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Acidogenic boluses can mitigate potential negative effects of high milk yield at dry-off on udder health. This randomized controlled trial aimed to investigate the effect of administering acidogenic boluses at dry-off on dry period intramammary infection (IMI) dynamics and on milk production parameters, somatic cell count linear score (LSCC), clinical mastitis (CM), and herd removal in the next lactation. A total of 901 cows from 3 dairy farms were randomly allocated to a control (CON, n = 458; no administration of acidogenic boluses at dry-off) or treatment group (TRT, n = 443; administration of 2 acidogenic boluses at dry-off). Quarter milk samples were collected at dry-off and after calving and submitted for bacteriological milk culture. The effects of treatment on the presence of quarter-level postpartum IMI, cure of existing IMI, and acquisition of new IMI, and on the prevalence of cow-level high LSCC (LSCC ≥4) in the first 30 days in milk (DIM) were analyzed using mixed effects logistic regression. Mixed linear regression was used to analyze cow-level milk production parameters (i.e., milk yield, fat corrected milk, fat and protein yield, and LSCC) in the first 90 DIM and until 300 DIM. For CM and herd removal, Cox proportional hazard regression models were used. In addition to treatment group, lactation group at dry-off, presence of high LSCC in the last test-day, average milk yield in the week before dry-off, presence of CM in the lactation of enrollment, and biologically relevant interactions were offered in all models. There was no evidence of a difference in IMI dynamics or in milk, fat corrected milk, protein or fat yields in the subsequent lactation between groups. The TRT group had a lower LSCC in the first 2 mo postpartum compared with the CON group (2.58 ± 0.3 vs. 2.92 ± 0.3 and 2.42 ± 0.3 vs. 2.81 ± 0.3, for first and second month postpartum). The prevalence of high LSCC in the first 30 DIM was 9.1% lower in the TRT compared with the CON group (16.3% vs. 25.5%; risk difference: −9.2; 95% confidence interval [CI]: −15.8, −2.5). Cows in the TRT group exhibited reduced hazards of CM in the subsequent lactation compared with cows in the CON group (hazard ratio: 0.75; 95% CI: 0.63, 0.89) as well as a reduced hazard of herd removal (hazard ratio: 0.82, 95% CI: 0.77, 0.88). The administration of acidogenic boluses as a component of dry-off management is a promising approach to maintain good udder health and reduce the hazard of CM and herd removal during the subsequent lactation. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to identify associations between the prepartum teat apex microbiome and the presence of Staphylococcus aureus intramammary infections (IMI) in primiparous cows during the first 5 weeks after calving. We performed a case-control study using shotgun metagenomics of the teat apex and culture-based milk data collected longitudinally from 710 primiparous cows on five organic dairy farms. Cases had higher odds of having S. aureus metagenomic DNA on the teat apex prior to parturition compared to controls (OR = 38.9, 95% CI: 14.84-102.21). Differential abundance analysis confirmed this association, with cases having a 23.8 higher log fold change (LFC) in the abundance of S. aureus in their samples compared to controls. Of the most prevalent microorganisms in controls, those associated with a lower risk of post-calving S. aureus IMI included Microbacterium phage Min 1 (OR = 0.37, 95% CI: 0.25-0.53), Corynebacterium efficiens (OR = 0.53, 95% CI: 0.30-0.94), Kocuria polaris (OR = 0.54, 95% CI: 0.35-0.82), Micrococcus terreus (OR = 0.64, 95% CI: 0.44-0.93), and Dietzia alimentaria (OR = 0.45, 95% CI: 0.26-0.75). Genes encoding for Microcin B17 AMPs were the most prevalent on the teat apex of cases and controls (99.7% in both groups). The predicted abundance of genes encoding for Microcin B17 was also higher in cases compared to controls (LFC 0.26). IMPORTANCE Intramammary infections (IMI) caused by Staphylococcus aureus remain an important problem for the dairy industry. The microbiome on the external skin of the teat apex may play a role in mitigating S. aureus IMI risk, in particular the production of antimicrobial peptides (AMPs) by commensal microbes. However, current studies of the teat apex microbiome utilize a 16S approach, which precludes the detection of genomic features such as genes that encode for AMPs. Therefore, further research using a shotgun metagenomic approach is needed to understand what role prepartum teat apex microbiome dynamics play in IMI risk. [ABSTRACT FROM AUTHOR]

The study aimed to characterize meat quality traits of Milanino chickens reared according to a specific free-range farming program. A total of 120 birds was reared straight-run in outdoor pens (8 m²/bird) from 35 d of life and fed ad libitum a low (16%) protein diet. At 180 d of age, 20 birds (10 birds/sex) were slaughtered, and carcass weight data were recorded. After processing, carcasses were refrigerated at 4°C for 24 hours. Then, the right breast and thigh with skin were collected and color parameters, pH, water-holding capacity (WHC), and chemical composition were determined. The left breast and thigh were stored at -20°C until cooking loss and tenderness evaluation. Milanino was confirmed to be a heavy breed with a sexual dimorphism in relation to adult body weight. A high general carcass yield was recorded. Milanino meat was characterized by high protein and low fat contents compared with the standard broiler meat. Differences in meat composition were recorded according to the sex: females presented higher values of dry matter (breast and thigh), protein (breast), and fat (breast and thigh) contents. The meat with skin presented an intense luminosity, and this trait was higher in the females. The muscle color was characterized by high redness and yellowness indices with differences according to the sex: Higher yellowness index was observed in female carcasses, while higher redness index was detected in male breast samples. The pH muscle values were similar to those reported in other autochthonous breeds. WHC values did not show variation between sexes. In contrast, cooking loss values recorded in thigh samples were lower in males compared to females. The degree of tenderness of Milanino meat was not affected by the sex. However, the potential loss of water and the toughness in Milanino meat were low compared to other local chicken breed meat. The present results support the breeding of Milanino chickens for meat production according to its specific straight-run free-range system. [ABSTRACT FROM AUTHOR]

The aim of the present trial was to study the effect of different freezing rates on the survival of cryopreserved rooster semen packaged in straws. Slow and fast freezing rates were obtained keeping straws at different distances in the vapor above the surface of the nitrogen during freezing. Adult Lohmann roosters ( n = 27) were used. Two experiments were conducted. In Experiment 1, semen was packaged in straws and frozen comparing the distances of 1, 3 and 5 cm in nitrogen vapor above the surface of the liquid nitrogen. In Experiment 2, the distances of 3, 7 and 10 cm above the surfaces of the liquid nitrogen were compared. Sperm viability, motility and progressive motility and the kinetic variables were assessed in fresh and cryopreserved semen samples. The recovery rates after freezing/thawing were also calculated. In Experiment 1, there were no significant differences among treatments for all semen quality variables. In Experiment 2, the percentage of viable (46%) and motile (22%) sperm in cryopreserved semen was greater when semen was placed 3 cm compared with 7 and 10 cm in the vapor above the surface of the liquid nitrogen. The recovery rate of progressive motile sperm after thawing was also greater when semen was stored 3 cm in the vapor above the surface of the liquid nitrogen. More rapid freezing rates are required to improve the survival of rooster sperm after cryopreservation and a range of distances from 1 to 5 cm in nitrogen vapor above the surface of the liquid nitrogen is recommended for optimal sperm viability. [ABSTRACT FROM AUTHOR]

1. Milanino is a heavy Italian chicken breed included in a conservation project of the University of Milan and is an important genetic resource for alternative production systems. This research was aimed to study the effect of the dietary protein concentration on growth, slaughter performance and meat composition in free-range reared Milanino chickens. 2. A total of 120 Milanino chickens were fed on different protein concentrations (HP = 20% CP and LP = 16% CP), reared according to a free-range system and slaughtered at 150 and 180 d of age. Growth, slaughter performance and meat (breast and thigh) composition were recorded. 3. The protein concentration of the diet did not affect the overall Milanino mean body weight recorded in the straight-run group in the whole rearing period. However, the growth rate within sex was significantly different between the dietary treatments: heavier females were found in the HP group from 125 d onwards, while no differences were recorded in male body weights. The protein concentration of the diet did not affect carcass weight data or meat composition. 4. The present results suggest the use of a low-protein diet for rearing straight-run Milanino chickens for long rearing periods. However, in females, a high-protein diet is recommended from 125 d of age onwards. [ABSTRACT FROM AUTHOR]

The Milanino is an Italian chicken breed included in a conservation project run by the University of Milan. It is characterized by good fertility, heavy body weights, high adaptation ability to adverse climate conditions, and disease resistance. Because of these characteristics, the Milanino could represent an important genetic resource for alternative production systems. This research was aimed at studying the effect of bird density on growth and slaughter performance, as well as stress response in Milanino chickens kept in outdoor pens. One hundred and sixty Milanino chickens were randomly assigned to 2 experimental groups kept at different densities (2 m²/bird and 8 m²/bird) and were slaughtered at 185 days of age. Growth and slaughter performance and stress condition were recorded. The interaction bird density * sex * age significantly affected body weight and an opposite trend was found between females and males: heavier females were found in the high-density group, while heavier males were found in the low-density group. Bird density did not affect carcass weight data. The stress marker (H/L ratio) was significantly higher in birds kept at the higher density (2 m²/bird). In conclusion, the Milanino provided satisfactory growth performance with different rearing density but the lower density, 8 m²/bird, should be preferred to minimize welfare problems for male birds. [ABSTRACT FROM AUTHOR]

Oil-in-water emulsions are potent human adjuvants used for effective pandemic influenza vaccines; however, their mechanism of action is still unknown. By combining microarray and immunofluorescence analysis, we monitored the effects of the adjuvants MF59 oil-in-water emulsion, (pG. and alum in the mouse muscle. MF59 induced a time-dependent change in the expression of 891 genes, whereas (pG and alum regulated 387 and 312 genes, respectively. All adjuvants modulated a common set of 168 genes and promoted antigen-presenting cell recruitment. MF59 was the stronger inducer of cytokines, cytokine receptors, adhesion molecules involved in leukocyte migration, and antigen-presentation genes. In addition, MF59 triggered a more rapid influx of CD11b+ blood cells compared with other adjuvants. The early biomarkers selected by microarray, JunB and Ptx3, were used to identify skeletal muscle as a direct target of MF59. We propose that oil-in-water emulsions are the most efficient human vaccine adju vants, because they induce an early and strong immunocompetent environment at the injection site by targeting muscle cells. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Portal-enteric drainage (PED) might be particularly suitable for pancreas transplantation alone (PTA), since it has been associated with an immunologic advantage and achieves excellent metabolic results. We describe our experience with a consecutive series of 40 PTAs with PED. Methods: Between April 2001 and March 2004, 40 consecutive PTAs were performed with PED. Recipients were selected according to the American Diabetic Association recommendations. Donors were selected according to standard criteria irrespective of HLA match, although matching for A and B loci was considered at the time of graft allocation. Immunosuppression consisted of induction treatment with basiliximab (n = 34) or thymoglobulin (n = 6), and maintenance therapy with steroids, mycophenolate mofetil, and tacrolimus. Results: After a mean cold ischemia time of 690 minutes (range, 517¿965 min) all pancreases functioned immediately. Three grafts were lost due to hyperacute or accelerated rejection. No graft was lost to vascular thrombosis, although 5 (12.5%) nonocclusive thromboses were identified and the grafts were rescued with intravenous heparin infusion. A repeat laparotomy was required in 7 recipients (17.5%) No patient required multiple repeat laparotomies, and none died. After a mean follow-up of 16.4 months (range, 1¿36 mo), 2 recipients were diagnosed with rejection episodes, which were reversed with steroid boluses. Actuarial 3-year patient, and graft survival rates were 100% and 94.9%, respectively. The following parameters showed significant improvement compared with pretransplantation evaluation: hemoglobin A1C concentration, total and high-density lipoprotein cholesterol levels, arterial blood pressure, cardiac performance, retinopathy, proteinuria, and neuropathy. Conclusions: Pancreas transplantation alone with PED provides high rates of long-term insulin-independence. [Copyright &y& Elsevier]

SUMMARY Palliative treatment of malignant strictures of the esophagus and cardia is usually carried out by the endoscopic placement of a prosthesis. The aim of this retrospective study was to evaluate short- and long-term outcomes of the use of expandable stents, compared with conventional plastic prostheses. One hundred and thirteen endoscopic intubations were carried out in 120 patients affected by malignant stenosis of the esophagus and cardia using plastic prosthesis and self-expanding metal stents. Dysphagia was scored according to Atkinson and Ferguson's classification and the preoperative median score (3.6) was comparable in both groups. The technical success rate was 94.4% with plastic prosthesis and 93.7% with self-expanding metal stent while the functional success rate was, respectively, 85.2% and 88.8%. Three deaths occurred with plastic prostheses (4.4%), while no deaths were observed with metal stents. A comparative analysis of the results of this study suggests that the endoscopic placement of self-expanding metal stents is effective and safe and has to be preferred to the conventional plastic prosthesis for easier implantation and lower morbidity. [ABSTRACT FROM AUTHOR]

Endoscopic tube implantations were carried out in 40 patients with malignant stenosis of the esophagus and gastric cardia using self-expanding metallic stents. The indications for endoscopic intubation were the advanced stage of the tumor in 27 cases and risk factors that made resection inadvisable in 13 cases. In three patients, it proved impossible to implant a stent endoscopically because we were not able to pass the guide wire through the stenosis, whereas correct stent placement was achieved in 37 cases. Functional results were good in 33 patients, but four patients did not show any improvement of symptoms. Complications occurred in nine patients (24.3%): two bleedings, three neoplastic obstructions, one food obstruction, and three distal dislodgements of the prosthesis were observed, but could be readily corrected. No deaths occurred. The median survival time was 151 days (range 25-545 days). This study suggests that endoscopic placement of metallic self-expanding stents is safe and is to be preferred to plastic stents for easier implantation and lower morbidity. [ABSTRACT FROM AUTHOR]

The preterm surfactant-deficient lung is highly susceptible to tissue injury with the initiation of ventilation. The respiratory management of preterm infants in the delivery room may be the key to minimizing acute lung injury and its sequelae, including chronic lung disease. Volume-targeted ventilation, optimization of the alveolar recruitment with positive end-expiratory pressure and prophylaxis with surfactant in infants with small volumes of lung gas and delicate lung tissue might help in limiting acute damage during resuscitation in the delivery room. It is desirable to monitor oxygen saturation and tailor oxygen supplementation when resuscitating premature infants. [ABSTRACT FROM AUTHOR]

A double-blind, randomized, controlled study was performed in 90 full term infants to evaluate dose-related bifidogenic effects of a new synergistic mixture of galacto-oligosaccharides (GOS) and fructo-oligosacharides (FOS). The GOS/FOS mixture showed a dose-dependent stimulatory effect on the intestinal growth of bifidobacteria. Also stool consistency and faecal pH were positively affected. [ABSTRACT FROM AUTHOR]

The objective of this observational cohort study was to characterize the pattern of rumination time (RT), physical activity (PA), and lying time (LT) monitored by an automated health monitoring system, based on an ear-attached sensor, immediately before, during, and after clinical diagnosis (CD) of metabolic-digestive disorders. Sensor data were collected from 820 lactating Holstein cows monitored daily from calving up to 21 DIM for detection of health disorders (HD). Cows were grouped retrospectively in the no-clinical health disorder group (NCHD; n = 616) if no HD were diagnosed, or the metabolic-digestive group (METB-DIG; n = 58) if diagnosed with clinical ketosis or indigestion only. Cows with another clinical health disorder within −7 to +7 d of CD of displaced abomasum, clinical ketosis, or indigestion were included in the metabolic-digestive plus one group (METB-DIG+1; n = 25). Daily RT, PA, and LT, and absolute and relative changes within −7 to +7 d of CD were analyzed with linear mixed models with or without repeated measures. Rumination time and PA were smaller, and LT was greater for the METB-DIG and METB-DIG+1 group than for cows in the NCHD group for most days from −7 to +7 d of CD of HD. In general, daily RT, PA, and LT differences were larger between the METB-DIG+1 and NCHD groups than between the METB-DIG and NCHD groups. In most cases, RT and PA decreased to a nadir and LT increased to a peak immediately before or after CD of HD, with a return to levels similar to the NCHD group within 7 d of CD. Absolute values and relative changes from 5 d before CD to the day of the nadir for RT and PA or peak for LT were different for cows in the METB-DIG and METB-DIG+1 group than for the NCHD group. For PA, the METB-DIG+1 group had greater changes than the METB-DIG group. For cows affected by metabolic-digestive disorders, RT, PA, and LT on the day of CD and resolution of clinical signs were different than for cows in the NCHD group, but an increase in RT and PA or a decrease in LT was observed from the day of CD to the day of resolution of clinical signs. We conclude that dairy cows diagnosed with metabolic-digestive disorders including displaced abomasum, clinical ketosis, and indigestion presented substantial alterations in the pattern of RT, PA, and LT captured by an ear-attached sensor. Thus, automated health monitoring systems based on ear-attached sensors might be used as an aid for identifying cows with metabolic-digestive disorders. Moreover, RT, PA, and LT changes after CD might be positive indicators of recovery from metabolic-digestive disorders. [ABSTRACT FROM AUTHOR]

Understanding changes in parameters recorded by automated health monitoring systems based on ear-attached sensors on the days immediately before and after diagnosis of metritis and clinical mastitis can help develop dairy cow health monitoring strategies. The objective of this observational cohort study was to characterize rumination time, physical activity, and lying time monitored by an ear-attached sensor before, during, and after clinical diagnosis (CD) of metritis and clinical mastitis. Lactating Holsteins monitored daily for 21 d in milk for detection of health disorders were retrospectively included in the no clinical health disorder group (NCHD; n = 616) if no disorders were diagnosed. Cows were included in the metritis (MET; n = 69) or clinical mastitis (MAST; n = 36) group if diagnosed only with nonsevere metritis (watery, reddish, and fetid uterine discharge with or without pyrexia) or nonsevere clinical mastitis (visibly abnormal milk secretion with or without signs of udder inflammation, with no pyrexia and no systemic signs of disease), respectively. Cows diagnosed with severe metritis (signs of metritis plus systemic signs of disease) or severe clinical mastitis (signs of mastitis plus pyrexia and systemic signs of disease), and cows diagnosed with nonsevere metritis or clinical mastitis plus another disorder within −7 to +7 d of CD of metritis or clinical mastitis diagnosis, were included in the metritis plus (MET+; n = 25) or the clinical mastitis plus (MAST+; n = 15) group, respectively. Cows were fitted with an ear-attached accelerometer to measure rumination time, physical activity, and lying time. Mean daily values, mean value absolute change, and relative change for the mean daily value from 3 or 5 d before CD to the nadir for cows with metritis and clinical mastitis, respectively, were analyzed with linear mixed models with or without repeated measures. Rumination time and physical activity were lesser, and lying time was greater for the MET and MET+ groups than for the NCHD group for most days from −4 to +7 d of CD of metritis. Generally, daily rumination time, physical activity, and lying time differences were greater and more prolonged between the MET+ and NCHD than between the MET and NCHD groups. Similarly, cows in the MAST and MAST+ groups had lesser rumination time and physical activity than cows in the NCHD group for several days before diagnosis. Lying time was greater for the MAST+ than the NCHD group on d −1 and 0 relative to CD. Absolute values and relative changes from 3 d before CD to the day of the nadir for rumination time and physical activity, or peak for lying time, were different for cows in the MET and MET+ groups than for the NCHD group. Similar results were observed for the MAST and MAST+ groups compared with the NCHD group. For cows with metritis, either an increase in rumination time and physical activity or a decrease in lying time was observed from the day of CD to resolution of clinical signs, but no changes were observed for the NCHD. Cows with clinical mastitis and the NCHD group had different rumination times, physical activity, and lying times on the day of CD and resolution of clinical signs, but cows with clinical mastitis had no significant changes from the day of CD to resolution of clinical signs. We conclude that cows affected by metritis and clinical mastitis presented substantial alterations of the patterns of rumination time, physical activity, and lying time captured by an ear-attached sensor. Thus, automated health monitoring systems based on ear-attached sensors might be used as an aid for identifying cows with metritis and clinical mastitis. Moreover, behavioral parameter changes after CD might be good indicators of resolution of clinical signs of metritis but not mastitis. [ABSTRACT FROM AUTHOR]

Respiratory failure in the premature infants remains a difficult challenge. An alternative to the use of nasal continuous positive airway pressure (NCPAP) as a non-invasive modality to support respiratory distress in premature infants has been the recent introduction of high flow nasal cannula (HFNC) devices in many neonatal units. There has been increased use of HFNC presumably because of anecdotal reports and experience that it is easy to use, and well tolerated by the infants, while experiencing decreased nasal septumerosion. The paucity of evidenceregarding its efficacy and safety, would support a caution approach to the use of HFNC. Particularconcern hasfocused on the imprecise regulation and generation of pressure that may occur at higher flows especially in the smallest of infants. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "A comparison of albumin-bolus therapy versus normal saline-bolus therapy for hypotension in neonates," by S. K. Lynch and colleagues in the previous issue.

1. Curcumin has anti-carcinogen effects and is under clinical evaluation as a potential colon cancer chemopreventive agent. The first aim was to see whether curcumin inhibited phenol sulfotransferase (SULT1A1) and, if so, to study the variability of the IC 50 of curcumin for SULT1A1 in 50 human liver samples. For comparative purposes, the inhibition of catechol sulfotransferase (SULT1A3) in five human liver specimens was studied. The second aim was to measure the IC 50 of curcumin against SULT1A1 in five samples of human duodenum, colon, kidney and lung. 2. Curcumin was a potent inhibitor of SULT1A1 in human liver; the mean ± SD and median of IC 50 were 14.1 ± 7.3 nM and 12.8 nM, respectively. The IC 50 ranged from 6.2 to 30.6 nM between the 5th and 95th percentiles and the fold of variation was 4.9. The distribution of IC 50 was positively skewed (skewness 1.2) and deviated from normality ( p = 0.0004). 3. Curcumin inhibited human SULT1A3, and the inhibition was studied in five liver specimens with an IC 50 of 4324 ± 1026 nM. This inhibition was greater than the IC 50 of curcumin for SULT1A1 ( p < 0.0001). 4. In the extrahepatic tissues, the IC 50 of curcumin for SULT1A1 was 25.9 ± 4.8 nM (duodenum), 25.4 ± 6.8 nM (colon), 23.4 ± 2.2 nM (kidney) and 25.6 ± 5.6 nM (lung). Inhibition in these tissues is greater than that of curcumin for SULT1A1 in human liver ( p < 0.0001). 5. In conclusion, curcumin is a potent inhibitor of SULT1A1 in human liver, duodenum, colon, kidney and lung. The IC 50 of curcumin for SULT1A1 varied 4.9-fold in human liver. The comparison of the present data with those of the literature revealed that the IC 50 of curcumin in the liver and extrahepatic tissues is one order of magnitude lower that the peak serum concentration of curcumin after therapeutic doses of 4 g to humans. [ABSTRACT FROM AUTHOR]

1. Quercetin is one of the most abundant flavonoids in edible vegetables, fruit and wine. The aim was to study the type of inhibition of SULT1A1 by quercetin in the human adult and foetal livers. 2. The activity of SULT1A1 was measured with 4 µM 4-nitrophenol and 0.4 µM 3′-phosphoadenosine-5′-phosphosulphate-[[sup 35]S], and its mean (±SD) and median were 769 ± 311 and 740 pmol min[sup -1] mg[sup -1], respectively (adult liver, n = 10), and 185 ± 98 and 201 pmol min[sup -1] mg[sup -1], respectively (foetal liver, n = 8, p < 0.0001). 3. In non-inhibited samples, K[sub m] for SULT1A1 (mean ± SD) was 0.31 ± 0.14 µM (adult liver) and 0.49 ± 0.17 µM (foetal liver, n.s.). V[sub max] for SULT1A1 (mean ± SD) was 885 ± 135 pmol min[sup -1] mg[sup -1] (adult liver) and 267 ± 93 pmol min[sup -1] mg[sup -1] (foetal liver, p = 0.007). 4. The IC[sub 50] of quercetin for SULT1A1 was measured in three samples of adult and foetal livers and was 13 ± 2.1 and 12 ± 1.4 nM, respectively. 5. The type of inhibition was mixed non-competitive in adult and foetal livers and K[sub i] was 4.7 ± 2.5 nM (adult liver) and 4.8 ± 1.6 nM (foetal liver). 6. In the adult liver, the intrinsic clearance (mean ± SD) was 3.3 ± 1.5 ml min[sup -1] mg[sup -1] (non-inhibited samples), 0.9 ± 0.4 ml min[sup -1] mg[sup -1] (12.5 nM quercetin) and 0.5 ± 0.06 ml min[sup -1] mg[sup -1] (25 nM quercetin). In the foetal liver, the intrinsic clearance (mean ± SD) was 0.5 ± 0.2 ml min[sup -1] mg[sup -1] (non-inhibited samples), 0.12 ± 0.01 ml min[sup -1] mg[sup -1] (12.5 nM quercetin) and 0.2 ± 0.09ml min[sup -1] mg[sup -1] (25nM quercetin). 7. In conclusion, quercetin is a potent inhibitor of human adult and foetal liver SULT1A1. It reduces the sulphation rate and intrinsic clearance of 4-nitrophenol in both human adult and foetal livers. This suggests that quercetin may inhibit the sulfation rate of those drugs sulphated by SULT1A1. The inhibition of SULT1A1 is complex and not due solely to competition at the catalytic site of SULT1A1. [ABSTRACT FROM AUTHOR]

1. The aim was to see whether mefenamic acid and salicylic acid had different inhibition profiles for SULT1A1 (substrate: 4-nitrophenol) and SULT1A3 (dopamine) activities and on (-)-salbutamol and minoxidil sulphation rates in the human adult and mid-gestational foetal livers. 2. The activity (pmol min[sup -1] mg[sup -1]) of SULT1A1 was 662 ± 78 (adult) and 246 ± 159 (foetus; p = 0.0003) and that of SULT1A3 was 24 ± 4 (adult) and 121 ± 90 (foetus; p = 0.030). The rate (pmol min[sup -1] mg[sup -1]) of (-)-salbutamol sulphation was 109 ± 27 (adult) and 117 ± 34 (foetus; p = 0.144) and that of minoxidil sulphation was 202 ± 38 (adult) and 108 ± 44 (foetus; p = 0.001). 3. With mefenamic acid as an inhibitor, the IC[sub 50] (μm) for SULT1A1 was 0.02 ± 0.004 (adult) and 0.01 ± 0.002 (foetus; p = 0.001); for SULT1A3 it was 76 ± 6 (adult) and 77 ± 13 (foetus; p = 0.889); for the rate of (-)-salbutamol sulphation it was 0.07 ± 0.005 (adult) and not determinable (foetus) and for minoxidil sulphation it was 1.6 ± 0.7 (adult) and 0.15 ± 0.04 (foetus; p = 0.076). 4. With salicylic acid as an inhibitor, the IC[sub 50] (μm) for SULT1A1 was 30 ± 2 (adult) and 25 ± 1 (foetus; p = 0.011); for SULT1A3 it was 690 ± 36 (adult) and 570 ± 16 (foetus; p = 0.229); for the rate of (-)-salbutamol sulphation it was 93 ± 11 (adult) and 344 ± 42 (foetus; p = 0.010); with minoxidil as substrate, the IC[sub 50] was not determinable. 5. In summary, SULT1A1, SULT1A3 and the sulphotransferases towards (-)-salbutamol and minoxidil had measurable activities in the mid-gestational human foetal liver. Mefenamic acid was a more potent inhibitor than salicylic acid of both human adult and foetal liver SULT1A1 and SULT1A3 activities. Foetal liver SULT1A1 was more susceptible than adult liver SULT1A1 to inhibition by mefenamic acid and salicylic acid. These results are consistent with the view that sulphotransferases develop early in the human foetal liver and drugs may inhibit their activities. [ABSTRACT FROM AUTHOR]

1. Resveratrol, a polyphenolic compound present in grape and wine, has beneficial effects against cancer and protective effects on the cardiovascular system. It has been shown that the compound is sulphated in human liver and the aims of the present investigation were to study resveratrol glucuronidation in human liver microsomes and to determine whether flavonoids inhibit resveratrol glucuronidation. 2. A simple and reproducible radiometric assay for resveratrol glucuronidation was developed. The assay employed uridine-5'-diphosphoglucuronic acid-[[sup 14]C] and unlabelled resveratrol. Resveratrol-glucuronide was isolated by TLC. The intra- and interassays variabilities were 1 and 1.5%, respectively. 3. The rate of resveratrol glucuronidation was measured in 10 liver samples. The mean SD and median of resveratrol glucuronidation rate were 0.69±0.34 and 0.80 nmol/min/mg, respectively. Resveratrol glucuronosyl transferase followed Michaelis-Menten kinetics and the K[sub m] and V[sub max] (mean±SD; n=5) were 0.15±0.09 mM and 1.3±0.3 nmol/min/mg, respectively. The intrinsic clearance was 11±4x10[sup -3] ml/min.mg. 4. The flavonoid quercetin inhibited resveratrol glucuronidation and its IC50 (mean SD; n = 3) was 10±1 μM. Myricetin, catechin, kaempferol, fisetin and apigenin (all at 20 μM) inhibited resveratrol glucuronidation and the percent of control ranged between 46% (catechin) to 72% (apigenin). 5. The present results show that resveratrol is glucuronated in the human liver. Glucuronidation may reduce the bioavailability of this compound however, flavonoids inhibitresveratrol glucuronidationand suchan inhibition might improvethe bioavailability of resveratrol. [ABSTRACT FROM AUTHOR]

In the general population, the likelihood of an individual receiving a transfusion has been calculated to be about 0.89% per year, increasing dramatically with age. Massive intraoperative hemorrhage from trauma, cardiopulmonary bypass, and orthotopic liver transplantation need substantial replacement therapy. In renal transplantation, blood transfusion is a debated induction tool for specific allograft tolerance, since it causes a nonspecific down-regulation of immune function. In transplantations, in humoral immune deficiencies, in hematological disorders, and in HIV infection, the intravenous immunoglobulin prophylaxis may alter the monocyte/macrophage system host immunity and immune surveillance against infection, tissue or cell damage, and malignancy. Some persons, like Jehovah''s Witnesses, object to transfusion of blood products, posing ethical and practical issues concerning treatment of blood disorders, transplantation, and trauma. In this review we examined the actual risk of contracting an infectious disease from an allogeneic blood transfusion to contribute to an uneasy decision-making process. We have found that the procedure is presently considerably safe. [Copyright &y& Elsevier]

Objective: To report mode of delivery and immediate neonatal outcome in women infected with COVID-19.Design: Retrospective study.Setting: Twelve hospitals in northern Italy.Participants: Pregnant women with COVID-19-confirmed infection who delivered.Exposure: COVID 19 infection in pregnancy.Methods: SARS-CoV-2-infected women who were admitted and delivered from 1 to 20 March 2020 were eligible. Data were collected from the clinical records using a standardised questionnaire on maternal general characteristics, any medical or obstetric co-morbidity, course of pregnancy, clinical signs and symptoms, treatment of COVID 19 infection, mode of delivery, neonatal data and breastfeeding.Main Outcome and Measures: Data on mode of delivery and neonatal outcome.Results: In all, 42 women with COVID-19 delivered at the participating centres; 24 (57.1%, 95% CI 41.0-72.3) delivered vaginally. An elective caesarean section was performed in 18/42 (42.9%, 95% CI 27.7-59.0) cases: in eight cases the indication was unrelated to COVID-19 infection. Pneumonia was diagnosed in 19/42 (45.2%, 95% CI 29.8-61.3) cases: of these, 7/19 (36.8%, 95% CI 16.3-61.6) required oxygen support and 4/19 (21.1%, 95% CI 6.1-45.6) were admitted to a critical care unit. Two women with COVID-19 breastfed without a mask because infection was diagnosed in the postpartum period: their newborns tested positive for SARS-Cov-2 infection. In one case, a newborn had a positive test after a vaginal operative delivery.Conclusions: Although postpartum infection cannot be excluded with 100% certainty, these findings suggest that vaginal delivery is associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn.Tweetable Abstract: This study suggests that vaginal delivery may be associated with a low risk of intrapartum SARS-Cov-2 transmission to the newborn. [ABSTRACT FROM AUTHOR]

In the context of SARS-CoV-2 pandemic, the hospital management of mother-infant pairs poses to obstetricians and neonatologists previously unmet challenges. In Lombardy, Northern Italy, 59 maternity wards networked to organise the medical assistance of mothers and neonates with suspected or confirmed SARS-CoV-2 infection. Six "COVID-19 maternity centres" were identified, the architecture and activity of obstetric and neonatal wards of each centre was reorganised, and common assistance protocols for the management of suspected and proven cases were formulated. Here, we present the key features of this reorganization effort, and our current management of the mother-infant dyad before and after birth, including our approach to rooming-in practice, breastfeeding and neonatal follow-up, based on the currently available scientific evidence. Considered the rapid diffusion of COVID-19 all over the world, we believe that preparedness is fundamental to assist mother-infant dyads, minimising the risk of propagation of the infection through maternity and neonatal wards. [ABSTRACT FROM AUTHOR]

Objective: To determine variations in cord blood gas (CBG) parameters after 3-minute delayed cord clamping (DCC) in vaginal deliveries (VDs) and caesarean deliveries (CDs) at term without fetal distress.Design: Prospective observational study.Setting: University hospital.Sample: CBG from 97 VDs and 124 CDs without fetal distress.Methods: Comparison of paired arterial-venous CBG parameters drawn at birth from the unclamped cord and after 3-minutes DCC for VDs and CDs.Main Outcome Measures: Base excess, bicarbonate, haematocrit and haemoglobin from both arterial and venous cord blood, lactate, neonatal outcomes, partial pressure of oxygen (pO2 ), partial pressure of carbon dioxide (pCO2 ), pH, and postpartum haemorrhage.Results: Arterial cord blood pH, bicarbonate ( HCO3- , mmol/l), and base excess (BE, mmol/l) decreased significantly after 3-minute DCC both in VDs (pH = 7.23 versus 7.27; P < 0.001; HCO3-  = 23.3 versus 24.3; P = 0.004; BE = -5.1 versus -2.9; P < 0.001) and CDs (pH = 7.28 versus 7.34; P < 0.001; HCO3-  = 26.2 versus 27.2; P < 0.001; BE = -1.5 versus 0.7; P < 0.001). After 3-minute DCC, pCO2 increased in CDs only (57 versus 51; P < 0.001), whereas lactate increased more in CDs compared with VDs (lactate, +1.1 [0.9, 1.45] versus +0.5 [-0.65, 2.35]; P = 0.01). Postpartum maternal haemorrhage, neonatal maximum bilirubin concentration, and need for phototherapy were similar between the two groups. Newborns born by CD more frequently required postnatal clinical monitoring or admission to a neonatal intensive care unit.Conclusions: After 3-minute DCC, the acid-base status shifted towards mixed acidosis in CDs and prevalent metabolic acidosis in VDs. CDs were associated with a more pronounced increase in arterial lactate, compared with VDs.Tweetable Abstract: By 3-minute DCC, acid-base status shifts towards mixed and metabolic acidosis in caesarean and vaginal delivery, respectively. [ABSTRACT FROM AUTHOR]

Abstract: Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end‐stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5‐mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3‐mm uterine entry was used. In the second case, a new approach was adopted using an ‘all‐seeing needle’ 1.6‐mm endoscope. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background The heel stick is the method of choice in most neonatal units for capillary blood sampling, and it represents the most common event among all painful procedures performed on newborns. The type and design of heel stick device and the clinical procedure to collect a blood sample may have an impact on newborn pain response as well. Objective To compare the pain response and efficiency of different automated devices for capillary blood collection in newborns. Design Randomized clinical trial. Setting Postnatal ward of a tertiary-care university hospital in Italy. Participants Newborn infants at gestational age ≥34 weeks undergoing the metabolic screening test after the 49th hour of life. Methods A total of 762 neonates were recruited and randomized into 6 groups (127 babies in each group) assigned to 6 different capillary blood collection devices (Ames Minilet™ Lancet; Cardinal Health Gentleheel ® ; Natus Medical NeatNick™; BD Quikheel™ Lancet; Vitrex Steriheel ® Baby Lancet; Accriva Diagnostics Tenderfoot ® ). Main outcome measures The following data were collected and assessed for each of the 6 groups evaluated: a) number of heel sticks, b) pain score according to the Neonatal Infant Pain Scale (NIPS) and c) need to squeeze the heel. Results The Ames Minilet™ Lancet device was found to perform by far the worst compared to the five device underexamination: it required the highest number of sticks (mean = 3.91; 95% CI: 3.46–4.36), evoked the most intense pain (mean = 3.98; 95% CI: 3.77–4.20), and most frequently necessitated squeezing the heel (92.9%; 95% CI: 86.9–96.3). The five devices under examination appeared to be similar in terms of the number of sticks required, but differed slightly in NIPS score and in need to squeeze the heel. Conclusion The Accriva Diagnostics Tenderfoot ® device demonstrated the greatest efficiency for blood sampling and evoked the least pain. With this device, the metabolic screening test could be performed with a single skin incision in the large majority of infants (98.4%), heel squeezing was limited to only 6.3% of infants, and the NIPS score turns out to be lower than other devices in our study (1.22; 95% CI 1.05–1.39). [ABSTRACT FROM AUTHOR]

Prenatal ultrasound detection of fetal ureterocele with bilateral hydroureteronephrosis, obstruction of the bladder outlet and progressive amniotic fluid reduction have been associated with a significant risk of end-stage chronic renal disease after birth. Fetal cystoscopic laser incision of the ureterocele, using standard 3.5-mm fetoscopic access to the amniotic cavity and the fetal bladder with the aim of relieving the bladder outflow obstruction to preserve renal function, has been reported previously in a case with a favorable outcome. We report on two additional cases of fetal ureterocele treated by cystoscopic laser decompression. In the first case, a standard 3.3-mm uterine entry was used. In the second case, a new approach was adopted using an 'all-seeing needle' 1.6-mm endoscope. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background. Chronic neonatal pain can lead to long-term adverse effects on the immature brain. EDIN scale for prolonged pain might not be fully suitable for premature infants. We aimed to test a modified EDIN scale, adding postmenstrual age (PMA) as a sixth item (EDIN6). Methods. In a two-phase prospective study, pain was assessed in all neonates admitted in our NICU. In T1 EDIN was applied; in T2 EDIN6 with additional scores of 2, 1, and 0, respectively, for 25–32, 33–37, and >37 weeks PCA was tested. Scores > 6 suggested pain. The nursing staff was given a questionnaire to evaluate EDIN and EDIN6. Results. A total of 15960 pain assessments were recorded (8693 in T1; 7267 in T2). With EDIN6, cumulative detection of pain almost tripled (117/7267 versus 52/8693, p=0.001). Main differences were found among less mature categories (50/1472 versus 17/1734, p=0.001 in PCA 25–32; 26/2606 versus 10/4335, p=0.001 in PMA 33–37; 41/3189 versus 25/2624, p=0.26 in PMA > 37). Adequacy of pain assessment in lower PMA was judged “medium-high” in 13,4% of nurses in T1 and 71,4% in T2. Conclusions. EDIN6 may allow improved evaluation of pain in preterm infants. [ABSTRACT FROM AUTHOR]

Abstract: In 1999, the Italian Parliament passed a law aimed at setting the standards of practice and quality in organ, tissue and cell donation, and transplantation. For the first time in the history of Italian transplantation, a coordinator-based model reproducing some of the basic principles of the Spanish system was officially enacted by the Parliament, bringing to an end years of lacking regulation. What differentiates those coordinator-based systems adopted in Southern Europe from Northern European national and multinational transplant organizations is the functional integration of donor and transplant care activities enacted by national governments. The Italian model of transplant health care consists of four levels of transplant coordination: local, regional, interregional, and national. The latter is represented by Centro Nazionale Trapianti (CNT; the Italian National Center for Transplantation). CNT objectives consist of ensuring equitable access to donation and transplant care for all citizens according to the principles of the Italian National Health System. In achieving these goals, CNT acts in cooperation with three interregional transplant agencies: the Nord Italia Transplant program, the Associazione InterRegionale Trapianti, and the Organizzazione Centro Sud Trapianti. Whereas local and interregional coordinators are at the front line of all donation and transplant activities, regional and national coordinators function to monitor, direct, and plan donation and transplant health care activities. Based on the increase in donation and transplant activities recently achieved in those countries that have adopted a governmental coordinator-based transplant care model, we believe that such a system is appropriate to serve patients’ interests according to the principles of subsidiary and equity. However, it should further be improved by expansion of the governance model throughout Europe, through implementation of current standards of care, and by adopting the definition of common European objectives, health care strategies, and research integration. [Copyright &y& Elsevier]

Aim Prematurity is associated with features of metabolic syndrome in young adulthood. We investigated the body composition and blood pressure of children born preterm. Methods A longitudinal, observational study was conducted with preterm infants who had a birth weight of <1500 g and a gestational age of <32 weeks. Growth and body composition were assessed by air displacement plethysmography at term equivalent age and at school age and were compared to those of 61 healthy, term breastfed subjects. Results A total of 63 preterm infants were enrolled. At term equivalent age, growth and fat-free mass were lower in preterm infants than in term newborns, but fat mass was higher. At 5 years of age, children born preterm were still lighter and shorter than children born at term. When the results were analysed by gender, the fat-free mass index was lower in boys born preterm than in their peers (12.1 ± 1.1 versus 13.0 ± 1.0 kg/h2 p < 0.005), whereas no difference was detected among girls. Diastolic blood pressure was higher in children born preterm than in children born at term (61.14 ± 7.8 vs 56.69 ± 8.2 mmHg, p = 0.009). Conclusion Boys born preterm showed a relative lack of fat-free mass at school age compared to their peers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Preterm birth is associated with variable degrees of brain injury, adverse neurodevelopmental outcomes and continuing special health care needs. Study and aims: This observational, retrospective and cross-sectional study aims to describe the functional features of VLBW infants using the ICF-CY classification and to identify the association between gender, twinship, birth weight, gestational age, adjusted age and functioning as defined by the ICF biopsychosocial model. Sample: 56 VLBW infants (corrected age of 12–24months) were consecutively enrolled. Instruments: Three assessment tools were used: a neuro-functional assessment (NFA); the Griffiths Mental Development Scales-Revised: Birth to 2years (Griffiths 0–2) to evaluate psychomotor development and the ICF-CY questionnaire for ages 0–3. Results: A two-step cluster component analysis with the Bayesian information criterion was conducted based on NFA and Griffiths 0–2 scores and four groups of infant's functioning (very low, low, intermediate, high) emerged. Study findings demonstrate that the traditional assessment tools tend to poorly evaluate the interaction between the person's functioning and environment factors (EF), even thought EF results to be relevant for VLBW infants. The higher number of symptoms, more difficulties in activities and participations and the higher number of environmental facilitators maximize the difference between infants with very low and those with intermediate or higher functioning. The distribution of gender or the presence of siblings is not significantly associated to any group. Conclusion: This study shows that a more complete evaluation of functioning of VLBW children, based on the biopsychosocial approach, is needed and can be successfully implemented in the follow-up routine through ICF-CY questionnaire. [Copyright &y& Elsevier]

Background Laparoscopic pancreaticoduodenectomy is feasible, but requires adaptations to established surgical techniques. The improved dexterity offered by robotic assistance provides the opportunity to see whether laparoscopic pancreaticoduodenectomy can be performed safely when faithfully reproducing the open operation. Methods Patients were selected for robotic pancreaticoduodenectomy when generally suitable for laparoscopy. Obese patients were excluded, and those with pancreatic cancer were highly selected. A prospectively designed database was used for data collection and analysis. Results Of 238 patients undergoing pancreaticoduodenectomy, 34 (14·3 per cent) were operated on robotically. No procedure was converted to conventional laparoscopy or open surgery, despite three patients requiring segmental resection of the superior mesenteric/portal vein and reconstruction. The mean duration of operation was 597 (range 420-960) min. The mean number of lymph nodes retrieved and analysed from patients with neoplasia was 32 (range 15-76). Four patients required blood transfusions and five developed postoperative complications exceeding Clavien-Dindo grade II. There were four grade B pancreatic fistulas. One patient died on postoperative day 40. Excess mean operative cost compared with open resection was €6193. Conclusion Selected patients can safely undergo robotic pancreaticoduodenectomy. The main downsides are high costs and prolonged operating times compared with open resection. [ABSTRACT FROM AUTHOR]

Objective: While propranolol pharmacokinetics has been extensively studied in adults, this study reports the first evaluation of propranolol pharmacokinetics in term and preterm neonates. Methods: Propranolol concentrations were measured in four term and 32 preterm newborns treated with oral propranolol at the dose of 0.5 or 0.25 mg/kg every 6 h by serial dried blood spots. Results: The levels of propranolol, although with high inter-individual variability, were proportional with the administered dose. Pharmacokinetic parameters evaluated at the steady state in newborns treated with 0.5 mg/kg/6 h showed values of maximal (71.7 ± 29.8 ng/mL), minimal (42.2 ± 20.8 ng/mL) and average concentration (60.8 ± 25.0 ng/mL), time of maximal concentration (2.6 ± 0.9 h) and area under the time-concentration curve (364.7 ± 150.2 ng/mL/h) similar to those observed in adults. In both dosing groups, elimination half-life was significantly longer (14.9 ± 4.3 and 15.9 ± 6.1 h), and apparent total body clearance (27.2 ± 13.9 and 31.3 ± 13.3 mL/kg/min) lower than those reported in adults, suggesting a slower metabolism in newborns. No differences were observed between newborns with different gestational age or different sex. Conclusions: Neonates treated with propranolol-exhibited drug concentrations proportional with the dose, with significant long half-life. [ABSTRACT FROM AUTHOR]

Background This multicenter study evaluated three candidate microRNAs (miRNAs) (miR-21, miR-155 and miR-101) as potential biomarkers in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Patients and methods miRNA expression was quantified by quantitative RT-PCR in 86 laser-microdissected specimens, including 65 invasive IPMNs, 16 non-invasive IPMNs and 5 normal pancreatic ductal tissues. Univariate and multivariate analyses compared miRNAs and clinical parameters with overall (OS) and disease-free survival (DFS). Results miR-21 and miR-155 were up-regulated in invasive IPMNs compared with non-invasive IPMNs, as well as in non-invasive IPMNs compared with normal tissues. Conversely, miR-101 levels were significantly higher in non-invasive IPMNs and normal tissues compared with invasive IPMNs. High levels of miR-21 were associated with worse OS [hazard ratio (HR) = 2.47, 95% confidence interval (CI) = 1.37–5.65, P = 0.0047]. Patients with high-miR-21 expression also had a shorter median DFS (10.9 versus 29.9 months, P = 0.01). Multivariate analysis confirmed miR-21 as independently prognostic for mortality and disease progression (death risk: HR = 3.3, 95% CI = 1.5–7.0, P = 0.02; progression risk: HR = 2.3, 95% CI = 1.2–4.8, P = 0.02), as well as positive lymph-node status (death risk: HR = 2.6, 95% CI = 1.1–6.3, P = 0.03; progression risk: HR = 2.2, 95% CI = 1.0–4.8, P = 0.04). Conclusions miR-21, miR-155 and miR-101 showed significant differences in invasive versus non-invasive IPMNs. miR-21 emerged as an independent prognostic biomarker in invasive IPMNs and should be validated in prospective studies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the feasibility of forced oscillation technique (FOT) measurements at the bedside and to describe the relationship between positive end-expiration pressure (PEEP) and lung mechanics in different groups of ventilated infants. Methods: Twenty-eight infants were studied: 5 controls, 16 newborns with respiratory distress syndrome (RDS) and 7 chronically ventilated newborns that developed bronchopulmonary dysplasia. An incremental/decremental PEEP trial was performed by changing PEEP in 1-min steps of 1 cmHO between 2 and 10 cmHO. Forced oscillations at 5 Hz were superimposed on the ventilator waveform. Pressure and flow, measured at the inlet of the ETT, were used to compute resistance (Rrs) and reactance (Xrs). Results: In controls Rrs and Xrs were on average 41 ± 21 and −22 ± 6 cmHO s/l respectively and were almost unaffected by PEEP. RDS infants presented similar Rrs (48 ± 25 cmHO s/l) and reduced Xrs (−71 ± 19 cmHO s/l) at the beginning of the trial. Two behaviours were observed as PEEP was increased: in extremely low birth weight infants Xrs decreased with PEEP with marked hysteresis; in very low and low birth weight infants Xrs and Rrs were less PEEP dependent. Chronically ventilated infants had very high Rrs and very negative Xrs values at very low PEEPs (121 ± 41 and −95 ± 13 cmHO s/l at PEEP = 2 cmHO) that markedly changed as PEEP exceeded 3-4 cmHO. Conclusions: Rrs and Xrs measurement in preterm newborns is feasible, and data are representative of the lung mechanics and very sensitive to its changes with PEEP, making FOT a promising technique for the non-invasive bedside titration of mechanical ventilation in preterm newborns. [ABSTRACT FROM AUTHOR]

Preterm infants are at increased risk of low bone mass. Quantitative ultrasound (QUS) is a non-invasive method for assessment of bone status. The application of QUS in a cohort of ex-preterm infants was investigated. This study suggests that QUS cannot be used as a surrogate for dual-energy x ray absorptiometry. [ABSTRACT FROM AUTHOR]

Delayed meconium passage, typical of premature newborns, is a predisposing condition for bowel perforation with a significant risk of morbidity and mortality.A retrospective study was undertaken to verify the entity of the disease, assess the average time to meconium passage in a neonatal population of very low birth weight (VLBW) infants, and identify associated risk factors.The time of first stool passage was studied in 110 VLBW infants (weighing less than 1 500 g at birth). Their perinatal features, clinical course, and treatment were reviewed and studied retrospectively.Delayed meconium passage was recorded in 81% of this group. Patent ductus arteriosus, mechanical ventilation and uteroplacental insufficiency were significantly associated with delayed passage. An inverse relationship between gestational age, birth weight and meconium passage was found. Bowel perforation occurred in 4.5% of this neonatal population with a mortality of 50%.In very low birth weight infants delay in the passage of the first stool is common. Perforation in these patients may represent a fatal event, and procedures such as daily rectal enemas, which can prevent this complication, must be applied. [ABSTRACT FROM AUTHOR]

Background/purpose: Anorectal malformations (ARM) are a spectrum of defects ranging from the very minor ones, with an excellent functional prognosis, to those that are more complex, often associated with other anomalies, difficult to manage and with a poor functional outcome. A significant number of these children suffer from fecal and urinary incontinence despite major advances in the management of ARM patients have significantly improved the quality of life. The role of sacrovertebral anomalies/dysraphism (SD) and neurospinal cord anomalies/dysraphism (ND) associated with ARM on the continence of these patients is still controversial. The authors made a review of their experience in a period of 5 years, focusing on the role of neurospinal cord anomalies in patients with ARM.Materials: At colorectal clinic of our department of pediatric surgery 215 patients who underwent a procedure of posterior sagittal anorectoplasty for ARM are followed-up in a multidisciplinary clinic. Among them 60 patients with either SD or ND were documented. In 37 patients the anomaly involved the spinal cord (ND). 12 of these 37 patients underwent neurosurgical treatment and 25 were managed conservatively. Data collected from their follow-up were analyzed and compared, focusing on their bowel and urinary continence.Results: All 37 patients acquired regular bowel movements with an appropriate bowel management according to Peña's protocols. Urinary incontinence required clean intermittent catheterization in four cases. None of the patients who did not receive neurosurgical treatment developed acute complications due to the progression of the neurospinal anomaly, like acute urinary retention, orthopedic and motility problems or acute hydrocephalus. From literature review we were unable to find good evidence that the presence of ND worsens the functional prognosis of patients with ARM. We were also unable to find convincing evidence to support the practice of prophylactic neurosurgical procedures.Conclusions: The present study supports the theory that for ARM patients the prognosis in terms of continence depends mainly on the type of malformation and is not complicated by the association with ND. In our series neurosurgical treatments did not have any effect in improving the continence of ARM patients and a conservative management of ND did not expose the patients to the sequelae of progressive deterioration, reported elsewhere, requiring rescue neurosurgery. We believe that the correct practice of pediatric surgeons following-up ARM patients is a protocol which includes appropriate investigations to detect the presence of a SD or ND and, once these entities are detected, it is mandatory to manage the patient with a multidisciplinary team, where a conservative non-operative management is initially justified and advocated in the absence of neurosensorymotor symptoms. [ABSTRACT FROM AUTHOR]

Objective: Infants classified as small for gestational age are considered to have developed under adverse intrauterine conditions that lead to lack of fat mass accretion. The aim of this study was to test the null hypothesis that the fat mass in preterm small for gestational age infants assessed at term equivalent age was not different from that of full-term small for gestational age newborns. Design: Observational study. Setting: Northern Italy. Patients: 67 small for gestational age preterm infants and 132 small for gestational age full-term newborns. Main outcome measures: Growth and body composi- tion, assessed by means of a paediatric air displacement plethysmography system, were measured at term equivalent age in the preterm infants and on the third day of life in the full-term newborns. Results: The mean (SD) gestational age of preterm infants was 30.6 (2.3) weeks and their mean (SD) birth weight was 1140 (237) g. At assessment weight was not different between the preterm and full-term infants, whereas the percentage of total body fat mass was higher in the preterm infants (14.3% (SD 4.7%) vs 5.8% (SD 3.5%), p<0.005). Conclusions: Preterm infants, born small for gestational age, appear to be at risk for increased adiposity, which is a risk factor for the development of the metabolic syndrome. [ABSTRACT FROM AUTHOR]

Muscolo-skeletal disorders and hip deformity play a key role on future development of motor and adaptive functions in children with cerebral palsy (CP). Lateral migration of the femoral head increases on average 7.7% per year and may progress in association with acetabular dysplasia to hip dislocation. Conservative preservation of muscle length and balance may prevent or reduce femoral head migration and acetabular dysplasia. Equipment for position lying, sitting, and standing is an established method of maintaining muscle length and joint range. French approach (Le Métayer et al) include the use of customised plaster cast orthoses, for sitting and standing positions, called siège moulé and gouttière, tailor-made according to the child's muscolo-skeletal characteristics and motor abilities. At our department, hips with clinical and radiological evidence of displacement unresponsive to pharmacological and surgical treatment were treated with postural management. The two cases we show in this paper underwent a physiotherapy programme (neurodevelopment treatment ) twice a week and a seated postural programme 5 hours a day with the siège moulé. Hip radiographs were measured with the migration percentage (MP) described by Reimers. The follow-up measurements showed a progressive reduction of MP values of the hip treated, confirming the significant benefit from the combined non surgical approach. The study supports the evidence that conservative management of hip deformity with siège moulé can be successful if implemented before the development of hip dysplasia. (Hip International 2009; 19 (suppl 6): S56-62) [ABSTRACT FROM AUTHOR]