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Organic forms of phosphorus (P) account for over half of the total P present in most soils and make a significant contribution to P cycling and plant nutrition through the actions of various plant and microbial phosphatase enzymes. However, not much is known about the bacterial communities harbouring phosphatase genes, either in composition, abundance, or transcriptional activity. Thus a grassland trial was selected that was undergoing long-term management of plant biomass removal/retention. Treatment plots were sampled after 22 years to examine the impact of prolonged nutrient depletion on bacterial communities helping to mediate organic P turnover. Total bacteria, total fungi, alkaline phosphatase (phoD) and the three classes (A, B, C) of non-specific acid phosphatases (NSAPs) were quantified and amplicons of the phoD and NSAP genes were sequenced. Of the genes quantified, class B (CBAP) genes were positively impacted by biomass removal (p < 0.01). Phosphatase gene transcripts generally appeared to increase in the biomass removed plots, but perhaps only weakly differentiated at this one time point. In the removed plots, we identified the class A (CAAP) community as the most significantly differentiated (p < 0.05). This difference was found strongly at the level of the operational taxonomic unit, indicating that changes in composition are reflective of the biomass management. Several key differentiating bacteria were found, many of which shared a closest known identity to Stenotrophomonas spp. Further, Mantel tests also revealed strong associations of NSAP communities CAAP and CCAP to measures of soil biogeochemistry. The findings of this study further support the importance of microbial mediated P cycling and in the contribution of under-studied P cycling enzymes such as bacterial acid phosphatases. • The class A NSAP community was distinct after 22 years of biomass removal. • The class A NSAP community was highly associated with soil biogeochemistry. • Biomass removal resulted in a higher abundance of class B NSAP genes. • Biomass removal lead to elevated phosphatase gene transcript abundance. • In silico analysis estimated high target specificity using these NSAP primers. [ABSTRACT FROM AUTHOR]

Wind-blown dust deposits are considered one of the most important terrestrial archives for past climate change studies. In the Southern Hemisphere, the Pampean loess is the most extensive paleo-dust record, whose origin is still a matter of debate. In this paper, grain-size was carried out at three high-resolution loess profiles deposited during the late Pleistocene-early Holocene and for present-day dust collected on the Pampean plain. Based on comparing loess records with in situ present-day dust, this work aims to provide constraints on the climatic conditions that allowed deposition of the Argentinean loess mantle. Unmixing methods allow differentiating three grain-size subpopulations/end members in the Pampean loess which are comparable to end members found in present-day dust. The provenance and transport conditions observed for present-day dust were used to infer that the fine silt components of Pampean loess were transported by high-level air stream associated with the deflation of the Puna-Altiplano Plateau. On the other side, the coarse-silt sediments were carried by dust storms associated with high transport energy events taking place in proximal dust sources. In the central Pampas, the increased abundance of coarse-silt sediments during the Antarctic Cold Reversal (ACR) may indicate the existence of an increased frequency of dust storm episodes. During the beginning of the Holocene, the rise in fine-silt loess could be linked to the activation of distant sources associated with lake desiccation in the Puna-Altiplano Plateau. [ABSTRACT FROM AUTHOR]

This work investigates the impact of ENSO on aerosols and lightning activity in subtropical South America (SSA). An analysis of the interannual variability of Aerosol Optical Depth (AOD), Ångström Exponent (AE) and different cloud parameters using MODIS satellite datasets and the lightning activity based on the lightning observations from the World Wide Lightning Location Network was performed. High positive AE, AOD anomalies and high lightning activity were found in the northeastern region of SSA during the Super El Niño event during 2015/2016 in latter spring and summer. The Pearson correlation coefficients between these aerosol parameters and monthly discharges were higher than 0.7 in the northeastern region during the Super El Niño. These positive correlations, which have been widely reported in previous studies, were explained considering the vegetation cover, consisting mainly of subtropical forests in the northeastern region of SSA, and the increase in rainfall during El Niño in this area in spring and summer. The increases in AOD and AE during latter spring and summer in the northeastern region were therefore related to the release of biological aerosols and to aerosols emission mechanisms independent of the background aerosol concentration, respectively. The increase in lightning activity was related to the role of these released aerosols as ice nuclei particles and/or as cloud condensation nuclei, affecting cloud properties and thus the lightning activity. The results reported in this work show the effect of the Super El Niño on aerosol and lightning activity and, in this way on aerosol-cloud interactions. • Aerosol Optical Depth (AOD) and Ångström Exponent (AE) anomalies were analyzed in subtropical South America (SSA). • High AOD and AE anomalies were found during the Super El Niño in latter spring and summer in northeastern SSA. • Monthly discharges followed the same behavior as AE and AOD anomalies in northeastern SSA in latter spring and early summer. • Monthly discharges and AE and AOD anomalies showed positive correlations in northeastern SSA during the Super El Niño. • These results evidenced an effect of the Super El Niño on aerosol properties and lightning activity. [ABSTRACT FROM AUTHOR]

Major ions, pH and electrical conductivity (EC) were analyzed in rainwater samples collected at Salta city (NW Argentina) during the summer seasons of years 2010-2011 and 2011-2012. Precipitations in the area are characterized by low total dissolved load and slightly acidic pH. The pH values are in agreement with low concentrations of anthropogenic acid species such as NO3− and SO42− and consistent with a low urban development. Data indicate that the high concentrations of dissolved Ca are probably associated with the existence of marble quarry mining in the valley. According to a below-cloud process, it is observed that during the dry season, dust particles and contaminants are concentrated in the lower troposphere and washed-out immediately after a rainfall occurred. This process is in part responsible for the chemical composition of the local rainwater. Apart from quarry mining activity, the area does not have significant extra atmospheric pollution linked to anthropogenic sources. The new data permit to establish the baseline of the chemical composition of the local rainwater. [ABSTRACT FROM AUTHOR]

Paleoclimatic reconstruction is critical for understanding present-day climate and for testing models that are currently used to predict future climatic changes. Different climatic conditions produce different clay minerals that can be recorded in geological archives providing insights into past weathering scenarios. However, in southern South America, scarce information is available from clay mineral assemblages found in aeolian sediments, such as loess deposits. Moreover, there is a lack of studies employing clay minerals for paleoclimatic reconstruction at dust sources and loess deposits. Therefore, this work explores clay mineral composition of modern dust source areas in southern South America and in the pampean loess records to gain insight into paleoenvironmental conditions prevailing during the late Pleistocene-early Holocene in the region. Clay minerals recovered from the loess deposits are of an allochthonous origin, implying their formation at the 'arid diagonal', then blown away, and deposited downwind in the Pampas without post-depositional changes. Clay mineral assemblages indicate that these minerals and rare earth elements (REE) analyzed in two loess sections of the Pampean Plain helped to reconstruct past climatic scenarios in the dust source areas during the transition from the last glacial to the current interglacial period. Furthermore, our work contributes to the assessment of the strengthening/weakening of the different South American dust sources in light of recent published geochemical and textural evidence. [ABSTRACT FROM AUTHOR]

Microbial community structure and function were assessed in the organic and upper mineral soil across a ~4000‐year dune‐based chronosequence at Big Bay, New Zealand, where total P declined and the proportional contribution of organic soil in the profile increased with time. We hypothesized that the organic and mineral soils would show divergent community evolution over time with a greater dependency on the functionality of phosphatase genes in the organic soil layer as it developed. The structure of bacterial, fungal, and phosphatase‐harbouring communities was examined in both horizons across 3 dunes using amplicon sequencing, network analysis, and qPCR. The soils showed a decline in pH and total phosphorus (P) over time with an increase in phosphatase activity. The organic horizon had a wider diversity of Class A (phoN/phoC) and phoD‐harbouring communities and a more complex microbiome, with hub taxa that correlated with P. Bacterial diversity declined in both horizons over time, with enrichment of Planctomycetes and Acidobacteria. More complex fungal communities were evident in the youngest dune, transitioning to a dominance of Ascomycota in both soil horizons. Higher phosphatase activity in older dunes was driven by less diverse P‐mineralizing communities, especially in the organic horizon. [ABSTRACT FROM AUTHOR]

Accidents are the main cause of injury in children, more than half events happen at home. Aims of this study were to assess if SARS-CoV-2 lockdown influence emergency department (ED) visits due to children domestic accident (DAs) and to identify factors associated with hospitalization. This was a multicentre, observational, and retrospective cohort study involving 16 EDs in Italy and enrolling children (3–13 years) receiving a visit in ED during March–June 2019 and March–June 2020. Risk factors for hospitalization were identified by logistic regression models. In total, 8860 ED visits due to domestic accidents in children occurred before (4380) and during (4480) lockdown, with a mean incidence of DA of 5.6% in 2019 and 17.9% in 2020 (p < 0.001) (IRR: 3.16; p < 0.001). The risk of hospitalization was influenced by the type of occurred accident, with fourfold higher for poisoning and twofold lower risk for stab-wound ones. In addition, a higher risk was reported for lockdown period vs 2019 (OR: 1.9; p < 0.001), males (OR: 1.4; p < 0.001), and it increased with age (OR: 1.1; p < 0.001). Conclusions: The main limitation of this study is the retrospective collection of data, available only for patients who presented at the hospital. This does highlight possible differences in the total number of incidents that truly occurred. In any case, the COVID-19 lockdown had a high impact on the frequency of DAs and on hospitalization. A public health campaign aimed at caregivers would be necessary to minimize possible risks at home. What is Known: • In Italy, domestic accidents are the second leading cause of paediatric mortality after cancer. • During the first SARS-CoV-2 lockdown in 2020, a sharp decrease in the total number of Emergency Departments visits for all causes was observed, both in children and in adults. What is New: • During the first SARS-CoV-2 lockdown in 2020, domestic accidents involving children increased threefold from the previous year. • Higher risk of hospitalization was showed in minors accessing during 2020 vs 2019, in males than in females and it increased with advancing age. Considering the type of injury, a significant higher risk of hospitalization for poisoning was observed. [ABSTRACT FROM AUTHOR]

Phosphorus (P) is a limiting nutrient in many environments but plants and microbes have evolved with mechanisms for acquiring soil P, including the excretion of phosphatase enzymes. Molecular analysis of bacterial phosphatase genes can provide insight into biological P transformations and the contribution to soil P availability and plant uptake. To assess these relationships, soil and plant samples were collected from 12 organically-managed soybean fields varying in pH, labile P concentration, and potential phosphatase activity (pH 6.5) across Prince Edward Island, Canada. Real-time PCR was used to quantify bacterial phosphatase genes ( phoC and phoD ) in bulk and rhizosphere soil. Primers targeting class A ( phoC ) of the bacterial non-specific acid phosphatases (NSAPs) were designed and confirmed as effectively targeting phoC genes through sequencing, and phylogenetic comparison with acid phosphatase genes from Genbank. Across all sites, we found that labile P in bulk soil was negatively correlated with phoC and phoD gene abundance and phosphatase activity. In addition, phosphatase activity was consistently higher in rhizosphere compared to bulk soil and was significantly correlated with phoC (bulk soil only) and phoD (rhizosphere soil only) gene abundance. A positive relationship was observed between phosphatase activity, nodule weight, and plant P uptake. Quantification of bacterial genes involved in organic P transformations has been limited, with this study providing the first attempt at quantifying phoC genes in field soils. [ABSTRACT FROM AUTHOR]

The main Patagonian rivers (Colorado, Negro, Chubut, Deseado, Coyle, Chico, Santa Cruz and Gallegos) were sampled between September 1995 and November 1998 to determine their chemical and isotopic compositions, the origins of the suspended and dissolved river loads and their inputs to the South Atlantic Ocean. This paper focuses on the dissolved inorganic carbon (DIC) transport and its δ13C isotopic signature. The δ13CDIC values vary between −12·8 and −1·8‰ and allow one to distinguish two river groups: (i) the Colorado, Negro, Chubut and Santa Cruz, which display the highest values and the lowest seasonal variations; (ii) the Deseado, Coyle, Chico and Gallegos, which show the lowest values and the highest seasonal variations. For the first group, δ13CDIC is mainly controlled by important exchanges between the river waters and atmospheric CO2, due to the presence of lakes and dams. For the second group, δ13CDIC also appears to be controlled by the oxidation of organic carbon, showing a negative relationship between δ13CDIC and the dissolved organic carbon. These biogeochemical processes interfere with the contribution of carbonate and silicate weathering to the riverine DIC and do not allow use of δ13CDIC alone to distinguish these contributions.The annual DIC flux exported by Patagonian Rivers to the South Atlantic Ocean averages 621 × 109 g. of C, i.e. a specific yield of 2·7 g m−2 year−1. The mean δ13CDIC can be estimated to − 4·9‰, which is high compared with other rivers of the world. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Suquia is a semiarid (rainfall, 700--900 mm y{sup}-1{end}), medium-size (7700 km{sup}2{end}) river system located in central Argentina. Its mountainous upper catchment includes pristine areas as well asa variety of human settlements and a reservoir lake. A large city (Cordoba, ca. 1.3 million inhabitants) and a terminal hypersaline lake are included in the middle and lower basin. Total non-residual (TNR) heavy metals (Pb, Cu, Ni, Zn, Mn, and Fe) have been determined in river bed sediments in two seasons (spring and autumn), seeking to establish the factors which control the temporal and spatial variability. The major findings were: a) concentrations of TNR metals were, in general, higher during springtime than during autumn, particularly downstream from the city of Cordoba; b) organic matter played a significant role as a controlling factor wherever it defined reducing conditions, lowering the concentrations of Mn and Fe hydrous oxides; c) a higher organic load (e.g., downstream the city) and more pronounced reducing conditions could be the causes for the increased Fe concentration, probably precipitated as sulfides; d) organic matter exhibited a closer correlation with some TNR metals in autumn, probably caused by alarger capacity for complexation in the biologically-processed organic debris; and, e) the existence of pristine areas in the drainage basin allowed for the calculation of enrichment factors (EF) which showthe significance of several environmental impacts in the Suquia system. [ABSTRACT FROM AUTHOR]

Where atmospheric processing is weak due to low anthropogenic emissions, fertilization of iron-limited oceans by non-volcanic mineral dust aerosols strongly depends on iron solubility at the sources. Southern South America (SSA) is a pristine environment and the main dust supplier to the southern oceans, the most sensitive to iron fertilization. Thus, the present-day lack of SSA dust fertilization of the southern oceans is hypothesized to reflect low source-inherited iron bioavailability. However, a dearth of geochemical studies on SSA dust prevents testing this hypothesis. To remedy this, we conducted the first systematic sampling of SSA dust sources. Iron leaching experiments showed fractional solubilities of close-to-source dust (bulk) and dust-emitting surface sediments (<63 µm) in pure water (0.05 ± 0.05%), seawater (0.03 ± 0.04%) and 1% nitric acid (5 ± 6%) that imply a low mass-normalized fertilization potential of SSA dust compared to dust from other regions. Based on grain size, size-resolved mineralogy, elemental chemistry and iron speciation determinations, we found that variability in labile iron is enhanced by high clay contents, small grain size and higher proportions of paramagnetic versus non-paramagnetic iron, irrespective of oxidation state. The independence of the most labile, water-soluble iron on grain size and its strong negative correlation to the Chemical Index of Alteration may imply that we currently underestimate the role of coarse glaciogenic dust as a supplier of bioavailable iron during drier-than-present ice ages when continental chemical weathering was reduced, and during which enhanced supply of dust-borne bioavailable iron to the southern oceans is observed. [ABSTRACT FROM AUTHOR]

Reconstructions of the deposition rate of windblown mineral dust in ocean sediments offer an important means of tracking past climate changes and of assessing the radiative and biogeochemical impacts of dust in past climates. Dust flux estimates in ocean sediments have commonly been based on the operationally defined lithogenic fraction of sediment samples. More recently, dust fluxes have been estimated from measurements of helium and thorium, as rare isotopes of these elements (He-3 and Th-230) allow estimates of sediment flux, and the dominant isotopes (He-4 and Th-232) are uniquely associated with the lithogenic fraction of marine sediments. In order to improve the fidelity of dust flux reconstructions based on He and Th, we present a survey of He and Th concentrations in sediments from dust source areas in East Asia, Australia and South America. Our data show systematic relationships between He and Th concentrations and grain size, with He concentrations decreasing and Th concentrations increasing with decreasing grain size. We find consistent He and Th concentrations in the fine fraction (<5 μm) of samples from East Asia, Australia and Central South America (Puna-Central West Argentina), with Th concentrations averaging 14 μg/g and He concentrations averaging 2 μcc STP/g. We recommend use of these values for estimating dust fluxes in sediments where dust is dominantly fine-grained, and suggest that previous studies may have systematically overestimated Th-based dust fluxes by 30%. Source areas in Patagonia appear to have lower He and Th contents than other regions, as fine fraction concentrations average 0.8 μcc STP/g and 9 μg/g for 4 He and 232 Th, respectively. The impact of grain size on lithogenic He and Th concentrations should be taken into account in sediments proximal to dust sources where dust grain size may vary considerably. Our data also have important implications for the hosts of He in long-traveled dust and for the 3 He/ 4 He ratio used for terrigenous He in studies of extraterrestrial He in sediments and ice. We also investigate the use of He/Th ratios as a provenance tracer. Our results suggest differences in fine fraction He/Th ratios between East Asia, Australia, central South America and Patagonia, with ratios showing a positive relationship with the geological age of source rocks. He/Th ratios may thus provide useful provenance information, for example allowing separation of Patagonian sources from Puna-Central West Argentina or Australian dust sources. He/Th ratios in open-ocean marine sediments are similar to ratios in the fine fraction of upwind dust source areas. He/Th ratios in mid-latitude South Atlantic sediments suggest that dust in this region primarily derives from the Puna-Central West Argentina region (23–32°S) rather than Patagonia (>38°S). In the equatorial Pacific, He/Th ratios are much lower than in extratropical Pacific sediments or potential source areas measured as a part of this study (East Asia, South America, Australia) for reasons that are at present unclear, complicating their use as provenance tracers in this region. [ABSTRACT FROM AUTHOR]

Records of wind-blown mineral dust provide an excellent proxy of past atmospheric circulation, a key parameter to understanding Earth's climate changes. Dust deposition at distal sites depends on atmospheric conditions both in sink areas, along transport pathways, and close to dust sources. To disentangle the contributions of changes in these conditions to distal dust deposition, it is necessary to retrieve complementary information from geological dust archives at different distances from sources. In the Southern Hemisphere, paleo-dust recorded at proximal loess remains under-studied compared to dust recorded at medium- and long-range archives. Here, we expand previous sampling of southern South America's Pampean loess. New age models based on luminescence dating of potassium feldspar imply minimum dust mass accumulation rates during the early part of the Last Glacial Maximum (LGM) across all three sampled sites, in opposition to coeval maximum dust deposition in the East Antarctic Plateau (EAP). In turn, provenance analysis based on neodymium and strontium isotopes suggests that <5-μm loess mostly derived from the Puna-Altiplano Plateau (PAP). In EAP, unmixing of neodymium, strontium and lead isotopic signals confirms that LGM dust mostly derived from southern South America (contrasting with Holocene EAP dust records that suggest a combined dust contribution from southern South America and Australia), either from southern central-western Argentina or from a combination of Patagonia/Tierra del Fuego and southern Puna in the PAP. Our results favor this second scenario, in which the coincidence of minimum dust deposition in the Pampas and maximum deposition in the EAP during the LGM is in part associated with reduced close-to-source wet scavenging of fine-grained dust due to more local arid conditions and less frequent rainfall, allowing more vigorous long-range transport of southern Puna dust. • The isotopic signal of last glacial East Antarctic dust is mostly from South America. • Last glacial Pampean loess accumulation contrasts with Antarctic dust deposition. • Radiogenic isotopes suggest a Puna-Altiplano origin for <5-μm Pampean loess. • Enhanced Pampean aridity reduced dust wet scavenging during the Last Glacial Maximum. • East Antarctic last glacial dust has a mixed Patagonia and Puna origin. [ABSTRACT FROM AUTHOR]

Introduction: Impaired testosterone secretion is a frequent sequela following hematopoietic stem cell transplantation (HSCT) in pediatrics, but long-term longitudinal trendlines of clinical and biochemical findings are still scanty., Methods: Monocentric, retrospective analysis. Male patients transplanted <18 years between 1992 and 2021, surviving ≥2 years after HSCT and showing, upon enrollment, clinical and biochemical signs consistent with pubertal onset and progression were included. Clinical and biochemical data collected every 6-12 months were recorded., Results: Of 130 patients enrolled, 56% were prepubertal, while 44% were peri-/postpubertal upon HSCT. Overall, 44% showed spontaneous progression into puberty and normal gonadal profile, while the remaining experienced pubertal arrest (1%), isolated increase of FSH (19%), compensated (23%) or overt (13%) hypergonadotropic hypogonadism. Post-pubertal testicular volume (TV) was statistically smaller among patients still pre-pubertal upon HSCT ( p 0.049), whereas no differences were recorded in adult testosterone levels. LH and testosterone levels showed a specular trend between 20 and 30 years, as a progressive decrease in sexual steroids was associated with a compensatory increase of the luteinizing hormone. A variable degree of gonadal dysfunction was reported in 85%, 51%, 32% and 0% of patients following total body irradiation- (TBI), busulfan-, cyclophosphamide- and treosulfan-based regimens, respectively. TBI and busulfan cohorts were associated with the lowest probability of gonadal event-free course ( p <0.0001), while it achieved 100% following treosulfan. A statistically greater gonadotoxicity was detected after busulfan than treosulfan ( p 0.024). Chemo-only regimens were associated with statistically larger TV ( p < 0.001), higher testosterone ( p 0.008) and lower gonadotropin levels ( p < 0.001) than TBI. Accordingly, the latter was associated with a 2-fold increase in the risk of gonadal failure compared to busulfan (OR 2.34, CI 1.08-8.40), whereas being pre-pubertal upon HSCT was associated with a reduced risk (OR 0.15, CI 0.08-0.30)., Conclusions: a) patients pre-pubertal upon HSCT showed a reduced risk of testicular endocrine dysfunction, despite smaller adult TV; b) patients showed downwards trend in testosterone levels after full pubertal attainment, despite a compensatory increase in LH; c) treosulfan was associated to a statistically lower occurrence of hypogonadism than busulfan, with a trend towards larger TV, higher testosterone levels and lower gonadotropins., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2023 Cattoni, Nicolosi, Capitoli, Gadda, Molinari, Louka, Buonsante, Orlandi, Salierno, Bellani, Vendemini, Ottaviano, Gaiero, Fichera, Biondi and Balduzzi.)

Background: Drowning is a serious and underestimated public health problem, with the highest morbidity and mortality reported among children. Data regarding pediatric outcomes of drowning are often inadequate, and data collection is poorly standardized among centers. This study aims to provide an overview of a drowning pediatric population in pediatric emergency department, focusing on its main characteristics and management and evaluating prognostic factors., Methods: This is a retrospective multicenter study involving eight Italian Pediatric Emergency Departments. Data about patients between 0 to 16 years of age who drowned between 2006 and 2021 were collected and analyzed according to the Utstein-style guidelines for drowning., Results: One hundred thirty-five patients (60.9% males, median age at the event 5; interquartile range, 3-10) were recruited and only those with known outcome were retained for the analysis (133). Nearly 10% had a preexisting medical conditions with epilepsy being the most common comorbidity. One third were hospitalized in the intensive care unit (ICU) and younger males had a higher rate of ICU admission than female peers. Thirty-five patients (26.3%) were hospitalized in a medical ward while 19 (14.3%) were discharged from the emergency department and 11 (8.3%) were discharged after a brief medical observation less than 24 hours. Six patients died (4.5%). Medium stay in the ED was approximately 40 hours. No difference in terms of ICU admission was found between cardiopulmonary resuscitation performed by bystanders or trained medical personnel ( P = 0.388 vs 0.390)., Conclusions: This study offers several perspectives on ED victims who drowned. One of the major finding is that no difference in outcomes was seen in patients who received cardiopulmonary resuscitation performed by bystanders or medical services, highlighting the importance of a prompt intervention., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Thyroid late effects are among the most frequent sequelae reported after pediatric hematopoietic stem cell transplantation (HSCT). Although the detrimental effects of radiotherapy on the developing thyroid gland have been extensively assessed, the role of chemotherapy-only conditioning regimens remains controversial. We aimed to describe the occurrence, monitoring, and management of thyroid function disorders (ie, Graves disease, Hashimoto thyroiditis, and nonautoimmune hypothyroidism), nodules, and volumetric changes over a 20-year observation period in a single pediatric transplantation unit. In addition, we assessed the impact of different conditioning regimens on thyroid health. The study population for this retrospective observational analysis comprised 244 pediatric patients who underwent HSCT for malignant or nonmalignant diseases between 1999 and 2018 and for whom at least 4 thyroid function tests and 1 or more thyroid ultrasound(s) assessed sequentially after HSCT were available. The 15-year cumulative incidence of either autoimmune or nonautoimmune thyroid dysfunctions (34%, SE 5.3%) did not differ statistically between total body irradiation (TBI)-based and chemotherapy-based regimens (P = .23). Indeed, the cumulative incidence after busulfan (Bu)-based conditioning was overall superimposable to that recorded after TBI (10-year cumulative incidence, 22.2% versus 25.9%, respectively). Nevertheless, the cumulative incidence of nonautoimmune hypothyroidism was statistically higher after Bu-based conditioning (12.4%, SE 3.7%) than after other chemotherapy-only-based conditioning regimens (3.1%, SE 3.1%; P = .02, 5-year cumulative incidence), treosulfan (Treo) included. The overall cumulative incidence of nodules was low for the first 5 years after HSCT (1.9%, SE .9%) but subsequently increased steeply over time, with a 15-year cumulative incidence as high as 52.1% (SE 7.5%). TBI-conditioned patients had a higher 15-year cumulative incidence of nodules (66.8%, SE 9.1%) compared with patients receiving chemotherapy-only regimens (33.6%, SE 9.5%; P = .02), whereas age >10 years at transplantation showed a protective effect (hazard ratio, .42, 95% confidence interval, .2 to .88). Finally, a systematic sonographic follow-up highlighted a progressive statistically significant reduction in thyroid anteroposterior diameter among patients conditioned with TBI (P = .005), but not in those who received chemotherapy-only regimens. TBI and younger age at HSCT have a statistically significant detrimental effect on the occurrence of thyroid nodules, both benign and malignant. TBI and Bu expose patients to a higher cumulative incidence of thyroid dysfunction compared with other chemotherapy-only regimens, Treo included. Accordingly, Bu can be considered the most thyrotoxic agent among those administered as a part of a chemotherapy-only conditioning regimen. Finally, patients conditioned with TBI, but not those with other regimens, show a progressive decrease in thyroid volume over time, as assessed by sequential ultrasound examinations., (Copyright © 2022 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)

Aims: Diabetic ketoacidosis is the most severe metabolic derangement due to prolonged insulin deficiency as in type 1 diabetes. Diabetic ketoacidosis, a life-threatening condition, is often diagnosed late. A timely diagnosis is mandatory to prevent its consequences, mainly neurological. The COVID-19 pandemic and lockdown have reduced the availability of medical care and access to hospitals. The aim of our retrospective study was to compare the frequency of ketoacidosis at the diagnosis of type 1 diabetes between the lockdown-post lockdown period and the previous two calendar years, in order to evaluate the impact of the COVID-19 pandemic., Patients and Methods: We retrospectively assessed the clinical and metabolic data at the diagnosis of type 1 diabetes in children in the Liguria Region during 3 different time periods: calendar year 2018 (Period A), calendar year 2019 until February 23,2020 (Period B) and from February 24, 2020 onwards to March 31, 2021 (Period C)., Results: We analyzed 99 patients with newly-diagnosed T1DM from 01/01/2018 to 31/03/2021. Briefly, a younger age at diagnosis of T1DM was observed in Period 2 compared to Period 1 (p = 0.03). The frequency of DKA at clinical onset of T1DM was similar in Period A (32.3%) and Period B (37.5%), while it significantly increased in Period C (61.1%) compared to Period B (37.5%) (p = 0.03). PH values were similar in Period A (7.29 ± 0.14) and Period B (7.27 ± 0.17), while they were significantly lower in Period C (7.21 ± 0.17) compared to Period B (p = 0.04)., Conclusions: An increase in the frequency of diabetic ketoacidosis has been documented in newly diagnosed pediatric patients in the Liguria Region during and after the lockdown period compared to previous calendar years. This increase could have been caused by the delay in diagnosis following the restrictions imposed by the lockdown with consequently reduced access to health care facilities. More information on the risks of ketoacidosis is desirable by means of social and medical awareness campaigns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 d’Annunzio, Bassi, De Rose, Lezzi, Minuto, Calevo, Gaiero, Fichera, Borea and Maghnie.)