [-0.20, 0.06] p = 0.3). Improvements in the sleep quality were sustained over 7 months for both groups. Conclusions Training in MBSR and EX produced small but statistically significant and sustained improvements in sleep quality. For EX participants, this improvement was due primarily to improvements in perceived sleep quality. For MBSR, the decrease in daytime disturbance was more important.Purpose Evidence supports that providing preoperative education using an audiovisual format is an effective method to reduce anxiety in the surgical patient. The purpose of this quality improvement project was to evaluate the effect of viewing a video tour of the perioperative division had on patient-perceived preoperative anxiety. Design A quasi-experimental design using a pre-post survey method of two individual groups. Methods Sixty bariatric surgery patients completed a visual analog scale for anxiety (VAS-A), consisting of 10 items, on arrival and at the end of their preassessment appointment. Thirty patients in the comparison group received preoperative education with the current process of written and verbal instructions. Thirty patients in the intervention group received education with written and verbal instructions as well as inclusion of an informational video tour of the perioperative division. A paired sample t test was used to compare VAS-A results of the comparison and intervention groups. Findings Data supported that bariatric patients who received only verbal and written instructions preoperatively had a statistically significant reduction in anxiety levels in five of 10 items on the VAS-A. Bariatric patients who received education with verbal and written instructions, as well as inclusion of the informational video tour, had a statistically significant reduction in self-perceived anxiety in 9 of 10 items on the VAS-A. Conclusions Data supported that the addition of an audiovisual component in the form of an informational tour of the perioperative division is an effective method to reduce perceived preoperative anxiety in patients having bariatric surgery.Introduction The role of voice prosthesis (VP) in causing swallowing difficulties has not been thoroughly evaluated. A laryngectomee with dysphasia caused by a VP is presented. Case report A 77-year-old laryngectomee presented with dysphagia. He had hypo pharyngeal squamous cell carcinoma, which was treated with intensity-modulated radiotherapy 13 years earlier. Cancer recurrence 2 years later required laryngectomy and forearm free flap restoration. The patient used trachea-oesophageal speech for communication using Provox® Vega 22.5/Fr 6mm. Diagnostic endoscopy revealed significant oesophageal stenosis at the upper portion of the flap immediately below the VP. The VP was replaced with a 22.5 Fr/4mm Provox® Vega that was modified by cutting out its distal hood that protruded into the oesophageal lumen. The patient noted an immediate improvement in his dysphagia that persisted through the 14-month follow-up. Conclusions This report underscores the need to evaluate the role of VP in laryngectomees with swallowing difficulties.