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Stored non-structural carbohydrates (NSC) have been proposed as a key determinant of drought resistance in plants. However, the evidence for this role is controversial, as it comes mostly from observational, short-term studies. Here, we take advantage of a long-term experimental throughfall reduction to elucidate the response of NSC to increased drought 14 years after the beginning of the treatment in three Mediterranean woody species (Quercus ilex L., Arbutus unedo L. and Phillyrea latifolia L.). In addition, we selected 20 Q. ilex individuals outside the experimental plots to directly assess the relationship between defoliation and NSC at the individual level. We measured the seasonal course of NSC concentrations in leaves, branches and lignotuber in late winter, late spring, summer and autumn 2012. Total concentrations of NSC were highest in the lignotuber for all species. In the long-term drought experiment we found significant depletion in concentrations of total NSC in treatment plots only in the lignotuber of A. unedo. At the same time, A. unedo was the only species showing a significant reduction in BAI under the drought treatment during the 14 years of the experiment. By contrast, Q. ilex just reduced stem growth only during the first 4 years of treatment and P. latifolia remained unaffected over the whole study period. However, we found a clear association between the concentrations of NSC and defoliation in Q. ilex individuals sampled outside the experimental plots, with lower total concentrations of NSC and lower proportion of starch in defoliated individuals. Taken together, our results suggest that stabilizing processes, probably at the stand level, may have been operating in the long-term to mitigate any impact of drought on NSC levels, and highlight the necessity to incorporate long-term experimental studies of plant responses to drought.

Aim: The aim of the study was to investigate the presence of H. pylori in the dental plaque of children, who underwent endoscopy for upper GI symptoms and correlate it with the H. priori infection status of their parents. Methods: The study sample consisted of 35 children aged 4 to 14 years old and 49 family members (mother and/or father). Gastric biopsies were collected from all the children for CLO-test, histology and culture. Serology was used to assess the H. pylori status of the parents. Subgingival plaque samples were collected from the parents and children before endoscopy. Only samples positive by two different PCR methods were considered positive for the presence of H. pylori in dental plaque. Results: Fifteen out of 35 (43%) children were considered H. pylori infected by at least two methods (CLO, histology, culture). H. pylori was detected in dental plaques of 6/15 biopsy positive children and in only 1 of the 20 biopsy negative children. The presence of H. pylori in the dental plaque was significantly associated with H. pylori detection in gastric samples from the antrum (Fisher's p=0.027). On the basis of serology, 33.3% of mothers and 45% of fathers were considered positive for H. pylori infection. Children who had H. pylori identified in their plaque belonged to families who also had H. pylori in dental plaque. The presence of H. pylori in mother's dental plaque or positive serology was associated with H. pylori infection in the respective child (p=0.008 and p=0.002 respectively). Although the same trend was also observed for the fathers, the difference was not statistically significant (p=0.11 and p=0.576 respectively). Conclusions: Dental plaque of children and their families may play an important role-acting as a "reservoir" -for H. pylori transmission. The detection of H. pylori in mother's dental plaque seems to be a critical factor for the intrafamilial spread. [ABSTRACT FROM AUTHOR]

Abstract Background Particulate matter with diameter less than 10 micrometers (PM10) that originates from anthropogenic activities and natural sources may settle in the bronchi and cause adverse effects possibly via oxidative stress in susceptible individuals, such as asthmatic children. This study aimed to investigate the effect of outdoor PM10 concentrations on childhood asthma admissions (CAA) in Athens, Greece. Methods Daily counts of CAA from the three Children's Hospitals within the greater Athens' area were obtained from the hospital records during a four-year period (2001-2004, n = 3602 children). Mean daily PM10 concentrations recorded by the air pollution-monitoring network of the greater Athens area were also collected. The relationship between CAA and PM10 concentrations was investigated using the Generalized Linear Models with Poisson distribution and logistic analysis. Results There was a statistically significant (95% CL) relationship between CAA and mean daily PM10 concentrations on the day of exposure (+3.8% for 10 μg/m3 increase in PM10 concentrations), while a 1-day lag (+3.4% for 10 μg/m3 increase in PM10 concentrations) and a 4-day lag (+4.3% for 10 μg/m3 increase in PM10 concentrations) were observed for older asthmatic children (5-14 year-old). High mean daily PM10 concentration (the highest 10%; >65.69 μg/m3) doubled the risk of asthma exacerbations even in younger asthmatic children (0-4 year-old). Conclusions Our results provide evidence of the adverse effect of PM10 on the rates of paediatric asthma exacerbations and hospital admissions. A four-day lag effect between PM10 peak exposure and asthma admissions was also observed in the older age group.

Background: H. pylori infection is common and its acquisition is mainly in young ages. It has been claimed that during early childhood intrafamilial contamination is more possible than from other sources outside home. Aim: The aim of the study was to investigate the H. pylori status within families of children with upper GI symptoms. Methods: 45 symptomatic children without previous eradication therapy aged 4-16 years (median 11yrs) were investigated by [sup 13]C-UBT as well as all their 125 family members (parents and siblings) living in the same house. Socioeconomic status and conditions of living were also investigated. Results: According to H. pylori status the index children were divided into group A: 20 (44%) who were H. pylori infected and group B: 25 (56%) who were negative for H. pylori infection. Forty four out of 57 (77%) relatives of group A were also infected, while H. pylori was found only in 19 out of 68 (28%) relatives of group B, (p=0.000). In group A 79% of fathers, 90% of mothers and 65% of siblings were found H. pylori positive, while in group B 29%, 44% and 5.2% respectively (p=0.001, p=0.01,p=0.001). There was not found any difference concerning living conditions between H. pylori positive and negative children. Conclusions: The significantly higher prevalence H. pylori infection within families of H. pylori positive symptomatic children, compared to the negative ones, supports the hypothesis that transmission of H. pylori in children could be from the infected members of the family or the same source within house. [ABSTRACT FROM AUTHOR]

Aim: To genotype in terms of cagA and vacA status, H. pylori clinical strains, isolated from children and adults in the Greek population. Materials and Methods: 45 clinical strains from children and 56 from adult patients were isolated from gastric biopsies following gastroscopy. The presence of cagA as well as subtyping of vacA mid-and signal-region was effected by PCR on genomic DNA as described by Atherton et al, 1999 and Yamaoka et al., 1999. Results: 84 (83%) out of 101 strains were detected positive for the presence of cagA (86% in the adult and 80% in the children population). Out of 79 strains analysed, 52 belonged to the vacAs1 and 27 to the vacAs2 subtype (66% and 34% respectively). Out of 74 strains analysed, 23 (31%) were of the vacAm1 and 48 (65%) vacAm2 subtypes while 3 (4%) remained untypeable. The combinations of vacA subtypes observed are summarized in the following table: We did not detect the vacAs2/m1 subtype in the sample population. Conclusion: A high frequency of cagA positive strains was observed in the Greek population. There was no significant difference in the frequency between the vacA mid- and signal-region subtypes. No statistically significant differences among the subtypes were detected between the adult and the children study groups. [ABSTRACT FROM AUTHOR]

We report a case of a seven-year-old girl who suffered from atypical Hemolytic Uremic Syndrome (aHUS) complicated by septicaemia, central nervous system involvement, and cholangiitis. She remained anuric requiring treatment with peritoneal dialysis (PD) for a five-month period. In addition to conventional therapeutic measures including fresh frozen plasma (FFP) and blood cells transfusions she also underwent to plasma exchange (PE) treatment. Following a stormy hospitalization period of 17 weeks, the patient finally regained renal function and three years later she remains well on antihypertensive treatment and free of dialysis. [ABSTRACT FROM AUTHOR]

Introduction: Central nervous system excitability depends on the task performed, muscle group solicited, and contraction type. However, little is known on corticospinal and motoneuronal excitability measured during locomotor exercise. This study aimed at determining the reliability of motor-evoked potentials (MEP) and thoracic motor-evoked potentials (TMEP) in dynamic mode during unfatiguing and fatiguing cycling exercise., Methods: Twenty-two participants completed four visits. Visit 1 comprised familiarization and an incremental cycling test to determine maximal power output ( Wmax ). The remaining visits encompassed unfatiguing evaluations, which included a total of eight brief bouts of moderate- (50% Wmax ) and high-intensity cycling (80% Wmax ), four at each intensity. In each bout, a set of two TMEPs, five MEPs, and one M-max were obtained. Subsequently, a fatiguing exercise to exhaustion at 80% Wmax was performed, with four sets of measurements 3 min through the exercise and four additional sets at exhaustion, both measured at 50% Wmax ., Results: Intraclass correlation coefficients (ICCs) for 5, 10, 15, and 20 MEP·Mmax -1 revealed excellent reliability at both intensities and during cycling to exhaustion (ICC ≥0.92). TMEP·Mmax -1 showed ICCs ≥0.82 for moderate and high intensity, and it was not affected by fatigability. Overall standard error of measurement was 0.090 (0.083, 0.097) for MEP·Mmax -1 and 0.114 (0.105, 0.125) for TMEP·Mmax -1 . A systematic bias associated with the number of stimulations, especially at high intensity, suggested that the evaluation itself may be influenced by fatigability. A mean reduction of 8% was detected in TMEP·Mmax -1 at exhaustion., Conclusions: Motoneuronal and corticospinal excitability measured in dynamic mode presented good to excellent reliability in unfatiguing and fatiguing exercise. Further studies inducing greater fatigability must be conducted to assess the sensitivity of central nervous system excitability during cycling., (Copyright © 2024 by the American College of Sports Medicine.)

Developing an efficient and sustainable precision irrigation strategy is crucial in contemporary agriculture. This study aimed to combine proximal and remote sensing techniques to show the benefits of using both monitoring methods, simultaneously assessing the water status and response of 'Calatina' olive under two distinct irrigation levels: full irrigation (FI), and drought stress (DS, -3 to -4 MPa). Stem water potential (Ψ stem ) and stomatal conductance (g s ) were monitored weekly as reference indicators of plant water status. Crop water stress index (CWSI) and stomatal conductance index (Ig) were calculated through ground-based infrared thermography. Fruit gauges were used to monitor continuously fruit growth and data were converted in fruit daily weight fluctuations (ΔW) and relative growth rate (RGR). Normalized difference vegetation index (NDVI), normalized difference RedEdge index (NDRE), green normalized difference vegetation index (GNDVI), chlorophyll vegetation index (CVI), modified soil-adjusted vegetation index (MSAVI), water index (WI), normalized difference greenness index (NDGI) and green index (GI) were calculated from data collected by UAV-mounted multispectral camera. Data obtained from proximal sensing were correlated with both Ψ stem and g s , while remote sensing data were correlated only with Ψ stem . Regression analysis showed that both CWSI and Ig proved to be reliable indicators of Ψ stem and g s . Of the two fruit growth parameters, ΔW exhibited a stronger relationship, primarily with Ψ stem . Finally, NDVI, GNDVI, WI and NDRE emerged as the vegetation indices that correlated most strongly with Ψ stem , achieving high R 2 values. Combining proximal and remote sensing indices suggested two valid approaches: a more simplified one involving the use of CWSI and either NDVI or WI, and a more comprehensive one involving CWSI and ΔW as proximal indices, along with WI as a multispectral index. Further studies on combining proximal and remote sensing data will be necessary in order to find strategic combinations of sensors and establish intervention thresholds., 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 © 2024 Carella, Massenti, Marra, Catania, Roma and Lo Bianco.)

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary., Methods: A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations., Results: A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline., Conclusion: Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE., (© 2024 European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal-jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m 2 and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications., (© 2024. Italian Society of Surgery (SIC).)

Despite the growing interest, information regarding the psychometric properties of maximal voluntary isometric toe plantarflexion force and rate of force development (RFD) is lacking. Hence, we investigate the test-retest reliability and measurement error of these outcome measurement instruments measured with a custom-built dynamometer. Twenty-six healthy adults participated in a crossed design with four sessions separated by 5-7 days. RFD was quantified using manual onset and calculating the impulse and the slope in the following time windows: 0-50 ms, 0-100 ms, 0-150 ms, 0-200 ms, 0-250 ms. We estimated the systematic bias of the mean, the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) from the agreement and consistency models. The ICC and the SEM agreement for maximal voluntary isometric toe plantarflexion force along the perpendicular axis were respectively 0.87 (95%CI: 0.76, 0.93) and 27 N (22, 32), while along the resultant of the perpendicular and anterior posterior axis they were 0.85 (0.73, 0.92) and 29 N (23, 35). The results of the consistency model were similar as the estimated variance for session was closer to zero. A systematic bias of the mean between session 1 and 3 was found. For the RFD variables, the ICC agreement ranged from 0.35 to 0.65. The measurement process was found to be reliable to assess maximal voluntary isometric toe plantarflexion force but not RFD. However, a familiarization session is mandatory and these results need to be confirmed in less coordinated (e.g. aging population) individuals., Competing Interests: Declaration of Competing Interest none., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Functional Gastrointestinal Disorders (FGIDs) present a higher prevalence in individuals with Neurodevelopmental Disorders (NDDs). The Stress System and the Gut-Brain axis (GBA) may mediate these relations. We aimed to assess the prevalence and profile of FGIDs in a clinical sample of children with Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD) compared to typically developing children (TD) as well as to investigate possible relations between stress-related biomarkers and internalizing/externalizing problems in children with NDDS., Methods: In total, 120 children, aged between 4 and 12 years old, formed three groups (N = 40, each): ADHD, ASD and TD. Salivary cortisol, hair cortisol and serum leptin were measured., Results: The ASD group had more FGID problems than the TD group ( p = 0.001). The ADHD and ASD groups had higher total internalizing/externalizing problems than the TD group ( p < 0.0001, p < 0.0001, p = 0.005, respectively). Children with FGIDs showed more total, internalizing and externalizing problems compared to children without FGIDs ( p < 0.0001, p < 0.0001, p = 0.041, respectively). The ADHD group showed lower AUCg values ( p < 0.0001), while the hair cortisol was higher for the TD group ( p < 0.0001)., Conclusion: In conclusion, children with NDDs had more FGID symptoms and present higher internalizing and externalizing problems. Children with ADHD and FGIDs had more internalizing problems compared to those without FGIDs. No differences in stress-related biomarkers were shown to differentiate children with NDDs with and without FGIDs. Future prospective studies including a greater number of children may elucidate the biological pathways linking these comorbidities.

Background: Helicobacter pylori may be found during upper gastrointestinal endoscopy (UGE) performed to diagnose celiac disease (CeD), inflammatory bowel disease (IBD), and eosinophilic esophagitis (EoE). We aimed to describe the frequency of H. pylori in children undergoing UGE for CeD, IBD, and EoE and the number of children receiving eradication treatment., Materials and Methods: A retrospective multicenter study from 14 countries included pediatric patients diagnosed with CeD, IBD, and EoE between January 2019 and December 2021., Data Collected: age, gender, hematologic parameters, endoscopic, histologic, and H. pylori culture results, and information on eradication treatment., Results: H. pylori was identified in 349/3890 (9%) children [167 (48%) male, median 12 years (interquartile range 8.1-14.6)]. H. pylori was present in 10% (173/1733) CeD, 8.5% (110/1292) IBD and 7.6% (66/865) EoE patients (p = NS). The prevalence differed significantly between Europe (Eastern 5.2% (28/536), Southern 3.8% (78/2032), Western 5.6% (28/513)) and the Middle East 26.6% (215/809) [odds ratio (OR) 7.96 95% confidence interval (CI) (6.31-10.1) p < 0.0001]. Eradication treatment was prescribed in 131/349 (37.5%) patients, 34.6% CeD, 35.8% IBD, and 56.1% EoE. Predictors for recommending treatment included erosions/ulcers [OR 6.45 95% CI 3.62-11.47, p < 0.0001] and nodular gastritis [OR 2.25 95% CI 1.33-3.81, p 0.003]. Treatment rates were higher in centers with a low H. pylori prevalence (<20%) [OR 3.36 95% CI 1.47-7.66 p 0.004]., Conclusions: Identifying H. pylori incidentally during UGE performed for the most common gastrointestinal diseases varies significantly among regions but not among diseases. The indications for recommending treatment are not well defined, and less than 40% of children received treatment., (© 2024 John Wiley & Sons Ltd.)

Rationale: Benzene has been classified as carcinogenic to humans, but there is limited evidence linking benzene exposure to lung cancer. Objectives: We aimed to examine the relationship between occupational benzene exposure and lung cancer. Methods: Subjects from 14 case-control studies across Europe and Canada were pooled. We used a quantitative job-exposure matrix to estimate benzene exposure. Logistic regression models assessed lung cancer risk across different exposure indices. We adjusted for smoking and five main occupational lung carcinogens and stratified analyses by smoking status and lung cancer subtypes. Measurements and Main Results: Analyses included 28,048 subjects (12,329 cases, 15,719 control subjects). Lung cancer odds ratios ranged from 1.12 (95% confidence interval, 1.03-1.22) to 1.32 (95% confidence interval, 1.18-1.48) ( P trend  = 0.002) for groups with the lowest and highest cumulative occupational exposures, respectively, compared with unexposed subjects. We observed an increasing trend of lung cancer with longer duration of exposure ( P trend  < 0.001) and a decreasing trend with longer time since last exposure ( P trend  = 0.02). These effects were seen for all lung cancer subtypes, regardless of smoking status, and were not influenced by specific occupational groups, exposures, or studies. Conclusions: We found consistent and robust associations between different dimensions of occupational benzene exposure and lung cancer after adjusting for smoking and main occupational lung carcinogens. These associations were observed across different subgroups, including nonsmokers. Our findings support the hypothesis that occupational benzene exposure increases the risk of developing lung cancer. Consequently, there is a need to revisit published epidemiological and molecular data on the pulmonary carcinogenicity of benzene.

Background: While much research has been done to identify individual workplace lung carcinogens, little is known about joint effects on risk when workers are exposed to multiple agents., Objectives: We investigated the pairwise joint effects of occupational exposures to asbestos, respirable crystalline silica, metals (i.e., nickel, chromium-VI), and polycyclic aromatic hydrocarbons (PAH) on lung cancer risk, overall and by major histologic subtype, while accounting for cigarette smoking., Methods: In the international 14-center SYNERGY project, occupational exposures were assigned to 16,901 lung cancer cases and 20,965 control subjects using a quantitative job-exposure matrix (SYN-JEM). Odds ratios (ORs) and 95% confidence intervals (CIs) were computed for ever vs. never exposure using logistic regression models stratified by sex and adjusted for study center, age, and smoking habits. Joint effects among pairs of agents were assessed on multiplicative and additive scales, the latter by calculating the relative excess risk due to interaction (RERI)., Results: All pairwise joint effects of lung carcinogens in men were associated with an increased risk of lung cancer. However, asbestos/metals and metals/PAH resulted in less than additive effects; while the chromium-VI/silica pair showed marginally synergistic effect in relation to adenocarcinoma (RERI: 0.24; CI: 0.02, 0.46; p = 0.05). In women, several pairwise joint effects were observed for small cell lung cancer including exposure to PAH/silica (OR = 5.12; CI: 1.77, 8.48), and to asbestos/silica (OR = 4.32; CI: 1.35, 7.29), where exposure to PAH/silica resulted in a synergistic effect (RERI: 3.45; CI: 0.10, 6.8)., Discussion: Small or no deviation from additive or multiplicative effects was observed, but co-exposure to the selected lung carcinogens resulted generally in higher risk than exposure to individual agents, highlighting the importance to reduce and control exposure to carcinogens in workplaces and the general environment. https://doi.org/10.1289/EHP13380.

The study aimed to assess the total prevalence of functional gastrointestinal disorders (FGID), and separately, irritable bowel syndrome (IBS) among adults and to determine their potential association with fructose consumption. Data from the Hellenic National Nutrition and Health Survey were included (3798 adults; 58·9 % females). Information regarding FGID symptomatology was assessed using self-reported physician diagnosis questionnaires the reliability of which were screened using the ROME III, in a sample of the population. Fructose intake was estimated from 24 h recalls, and the MedDiet score was used to assess adherence to the Mediterranean diet. The prevalence of FGID symptomatology was 20·2 %, while 8·2 % had IBS (representing 40·2 % of total FGID). The likelihood of FGID was 28 % higher (95 %CI: 1·03-1·6) and of IBS 49 % (95 %CI: 1·08-2·05) in individuals with higher fructose intake than with lower intake (3rd tertile compared with 1st). When area of residence was accounted for, individuals residing in the Greek islands had a significantly lower probability of FGID and IBS compared with those residing in Mainland and the main Metropolitan areas, with Islanders also achieving a higher MedDiet score and lower added sugar intake, comparatively to inhabitants of the main metropolitan areas. FGID and IBS symptomatology was most prominent among individuals with higher fructose consumption, and this was most conspicuous in areas with a lower Mediterranean diet adherence, suggesting that the dietary source of fructose rather than total fructose should be examined in relation to FGID.

This study aims to compare different types of metabolic bariatric surgery (MBS) with lifestyle intervention/medical therapy (LSI/MT) for the treatment of overweight/obesity. The present and network meta-analysis (NMA) includes randomized trials. MBS was associated with a reduction of BMI, body weight, and percent weight loss, when compared to LSI/MT, and also with a significant reduction of HbA1c and a higher remission of diabetes. Meta-regression analyses revealed that BMI, a higher proportion of women, and a longer duration of trial were associated with greater effects of MBS. The NMA showed that all surgical procedures included (except greater curvature plication) were associated with a reduction of BMI. MBS is an effective option for the treatment of obesity. The choice of BMI thresholds for eligibility for surgery of patients with different complications should be performed making an evaluation of risks and benefits in each BMI category., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study analyzed hospital admissions for invasive meningococcal disease (IMD) in epidemiological and economic terms in Italy from 2015 to 2019. The volume of acute admissions for meningococcal diagnosis was analyzed in the period from 2015 to 2019. IMD admissions were identified by ICD-9-CM diagnoses. Costs were assessed using current DRG tariffs. In 2019, a total of 237 admissions for meningococcal disease were recorded in Italy. The mean age of patients was 36.1 years. Lumbar puncture was reported in only 14% of hospital discharge forms. From 2015 to 2019, there was a mean annual reduction of - 1.2% nationally for IMD hospitalizations. For 2019, the total costs for acute inpatient admissions were €2,001,093. Considering annual incidence due to IMD, a significant decrease was noted in the age group from 0 to 1 year (p = 0.010) during 2015-2019. For all years, mortality associated with meningeal syndrome was lower compared to septic shock with or without meningitis. From 2015 to 2019, hospitalizations for IMD appear to be decreasing slightly in Italy, even if mortality remains high. Favorable trends in hospitalizations for IMD were seen in the 0-1-year age group, which may be attributable to increased vaccination. Costs of hospitalizations for IMD remain high., (© 2023. The Author(s).)

This paper is addressed to the cardiologist, who in his or her clinical practice interacts with and treats cardiovascular risk factors associated with obesity and its complications; it may also be useful for other specialists, to whom patients with excess weight may be referred. We hope that the cardiologist will consider obesity as a preventable and treatable disease that contributes to overall cardiovascular risk, and will deploy a strong commitment to cope with this disease. To this purpose, the text is composed of 8 questions aimed to cover relevant topics for the clinical practice.

The ringdown signal emitted during a binary black hole coalescence can be modeled as a linear superposition of the characteristic damped modes of the remnant black hole that get excited during the merger phase. While checking the consistency of the measured frequencies and damping times against the Kerr BH spectrum predicted by general relativity (GR) is a cornerstone of strong-field tests of gravity, the consistency of measured excitation amplitudes and phases have been largely left unexplored. For a nonprecessing, quasicircular binary black hole merger, we find that GR predicts a narrow region in the space of mode amplitude ratio and phase difference, independently of the spin of the binary components. Using this unexpected result, we develop a new null test of strong-field gravity which demands that the measured amplitudes and phases of different ringdown modes should lie within this narrow region predicted by GR. We call this the amplitude-phase consistency test and introduce a procedure for performing it using information from the ringdown signal. Lastly, we apply this test to the GW190521 event, using the multimodal ringdown parameters inferred by Capano et al. [arXiv:2105.05238]. While ringdown measurements errors for this event are large, we show that GW190521 is consistent with the amplitude-phase consistency test. Our test is particularly well suited for accommodating multiple loud ringdown detections as those expected in the near future, and can be used complementarily to standard black-hole spectroscopy as a proxy for modified gravity, compact objects other than black holes, binary precession and eccentricity.

John Keats (1795-1821), besides being the famous English poet, was a student of medicine at the United Hospitals in London. On the occasion of the bicentenary of his death, we would like to pay tribute to this versatile figure with a photographic itinerary of his medical life. This article, in connection with the project "Himetop - The History of Medicine Topographical Database", retraces objects and places where the poet lived, studied, worked, and prematurely died, showing the importance of material culture. The photographic journey starts in London with the birthplace of the poet and continues through the places of his infancy and youth, the school in Enfield, the lodgings at 8 St. Thomas Street, the United Hospitals, etc. After giving up medicine to devote to poetry, the itinerary proceeds in the Hampstead and, as the ultimate destination, in Rome, where John Keats spent his last months of life due to tuberculosis. To conclude the path at the Protestant Cemetery in Rome, where he was buried, surrounded by grass and flowers. The material memories left by John Keats, as well as preserving his memory, take on a significant educational and inspirational role for everybody and, in particular, literary people and medical students.

Introduction: The COVID-19 pandemic represented an unprecedented challenge for the healthcare world and the introduction of a new stronger and believable project plays a fundamental role for the quality of work and the provision of qualitative care., Aim: The survey provided by Italian Association for the Quality of Health and Social Care (ASIQUAS) aims to examines the impact of "Health" chapter included in the Recovery Plan, through the assessment of management quality of the COVID-19 pandemic., Methods: Starting from a literature review, in September 2021, a web-based survey has been conducted and administered by e-mail. It has been taken into account measures widely used by different healthcare structures in order to analyze the projects implemented in the face of pandemic and to evaluate the new real possibility to invest funds in new healthcare structures and projects., Results: The survey consists of 19 multiple choices and respondents were from different types of structures, including regional departments and regional health agencies (1.4%), universities, research centers and scientific hospitalization and treatment institutes (IRCCS) (11%), hospitals and university polyclinics (34.2%), Local Health Authorities (39.7%), socio-health organizations and Others (13.7%). The pandemic has highlighted many vulnerabilities at both hospitals and territorial level. The major weaknesses revealed by the survey are mainly due to the lack of support from new staff units and poor availability of specific training tools for COVID-19 procedures. The Recovery Plan is still unclear with a lot of concern about the implementation and many limits of diffusion., Conclusions: It becomes essential to guarantee a new effective and interoperative model of integration. Today we can start more aware for the implementation of a system closer to everyone's needs, making shortcomings the new strength and starting point., (©2022 Pacini Editore SRL, Pisa, Italy.)

Objectives: Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel., Methods: pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected., Results: A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children ( P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children( P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%)., Conclusions: EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response., Competing Interests: Noam Zevit: consultation fees – Dr Falk Pharma, Adare Pharmaceuticals; speaker fees – Rafa inc and Sanofi. Salvatore Oliva: consultation fees – Medtronic, Ocean Farma; speaker fees – Medtronic. Marcus Karl-Heinz Auth – consultation fees: Dr Falk Pharma; educational grants: Nutricia, Mead Johnson. Alexandra Papadopoulou: research grants from Abbvie, United Pharmaceuticals, Dr Falk Pharma GmbH, Takeda, AstraZeneca; speaker or consultation fees from Adare Pharmaceuticals, Dr Falk Pharma GmbH, Specialty Therapeutics, Uni-Pharma Pharmaceuticals Laboratories S.A., Cross Pharmaceuticals, Petsiavas, Nestle, Touch Independent Medical Education, and Sanofi-Aventis. The remaining authors report no conflicts of interest., (Copyright © 2022 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Background: Exposure to polycyclic aromatic hydrocarbons (PAH) occurs widely in occupational settings. We investigated the association between occupational exposure to PAH and lung cancer risk and joint effects with smoking within the SYNERGY project., Methods: We pooled 14 case-control studies with information on lifetime occupational and smoking histories conducted between 1985 and 2010 in Europe and Canada. Exposure to benzo[a]pyrene (BaP) was used as a proxy of PAH and estimated from a quantitative general population job-exposure matrix. Multivariable unconditional logistic regression models, adjusted for smoking and exposure to other occupational lung carcinogens, estimated ORs, and 95% confidence intervals (CI)., Results: We included 16,901 lung cancer cases and 20,965 frequency-matched controls. Adjusted OR for PAH exposure (ever) was 1.08 (CI, 1.02-1.15) in men and 1.20 (CI, 1.04-1.38) in women. When stratified by smoking status and histologic subtype, the OR for cumulative exposure ≥0.24 BaP μg/m3-years in men was higher in never smokers overall [1.31 (CI, 0.98-1.75)], for small cell [2.53 (CI, 1.28-4.99)] and squamous cell cancers [1.33 (CI, 0.80-2.21)]. Joint effects between PAH and smoking were observed. Restricting analysis to the most recent studies showed no increased risk., Conclusions: Elevated lung cancer risk associated with PAH exposure was observed in both sexes, particularly for small cell and squamous cell cancers, after accounting for cigarette smoking and exposure to other occupational lung carcinogens., Impact: The lack of association between PAH and lung cancer in more recent studies merits further research under today's exposure conditions and worker protection measures., (©2022 The Authors; Published by the American Association for Cancer Research.)

While there is great demand for effective, affordable radiation detectors in various applications, many commonly used scintillators have major drawbacks. Conventional inorganic scintillators have a fixed emission wavelength and require expensive, high-temperature synthesis; plastic scintillators, while fast, inexpensive, and robust, have low atomic numbers, limiting their X-ray stopping power. Formamidinium lead halide perovskite nanocrystals show promise as scintillators due to their high X-ray attenuation coefficient and bright luminescence. Here, we used a room-temperature, solution-growth method to produce mixed-halide FAPbX3 (X = Cl, Br) nanocrystals with emission wavelengths that can be varied between 403 and 531 nm via adjustments to the halide ratio. The substitution of bromine for increasing amounts of chlorine resulted in violet emission with faster lifetimes, while larger proportions of bromine resulted in green emission with increased luminescence intensity. By loading FAPbBr3 nanocrystals into a PVT-based plastic scintillator matrix, we produced 1 mm-thick nanocomposite scintillators, which have brighter luminescence than the PVT-based plastic scintillator alone. While nanocomposites such as these are often opaque due to optical scattering from aggregates of the nanoparticles, we used a surface modification technique to improve transmission through the composites. A composite of FAPbBr3 nanocrystals encapsulated in inert PMMA produced even stronger luminescence, with intensity 3.8× greater than a comparative FAPbBr3/plastic scintillator composite. However, the luminescence decay time of the FAPbBr3/PMMA composite was more than 3× slower than that of the FAPbBr3/plastic scintillator composite. We also demonstrate the potential of these lead halide perovskite nanocomposite scintillators for low-cost X-ray imaging applications.

Introduction: Respiratory insufficiency is one of the main causes of death in myotonic dystrophy type 1 (DM1). Although there is general consensus that these patients have a restrictive ventilatory pattern, hypoventilation, chronic hypercapnia, and sleep disturbances, the prevalence of respiratory disease and indication for the effects of noninvasive ventilation (NIV) need to be further explored., Objectives: To describe respiratory function and need for NIV at baseline and over time in a cohort of adult patients with DM1., Methods: A total of 151 adult patients with DM1 were subjected to arterial blood gas analysis, sitting and supine forced vital capacity (FVC), peak cough expiratory flow (PCEF), nocturnal oximetry, and maximal inspiratory pressure and expiratory pressure (MIP/PEP)., Results: On first assessment, 84 of 151 had normal respiratory function (median age: 38 years, median BMI: 23.9, and median disease duration: 11 years); 67 received an indication to use NIV (median age: 49 years, median BMI: 25,8, and median disease duration: 14 years). After a median time of 3.85 years, 43 patients were lost to follow-up; 9 of 84 required NIV; only 17 of 67 with the new NIV prescription were adherent., Conclusions: We provide additional data on the natural history of respiratory function decline and treatment adherence in a relatively large cohort of well-characterized patients with DM1. A high proportion (28%) was lost to follow-up. A minority (11%) required NIV, and only 25% were treatment adherent, irrespective of specific demographics and respiratory features. Our results also confirm previous findings, showing that age, disease duration, and higher BMIs are predisposing factors for respiratory impairment., Competing Interests: The authors declared that they have no conflicts of interest., (Copyright © 2022 Carola R. Ferrari Aggradi et al.)

Background: The increased intake of FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyol) rich foods has been suggested as a possible trigger of functional gastrointestinal disorders (FGIDs). Despite the high FODMAP content, the Mediterranean diet (MD) appears to have beneficial effects on health. Our aim was to evaluate whether the prevalence of FGIDs in different Mediterranean countries may be influenced by FODMAP consumption and adherence to the MD. Methods: A school-based, cross-sectional, multicenter study was performed in six countries in the Mediterranean area: Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects 4-18 years were examined in relation to their eating habits and the presence of FGIDs, using Rome IV criteria, 3-day food diaries and Mediterranean Diet Quality Index in Children and Adolescents (KIDMED) questionnaires. Results: We enrolled 1972 subjects between 4 and 9 years old (Group A), and 2450 subjects between 10 and 18 years old (Group B). The overall prevalence of FGIDs was 16% in Group A and 26% in Group B. FODMAP intake was significantly different among countries for both age groups. In both groups, no significant association was found between FGIDs and FODMAPs. Adherence to the MD in all countries was intermediate, except for Serbia, where it was low. In both groups, we found a statistically significant association between FGIDs and the KIDMED score (Group A: OR = 0.83, p < 0.001; Group B: OR = 0.93, p = 0.005). Moreover, a significant association was found between the KIDMED score and functional constipation (Group A: OR = 0.89, p = 0.008; Group B: OR = 0.93, p = 0.010) and postprandial distress syndrome (Group A: OR = 0.86, p = 0.027; Group B: OR = 0.88, p = 0.004). Conclusions: Our data suggest that the prevalence of FGIDs in the Mediterranean area is not related to FODMAP consumption, whereas adherence to the MD seems to have a protective effect.

Objectives: The aim of this study was to assess the prevalence of functional gastrointestinal disorders (FGIDs) in children of Mediterranean area using Rome IV criteria and to compare the prevalence of FGIDs using Rome IV and Rome III criteria., Methods: This was a cross-sectional study enrolling children and adolescents living in Croatia, Greece, Israel, Italy, Macedonia, and Serbia. Subjects were examined in relation to the presence of FGIDs, using the Rome IV criteria. Data were compared with the results of a previous study using Rome III data., Results: We analyzed 1972 children ages 4 to 9 years (group A), and 2450 adolescents 10 to 18 years old (group B). The overall prevalence of FGIDs was 16% in group A and 26% in group B, with statistical differences among countries in both groups (P < 0.001). In group A, the prevalence of FGIDs and of functional constipation (FC) was significantly lower than in the previous study (P < 0.001), whereas in group B no significant difference was found. In both groups of age, the prevalence of abdominal migraine and irritable bowel syndrome decreased significantly (P < 0.001 and P < 0.001, respectively) using Rome IV versus Rome III criteria, conversely functional dyspepsia increased (P < 0.001)., Conclusions: FGIDs are common in children and adolescents, their frequency increases with age, and there is a significant variation in the prevalence of some FGIDs among different European countries. The application of the Rome IV criteria resulted in a significantly lower prevalence of FGIDs in children compared with Rome III criteria., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)