Search

BACKGROUND The impact of intrauterine growth restriction (IUGR) on lung function in very preterm children is largely unknown as current evidence is mainly based on studies in children born small for gestational age but not necessarily with IUGR. METHODS Spirometry, transfer factor of the lung for carbon monoxide (TLco), and lung clearance index (LCI) were cross-sectionally evaluated at 8.0-15.0 years of age in children born

Infective uvulitis is a rare condition in children. In this report, we describe the case of a 4-year old-patient who presented a group A Streptococcus pharyngitis with uvulitis. No signs of epiglottitis were detected at nasal fibroscopy. She recovered rapidly with intravenous antibiotic therapy and 2 days of corticosteroid. Uvulitis is usually caused by group A Streptococcus or Haemophilus influentiae, but also other bacteria can be detected. Uvulitis can be isolated, or it can occur with epiglottitis and become an emergency.

This article is a report of our extensive experimentation, during the last two years,of deep reinforcement techniques for training an agent to move in the dungeons of the famous Rogue video-game. The challenging nature of the problem is tightly related the procedural, random generation of new dungeon maps at each level, that forbids any form of level-specific learning, and forces to address the navigation problem in its full generality. Other interesting aspects of the game from the point of view of automatic learning are the partially observable nature of the problem, since maps are initially not visible and get discovered during exploration, and the problem of sparse rewards, requiring the acquisition of complex, non-reactive behaviors involving memory and planning. In this article, we develop on previous works to make a more systematic comparison of different learning techniques, focusing in particular on Asynchronous Advantage Actor-Critic (A3C) and Actor-Critic with Experience Replay (ACER). In a game like Rogue, sparsity of rewards is mitigated by the variability of the dungeon configurations (sometimes, by luck, exit is at hand); if this variability can be tamed - as ACER, better than other algorithms, seems able to do - the problem of sparse rewards can be overcome without any need of intrinsic motivations.

Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO2), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants’ lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children’s respiratory health is incomplete. This advocates for paediatricians’ increased awareness and a better understanding of the CC impact on children’s respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.

INTRODUCTION Survivors of extreme prematurity may have disrupted lung development. We hypothesized that the multiple breath washout (MBW) index Scond, which is intended to reflect ventilation inhomogeneity from the conducting airways, could be a sensitive marker of respiratory impairment in this group. METHODS Spirometry, TLco, and MBW were cross-sectionally evaluated at 8 to 14 years of age in children born at

We investigated whether a 1-week stay in the mountains may have a positive impact on Exercise-Induced Bronchoconstriction (EIB) and cardiorespiratory endurance in asthmatic children from an urban area. Spirometry was performed before and 10 min after a 20 m shuttle run test (20mSRT) on the first and seventh day of a summer asthma camp in the Italian Alps at 900 m of altitude. Spirometry z-scores were derived from the Global Lung Initiative 2012 prediction equations, and percentiles of the 20mSRT performance were assigned according to De Miguel-Etayo’s and Tomkinson’s predictive equations. A FEV1 decrease ≥10% after the exercise was defined as EIB. Particulate matter pollution was monitored during the camp and in the urban area of provenience. Twenty-four subjects (age range 7–16 years) were included. Frequency of EIB decreased from 58% (14/24) at day-1 to 33% (8/24) at the end of the camp (p = 0.08). Most subjects with a 20mSRT in the lowest quartile at day 1 had EIB (9/11). The proportion of children with a 20mSRT &lt, 25° percentile decreased from 45% (11/24) at day-1 to 16% (4/24) at day-7 (p = 0.02). Conclusion: One-week climate therapy in the mountains improved both bronchial hyperreactivity and cardiorespiratory endurance in our cohort of asthmatic children.

Background: Bronchial asthma is not always easily diagnosed in children because of poor compliance performing spirometric manoeuvres. Little is known about the distribution of pulmonary regional ventilation in these patients. Electric Impedance Tomography (EIT) is a technique where the electrical conductivity and impedance of ventilation is inferred from surface electrodes to form a tomographic image. Objectives: This study aims to determine the role of EIT to investigate the distribution of ventilation during methacholine challenge test (MCT) in order to discriminate healthy from asthmatic patients. Methods: Patients from 5 to 16 years old were enrolled. Positive MCT was defined as a reduction of FEV1 ≥20%. For each patient, spirometry and EIT were assessed at baseline (B), at PD20 (or Step 6 of the MCT) and 10 minutes after administration of the bronchodilator. Results: 36 positive and 7 negative patients were found. Positive group at PD20 showed a significant air trapping (550 ±180 ml, p Conclusions: EIT is a good tool to evaluate regional pulmonary ventilation without requiring collaboration. It could be useful to identify an early air trapping in patients with methacholine challenge test and, possibly, discriminate severe asthmatic in order to administer specific therapy.

The comparison of patient-bases, approaches, social support and results of pediatric long-term home ventilation (LTHV) requires the collection of detailed data and careful analysis. In 2016, Italian centers established a national network of hospitals that deal with LTHV. The central purpose was to describe the variation in indications, approaches, structures and policies between different places in Italy. A documentation tool, the Ve.Do. Piccolo database, was developed for children on LTHV. The inclusion criteria were pediatric age (0-18 years) and mechanical ventilation at home for at least three months and six hours per day. By 1.12.2018 the database included 436 patients from 12 Italian hospitals. The age at initiation of ventilation and at last data point was 6 (1-13) years and 12 (5,6-17,3) years respectively (median, IQR). The distribution of underlying diseases is shown in Figure 1. Details on the indication, interface, ventilatory modes, settings, duration, home and social support are presented. We have shown that multi-center data collection is feasible and informative. As a next step we aim to extend data collection to European centers outside of Italy. A large participating European network of LTHV centers could improve standardization and quality of care through benchmarking.

In this article we introduce Rogueinabox: a highly modular learning environment built around the videogame Rogue, the father of the roguelike genre. It offers easy ways to interact with the game and a whole framework to build, customize, run and analyze learning agents. We discuss the interest and challenges of this game for machine learning and deep learning, and then discuss our initial experiments of training.

We investigated exercise induced bronchocostrinction (EIB) and CRE in asthmatic children before and after a 1-week summer camp in the mountains (900 m of altitude). Methods: Asthmatic children from an urban area performed spirometry (Spirolab, MIR, IT) before and 10 minutes after a 20-m shuttle run test (20mSRT) on the 1st and 7th day of the camp. Spirometry z-scores were derived from GLI-2012 equations (Quanjer, ERJ 2012) and percentiles of 20mSRT performances were assigned according to De Miguel-Etayo (Int J Obes, 2014) for children aged 7-9 years and to Tomkinson (Br J Sports Med, 2016) for older subjects. A repeatable flow-volume curve at each testing point was required. EIB was defined as a FEV1 decrease ≥10% after the 20mSRT (Crapo, AJRCCM, 2000). Results: 24 children (mean age 11. 8y, 7-16y, 17 mild, 6 moderate, 1 severe asthma) were included. Most of the subjects with a 20mSRT performance

Background Periodic fever syndromes (PFS) are an emerging group of autoinflammatory disorders. Clinical overlap exists and multiple genetic analyses may be needed to assist diagnosis. We evaluated the diagnostic value of a 5-gene sequencing panel (5GP) in patients with undiagnosed PFS. Methods Simultaneous double strand Sanger sequencing of MEFV, MVK, TNFRSF1A, NLRP3, NLRP12 genes was performed in 42 patients with unexplained PFS. Clinical features were correlated with genetic results. Results None of 42 patients analyzed displayed a causative genotype. However, single or multiple genetic variants of uncertain significance were detected in 24 subjects. Only in 5 subjects a definite diagnosis was made by taking into account both genetic and clinical data (2 TRAPS syndrome; 2 FMF; 1 FCAS). Statistical analysis showed that patients carrying genetic variants in one or more of the five selected genes displayed a significantly lower response to glucocorticoids compared with subjects who had completely negative genetic results. Conclusions The sequencing of multiple genes is of little help in the diagnostics of PFS and can often lead to results of uncertain interpretation, thus the clinically driven sequencing of single genes should remain the recommended approach. However, the presence of single or multiple genetic variants of uncertain significance, even if not allowing any specific diagnosis, correlated with a poorer response to glucocorticoids, possibly indicating a multifactorial subgroup of PFS with differential response to pharmacological treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12969-015-0006-z) contains supplementary material, which is available to authorized users.

The causes of extremely elevated IgA, whether isolated or associated with an increase in other classes of immunoglobulin, are poorly defined in paediatrics. We reviewed the diagnostic significance of very high IgA levels (greater than 3 SD above the mean for age) in a cohort of patients referred to a tertiary care children's hospital. Hyper-IgA was found in 91 of 6364 subjects (1.4%) and in 68 cases was not associated with an increased IgG and/or IgM level. Most subjects with hyper-IgA (73.5%) had a severe immune defect, a chronic rheumatic disease or inflammatory bowel disease, while these conditions were very rare in a control group with normal IgA values (8%). Although our results may in part reflect the experience of a tertiary care centre, we suggest that hyper-IgA in children should always arouse suspicion of a serious disease.

Very high levels of one or more classes of immunoglobulins can be found in children with various clinical conditions. Diagnostic protocols have been developed for defined forms of IgG, IgM or IgE hypergammaglobulinemia, which could be the expression of both chronic inflammatory disease and primary immunodeficiency syndromes. In contrast, except for well described conditions such as IgA nephropathy and Henoch Schonlein Purpura, much less is known about hyper-IgA.

Oxidative stress and its contribution to low-density lipoprotein (LDL) oxidation have been implicated in the pathogenesis of vascular diabetic complications. However, the relationship between hyperglycemia, hyperinsulinemia, hyperlipidemia, and oxidative stress is still debated. If plasma glucose and/or insulin and/or lipid are some of the most important determinants of oxidative stress in diabetes, then their typical postprandial elevations in diabetes would be expected to favor oxidative stress and LDL oxidation. To test this hypothesis, in type 2 diabetic patients, we evaluated the effects of two different standard meals designed to produce different levels of postprandial hyperglycemia on the plasma oxidative status and LDL oxidation. The meals were administered in randomized order to each of 10 type 2 diabetic patients. Blood samples were collected at baseline and 60 and 120 minutes after the meals. In every sample, plasma levels of glucose, insulin, cholesterol, triglycerides, nonesterified fatty acids (NEFAs), malondialdehyde (MDA), and the total radical-trapping antioxidant parameter (TRAP) were measured. LDL susceptibility to oxidation was evaluated at baseline and after 120 minutes. Plasma glucose, insulin, triglycerides, and MDA increased and NEFAs and TRAP significantly decreased after either meal. The variations in plasma glucose, MDA, and TRAP were significantly greater and LDL was more susceptible to oxidation after the meal that produced a significantly higher degree of hyperglycemia. These results suggest that postprandial hyperglycemia may contribute to oxidative stress in diabetic patients, providing a mechanistic link between hyperglycemia and diabetic vascular disease.

IgE-mediated cow’s milk protein allergy (CMPA) is one of the most prevalent food allergies in early childhood. Though the cornerstone of management involves the strict avoidance of milk products while awaiting natural tolerance, research increasingly shows that the rates of resolution are slowing down. Therefore, there is a need to explore alternative pathways to promote tolerance to cow’s milk in pediatric populations. This review aims to combine and appraise the scientific literature regarding the three CMPA management methods: avoidance, the milk ladder, and oral immunotherapy (OIT) and their outcomes in terms of efficacy, safety, and immunological effects. Cow’s milk (CM) avoidance virtually protects against allergic reaction until natural tolerance occurs, with hypoallergenic substitutes available in the market, but accidental ingestion represents the main issue for this strategy. Introduction to baked milk using the milk ladder was designed, with most CMPA patients successfully completing the ladder. Similar to baked milk treatment, many OIT protocols also demonstrated decreased IgE and increased IgG4 levels post protocol, as well as a reduction in wheal size diameter. Though these strategies are shown to be safe and effective in CMPA, future clinical trials should compare the safety and effectiveness of these three management strategies.

Rogue is a famous dungeon-crawling video-game of the 80ies, the ancestor of its gender. Due to their nature, and in particular to the necessity to explore partially observable and always different labyrinths (no level replay), roguelike games are a very natural and challenging task for reinforcement learning and Q-learning, requiring the acquisition of complex, non-reactive behaviours involving memory and planning. In this article we present Rogueinabox: an environment allowing a simple interaction with the Rogue game, especially designed for the definition of automatic agents and their training via deep-learning techniques. We also show a few initial examples of agents, discuss their architecture and illustrate their behaviour