A high-glucose meal produces an increase in oxidation parameters in patients with DMT2. The administration of NAC reduces the oxidative stress and, by doing so, reduces the endothelial activation. In conclusion, NAC could be efficacious in the slackening of the progression of vascular damage in DMT2.

This mini-review takes into consideration the physiology, synthesis and mechanisms of action of the nitric oxide (NO) and, subsequently, the causes and effects of the NO bioavailability impairment. In diabetes mellitus the reduced NO bioavailability is caused by the increased free radicals production, secondary to hyperglycemia. The reactive oxygen species oxidize the cofactors of the nitric oxide synthase, diminishing their active forms and consequently leading to a decreased NO production. Furthermore the decreased concentration of reduced glutathione results in a diminished production of nitrosoglutathione. These molecules are important intermediates of the NO pathway and physiologically activate the soluble guanylate cyclase. Their decrease in oxidative states of the cell, therefore, leads to a reduced cGMP production which represents the principal molecule that carries out NO's major effects. Finally we considered the eventual therapeutic strategies to improve NO bioavailability by acting on the causes of its decrease. Therefore the treatments proposed are based on the possibility to counteract the oxidation and, in this context, the physiopathological mechanisms strongly support the treatment with thiols.

Nitric oxide (NO) plays a wide spectrum of biological actions including a positive role in oocyte maturation and ovulation. Free radicals levels have been shown elevated in polycystic ovary syndrome (PCOS) and therefore would be responsible for quenching NO that, in turn, would play a role in determining oligo- or amenorrhea connoting PCOS. Eight patients with PCOS displaying oligo-amenorrhea from at least 1 yr underwent a combined treatment with N-acetylcysteine (NAC) (1200 mg/die) plus L-arginine (ARG) (1600 mg/die) for 6 months. Menstrual function, glucose and insulin levels, and, in turn, homeostasis model assessment (HOMA) index were monitored. Menstrual function was at some extent restored as indicated by the number of uterine bleedings under treatment (3.00, 0.18-5.83 vs 0.00, 0.00-0.83; p<0.02). Also, a well-defined biphasic pattern in the basal body temperature suggested ovulatory cycles. The HOMA index decreased under treatment (2.12, 1.46-4.42 vs 3.48, 1.62-5.95; p<0.05). In conclusion, this preliminary, open study suggests that prolonged treatment with NAC+ARG might restore gonadal function in PCOS. This effect seems associated to an improvement in insulin sensitivity.

Background Frozen shoulder (FS) is a painful condition characterized by progressive loss of shoulder function with passive and active range of motion reduction. To date, there is still no consensus regarding its rehabilitative treatment for pain management. Purpose The aim of this umbrella review of systematic reviews was to analyze the literature, investigating the effects of non-surgical and rehabilitative interventions in patients suffering from FS. Patients and Methods A review of the scientific literature was carried out from 2010 until April 2020 using the following search databases: PubMed, Medline, PEDro, Scopus and Cochrane Library of Systematic Reviews. A combination of terms was used for the search: frozen shoulder OR adhesive capsulitis AND systematic review OR meta-analysis AND rehabilitation NOT surgery NOT surgical intervention. We included systematic reviews that specifically dealt with adults with FS, treated with non-surgical approaches. All the systematic reviews and meta-analyses included in the study that met the inclusion criteria were assessed using the Assessment of Multiple Systematic Reviews as a quality assessment tool. Results Out of 49 studies, only 14 systematic reviews respected the eligibility criteria and were included in this study. Their results showed an important heterogeneity of the studies and all of them agree on the lack of high-quality scientific work to prove unequivocally which rehabilitative treatment is better than the other. Due to this lack of gold standard criteria, there may be also a heterogeneity in the diagnosis of the reviews analyzed. Conclusion Non-surgical and rehabilitative interventions are undoubtedly effective in treating FS, but there is no evidence that one approach is more effective than the other regarding the methods reported. Future high-quality RCTs are needed to standardize the treatment modalities of each physiotherapy intervention to provide strong recommendations in favor.

Background and Aim: Our previous data showed that transition from pediatric to an adult care center (ACC) improves glycaemic control in youth with type 1 diabetes (T1D). However, factors that might impact the success of transition are still unclear. In this study we aimed to evaluated whether metabolic control after transition differs by different ACC, insulin regimens and age at transition. Methods: In this retrospective observational study we evaluated data from 178 patients with T1D moving from two pediatric clinics to two different ACC in Rome. The transition process was performed according to the American Diabetes Association Standard of Care. A1c was reassessed three and six months after transition and compared to baseline values by within-subjects analysis of variance, fitting interaction terms with referral center, baseline insulin regimen (multiple daily insulin injection [MDI] and continuous subcutaneous insulin infusion [CSII]) and age. Results: At baseline, mean ± SD age was 28.4 ± 6.7 years, disease duration was 18.6 ± 8 years and A1c was 7.9 % ± 1.3. Mean transition gap was 8.0 ± 6.2 months. A1c values significantly improved both three (ΔA1c: -0.2%, p &lt;0.001), and six months (ΔA1c: -0.4 %, p &lt;0.001) after transitioning. At 6 months, ΔA1c was similar in the two centers (-0.4±1.0% and -0.4±0.7, p-value for interaction: 0.58) and in subjects on MDI or CSII at baseline (-0.5±1.0% and -0.4±0.6%, p-value for interaction: 0.37). No interaction between age at baseline and time was found (p-value: 0.22) The number of subjects on CSII increased from 46 (26.9%) at baseline to 64 (37.4%) after 6 months. There was no difference in A1c improvement between subjects changing compared to those not changing insulin regimen (p-value: 0.71). Conclusion: This study shows a rapid improvement of metabolic control in T1D after transition, regardless of referral center, insulin regimen and age at transition. Further analysis evaluating different educational programs are needed. Disclosure S. Pieralice: None. E. Maddaloni: Consultant; Self; Merck KGaA. Speaker’s Bureau; Self; Abbott, AstraZeneca, Pikdare. C. Moretti: None. A. Maurizi: Employee; Self; AstraZeneca. C. Mignogna: Research Support; Self; Eli Lilly and Company. Other Relationship; Self; AstraZeneca. S. Dinatale: None. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. R. Buzzetti: Advisory Panel; Self; Sanofi. Speaker’s Bureau; Self; AstraZeneca, Lilly Diabetes, Merck Sharp & Dohme Corp.