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Using plant extracts to replace traditional chemical herbicides plays an essential role in sustainable agriculture. The present work evaluated the quality of durum wheat cv Valbelice in two years (2014 and 2016) using plant aqueous extracts of sumac ( Rhus coriaria L.) and mugwort ( Artemisia arborescens L.) as bio-herbicides on the main quality characteristics of durum wheat. The untreated, water-treated, and chemically treated durum wheat products were also analyzed as controls. Following the official methodologies, grain commercial analyses and defects of the kernels were determined. The main chemical and technological features were determined on the wholemeal flour: proteins, dry matter, dry gluten, gluten index, colorimetric parameters, mixograph, falling number, and sedimentation test in SDS. An experimental bread-making test was performed, and the main parameters were detected on the breads: bread volume, weight, moisture, porosity, hardness, and colorimetric parameters on crumb and crust. Within the two years, grain commercial analyses of the total five treatments showed no statistically significant differences concerning test weight (range 75.47-84.33 kg/hL) and thousand kernel weight (range 26.58-35.36 kg/hL). Differently, significant differences were observed in terms of kernel defects, particularly starchy kernels, black pointed kernels, and shrunken kernels, mainly due to the year factor. Analyses on the whole-grain flours showed significant differences. This affected dry gluten content (7.35% to 16.40%) and gluten quality (gluten index from 6.44 to 45.81). Mixograph results for mixing time ranged from 1.90 min to 3.15 min, whilst a peak dough ranged from 6.83 mm to 9.85 mm, showing, in both cases, statistically significant differences between treatments. The falling number showed lower values during the first year (on average 305 s) and then increased in the second year (on average 407 s). The sedimentation test showed no statistically significant differences, ranging from 27.75 mm to 34.00 mm. Regarding the bread produced, statistically significant year-related differences were observed for the parameters loaf volume during the first year (on average 298.75 cm 3 ) and then increased in the second year (on average 417.33 cm 3 ). Weight range 136.85 g to 145.18 g and moisture range 32.50 g/100 g to 39.51 g/100 g. Hardness range 8.65 N to 12.75 N and porosity (range 5.00 to 8.00) were closely related to the type of treatment. Finally, the color of flour and bread appeared to be not statistically significantly affected by treatment type. From a perspective of environmental and economic sustainability, the use of plant extracts with a bio-herbicidal function could replace traditional chemical herbicides.

Introduction and objectives: Aortic valve replacement surgery (SAVR) remains a recommended indication, though its pre-surgical stratification is an ongoing challenge. Despite the widespread use of scores like the STS and EuroSCORE II, they have a number of limitations, while often neglecting structural parameters like left ventricular hypertrophy or left atrium volume. This study aimed to evaluate whether a new adaptation of the Généreux classification in the preoperative risk stratification of severe aortic stenosis (AS) is associated with the primary outcome, and to compare it with the original classification versus the traditional scores in short- and long-term follow-up. Methods: We conducted a retrospective, single-center study involving patients with confirmed severe AS who underwent SAVR. The new stratification categorized patients into three stages. Cox regression analyses were conducted to identify factors associated with mortality, with survival analysis performed using Kaplan-Meier curves. A p -value < 0.05 was considered statistically significant. Results: A total of 508 patients were included. Stage 3 patients had a lower median age (67 years). The median EuroSCORE II and STS scores were 2.75 and 2.62%, respectively ( p ≤ 0.001). Over a median follow-up of 81 months, 56 deaths occurred (11%). Kaplan-Meier curve analysis revealed significant differences in all-cause mortality among the three groups (HR 4.073, log-rank p ≤ 0.001). Multivariable analysis identified the three preoperative stages (HR 3.22, [95% CI 1.44-7.20], p = 0.004) and mean transaortic gradient (HR 0.96, [95% CI 0.92-0.99], p = 0.021) as independent variables of mortality. The original Généreux scale AUC was higher (AUC: 0.760, 95% CI: 0.692-0.829) compared to the modified Généreux scale (AUC: 0.758, 95% CI: 0.687-0.829). However, no statistical differences were found between the different scales. Conclusions: Preoperative three-stage classification and low transaortic gradient are factors associated with increased all-cause mortality in patients undergoing SAVR. The proposed staging system performed better in the mortality analysis than EuroSCORE II and STS and was similar to the original classification.

We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, p < .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, p < .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

In this study, we examined the relationship between optimism and pessimism associated with the Covid-19 pandemic, mental health, and perceived risk of infection. In particular, we tested the hypothesis that, when optimism and pessimism were high during the pandemic period, a worse mental health and a higher perception of risk would be reported. To this end, a convenience sample of 374 Italian adults was enrolled. Measures included perceived stress, optimism, and pessimism associated with the development of the pandemic situation, as well as the perceived risk of Covid-19 infection. The results showed that optimism and pessimism were associated with perceived stress and Covid-19 risk perception while controlling for demographic variables. Optimism and stress were negatively related, while pessimism was positively related to both stress and risk perception. Furthermore, the interaction between optimism and optimism was significant, with a higher perception of risk in the presence of both high optimism and pessimism, and a lower perception of risk with high optimism and low pessimism. These results support the hypothesis that optimism and pessimism interacted in predicting Covid-19 risk perception and show that they should be measured as partially correlated but independent constructs in future investigations., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Transitions in eruptive style during volcanic eruptions strongly depend on how easily gas and magma decouple during ascent. Stronger gas-melt coupling favors highly explosive eruptions, whereas weaker coupling promotes lava fountaining and lava flows. The mechanisms producing these transitions are still poorly understood because of a lack of direct observations of bubble dynamics under natural magmatic conditions. Here, we combine x-ray radiography with a novel high-pressure/high-temperature apparatus to observe and quantify in real-time bubble growth and coalescence in basaltic magmas from 100 megapascals to surface. For low-viscosity magmas, bubbles coalesce and recover a spherical shape within 3 seconds, implying that, for lava fountaining activity, gas and melt remain coupled during the ascent up to the last hundred meters of the conduit. For higher-viscosity magmas, recovery times become longer, promoting connected bubble pathways. This apparatus opens frontiers in unraveling magmatic/volcanic processes, leading to improved hazard assessment and risk mitigation.

Background: Literature describing outcomes and integrity after isolated subscapularis (SSC) tendon repair is emerging but remains limited to a few small case series with short-term follow-up. The aim of this study was to evaluate the long-term clinical outcomes and repair integrity in patients who underwent arthroscopic repair of isolated SSC tears., Methods: A retrospective study was conducted with the following inclusion criteria: (1) primary and elective shoulder arthroscopy for isolated SSC repair, (2) type III (a full-thickness tear in the upper two-thirds of the tendon) or IV (a complete tear without tendon retraction) SSC tear according to the Lafosse classification, and (3) a minimum 24-month follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley score (CMS) and at follow-up, the ROM, the University of California-Los Angeles (UCLA) Shoulder Rating Scale, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the CMS were evaluated; an ultrasonographic assessment of tendon healing was performed according to the Sugaya classification., Results: The final sample consisted of 45 patients with an average age of 55 ± 9 years. After a mean follow-up time of 107 ± 54 months, the mean UCLA and DASH scores were 8.7 ± 1.3 and 42.2 ± 6.4, respectively. ROM and CMS showed statistically significant improvements (all P < .001). Before surgery, the mean CMS was 49% that of sex- and age-matched healthy individuals, and all patients showed a CMS lower than the normative data. At the final follow-up visit, the mean CMS was 94.2% that of sex- and age-matched healthy individuals, and no patients showed CMS of 30 or less. The mean increase in the CMS was 41.4 ± 9.8 points (range, 23-60 points). The ultrasonographic assessment showed SSC tendon healing in 39 (86.7%) cases; tendon retear was recorded in 5 (13.3%) cases. All scores directly correlated with the healing of the tendon. A higher postoperative DASH score was associated with male sex (P = .039, β = 5.538) and a longer follow-up period (P = .044, β = 0.001). The postoperative CMS (P < .001) and UCLA scores (P = .001) were significantly higher in patients younger than 60 years of age at surgery than in older individuals., Conclusion: Arthroscopic repair of isolated SSC tears achieves excellent clinical and functional results at a mean of 9 years postoperatively, with a satisfactory healing rate. Better functional outcomes correlate with SSC tendon integrity and were observed in male patients and in those younger than 60 years at surgery., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Anorexia nervosa (AN) is a severe eating disorder primarily affecting children and adolescents. Disorders of the gut-brain interaction (DGBIs) have gained recognition as significant symptoms in individuals with AN. However, limited studies have explored GI symptoms in pediatric populations with AN using age-specific diagnostic tools. This study aims to investigate the prevalence of DGBIs, their associated psychopathological aspects and their potential correlations with ultra-processed food (UPF) consumption among pediatric AN patients. The study included AN patients who were under the care of a specialized multidisciplinary team. We assessed DGBI-related symptoms using the Rome IV Pediatric Diagnostic Questionnaire on Functional Gastrointestinal Disorders (R4PDQ) and conducted psychological evaluations. Dietary intake and UPF consumption were evaluated. Among 56 AN patients, we observed a lower prevalence of DGBIs (functional constipation: 61%; functional dyspepsia: 54%; irritable bowel syndrome: 25%) compared to the existing literature. The psychological assessments revealed high rates of depression (72%) and anxiety (70%). UPF consumption was inversely related to depression levels ( p = 0.01) but positively correlated with functional constipation ( p = 0.046). This study highlights the importance of using age-specific diagnostic tools and emphasizes the crucial role of a specialized multidisciplinary team in the treatment of AN.

Background: Anorexia nervosa (AN) is a psychiatric disorders which may potentially led to a high risk of health medical complications, suicide and self-harming behaviour. Since Covid-19 pandemic onset in March 2020, evidence suggested an increase occurrence of AN. The main aim of the retrospective analysis is to define the cost of hospitalization in the acute phase (HAP) at IRCCS Bambino Gesù Children Hospital, Rome, Italy, over 2 years study. Secondary purposes are defining the main risk factors for a prolonged hospitalization (including age, sex and comorbidities) and the possible influence of Covid-19 pandemic on AN admission and hospital stay., Methods: for the purpose of the study, we included children and adolescents aged less than 18 years, admitted to IRCCS Bambino Gesù Children Hospital, Rome, Italy, with a diagnosis of AN. Medical costs were calculated consulting the Lazio Regional Health Service Tariffs. Basing on the date of hospital admission, patients were later divided into two subgroups: subgroup A included patients hospitalized prior than Covid-19 onset (from March 2019 to February 2020) and subgroup B those admitted after (from March 2020 to October 2022)., Results: a total of 260 patients has been included in the study with a median age of 15 years (range 6-18 years). The total health care cost of AN hospitalized patients was of EUR 3,352,333 with a median cost of EUR 11,124 for each admission (range EUR 930 - 45,739) and a median daily cost of EUR 593 (range EUR 557-930). Median cost was higher in case of comorbidities, guarded patients, enteral feeding. A prolonged hospitalization has been documented in subgroup A with a higher economic burden., Conclusions: the economic burden of eating disorders is of note. Adequate sanitary policies as well as health economic analyses are required to gain insight into the cost-effectiveness of AN management., Trial Registration: 2526-OPBG-2021., (© 2024. The Author(s).)

Nutritional rehabilitation with weight restoration is an important step in patients hospitalised for anorexia nervosa (AN). Naso-gastric feeding (NGF) should be considered when oral nutrition (OF) and oral nutritional supplementation (ONS) are insufficient. We evaluated the role of NGF on short- and long-term outcomes, considering weight gain, the length of hospitalisation (LOS) and the time to relapse. We report on the characteristics of patients under 18 years of age with AN admitted to the Department of Emergency and Acceptance of the Bambino Gesù Children's Hospital, IRCCS, Rome, between March 2019 and August 2022. Three hundred and fifteen patients were enrolled. We compared patients treated with NGF (group A) and patients without NGF (group B). Group A was characterised by a significantly lower BMI on admission and discharge, more frequent use of inpatient psychotropic therapy (IPDT) and longer hospital stay. The time to relapse was significantly longer in group A compared to group B. An early NGF setting correlates with a longer time to relapse and may be associated with a shorter LOS. A high caloric intake with a balanced nutritional formula provided by NGF allows an earlier recovery. The main advantages of this approach could be the rapid discharge of patients and a more effective psychological and social recovery.

Background: Varicella is considered a mild and self-limiting disease, but, in some cases, it may complicate and require hospitalization. Antibiotics are not the first line therapy but in some cases are prescribed either for the management of varicella-related complications or as a preventive strategy. Aim of this study is to analyze the rate and the patterns of antibiotics used in pediatric patients hospitalized for varicella as well as the relative costs in order to increase insights in antibiotic use in varicella., Methods: Patients less than 18 years hospitalized for varicella at the Bambino Gesù Children's IRCCS Hospital in Rome, Italy, from the 1 st of November 2005 to the 1 st of November 2021 entered the study. Retrospective data were collected from the hospital's database electronic medical records. The rate, the patterns and the costs of antibiotics used were considered., Results: According to the inclusion criteria, we enrolled 810 patients, with a median age of 2.4 years. Out of them, 345 patients (42.6%) underwent antibiotic therapy, of which 307 for a complication (90.0%) and the other 10.0%, antibiotic for the fear of developing complications. The cost for varicella hospitalizations was EUR 2,928,749 (median cost EUR 2689). As for antibiotic therapy, it represented the 5.9% of the total cost (EUR 174,527), with a median cost of EUR 198.8. The cost in patients who underwent antibiotic therapy was significantly higher than in those who did not (p-value < 0.0001), as well as the hospitalization length (p-value < 0.0001). The most commonly prescribed antibiotics were Amoxicillin-clavulanate and Ceftriaxone, which represented the 36.0% and 25.0% of all antibiotic prescription, respectively. Antibiotics may negatively affect the economic cost of hospitalization and the prescription is not always in accordance to guidelines, with potential important repercussions on the development of antimicrobial resistance. Actually, resistance to antibiotics is considered a major risk to the future health of the world population as it may lead to longer hospital stay, increased risk of mortality, health care costs and treatment failures., Conclusion: Strategies to reduce economical cost, hospitalization length and antimicrobial resistance include ensuring appropriate prescription and administration of empiric antibiotics as well as reducing the circulation of preventable infectious diseases through immunization., (© 2022. The Author(s).)

Purpose: Anorexia nervosa (AN) is the most frequent eating disorder (ED), whose cardiac complications may have life-threatening consequences for both the physical and psychological health of affected children. In this study, we reported and analysed the echocardiographic anomalies found in pediatric patients diagnosed with AN., Methods: We reported the demographic and clinical characteristics of children aged 8 to 18 years, who were diagnosed with AN and underwent a complete cardiological evaluation at the Emergency Department of the Bambino Gesù Children's Hospital, IRCCS, Rome between the 1st January 2021 and the 30th June 2021. Furthermore, we compared the patients according to the presence of pericardial effusion and a BMI (body mass index) cut-off 14.5 kg/m 2 ., Results: Forty-nine patients were included in the study. The mean age was 15.1 years. Most patients were female (89.8%). The mean length of hospitalization was 18 days. The mean BMI at admission was 14.8 kg/m 2 , with a median weight loss of 9 kg in the last year. Eleven patients (22.4%) presented with cardiovascular signs or symptoms at admission. Most patients had pericardial effusion on heart ultrasound, with a mean thickness of 6 mm (SD ± 4). The LV (left ventricle) thickness over age was significantly higher in patients with pericardial effusion, with a Z score of -2.0 vs -1.4 (p = 0.014). The administration of psychiatric drugs was significantly more frequent in patients with a lower BMI (37.5% vs 12%, p = 0.038)., Conclusion: Our study suggests that a non-urgent baseline echocardiographic evaluation with focus on left-ventricular wall thickness and mass in children with anorexia nervosa is advisable., Level Iii: Evidence obtained from cohort or case-control analytic studies., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: Depression and antidepressants are among risk factors for osteoporosis. However, there are still inconsistencies in literature regarding bone consequences of antidepressant drugs and the role of age and the natural decline of bone health in patients with depression., Objective: To investigate the relationship between antidepressant and bone mineral density (BMD)., Methods: We conducted a systematic review and metanalysis according to PRISMA guidelines searching on PubMed/Medline, Cochrane Database, and Scopus libraries and registered with PROSPERO (registration number CRD42021254006) using generic terms for antidepressants and BMD. Search was restricted to English language only and without time restriction from inception up to June 2021. Methodological quality was assessed with the Newcastle-Ottawa scale., Results: Eighteen papers were included in the qualitative analysis and five in the quantitative analysis. A total of 42,656 participants affected by different subtypes of depression were identified. Among the included studies, 10 used serotonin reuptake inhibitors (SSRIs) only, 6 involved the use of SSRIs and tricyclic antidepressants, and 2 the combined use of more than two antidepressants. No significant studies meeting the inclusion criteria for other most recent categories of antidepressants, such as vortioxetine and esketamine. Overall, we observed a significant effect of SSRI on decrease of BMD with a mean effect of 0.28 (95% CI = 0.08, 0.39)., Conclusion: Our data suggest that SSRIs are associated with a decrease of BMD. We aim to raise clinicians' awareness of the potential association between the use of antidepressants and bone fragility to increase monitoring of bone health., Competing Interests: The authors declare that they have no conflict of interests.

Purpose: Since the beginning of COVID-19 pandemic, social distancing and home confinement had a significant impact on children, especially on those with eating disorders (ED). The primary objective of this retrospective study was to describe and analyze the demographic and clinical profiles of children presenting with ED during the COVID-19 pandemic., Methods: We conducted a retrospective review of clinical charts of patients with ED younger than 18 years who accessed the emergency department of the Bambino Gesù Children's Hospital, Rome, between March 2019 and March 2021. Of these, we reported and compared the demographic, clinical and laboratory data before and after the COVID-19 pandemic and looked for predictors of ED severity., Results: A total of 211 admissions for ED were recorded. The patients, mostly females (86.3%) were on average 14.1 years old. The mean weight loss on admission was 11 kg. Bradycardia was observed in 31.3% of the study sample. 16.6% of patients had an associated psychiatric disorder and 60.2% required psychotropic drugs. 68.7% of the patients required hospitalization. Respectively, 96 and 115 patients were admitted before and during the COVID-19 pandemic. The latter were hospitalized more (78.3 vs 57.3%; p = 0.001), yet for less time (19 vs 26 days; p = 0.004), had a higher mean serum creatinine (0.68 vs 0.47; p < 0.001) and were more frequently diagnosed with an associated psychiatric disorder (23.5 vs 8.3%; p = 0.003)., Conclusion: Our study shows a significant increase of hospitalizations of children with ED during the COVID-19 pandemic, along with a shorter length of stay, more psychiatric comorbidities, and some distinctive features at the laboratory work-up, such as an increase of serum creatinine and/or a reduction of serum albumin., Level of Evidence: III, evidence obtained from well-designed cohort or case-control analytic studies., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In recent years, social media has become part of our lives, even among children. From the beginning of COVID-19 pandemic period, media device and Internet access rapidly increased. Adolescents connected Internet alone, consulting social media, mostly Instagram, TikTok, and YouTube. During "lockdown", the Internet usage allowed communication with peers and the continuity activities such as school teaching. However, we have to keep in mind that media usage may be related to some adverse consequences especially in the most vulnerable people, such as the young. Aim of the review is to focus on risks correlated to social media use by children and adolescents, identifying spies of rising problems and engaging in preventive recommendations. The scoping review was performed according to PRISMA guidelines, searching on PubMed the terms "social media" or "social network", "health", and "pediatrics". Excluding articles not pertinent, we found 68 reports. Out of them, 19 were dealing with depression, 15 with diet, and 15 with psychological problems, which appeared to be the most reported risk of social media use. Other identified associated problems were sleep, addiction, anxiety, sex related issues, behavioral problems, body image, physical activity, online grooming, sight, headache, and dental caries. Public and medical awareness must rise over this topic and new prevention measures must be found, starting with health practitioners, caregivers, and websites/application developers. Pediatricians should be aware of the risks associated to a problematic social media use for the young's health and identify sentinel signs in children as well as prevent negative outcomes in accordance with the family.

Background: Quarantine and isolation measures during COVID-19 pandemic may have caused additional stress and challenged the mental health of the youth. Aim of the study is to investigate the COVID-19 pandemic impact on neuropsychological disorders (NPD) of Italian children and adolescents to provide general pediatric recommendations., Material and Methods: A retrospective multicenter observational study was planned by the Italian Pediatric Society (SIP) to explore the impact of COVID-19 on the access of children to pediatric Emergency Departments (pED) for the evaluation of neuropsychological symptoms, collecting the classification codes of diagnoses between March 1, 2019 and March 2, 2021. The period study was split into two sub-periods: a pre COVID-19 period (from March 1 2019 to March 1, 2020) and a COVID-19 period (from March 2, 2020 to March 2, 2021). As additional information, data on NPD hospitalizations in any pediatric department of the involved centers were recorded., Results: During the study period, a total of 533,318 children were admitted to the pED involved in the study. Despite a 48.2% decline of pED admissions, there was a significant increase (83.1%) in patient admissions for NPD. The most frequent NPD conditions which increased during the COVID-19 pandemic were suicidal ideation (+ 147%), depression (+ 115%), eating disorder (+ 78.4%), and psychosis (+ 17.2%). During the pandemic period, a 39.5% increase in NPD hospitalizations was observed as well. The NPD disorders that mostly required hospitalizations were suicidal ideation (+ 134%), depression (+ 41.4%), eating disorder (+ 31.4%), and drug abuse (+ 26.7%). COVID-19 pandemic had a major impact on children's health, mainly on their NPD development. Neuropsychological assessment should be required at the primary level, in the pediatrician's office, to facilitate early capture of the sign of impairment and provide an adequate treatment., Conclusion: SIP underlines the psychological consequences of COVID 19 pandemic on the youngest and recommends an early identification of NPD in the pediatric population to avoid other serious consequences for children's physical and mental health., (© 2022. The Author(s).)

The majority of basaltic magmas stall in the Earth's crust as a result of the rheological evolution caused by crystallization during transport. However, the relationships between crystallinity, rheology and eruptibility remain uncertain because it is difficult to observe dynamic magma crystallization in real time. Here, we present in-situ 4D data for crystal growth kinetics and the textural evolution of pyroxene during crystallization of trachybasaltic magmas in high-temperature experiments under water-saturated conditions at crustal pressures. We observe dendritic growth of pyroxene on initially euhedral cores, and a surprisingly rapid increase in crystal fraction and aspect ratio at undercooling ≥30 °C. Rapid dendritic crystallization favours a rheological transition from Newtonian to non-Newtonian behaviour within minutes. We use a numerical model to quantify the impact of rapid dendritic crystallization on basaltic dike propagation, and demonstrate its dramatic effect on magma mobility and eruptibility. Our results provide insights into the processes that control whether intrusions lead to eruption or not., (© 2022. The Author(s).)

Purpose: The rapid spread of coronavirus disease 2019 (COVID-19) has increased the use of personal protective equipment. The purpose of this study was to investigate whether a commercially available sterile surgical helmet system (SSHS) can be considered protective against COVID-19 and therefore safe for use., Methods: A double-blinded randomized controlled study was performed to investigate the efficacy of the ViVi® SSHS with a high-efficiency particulate air filter called HFD Hood (THI, Total Healthcare Innovation GmbH, Feistritz im Rosental, Austria) to protect against respiratory droplets. Forty recruited participants were divided into two different groups. The SSHS was tested using a validated qualitative test for respirator masks through saccharin or placebo solutions based on random allocation into two cohorts. Saccharin droplets are a validated surrogated marker for any elements of viral size, such as coronaviruses. A positive report of sweet taste after saccharin exposure was suggestive of ViVi® SSHS inefficacy in protection against droplets., Results: One participant out of 21 (4.8%) reported positive for taste within the placebo cohort, while five out of 19 (26.3%) reported positive for taste within the saccharin cohort upon testing. Two out of 21 (9.5%) participants reported positive for taste within the placebo cohort, and two out of 19 (10.5%) reported positive for taste within the saccharin cohort upon retesting. There were no statistically significant differences between the saccharin and placebo groups in either the test or retest measurements (p = 0.085 and p = 1.000, respectively)., Conclusions: This study demonstrates that the ViVi® SSHS equipped with HFD Hood protects against respiratory droplets, increasing protection against several microorganisms, including the virus that causes COVID-19, allowing surgeons to carry out procedures on COVID-positive patients in a more comfortable and safer way., (© 2022. The Author(s) under exclusive licence to SICOT aisbl.)

Although antidepressant drugs appear to play an active role in increasing fracture risk, their weight is still unclear. We conducted a PRISMA compliant systematic review and meta-analysis through PubMed/Scopus/Cochrane libraries and registered with PROSPERO (registration number CRD42021254006) to investigate the relationship between antidepressant drugs categories, including SSRIs, SNRIs, and TCAs, and the risk of hip and vertebral fractures. After screening 3122 items, we finally found 26 papers for qualitative analysis and 11 for quantitative synthesis. A total of 15,209,542 adult and elderly patients were identified, with a mean follow-up of 51 months and a major prevalence of women. We identified results largely for SSRIs, with only a small amount of data for SNRIs, TCAs, and NaSSA. No data were found among the most recent categories of antidepressants, such as vortioxetine and esketamine. All included studies reported hip fractures, while three of them also included vertebral fractures. Overall, we observed a significant effect of SSRIs on fracture risk with a mean effect of 0.98 (95% CI = 0.75-1.20). This meta-analysis reveals that the use of SSRIs increases the risk of fractures. Clinicians' awareness in antidepressant prescription should optimize their potential while reducing this risk.

Epidermolysis bullosa (EB) is a severe hereditary disease characterized by defective epithelial adhesion causing mucocutaneous fragility. The major types are EB simplex (EBS), junctional EB (JEB), dystrophic EB (DEB) and more than 35 EB subtypes. Another very rare type of EB is Kindler EB (KEB). Clinically, it is a very heterogeneous disease which ranges from localized to extensive skin lesions with frequent multisystem extra cutaneous involvement. The role of a pediatrician-dermatologist cooperation within a multidisciplinary team is fundamental for both the diagnosis and management contributing to these patients' better life expectancy. Aim of this study is to describe clinical and laboratory characteristics of the main EB subtypes focusing on nutritional and gastrointestinal aspects, providing information to aid the paediatric management of children with EB. This retrospective study reviewed the cases of 160 pediatric EB patients (76 male and 84 female): 31 patients affected by EBS (mean age ± SD: 4.37 ± 7.14), 21 patients affected by JEB (mean age ± SD: 9.26± 17.30) and 108 with DEB (mean age ± SD: 11.61 ± 13.48). All patients were admitted at the Bambino Gesù Children's Hospital in Rome, between June 2005 to June 2020. The reduced gastrointestinal absorption, chronic losses, esophageal stenosis and chronic inflammatory state, represent the basis of nutritional problems of EB patients. In particular, anemia represents one of the most important complications of DEB patients which could require transfusion-dependent patterns. Malnutrition, vitamin deficiencies and anemia have been related to growth delay in EB patients. A specific diet with a balance of all macronutrients is required and improving caloric intake with sugar limitations is fundamental to prevent dental caries and tooth decay typical of EB patients. While sepsis proved to be the major cause of morbidity and mortality in younger patients, squamous cell carcinoma was mostly observed in older patients, especially those affected by DEB. Patients with EB require regular monitoring for complications and sequelae with a frequency of evaluations which varies based on age and EB subtypes. Cooperation among medical teams involving paediatricians, dermatologists, specialist clinicians including nutritionists such as families and patient's association is fundamental to approach the disease and improve the quality of life of these patients., (© 2022. The Author(s).)

Background: The novel coronavirus has a high mortality rate (over 1% for patients older than 50 years). This can only be partially ascribed to other comorbidities. A possible explanation is a factor that assures a prompt response to SARS-CoV-2 in younger people, independent from the novelty of the virus itself. A factor is believed to stimulate the immune system and provide immunity against more antigens. The only external stimulation received by healthy people is vaccination (eg, the diphtheria, tetanus, and pertussis [DTP] vaccine). One hypothesis is that vaccination helps develop specific immunity but generates sprouting immunity against antigens in transit. The underlying immunological phenomena are the "bystander effect" and "trained immunity." The developed immunity gives protection for years until it naturally fades out. After the fifth decade of life, the immune system is almost incompetent when a viral infection occurs, and thus, at this stage, the novel coronavirus can enter the body and cause acute respiratory distress syndrome., Objective: The initial aim is to demonstrate that blood monocytes and natural killer cells show overpowering hyperactivity, while CD4+ and CD8+ T cells experience impediments to their defensive functions in patients with severe SARS-CoV-2 infection. The secondary objectives are to correlate clinical data and vaccination history with laboratory immune patterns in order to identify protective factors. Subsequently, we are also interested in characterizing the phenotypes and state of the degree of activation of peripheral blood mononuclear cells, including monocytes, natural killer cells, and CD4+ and CD8+ T cells, in healthy subjects vaccinated with the Pfizer vaccine., Methods: Data will be collected using the following 3 approaches: (1) an experimental analysis to study the innate immune response and to identify genetic profiles; (2) an epidemiological analysis to identify the patients' vaccination history; and (3) a clinical analysis to detect the immunological profile., Results: The protocol was approved by the Ethics Committee on April 16, 2020, and the study started on April 27, 2020. As of February 2021, enrollment has been completed. Immunological analysis is ongoing, and we expect to complete this analysis by December 2022., Conclusions: We will recognize different populations of patients, each one with a specific immunological pattern in terms of cytokines, soluble factor serum levels, and immune cell activity. Anamnestic data, such as preceding vaccinations and comorbidities, biochemical findings like lymphocyte immunophenotyping, and pre-existing persistent cytomegalovirus infection, allow depicting the risk profile of severe COVID-19. Proof of the roles of these immunological phenomena in the development of COVID-19 can be the basis for the implementation of therapeutic immunomodulatory treatments., Trial Registration: ClinicalTrials.gov NCT04375176; https://clinicaltrials.gov/ct2/show/NCT04375176., International Registered Report Identifier (irrid): DERR1-10.2196/29892., (©Giuseppe Ietto, Lorenzo Mortara, Daniela Dalla Gasperina, Domenico Iovino, Lorenzo Azzi, Andreina Baj, Walter Ageno, Angelo Paolo Genoni, Francesco Acquati, Matteo Gallazzi, Giorgia Spina, Grace Coco, Federica Pierin, Douglas Noonan, Andrea Vigezzi, Elisa Monti, Valentina Iori, Federica Masci, Caterina Franchi, Salomone Di Saverio, Giulio Carcano. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 25.01.2022.)

The spread of COVID-19 and its related confinement measures were important stressors for a large part of the global population, with massive effects on both physical and mental health. Assessing how individuals coped with such a stressor and which strategies were effective is one of the main challenges for psychological research. In this study, we aimed to investigate the coping strategies implied during the COVID-19 lockdown and their effectiveness. We recruited 374 Italian participants through convenience sampling during the first pandemic wave (April 2020). We administered to our participants an online battery of questionnaires including the Brief COPE, the use of alternative coping strategies proposed by the WHO to help people facing lockdown stress, and a range of psychological symptoms. An exploratory factor analysis conducted on the subscales of the Brief COPE revealed a three-factor structure. Following the previous literature, we named these factors engagement, disengagement, and help-seeking coping styles. In the pandemic scenario, the engagement and disengagement styles revealed the typical correlation patterns with psychological symptoms (i.e., the engagement was adaptive while the disengagement was maladaptive). Instead, contrary to previous literature, help-seeking was positively related to psychological symptoms, suggesting a mismatch between searching for help and finding it during the lockdown. This result supports the importance of evaluating the effectiveness of coping strategies in the pandemic scenario, to give more compelling and precise advice to the population.

Background: Varicella is a common pediatric infection. Even if it generally has a benign course, it may complicate and require hospitalization. The aim of our study was to estimate the acute hospitalization cost (AHC) for varicella in the acute phase in a pediatric population., Methods: We calculated the AHC of pediatric patients admitted for varicella at Bambino Gesù Children Hospital, Rome, Italy, from 1 November 2005 to 1 November 2020., Results: In the study period, 825 pediatric patients affected by varicella were hospitalized. The mean hospitalization cost was EUR 4015.35 (range from EUR 558.44 to EUR 42,608.00). Among patients, 55% were unvaccinable due to either their age or their immunosuppression status. They would benefit from herd immunity, reducing the overall AHC by EUR 182,196,506. Since the introduction of the compulsory vaccination against varicella in Italy, we observed a significant reduction in AHC cost of 60.6% in 2019 and of 93.5% in 2020. Finally, from the beginning of the COVID-19 pandemic, we documented a decline of 81.2% and 76.9% in varicella hospitalization, compared to 2018 and 2019, respectively., Conclusions: Varicella AHC is an important economic and health assessment point and can be useful for improving preventive strategies.

Background: Fake news on children's and adolescent health are spreading. Internet availability and decreasing costs of media devices are contributing to an easy access to technology by families. Public health organizations are working to contrast misinformation and promote scientific communication. In this context, a new form of communication is emerging social media influencers. Aim of this study is to evaluate the role of paediatric influencers (PI) in communicating information about children and adolescents' health., Materials and Methods: A group of PI was enrolled from December 2019 to January 2020 by a scientific commission nominated by the Italian Paediatric Society (SIP). PI were asked to share Facebook messages from the official page of the SIP to their own network. Social media tools have been evaluated across 12 months, from July 28, 2019, to July 11, 2020. For the purposes of clarity, we schematically divided the study period as follows: the period of PIs activity (January 6, 2020, to July 11, 2020) and the period when PIs were not yet active (July 28, 2019, to January 4, 2020). Information on Facebook page (lifetime total likes, daily new likes, daily page engaged, daily total reach) and on published post (lifetime post total reach, lifetime post organic reach, lifetime engaged users) were evaluated., Results: A significant increase in Facebook daily new likes, page engagement and total reach, as well as in lifetime post total and organic reach was evidenced. As for PI, they reported a positive experience in most cases., Discussion: In the digital era, communication strategies are becoming more important, so that the scientific community has to be actively involved in social media communication. Our pilot study demonstrated that the recruitment of paediatric influencers has increased communication and interaction of the SIP Facebook page., Conclusion: Our study shows the potential role of influencers: spreading health messages via PI seems to be a successful strategy to promote correct communication about children's and adolescents' health., (© 2021. The Author(s).)

Nighttime symptoms are important indicators of impairment for many diseases and particularly for respiratory diseases such as chronic obstructive pulmonary disease (COPD). The use of wearable sensors to assess sleep in COPD has mainly been limited to the monitoring of limb motions or the duration and continuity of sleep. In this paper we present an approach to concisely describe sleep patterns in subjects with and without COPD. The methodology converts multimodal sleep data into a text representation and uses topic modeling to identify patterns across the dataset composed of more than 6000 assessed nights. This approach enables the discovery of higher level features resembling unique sleep characteristics that are then used to discriminate between healthy subjects and those with COPD and to evaluate patients' disease severity and dyspnea level. Compared to standard features, the discovered latent structures in nighttime data seem to capture important aspects of subjects sleeping behavior related to the effects of COPD and dyspnea., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Media device (MD) use is increasing worldwide among children. Adolescents and young children spend a lot of time using MD, Internet, and social networks. The age of initial use is getting lower to 12 years old. The aim of this research is to study children's use and perception of MD. The Italian Paediatric Society (SIP) conducted a Survey on Italian children in collaboration with Skuola.net using an online questionnaire. A total of 10,000 questionnaires were completed. Children admitted they spend more than 3 h (41%), more than 2 h (29%), more than 1 h (21%) and less than 1 h (9%) daily. Problematic MD use has been found with children using MD before sleeping (38%), during school (24%), and at wake up in the morning (21%). Addiction was documented in 14% of adolescents. Among the reported consequences, low academic outcomes, and reduced concentration (24%), neck and back pain (12%), insomnia (10%), and mood disturbances (7%) were referred. Adolescents may have a low perception of the risks related to excessive MD. The duration of time spent using media devices is a main risk factor. In this context, parents should strongly discourage excessive MD use, mainly during school, at bedtime, and wake-up. Additionally, parents should be informed and start conversations with their children on the potential negative effects of prolonged MD use.

Background: Acute Cerebral Nervous System Infections (ACNS) may cause death or severe complications even to promptly treated children. The role of the immune system in influencing the course and the outcome of meningitis has been studied but it is not yet completely understood. The aim of the research is to ascertain whether children who experienced ACNS infection had a normal immune system., Methods: Patients under 18 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for meningitis were asked to participate to the follow-up study. The immune status was evaluated both clinically and by laboratory investigations., Results: Most of the patients over 3 years at follow up had at least one immunological alteration at follow-up evaluation (74%). Considering ACNS infection etiology, certain pathogens were almost exclusive of patients affected by some immunological alteration, regardless of their age., Discussion: Our preliminary results indicate that sub-clinical immunological defects may be associated to ACNS pediatric infections. Moreover, to the best of our knowledges, this is the first study correlating pathogens to immune evaluation in ACNS infections. It is, however, important to underline the high frequency of persistent immunological alterations in the analyzed patients. Further studies are needed to confirm our conclusions., Conclusions: We recommend an immunological assessment at follow up evaluation in children who experienced an ACNS infection.

Background: Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition., Aim of the Study: To elaborate a diagnostic guide for PINS., Materials and Methods: We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children's Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words "Post-Infectious Neurological Syndromes" were used., Results: A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment., Discussion: We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging., Conclusions: We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.

A safe vaccine against measles has been available and globally recommended since 1974. The World Health Organization established measles elimination as a goal for 2020 but, unfortunately, this objective has not been achieved yet and outbreaks still occur. Herd immunity, ie, a population immunity higher than 95%, is required to stop the measles virus transmission. Communication plays a crucial role in immunization strategy to obtain high coverage levels, as it helps to fight barriers against vaccination. Delay and refusal of measles vaccination have become widespread due to misinformation, fake news and barriers to effective communication. This phenomenon has been defined as "vaccine hesitancy" and is considered as one of the top ten risks for global health. The alleged association between measles vaccination and autism has caused a sharp decline in vaccination rates. In this current situation, mass communication integrated into public health policies is fundamental to sway people's positive attitudes toward vaccination. Digital communication strategies based on social media and other internet platforms may represent useful tools to promote immunization and discourage skepticism and complement information provided by health-care professionals who have been considered as the most credible source on risk/benefits on vaccines for families. Digital communication strategies that may help supporting the measles elimination strategy include monitoring information needs online, integrating digital communication into immunization programs, involving a multidisciplinary group in communication, developing content that balances facts with positive messaging, using multiple communication channels. Further research activities should be promoted in the field of effective communication for immunization., Competing Interests: Alberto Eugenio Tozzi reports personal fees from Roche, Novartis, and Astra Zeneca, outside the submitted work. The authors report no other potential conflicts of interest for this work., (© 2020 Bozzola et al.)

Although gas exsolution is a major driving force behind explosive volcanic eruptions, viscosity is critical in controlling the escape of bubbles and switching between explosive and effusive behavior. Temperature and composition control melt viscosity, but crystallization above a critical volume (>30 volume %) can lock up the magma, triggering an explosion. Here, we present an alternative to this well-established paradigm by showing how an unexpectedly small volume of nano-sized crystals can cause a disproportionate increase in magma viscosity. Our in situ observations on a basaltic melt, rheological measurements in an analog system, and modeling demonstrate how just a few volume % of nanolites results in a marked increase in viscosity above the critical value needed for explosive fragmentation, even for a low-viscosity melt. Images of nanolites from low-viscosity explosive eruptions and an experimentally produced basaltic pumice show syn-eruptive growth, possibly nucleating a high bubble number density., (Copyright © 2020 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works. Distributed under a Creative Commons Attribution License 4.0 (CC BY).)

Background: Chickenpox is a highly contagious airborne disease caused by the varicella zoster virus. It is generally benign and self-limiting, but it may be responsible of life-threatening complications. Acute cerebellitis (AC) is the most common neurological complication and is associated with prolonged hospitalization in the acute phase (HAP)., Aim of the Study: To estimate the costs of AC HAP in children affected by varicella., Materials and Methods: We retrospectively reviewed the medical records of a pediatric cohort hospitalized for chickenpox AC over a period of 15 years (from October 2003 to October 2018) and we analyzed acute care costs. For any patient the HAP has been calculated. The final value includes cost of hospital accommodation and management at the Pediatric and Infectious Diseases Unit. To this cost, the price of procedures (imaging, laboratory exams, medical and paramedical evaluations) and medical treatments was added., Results: In the study period, 856 children had been hospitalized for varicella. Out of them, 65 met a diagnosis of AC and were included in the study. The hospitalization length was of 10 days (range 3-20 days). The median cost of HAP for each patient was of 5366 euro, with an average annual cost of 23,252 €. The most significant part of HAP is due to the cost of hospital accommodation and management at the Pediatric Infectious Diseases Unit, which was about € 537.78 for a single day., Discussion: Although AC post-varicella is rare, its HAP cost is not negligible resulting in substantial economic burden. Vaccination would have probably prevented varicella and AC complication, avoiding hospitalization., Conclusions: Financial studies are important for evaluate the cost saving in order to influence public funding decisions. Further studies are necessary to investigate the economic burden of the disease.

To predict the spread of coronavirus disease globally and consequently prepare the hospital facilities with the required technology is a challenge. The availability of essential medical equipment to support patients affected by Covid-19 is globally limited. Areas covered This perspective gives a technical view of the pandemic focusing on the main actions taken by regulatory agencies to cope with the shortage of devices. The risk/benefit assessment and the main infection control policies in the clinical practices are also looked at. Expert opinion Regulatory agencies have amended their medical devices directives to address the pandemic, but each in a different way. In this exceptional situation scientist and technology experts in collaboration with medical specialists should work together to re-assess the risk analysis on medical equipment management and their use and re-use in this context with the aim to improve global health care Every effort must be made to provide the necessary devices at least with the minimum acceptable performances for Covid-19 patients while maintaining a high standard of safety for users. The aim of the present manuscript is to highlight the technical challenges in order to prevent, through targeted actions, operating standards from falling below the standards of care due to a lack of medical devices. Abbreviations AKI: acute Kidney Injury; ARGMD: Australian Regulatory Guidelines for Medical Devices; Covid-19: Coronavirus disease; FDA: Food and Drug Administration; ECMO: Extracorporeal Membrane Oxygenation; EU: European Union; ICU: Intensive Care Unit; WHO: World Health Organization; MHRA: Medicines and Healthcare products Regulatory Agency; MDR: Medical Device Regulation; SARI: Severe Acute Respiratory Infection.

Introduction: Varicella may complicate with cerebellitis in previously healthy children, requiring hospitalization. Aim of our study was to define whether children who experienced varicella cerebellitis have a normal immune system., Methods: Patients over 3 years of age admitted at Bambino Gesù Children from January 2006 till June 2016 for cerebellitis in varicella were asked to participate to the follow-up study. The immune status was evaluated clinically and by laboratory investigations., Results: Twenty-five patients were included in the study. At follow up, at least one immunological alteration was detected in 80% of patients. To avoid bias due to possible effects of the recent disease, we separately analyzed patients who had the follow-up control at least 1 year (Group 1) or between 1 month and 1 year (Group 2) after the hospitalization for acute varicella cerebellitis. The results were similar in both groups with immunological alterations detected in 84,6 and 75% of the patients, respectively., Conclusions: Our preliminary results indicate that sub-clinical immunological defects may correlate to cerebellitis in varicella.

The spin crossover (SCO) efficiency of [ 57 Fe(bpz) 2 (phen)] (where bpz = bis(pyrazol-1-yl)borohydride and phen = 9,10-phenantroline) molecules deposited on gold substrates was investigated by means of synchrotron Mössbauer spectroscopy. The spin transition was driven thermally, or light induced via the LIESST (light induced excited spin-state trapping) effect. Both sets of measurements show that, once deposited on a gold substrate, the efficiency of the SCO mechanism is modified with respect to molecules in the bulk phase. A correlation in the distribution of hyperfine parameters in the sublimated films, not evidenced so far in the bulk phase, is reported. This translates into geometrical distortions of the first coordination sphere of the iron atom that seem to correlate with the decreased spin conversion. The work reported clearly shows the potentiality of synchrotron Mössbauer spectroscopy for the characterization of nanostructured Fe-based SCO systems, thus resulting as a key tool in view of their applications in innovative nanoscale devices.

Background: Patients affected by acute central nervous system (ACNS) infectionsmay present different complications, including neuropsychological disorders. Nevertheless, psychopathological impairment has been rarely measured by appropriate and validated tests., Material and Methods: Survivors of childhood ACNS infections admitted to the Bambino Gesù Children's Hospital, Rome, Italy, from June 2013 to June 2015 were re-evaluated at follow-up from June 2016 to June 2017. Both patients and their parents underwent a psychological interview and neuropsychological tests (the Leiter International Performance Scale - revised (Leiter-R), the Child Behaviour Checklist (CBCL), the K-SADS-PL test)., Results: Thirty children were included in the study. The mean score of IQ and fluid reasoning was within the normal range. A percentage of 20% of the children enrolled showed criteria for generalized anxiety disorder., Conclusion: Our study revealed the importance of follow-up evaluations after ACNS infections, in order to prevent mayor psychological sequelae and to perform treatment or rehabilitation.

Objectives: Although sedatives and analgesic drugs defuse anxiety and relieve pain, digestive endoscopy still is uncomfortable and painful for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. The present study evaluated the relations between procedural anxiety, catastrophizing thoughts, and pain, using a prospective design and multimodal assessments of pain., Methods: A total of 118 consecutive patients were assessed for procedural anxiety before endoscopy. During endoscopy, a doctor rated the patients' pain behavior. Before discharge, the patients retrospectively rated endoscopy pain and related catastrophizing thoughts., Results: Notwithstanding sedation, our study revealed large between-subject variability in pain. Catastrophizing thoughts mediated the relation between procedure-related pain observed by the doctor and pain intensity reported by the patient. Catastrophizing thoughts also mediated the effect of procedural anxiety. Our study showed that anxiety exacerbates endoscopy pain when the patient engages in ruminative thinking and feels unable to cope with unpleasant bodily sensations., Conclusions: This study shows that catastrophizing thoughts account for between-subject differences in endoscopy pain. Rumination and helplessness but not magnification explain how procedural anxiety may evolve in a painful endoscopy experience. To the extent that one can address catastrophizing thoughts, endoscopy pain can be mitigated, especially for patients who are difficult to sedate.

Background: To evaluate the rate of nocturnal enuresis (NE), body weight and obstructive sleep apnea in children 5 to 10 years of age in South Italy and the possible association among these disorders., Methods: We have administered 1100 validated questionnaires, in Italian language, to parents and we have analyzed data with a logistic regression., Results: Forty-two percent of children had a BMI≥85th (group 1) vs 58.0% normal weight children at the same age (group 2). There is a higher number of overweight males compared to females without statistically differences. In group 1 there was a higher number of children with NE and obstructive sleep disorders and some children present with the association among these three disorders., Conclusions: There are no statistically differences between two study groups for the association body weight-NE, body weight-NE-obstructive sleep disorders.

Background: The use of media device, such as smartphone and tablet, is currently increasing, especially among the youngest. Adolescents spend more and more time with their smartphones consulting social media, mainly Facebook, Instagram and Twitter because. Adolescents often feel the necessity to use a media device as a means to construct a social identity and express themselves. For some children, smartphone ownership starts even sooner as young as 7 yrs, according to internet safety experts., Material and Methods: We analyzed the evidence on media use and its consequences in adolescence., Results: In literature, smartphones and tablets use may negatively influences the psychophysical development of the adolescent, such as learning, sleep and sigh. Moreover, obesity, distraction, addiction, cyberbullism and Hikikomori phenomena are described in adolescents who use media device too frequently. The Italian Pediatric Society provide action-oriented recommendations for families and clinicians to avoid negative outcomes., Conclusions: Both parents and clinicians should be aware of the widespread phenomenon of media device use among adolescents and try to avoid psychophysical consequences on the youngest.

Background and Aim: Infection of commercial poultry with avian encephalomyelitis (AE) and fowlpox (FP) virus causes heavy economic loss in endemic areas. Although vaccines are routinely used to control these two diseases, the problem still persists almost all over the world. This study aimed to evaluate safety and efficacy of a unique AE + FP + pigeon pox (PP) live virus vaccine in layer-type chickens under both laboratory and field conditions., Materials and Methods: The study was conducted using 289 specific-pathogen-free (SPF) chickens under the laboratory conditions and 185,648 commercial layer-type chickens under field conditions. In two consecutive laboratory trials, 8-week-old SPF chickens were vaccinated with the AE + FP + PP live virus vaccine through wing web route and challenged against virulent strains of FP and AE viruses at 3-week post-vaccination (WPV). Challenged chickens were observed for disease protection for 10-21 days. For field safety trials, commercial layer-type chickens in three different geographical areas in the USA were vaccinated with the AE + FP + PP vaccine and observed daily up to 21 days for vaccine "take," adverse reactions, and mortality., Results: The vaccine was found safe and efficacious under both laboratory and field conditions. Vaccine "take" and protection against FP challenge were 100%. Average protection against AE challenge was 97%. Mean AE enzyme-linked immunosorbent assay (ELISA) antibody titer in the field vaccinated chickens was >1200 at 10 WPV. Average daily post-vaccination mortality in the field vaccinated chickens was 0.04%. So far, more than 400 million chickens in the USA have been vaccinated with this vaccine. No vaccine-associated adverse reactions, other safety issues, or immunity breakdown cases in the vaccinated flocks due to field virus infection have been reported., Conclusion: This unique vaccine containing AE, FP, and PP viruses in a single preparation was found to be safe and efficacious in controlling the diseases caused by the virulent field strains of AE and FP. Besides being safe and efficacious, this vaccine also offered distinct advantages over the traditional vaccination practices in controlling these two diseases in poultry., (Copyright: © Sarma, et al.)

Although sedatives can defuse anxiety and relieve pain, Esophagogastroduodenoscopy (EGD) still is uncomfortable and threatening for some patients. Identifying patients who tolerate digestive endoscopy less well remains difficult. Using a prospective design and a multimodal assessment of pain, the present study evaluated how anxiety-related variables predicted subsequent pain outcomes. Sixty-two consecutive patients referred for elective EGD were assessed for intolerance of uncertainty (IU), procedure-related worries, anxiety sensitivity and health distress before endoscopy. During endoscopy, a doctor rated patients' pain behavior. After complete recovery from sedation, the patients retrospectively rated endoscopy pain and situation specific catastrophizing thoughts. Descriptive analyses showed that patients undergoing EGD for the first time were more distressed and anxious than patients accustomed to the procedure and needed a higher sedative dose. Notwithstanding sedation, the behavioral rating of pain was above the cut-off value for probable pain for more than half of the patients. IU assessed before endoscopy predicted situational pain catastrophizing (PC) and self-reported pain after endoscopy through procedure related worries. Situational PC not only mediated the effect of worry, but also female gender and younger age were associated with self-reported pain through increased catastrophizing thoughts. Health distress and anxiety sensitivity predicted PC only for women, younger patients, and those not accustomed to the procedure. Our study showed that psychological preparation before sedation is needed especially for first-timers, women, and younger patients, addressing maladaptive cognitive beliefs and acquainting patients with the somatic sensations that they might experience during the procedure.

Background: Mobility impairment is common in older adults and negatively influences the quality of life. Mobility level may change rapidly following surgery or hospitalization in the elderly. The timed up and go (TUG) is a simple, frequently used clinical test for functional mobility; however, TUG requires supervision from a trained clinician, resulting in infrequent assessments. Additionally, assessment by TUG in clinic settings may not be completely representative of the individual's mobility in their home environment., Objective: In this paper, we introduce a method to estimate TUG from activities detected in free-living, enabling continuous remote mobility monitoring without expert supervision. The method is used to monitor changes in mobility following total hip arthroplasty (THA)., Methods: Community-living elderly (n  =  239, 65-91 years) performed a standardized TUG in a laboratory and wore a wearable pendant device that recorded accelerometer and barometric sensor data for at least three days. Activities of daily living (ADLs), including walks and sit-to-stand transitions, and their related mobility features were extracted and used to develop a regularized linear model for remote TUG test estimation. Changes in the remote TUG were evaluated in orthopaedic patients (n  =  15, 55-75 years), during 12-weeks period following THA., Main Results: In leave-one-out-cross-validation (LOOCV), a strong correlation (ρ  =  0.70) was observed between the new remote TUG and standardized TUG times. Test-retest reliability of 3-days estimates was high (ICC  =  0.94). Compared to week 2 post-THA, remote TUG was significantly improved at week 6 (11.7  ±  3.9 s versus 8.0  ±  1.8 s, p   <  0.001), with no further change at 12-weeks (8.1  ±  3.9 s, p   =  0.37)., Significance: Remote TUG can be estimated in older adults using 3-days of ADLs data recorded using a wearable pendant. Remote TUG has discriminatory potential for identifying frail elderly and may provide a convenient way to monitor changes in mobility in unsupervised settings.

There is currently a lack of information adjacent on the influence of sex and age in heart rate variability (HRV), adjusted according to accelerometer-based physical activity (PADL). We hypothesized that the effect of sex and age on the HRV should be reduced or absent in individuals with a suitable PADL level. We aim to evaluate the influence of sex and age on HRV, adjusted for the confounding effects of the PADL level. A total of 485 age-stratified subjects (18-39, 40-59, and ≥60 years) underwent HRV analyses at rest and 7-day assessments of accelerometer-based PADL. Multivariate analyses of covariance were done using log-transformed HRV indices as outcomes, age and sex as fixed factors, and PADL, cardiovascular risk, fat body mass, and heart rate (HR) at rest as covariates. Despite the adjustment for directly measured PADL, women had better indices of vagal tone, whereas men had higher sympathetic influence. Also, compared to middle-aged and older adults, younger individuals (ages 18-39 years) presented better HRV. Multiple regression analyses confirmed that age and sex were the main predictors of HRV indices, even after adjusting for PADL directly assessed by triaxial accelerometer and HR. We also observed that the correlation between some HRV indexes and the different indexes of physical activity directly evaluated was significant, but not very consistent. Thus, HRV indices are influenced by age and sex, regardless of accelerometer-based physical activity. Interventions with physical activity and exercise aimed at improving the autonomic modulation of asymptomatic adults should take such differences into account.

Background: Young children are too often exposed to mobile devices (MD) and most of them had their own device. The adverse effects of a early and prolonged exposure to digital technology on pre-school children has been described by several studies. Aim of the study is to analyze the consequences of MD exposure in pre-school children., Methods: We analyzed the documented effects of media exposure on children's mental and physical health., Results: According to recent studies, MD may interfere with learning, children development, well being, sleep, sight, listening, caregiver-child relationship., Discussion: Pediatricians should be aware of both the beneficial and side effects of MD and give advice to the families, according to children's age., Conclusion: In according to literature, the Italian Pediatric Society suggest that the media device exposure in childhood should be modulated by supervisors.

Background: High rates of vaccination coverage are important in preventing infectious diseases. Enforcing mandatory vaccinations is one of the strategies that some Countries adopted to protect the community when vaccination coverage is not satisfactory. In Italy, in 2017 vaccination against diphtheria, tetanus, pertussis, hepatitis B, poliovirus, Haemophilus influenzae type b, measles, mumps, rubella and varicella became compulsory in childhood. In order to contrast vaccination policies, anti-vaccination campaigns contribute to the spread of fake news. Among them, there is the false information that Italy is the only one country with mandatory vaccination policy. Aim of our study is confronting vaccination policies in children under 18 months against among different European countries for the following vaccines: diphtheria, tetanus, pertussis, hepatitis B, poliovirus, Haemophilus influenzae type b, measles, mumps, rubella and varicella., Methods: Information on policies of mandatory or recommended vaccinations of the European Countries were gathered by ECDC and compared to the Italian one., Results: European Countries recommend or contemplate compulsory vaccines. Among them, eleven Countries (35.4%) have mandatory vaccinations for at least one out of diphtheria, tetanus, pertussis, hepatitis B, poliovirus, Haemophilus influenzae type b, measles, mumps, rubella and varicella vaccine., Conclusion: Not only in Italy, vaccination against diphtheria, tetanus, pertussis, hepatitis B, poliovirus, Haemophilus influenzae type b, measles, mumps, rubella and varicella is mandatory in children under 18 months. Other European countries adopted compulsory policies in order to prevent the spread of infectious diseases and to protect the community.

Magma crystallisation is a fundamental process driving eruptions and controlling the style of volcanic activity. Crystal nucleation delay, heterogeneous and homogeneous nucleation and crystal growth are all time-dependent processes, however, there is a paucity of real-time experimental data on crystal nucleation and growth kinetics, particularly at the beginning of crystallisation when conditions are far from equilibrium. Here, we reveal the first in situ 3D time-dependent observations of crystal nucleation and growth kinetics in a natural magma, reproducing the crystallisation occurring in real-time during a lava flow, by combining a bespoke high-temperature environmental cell with fast synchrotron X-ray microtomography. We find that both crystal nucleation and growth occur in pulses, with the first crystallisation wave producing a relatively low volume fraction of crystals and hence negligible influence on magma viscosity. This result explains why some lava flows cover kilometres in a few hours from eruption inception, highlighting the hazard posed by fast-moving lava flows. We use our observations to quantify disequilibrium crystallisation in basaltic magmas using an empirical model. Our results demonstrate the potential of in situ 3D time-dependent experiments and have fundamental implications for the rheological evolution of basaltic lava flows, aiding flow modelling, eruption forecasting and hazard management.

Ferritins are ubiquitous and conserved proteins endowed with enzymatic ferroxidase activity, that oxidize Fe(II) ions at the dimetal ferroxidase centre to form a mineralized Fe(III) oxide core deposited within the apo-protein shell. Herein, the in vitro formation of a heterodimetal cofactor constituted by Fe and Mn ions has been investigated in human H ferritin (hHFt). Namely, Mn and Fe binding at the hHFt ferroxidase centre and its effects on Fe(II) oxidation have been investigated by UV-Vis ferroxidation kinetics, fluorimetric titrations, multifrequency EPR, and preliminary Mössbauer spectroscopy. Our results show that in hHFt, both Fe(II) and Mn(II) bind the ferroxidase centre forming a Fe-Mn cofactor. Moreover, molecular oxygen seems to favour Mn(II) binding and increases the ferroxidation activity of the Mn-loaded protein. The data suggest that Mn influences the Fe binding and the efficiency of the ferroxidation reaction. The higher efficiency of the Mn-Fe heterometallic centre may have a physiological relevance in specific cell types (i.e. glia cells), where the concentration of Mn is the same order of magnitude as iron., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Neurofibromatosis type 1 (NF1) is a genetic disorder associated with neurocutaneus manifestations, as well as attention and learning problems. The aim of this study was to examine the psychosocial functioning, quality of life, and self-image of children with NF1., Method: Two hundred forty participants were recruited, comprising 60 children and adolescents with NF1, 60 parents of children with NF1, 60 children and adolescents without NF1, and 60 parents of children without NF1. The children/adolescents completed the Self-administered Psychiatric Scales test for Children and Adolescents and the human figure drawing test, whereas parents completed the Child Behavior Checklist. Both children and parents completed the Pediatric Quality of Life Inventory., Results: Compared to healthy subjects, individuals with NF1 reported anxiety problems, poorer quality of life, and greater distortions in terms of self-image. When compared to healthy participants' parents, the parents of NF1 participants reported having more concerns about the quality of life, sociality, school performance, and attention span of their children., Conclusions: Results show that the psychological functioning, behavior, self-image, and quality of life of children and adolescents with NF1 are compromised. Health services should take into account the psychosocial difficulties associated with NF1 and design rehabilitation programs aimed at increasing NF1 children's interpersonal skills, improving their social life and quality of life, and promoting more adaptive behaviors. In addition, health care interventions should also involve the parents of children with NF1., (© 2017 John Wiley & Sons Ltd.)

Water plays a key role in magma genesis, differentiation, ascent and, finally, eruption. Despite the recognized crucial function of water, there are still several issues that continue to blur our view about its role in magmatic systems. What are the timescales of H 2 O accumulation in crystallizing magmas? What are the ascent rates of water-rich residual melts leading to explosive eruptions? Here, we track the timescale of water accumulation in a residual melt resulting from crystallization of a hydrous CO 2 -bearing magmatic mass stored at mid- to deep-crustal levels in a subduction-related geodynamic setting. Our results indicate that, after a repose period ranging from few to several thousand years, water-rich melts with water concentrations larger than 6-9 wt.% can migrate towards the Earth surface in very short timescales, on the order of days or even hours, possibly triggering explosive eruptions with short warning times and devoid of long-term geophysical precursors.

The use of single molecule magnets (SMMs) as cornerstone elements in spintronics and quantum computing applications demands that magnetic bistability is retained when molecules are interfaced with solid conducting surfaces. Here, we employ synchrotron Mössbauer spectroscopy to investigate a monolayer of a tetrairon(III) (Fe 4 ) SMM chemically grafted on a gold substrate. At low temperature and zero magnetic field, we observe the magnetic pattern of the Fe 4 molecule, indicating slow spin fluctuations compared to the Mössbauer timescale. Significant structural deformations of the magnetic core, induced by the interaction with the substrate, as predicted by ab initio molecular dynamics, are also observed. However, the effects of the modifications occurring at the individual iron sites partially compensate each other, so that slow magnetic relaxation is retained on the surface. Interestingly, these deformations escaped detection by conventional synchrotron-based techniques, like X-ray magnetic circular dichroism, thus highlighting the power of synchrotron Mössbauer spectroscopy for the investigation of hybrid interfaces.

The inflammation of aortic wall, named aortitis, is a rare condition that can be caused by a number of pathologies, mainly inflammatory or infectious in nature. In this context, the occurrence of combined audiovestibular and/or ocular manifestations eventually led to the diagnosis of Cogan's syndrome, making it the rare case, but susceptible to adequate immunosuppressive treatment and satisfactory disease control.