Use of the PARO robot as a social mediator in a sample of children with neurodevelopmental disorders and typical development

Background

Social robotics is a research field aimed at providing robots with skills related to social behavior and natural human interaction. Many studies have demonstrated the efficacy of these robots as socio-communicative mediators. Others have used them to create a new communication channel and promote social interaction in chil-dren with autism spectrum disorder (ASD). For children with ASD prolonged interpersonal interaction can sometimes generate extreme frustration. They may find it difficult to focus their attention and learn social skills. The robot may therefore become a reliable and more predictable technological intermediary for the child.

Methods

Our study involved the use of the PARO seal robot as a social mediator in groups of children with neurodevelopmental disorders. We aimed to investigate whether the social robot could facilitate relationships with adults in children with neurodevelopmental disorders by comparing their interactions with those of typically developing children.

Results

The results of our research partially confirm what has been reported in the existing literature, while introducing some innovations that could be addressed by future research. The results of the statistical analysis show a positive correlation in the 'interaction' dimension and the presence of the PARO seal in subjects diagnosed with autism without intellectual impairment. These data highlight the PARO robot's ability to facilitate communication and social.

Conclusions

The results of the present study confirm that social robotics can be a valid tool to improve socio-communication skills in clinical samples of children with autism without intellectual impai-rment.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Increased carotid cross-sectional area is a marker of organ damage in young hypertensive patients

Background

Common Carotid artery (CA) cross sectional area (CCSA) is strictly related to vessel remodelling stimulated by mechanical stress due to arterial hypertension. Accordingly, increased CCSA might represent an early marker of vascular target organ damage independently of presence of atherosclerotic plaque.

Purpose

To assess early correlates and prognostic impact of CCSA in a large population of young treated HTN patients.

Methods

We selected 970 hypertensive patients, 18 to 40 years old (mean age 34±5 yrs; 30% women) of the Campania Salute Network registry with available CA ultrasound and follow-up data, free of overt cardiovascular (CV) disease. CCSA was computed as:

CCSA = π [(CAd/2 + IMT)2 – (CAd/2)2]

where CAd = CA diameter and IMT = mean intima media thickness. Participants were compared by CCSA tertiles.

Results

Compared to the lowest and intermediate tertiles, patients in the highest tertile were more often male, smokers, older, and had higher body mass index (BMI), diastolic blood pressure (BP), higher fasting glucose, triglycerides, LDL cholesterol and uric acid, with lower level of HDL cholesterol. They also exhibited higher left ventricular mass index and IMT and had more often carotid atherosclerotic plaque (all p&lt;0.05). During a median follow-up of 45 months, 22 incident composite CV events occurred. In Cox-Regression analyses, adjusting for the above covariates, presence of carotid plaque and classes of antihypertensive medications, increased CCSA was significantly associated with increased CV risk (HR 1.08/mm2; 95% CI 1.02–1.13; p&lt;0.01).

Conclusions

In a population of young hypertensive patients, increased CCSA is related to metabolic and atherosclerotic disease and is associated with increased CV risk, also independently of overt carotid plaque.

Funding Acknowledgement

Type of funding source: None

HFpEF score discriminates severity of cardiovascular profile in asymptomatic treated hypertensive patients: the campania salute network

Background

The heart failure with preserved ejection fraction (HFpEF) score is easy to use and potentially useful to discriminate HFpEF from noncardiac causes of dyspnea. HFpEF score may be expressed also as probability to have HFpEF.

Purpose

We investigated whether a high HFpEF score can identify specific cardiovascular (CV) profile in treated hypertensive patients even without dyspnea.

Methods

From September to December 2019, we consecutively enrolled treated hypertensive patients without dyspnea, with normal left ventricular (LV) ejection fraction (&gt;50%), and chronic kidney disease of no more than stage III. In addition to standard echocardiographic parameters we evaluated: 1) inappropriate LV mass, identified as a percent of predicted LV mass &gt;128%, 2) myocardial energetic efficiency as the ratio of stroke volume to heart rate normalized by LV mass (MEEi), and 3) an estimate of arterial stiffness, i.e. the ratio of pulse pressure and stroke index (by allometric normalization by height), as previously reported. The probability of HFpEF was calculated from the HFpEF score, using body mass index, pulmonary systolic pressure, mitral E/E' ratio, age, and history or evidence of atrial fibrillation.

Results

188 patients with complete data were analyzed (42% women, age 61±14 years, 9% diabetic). Patients were then divided into 3 groups according to HFpEF probability tertiles and compared by ANOVA and trend analysis (Table 1).

Conclusions

Probability of HFpEF using HFpEF score and non-standard echocardiographic parameters identify worse CV profile in treated hypertensive patients without dyspnea.

Funding Acknowledgement

Type of funding source: None

P5457Assessment of carotid cross sectional area in hypertensive patients: phenotyping and prognostic validation in the campania salute network

Background

Increased intima media thickness (IMT) of common carotid artery (CA) is considered the hallmark of vascular hypertension-mediated target organ damage, even though vessel remodeling due to mechanical stress can be accompanied also by changes in diameter.

Purpose

We developed a method computing both diameter and IMT of CA, and assessed correlates and prognostic impact of carotid cross sectional area (CCSA) in a large registry of treated hypertensive patients.

Methods

We selected 7049 hypertensive patients of the Campania Salute Network registry free of overt cardiovascular (CV) disease and with available CA ultrasound (54±11 yrs; 57% male). CCSA was computed as:

π × [((CA diameter + 2 × (mean IMT)) / 2)]2 − π × [((CA diameter) / 2)]2.

Results

CCSA was considered high if >90th percentile of the sex-specific distribution (>48 mm2 in men and >41 mm2 in women). Higher CCSA correlated with older age, male sex, higher pulse pressure (PP), higher total and LDL cholesterol and presence of diabetes (p<0.01 for all). During a median follow-up of 45 months (IQR 19–92), 324 incident composite major and minor CV events occurred. In Cox regression analysis high CCSA was associated with more than 100% increased risk of incident CV events (p<0.0001, figure), independently of the effect of older age, male sex, PP>60mmHg, presence of left ventricular hypertrophy (LVH), carotid plaque (CP), and less anti-RAS therapy (p<0.05 for all).

Conclusions

In treated hypertensive patients, increased CCSA is associated with worse metabolic and lipid profile and predict incident CV events, independently of high PP, presence of LVH and CP.

P2775Evaluation of right ventricular function in patients with idiopathic and non-idiopathic interstitial pulmonary fibrosis: a speckle tracking echocardiography study

Background

Pulmonary fibrosis (PF) is a heterogeneous group of diffuse parenchymal lung diseases, including idiopathic PF (IPF), which is the most frequent type in adults, and non-IPF. The impairment of right ventricular (RV) myocardial function of PF patients is not fully elucidated.

Purpose

To identify RV alterations in patients with interstitial PF and to evaluate possible differences between IPF and non-IPF by a combined assessment with standard and advanced echocardiography.

Methods

We enrolled 61 patients affected by interstitial PF (F/M: 16/45; age 67.9±8.1 years). 33 patients had IPF fibrosis and 28 non-IPF (bronchiolitis obliterans-organizing pneumonia and nonspecific interstitial pneumonia/fibrosis). Patients with coronary artery disease, overt heart failure, primary cardiomyopathies, other forms of diffuse parenchymal lung disease, history of pulmonary embolism and primary pulmonary hypertension were excluded. PF diagnosis was made by chest radiography, spirometry and chest high-resolution computed tomography. Lung cumulative damage was evaluated by diffusion capacity of the lung for carbon monoxide (DLco). Anthropometric parameters and blood pressure (BP) were recorded. All patients underwent a complete standard and advanced echo-Doppler exam including assessment of RV structure and function. RV global longitudinal strain (RVGLS), septal and lateral longitudinal strain (SLS and LLS respectively), were estimated by speckle tracking echocardiography (all strains were reported in absolute values).

Results

No significant difference was found in sex prevalence, systolic and diastolic BP and heart rate between the two groups, whereas IPF patients were older (65.2±8.1 vs. 70.1±7.6 years, p<0.01) than non-IPF. There was no difference in DLco between IPF and non-IPF patients. The two groups had similar left ventricular (LV) mass index, LV E/A ratio and E/e' ratio, and LV ejection fraction. RV diameters, tricuspid annulus plane systolic excursion (TAPSE) and pulmonary systolic artery pressure (PAPs) were not significantly different between the two groups, whereas IPF patients had lower RV GLS (20.2±3.1 vs. 23.0±3.6%, p=0.006), SLS (17.4±3.4 vs. 20.5±4.7%, p<0.01) and LLS (22.6±4.5 vs. 25.8±4.7%, p<0.02) compared to non-IPF patients. In the pooled population, DLco was related to RV GLS (r=0.51, p=0.004) and SLS (r=0.47, p<0.01), but not with age (p=0.121), TAPSE (p=0.532), and PAPs (p=0.875). In separate sub-analyses according to PF type, DLco was related to RVGLS in patients with IPF (r=0.52, p=0.03), but not in patients with non-IPF (r=0.41, p=0.16).

Conclusion

In patients with PF, RV systolic myocardial dysfunction is detectable by speckle tracking but not with standard echocardiography. In patients with IPF, RV dysfunction is associated with the degree of lung disease damage, as assessed by DLco.

Weight loss facilitates reduction of left ventricular mass in obese hypertensive patients: The Campania Salute Network

BACKGROUND AND AIMS

Reduction of left ventricular mass index (LVMi) during antihypertensive treatment is less likely to occur in obese subjects. The aim of the study was to assess whether weight loss influences reduction of LVMi in treated, obese, hypertensive patients.

METHODS AND RESULTS

From the Campania Salute Network registry, we identified 1546 obese hypertensive patients (50 ± 9 years, 43% women) with more than 12 months follow-up. Echocardiographic reduction of LVMi was considered as achievement of normal values (<47 g/m^2.7 in women or <50 g/m^2.7 in men) or a reduction of ≥10% during follow-up. Weight loss was considered as ≥5% reduction in body weight, and occurred in 403 patients (26%) during a median follow-up of 50 months (IQrange:31-93). Median weight loss was 8.6% (IQrange:6.5-12). Patients with weight loss had higher baseline body mass index (p < 0.05), while there was no difference in age, sex, duration of hypertension, prevalence of diabetes, metabolic syndrome and average blood pressure during follow-up. During follow-up, 152 patients (9.8%) exhibited reduction of LVMi. Reduction of LVMi was more frequent (12.9% vs 9.1%, p < 0.030) in patients losing weight than in those who did not. In logistic regression analysis, weight loss was associated with reduction of left ventricular mass index (OR 1.51 [95%CI 1.02-2.23], p = 0.039), independent of significant associations with younger age, lower average systolic blood pressure during follow-up, longer follow-up time and higher LVMi at baseline.

CONCLUSION

In treated obese hypertensive patients, weight loss during follow-up promotes significant reduction of LVMi, independent of baseline characteristics and blood pressure control.

Is increased uric acid a risk factor or a defensive response? The Campania Salute Network

BACKGROUND AND AIMS

Circulating uric acid (UA) is positively associated with body mass index (BMI), blood glucose, blood pressure (BP), markers of inflammation, and altered lipid profile. UA has also anti-oxidative properties which might be beneficial for cardiovascular (CV) system. It is still debated whether or not UA is independently associated with increased CV morbidity and/or mortality.

METHODS AND RESULTS

We studied prognostic impact of UA in 8833 hypertensive adults (mean age 53 ± 12 yrs, 3857 women) from the Campania Salute Network, without prevalent CV disease and more than stage 3 CKD. We calculated standardized UA Z-score, adjusted for age, sex, glomerular filtration rate, and BMI. Low and high UA and UA Z-score quartiles were compared to the 2 middle quartiles assumed to be "normal". Prevalence of obesity and diabetes was higher in low and high than in normal UA Z-score group (all p < 0.001). Systolic BP, left ventricular mass, carotid intima thickness were significantly higher and ejection fraction was reduced in the presence of high UA Z-score (all p < 0.001). Over 33-months average follow-up, incident major CV end-points (MACE) were not significantly different among low, normal and high UA or UA Z-score. In the latter analysis, however, incident MACE tended to be more frequent in the low than the high UA Z-score. Despite the results of multivariable analyses, the effect of less aggressive therapy in low UA Z-score cannot be excluded with certainty.

CONCLUSION

In treated hypertensive patients, high levels of UA normalized for major biological determinants do not independently predict CV outcome. CLINICALTRIALS.

GOV IDENTIFIER

NCT02211365.

Efficacy and safety of glucagon-like peptide-1 agonists on macrovascular and microvascular events in type 2 diabetes mellitus: A meta-analysis

AIMS

Glucagon-like peptide-1 (GLP-1) agonists improve glycaemic control in type 2 diabetes mellitus (DM). Outcome trials investigating macro and microvascular effects of GLP-1 agonists reported conflicting results. The aim of this study was to assess, in a meta-analysis, the effects of GLP-1 agonists on mortality, major nonfatal cardiovascular (CV) events, renal and retinal events.

DATA SYNTHESIS

MEDLINE, Cochrane, ISI Web of Science, SCOPUS and ClinicalTrial.gov databases were searched for articles published until June 2017. Randomized trials enrolling more than 200 patients, comparing GLP-1 versus placebo or active treatments in patients with DM, and assessing outcomes among all-cause death, CV death, MI, stroke, HF, diabetic retinopathy and nephropathy were included. 77 randomized trials enrolling 60,434 patients were included. Compared to control, treatment with GLP-1 significantly reduced the risk of all-cause death (RR: 0.888; CI: 0.804-0.979; p = 0.018) and the risk of CV death (RR: 0.858; CI: 0.757-0.973; p = 0.017). GLP-1 agonists did not affect the risk of MI (RR: 0.917; CI: 0.830-1.014; p = 0.092) as well as the risk of stroke (RR: 0.882; CI: 0.759-1.023; p = 0.097), HF (RR: 0.967; CI: 0.803-1.165; p = 0.725), retinopathy (RR: 1.000; CI: 0.807-1.238; p = 0.997) and nephropathy (RR: 0.866; CI: 0.625-1.199; p = 0.385).

CONCLUSIONS

Treatment with GLP-1 agonists in DM patients is associated with a significant reduction of all cause and CV mortality.

Vitamin D deficiency and clinical outcome in patients with chronic heart failure: A review

AIM

The aim of this review was to summarize evidence on the role of Vitamin D deficiency in heart failure (HF), from pathophysiological mechanisms to clinical effects of Vitamin D supplementation.

DATA SYNTHESIS

Chronic HF secondary to left ventricular (LV) systolic dysfunction is a growing health problem, still associated with poor clinical outcome. In recent years, experimental and epidemiological evidence focused on the role of Vitamin D in HF. Cross sectional studies demonstrated that prevalence of HF is increased in patients with Vitamin D deficiency or parathyroid hormone (PTH) plasma level increase, whereas longitudinal studies showed enhanced risk of developing new HF in patients with Vitamin D deficiency. In addition, in patients with established HF, low plasma levels of Vitamin D are associated with worsening clinical outcome. Yet, clinical studies did not definitively demonstrate a benefit of Vitamin D supplementation for preventing HF or ameliorating clinical outcome in patients with established HF.

CONCLUSIONS

Despite convincing experimental and epidemiological data, treatment with Vitamin D supplementation did not show clear evidence of benefit for preventing HF or influencing its clinical course. Ongoing clinical studies will hopefully shed lights on the effects of Vitamin D supplementation on clinical endpoints along the spectrum of HF.

Opposite effects of β2-adrenoceptor gene deletion on insulin signaling in liver and skeletal muscle

BACKGROUND AND AIM

β₂-Adrenoceptors (β₂-ARs) are G protein-coupled receptors (GPCRs) expressed in the major insulin target tissues. The interplay between β₂-AR and insulin pathways is involved in the maintenance of glucose homeostasis. The aim of this study was to explore the consequences of β₂-ARs deletion on insulin sensitivity and insulin signaling cascade in metabolically active tissues.

METHODS AND RESULTS

We evaluated glucose homeostasis in skeletal muscle and liver of β₂-AR-null mice (β₂-AR^-/-) by performing in vivo (glucose tolerance test and insulin tolerance test) and ex vivo (glucose uptake and glycogen determination) experiments. β₂-AR gene deletion is associated with hepatic insulin resistance and preserved skeletal muscle insulin sensitivity. Importantly, we demonstrate that hepatic β₂-AR regulates insulin-induced AKT activation via Grb2-mediated SRC recruitment through a G_i-independent mechanism.

CONCLUSIONS

β-AR stimulation contributes to the development of early stages of insulin resistance progression in the liver. Our findings indicate that the cross-talk between β₂-AR and insulin signaling represents a fundamental target towards the development of novel therapeutic approaches to treat type 2 diabetes and metabolic syndrome.

Effect of diabetes and metabolic syndrome on myocardial mechano-energetic efficiency in hypertensive patients. The Campania Salute Network

Reduced myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM), and expressed in μl s^-1 g^-1 (MEEi), is a strong predictor of cardiovascular (CV) events, independently of LV hypertrophy and other confounders, including type II diabetes (DM). Decreased MEEi is more frequent in patients with diabetes. In the present analysis we evaluated the interrelation among MEEi, DM and metabolic syndrome (MetS) in the setting of arterial hypertension. Hypertensive patients from the Campania Salute Network, free of prevalent CV disease and with ejection fraction >50% (n=12 503), were analysed. Coexistence of MetS and DM was ordinally categorized into 4 groups: 8235 patients with neither MetS nor DM (MetS-/DM-); 502 without MetS and with DM (MetS-/DM+); 3045 with MetS and without DM (MetS+/DM-); and 721 with MetS and DM (MetS+/DM+). After controlling for sex, systolic blood pressure, body mass index, relative wall thickness (RWT), antihypertensive medications and type of antidiabetic therapy, MEEi was 333 μl s^-1 g^-1 in MetS-/DM-, 328 in MetS-/DM+, 326 in MetS+/DM- and 319 in MetS+/DM+ (P for trend <0.0001). In pairwise comparisons (Sidak-adjusted), all conditions, except MetS-/DM+, were significantly different from MetS-/DM- (all P<0.02). No statistical difference was detected between MetS-/DM+ and MetS+/DM-. Both MetS and DM are associated with decreased MEEi in hypertensive patients, independently to each other, but the reduction is statistically less evident for MetS-/DM+. MetS+/DM+ patients have the lowest levels of MEEi, consistent with the alterations of energy supply associated with the combination of insulin resistance with insulin deficiency.

Rays Sting: The Acute Cellular Effects of Ionizing Radiation Exposure

High-precision radiation therapy is a clinical approach that uses the targeted delivery of ionizing radiation, and the subsequent formation of reactive oxygen species (ROS) in high proliferative, radiation sensitive cancers. In particular, in thoracic cancer ratdiation treatments, can not avoid a certain amount of cardiac toxicity. Given the low proliferative rate of cardiac myocytes, research has looked at the effect of radiation on endothelial cells and consequent coronary heart disease as the mechanism of ratdiation induced cardiotoxicity. In fact, little is known concerning the direct effect of radiation on mitochondria dynamis in cardiomyocyte. The main effect of ionizing radiation is the production of ROS and recent works have uncovered that they directly participates to pivotal cell function like mitochondrial quality control. In particular ROS seems to act as check point within the cell to promote either mitochondrial biogenesis and survival or mitochondrial damage and apoptosis. Thus, it appears evident that the functional state of the cell, as well as the expression patterns of molecules involved in mitochondrial metabolism may differently modulate mitochondrial fate in response to radiation induced ROS responses. Different molecules have been described to localize to mitochondria and regulate ROS production in response to stress, in particular GRK2. In this review we will discuss the evidences on the cardiac toxicity induced by X ray radiation on cardiomyocytes with emphasis on the role played by mitochondria dynamism.