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Di solito, il compito attribuito all’incipit di un’introduzione è quello di fornire al lettore una definizione sintetica ed efficace del principale oggetto di analisi di un testo. Nel caso della smart city l’impresa appare, secondo gli autori, quasi sisifea. L’espressione smart city non rimanda a un concetto universalmente condiviso ma, a partire dagli anni Novanta, è stata generica- mente utilizzata per riferirsi a uno spazio urbano all’interno del quale, grazie alla rivoluzione delle ICT (Information and Communication Technologies), i cittadini possono usufruire di maggiori servizi erogati in tempi rapidi. Se nel villaggio globale teorizzato da McLuhan (1967) la comunicazione era soprattutto unidirezionale dal centro alla periferia, come nel caso della televisione, dei giornali e delle radio, nell’epoca della smart city l’informatica diffusa sembra essere in grado di sviluppare una struttura connettiva multidirezionale che garantisce scambi costanti di dati e una sovrapposizione tra spazi fisici e virtuali (Ratti 2017). Il modello ideale di smart city prevede infatti la diffusione nel tessuto urbano di sensori (quali rilevatori divelocità, videocamere, misuratori dell’aria o del traffico) che sono in grado di registrare informazioni, trasmetterle e, soprattutto, analizzarle attraverso algoritmi. L’interazione di questi sensori con i dati forniti dai cittadini, magari attraverso i loro dispositivi smart di uso quotidiano, garantirebbe una fruizione degli spazi pubblici capace di adattarsi in tempo reale alle esigenze degli utenti. In questo senso, la smartness2 delle città migliorerebbe la vita degli abitanti in diversi ambiti (Mosannenzadeh, Vettorato 2014; Papa, Gargiulo, Battara 2016)): dalla mobilità e trasporto pubblico alla gestione e distribuzione dell’energia, dalla sicurezza alla gestione ambientale e alla comunicazione.

Giustino Varrassi,1 Franco De Conno,2 Luciano Orsi,3 Filomena Puntillo,4 Giovanni Sotgiu,5 John Zeppetella,6 Furio Zucco7 1Paolo Procacci Foundation, Rome, Italy; 2Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy; 3SC Cure Palliative ASST Carlo Poma, Mantova, Italy; 4Anesthesia and Intensive Care Unit, Department of Emergency and Organ Transplants, University Hospital of Bari, Bari, Italy; 5Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy; 6St Claire’s Hospice, Hastingwood, UK; 7Azienda Ospedaliera Salvini, Garbagnate Milanese, ItalyCorrespondence: Giustino VarrassiPaolo Procacci Foundation, Via Tacito 7, Rome 00193, ItalyEmail giuvarr@gmail.comBackground: In patients with cancer, the prevalence of pain is high, and pain management is often challenging despite the wide availability of drugs and guidelines.Methods: This Delphi survey was organized within the Rational Use of Analgesics (RUA) Group projects to reach a consensus among Italian palliative care specialists on pain assessment and management. Items were identified from recent publications on cancer pain and guidelines.Results: This survey included input from 190 palliative care specialists representing all Italian territory. A consensus was reached on 17 statements. Items concerning pain assessment achieved over 70% agreement amongst the participants. Items on principles of pain management and management according to type of pain, including breakthrough cancer-related pain and neuropathic pain also achieved high levels of agreement.Conclusion: Results from the RUA project showed that Italian palliative care specialists had a particular interest in items related to pain challenges, in addition to the evaluation and control of pain associated with cancer. However, some discrepancies between current guidelines and clinical practice were observed.Keywords: cancer, pain, breakthrough cancer pain, neuropathic pain, Delphi survey

Questo articolo riflette sul contributo che lo sguardo antropologico può apportare al dibattito interdisciplinare attorno alla smart city e sui quadri interpretativi attraverso i quali approcciarsi etnograficamente all’integrazione delle tecnologie dell’informazione e della comunicazione nel tessuto cittadino. Il testo ricostruisce il dibattito attorno alla nuova policy urbana, mettendo in luce la contrapposizione tra coloro che vedono nella smart city una risposta ai bisogni di inclusione sociale, sostenibilità ambientale e sviluppo economico, e quegli studi critici che ne mettono in luce le potenziali forme di controllo ed esclusione. Il saggio sottolinea come entrambe le posizioni si fondino su uno sguardo in gran parte interno al momento della progettazione e suggerisce di non restare abbagliati dall’autorappresentazione del nuovo paradigma urbano come forza omogeneizzante e globalizzante. Attraverso l’analisi di alcuni lavori etnografici, il testo sottolinea l’importanza di sviluppare un approccio teorico e metodologico “non-smart-centrico” che possa (ri)comprendere le dinamiche di smartizzazione all’interno di più lunghi e sedimentati processi di costruzione della località, facendo emergere gli immaginari prodotti dalle politiche smart, gli usi informali e imprevisti delle tecnologie e il modo in cui questi contribuiscono a ridefinire il senso dei luoghi. This article reflects on the contribution that cultural anthropology brings to the interdisciplinary debate on the smart city, and the analytical frameworks through which we can investigate through ethnography the dissemination of information and communication technologies within urban spaces. The essay retraces the debate on new urban policies, and highlights the dichotomy between those for whom the smart city is an instrument of social inclusion, environmental sustainability and economic development, and those who see its potential forms of control and exclusion. We argue that both tendencies share an analytical approach mainly focused on the moment of planning, which is unable to escape from the self-representation of the new urban paradigm as a globalizing and homogenizing force. Drawing from ethnographic cases, the article argues for a “non smart-centered” approach to investigate urban smartization in the context of long-term processes of place-making. This would shed light on the imaginaries produced by smart policies, ICT’s informal and unpredictable uses and the ways these (re-)shape senses of locality

Background: Dietary habits during pregnancy have been inconsistently linked to childhood acute myeloid leukemia (AML), given the putative intrauterine onset of the disease as a result of triggering events during the critical period of fetal hematopoiesis. We investigated the potential association of maternal coffee and tea consumption during pregnancy with childhood AML risk, pooling primary data from eight case-control studies participating in the Childhood Leukemia International Consortium. Methods: Information on coffee and/or tea consumption was available for 444 cases and 1255 age- and sex-matched controls, on coffee consumption for 318 cases and 971 controls and on tea consumption for 388 cases and 932 controls. Categories for cups of daily coffee/tea consumption were created in order to explore potential dose-response associations. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. Results: Associations were found neither in the analysis on coffee or tea nor in the analysis on coffee only consumption (any versus no). A positive association with increasing coffee intake was observed (>1 cup per day; OR: 1.40, 95% CI: 1.03–1.92, increment of one cup per day; OR: 1.18, 95% CI: 1.01–1.39). No associations were observed with tea consumption. Interaction analyses showed non-significant associations between coffee/tea and smoking. Hyperdiploidy was inversely associated with tea consumption, with other cytogenetic markers having no association with coffee/tea. Conclusion: Given the widespread consumption of caffeinated beverages among pregnant women, our finding is of important public health relevance, suggesting adverse effects of maternal coffee consumption during pregnancy in the offspring. © 2019

IMPORTANCE Molecular diagnosis is difficult to achieve in disease groups with a highly heterogeneous genetic background, such as cerebellar ataxia (CA). In many patients, candidate gene sequencing or focused resequencing arrays do not allow investigators to reach a genetic conclusion. OBJECTIVES To assess the efficacy of exome-targeted capture sequencing to detect mutations in genes broadly linked to CA in a large cohort of undiagnosed patients and to investigate their prevalence. DESIGN, SETTING, AND PARTICIPANTS Three hundred nineteen index patients with CA and without a history of dominant transmission were included in the this cohort study by the Spastic Paraplegia and Ataxia Network. Centralized storage was in the DNA and cell bank of the Brain and Spine Institute, Salpetriere Hospital, Paris, France. Patients were classified into 6 clinical groups, with the largest being those with spastic ataxia (ie, CA with pyramidal signs [n = 100]). Sequencing was performed from January 1, 2014, through December 31, 2016. Detected variants were classified as very probably or definitely causative, possibly causative, or of unknown significance based on genetic evidence and genotype-phenotype considerations. MAIN OUTCOMES AND MEASURES Identification of variants in genes broadly linked to CA, classified in pathogenicity groups. RESULTS The 319 included patients had equal sex distribution (160 female [50.2%] and 159 male patients [49.8%]; mean [SD] age at onset, 27.9 [18.6] years). The age at onset was younger than 25 years for 131 of 298 patients (44.0%) with complete clinical information. Consanguinity was present in 101 of 298 (33.9%). Very probable or definite diagnoses were achieved for 72 patients (22.6%), with an additional 19 (6.0%) harboring possibly pathogenic variants. The most frequently mutated genes were SPG7 (n = 14), SACS (n = 8), SETX (n = 7), SYNE1 (n = 6), and CACNA1A (n = 6). The highest diagnostic rate was obtained for patients with an autosomal recessive CA with oculomotor apraxia-like phenotype (6 of 17 [35.3%]) or spastic ataxia (35 of 100 [35.0%]) and patients with onset before 25 years of age (41 of 131 [31.3%]). Peculiar phenotypes were reported for patients carrying KCND3 or ERCC5 variants. CONCLUSIONS AND RELEVANCE Exome capture followed by targeted analysis allows the molecular diagnosis in patients with highly heterogeneous mendelian disorders, such as CA, without prior assumption of the inheritance mode or causative gene. Being commonly available without specific design need, this procedure allows testing of a broader range of genes, consequently describing less classic phenotype-genotype correlations, and post hoc reanalysis of data as new genes are implicated in the disease. © 2018 American Medical Association. All rights reserved.

BACKGROUND AND PURPOSE: Duchenne muscular dystrophy (DMD), caused by dystrophin deficiency, results in chronic inflammation and irreversible skeletal muscle degeneration. Moreover, the associated impairment of autophagy greatly contributes to the aggravation of muscle damage. We explored the possibility of using non-euphoric compounds present in Cannabis sativa, cannabidiol (CBD), cannabidivarin (CBDV) and tetrahydrocannabidivarin (THCV), to reduce inflammation, restore functional autophagy and positively enhance muscle function in vivo. EXPERIMENTAL APPROACH: Using quantitative PCR, western blots and [Ca2+ ]i measurements, we explored the effects of CBD and CBDV on the differentiation of both murine and human skeletal muscle cells as well as their potential interaction with TRP channels. Male dystrophic mdx mice were injected i.p. with CBD or CBDV at different stages of the disease. After treatment, locomotor tests and biochemical analyses were used to evaluate their effects on inflammation and autophagy. KEY RESULTS: CBD and CBDV promoted the differentiation of murine C2C12 myoblast cells into myotubes by increasing [Ca2+ ]i mostly via TRPV1 activation, an effect that undergoes rapid desensitization. In primary satellite cells and myoblasts isolated from healthy and/or DMD donors, not only CBD and CBDV but also THCV promoted myotube formation, in this case, mostly via TRPA1 activation. In mdx mice, CBD (60 mg·kg-1 ) and CBDV (60 mg·kg-1 ) prevented the loss of locomotor activity, reduced inflammation and restored autophagy. CONCLUSION AND IMPLICATIONS: We provide new insights into plant cannabinoid interactions with TRP channels in skeletal muscle, highlighting a potential opportunity for novel co-adjuvant therapies to prevent muscle degeneration in DMD patients.[object Object]

The associations between childhood acute lymphoblastic leukemia (ALL) and several factors related to early stimulation of the immune system, that is, farm residence and regular contacts with farm animals (livestock, poultry) or pets in early childhood, were investigated using data from 13 case–control studies participating in the Childhood Leukemia International Consortium. The sample included 7847 ALL cases and 11,667 controls aged 1–14 years. In all studies, the data were obtained from case and control parents using standardized questionnaires. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by unconditional logistic regression adjusted for age, sex, study, maternal education, and maternal age. Contact with livestock in the first year of life was inversely associated with ALL (OR = 0.65, 95% CI: 0.50, 0.85). Inverse associations were also observed for contact with dogs (OR = 0.92, 95% CI: 0.86, 0.99) and cats (OR = 0.87, 95% CI: 0.80, 0.94) in the first year of life. There was no evidence of a significant association with farm residence in the first year of life. The findings of these large pooled and meta-analyses add additional evidence to the hypothesis that regular contact with animals in early childhood is inversely associated with childhood ALL occurrence which is consistent with Greaves’ delayed infection hypothesis. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Purpose: The early onset of childhood acute lymphoblastic leukemia (ALL) suggests that critical exposures occurring during pregnancy may increase risk. We investigated the effects of maternal coffee and tea consumption during pregnancy on ALL risk by pooling data from eight case–control studies participating in the Childhood Leukemia International Consortium. Method: Data on maternal coffee intake were available for 2,552 cases and 4,876 controls, and data on tea intake were available for 2,982 cases and 5,367 controls. Coffee and tea intake was categorized into 0, > 0–1, > 1–2, and > 2 cups/day, and covariates were combined and harmonized. Data on genetic variants in NAT2, CYP1A1, and NQO1 were also available in a subset. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression, and linear trends across categories were assessed. Results: No association was seen with ‘any’ maternal coffee consumption during pregnancy, but there was evidence of a positive exposure–response; the pooled OR for > 2 cups/day versus none was 1.27 (95% CI 1.09–1.43), p trend = 0.005. No associations were observed with tea consumption. No interactions were seen between coffee or tea intake and age, maternal smoking or genotype, and there was little or no evidence that associations with coffee or tea differed among cases with and without chromosomal translocations. Conclusions: Despite some limitations, our findings suggest that high coffee intake during pregnancy may increase risk of childhood ALL. Thus, current advice to limit caffeine intake during pregnancy to reduce risk of preterm birth may have additional benefits. © 2018, Springer International Publishing AG, part of Springer Nature.

Background: Results from case-control studies have shown an increased risk of acute lymphoblastic leukaemia (ALL) in young children born by caesarean delivery, and prelabour caesarean delivery in particular; however, an association of method of delivery with childhood leukaemia subtypes has yet to be established. We therefore did a pooled analysis of data to investigate the association between childhood leukaemia and caesarean delivery. Methods: We pooled data from 13 case-control studies from the Childhood Leukemia International Consortium done in nine countries (Canada, Costa Rica, Egypt, France, Germany, Greece, Italy, New Zealand, and the USA) for births from 1970-2013. We analysed caesarean delivery overall and by indications that probably resulted in prelabour caesarean delivery or emergency caesarean delivery. We used multivariable logistic regression models, adjusted for child's birthweight, sex, age, ethnic origin, parental education, maternal age, and study, to estimate odds ratios (ORs) and 95% CIs for the risk of ALL and acute myeloid leukaemia (AML) in children aged 0-14 years at diagnosis. Findings: The studies provided data for 8780 ALL cases, 1332 AML cases, and 23 459 controls, of which the birth delivery method was known for 8655 (99%) ALL cases, 1292 (97%) AML cases, and 23 351 (>99%) controls. Indications for caesarean delivery were available in four studies (there were caesarean deliveries for 1061 of 4313 ALL cases, 138 of 664 AML cases, and 1401 of 5884 controls). The OR for all indications of caesarean delivery and ALL was 1·06 (95% CI 0·99-1·13), and was significant for prelabour caesarean delivery and ALL (1·23 [1·04-1·47]; p=0·018). Emergency caesarean delivery was not associated with ALL (OR 1·02 [95% CI 0·81-1·30]). AML was not associated with caesarean delivery (all indications OR 0·99 [95% CI 0·84-1·17]; prelabour caesarean delivery 0·83 [0·54-1·26]; and emergency caesarean delivery 1·05 [0·63-1·77]). Interpretation: Our results suggest an increased risk of childhood ALL after prelabour caesarean delivery. If this association is causal, maladaptive immune activation due to an absence of stress response before birth in children born by prelabour caesarean delivery could be considered as a potential mechanism. Funding: National Cancer Institute. © 2016 Elsevier Ltd.

Background Diabetes is associated with long-term damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. The risk of developing type 2 diabetes increases with age, obesity and lack of physical activity. Insulin resistance is a fundamental aspect of the aetiology of type 2 diabetes. Insulin resistance has been shown to be associated with atherosclerosis, dyslipidaemia, glucose intolerance, hyperuricaemia, hypertension and polycystic ovary syndrome. The mineral zinc plays a key role in the synthesis and action of insulin, both physiologically and in diabetes mellitus. Zinc seems to stimulate insulin action and insulin receptor tyrosine kinase activity. Objectives To assess the effects of zinc supplementation for the prevention of type 2 diabetes mellitus in adults with insulin resistance. Search methods This review is an update of a previous Cochrane systematic review published in 2007. We searched the Cochrane Library (2015, Issue 3), MEDLINE, EMBASE, LILACS and the ICTRP trial register (from inception to March 2015). There were no language restrictions. We conducted citation searches and screened reference lists of included studies. Selection criteria We included studies if they had a randomised or quasi-randomised design and if they investigated zinc supplementation compared with placebo or no intervention in adults with insulin resistance living in the community. Data collection and analysis Two review authors selected relevant trials, assessed risk of bias and extracted data. Main results We included three trials with a total of 128 participants in this review. The duration of zinc supplementation ranged between four and 12 weeks. Risk of bias was unclear for most studies regarding selection bias (random sequence generation, allocation concealment) and detection bias (blinding of outcome assessment). No study reported on our key outcome measures (incidence of type 2 diabetes mellitus, adverse events, health-related quality of life, all-cause mortality, diabetic complications, socioeconomic effects). Evaluation of insulin resistance as measured by the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) showed neutral effects when comparing zinc supplementation with control (two trials; 114 participants). There were neutral effects for trials comparing zinc supplementation with placebo for total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides (2 studies, 70 participants). The one trial comparing zinc supplementation with exercise also showed neutral effects for total cholesterol, HDL and LDL cholesterol, and a mean difference in triglycerides of -30 mg/dL (95% confidence interval (CI) -49 to -10) in favour of zinc supplementation (53 participants). Various surrogate laboratory parameters were also analysed in the included trials. Authors' conclusions There is currently no evidence on which to base the use of zinc supplementation for the prevention of type 2 diabetes mellitus. Future trials should investigate patient-important outcome measures such as incidence of type 2 diabetes mellitus, health-related quality of life, diabetic complications, all-cause mortality and socioeconomic effects.

Some previous studies have suggested that home pesticide exposure before birth and during a child's early years may increase the risk of childhood leukemia. To further investigate this, we pooled individual level data from 12 case-control studies in the Childhood Leukemia International Consortium. Exposure data were harmonized into compatible formats. Pooled analyses were undertaken using multivariable unconditional logistic regression. The odds ratio (ORs) for acute lymphoblastic leukemia (ALL) associated with any pesticide exposure shortly before conception, during pregnancy and after birth were 1.39 (95% confidence interval [CI]: 1.25, 1.55) (using 2,785 cases and 3,635 controls), 1.43 (95% CI: 1.32, 1.54) (5,055 cases and 7,370 controls) and 1.36 (95% CI: 1.23, 1.51) (4,162 cases and 5,179 controls), respectively. Corresponding ORs for risk of acute myeloid leukemia (AML) were 1.49 (95% CI: 1.02, 2.16) (173 cases and 1,789 controls), 1.55 (95% CI: 1.21, 1.99) (344 cases and 4,666 controls) and 1.08 (95% CI: 0.76, 1.53) (198 cases and 2,655 controls), respectively. There was little difference by type of pesticide used. The relative similarity in ORs between leukemia types, time periods and pesticide types may be explained by similar exposure patterns and effects across the time periods in ALL and AML, participants' exposure to multiple pesticides, or recall bias. Although some recall bias is likely, until a better study design can be found to investigate the associations between home pesticide use and childhood leukemia in an equally large sample, it would appear prudent to limit the use of home pesticides before and during pregnancy, and during childhood. What's new? Some studies have suggested that early pesticide exposure may increase the risk of childhood leukemia. In this investigation, the authors pooled individual level data from twelve previous case-control studies to further examine this question. They found an association between home pesticide exposure before birth and during a child's early years and acute lymphoblastic leukemia (ALL) and with exposure before birth and acute myeloid leukemia (AML). These results indicate that it would be prudent for parents to limit the use of home pesticides before and after a child's birth. © 2015 UICC.

Le nuove possibilità offerte dal progresso delle scienze biologiche e biomediche non solo possono mettere a rischio la garanzia dei diritti fondamentali degli individui, ma contribuiscono anche a rimodellare e a ridefinire il significato di quei diritti che sembravano essere, solo qualche anno fa, acquisiti e consolidati. Proprio per questo, da più parti, si afferma la necessità di formulare veri e propri "nuovi diritti" che siano in grado di offrire delle tutele reali ai cittadini. Per poter comprendere quali siano i problemi reali e quali le possibili risposte è necessario innanzitutto che si crei un dialogo tra le differenti discipline e che i vari punti di vista scientifico, etico, filosofico, giuridico, medico e della comunicazione trovino luoghi in cui si possano confrontare liberamente e senza pregiudizi.

Maternal occupational pesticide exposure during pregnancy and/or paternal occupational pesticide exposure around conception have been suggested to increase risk of leukemia in the offspring. With a view to providing insight in this area we pooled individual level data from 13 case-control studies participating in the Childhood Leukemia International Consortium (CLIC). Occupational data were harmonized to a compatible format. Pooled individual analyses were undertaken using unconditional logistic regression. Using exposure data from mothers of 8,236 cases, and 14,850 controls, and from fathers of 8,169 cases and 14,201 controls the odds ratio (OR) for maternal exposure during pregnancy and the risk of acute lymphoblastic leukemia (ALL) was 1.01 [95% confidence interval (CI) 0.78, 1.30] and for paternal exposure around conception 1.20 (95% 1.06, 1.38). For acute myeloid leukemia (AML), the OR for maternal exposure during pregnancy was 1.94 (CI 1.19, 3.18) and for paternal exposure around conception 0.91 (CI 0.66, 1.24.) based on data from 1,329 case and 12,141 control mothers, and 1,231 case and 11,383 control fathers. Our finding of a significantly increased risk of AML in the offspring with maternal exposure to pesticides during pregnancy is consistent with previous reports. We also found a slight increase in risk of ALL with paternal exposure around conception which appeared to be more evident in children diagnosed at the age of 5 years or more and those with T cell ALL which raises interesting questions on possible mechanisms. What's new? When parents are exposed to pesticides during pregnancy or conception, does this increase the risk of leukemia in their child? The answer is yes. Using pooled individual level occupational pesticide exposure data from 13 case-control studies the authors found an increased risk of acute myeloid leukemia with maternal exposure during pregnancy and a slightly increased risk of acute lymphoblastic leukemia with paternal exposure around conception. The next step is to get more detailed information on pesticide types and protective measures during application before conclusive recommendations for pesticide use in the workforce can be made. © 2014 UICC.

The grapsid crab Percnon gibbesi (H. Milne Edwards, 1853), not previously recorded in the Mediterranean, has been found by underwater observations in several localities of Linosa, Pelagie Islands, (Italy). This presence increases the list of alien Decapods in the Mediterranean, with a form which can be considered a western migrant., No disponible

Positive associations have been reported between the measures of accelerated fetal growth and risk of childhood acute lymphoblastic leukemia (ALL). We investigated this association by pooling individual-level data from 12 case-control studies participating in the Childhood Leukemia International Consortium. Two measures of fetal growth - weight-for-gestational-age and proportion of optimal birth weight (POBW) - were analysed. Study-specific odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression, and combined in fixed effects meta-analyses. Pooled analyses of all data were also undertaken using multivariable logistic regression. Subgroup analyses were undertaken when possible. Data on weight for gestational age were available for 7,348 cases and 12,489 controls from all 12 studies and POBW data were available for 1,680 cases and 3,139 controls from three studies. The summary ORs from the meta-analyses were 1.24 (95% CI: 1.13, 1.36) for children who were large for gestational age relative to appropriate for gestational age, and 1.16 (95% CI: 1.09, 1.24) for a one-standard deviation increase in POBW. The pooled analyses produced similar results. The summary and pooled ORs for small-for-gestational-age children were 0.83 (95% CI: 0.75, 0.92) and 0.86 (95% CI: 0.77, 0.95), respectively. Results were consistent across subgroups defined by sex, ethnicity and immunophenotype, and when the analysis was restricted to children who did not have high birth weight. The evidence that accelerated fetal growth is associated with a modest increased risk of childhood ALL is strong and consistent with known biological mechanisms involving insulin-like growth factors. © 2013 UICC.