Search

Acceptance of rotavirus (RV) vaccination may be impacted by several factors including the feasibility of the full schedule administration within the fixed immunization timelines. The human RV vaccine Rotarix (GSK) and the human bovine reassortant vaccine RotaTeq (Merck & Co.) were developed with different posologies (2 doses vs 3 doses respectively), which have both scientific and technical implications. A non-systematic literature review revealed that, in the Italian context, topics such as time to achieve RV protection in children, number of preventable cases and administration time window, compatibility/ease of inclusion in the national vaccination calendar, potential overlaps with the peak of natural history of intussusception and adherence to posology could be impacted by the RV vaccine posology. Results suggest that a shorter schedule would allow for greater flexibility of use as well as a greater documented ease of inclusion in the vaccination calendar, thereby reducing potential direct healthcare costs.

Studying the formation processes of carbon nanodots remains crucial for understanding their properties and chemical structure. Here, the authors investigate the steps involved in their formation process and provide examples for tuning the core-shell design.

Abstract During the last decade we experienced a surge in the number of glucose lowering agents that can be used to treat patients with type 2 diabetes. Especially important are the discoveries that sodium glucose co-transporter type 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve patients’ cardiovascular and renal outcomes. Accordingly, various medical associations have updated their guidelines for the treatment of diabetes in this new era. Though not agreeing on every issue, these position-statements generally share a detailed and often complex workflow that may be too complicated for the busy and overworked primary care setting, where the majority of patients with type 2 diabetes are managed in many countries. Other guidelines, generally those from the cardiology associations focus primarily on the population of patients with high risk for or pre-existing cardiovascular disease, which represent only the minority of patients with type 2 diabetes. We believe that we should re-define SGLT2i and GLP-1 RA as diabetes/disease modifying drugs (DMDs) given the recent evidence of their cardiovascular and renal benefits. Based on this definition we have designed a SIMPLE approach in order to assist primary care teams in selecting the most appropriate therapy for their patients. We believe that most subjects newly diagnosed with type 2 diabetes should initiate early combination therapy with metformin and a prognosis changing DMD. The decision whether to use GLP-1 RA or SGLT2i should be made based on specific patient’s risk factors and preferences. Importantly, DMDs are known to have a generally safe side-effect profile, with lower risk for hypoglycemia and weight gain, further promoting their wider usage. Early combination therapy with DMDs may improve the multiple pathophysiological abnormalities responsible for type 2 diabetes and its complications, thus resulting in the greatest long term benefits.

Abstract Background Accurate quantification of radioactivity, measured by an integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) system, is still a challenge. One aspect of such a challenge is to correct for the hardware attenuation, such as the patient table and radio frequency (RF) resonators. For PET/MRI systems, computed tomography (CT) is commonly used to produce hardware attenuation correction (AC) maps, by converting Hounsfield units (HU) to a linear attenuation coefficients (LAC) map at the PET energy level 511 keV, using a bilinear model. The model does not address beam hardening, nor higher density materials, which can lead to inaccurate corrections. Purpose In this study, we introduce a transmission-based (TX-based) AC technique with a static Germanium-68 (Ge-68) transmission source to generate hardware AC maps using the PET/MRI system itself, without the need for PET or medical CT scanners. The AC TX-based maps were generated for a homogeneous cylinder, made of acrylic as a validator. The technique thereafter was applied to the patient table and posterior part of an RF-phased array used in cardiovascular PET/MRI imaging. The proposed TX-based, and the CT-based, hardware maps were used in reconstructing PET images of one cardiac patient, and the results were analysed and compared. Results The LAC derived by the TX-based method for the acrylic cylinder is estimated to be 0.10851 ± 0.00380 cm−1 compared to the 0.10698 ± 0.00321 cm−1 theoretical value reported in the literature. The PET photon counts were reduced by 8.7 ± 1.1% with the patient table, at the region used in cardiac scans, while the CT-based map, used for correction, over-estimated counts by 4.3 ± 1.3%. Reconstructed in vivo images using TX-based AC hardware maps have shown 4.1 ± 0.9% mean difference compared to those reconstructed images using CT-based AC. Conclusions The LAC of the acrylic cylinder measurements using the TX-based technique was in agreement with those in the literature confirming the validity of the technique. The over-estimation of photon counts caused by the CT-based model used for the patient table was improved by the TX-based technique. Therefore, TX-based AC of hardware using the PET/MRI system itself is possible and can produce more accurate images when compared to the CT-based hardware AC in cardiac PET images.

In this paper, we propose a new deep learning approach based on unfolded neural networks for the reconstruction of X-ray computed tomography images from few views. We start from a model-based approach in a compressed sensing framework, described by the minimization of a least squares function plus an edge-preserving prior on the solution. In particular, the proposed network automatically estimates the internal parameters of a proximal interior point method for the solution of the optimization problem. The numerical tests performed on both a synthetic and a real dataset show the effectiveness of the framework in terms of accuracy and robustness with respect to noise on the input sinogram when compared to other different data-driven approaches.

The effect of tetrabutylammonium nitrate ([N4444][NO3]) was studied as a surface coating over 1Pd9Ag/Al2O3 and applied in the selective hydrogenation of 1,7-octadiene in a mixture with 1-octene. Weight loadings up to a surface of three monolayers (MLs) were investigated and a further comparison coating with 1-ethylimidazole ([EIM]) was carried out to assess anionic effects in the Solid Catalysts with an Ionic Liquid Layer (SCILLs). Catalysts were characterised by H2-chemisorption, TGA-DSC, BET measurements, XPS, and HR-TEM. Catalytic studies showed that the uncoated and EIM-coated (10 wt%) catalysts gave nearly a 100% conversion of 1,7-octadiene and 1-octene with a selectivity mainly towards octane. Coating with [N4444][NO3] at 1 ML significantly decreased the 1-octene conversion by almost 50%, as well as the selectivity to octane (38%) at close to a 100% diene conversion. However, no net gain in 1-octene in the output stream was noted. At 2 ML IL/EIM coverage, a further decline in 1-octene conversion and octane selectivity was found at a diene conversion of 75%. The selectivity to 1-octene steadily increased from over the bare catalyst (52%) to the EIM-coated (62%) catalyst and SCILL (75%). At 3 ML IL coverage, the diene conversion (35%) was significantly reduced due to mass transfer limitations of hydrogen through the thick IL layer. Characterisation of the used catalysts by TG and BET analyses confirmed a leaching of up to 14% of the ionic liquid in the SCILLs coated at 1 ML and 2 ML, with an increase in surface area noted. Furthermore, smaller particle sizes of the used catalysts showed that the metal–support interaction was re-established. These results confirm a mild ligand coordination between the nitrogen in the IL anion and Pd and Ag where the ionic liquid remained physisorbed over the surface of the catalyst. In addition, component miscibility tests revealed partial solubility of the diene in the ionic liquid, indicating the presence of solvent effects also.

Mussels are an important source of the essential omega-3 polyunsaturated fatty acids (n-3 PUFAs), which play a critical role in human health, preventing a variety of diseases. This study aimed to evaluate, for the first time, the combined effect of glyphosate (Gly) and culturing temperature on the lipid content and fatty acid (FA) profile of the Mediterranean mussel M. galloprovincialis. In addition, a number of lipid nutritional quality indices (LNQIs) were applied as important tools to assess the nutritional value of food. Mussels were exposed for 4 days to two Gly concentrations (1 mg/L, 10 mg/L) and two temperatures (T°: 20–26 °C). Statistical analysis showed significant effects of T°C, Gly, and T°C × Gly interaction (p < 0.05) on the lipid and FA profiles of M. galloprovincialis. Mussels exposed to 10 mg/L Gly at 20 °C showed a decrease in eicosapentaenoic (EPA, from 14.6% to 12% of total FAs) and docosahexaenoic acids (DHA, from 10% to 6.4% of total FAs), compared to the control mussels. Both stressors caused a considerable decrease in n-3 PUFAs, which resulted in a less favorable n-6/n-3 PUFA ratio. Overall, this study demonstrated a decline in the nutritive values of mussels, most prominently in groups exposed to 10 mg/L Gly at a temperature of 20 °C and in those exposed to a temperature of 26 °C. This was confirmed by such LNQIs as EPA + DHA, PUFA/Saturated FAs, atherogenic and thrombogenic indices (AI and TI), the health promoting index (HPI), and the unsaturation index (UI). Further investigations into chronic exposure to both stressors are desirable to predict the impacts on aquatic ecosystems and food quality.

In recent years, the availability on the market of low-cost sensors (LCSs) and low-cost monitors (LCMs) for air quality monitoring has attracted the interest of scientists, communities, and professionals. Although the scientific community has raised concerns about their data quality, they are still considered a possible alternative to regulatory monitoring stations due to their cheapness, compactness, and lack of maintenance costs. Several studies have performed independent evaluations to investigate their performance, but a comparison of the results is difficult due to the different test conditions and metrics adopted. The U.S. Environmental Protection Agency (EPA) tried to provide a tool for assessing the possible uses of LCSs or LCMs by publishing guidelines to assign suitable application areas for each of them on the basis of the mean normalized bias (MNB) and coefficient of variance (CV) indicators. Until today, very few studies have analyzed LCS performance by referring to the EPA guidelines. This research aimed to understand the performance and the possible application areas of two PM sensor models (PMS5003 and SPS30) on the basis of the EPA guidelines. We computed the R2, RMSE, MAE, MNB, CV, and other performance indicators and found that the coefficient of determination (R2) ranged from 0.55 to 0.61, while the root mean squared error (RMSE) ranged from 11.02 µg/m3 to 12.09 µg/m3. Moreover, the application of a correction factor to include the humidity effect produced an improvement in the performance of the PMS5003 sensor models. We also found that, based on the MNB and CV values, the EPA guidelines assigned the SPS30 sensors to the “informal information about the presence of the pollutant” application area (Tier I), while PMS5003 sensors were assigned to the “supplemental monitoring of regulatory networks” area (Tier III). Although the usefulness of the EPA guidelines is acknowledged, it appears that improvements are necessary to increase their effectiveness.

Microvascular injury immediately following reperfusion therapy in acute myocardial infarction (MI) has emerged as a driving force behind major adverse cardiovascular events in the postinfarction period. Although postmortem investigations and animal models have aided in developing early understanding of microvascular injury following reperfusion, imaging, particularly serial noninvasive imaging, has played a central role in cultivating critical knowledge of progressive damage to the myocardium from the onset of microvascular injury to months and years after in acute MI patients. This review summarizes the pathophysiological features of microvascular injury and downstream consequences, and the contributions noninvasive imaging has imparted in the development of this understanding. It also highlights the interventional trials that aim to mitigate the adverse consequences of microvascular injury based on imaging, identifies potential future directions of investigations to enable improved detection of disease, and demonstrates how imaging stands to play a major role in the development of novel therapies for improved management of acute MI patients. [Display omitted] • In patients reperfused for acute MI, microvascular injury following reperfusion therapy substantially increases the risk for MACE, with those that develop intramyocardial hemorrhage within the MI zone carrying the greatest risk for MACE in the post-MI period. • Currently available advanced imaging techniques can noninvasively detect and accurately characterize the type of microvascular injury following reperfusion therapy as those with microvascular obstruction only or microvascular obstruction and intramyocardial hemorrhage. • Therapies to mitigate reperfusion injury and improve outcomes need to take the type and extent of microvascular injury into account. [ABSTRACT FROM AUTHOR]

Abstract Early differential diagnosis of several motor neuron diseases (MNDs) is extremely challenging due to the high number of overlapped symptoms. The routine clinical practice is based on clinical history and examination, usually accompanied by electrophysiological tests. However, although previous studies have demonstrated the involvement of altered metabolic pathways, biomarker-based monitoring tools are still far from being applied. In this study, we aim at characterizing and discriminating patients with involvement of both upper and lower motor neurons (i.e., amyotrophic lateral sclerosis (ALS) patients) from those with selective involvement of the lower motor neuron (LMND), by using blood data exclusively. To this end, in the last ten years, we built a database including 692 blood data and related clinical observations from 55 ALS and LMND patients. Each blood sample was described by 108 analytes. Starting from this outstanding number of features, we performed a characterization of the two groups of patients through statistical and classification analyses of blood data. Specifically, we implemented a support vector machine with recursive feature elimination (SVM-RFE) to automatically diagnose each patient into the ALS or LMND groups and to recognize whether they had a fast or slow disease progression. The classification strategy through the RFE algorithm also allowed us to reveal the most informative subset of blood analytes including novel potential biomarkers of MNDs. Our results show that we successfully devised subject-independent classifiers for the differential diagnosis and prognosis of ALS and LMND with remarkable average accuracy (up to 94%), using blood data exclusively.

Abstract Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients’ clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4–50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0–11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.

The poor environmental stability of lead halide perovskites limits their performance in solar cells. Here, a CuSCN nanoplateletes/p-type semiconducting polymer composite layer enables the stable performance of a solar cell for 28 days in high-moisture conditions, attributed to water splitting.

Abstract Patients who develop brain abscesses must be evaluated through a complete set of diagnostic tests including a microbiological and clinical periodontal assessment. A genetic comparison of the pathogens from intracranial/extracranial sites is necessary.

ObjectiveTo evaluate the clinical effectiveness of online remote behavior therapy, compared with face-to-face therapy in reducing tics and co-occurring disorders associated with the tics in a sample of youths with Tourette Syndrome.DesignA randomized controlled trial. TS patients were randomized to receive face-to-face or online remote behavior therapy.Participants40 children aged between 9 and 16 years affected by Tourette Syndrome.ResultsOnline remote and face-to-face behavior therapy are equally effective in the treatment of tics and co-occurring disorders in children and adolescents affected by Tourette Syndrome. Both groups showed an improvement in the severity of tics, obsessive-compulsive symptoms, and anxiety symptoms, as assessed by neuropsychological findings. Online remote behavior therapy was more effective for reducing depressive symptoms than face-to-face behavior therapy.ConclusionsOnline remote behavior therapy is a promising tool for behavioral therapies for patients with Tourette Syndrome and may represents an alternative treatment option.

Emerging evidence indicates that persistent microvascular obstruction (PMO) is more predictive of major adverse cardiovascular events than myocardial infarct (MI) size. But it remains unclear how PMO, a phenomenon limited to the acute/subacute period of MI, drives adverse remodeling in chronic MI setting. We hypothesized that PMO resolves into chronic iron crystals within MI territories, which in turn are proinflammatory and favor adverse remodeling post-MI. Canines (n=40) were studied with cardiac magnetic resonance imaging to characterize the spatiotemporal relationships among PMO, iron deposition, infarct resorption, and left ventricular remodeling between day 7 (acute) and week 8 (chronic) post-MI. Histology was used to assess iron deposition and to examine relationships between iron content with macrophage infiltration, proinflammatory cytokine synthesis, and matrix metalloproteinase activation. Atomic resolution transmission electron microscopy was used to determine iron crystallinity, and energy-dispersive X-ray spectroscopy was used to identify the chemical composition of the iron composite. PMO with or without reperfusion hemorrhage led to chronic iron deposition, and the extent of this deposition was strongly related to PMO volume (r>0.8). Iron deposits were found within macrophages as aggregates of nanocrystals (≈2.5 nm diameter) in the ferric state. Extent of iron deposits was strongly correlated with proinflammatory burden, collagen-degrading enzyme activity, infarct resorption, and adverse structural remodeling (r>0.5). Crystallized iron deposition from PMO is directly related to proinflammatory burden, infarct resorption, and adverse left ventricular remodeling in the chronic phase of MI in canines. Therapeutic strategies to combat adverse remodeling could potentially benefit from taking into account the chronic iron-driven inflammatory process.

Abstract Background Systemic inflammation in COVID-19 often leads to multiple organ failure, including acute kidney injury (AKI). Renal replacement therapy (RRT) in combination with sequential extracorporeal blood purification therapies (EBP) might support renal function, attenuate systemic inflammation, and prevent or mitigate multiple organ dysfunctions in COVID-19. Aim Describe overtime variations of clinical and biochemical features of critically ill patients with COVID-19 treated with EBP with a hemodiafilter characterized by enhanced cytokine adsorption properties. Methods An observational prospective study assessing the outcome of patients with COVID-19 admitted to the ICU (February to April 2020) treated with EBP according to local practice. Main endpoints included overtime variation of IL-6 and multiorgan function-scores, mortality, and occurrence of technical complications or adverse events. Results The study evaluated 37 patients. Median baseline IL-6 was 1230 pg/ml (IQR 895) and decreased overtime (p

Abstract Introduction This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy. Methods A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units. Results The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern

La comunicación es una de las habilidades sobre las cuales se fundamenta la construcción de sociedades pues por su intermedio se organizan individualmente el pensamiento y las ideas y se realiza el intercambio colectivo de ideas, la puesta en común de opiniones (diversas o encontradas) todo lo cual permite activar el complejo entramado de las relaciones sociales. Entre todas las prácticas humanas de comunicación el lenguaje constituye sin duda alguna el sistema más perefecto y acabado, pues al tiempo que permite la elaboración de tipos de pensamiento complejo faculta asimismo su socialización. Aunque el desarrollo lingüístico acompaña a toda persona a lo largo de su vida, se trata de facultad que se activa naturalmente de manera temprana en el periodo crítico de la primera infancia. En el caso de las personas con Síndrome de Down suelen presentarse dificultades en el desarrollo lingüístico, tanto en su vertiente oroal como en la escrita, lo cual se convierte en una barera en su proceso de adaptación social y formación académica.Una de estas dificultades tiene que ver con el desarrollo de destrezas en el gesto gráfico. En esta dirección, la intención del presente estudio, de naturaleza documental, ha consistido en establecerunasíntesissobre un conjunto de indicadores relacionados con técnicas de enseñanza-aprendizaje, destrezas de ejecución y el uso de objetos y elementos para el desarrollo del gesto gráfico en un protocolo de intervención terapútica en infantes escolarizados con síndrome de Down. Los resultados representan un conjunto de indicadores y estrategias de referencia para los profesionales que están a cargo de la intervención terapeútica. En este protocolo se detallan las orientaciones y acciones a seguir en relación con cada uno de los aspectos vinculados con el desarrollo del gesto gráfico en niños con Síndrome de Down.

A recombinant respiratory syncytial virus (RSV) fusion glycoprotein candidate vaccine (RSV-PreF) manufactured in Chinese hamster ovary cells was developed for immunization of pregnant women, to protect newborns against RSV disease through trans-placental antibody transfer. Traces of a host-cell protein, hamster neogenin (haNEO1), were identified in purified RSV-PreF antigen material. Given the high amino-acid sequence homology between haNEO1 and human neogenin (huNEO1), there was a risk that potential vaccine-induced anti-neogenin immunity could affect huNEO1 function in mother or fetus. Anti-huNEO1 IgGs were measured by enzyme-linked immunosorbent assay in sera from rabbits and trial participants (Phase 1 and 2 trials enrolling 128 men and 500 non-pregnant women, respectively; NCT01905215/NCT02360475) collected after immunization with RSV-PreF formulations containing different antigen doses with/without aluminum-hydroxide adjuvant. In rabbits, four injections administered at 14-day intervals induced huNEO1-specific IgG responses in an antigen-dose- and adjuvant-dependent manner, which plateaued in the highest-dose groups after three injections. In humans, no vaccination-induced anti-huNEO1 IgG responses were detected upon a single immunization, as the values in vaccine and control groups fluctuated around pre-vaccination levels up to 90/360 days post-vaccination. A minority of participants had anti-huNEO1 levels ≥ assay cutoff before vaccination, which did not increase post-vaccination. Thus, despite detecting vaccine-induced huNEO1-specific responses in rabbits, we found no evidence that the candidate vaccine had induced anti-huNEO1 immunity in human adults. The antigen purification process was nevertheless optimized, and haNEO1-reduced vaccines were used in a subsequent Phase 2 trial enrolling 400 non-pregnant women (NCT02956837), in which again no vaccine-induced anti-huNEO1 responses were detected.

Abstract Since the outbreak of COVID-19 pandemic, the number of cases registered worldwide has risen to over 3 million. While COVID-19 per se does not seem to represent a significant threat to the pediatric population, which generally presents a benign course and a low lethality, the current emergency might negatively affect the care of pediatric patients and overall children welfare. In particular, the fear of contracting COVID-19 may determine a delayed access to pediatric emergency facilities. Present report focuses on the experience of The Children Hospital in Alessandria (northern Italy). The authors document a drop in the number of admissions to the emergency department (A&E) during the lock-down. They will also focus on four emblematic cases of pediatric patients who were seen to our A&E in severe conditions. All these cases share a significant diagnostic delay caused by the parents’ reluctance to seek medical attention, seen as a potential risk factor for COVID-19 contagion. None was found positive to all COVID-19 swab or immunologic testing. All in all, our data strongly support the importance of promoting a direct and timely interaction between patients and medical staff, to prevent the fear of COVID-19 from causing more harm than the virus itself.