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In several regions, but especially in semi-arid areas, raising frequency, duration and intensity of drought events, mainly driven by climate change dynamics, are expected to dramatically reduce the current stocks of freshwater resources, limiting crop development and yield especially where agriculture largely depends on irrigation. The achievement of an affordable and sustainable equilibrium between available water resources and irrigation demand is essentially related to the planning and implementation of evidence-based adaptation strategies and actions. The present study proposed a state-of-the art conceptual framework and computational methodology to assess the potential water scarcity risk, due to changes in climate trends and variability, on irrigated croplands. The model has been tested over the irrigated agriculture of Puglia Region, a semi-arid territory with the largest agricultural production in Southern Italy. The methodology, based on the Regional Risk Assessment (RRA) approach, has been applied within a scenario-based hazard framework. Regional climate projections, under alternative greenhouse gas concentration scenarios (RCP4.5 and RCP8.5) and for two different timeframes, 2021–2050 and 2041–2070 compared to the baseline 1976–2005 period, have been used to drive hydrological simulations of river inflow to the most important reservoirs serving irrigation purposes in Puglia. The novelty of the proposed RRA-based approach does not simply rely on the concept of risk as combination of hazard, exposure and vulnerability, but rather elaborates detailed (scientific and conceptual) framing and computational description of these factors, to produce risk spatial pattern maps and related statistics distinguishing the most critical areas (risk hot spots).. The application supported the identification of the most affected areas (i.e. Capitanata Reclamation Consortia under RCP8.5 2041–2070 scenario), crops (fruit trees and vineyards), and, finally, the vulnerability pattern of irrigation systems and networks. The implemented assessment singled out future perspectives of water scarcity risk levels for irrigated agriculture by the administrative extent where individual bodies are in charge of the coordination of public and private irrigation activities (i.e. Reclamation Consortia). Based on the outcomes of the proposed methodology, tailored and knowledge-based adaptation strategies and related actions can be developed, to reduce the risk at both agronomic level (i.e. preferring crops with low vulnerability score, as olive groves) and at structural level (i.e. differentiating the water stocks and supplies and reducing losses and inefficiencies). [ABSTRACT FROM AUTHOR]

Teleradiology is a useful practice to provide remote consultation from specialists or senior staff, when no staff is available "on-site", and a quick consultation or a second opinion is necessary. Recently smartphones with high quality display have been marketed. The aim of our study was to determine if these devices could be used for paediatric radiologic remote consultation without loss of diagnostic information. Ninety-three paediatric exams were evaluated. CT and MRI examinations were randomly chosen among performed exams and sent to two different smartphones (Apple iPhone and Nexus One -Android OS-) using a VPN encrypted connection. Two independent radiologists evaluated the images prospectively. Results were collected in a database and compared with the gold standard result (PACS system, EBIT Aet DICOMed Review v.4.1, and monitors officially certified for radiologic interpretation). Concordance between diagnostic interpretation using smartphones and the golden standard was 97.52%. Values of specificity and sensitivity were respectively 100% and 96.3%, with a PPV of 100% and a NPV of 93.0%. Missing findings were only minor ones, while the overall diagnostic interpretation was essentially the same. These preliminary results show that diagnostic accuracy of radiologic paediatric interpretation using smartphones is overall acceptable. Although such system is not suitable for long consultation sessions, they can be used for quick remote consultation on single cases. [ABSTRACT FROM AUTHOR]

Background: MAGE genes encode for tumor-rejection antigens and are expressed in tumors of different histologic types but not in normal tissues, with the exception of testis and placenta. The aim of this study was to evaluate the frequency of MAGE-1 and -2 expression in gastric and in cardial carcinomas; these conditions have been described as two distinct diseases, having different etiologies, epidemiologic patterns, and gene mutations. Methods: Two groups of patients were studied: patients with distal gastric carcinoma and patients with carcinoma of the cardia. A group of patients with intestinal metaplasia in the gastric mucosa and controls were also included. All of them underwent upper GI endoscopy. Paired biopsy specimens were taken for routine histology and for RNA extraction, to study the expression of MAGE-1 and -2 genes. Results: None of the intestinal metaplastic samples or controls expressed MAGE-1 and -2 at detectable levels. Whereas 40% of the gastric cancer patients expressed either MAGE-1 or -2, 26.6% transcribed both. In the cardial cancer group, 20% of the cases expressed at least one MAGE, and only 6.6% expressed both genes. These results might reinforce the concept that cancer of the cardia is a distinct neoplastic disease with regard to esophageal and gastric (distal) carcinomas. Conclusions: Here we show that MAGE gene expression occurs in advanced stages of gastric and cardial cancer and therefore appears to be a late event. This might point to a reconsideration of their potential role in cancer immunotherapy. [ABSTRACT FROM AUTHOR]

An abstract of the article "Fetal MRI using open machines: preliminary results," by F. Zennaro, G. Pelizzo and G. d'Ottavio, is presented.

An abstract of the article "Prenatal diagnosis of left lung agenesis. MRI advantages on early diagnosis and prognosis," by G. Pelizzo, G. d'Ottavio and F. Zennaro, is presented.

Climate change pressures include the dissolved oxygen decline that in lagoon ecosystems can lead to hypoxia, i.e. low dissolved oxygen concentrations, which have consequences to ecosystem functioning including biogeochemical cycling from mild to severe disruption. The study investigates the potential of machine learning (ML) and deterministic models to predict future hypoxia events. Employing ML models, e.g. Random Forest and AdaBoost, past hypoxia events (2008-2019) in the Venice Lagoon were classified with an F1 score of around 0.83, based on water quality, meteorological, and spatio-temporal factors. Future scenarios (2050, 2100) were estimated by integrating hydrodynamic-biogeochemical and climate projections. Results suggest hypoxia events will increase from 3.5 % to 8.8 % by 2100, particularly in landward lagoon areas. Summer prediction foresee a rise from 118 events to 265 by 2100, with a longer hypoxia-prone season. This model is a valuable tool for developing hypoxia scenarios, aiding in identifying restoration hotspots for climate-threatened lagoons., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aims to assess accuracy and clinical utility of postmortem radiological exams [Magnetic Resonance Imaging (MRI), Computed Tomography (CT) and Radiography (XR)] after termination of pregnancy at <23 weeks' gestation for congenital fetal malformations in comparison to autopsy., Study Design: This a prospective single-center study on fetuses underwent termination of pregnancy for fetal defects. Overall concordance between any radiological exam and autopsy was evaluated. For postmortem MRI only, the following subgroups were analyzed: 1) total agreement; 2) agreement for main findings; 3) agreement for main findings but major relevant additional findings at autopsy; 4) total disagreement., Results: 174 cases were collected. The overall concordance with autopsy for main findings was 71% (115/163) for postmortem MRI and 99% (173/174) for prenatal ultrasound (US). Postmortem MRI detection rate was high for central nervous system (CNS) defects (98%), gastrointestinal, genitourinary and respiratory defects (100%), while it was poor for cardiovascular and musculoskeletal defects (25% and 42%, respectively). For musculoskeletal abnormalities, the performance of postmortem XR and postmortem CT exams improved the detection rate from 42% for postmortem MRI alone to 92%., Conclusions: Postmortem MRI has a good overall concordance for fetal defects after termination of pregnancy performed at <23 weeks. Along with autopsy, postmortem MRI may be offered for all cases of CNS defects in order to prevent inconclusive exams due to autolysis of the brain tissue, while postmortem CT and postmortem XR are indicated for musculoskeletal defects. In the presence of multiple abnormalities or cardiac defects the couple should be counseled on the poor performance of radiological investigations., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Early post-transplant is the critical phase for the success of hematopoietic stem cell transplantation (HSCT). New viral infections and the reactivations associated with complete ablation of the recipient's T-cell immunity and inefficient reconstitution of the donor-derived system represent the main risks of HSCT. To date, the pharmacological treatments for post-HSCT viral infection-related complications have many limitations. Adoptive cell therapy (ACT) represents a new pharmacological strategy, allowing us to reconstitute the immune response to infectious agents in the post-HSC period. To demonstrate the potential advantage of this novel immunotherapy strategy, we report three cases of pediatric patients and the respective central nervous system complications after donor lymphocyte infusion.

Objective: To evaluate if limiting factors of intrauterine magnetic resonance imaging (iuMRI) performed in the early second trimester of pregnancy (19-23 weeks) affect its accuracy in comparison to post-mortem MRI (pmMRI) in fetuses that underwent termination of pregnancy (TOP) for central nervous system (CNS) defects., Study Design: This is a secondary analysis of a 10 years prospective observational study. Cases of TOP < 23 weeks for CNS malformation that had undergone neurosonography (NSG), iuMRI, pmMRI and autopsy were included. The agreement between iuMRI and pmMRI was calculated. The autopsy represented the gold-standard., Results: Overall, 143 TOPs for fetal congenital anomaly underwent the post-mortem diagnostic protocol. Of these, 31 cases underwent iuMRI and pmMRI for CNS abnormality. Three cases were excluded due to brain autolysis at autopsy. Corpus callosum defects were the most represented (16/28; 57 %). In only one case of posterior fossa defect, pmMRI identified the presence of vermian hypoplasia not diagnosed at iuMRI. In 2 cases (7%), iuMRI added clinically relevant additional findings to NSG, that were posteriorly confirmed by pmMRI., Conclusions: The study shows that, at 19-23 weeks and for CNS defects, limiting factors that might influence the performance of iuMRI have little influence on iuMRI accuracy. This finding is particularly important for professionals who work in countries with legal bound for TOP in the early second trimester., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective: Autosomal recessive osteopetrosis (ARO) is a rare congenital disorder of defective bone resorption. The inability of osteoclasts to resorb bone compromises the development of bone marrow cavity, and ultimately, leads to defective hematopoiesis and death within the first decade. The only curative treatment currently available for certain forms of ARO is hematopoietic stem cell transplantation (HSCT). Infants over ten months of age suffering from ARO are defined as patients with advanced disease; HSCT to these patients is associated with high risk of transplant-related mortality (TRM). Because of the extreme variability of ARO clinical phenotypes, the most reliable predictive factor of TRM and graft failure risk is the residual bone marrow space volume., Case Report: We report clinical and radiological outcomes of one patient affected by ARO and treated with HSCT at advance stage of the disease. We describe the anomalies in various tissues, including bone marrow and bones at the moment of the diagnosis and document their gradual disappearance after HSCT until their complete resolution based on magnetic resonance imaging (MRI) observations. We provided radiological images of the cranial vault bone structure modifications, correlating the radiological appearance of the optical canals and nerves and of the cerebellum with the neurological manifestations of the disease., Conclusions: Our results demonstrate that MRI is a highly sensitive technique that provides excellent images of bone marrow space before and after HSCT without exposing children to ionizing radiation. MRI also permits us to evaluate post-transplant skeletal remodeling and the deriving changes in the hematopoietic and sensory system., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Mesenchymal stromal cell (MSC)-mediated therapeutic effects have been observed in the treatment of lung diseases. For the first time, this treatment was used as rescue therapy in a pediatric patient with a life-threatening respiratory syndrome associated with the filamin A (FLNA) gene mutation., Methods: A child with a new pathogenic variant of the FLNA gene c.7391&#95;7403del (p.Val2464AlafsTer5), at the age of 18 months, due to serious and irreversible chronic respiratory failure, was treated with repeated intravenous infusions of allogeneic bone marrow (BM)-MSCs. The child's respiratory condition was monitored. Immunologic studies before each MSC treatment were performed., Results: No acute adverse events related to the MSC infusions were observed. After the second infusion, the child's respiratory condition progressively improved, with reduced necessity for mechanical ventilation support. A thorax computed tomography (CT) scan showed bilateral recovery of the basal parenchyma, anatomical-functional alignment and aerial penetration improvement. After the first MSC administration, an increase in Th17 and FoxP3 + T percentages in the peripheral blood was observed. After the second MSC infusion, a significant rise in the Treg/Th17 ratio was noted, as well as an increased percentage of CD20 + /CD19 + B lymphocytes and augmented PHA-induced proliferation., Discussion: MSC infusions are a promising therapeutic modality for patients in respiratory failure, as observed in this pediatric patient with an FLNA mutation. MSCs may have an immunomodulatory effect and thus mitigate lung injury; although in this case, MSC antimicrobial effects may have synergistically impacted the clinical improvements. Further investigations are planned to establish the safety and efficacy of this treatment option for interstitial lung diseases in children., (© 2019 Wiley Periodicals, Inc.)

Background: Statins and sildenafil have been shown to exert beneficial effects in cardiac injury. We hypothesized that antenatal maternal administration of simvastatin and/or sildenafil might also promote benefits in cardiac remodeling of congenital diaphragmatic hernia (CDH). Therefore, we performed micro-CT image analysis and histology of the heart after antennal treatment in experimental nitrofen-induced CDH., Methods: At 9.5 days post conception (dpc), pregnant rats were exposed to nitrofen. At 16 and 20 dpc fetuses were treated with simvastatin and/or sildenafil. At 21 dpc postmortem micro-CT and autopsy were performed., Results: All nitrofen-treated fetuses had a lower birth weight compared to controls; in the simvastatin-treated group, a significant improvement in CDH was noted. Impairment of the lung and liver was also noted in CDH. Compared to controls, CDH rats showed lower ventricular mass, with greater left ventricular thickness; simvastatin decreased the ventricular mass and improved wall thickness. CDH rats exhibited myocardial hypotrophy, severe vascular depression in the left ventricle, and intense interstitial edema compared to controls and nitrofen-exposed animals without CDH. In CDH, the cardiac morphology appeared deformed with left ventricular wall verticalization. Simvastatin improved cardiac myocyte appearance and heart morphology., Conclusion: The potential to treat CDH with antenatal simvastatin may improve the management of this malformation., (© 2018 S. Karger AG, Basel.)

Introduction: We assessed the post-mortem micro-CT utility to evaluate fetal cardiac impairment in nitrofen-induced congenital diaphragmatic hernia (CDH)., Methods: At 9.5d postconception (dpc), pregnant rats were exposed to nitrofen. At +18 and +21dpc, fetuses were harvested by cesarean section. Postmortem micro-CT and autopsy were performed. Fetuses were assigned to three experimental groups: Control group (C), Nitrofen group (N, exposition to nitrofen without CDH), CDH group. Cardio-pulmonary indices were evaluated., Results: An accurate morphological evaluation of the lung and heart was obtained. Early cardiac impairment was present in the N and CDH groups. At term pregnancy, an increased maximum diameter and decreased minimum diameter of the ventricles and increased interventricular septal thickness were noted in CDH. Histology showed a myocardial "disarray" and an high density of mitotic myocytes in CDH at midgestation., Conclusions: The potential utility of post-mortem fetal micro-CT examination in CDH was introduced. The results highlighted the presence of cardiac adaptation in affected fetuses.

The medical records of 44 pediatric patients who underwent allogeneic transplantation from 2011 to 2015 were retrospectively reviewed. Magnetic resonance imaging was used to measure iron concentrations in the liver, spleen, pancreas and bone. These patients were divided into two groups, 18 with non-elevated (< 100 μmol/g; Group 1) liver iron concentration before transplantation and 26 with elevated (> 100 μmol/g; Group 2) concentration . We compared transplant-related outcomes in the two groups. Iron overload was a negative prognostic risk factor for sinusoidal obstruction syndrome (OR = 17), osteoporosis (OR = 6.8), pancreatic insufficiency (OR = 17) and metabolic syndrome (OR = 15.1). No statistically significant differences in overall survival, disease-free survival, relapse incidence and incidence of acute or chronic graft-versus host disease were observed between the two groups. Mean times to engraftment of platelets (43.0 ± 35.3 days vs. 22.1 ± 9.5 days, p < 0.05) and neutrophils (23.1 ± 10.4 days vs. 17.8 ± 4.6 days, p < 0.05) appear significantly longer in Group 2 than in Group 1. Time to platelet engraftment showed statistically significant correlation with pre-transplant liver ( r = 0.5775; p < 0.001) and bone iron concentration ( r = 0.7305; p < 0.001). Post-transplant evaluation pointed out that iron concentration analyzed at the first follow-up peaked in all tissues. The iron accumulation was highest in bone, followed by the spleen, liver and pancreas. One year post transplant 9 of 18 (50%) patients in Group 1 and 6 of 22 (27%) in Group 2 presented with bone and/or spleen iron overload, but not with liver overload. Liver iron concentration is not always a reliable indicator of systemic siderosis or of the efficacy of chelation therapy., Competing Interests: CONFLICTS OF INTEREST The authors declare that they have no competing interests.

Chronic recurrent multifocal osteomyelitis (CRMO), also known as chronic non-bacterial osteomyelitis (CNO), is a rare inflammatory disorder that primarily affects children. It is characterized by pain, local bone expansion, and radiological findings suggestive of osteomyelitis, usually at multiple sites. CRMO predominantly affects the metaphyses of long bones, but involvement of the clavicle or mandible are suggestive of the diagnosis. CRMO is a diagnosis of exclusion, and its pathogenesis remains unknown. Differential diagnosis includes infection, malignancies, benign bone tumors, metabolic disorders, and other autoinflammatory disorders. Biopsy of the bone lesion is not often required but could be necessary in unclear cases, especially for differentiation from bone neoplasia. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment. Alternative therapies have been used, including corticosteroids, methotrexate, bisphosphonates, and tumor necrosis factor (TNF)-α inhibitors. No guidelines have been established regarding diagnosis and treatment options. This manuscript gives an overview of the most recent findings on the pathogenesis of CRMO and clinical approaches for patients with the condition.