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Unlabelled: Calgranulin-C (S100A12) and zonulin are considered markers of intestinal inflammation. Our aim was to evaluate fecal S100A12 (f-S100A12) and fecal zonulin (f-zonulin) in children with inflammatory bowel disease (IBD), compared to fecal calprotectin (FC) and serum inflammatory markers. We enrolled children with a previous diagnosis of Crohn's disease (CD) and ulcerative colitis (UC). F-S100A12, f-zonulin, and FC were determined by enzyme-linked immunosorbent assay (ELISA). Endoscopic examination was considered in the patients who underwent ileocolonoscopy within 2 weeks from the enrollment. One hundred seventeen children, 39.3% with CD and 60.7% with UC were enrolled. In both CD and UC, there was a significant direct correlation between FC and f-S100A12 levels. In children with CD and UC, both FC and f-S100A12 correlated with markers of serum inflammation. We found difference in FC and f-S100A12 levels between patients in clinical relapse and remission (FC: mean 1027 ± 818 mcg/ml vs 580 ± 695 mcg/ml respectively, p = 0.028; f-S100A12: mean 66.4 ± 48.2 mcg/ml vs 42.7 ± 40 mcg/ml, respectively p = 0.02). Moreover, we found difference in FC between children with endoscopic inflammation and remission (mean 825 ± 779 mcg/ml vs 473.3 ± 492 mcg/ml, respectively p = 0.048), as well as for f-S100A12 (53 ± 43 mcg/ml vs mean 31 ± 33 mcg/ml vs, respectively p = 0.019). No significant results were found for f-zonulin. Conclusion: Our data suggest that f-S100A12 and FC are both useful non-invasive biomarkers in the management of pediatric IBD in follow up and in monitoring endoscopic and clinical relapse. What is known: • Fecal calprotectin (FC), fecal S100A12 (f- S100A12), and fecal zonulin represent potential noninvasive markers of gut inflammation. • Since S100A12 is predominantly expressed by granulocytes, high levels of f-S100A12 should be more specific for inflammation than FC. What is new: • FC and f-S100A12 were correlated to each other and despite the lack of correlation with disease location, they were associated with endoscopic inflammation and clinical relapse in children with IBD. • No significant correlations were found between f-zonulin and the inflammatory parameters.

Correct classification is the main aspect in evaluating the quality of an artificial intelligence system, but what happens when you reach top accuracy and no method explains how it works? In our study, we aim at addressing the black-box problem using an ad-hoc built classifier for lung ultrasound images

Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results' analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.

In recent years, the impressive advances in artificial intelligence, computer vision, pervasive computing, and augmented reality made them rise to pillars of the fourth industrial revolution. This short paper aims to provide a brief survey of current use cases in factory applications and industrial inspection under active development at the Signals and Images Lab, ISTI-CNR, Pisa.

In recent times, except for sporadic cases, the trend in Computer Vision is to achieve minor improvements over considerable increases in complexity. To reverse this tendency, we propose a novel method to boost image classification performances without an increase in complexity. To this end, we revisited ensembling, a powerful approach, not often adequately used due to its nature of increased complexity and training time, making it viable by specific design choices. First, we trained end-to-end two EfficientNet-b0 models (known to be the architecture with the best overall accuracy/complexity trade-off in image classification) on disjoint subsets of data (i.e. bagging). Then, we made an efficient adaptive ensemble by performing fine-tuning of a trainable combination layer. In this way, we were able to outperform the state-of-the-art by an average of 0.5\% on the accuracy with restrained complexity both in terms of number of parameters (by 5-60 times), and FLoating point Operations Per Second (by 10-100 times) on several major benchmark datasets, fully embracing the green AI.

We aimed to assess how the first phase of COVID-19 pandemic influenced symptoms in children with functional abdominal pain disorders (FAPDs) and to characterize their quality of life (QoL), anxiety and global health.

Additional file 2. (A) Plasma cholesterol (grey triangles) and TG (black circles) before and after empagliflozin (reference values for cholesterol (3–5) and TG (0.5–1.5) are underlined); (B) Plasma uric acid concentrations before and after empagliflozin (reference values are underlined). TG: triglycerides.

Additional file 3. Flash glucose monitoring data.

The Signal & Images Laboratory (SI-Lab) is an interdisciplinary research group in computer vision, signal analysis, smart vision systems and multimedia data understanding. It is part of the Institute for Information Science and Technologies of the National Research Council of Italy. This report accounts for the research activities of the Signal and Images Laboratory of the Institute of Information Science and Technologies during the year 2020.

Additional file 1. Neutrophil count (light grey triangles), 1,5AG (black circles) and 1,5AG6P (dark grey squares) before and after empagliflozin. Plasma 1,5-AG concentration dropped from ±250 μM before treatment to ±50 μM after 2 weeks on empagliflozin. Concentration of 1,5-AG stayed relatively constant until day + 164, before a change in the diet introducing a daily oral intake of carbohydrates. On day + 232, approximately 2 months after this change, plasma 1,5-AG was only very slightly increased to 60 μM. After treatment, 1,5-AG6P present in leukocytes and measured in whole blood samples was reduced by 4- to 5-fold when compared to values before starting empagliflozin. 1,5AG: 1,5-anhydroglucitol; 1,5AG6P: 1,5-anhydroglucitol-6-phosphate.

Additional file 1.

Una introduzione divulgativa all'Intelligenza Artificiale (IA). La nascita e gli approcci dell’IA. le applicazioni rese possibili dal Deep Learning; etica e rischi dell’utilizzo non controllato delle nuove tecnologie; applicazioni in ambito sanitario, industriale e nell’agricoltura di precisione co-realizzate al CNR. La presentazione fa parte dell'evento "Le Escursioni del domedì"

Supplemental material, Symptom_prevalence_table_supplementary_materials for Assessment and Diagnostic Accuracy Evaluation of the Reflux Symptom Index (RSI) Scale: Psychometric Properties using Optimal Scaling Techniques by Andrea Nacci, Luca Bastiani, Maria Rosaria Barillari, Jerome R. Lechien, Massimo Martinelli, Nicola De Bortoli, Stefano Berrettini and Bruno Fattori in Annals of Otology, Rhinology & Laryngology

Background: Vaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2). Methods: This was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved. Results: Vaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies. Conclusions: We demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.

Supplemental material, UEG912877 Supplemental Material for Post-induction infliximab trough levels and disease activity in the clinical evolution of pediatric ulcerative colitis by Hillary Moore, Pasquale Dolce, Nina Devas, Robert Baldassano and Massimo Martinelli in United European Gastroenterology Journal

A growing body of evidence supports the need for detailed attention to nutrition and diet in children with IBD. We aimed to define the steps in instituting dietary or nutritional management in light of the current evidence and to offer a useful and practical guide to physicians and dieticians involved in the care of paediatric IBD patients.

Questo documento descrive il lavoro scientifico di ricerca e il suo sviluppo denominato “Ultra- GEO”. UltraGEO è il cuore di un’idea nata dal Laboratorio Segnali e Immagini (SILab) dell’Istituto di Scienza e Tecnologie dell’Informazione del Consiglio Nazionale delle Ricerche con sede a Pisa e dal Comune di Massa. UltraGEO si propone come un nuovo sistema per il controllo degli smottamenti del terreno e delle frane. Per la misura degli smottamenti questo progetto di R&D prevede la rea- lizzazione di un prototipo costituito da una rete di nodi attivi e passivi. I nodi sono adattivi in base alle caratteristiche dell’ambiente dove sono inseriti: basati su marker grafici (nodi passivi) oppure basati su marker con basse emissioni di segnali elettromagnetici e/o acustici (nodi attivi). UltraGEO è progettato per essere modulare e utilizzabile in zone difficilmente accessibili, anche dove non vi è nessuna sorgente di energia elettrica e non è possibile dotare il nodo di batterie e pannelli solari. UltraGEO ha caratteristiche che vertono alla semplificazione dell’installazione dei sensori rispetto alle attuali tecnologie, riducendone i costi e semplificandone l’utilizzo nel breve e lungo periodo.

This document describes the scientific research work and its development called "Ultra-GEO". UltraGEO is the heart of an idea born from the Signals and Images Laboratory (SILAB) of the Institute of Science and Information Technology of the National Research Council of Italy, based in Pisa and the Municipality of Massa. UltraGEO is proposed as a new system for the control of landslides and fast failures. For the measurement of landslides this R & D project involves the realization of a prototype made up of a network of active and passive nodes. The nodes are adaptive according to the characteristics of the environment where they are inserted: based on graphic markers (passive nodes) or based on markers with low emissions of electromagnetic and / or acoustic signals (active nodes). UltraGEO is designed to be modular and usable in areas difficult to access, even where there is no source of electricity and it is not possible to equip the node with batteries and solar panels. UltraGEO has features that simplify the installation of sensors compared to current technologies, reducing costs and simplifying their use in the short and long term.; Questo documento descrive il lavoro scientifico di ricerca e il suo sviluppo denominato "Ultra-GEO". UltraGEO è il cuore di un'idea nata dal Laboratorio Segnali e Immagini (SILab) dell'Istituto di Scienza e Tecnologie dell'Informazione del Consiglio Nazionale delle Ricerche con sede a Pisa e dal Comune di Massa. UltraGEO si propone come un nuovo sistema per il controllo degli smottamenti del terreno e delle frane. Per la misura degli smottamenti questo progetto di R&D prevede la rea-lizzazione di un prototipo costituito da una rete di nodi attivi e passivi. I nodi sono adattivi in base alle caratteristiche dell'ambiente dove sono inseriti: basati su marker grafici (nodi passivi) oppure basati su marker con basse emissioni di segnali elettromagnetici e/o acustici (nodi attivi). UltraGEO è progettato per essere modulare e utilizzabile in zone difficilmente accessibili, anche dove non vì e nessuna sorgente di energia elettrica e nonènonè possibile dotare il nodo di batterie e pannelli solari. UltraGEO ha caratteristiche che vertono alla semplificazione dell'installazione dei sensori rispetto alle attuali tecnologie, riducendone i costi e semplificandone l'utilizzo nel breve e lungo periodo.

The ability to detect and monitor oil spills at sea is becoming increasingly important due to the high demand of oil-based products. Remote sensing frameworks have been proven to give accurate results in case of major events, nonetheless, also medium and micro oil spills have their own importance, especially in protected areas that deserve special attention. In this paper, we propose a monitoring framework based on the collection of in situ observations and on their integration with remote sensing in order to fill out existing observational gaps. In particular, besides the data collected by special monitoring devices, in situ observations include volunteered geographical information as an additional source of valuable data. Oil spill sights, notified by volunteers through a specially-designed app, are integrated in the monitoring system and therein processed together with remote sensing data in order to proactively detect anomalous events and produce alerts. Field operational tests in two areas demonstrate the technical validity of the approach, while users&rsquo, reception testifies to its potential in raising people&rsquo, s awareness on marine pollution.

In this presentation (delivered at DREIS held in Rome on April 17, 2018) we show the activities carried out at CNR-ISTI concerning the use of UAVs and multimodal image analysis for power line inspection. The work here presented has been partially supported by "SCIADRO", a project funded by the Tuscany Region under the PAR FAS program.

Background and Aims: A growing body of evidence supports the need for detailed attention to nutrition and diet in children with inflammatory bowel disease (IBD). We aimed to define the steps in instituting dietary or nutritional management in light of the current evidence and to offer a useful and practical guide to physicians and dieticians involved in the care of pediatric IBD patients. Methods: A group of 20 experts in pediatric IBD participated in an iterative consensus process including 2 face-to-face meetings, following an open call to Nutrition Committee of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition Porto, IBD Interest, and Nutrition Committee. A list of 41 predefined questions was addressed by working subgroups based on a systematic review of the literature. Results: A total of 53 formal recommendations and 47 practice points were endorsed with a consensus rate of at least 80% on the following topics: nutritional assessment ; macronutrients needs ; trace elements, minerals, and vitamins ; nutrition as a primary therapy of pediatric IBD ; probiotics and prebiotics ; specific dietary restrictions ; and dietary compounds and the risk of IBD. Conclusions: This position paper represents a useful guide to help the clinicians in the management of nutrition issues in children with IBD.

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD), Ulcerative colitis (UC) and IBD-unclassified (IBD-U) is a group of life-long chronic and relapsing inflammatory disorders of the gastrointestinal tract whose etiology has not been completely understood. The most recent evidences involve a complex interaction between host genetic, environmental and microbial influences, resulting in a dysregulated mucosal immune response against the commensal intestinal microbiota. Although the incidence and prevalence of IBD differ among countries, the general trend clearly highlights an overall increase over the past few decades in western countries, especially in adolescence and young adulthood. Paediatric IBD has several specific considerations when compared with adult IBD. These certainly include the relevant issues related to growth, development, pubertal maturation, bone health, and psychological impact on the patient and family, but also the unique features related to paediatric IBD phenotype, which is well-renowned to represent both a diagnostic and therapeutic challenge, being characterized by higher severity, including poor response to medical treatment, presence of extra-intestinal manifestations (EIM), and increased risk of surgery. This thesis project aims to provide new insights in paediatric IBD pathogenesis, to characterize the phenotype and the disease course of IBD in paediatric age and to improve the clinical and therapeutic strategies for the management of paediatric IBD.

Background and aims: We sought to correlate hepcidin levels in Inflammatory Bowel Disease (IBD) children with disease activity, inflammatory markers and iron load test (ILT) and to compare IBD patients with celiac and healthy patients. Methods: One-hundred-forty-five subjects (50 IBD, 45 celiac patients and 50 healthy controls) were included in the study between December 2012 and June 2013. All patients underwent the following examinations: blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein, and erythrocyte sedimentation rate. In order to evaluate the efficacy of iron absorption ILT was performed in IBD patients. Disease activity indexes, IBD duration, localization and therapy were also evaluated and a fecal sample for calprotectin collected. Results: Serum hepcidin was significantly higher in IBD patients with active disease compared with both celiac and healthy patients (p=0.005; p=0.003 respectively). In a multivariate logistic regression model, having a PCDAI/PUCAI≥30 resulted the only variable independently associated with a positive serum hepcidin [OR= 6.87; CI 95% 1.4-33, p=0.01)]. Patients with iron malabsorption (IM) showed higher values of ESR, CRP and hepcidin (p=0.02, p=0.001 and p=0.06, respectively). Eight out of 12 (66.7%) children with IM showed an active disease compared with 6/31 (19.3%) children with normal ILT (p=0.01). Hepcidin levels correlated negatively with ILT (r=-0.451, p=0.002,), and positively with ferritin and CRP (r=0.442, p=0.0001; r=0.243, p=0.009, respectively) Conclusions: Our study demonstrates that serum hepcidin is increased in IBD children with active disease and it is responsible for IM. Background and Aims: We sought to correlate hepcidin levels in inflammatory bowel disease [IBD] children with disease activity, inflammatory markers, and iron load test [ILT] and to compare IBD patients with coeliac and healthy patients. Methods: Between December 2012 and June 2013, 145 subjects [50 IBD patients, 45 coeliac patients and 50 healthy controls] were included in the study. All patients underwent the following examinations: Blood count, iron status, erythropoiesis parameters, serum hepcidin, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]. In order to evaluate the efficacy of iron absorption, ILT was performed in IBD patients. Disease activity indexes and IBD duration, localisation, and therapy were also evaluated, and a faecal sample for calprotectin collected. Results: Serum hepcidin was significantly higher in IBD patients with active disease compared with both coeliac and healthy patients [p = 0.005, p = 0.003 respectively]. In a multivariate logistic regression model, having a Paediatric Crohn's Disease Activity Index [PCDAI] / Paediatric Ulcerative Colitis Activity Index [PUCAI] ≥ 30 resulted in the only variable independently associated with a positive serum hepcidin (odds ratio [OR] = 6.87; 95% confidence interval [CI] 1.4-33, p = 0.01]]. Patients with iron malabsorption [IM] showed higher values of ESR, CRP, and hepcidin [p = 0.02, p = 0.001, and p = 0.06, respectively]. Eight out of 12 [66.7%] children with IM showed an active disease compared with 6/31 [19.3%] children with normal ILT [p = 0.01]. Hepcidin levels correlated negatively with ILT [r = -0.451, p = 0.002], and positively with ferritin and CRP [r = 0.442, p = 0.0001; r = 0.243, p = 0.009, respectively] Conclusions: Our study demonstrates that serum hepcidin is increased in IBD children with active disease and it is responsible for IM.

BACKGROUND: The demand for paediatric gastrointestinal (GI) endoscopy has increased, resulting in a significant rise of overall costs. AIM: To assess the clinical impact of the Rome II criteria for functional gastrointestinal disorders when selecting paediatric patients who underwent GI endoscopy. METHODS: The indications and findings of GI endoscopic procedures performed before and after the publication of the Rome II criteria were evaluated retrospectively. RESULTS: Upper GI endoscopy was performed in 1124 children, whereas colonoscopy was performed in 500 subjects. A total of 607 (54%) oesophago-gastro-duodenoscopies (OGDs) were positive and 517 (46%) were negative, whereas 306 (61.1%) colonoscopies were positive and 194 (38.9%) were negative. Of the 1624 procedures, 26% were considered inappropriate according to the Rome II criteria. Inappropriate procedures decreased significantly after publication of the Rome II criteria (OR, 3.7; 95% CI, 1.8-7.5). Of 1202 appropriate GI endoscopies, 502 OGD (62.7%) were significantly contributive, compared with only 105 (32.5%) of the 323 inappropriate procedures (OR, 3.5; 95% CI, 2.6-4.6), whereas 265 (65.8%) colonoscopies were significantly contributive, compared with only 41 (42.3%) of the 97 inappropriate procedures (OR, 2.6; 95% CI, 1.6-4.1). CONCLUSIONS: The use of the criteria for functional gastrointestinal disorders makes a significant positive impact, they should reduce unnecessary paediatric GI endoscopy.

Thesaurus Project aims at promoting the knowledge of the underwater cultural heritage, ancient and modern, through the application of several typologies of tools: underwater autonomous vehicles, which will be able to explore the sea bottom in teams communicating with each other; a database, which will be useful to store and manage all the information referring to archaeological or historical objects, shipwrecks and sites. This paper aims to explain the logic structure of the database indicating the particular needs of the research, the different typologies of items which have to be managed (archaeological and historical objects; ancient, medieval or modern shipwrecks; underwater sites; written or figurative sources, etc.), the relation with other similar databases and projects. The main task of this part of Thesaurus is to plan and organize an IT system, which will allow archaeologists to describe information in detail, in order to make an efficient managing and retrieving data system available.

This report aims at providing a technical introduction to the eXtensible Markup Language, known as XML. This language has been developed by W3C, the World Wide Web Consortium in order to offer an effective mechanism for managing structured data on the Web, thus overcoming the limits of HTML (Hyper Text Markup Language). We examine the components of the language and the way in which it differs with HTML. Examples are given of current possible uses and suggestion are made for future applications. We also briefly outline some of the new standards that are emerged, or now emering with respect to XML.

The impact of oil pollutions on coastal environment, concerns both the economy and the quality of life. The increasing importance of petroleum products and its maritime transportation raised the concern on navigation safety and environmental protection, leading to a major interest in frameworks for remotely detecting oil spill at sea. While many of the approaches have been focused on large oil spills, smaller ones and operational discharges in regional area received fairly less consideration. In this work we present a framework where, in addition to classical remote sensing the information is enriched with data collected in situ thanks to static and mobile sensors and thus leveraging on innovative methods for data correlation and fusion. The proposed GIS infrastructure is an integrated and interoperable system based on advanced sensing capabilities from a variety of electronic sensors along with geo-positioning tools, yet suitable for local authorities and stakeholders.

Within the European research project Argomarine (FP7-SST-2008-RTD-1-234096 “Argomarine-Automatic Oil–spill and geopositioning integrated in a marine information system”) [1], coordinated by the Park Authority of the Tuscan Archipelago, the Signals and Images Laboratory (SI-LAB) of the Institute of Information Science and Technology of the National Research Council of Pisa has developed a Marine Information System (MIS) to detect, monitor and manage marine pollution events, ranging from major accidents to micro oil spillages. The MIS was conceived as a connected group of subsystems for performing data storage, decision-support, data mining and analysis over data warehouses, as well as a web-GIS portal for easy access and usage of products and services released to end-users. The main task of the MIS is to serve as a shell to integrating data, information and knowledge from various sources pertained to the marine areas of interest, by means of adequate Information Technology tools. An integrant part of the MIS is represented by the data that can be collected and shared by volunteers who want to collaborate in monitoring the status of the sea. For this purpose, we have developed ARGO Sentinel [2], a free application for smartphones with a Geolocation System (GPS).Two versions of the app have been implemented: an HTML5 version, running as an Opera widget, distributed only to the partners of the project, and a native Android (v2.2 or higher) publicly distributed because of its level of stability, and downloadable by anyone from Google Play. ARGO Sentinel was conceived on the intuition that the contribution of volunteers could play a fundamental role in monitoring and protecting the environment. Indeed, by using the app, whenever someone at sea sights signs of oil or hydrocarbon pollution they can immediately report this to the SI-LAB in Pisa. The information is recorded in the MIS and complements the data obtained from more traditional sources (eg remote sensing, sensorized buoys, AUVs…), improving the quality and coverage of marine monitoring, especially in protected areas. In this way we can build up a detailed map of the status of our seas. The app has been installed by about 800 individuals all over the world. By integrating the alerts sent by the volunteers with all the other information sources collected in the MIS, a semi-automatic analysis eliminated the alerts identified as false positive. In addition, on the basis of the collected data, the MIS is capable of computing a real time dynamic map with estimated level of risk. The map draws the attention of the authorities to the particular areas where risky conditions are detected in order to foster a more accurate monitoring. Proactive alerting services can be buit on top of the dynamic risk map for issuing automatic warining messages. Our field tests demonstrate that the use of this new technology could be really important in combating pollution. Our experience suggests that this kind of technology can be applied to many other fields where environmental monitoring and safety is crucial. &nbsp

The impact of oil pollutions on coastal environment, concerns both the economy and the quality of life. The increasing importance of petroleum products and its maritime transportation raised the concern on navigation safety and environmental protection, leading to a major interest in frameworks for remotely detecting oil spill at sea. While many of the approaches have been focused on large oil spills, smaller ones and operational discharges in regional area received fairly less consideration. In this work we present a framework where, in addition to classical remote sensing the information is enriched with data collected in situ thanks to static and mobile sensors and thus leveraging on innovative methods for data correlation and fusion. The proposed GIS infrastructure is an integrated and interoperable system based on advanced sensing capabilities from a variety of electronic sensors along with geo-positioning tools, yet suitable for local authorities and stakeholders.

Chronic heart failure is a severe clinical syndrome among the most remarkable for prevalence and morbidity in the developed western countries. The European STREP project HEARTFAID aims at realizing an innovative platform of services which will improve the processes of diagnosis, prognosis and therapy provision in the heart failure domain. The core of the platform intelligence is a Clinical Decision Support System, designed by integrating innovative knowledge representation techniques and hybrid reasoning methods, and including advanced tools for the analysis of diagnostic data. In this paper we discuss how we are using semantic web technologies for implementing a real, significant clinical scenario, covering the clinical course of a heart failure patient., See http://ceur-ws.org/Vol-314/46.pdf

Chronic heart failure is a severe clinical syndrome among the most remarkable for prevalence and morbidity in the developed western countries. The European STREP project HEARTFAID aims at realizing an innovative platform of services which will improve the processes of diagnosis, prognosis and therapy provision in the heart failure domain. The core of the platform intelligence is a Clinical Decision Support System, designed by integrating innovative knowledge representation techniques and hybrid reasoning methods, and including advanced tools for the analysis of diagnostic data. In this paper we discuss how we are using semantic web technologies for implementing a real, significant clinical scenario, covering the clinical course of a heart failure patient.

This report summarizes a part of the activities carried out within the EU FP7-IP-Project CHRONIOUS, An Open, Ubiquitous and Adaptive Chronic Disease Management Platform for COPD and Renal Insufficiency (GA 216461), more precisely within Work Package 6. One of the key components of the platform is the CHRONIOUS Guidelines Framework. It is aimed at offering all the Decision Support services for professionals involved in the Chronic Disease Monitoring and Management Process. This module contains all the decision support functionalities needed for providing the possible diagnoses and treatments according to the medical category of the patient and the patient’s specific data available. This report addresses the work done on modelling the guidelines for Chronic Obstructive Pulmonary Disease (COPD).

Within the European research project Argomarine (FP7-SST-2008-RTD-1-234096 ���Argomarine-Automatic Oil���spill and geopositioning integrated in a marine information system���) [1], coordinated by the Park Authority of the Tuscan Archipelago, the Signals and Images Laboratory (SI-LAB) of the Institute of Information Science and Technology of the National Research Council of Pisa has developed a Marine Information System (MIS) to detect, monitor and manage marine pollution events, ranging from major accidents to micro oil spillages. The MIS was conceived as a connected group of subsystems for performing data storage, decision-support, data mining and analysis over data warehouses, as well as a web-GIS portal for easy access and usage of products and services released to end-users. The main task of the MIS is to serve as a shell to integrating data, information and knowledge from various sources pertained to the marine areas of interest, by means of adequate Information Technology tools. An integrant part of the MIS is represented by the data that can be collected and shared by volunteers who want to collaborate in monitoring the status of the sea. For this purpose, we have developed ARGO Sentinel [2], a free application for smartphones with a Geolocation System (GPS).Two versions of the app have been implemented: an HTML5 version, running as an Opera widget, distributed only to the partners of the project, and a native Android (v2.2 or higher) publicly distributed because of its level of stability, and downloadable by anyone from Google Play. ARGO Sentinel was conceived on the intuition that the contribution of volunteers could play a fundamental role in monitoring and protecting the environment. Indeed, by using the app, whenever someone at sea sights signs of oil or hydrocarbon pollution they can immediately report this to the SI-LAB in Pisa. The information is recorded in the MIS and complements the data obtained from more traditional sources (eg remote sensing, sensorized buoys, AUVs���), improving the quality and coverage of marine monitoring, especially in protected areas. In this way we can build up a detailed map of the status of our seas. The app has been installed by about 800 individuals all over the world. By integrating the alerts sent by the volunteers with all the other information sources collected in the MIS, a semi-automatic analysis eliminated the alerts identified as false positive. In addition, on the basis of the collected data, the MIS is capable of computing a real time dynamic map with estimated level of risk. The map draws the attention of the authorities to the particular areas where risky conditions are detected in order to foster a more accurate monitoring. Proactive alerting services can be buit on top of the dynamic risk map for issuing automatic warining messages. Our field tests demonstrate that the use of this new technology could be really important in combating pollution. Our experience suggests that this kind of technology can be applied to many other fields where environmental monitoring and safety is crucial.

This report summarizes a part of the activities carried out within the EU FP7-IP-Project CHRONIOUS, An Open, Ubiquitous and Adaptive Chronic Disease Management Platform for COPD and Renal Insufficiency (GA 216461), more precisely within Work Package 6. One of the key components of the platform is the CHRONIOUS Guidelines Framework. It is aimed at offering all the Decision Support services for professionals involved in the Chronic Disease Monitoring and Management Process. This module contains all the decision support functionalities needed for providing the possible diagnoses and treatments according to the medical category of the patient and the patient’s specific data available. This report addresses the work done on modelling the guidelines for Chronic Obstructive Pulmonary Disease (COPD).

Objectives: The aims of our study were to evaluate health-related quality of life (HRQoL) in children affected by inflammatory bowel disease (IBD) during the first wave of Coronavirus disease 2019 (COVID-19) pandemic and after 12 months. Methods: This was a single-center, prospective, observational study conducted between April 2020 and April 2021. Children from 10 to 18 years with a confirmed diagnosis of IBD were enrolled during the first COVID-19-related national quarantine. The following information was collected at the baseline and after 12 months: IBD subtype, location and phenotype, disease activity, current and previous therapies. Patients were asked to complete the PROMIS Anxiety and IMPACT III questionnaires. Results: One hundred and eighteen patients were enrolled, of whom 54 (46%) were affected by Crohn disease (CD) and 64 (54%) with ulcerative colitis (UC; median age: 15.5 years, range 10.3-18; M/F: 68/50). Median HRQoL was significantly decreased after 12 months compared with the beginning of COVID-19-related quarantine (T1: 76.7 vs T2: 72.8; P < 0.001). At 12 months, a higher number of children were reported to be in active disease when compared with the enrollment [T2: 22/108 (20.4%) vs T1: 12/118 (10%); P = 0.02]. Multivariate analysis showed a significant influence on HRQoL of quarantine period (P < 0.001), female sex (P = 0.016), biologic therapy (P = 0.011), and active disease (P < 0.001). Conclusions: A deterioration of HRQoL after 12 months from COVID-19-related quarantine was observed. Additionally, the higher number of children with active disease at 12 months compared with enrollment may suggest detrimental consequences of the reduced disease control, contributing to decreased HRQoL.

Background Scarce data have investigated the association between pediatric inflammatory bowel disease (IBD) and eosinophilic esophagitis (EoE). We, therefore, aimed to describe the epidemiology and the possible peculiar phenotype and natural history of such an association. Methods Case-control study is based on the Italian Society for Pediatric Gastroenterology (SIGENP) national registry. All children with a combined diagnosis of IBD and EoE were included. The overall prevalence and incidence in 2 periods, 2009 to 2015, and 2016 to 2021, were calculated. Cases were matched with IBD only and EoE only patients in a 1:3:3 ratio. Phenotype and outcomes (courses of steroids, risk of complications, surgery, treatment escalation, and hospitalization) were compared between groups. Results Eleven patients (age 11.2 ± 2.8 years, Males 91%) with EoE-IBD out of 3090 patients with IBD were identified, resulting in an overall prevalence of 0.35% and an incidence of 0.18% for 2009 to 2015 and 0.45% for 2016 to 2021. Treatment escalation rates for IBD were significantly higher in patients with IBD compared with EoE-IBD at 12- and 24-month follow-up (0% vs 30%, P = .04; and 9% vs 45.5%, P = .03, respectively). Furthermore, patients with IBD were at a significantly higher risk of hospitalization than both EoE-IBD and EoE patients (log rank P Conclusions The incidence and prevalence of EoE in children with IBD are low, although the incidence seems to be rising in recent years. Having EoE appears to be associated with a milder IBD disease course, whereas having IBD does not seem to affect the natural history of EoE. More data are needed to better define the phenotype of such association.

Background Exclusive enteral nutrition (EEN) is the first choice to induce remission and promote mucosal healing in pediatric Crohn’s disease (CD). However, full adherence to EEN treatment may be problematic for children with CD. Methods The goal of the current multicenter retrospective study was to define predictive factors of nonadherence to treatment and nonremission at the end of induction treatment. Those data together were analyzed with the ultimate goal of trying to define an individualized induction treatment for children with CD. Results Three hundred seventy-six children with CD from 14 IBD pediatric referral centers were enrolled in the study. The rate of EEN adherence was 89%. Colonic involvement and fecal calprotectin >600 μg/g at diagnosis were found to be associated with a reduced EEN adherence. Exclusive enteral nutrition administered for 8 weeks was effective for inducing clinical remission in 67% of the total cohort. Factors determining lower remission rates were age >15 years and Pediatric Crohn’s Disease Activity Index >50. Conclusion Although EEN is extremely effective in promoting disease remission, several patients’ related factors may adversely impact EEN adherence and response. Personalized treatments should be proposed that weigh benefits and risks based on the patient’s disease location, phenotype, and disease activity and aim to promote a rapid control of inflammation to reduce long-term bowel damage.

Background: Functional gastrointestinal disorders (FGIDs) are common during the pediatric age. FGIDs are not related to biochemical or structural abnormalities. However, since they have a high prevalence, several studies have evaluated an overlap between FGIDs and organic diseases. Individuals with celiac disease (CD) have been shown to be at an increased risk for functional abdominal pain, even if they adhere well to a gluten-free diet (GFD). Little information is available for the pediatric age group. The aims of our study were to evaluate the prevalence of FGIDS in CD children 1 year after diagnosis and to compare the prevalence of FGIDs in CD children on a GFD with processed foods compared with those on a GFD with natural products. Aim: To assess the prevalence of FGIDs in children with CD after 1 year of follow-up and to compare the prevalence of FGIDs in children with CD on a GFD with processed foods and in children on a GFD with natural products. Methods: We recruited pediatric patients aged 1-18 years with a new CD diagnosis. Participants were randomized to two groups: Group A on a GFD with processed foods (diet 1); and group B on a GFD with natural products (diet 2). Clinical monitoring, diet assessment and the questionnaire on pediatric gastrointestinal symptoms-Rome IV version were performed at diagnosis (T0) and after 12 mo of follow-up (T1). Dietary intake was assessed using a 3-d food diary record. Data from the diaries were evaluated using WinFood nutrient analysis software. We assessed the prevalence of FGIDs at T1 and the correlation with the type of GFD. Results: We registered 104 CD children, with 55 patients in group A (53.0%) and 49 patients in group B (47.0%). Initially, 30 of the 55 (54.5%) CD children were symptomatic in group A, while 25 of 49 (51.0%) were symptomatic in group B. At T1, in spite of a low or negative serology for CD, FGIDs prevalence was 10/55 (18.0%) in group A and 8/49 (16.3%) in group B, with no statistically significant difference between the two groups (P = 0.780). At T1 the macro- and micronutrient intake was similar across the two groups with no significant differences in nutrient analysis. However, in both groups at T1 we found that a lower prevalence of FGIDs (P = 0.055) was associated with an inferior caloric (odds ratio = 0.99, 95% confidence interval: 0.99-1.00) and fat (odds ratio = 0.33, 95% confidence interval: 0.65-0.95) intake. Conclusion: Our results showed that CD children on a GFD have gastrointestinal symptoms with an elevated prevalence of FGIDs. Our study suggests that developing FGIDs may be linked to caloric intake and percentage of food fat, but it does not change between a GFD with processed foods or a GFD with natural products. However, long-term monitoring is required to evaluate a correlation between FGIDs and various types of GFDs.

The RNA-binding protein Pcbp2 is widely expressed in the innate and adaptive immune systems and is essential for mouse development. To determine whether Pcbp2 is required for CD4+ T cell development and function, we derived mice with conditional Pcbp2 deletion in CD4+ T cells and assessed their overall phenotype and proliferative responses to activating stimuli. We found that Pcbp2 is essential for T conventional cell (Tconv) proliferation, working through regulation of co-stimulatory signaling. Pcbp2 deficiency in the CD4+ lineage did not impact Treg abundance in vivo or function in vitro. In addition, our data demonstrate a clear association between Pcbp2 control of Runx1 exon 6 splicing in CD4+ T cells and a specific role for Pcbp2 in the maintenance of peripheral CD4+ lymphocyte population size. Last, we show that Pcbp2 function is required for optimal in vivo Tconv cell activation in a T cell adoptive transfer colitis model system.

Background The reduction of bone mineral density and osteoporosis have high impacts on the health of patients with inflammatory bowel diseases (IBD). We have previously shown that a dysregulated iron metabolism occurs in IBD and leads to a decrease in circulating iron concentration and excessive intracellular sequestration of iron. Studies suggest that iron overload significantly affects the bone, accelerating osteoclast (OC) differentiation and activation, promoting bone resorption. Moreover, we demonstrated that iron overload causes OC overactivity. The cannabinoid receptor type 2 (CB2) and the transient receptor potential vanilloid type-1 (TRPV1) are potential therapeutic targets for bone diseases. The aim of this study was to evaluate the roles of CB2 and TRPV1 receptors and of iron in the development of osteoporosis in pediatric IBD. Methods We differentiated OCs from peripheral blood mononuclear cells of patients with IBD and healthy donors and evaluated CB2 and TRPV1 receptor expression; OC activity, and iron metabolism by Western blot, TRAP assays, bone resorption assays, and iron assays. Moreover, we analyzed the effects of the pharmacological modulation of CB2 and TRPV1 receptors on OC activity and on the iron metabolism. Results We confirmed the well-known roles of CB2 and TRPV1 receptors in bone metabolism and suggested that their stimulation can reduce the OC overactivity induced by iron, providing new insights into the pathogenesis of pediatric IBD-related bone resorption. Conclusions Stimulation of CB2 and TRPV1 could reduce IBD-related osteoporosis due to their direct effects on OC activity and to modulating the iron metabolism.

Background Besides major clinical/biochemical features, neutropenia and inflammatory bowel disease (IBD) constitute common complications of Glycogen storage disease type Ib (GSD Ib). However, their management is still challenging. Although previous reports have shown benefit of empagliflozin administration on neutropenia, no follow-up data on bowel (macro/microscopic) morphology are available. We herein present for the first time longitudinal assessment of bowel morphology in a GSD Ib child suffering from Crohn disease-like enterocolitis treated with empagliflozin. Case presentation A 14-year-old boy with GSD Ib and severe IBD was (off-label) treated with empagliflozin (20 mg/day) after informed oral and written consent was obtained from the patient’s parents. No adverse events were noted. Clinical symptoms and stool frequency improved within the first week of treatment. Pediatric Crohn disease activity index (PCDAI) normalised within the first month of treatment. Abdomen magnetic resonance imaging (MRI) performed 3 months after treatment initiation showed dramatic decrease in disease activity and length. Similar findings were reported on histology at 5.5 months. At 7.5 months hemoglobin levels normalised and fecal calprotectin almost normalised. Improved neutrophil count, metabolic control and quality of life were also noted. G-CSF dose was decreased by 33% and the patient was partly weaned from tube feeding. Conclusions This is the first report presenting extensive gastrointestinal morphology follow-up in a GSD Ib patient receiving empagliflozin. The present case suggests that empagliflozin can be safe and effective in inducing IBD remission in GSD Ib patients and can even postpone surgery. Future studies are required to confirm its effect over time and assess its benefit in various disease stages. The development of an international collaborating networks for systematic data collection is worthy.

Purpose of review Despite its recognized efficacy and tolerability profile, during the last decade a rise of adverse events following ibuprofen administration in children has been reported, including a possible role in worsening the clinical course of infections. Our aim was to critically evaluate the safety of ibuprofen during the course of pediatric infectious disease in order to promote its appropriate use in children. Recent findings Ibuprofen is associated with severe necrotizing soft tissue infections (NSTI) during chickenpox course. Pre-hospital use of ibuprofen seems to increase the risk of complicated pneumonia in children. Conflicting data have been published in septic children, while ibuprofen in the setting of Cystic Fibrosis (CF) exacerbations is safe and efficacious. No data is yet available for ibuprofen use during COVID-19 course. Summary Ibuprofen should not be recommended for chickenpox management. Due to possible higher risks of complicated pneumonia, we suggest caution on its use in children with respiratory symptoms. While it remains unclear whether ibuprofen may have harmful effects during systemic bacterial infection, its administration is recommended in CF course. Despite the lack of data, it is seems cautious to prefer the use of paracetamol during COVID-19 acute respiratory distress syndrome in children.

Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2, spreading in Italy during the first months of 2020, abruptly changed the way of practicing medicine in this country. As a consequence of the lockdown, the diagnostic and therapeutic management of paediatric chronic conditions, such as inflammatory bowel disease (IBD) has been affected. During the peak of COVID-19 pandemic, elective visits, endoscopies and infusions have been postponed, with potential clinical and psychological impact on disease course and a high likelihood of increasing waiting lists. While slowly moving back towards normality, clinicians need to recognize the best ways to care for patients with IBD, carefully avoiding risk factors for new potential epidemic outbreaks. In this uncertain scenario until the development and spread of COVID-19 vaccine, it is necessary to continue to operate with caution. Hereby we provide useful indications for a safer and gradual restarting of routine clinical activities after COVID-19 peak in Italy.

Background: The new concept of disease remission for pediatric inflammatory bowel diseases (IBD) implies the achievement of mucosal healing. Aims: We aimed to evaluate endoscopic and histologic healing in children with Ulcerative Colitis (UC) and Crohn's disease (CD) in clinical remission after 52 weeks of Azathioprine. Methods: From December 2012 to July 2015 we prospectively enrolled IBD children starting Azathioprine. Enrolled patients in clinical remission underwent colonoscopy after 52 weeks. Macroscopic assessment was described with Mayo score and the simplified endoscopic score for UC and CD, respectively. For microscopic assessment, an average histology score was used. Data on inflammatory markers and fecal calprotectin were also collected. Results: Fourty-seven patients were included in the analysis. Endoscopic healing was detected in 20/26 (76.9%) UC children and 10/21 (47.6%) CD patients. Median Mayo score and simplified endoscopic score were significantly decreased at week 52 (p < 0.001; p = 0.005). Median average histology score was not significantly different at week 52 in both diseases. Fecal calprotectin was directly correlated with simplified endoscopic score (T0: r = 0.4, p = 0.05; T52: r = 0.5, p = 0.01), but not with Mayo score. No correlation was found between endoscopic and histologic scores. Conclusions: IBD children under Azathioprine reach endoscopic healing, but not histological remission.

The primary role of environment on inflammatory bowel disease (IBD) onset has been recently stressed. We aimed to investigate the effect of environmental factors in an IBD pediatric cohort.A total of 467 subjects (264 IBD and 203 controls) were enrolled. All patients underwent a questionnaire including 5 different groups of environmental risk factors: family history of IBD and autoimmune diseases, perinatal period, home amenities and domestic hygiene, childhood diseases and vaccinations, and diet.In a multivariate model, mother's degree (odds ratio [OR]: 5.5; 2.5-11.6), duration of breast feeding3rd month (OR: 4.3; 1.6-10.5), father's employment (OR: 3.7; 1.2-8.7), gluten introduction6th month (OR: 2.8; 1.5-5), number of siblings2 (OR: 2.8; 1.5-5.3), and family history of autoimmune diseases (OR: 2.7; 1.4-5.3) were significant risk factors for Crohn disease. Low adherence to Mediterranean diet (OR: 2.3; 1.2-4.5), gluten introduction6th month (OR: 2.8; 1.6-4.9), and number of siblings2 (OR: 2; 1.1-3.6) were significant risk factors for ulcerative colitis. Owning pets (OR: 0.3; 0.1-0.7) and bed sharing (OR: 0.2; 0.1-0.6) were protective factors for Crohn disease, whereas owning pets (OR: 0.4; 0.2-0.8) and family parasitosis (OR: 0.07; 0.01-0.4) were protective factors for ulcerative colitis.Our study confirms that environmental factors are closely linked to IBD onset and may partly explain IBD rise in developed countries.

BackgroundVaccine-preventable diseases and opportunistic infections in pediatric inflammatory bowel disease (IBD) are increasingly recognized issues. The aims of this study were to evaluate vaccinations, immunization status, and consequent therapeutic management in children with IBD and to analyze the differences among patients diagnosed before (Group 1) and after June 2012 (Group 2).MethodsThis was a multicenter, retrospective cohort investigation. Between July 2016 and July 2017, 430 children with IBD were enrolled in 13 centers. Diagnosis, therapeutic history, vaccinations, and immunization status screening at diagnosis and at immunosuppressant (IM)/biologic initiation and reasons for incomplete immunization were retrieved.ResultsVaccination rates at diagnosis were unsatisfactory for measles, mumps, and rubella (89.3%), Haemophilus influenzae (81.9%), meningococcus C (23.5%), chickenpox (18.4%), pneumococcus (18.6%), papillomavirus (5.9%), and rotavirus (1.9%). Complete immunization was recorded in 38/430 (8.8%) children, but specific vaccines were recommended in 79/430 patients (18.6%), without differences between the 2 groups. At IM start, 22% of children were tested for Epstein-Barr virus (EBV) status, with 96.2% of EBV-naïve patients starting azathioprine, without differences between Groups 1 and 2. Screening for latent tuberculosis (TB) before start of biologics was performed in 175/190 (92.1%), with up to 9 different screening strategies and numerous inconsistencies.ConclusionsWe demonstrated a poor immunization status at diagnosis in children with IBD, which was not followed by proper vaccination catch-up. EBV status before IM initiation and latent TB before biologics were not adequately assessed. Thus, the overall impact of the current guidelines seems unsatisfactory.