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Abstract Plants cope with the environment by displaying large phenotypic variation. Two spectra of global plant form and function have been identified: a size spectrum from small to tall species with increasing stem tissue density, leaf size, and seed mass; a leaf economics spectrum reflecting slow to fast returns on investments in leaf nutrients and carbon. When species assemble to communities it is assumed that these spectra are filtered by the environment to produce community level functional composition. It is unknown what are the main drivers for community functional composition in a large area such as Amazonia. We use 13 functional traits, including wood density, seed mass, leaf characteristics, breeding system, nectar production, fruit type, and root characteristics of 812 tree genera (5211 species), and find that they describe two main axes found at the global scale. At community level, the first axis captures not only the ‘fast-slow spectrum’, but also most size-related traits. Climate and disturbance explain a minor part of this variance compared to soil fertility. Forests on poor soils differ largely in terms of trait values from those on rich soils. Trait composition and soil fertility exert a strong influence on forest functioning: biomass and relative biomass production. more...

Abstract We describe the geographical variation in tree species composition across Amazonian forests and show how environmental conditions are associated with species turnover. Our analyses are based on 2023 forest inventory plots (1 ha) that provide abundance data for a total of 5188 tree species. Within-plot species composition reflected both local environmental conditions (especially soil nutrients and hydrology) and geographical regions. A broader-scale view of species turnover was obtained by interpolating the relative tree species abundances over Amazonia into 47,441 0.1-degree grid cells. Two main dimensions of spatial change in tree species composition were identified. The first was a gradient between western Amazonia at the Andean forelands (with young geology and relatively nutrient-rich soils) and central–eastern Amazonia associated with the Guiana and Brazilian Shields (with more ancient geology and poor soils). The second gradient was between the wet forests of the northwest and the drier forests in southern Amazonia. Isolines linking cells of similar composition crossed major Amazonian rivers, suggesting that tree species distributions are not limited by rivers. Even though some areas of relatively sharp species turnover were identified, mostly the tree species composition changed gradually over large extents, which does not support delimiting clear discrete biogeographic regions within Amazonia. more...

Introduction Muscle volume is a crucial indicator of muscle strength and neuromuscular health, traditionally assessed using Magnetic Resonance Imaging (MRI). While MRI provides high accuracy, it is costly and time-consuming. Three-dimensional ultrasonography (3DUS) offers a more accessible alternative but requires rigorous validation due to setup dependent accuracy. This study evaluates the validity and reliability of a custom 3DUS setup for measuring lower limb muscle volumes, compares it to MRI, and documents the methodology for broader research adoption. Methods We recruited 10 healthy participants (5 males, 5 females; 18–40 years). The protocol included two 3DUS sessions and one MRI session spaced one week apart. The 3DUS scans were acquired by one experienced operator, while two operators analyzed the captured volumes from the second scanning timepoint. Target muscles—biceps femoris, gastrocnemius medialis and lateralis, tibialis anterior, and vastus lateralis—were scanned using a linear probe (12L3, Siemens, Erlangen, Germany) integrated with a motion capture system (Optitrack Flex 3, NaturalPoint, Corvallis, OR, USA). Data synchronization and reconstruction were performed using 3D Slicer. MRI scans were acquired using a 3T whole-body scanner (MAGNETOM Prisma, Siemens, Erlangen, Germany), and muscle volumes were segmented using Dafne and 3D-Slicer software. Validation was enhanced with phantom models (100–600 mL) scanned via both modalities. Reliability metrics included intra-class correlation (ICC), coefficients of variation (CV%), standard error of measurement (SEM), minimal detectable change (MDC) and standardized mean bias. Results Test-retest reliability of 3DUS was high for all muscles, with ICCs ranging from 0.97 to 0.99 (95% confidence intervals between 0.86–0.99) and CV% values between 2.0 and4.6% (95% CI between 1.3–6.7%). MDC values were below 5 mL for all muscles, indicating sensitivity to detect small volume changes. The biceps femoris exhibited the highest test-retest reliability, while the gastrocnemius medialis showed lower but acceptable agreement. Inter-rater reliability was similarly high, with ICCs exceeding 0.97 (95% CIs between 0.51–0.99) for all assessed muscles and minimal variability between operators (CV%: 2.1–3.2%, 95% CIs between 1.1–4.7%). Tibialis anterior yielded the highest inter-rater reliability results, vastus lateralis the lowest. Compared to MRI, 3DUS underestimated muscle volumes, with mean biases ranging from -15.4% to -44.6%. Agreement was highest for the tibialis anterior and lowest for the gastrocnemii. Standardized mean biases were classified as moderate to very large, ranging from -0.92 to -2.64. In contrast, phantom scans confirmed high accuracy for both 3DUS and MRI, suggesting measurement errors in vivo were likely due to probe pressure and sweep inconsistencies. Discussion/Conclusion Our 3DUS system demonstrated excellent reliability for assessing muscle volumes between sessions and raters, but showed limited comparability to MRI, systematically underestimating volumes. The magnitude of underestimation appeared to be influenced by muscle architecture and location. Calibration refinements, including reduced probe pressure and optimized sweep protocols, are underway to improve accuracy. Nonetheless, 3DUS is a promising, cost-effective tool for longitudinal muscle assessments, particularly for detecting intervention-induced changes. Our openly accessible documentation of the methodology supports reproducibility and further innovation in the field. more...

Abstract Restoration of vulnerable marine habitats is becoming increasingly popular to cope with widespread habitat loss and the resulting decline in biodiversity and ecosystem services. Lately, restoration strategies have been employed to enhance the recovery of degraded meadows of the Mediterranean endemic seagrass Posidonia oceanica. Typically, habitat restoration success is evaluated by the persistence of foundation species after transplantation (e.g., plant survival and growth) on the short and long-term, although successful plant responses do not necessarily reflect the recovery of ecosystem biodiversity and functions. Recently, soundscape (the spatial, temporal and frequency attribute of ambient sound and types of sound sources characterizing it) has been related to different habitat conditions and community structures. Thus, a successful restoration action should lead to acoustic restoration and soundscape ecology could represent an important component of restoration monitoring, leading to assess successful habitat and community restoration. Here, we evaluated acoustic community and metrics in a P. oceanica restored meadow and tested whether the plant transplant effectiveness after one year was accompanied by a restored soundscape. With this goal, acoustic recordings from degraded, transplanted and reference meadows were collected in Sardinia (Italy) using passive acoustic monitoring devices. Soundscape at each meadow type was examined using both spectral analysis and classification of fish calls based on a catalogue of fish sounds from the Mediterranean Sea. Seven different fish sounds were recorded: most of them were present in the reference and transplanted meadows and were associated to Sciaena umbra and Scorpaena spp. Sound Pressure Level (SPL, in dB re: 1 μPa-rms) and Acoustic Complexity Index (ACI) were influenced by the meadow type. Particularly higher values were associated to the transplanted meadow. SPL and ACI calculated in the 200–2000 Hz frequency band were also related to high abundance of fish sounds (chorus). These results showed that meadow restoration may lead to the recovery of soundscape and the associated community, suggesting that short term acoustic monitoring can provide complementary information to evaluate seagrass restoration success. more...

Giulia Lanfranchi,1 Irene Paraboschi,2 Ugo Maria Pierucci,1 Guglielmo Mantica,3 Sara Costanzo,1 Federica Marinoni,1 Andrea Pansini,1 Giorgio Giuseppe Orlando Selvaggio,1 Gloria Pelizzo1,2 1Department of Pediatric Surgery, Buzzi Children’s Hospital, Milan, 20154, Italy; 2Department of Biomedical and Clinical Sciences “L Sacco”, University of Milano, Milan, 20157, Italy; 3Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, 16131, ItalyCorrespondence: Gloria Pelizzo, Department of Biomedical and Clinical Sciences “L Sacco”, University of Milan, Milan, 20157, Italy, Email gloria.pelizzo@unimi.itAim: To review our 10 years of experience with the endoscopic treatment of vesicoureteral reflux (VUR) in children, emphasizing the long-term efficacy of the “combined STING-HIT” technique.Materials and Methods: A retrospective study was performed including all children with symptomatic VUR undergoing the cystoscopic injection of bulking agents from January 2013 to December 2022 in our pediatric tertiary referral center. Three different endoscopic techniques were adopted: the “combined STING-HIT” technique, the STING technique, and the HIT technique. Treatment success was defined as symptom remission and VUR resolution on the voiding cystourethrogram (VCUG) performed at the 3-month follow-up.Results: In the study period, 140 (F:M = 64:76) patients and 228 ureters were treated at a median patient age of 3 (2.0– 6.0) years. After a single endoscopic treatment, VUR resolved in 203 (88%) ureters. The VUR resolution rate after a single endoscopic treatment was 95% (n=70/74) in case of I–II VUR, 88% (n=87/99) in case of III VUR; 83% (n=38/46) in case of IV VUR; 89% (n=8/9) in case of V VUR (p-value: 0.174). Overall, one or two endoscopic treatments succeeded in 219 (96%) ureters. The overall VUR resolution rate following one or two endoscopic treatments was 100% (74/74) in case of I–II VUR, 93% (n=92/99) in case of III VUR; 96% (n=44/46) in case of IV VUR; 100% (n=9/9) in case of V VUR (p-value: 0.083). Despite not being statistically significant, the VUR resolution rate was higher for the “combined STING-HIT” technique, both after one (92%: n=110/119; versus 85%; n=62/73 versus 86%; n=31/36; p-value: 0.225) or two (98%: n=116/119; versus 95%; n=69/73 versus 94%; n=34/36; p-value: 0.469) endoscopic treatments.Conclusion: The endoscopic approaches were highly successful for the treatment of VUR in children. The “combined STING-HIT” technique was a safe and effective procedure, being associated with the higher resolution rate.Keywords: vesicoureteral reflux, injection technique, endoscopic technique, pediatrics more...

Abstract Background Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR). Methods We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score 15 ml/min. Results 237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p more...

Microbes exist everywhere on, in and around us. They are both ubiquitous and largely invisible, at least until they make their presence, or absence, felt. Recent years have seen a heightened sensitivity to microbial threats in the wake of the COVID-19 pandemic and widespread concerns about antimicrobial resistance (AMR) to antibiotics. At the same time, there is also a growing interest in the microbiome as a source of ‘wild immunology’. From this viewpoint, the human body is comprised of, embedded within, and dependent on its exposure to an ecosystem of microbes, and the absence of such exposure is linked to the development of auto-immune conditions such as Crohn’s disease and ulcerative colitis. Inspired by an emerging body of work in the humanities and social sciences which looks to engage with so-called lay knowledge and understandings of microbial forms (including bacteria, viruses, and fungi) and processes (such as contagion or digestion), this Field Note explores the piloting of ‘body mapping’ as a research method to engage with families to explore their collective understanding of their children’s microbiome. more...

The paper presents the acquisition and data processing approach for the Ground Penetrating Radar (GPR) and laser scanner surveys carried out within the SOS project (the acronym comes from ‘SOtto Siena’, in English ‘Beneath Siena’). SOS is a program aimed to overcome some of the problems and limitations currently present in the study of cities with long-term continuity of life, responding in particular to the need for a better understanding of the city’s ancient fabric and hence to improvements in its conservation by: GPR city survey full coverage (of all the public spaces, streets, squares, courtyards, gardens, etc.), GIS data entry of the historical-archaeological and geoarchaeological knowledge and the development of a 3D Archaeological WEBGIS.The paper discusses the procedure for the creation of a 3D viewer within an already active WEBGIS platform, specifically created for the visualisation and management of archaeological data. The GPR data, once acquired, were exported in 3D in the form of point clouds and subjected to a procedure of cleaning and filtering from noise, so as to eliminate geometries not referable to anomalies and therefore to the presence of buried structures or cavities, and then transformed into mesh to meet the needs of the subsequent process of semantic enrichment. The GPR survey of the underground was flanked by laser scanning of some of the most significant structures in the historic centre (e.g. the cathedral). All 3D geometries were then inserted into the new visualiser via a pipeline using open-source tools and libraries. more...

Wernicke–Korsakoff Syndrome (WKS) is a severe neurological disorder resulting from thiamine deficiency, commonly associated with alcohol consumption but also stemming from dietary imbalances or other clinical conditions. Cognitive deficits, affecting memory and executive functions, pose a serious concern, with partial recovery often not complete. A 28-year-old woman underwent surgery for acute necrotizing hemorrhagic pancreatitis, leading to admission for post-acute intensive treatment due to prolonged bed rest syndrome. Clinical examinations revealed sensory–motor neuropathy, denervation in the active phase, mammillary body hyperintensity, and cognitive impairment. The patient exhibited poor orientation, lacked awareness of her clinical condition, and experienced impaired nonverbal memory, practical constructive issues, and planning difficulties—consistent with WKS. The patient received high-dose thiamine (300 mg TDS), coupled with daily physiokinesitherapy and occupational therapy. A final neuropsychological evaluation three months later showed substantial remission of executive and memory difficulties, improved spatial–temporal orientation, and enhanced awareness. The complex case required timely multidisciplinary intervention for accurate diagnosis and effective rehabilitation. The patient experienced rapid clinical improvement and cognitive recovery with high-dose thiamine and physiotherapy. more...

In the Mediterranean Sea, restoration of marine habitats has mostly focused on the endemic seagrass Posidonia oceanica. Despite several transplanting experiments, large-scale projects are rare, and their success is poorly known. The present work describes a restoration project of a large, degraded area in northern Sardinia (Italy) using cuttings harvested from a donor meadow that was destined for destruction due to harbor expansion. The receiving site was selected through a multidisciplinary study including acoustic mapping, ROV surveys, sediment assessment, and analyses of satellite images across ten years to evaluate the site suitability. Plants were manually uprooted from the donor meadow and cuttings were selected and transplanted within 24 h by environmental engineering techniques. The cuttings were transplanted onto degradable mats of natural coconut nets coupled with a double-twist steel mesh and anchored to the bottom. Overall, 7000 patches, each containing 20 cuttings, were transplanted in three periods: June–July 2022, October–November 2022, and February–March 2023. One year after the restoration, all the patches were in situ, with an overall cutting survival of 59%. The results are comparable to those of previous small-scale projects using the same technique and also endorse its suitability for the restoration of large, degraded areas. more...

Abstract Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution. more...

Parkinson’s disease (PD) is a chronic neurodegenerative disease associated with a progressive loss of dopaminergic neurons, clinically characterized by motor and non-motor signs. Frailty is a clinical condition of increased vulnerability and negative health outcomes due to the loss of multiple physiological reserves. Chronic hyperglycemia and insulin resistance, which characterize diabetes mellitus (DM), have been reported to alter dopaminergic activity, increase the risk of PD, and influence the development of frailty. Even though diabetes may facilitate the development of frailty in patients with PD, this relationship is not established and a revision of the current knowledge is necessary. Furthermore, the synergy between DM, PD, and frailty may drive clinical complexity, worse outcomes, and under-representation of these populations in the research. In this review, we aimed to discuss the role of diabetes in the development of frailty among patients with PD. We summarized the clinical characteristics and outcomes of patients with concomitant DM, PD, and frailty. Finally, interventions to prevent frailty in this population are discussed. more...

The subject of lymphatics and cancer had been in the air for a lot of time. The Editor, Paolo Zamboni, came up at first with the idea of writing about this issue and was good enough to ask me to attempt this work after I provided him with images of mesenteric, intestinal and hepatic metastases from a young patient I treated for a malignant melanoma of the skin, in the last year of my surgical practice. more...

The glory of having discovered the lymphatic vessels belongs undoubtedly to the Italian Gaspare Aselli from Cremona; he established itself as an excellent anatomist and surgeon, also military, in Milan, where the first true description of the lymphatic system can really begin; later, he moved to Pavia, where in 1624 he obtained the chair of anatomy. more...

Abstract Global warming is expected to have inexorable and profound effects on marine ecosystems, particularly in foundation species such as seagrasses. Identifying responses to warming and comparing populations across natural temperature gradients can inform how future warming will impact the structure and function of ecosystems. Here, we investigated how thermal environment, intra-shoot and spatial variability modulate biochemical responses of the Mediterranean seagrass Posidonia oceanica. Through a space-for-time substitution study, Fatty acid (FA) profiles on the second and fifth leaf of the shoots were quantified at eight sites in Sardinia along a natural sea surface temperature (SST) summer gradient (about 4 °C). Higher mean SST were related to a decrease in the leaf total fatty acid content (LTFA), a reduction in polyunsaturated fatty acids (PUFA), omega-3/omega-6 PUFA and PUFA/saturated fatty acids (SFA) ratios and an increase in SFA, monounsaturated fatty acids and carbon elongation index (CEI, C18:2 n-6/C16:2 n-6) ratio. Results also revealed that FA profiles were strongly influenced by leaf age, independently of SST and spatial variability within sites. Overall, this study evidenced that the sensitive response of P. oceanica FA profiles to intra-shoot and spatial variability must not be overlooked when considering their response to temperature changes. more...

Abstract In a time of rapid global change, the question of what determines patterns in species abundance distribution remains a priority for understanding the complex dynamics of ecosystems. The constrained maximization of information entropy provides a framework for the understanding of such complex systems dynamics by a quantitative analysis of important constraints via predictions using least biased probability distributions. We apply it to over two thousand hectares of Amazonian tree inventories across seven forest types and thirteen functional traits, representing major global axes of plant strategies. Results show that constraints formed by regional relative abundances of genera explain eight times more of local relative abundances than constraints based on directional selection for specific functional traits, although the latter does show clear signals of environmental dependency. These results provide a quantitative insight by inference from large-scale data using cross-disciplinary methods, furthering our understanding of ecological dynamics. more...

Background. Acute mastoiditis (AM) is a severe infection of the mastoid air cells that occurs in cases of acute, sub-acute, or chronic middle ear infections. No definitive consensus regarding the management of AM has been identified. The current guidelines include a conservative approach (parenteral antibiotics alone, antibiotics plus minor surgical procedures such as myringotomy with a ventilation tube inserted or drainage of the subperiosteal abscess through retro-auricolar incision or needle aspiration) or surgical treatment (mastoidectomy). The main aim of this review was to evaluate and summarize the current knowledge about the management of pediatric AM by analyzing the current evidence in the literature. Methods. We examined the following bibliographic electronic databases: Pubmed and the Cochrane Library, from the inception date until February 2023. The search was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISM). The key words used for the search across electronic databases were: `mastoiditis` and `management`; `mastoiditis` and `surgery`; `mastoiditis` and `conservative`; `mastoiditis` and `antibiotics`; `mastoiditis` and `myringotomy`; `mastoiditis` and `grommet`; `mastoiditis` and `drainage`; and `mastoiditis` and `mastoidectomy`. Results. We selected 12 articles involving 1124 episodes of mastoiditis. Some of these studies considered medical therapy alone as a valid first step, whereas others considered a minor surgical intervention as an initial approach along with antibiotic therapy. Considering the studies that evaluated medical therapy as the initial sole treatment option, the success rate of antibiotics alone was 24.6%. Overall, the success rate of minor surgical procedures, excluding mastoidectomy, was 87.7%, whereas the mastoidectomy success rate was 97%. Conclusions. Overall, there is no shared consensus on the diagnostic or therapeutic approach to mastoiditis. Conservative therapy has gained considerable ground in recent times, quite limiting the predominant role of mastoidectomy. Further studies will be necessary to definitely develop standardized protocols shared in the scientific community. more...

Sepsis is a life-threatening condition that affects 1.2 million children annually. Although there are several criteria for diagnosing this condition, signs are often nonspecific, and identifying sepsis is challenging. In this context, presepsin (P-SEP) seems to be a promising new biomarker since its plasma levels increase earlier than other sepsis-related proteins and its measurement is faster. We enrolled 157 minors who presented to the Pediatric Emergency Department of Agostino Gemelli Hospital with fever and suspected sepsis. Biochemical, anamnestic, and clinical data were collected. Viral agents were identified as the causative factor in 64 patients, who had an average P-SEP value of 309.04 pg/mL (SD ± 273.2), versus an average P-SEP value of 526.09 pg/mL (SD ± 657) found in 27 bacterial cases (p value: 0.0398). Four cases of overt sepsis had an average P-SEP value of 3328.5 pg/mL (SD ± 1586.6). The difference in P-SEP levels in viral versus bacterial infections was found to be statistically significant; therefore, P-SEP may have a central role in the evaluation of febrile children, helping clinicians distinguish between these two etiologies. Furthermore, amongst the cases of confirmed sepsis, P-SEP was always greater than 2000 pg/mL, while C-reactive protein and procalcitonin values appeared lower than what was considered significant. more...

The dawn of Artificial intelligence (AI) in healthcare stands as a milestone in medical innovation. Different medical fields are heavily involved, and pediatric emergency medicine is no exception. We conducted a narrative review structured in two parts. The first part explores the theoretical principles of AI, providing all the necessary background to feel confident with these new state-of-the-art tools. The second part presents an informative analysis of AI models in pediatric emergencies. We examined PubMed and Cochrane Library from inception up to April 2024. Key applications include triage optimization, predictive models for traumatic brain injury assessment, and computerized sepsis prediction systems. In each of these domains, AI models outperformed standard methods. The main barriers to a widespread adoption include technological challenges, but also ethical issues, age-related differences in data interpretation, and the paucity of comprehensive datasets in the pediatric context. Future feasible research directions should address the validation of models through prospective datasets with more numerous sample sizes of patients. Furthermore, our analysis shows that it is essential to tailor AI algorithms to specific medical needs. This requires a close partnership between clinicians and developers. Building a shared knowledge platform is therefore a key step. more...

This paper contributes to prior literature and to the current debate concerning the prudential supervisory framework to measure interest rate risk in the banking book (IRRBB), which has been significantly changed on April 2016, when the Basel Committee on Banking Supervision (BCBS) published the latest update of its measurement standards. The consultation launched by the European Banking Authority (EBA) on December 2021, aiming at introducing the supervisory outlier test (SOT) on net interest income (NII), presents several issues and policy implications which could influence in the next future banks' asset and liability management strategies, their internal control systems, risk policies and procedures. By analyzing a sample of 28 Italian commercial banks at the end of 2021, representing more than 70% of Italian baking system’s total assets , we observe that the thresholds proposed by the EBA appear very strict and significantly depend on: i) the sample considered, ii) the lower bound applied to interest rates in the downward scenarios and iii) the current level of interest rates term structure. Our results suggest that the proposed values should be considered with caution as it seems that their potential impacts have not been thoroughly assessed. Further analyses are therefore necessary to guarantee greater robustness of the methodology used for the calibration of the thresholds, taking also into account a wider sample of banks and longer time series, as well as the correlation between the two approaches. more...

Introduction: A trichobezoar is a mass of indigestible hair in the gastrointestinal tract caused by hair ingestion, usually associated with trichotillomania and trichophagia. Although sometimes asymptomatic, it can become a rare cause of intestinal obstruction and require an emergent surgical intervention. The operative approach of choice, laparotomy versus laparoscopy, is still controversial. Case presentation: A 11-year-old girl was admitted to our institution with abdominal pain, vomiting and anorexia for 3 days. On abdominal examination, she had diffused abdominal pain with tenderness in the mesogastrium, with no palpable mass. Abdominal computed tomography (CT) scan and barium meal study shown a large gastric mass. Upper gastrointestinal (GI) endoscopy identified an enormous trichobezoar, which was later removed laparoscopically. An anterior gastrotomy was performed and the bezoar was then transferred en bloc into the endo-bag. The neck of the endobag was then exteriorized through the umbilical incision and removed by gradual fragmentation. The volume and size of the phytobezoars were 1875 cm3 and 25 × 15 × 5 cm. The patient was discharged on the 5th postoperative day without any complications. Conclusion: Successful laparoscopic management of pediatric trichobezoar may be accomplished by a 4-ports approach. It allows a lower intraoperative risk of contaminations, a rapid recovery and good cosmetic results in children. more...

Objective: To summarize the main evidence regarding osteometabolic changes in patients undergoing antineoplastic treatment. Methods: This is a scoping review, following the methodology of the Joanna Briggs Institute, using PubMed/MedLine, Cochrane Library, LILACS, The British Library, and Google Scholar. This review is registered in the Open Science Framework. Results: Many antineoplastics affect bone architecture by reducing its density, such as selective estrogen receptor modulators, aromatase inhibitors, androgen deprivation therapy, and glucocorticoids. To avoid such outcomes, treatment and prevention can be achieved by calcium and vitamin D supplementation, physical exercise, use of bisphosphonates, denosumab, and selective estrogen receptor modulators. Conclusion: people at a higher risk of developing cancer also have a higher risk of osteopenia and osteoporosis when the process is already established and undergoing antineoplastic treatment because of the grouping of risk factors. The need for bone densitometry in patients undergoing cancer treatment to prevent and promote bone health in these patients is evident, in addition to more research with a high level of evidence to support such use. more...

Abstract Inflammation and pain are consequences of injuries or diseases that affect a large number of people. This study aims to evaluate the effect of acupuncture and laserpuncture on nociception and inflammation in mice compared to the effects of morphine and dexamethasone. 140 male Swiss mice were used. Treatment with acupuncture and laserpuncture were performed at the acupoints LI11, ST36, GB34, and BL60 in mice. To evaluate the effect of acupuncture and laserpuncture on nociception, the hot plate test and intraplantar formalin injection were used. The effect of acupuncture and laserpuncture on the inflammation was evaluated through carrageenan-induced paw edema. Thermographic analysis was also applied to evaluate the anti-inflammatory effects. An antinociceptive effect (≈57%) was observed in treatments with acupuncture and laserpuncture, equivalent to the effect of morphine. Laserpuncture and acupuncture decreased paw edema by ≈25%. Acupuncture had an effect equivalent to dexamethason, basides reducing the neurogenic phase by 35% and the inflammatory phase in formalin-induced nociception by 40%, equivalent to the effects of morphine. In thermographic analysis, acupuncture, laserpuncture, morphine, and negative control had paw temperature of ≈27 °C, while formalin treatment was 31°C. Acupuncture and laserpuncture proved to be effective therapies for the treatment of inflammatory and painful processes. more...

Abstract P‐Wave Dispersion (PWD) is an ECG parameter defined as the difference between the longest and the shortest P‐Wave duration. PWD has been associated with hypertension, a leading cause of age‐related cognitive decline. Moreover, hypertension is associated with vascular dementia and Alzheimer's Disease. Based on these considerations, we evaluated PWD and global cognitive function in frail hypertensive older adults with a previous diagnosis of cognitive decline. We evaluated consecutive frail hypertensive patients ≥65‐year‐old with a Mini‐Mental State Examination (MMSE) score more...

Abstract Background Diabetes and hypertension are common in older adults and represent established risk factors for frailty. Frailty is a multidimensional condition due to reserve loss and susceptibility to stressors with a high risk of death, hospitalizations, functional and cognitive impairment. Comorbidities such as diabetes and hypertension play a key role in increasing the risk of mortality, hospitalization, and disability. Moreover, frail patients with diabetes and hypertension are known to have an increased risk of cognitive and physical impairment. Nevertheless, no study assessed the correlation between physical and cognitive impairment in frail older adults with diabetes and hypertension. Methods We evaluated consecutive frail older patients with diabetes and hypertension who presented at ASL (local health unit of the Italian Ministry of Health) Avellino, Italy, from March 2021 to October 2021. The inclusion criteria were: a previous diagnosis of diabetes and hypertension with no evidence of secondary causes; age > 65 years; a frailty status; Montreal Cognitive Assessment (MoCA) score more...

Intense changes in mineral and bone metabolism are frequent in chronic kidney disease (CKD) and represent an important cause of morbidity and reduced quality of life. These disorders have conventionally been defined as renal osteodystrophy and classified based on bone biopsy, but due to a lack of bone biopsy data and validated radiological methods to evaluate bone morphology in children, it has been challenging to effectively assess renal osteodystrophy in pediatric CKD; the consequence has been the suboptimal management of bone disorders in children. CKD–mineral and bone disorder (CKD-MBD) is a new expression used to describe a systemic disorder of mineral and bone metabolism as a result of CKD. CKD-MBD is a triad of biochemical imbalances in calcium, phosphate, parathyroid hormone, and vitamin D; bone deformities and soft tissue calcification. This literature review aims to explore the pathogenesis, diagnostic approach, and treatment of CKD-MBD in children and the effects of renal osteodystrophy on growing skeleton, with a specific focus on the biological basis of this peculiar condition. more...

A 2-year-old male intact goldendoodle presented for intermittent lameness, persistent draining tracts, and radiographic identified boney lytic lesions involving the metatarsal region, which had persisted for approximately 8 months before presentation to our referral hospital. Radiographic and computed tomography (CT) images suggested a tubular structure encircling and tunneling through the right metatarsal bones. Exploratory surgery confirmed a circumferential rubber band foreign body, with lytic boney tunneling within the metatarsal bones. CT provided vital information to assist in the surgical planning for this patient with a chronic tunneling foreign body. more...

Global warming and Marine Heat Waves (MHWs) are having large-scale impacts on the seagrasses and their effects on the Mediterranean endemic Posidonia oceanica need to be properly defined. This research aimed to sharpen the knowledge on P. oceanica response to the warming by correlating the shoot morphology and the productivity of the seagrass to temperature conditions and MHW occurrence. Two correlative studies, along a Mediterranean temperature range (sites at the same latitude), were conducted: one explored the associations of summer 2021 Sea Surface Temperature (SST) and MHWs on P. oceanica morphology and the other used a reconstruction technique (lepidochronological analysis) to relate past temperature conditions and MHW occurrence to proxies of seagrass productivity for the corresponding periods. The results showed that the mean summer temperature affected the P. oceanica leaf necrosis and that MHWs occurrence changed the morphology of the plant by lowering the leaf area and increasing leaf necrosis. Interesting results were also found relating the past thermal environment, since rhizome biomass has been negatively affected by the number of MHWs and rhizome length by the temperature range. This research provides fundamental insights about P. oceanica changes linked to warming and MHWs, identifying the potential plant indicators assisting future experimental and modelling studies. To the best of our knowledge, this is the first time a reconstruction technique is used to evaluate the effects of past MHWs on the morphology and productivity of a plant species. more...

Abstract Comparing populations across temperature gradients can inform how global warming will impact the structure and function of ecosystems. Shoot density, morphometry and productivity of the seagrass Posidonia oceanica to temperature variation was quantified at eight locations in Sardinia (western Mediterranean Sea) along a natural sea surface temperature (SST) gradient. The locations are spanned for a narrow range of latitude (1.5°), allowing the minimization of the effect of eventual photoperiod variability. Mean SST predicted P. oceanica meadow structure, with increased temperature correlated with higher shoot density, but lower leaf and rhizome width, and rhizome biomass. Chlorophyll a (Chl-a) strongly impacted seagrass traits independent of SST. Disentangling the effects of SST and Chl-a on seagrass meadow shoot density revealed that they work independently, but in the same direction with potential synergism. Space-for-time substitution predicts that global warming will trigger denser seagrass meadows with slender shoots, fewer leaves, and strongly impact seagrass ecosystem. Future investigations should evaluate if global warming will erode the ecosystem services provided by seagrass meadows. more...

To avoid risks, organisms must recognize threatening heterospecies from non-threatening ones via acoustic cues from a distance. With land-use change, humans have encroached considerably into natural areas. Therefore, it is beneficial to animals to use acoustic cues to discriminate between different levels of threats posed by humans. Our study aims at testing this discriminatory ability in Asian elephants (Elephas maximus), animals that have been for long history subjected to human interaction. We tested whether eighteen semi-captive elephants could discriminate between voices of their own mahouts (i.e., who take care of the elephants exclusively) and of other mahouts (unfamiliar individuals). The results showed that elephants responded successfully to the commands from their own mahouts, with an average response rate as high as 78.8%. The more years the mahouts had been as their caretakers, the more the elephant showed active responses toward the commands. Female elephants responded to the commands more frequently and faster than males. Also younger elephants responded more frequently and faster than older elephants. We argue that Asian elephants can discriminate between familiar and unfamiliar humans by acoustic cues alone. Proximity with humans may be a factor, as fundamental as domestication, for animals to develop heterospecies discriminatory ability. more...

Emerging evidence has shown that microRNAs (miRNAs) play critical role in the pathogenesis of several disorders. In the present minireview, we focus our attention on the functional role of a specific miRNA, namely miR-34a, in the pathophysiology of frailty and diabetes mellitus. Based on the current literature, we speculate that this miRNA may serve as a potential biomarker of frailty in diabetic older adults. Additionally, its actions on oxidative stress might represent a druggable target to obtain new potentials treatments. more...

Abstract Background The medical community has been deeply involved in fighting the Coronavirus disease 2019 (COVID-19) pandemic and, as a consequence, the care of non-COVID-19 patients has been impacted. However, the treatment of head and neck cancer patients is not deferrable, and an integrated strategy is required. The aim of the current article is to present the experience in the management of head and neck patients during the COVID-19 pandemic at the research hospital “Casa Sollievo della Sofferenza”. This review contains replicable and widely usable instructions on how to avoid delays in the diagnosis and treatment of head and neck tumors and to ensure a gradual return to elective procedures. Main text The Head and Neck Department of the research hospital “Casa Sollievo della Sofferenza” includes an Otolaryngology and a Maxillofacial Surgery Unit, both of which deal with the diagnosis and treatment of benign and malignant pathologies of the head and neck, as well as urgent/emergent consultations and surgical procedures that necessitate time sensitive operative management, such as cochlear implantation (CI). Given these premises and the complexity of the Department, the “COVID-19 organizing protocol” of the research hospital “Casa Sollievo della Sofferenza” was divided into two phases in accordance with the different stages of the pandemic and the priority of treatment. Special attention was given to the medical surveillance of health care workers and hospitalized patients, to the organization of the outpatient clinic and the operating setting as well as to the implementation of telehealth systems. Conclusions The COVID-19 pandemic is going to be a long-term situation with lasting effects on the public health and the entire society. Therefore, an efficient health care system has to adopt a double strategy: always being ready for a “new wave” of the pandemic and not forgetting non-COVID-19 patients, among whom head and neck cancer patients represent a priority. More than 1 year since the first outbreak in Wuhan, this review offers a unique and helpful perspective that incorporates awareness of the disease. more...

Abstract Predicting community-level responses to seawater warming is a pressing goal of global change ecologists. How far such predictions can be derived from a fine gradient of thermal environments needs to be explored, even if ignoring water climatology does not allow estimating subtidal marine heat waves. In this study insights about the influence of the thermal environment on the coralligenous community structure were gained by considering sites (Sardinia, Italy) at different temperature conditions. Heating events were measured (by loggers at 18 m, 23 m, 28 m, 33 m and 38 m deep) and proxies for their duration (the maximum duration of events warmer than the 90th percentile temperature), intensity (the median temperature) and variability (the number of daily ΔT larger than the mean daily ΔT, and the number of heating events larger in ΔT than the 90th percentile ΔT) were selected by GAM models. Reliable predictions of decrease in coralligenous richness of taxa/morphological groups, with relevant increment in turfs and encrusting coralline algae abundance at the expenses of bryozoans were made. Associations to the different types of heating descriptor have highlighted the aspect (intensity, duration or variability) of the heating events and the threshold for each of them responsible for the trajectories of change. more...

Abstract Background The aim of this study is to quantify the frequency content of the blood velocity waveform in different body regions by means of phase contrast (PC) cardiovascular magnetic resonance (CMR) and Doppler ultrasound. The highest frequency component of the spectrum is inversely proportional to the ideal temporal resolution to be used for the acquisition of flow-sensitive imaging (Shannon-Nyquist theorem). Methods Ten healthy subjects (median age 33y, range 24–40) were scanned with a high-temporal-resolution PC-CMR and with Doppler ultrasound on three body regions (carotid arteries, aorta and femoral arteries). Furthermore, 111 patients (median age 61y) with mild to moderate arterial hypertension and 58 patients with aortic aregurgitation, atrial septal defect, or repaired tetralogy of Fallot underwent aortic CMR scanning. The frequency power distribution was calculated for each location and the maximum frequency component, fmax, was extracted and expected limits for the general population were inferred. Results In the healthy subject cohort, significantly different fmax values were found across the different body locations, but they were nonsignificant across modalities. No significant correlation was found with heart rate. The measured fmax ranged from 7.7 ± 1.1 Hz in the ascending aorta, up to 12.3 ± 5.1 Hz in the femoral artery (considering PC-CMR data). The calculated upper boundary for the general population ranged from 11.0 Hz to 27.5 Hz, corresponding to optimal temporal resolutions of 45 ms and 18 ms, respectively. The patient cohort exhibited similar values for the frequencies in the aorta, with no correlation between blood pressure and frequency content. Conclusions The temporal resolution of PC-CMR acquisitions can be adapted based on the scanned body region and in the adult population, should approach approximately 20 ms in the peripheral arteries and 40 ms in the aorta. Trial registration This study presents results from a restrospective analysis of the clinical study NCT01870739 (ClinicalTrials.gov). more...

Cognitive impairment is a prevailing event in hypertensive patients and in frail older adults. Endothelial dysfunction has been shown to underlie both hypertension and cognitive dysfunction. Our hypothesis is that L-Arginine, which is known to ameliorate endothelial dysfunction, could counteract cognitive impairment in a high-risk population of hypertensive frail older adults. We designed a clinical trial to verify the effects of 4-weeks oral supplementation of L-Arginine on global cognitive function of hypertensive frail older patients. The study was successfully completed by 35 frail hypertensive elderly patients assigned to L-Arginine and 37 assigned to placebo. At follow-up, we found a significant difference in the Montreal Cognitive Assessment (MoCA) test score between the L-Arginine treated group and placebo (p: 0.0178). Moreover, we demonstrated that L-Arginine significantly attenuates Angiotensin II-induced mitochondrial oxidative stress in human endothelial cells. In conclusion, our findings indicate for the first time that oral L-Arginine supplementation significantly improves cognitive impairment in frail hypertensive older adults.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier: NCT04962841. more...

BackgroundFrailty is a multidimensional condition typical of elders. Frail older adults have a high risk of functional decline, hospitalization, and mortality. Hypertension is one of the most common comorbidities in elders. Hyperglycemia (HG) is frequently observed in frail older adults, and represents an independent predictor of worst outcomes, with or without diabetes mellitus (DM). We aimed at investigating the impact of HG on physical impairment in frailty.MethodsWe studied consecutive older adults with frailty and hypertension at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, from March 2021 to September 2021. Exclusion criteria were: age more...

Marine heat waves (MHWs), prolonged discrete anomalously warm water events, have been increasing significantly in duration, intensity and frequency all over the world, and have been associated with a variety of impacts including alteration of ecosystem structure and function. This study assessed the effects of current and future MHWs on the Mediterranean seagrass Posidonia oceanica performance, also testing the importance of the thermal environment where the plant lives. The effects of current MHWs were studied through a mensurative experiment in a cold and in a warm site (West and North-West Sardinia, Italy, respectively). Future MHWs effects were tested through a manipulative experiment using P. oceanica shoots collected from the cold and warm sites and transplanted in a common garden in front of a power plant (North-West Sardinia): here plants were exposed to heat longer in duration and stronger in intensity than the natural MHWs of the last 20 years, resembling the future scenario. Morphological (total # of leaves, maximum leaf length, and percentage of total necrotic leaf length per shoot) and biochemical variables (leaf proteins, carbohydrates, and lipids) were considered. Plants had similar sublethal responses in both the experiments for most of the variables, revealing that current and future MHWs had similar effect types, but different in magnitude depending on the intensity of the waves: in general, the number of leaves, the maximum leaf length and lipid content decreased, while the leaf necrosis and carbohydrates increased. However, also the origin of the plants affected the results, corroborating the hypothesis that the thermal context the plants live affects their tolerance to the heat. Overall, this study provided evidence about the importance of biochemical variations, such as carbohydrate and lipid levels, as potentially good indicators of seagrass heat stress. more...

Coralligenous reefs are the main biogenic constructions of the Mediterranean Sea and they are considered indicators of the ecological quality of coastal systems and of “seafloor integrity” by the Marine Strategy Framework Directive. The two main coralligenous morphologies are the cliffs and platforms, the former developing in shallow waters (about 20–50 m) on vertical/subvertical rocky substrate and the latter built over horizontal substrates below 50 m depth also on detritic bottoms. The present study aims at assessing whether patterns of spatial variability and ecological quality of the coralligenous cliff assemblages reflect those of platform assemblages. At this aim, six geographic areas around Sardinia (western Mediterranean, Italy) were considered and, within each area, the structure of both the coralligenous cliffs and platforms was investigated by SCUBA and ROV methods, and their ecological quality was assessed by ESCA and CBQI indices, respectively. Overall, 20 morphological groups (seven macroalgae and thirteen invertebrates) were found but differences in community structure were evident both spatially and between systems, platforms vs cliffs. In fact, spatial variability in assemblages structure changed between the two morphologies across the areas. Moreover, a different spatial pattern in the ecological quality was found between platform and cliff assemblages. The results of the present study corroborate the individual peculiarity of coralligenous platforms and cliffs, highlighting the importance of the concurrent assessment of both systems in monitoring programs.. more...

Background Marine protected areas (MPAs) usually have both positive effects of protection for the fisheries’ target species and indirect negative effects for sea urchins. Moreover, often in MPAs sea urchin human harvest is restricted, but allowed. This study is aimed at estimating the effect of human harvest of the sea urchin Paracentrotus lividus within MPAs, where fish exploitation is restricted and its density is already controlled by a higher natural predation risk. The prediction we formulated was that the lowest densities of commercial sea urchins would be found where human harvest is allowed and where the harvest is restricted, compared to where the harvest is forbidden. Methods At this aim, a collaborative database gained across five MPAs in Sardinia (Western Mediterranean, Italy) and areas outside was gathered collecting sea urchin abundance and size data in a total of 106 sites at different degrees of sea urchin exploitation: no, restricted and unrestricted harvest sites (NH, RH and UH, respectively). Furthermore, as estimates made in past monitoring efforts (since 2005) were available for 75 of the sampled sites, for each of the different levels of exploitation, the rate of variation in the total sea urchin density was also estimated. Results Results have highlighted that the lowest sea urchin total and commercial density was found in RH sites, likely for the cumulative effects of human harvest and natural predation. The overall rate of change in sea urchin density over time indicates that only NH conditions promoted the increase of sea urchin abundance and that current local management of the MPAs has driven towards an important regression of populations, by allowing the harvest. Overall, results suggest that complex mechanisms, including synergistic effects between natural biotic interactions and human pressures, may occur on sea urchin populations and the assessment of MPA effects on P. lividus populations would be crucial to guide management decisions on regulating harvest permits. Overall, the need to ban sea urchin harvest in the MPAs to avoid extreme reductions is encouraged, as inside the MPAs sea urchin populations are likely under natural predation pressures for the trophic upgrading. more...

Directly acting on Project Management practices, PMO provides companies with help to innovate, reaching competitive advantage and growth in the long run, ceteris paribus, and attempts to reduce uncertainty. Even though PMO is a more consolidated practice in some countries, the phenomenon has lately been introduced in Italy, and it is still evolving. Not all organizations and not all individuals clearly understand the potential of PMO, and its role is often limited to simple Project Management in its strict meaning, while areas for improvement are many and varied. The paper analyses the status of PMO through a survey conducted inside the Italian banking sector, trying to frame the role of PMO, throwing light on its importance for a company as a whole, and not just for a single project. A discussion of the results and future work concludes the paper. more...

Objective: This study aimed to assess indications for surgical treatment, position of the ankle, time and rate of fusion after arthrodesis; to ascertain whether the technique provides fusion rates similar to those described in the published literature; and to quantify patients’ improvement according to the AOFA and VAS scores, and patients’ satisfaction using a Likert scale. Methods: This is a clinical study with a cohort of 18 patients (9 women and 9 men) with a mean age of 49.10 years, conducted from 2006 and 2016. Results: Post-traumatic arthrosis (88.88%), rheumatoid arthritis (5.56%), and Charcot-Marie-Tooth disease (5.56%) motivated the surgeries. Six ankles fused in an equinus position, and 12 of them in a neutral position. Five ankles fused in valgus angulation, and 13 in a neutral position. Five ankles fused in external rotation, 2 in internal rotation and 11 in a neutral position. In the postoperative period, American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores showed an improvement of 31.6 points and 5.1 points, respectively. Regarding the Likert scale, 2 patients reported being very satisfied, 14 satisfied, and 2 partially satisfied. Conclusion: Fusion in a 100% of cases and patients’ overall satisfaction have led to the conclusion that this treatment method is appropriate to attain ankle fusion, with results similar to those found in the medical literature. Level of Evidence IV; Therapeutic Studies; Case Series. more...

In the Mediterranean Sea, the two sponges of the genus Aplysina (A. aerophoba and A. cavernicola) are identified on the basis of their external morphology and the environment in which they live. During a research program on the sponge fauna in semi-submerged caves of the Italian coasts, we have sampled an abundant very small yellow sponge, often living in the tidal zone, which were attributed to the genus Aplysina. Failing to assign the samples to a species through classical taxonomic methodologies (growth form and skeleton arrangement) and for the particular environment where this sponge lives, we have decided to use the COI analysis to solve the taxonomic problem offered by these miniaturized specimens. The analysis indicated that, in spite of the morphological differences, they belong to A. aerophoba. During old detailed surveys, conducted in the ’60 years in some of the studied caves, this species was not recorded. It is possible that its abundant presence is related to the modifications occurred in the Mediterranean sponge communities occurred in the last decades in relation to global warming. more...

Abstract Background Invasive meningococcal disease is a serious global health threat in the world; in 2016, the European Centre for Disease Control and Prevention reported 3280 confirmed cases (including 304 deaths) of Invasive Meningococcal Diseases in Europe. In Italy, in 2017 were reported 200 cases 41% of which due to menB serogroup. From January 2013 the European Medicines Agency (EMA) has authorized the marketing of the meningococcal B vaccine 4CMenB. Methods The study aimed to evaluate and complement the safety profile of 4CMenB in high risk children accessing the vaccine service of the Bambino Gesù Children’s Hospital. All individuals aged six weeks or more receiving the meningococcal 4CMenB (Bexsero®) vaccine that approached the vaccine Centre at the Bambino Gesù Children’s Hospital in Rome, were asked to participate. All parents or caregivers of vaccinated individuals in the study period, were recruited and requested to answer to a questionnaire on adverse events following immunization (AEFI) observed after 7 days, starting from the date of vaccination. Results During the study period (October 2016–October 2017), we collected 157 completed questionnaires (out of 200 distributed). Of those 132 were first doses and 25 were booster administered doses. The median age of the study population was 4.5 years (range 0.29 to 26.8 years), the majority of subjects were high-risk individuals (64%) with chronic health conditions. Overall, 311 adverse events were reported in the 7 days after vaccine administration. In particular 147 events (47%) after administration of first dose and 58 (19%) after the booster doses. A large majority of those events, were of little clinical importance and concentrated in the 24 h after vaccine administration. No hospitalizations or Emergency Department access were reported. Conclusions Results of our study demonstrated that the Bexsero® vaccine is almost well tolerated, with a low incidence of severe AEFIs. Our results also shown that the occurrence of AEFIs is similar within healthy and high risk children. more...

We investigated the geographical character of the COVID-19 infection in China and correlated it with satellite- and ground-based measurements of air quality. Controlling for population density, we found more viral infections in those prefectures (U.S. county equivalent) afflicted by high Carbon Monoxide, Formaldehyde, PM 2.5, and Nitrogen Dioxide values. Higher mortality was also correlated with relatively poor air quality. When summarizing the results at a greater administrative level, we found that the 10 provinces (U.S. state equivalent) with the highest rate of mortality by COVID-19, were often the most polluted but not the most densely populated. Air pollution appears to be a risk factor for the incidence of this disease, despite the conventionally apprehended influence of human mobility on disease dynamics from the site of first appearance, Wuhan. The raw correlations reported here should be interpreted in a broader context, accounting for the growing evidence reported by several other studies. These findings warn communities and policymakers on the implications of long-term air pollution exposure as an ecological, multi-scale public health issue. more...

Primary Obstructive Megaureter (POM) is a common cause of hydronephrosis in children with spontaneous resolution in most cases. High-Pressure Balloon Dilatation (HPBD) has been proposed as a minimally invasive procedure for POM correction in selected patients. The aim of the paper is to review our experience with HPBD in patients with POM. We performed a retrospective study in a single Centre collecting data on patients’ demographics, diagnostic modalities, surgical details, results and follow-up. In particular, the endoscopic aspect of the orifice permitted the identification of 3 patterns: adynamic ureteral segment, stenotic ureteric ring and pseudoureterocelic orifice. We performed HPBD in 30 patients over 6 years. We had 23 patients with adynamic distal ureteral segment (type 1), 4 with stenotic ring (type 2) and 3 with ureterocelic orifice (type 3). In 3 patients (10%) the guidewire did not easily pass into the ureter requiring ureteral stenting or papillotomy. Post-operative course was uneventful. Five patients (3 pseudoureterocelic) required open surgery during follow-up. HPBD for the treatment of POM is a safe and feasible procedure and it can be a definitive treatment of POM. Complications are mainly due to double J stent and none of our patients had symptoms related to vescico-ureteral reflux. The aspect of the orifice, identified during cystoscopy, seems to correlate with the efficacy of the dilatation: type 1 and 2 are associated with good and excellent results respectively; type 3 do not permit dilatation in almost all cases requiring papillotomy. HPBD can be performed in selected patients of all paediatric ages as first therapeutic line. The presence of a pseudoureterocelic orifice or long stenosis might interfere with the ureteral stenting and seems associated with worse outcomes. more...

Until now, only 177 species of sponges (Porifera) have been reported for Chilean coastal waters. Here we describe recent scuba diving surveys undertaken to improve our knowledge of the diversity of the sponge fauna of the Seno Magdalena, Puyuhuapi Fjord and Jacaf Canal in Chilean Patagonia. Despite these relatively harsh environments, our study yielded 23 species of Demospongiae, nine of which are new to science and described here: Hymerabdia imperfecta Bertolino, Costa & Pansini sp. nov., Axinella cylindrica Bertolino, Costa & Pansini sp. nov., Axinella coronata Bertolino, Costa & Pansini sp. nov., Biemna aurantiaca Bertolino, Costa & Pansini sp. nov., Biemna erecta Bertolino, Costa & Pansini sp. nov., Biemna typica Bertolino, Costa & Pansini sp. nov., Scopalina cribrosa Bertolino, Costa & Pansini sp. nov., Rhizaxinella strongylata Bertolino, Costa & Pansini sp. nov. and Darwinella pronzatoi Bertolino, Costa & Pansini sp. nov. One species, Hymedesmia (Stylopus) lissostyla (Bergquist & Fromont, 1988), is reported for the first time for Chile. more...