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Growth hormone deficiency (GHD) describes the impairment of growth hormone (GH) secretion by the pituitary somatotroph cells. GHD may be congenital, with causes, including genetic alterations and structural brain malformations, or acquired, including midline tumours, cranial irradiation, traumatic brain injury, central nervous system infections and inflammatory conditions. GHD in children is characterised by short stature, delayed bone maturation and abnormalities in substrate metabolism, body composition, physical and psychosocial functioning, all of which improve with recombinant human GH (rhGH) therapy. The diagnosis of GHD is based on clinical signs and symptoms, biochemistry and imaging. Although GH stimulation tests are considered the mainstay of diagnostic investigations, the results must be interpreted with caution owing to the variability in cut-off values and reproducibility. Transition refers to the physical and psychosocial changes in adolescent patients during the mid-teens to late teens (usually 15–18 years of age) until about 6–7 years after achievement of adult height. During the transition age, only a small residual capacity of longitudinal growth is left, but body maturity is not yet complete. Discontinuation of rhGH treatment at the end of longitudinal growth in adolescents with permanent GHD is associated with decreased muscle strength and mass, increased body fat (mainly in the abdomen), the arrest or reversal of muscle mass and bone mass density (BMD) gain and lipid profile deterioration. For these reasons, patients whose GHD persists during the transition age need to continue rhGH treatment to obtain full somatic maturation and normalisation of body composition, BMD, quality of life (QoL) and lipid metabolism. There is some evidence that rhGH treatment during transition may result in improved growth and bone health, as well as a better prognosis for metabolic and cardiovascular risks in the long term. Since these patients need to continue treatment to complete their body development, a multidisciplinary approach is required to ensure continuity of care during the transfer from paediatric to adult endocrinology services. Guidelines for the diagnosis and treatment of young adults with GHD have been published by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE), Endocrine Society, European Society of Paediatric Endocrinology (ESPE), Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society and Endocrine Society of Australia. However, clinical practice lacks uniformity in terms of diagnosis and treatment of transition-age patients, the impact of GH replacement during transition has not been adequately assessed in randomised clinical trials (RCTs), validated questionnaires to assess QoL in patients on rhGH treatment in the transition period are not available and there is still uncertainty about the multidisciplinary approach during transition [8]. Hence, a structured transition protocol is essential to establish the best practice for transitioning adolescents with GHD to adult care. A study in Italy in 2015 identified a low level of awareness of these issues in clinical practice and real-world gaps in the management of GHD patients during transition. To address these gaps and assist endocrinologists (adult and paediatric) in the diagnosis and treatment of GHD in transition-age patients, a Delphi consensus process was undertaken to develop clinically relevant recommendations. The current consensus statements address the diagnosis of GHD, benefits of treatment, monitoring and management of transition-age patients with GHD, along with treatment adherence and safety concerns.

In the published article, there was an error in affiliation(s) 29. Instead of “Departement of Pediatrics, Diabetes Research Institute, IRCCS San Raffaele, Milano, Italy”, it should be “Diabetes Research Institute, IRCCS San Raffaele Hospital, Milan, Italy”. The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.

BACKGROUND: Congenital hypothyroidism (CH) is the most common congenital endocrine disease with reported high prevalence of associated congenital anomalies which are also present in case of congenital cytomegalovirus (cCMV) infection. SUBJECTS AND METHODS: We present two cases of newborns cCMV infection with CH. In the first case thyroid agenesis was diagnosed and cCMV infection was also confirmed for the hypotonia persistence after L-thyroxine treatment. In the second case thyroid dyshormonogenesis was diagnosed with maternal CMV serological conversion in the first trimester of gestation and confirmed post-neonatal infection. Incidence of CH has increased in the Italian region of Piedmont in the years 2014-2019 up to 1:1090 with higher incidence of cCMV infection in the babies with diagnosis of CH (12/1000 vs. 5-7/1000 in the newborns without CH). To our knowledge, no data on the association of cCMV infection with a CH condition have been reported in the literature to date. CONCLUSIONS: The described cases could be useful to alert caregivers in case of maternal seroconversion to avoid maternal and foetal hypothyroidism. On the other hand, when the clinical condition of newborns with CH diagnosis do not improve after l-thyroxine treatment, it might be important to consider cCMV infection.

This paper presents the results of a numerical and theoretical study aimed at identifying optimal design solutions for the seismic design of bridge pier foundations in very soft soil deposits. The reference case study consists of the pier foundations of a cross-river bridge designed to complete a highway over the Po Valley (Northern Italy). The subsoil is of sedimentary origin, with alternating layers of clayey silts and clays interbedded by thin layers of silty sand and peat. The mechanical properties of the soils were defined by conventional site and laboratory investigations, including Resonant Column tests carried out to define the dissipative and nonlinear behaviour of the soils. Numerical 2D and 3D models are used to assess the dynamic soil-structure interaction for the bridge piers, focusing both on inertial and kinematic effects. The main goal of the work is to highlight the influence of the type and layout of the foundation system on the overall seismic response of the bridge pier.

This book is the 2015-2017 report of the RINTC project, which has been a joint project of ReLUIS and EUCENTRE. The project intended to assess the seismic risk of code conforming structures in Italy. The results presented herein are, in some cases, different from those presented in the previous years and from preliminary literature derived from this project. This is because, as discussed in the body of text, hypotheses and choices have been continuously revised until consolidation; this process might be continuing even after the end of the project. In general, all computed annual structural failure rates closely reflect specific assumptions on design, modeling and analysis of the considered structures, and this has to be always taken into account when discussing the results of this project. The working group of the project (listed below) consists of the following six sub-groups, each of which explores (i) seismic risk assessment of code-conforming structures, designs, modelling, and analyses of (ii) masonry buildings, (iii) precast reinforced concrete buildings, (iv) reinforced concrete buildings, (v) steel buildings, and (vi) base-isolated reinforced concrete buildings. The book is structured such that each chapter presents the research results from the corresponding sub-group: Chapter (i) introduces the objectives and framework of the project; Chapters (ii) ? (vi) develop code-conforming designs, modelling and analyses of buildings for each structural type; Chapter (vii) concludes the study presenting the final results of the computed failure rates for the structures examined in the preceding chapters. Moreover, readers can refer to Appendices A to C for the details of the considerations on (a) usability-preventing limit state, (b) soil-structure interaction, and (c) model-uncertainty, respectively.