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Background Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI. Methods After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon. Results Data regarding six patients (three males) were analysed (median age 14 years, range 12–17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI. Conclusions Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.

Patients with bipolar disorder (BD) experience a poor quality of life (QoL) and a weak adherence to the therapy due to the various side effects occurring during the pharmacological therapy. To date clinicians have no tools to intervene on such effects, considering them as an unavoidable part of the therapy. This review paves the way for a step forward in the management of patients with BD bridging the therapeutic gap in clinical practice.We reviewed the literature, searching through different databases (MEDLINE, Scopus, Google Scholar). We used different keywords, including bipolar disorder, lithium and valproic acid, inositol role in bipolar disorder, side effects, inositol depletion, supplementation of inositols under lithium treatment, inositol role in metabolism, hypothyroidism, renal and cardiac functionality. In particular, we narrowed the search down to English literature, excluding works before 1980s. Regarding clinical studies, we included case reports and both preclinical and clinical studies, especially only those exhibiting a control group. The outcome of the database search was to highlight the threat of side effects and the relationship with inositol lower levels, paving the way for a step forward in the management of patients with BD.Based on the collected evidence, the combined administration of myo-inositol (myo-ins) and d-chiro-inositol (d-chiro-ins) is strongly recommended in order to restore levels and metabolism of inositols. Previous studies pointed out the beneficial effects of inositols in recovering pathological conditions, like polycystic ovary syndrome (PCOS), hypothyroidism, weight gain, cardiac functionality, being all these conditions related to the depletion of inositols. Furthermore, a controlled dosage of inositols, up to 6 grams/daily, may reduce the side effects caused by lithium therapy, without hindering its central therapeutic role on patients' mood.Considering the iatrogenic depletion of inositols, the tailored ratio 80:1 in favour of myo-ins, may become a safe and effective strategy to counteract side effects, by providing a large amount of myo-ins and an adequate one of d-chiro-ins. The clinical dosage of inositols used as dietary supplementation is 4 grams/daily, and it may allow the recovery of the side effects and improve patients' QoL, without reducing the central therapeutic effect of the pharmacological therapy.

We investigated whether the joint inversion of geodetic and stress direction data can constrain long-term fault slip rates in the central Apennines, and ultimately how extension is partitioned among fault slip and bulk lithosphere permanent strain Geodetic velocities are collected in the fault interseismic stage with steady secular deformation;thus, long-term estimates can be derived with a model of elastically unloading seismogenic faults within a viscously deforming lithosphere As the average spacing of permanent Global Navigation Satellite Systems (GNSS) stations is similar to the average length of seismogenic faults (25?35 km), if not larger, we decided to merge permanent and temporary GNSS measurements, resulting in a denser geodetic data set Given that most normal faults in the Apennines have slip rates around or below 1 mm/a, and most campaign GNSS velocities carry similar uncertainties, simple local back slip models cannot be applied More sophisticated modeling is required to extract reasonable bulk deformation rates and long-term fault slip rates at signal-to-noise ratio of order unity Given the spatial distribution of the GNSS network, we estimated the long-term slip rate of seven major fault systems that are in satisfactory agreement with available geological slip rates The resulting spatial distribution of bulk deformation rates locally fits short-term transients;in other cases, they represent the currently unclear signature of tectonic processes like upper-crustal viscoplastic deformation and aseismic slip, or indicate missing faults in the adopted database We conclude that the time is ripe for determining fault slip rates using geodetic and stress direction data, particularly where fault activity rates are hard to determine geologically

Following the Mw 6.3 earthquake that hit the city of L'Aquila (Central Italy) on the 6th April 2009, a scientific project was proposed with the aim of investigating the Abruzzo area by means of different disciplinary approaches including geological, seismic, and physical studies. Electromagnetic field monitoring in the 0.01–500 mHz frequency band was implemented for the investigation of electromagnetic signals in the Earth's crust. Three measurement stations were installed in a tectonically active area with a radius of about 10 km. Each site was equipped with a fluxgate magnetometer with a 1 Hz sampling rate. This paper describes a long term geomagnetic deep sounding analysis for each site, aimed at investigating the dimensionality of the electrical structure of the subsurface in the area involved in the survey. According to a very simplified RL circuit model, some electrical properties of subsurface are also deduced.

Many people who have suffered a stroke will experience sensorimotor impairments that disrupt their performance of motor skills, including balance and gait. Furthermore, stroke-induced brain damage can Result in visual disorders that may significantly impact performance of normal daily activities. The primary aim of this study was to investigate the effects, on balance, of visual-spatial training as an add-on intervention to conventional neurorehabilitation in patients with subacute stroke without neglect; secondarily, it aimed to assess the effects of this training on activities of daily living. Thirty inpatients (17 M, age: 57.3±12.9 years) with a diagnosis of subacute stroke (180 days) were enrolled in this study and randomized into two groups: the visual-spatial training group and a control group. All patients were evaluated, using the Tinetti Balance and Gait Scale (TBG), the Berg Balance Scale, computerized posturography, and the Barthel Index (BI), both before (T0) and after (T1) four weeks of training sessions. In addition to conventional neurorehabilitation, each group performed a total of twelve 20-minute rehabilitation sessions (3 times/week for 4 weeks). Significant TIME x GROUP interactions were recorded in the experimental group with respect to the control group for the TBG score [F (1,18) =15.59; p = 0.0004] and BI score [F (1,28) =6.35; p = 0.01]. Both groups recorded non-significant improvements on the instrumental postural assessment. These data suggest that visualspatial training as an add-on intervention to conventional neurorehabilitation could be an effective complementary strategy to improve balance and activities of daily living.

In the last years, the interest in non-alcoholic grape products has considerably increased. Table grapes are largely produced in the Mediterranean area and their consumption has raised worldwide. Beside the positive pattern of nutrients, table grapes could provide benefits on human health. Among the health-promoting substances contained in table grapes, flavonoids (mainly anthocyanins, flavan-3-ols and flavonols) seem to be the most interesting. The aim of this study was the characterization of the phenolic pattern of sixteen grape varieties, and the evaluation of the associated antioxidant activity. The methods were: 1) Folin-Cocalteau's assay for the quantification of total polyphenol content; 2) DPPH (1,1,-diphenil-2—picrylhydrazyl) assay and 3) ORAC (Oxygen Radical Absorbance Capacity) spectrophotometric assays for the assessment of radical scavenging activity; 4) High Performance Liquid Chromatography (HPLC) method, coupled with electrospray ionization mass spectrometer (ESI-MS) and DAD detector was developed in order to obtain the phenolic pattern of grape samples. Data obtained in this study underline that some table grape varieties can show interesting phenolic pattern independently from the presence or not of seeds. This observation suggests that selected varieties of seedless grapes could represent an interesting source of healthy compounds, satisfying consumers' preferences and reducing concerns versus alcoholic beverages.

Background: Using water-perfused (WP) high-resolution manometry, we recently demonstrated that children with functional constipation (FC) lacked the postprandial increase in distal colonic cyclic motor patterns that was observed in healthy adults. Our aim was to determine if similar results could be detected using a solid-state (SS) manometry catheter. Methods: We performed a retrospective analysis of 19 children with FC (median age 11.1 years, 58% male) who underwent colonic manometry with a SS catheter (36 sensors, 3 cm apart). Data were compared with previously published data using a WP catheter (36 sensors, 1.5 cm apart) recorded from 18 children with FC (median age 15 years; 28% male). Key Results: The cyclic motor patterns recorded by the SS catheter did not differ from those previously recorded by the WP catheter. There was no detected increase in this activity in response to the meal in either group. Long-single motor patterns were recorded in most patients (n = 16, 84%) with the SS catheter. The number of these events did not differ from the WP recordings. In the SS data, HAPCs were observed in 4 children prior to the meal, in 5 after the meal. This did not differ significantly from the WP data. Conclusions & Inferences: These data recorded by SS manometry did not differ from WP manometry data. Regardless of the catheter used, both studies revealed an abnormal colonic response to a meal, indicating a pathology which is not related to the catheter used to record these data.

Background Evidence for the efficacy of commonly used drugs in the treatment of childhood functional constipation (FC) is scarce, studies are often of low quality and study designs are heterogeneous. Thus, recommendations for the design of clinical trials in childhood FC are needed. Purpose Members of the Rome Foundation and a member of the Pediatric Committee of the European Medicines Agency formed a committee to create recommendations for the design of clinical trials in children with FC. Key recommendations This committee recommends conducting randomized, double-blind, placebo-controlled, parallel-group clinical trials to assess the efficacy of new drugs for the treatment of childhood FC. Pediatric study participants should be included based on fulfilling the Rome IV criteria for FC. A treatment free run-in period for baseline assessment is recommended. The trial duration should be at least 8 weeks. Treatment success is defined as no longer meeting the Rome IV criteria for FC. Stool consistency should be reported based on the Bristol Stool Scale. Endpoints of drug efficacy need to be tailored to the developmental age of the patient population.

Botanicals are widely consumed all over the world for health purposes, with increased usage in the general population, in many different types of products, including foods and plant food supplements. Several reports support for the beneficial effects of botanicals against gastrointestinal inflammation. However, no studies regarding the anti-inflammatory activity in the gastrointestinal tract of red vine leaves have been reported so far. The present work investigates the biological activity of Vitis vinifera L. water extract (VVWE) from dried leaves in two in vitro models of gastric and intestinal inflammation. The extract was characterized by a validated HPLC-DAD method, and tested on human epithelial gastric (AGS) and intestinal (Caco-2) cells with the aim to investigate the inhibitory effect on IL-8 secretion and promoter activity, before and after in vitro gastric or gastrointestinal digestion. Our results show that the water extract from red vine leaves inhibits TNFα-induced IL-8 secretion and expression in human gastric epithelial cells; the effect should be maintained, although to a lesser extent, after gastric digestion. In contrast, the effect after intestinal digestion is dramatically decreased since degradation of the active components in the gut does not allow the extract to efficiently counteract TNFα or IL-1β induced IL-8 expression and the NF-κB pathway. The main molecular target of VVWE at the gastric level includes TNFα-induced activation of NF-κB and occurs at concentrations easily reachable after PFS consumption based on red vine leaf water extract as the ingredient. Our findings suggest that PFS containing water extracts from Vitis vinifera L. leaves could be useful to inhibit/attenuate gastric inflammation inhibiting IL-8 secretion and expression through impairment of the NF-κB pathway.

Background: Most of the recent reports suggest that inflammatory mediators play a central role in the etiopathogenesis of Alzheimer's disease (AD) and that the conditions leading to a chronic low-grade inflammation, such as stress, depression, obesity and metabolic syndrome, increase the odds of developing Mild Cognitive Impairment (MCI) and AD. Microglia cells are the main actors in the AD process: stimuli from the microenvironment may induce microglia cells to switch to a classically activated inflammatory phenotype M1, or, on the contrary to an alternatively activated M2 phenotype characterized by the secretion of different types of cytokines. Many attempts are currently being made in order to delay the progression of AD by reducing inflammatory mechanisms underlying the disease. Several studies support a relationship among neuroinflammation and nutrients, foods or dietary patterns, taking into account the synergistic or antagonistic biochemical interactions among nutrients as well as the different food sources of the same nutrient. Natural antioxidant and anti-inflammatory compounds found in plant foods, such as fruits, particularly berries (such as strawberry, blueberry, blackcurrant, blackberry, blueberry and mulberry) have been shown to exert neuroprotective activity. It is still unclear whether the dietary bioactive compounds enter the Blood Brain Barrier (BBB) playing a direct antiinflammatory or pro-inflammatory effect on microglia and/or other Central Nervous System (CNS) cells. Another hypothesis is that they may trigger a peripheral reaction that induce indirectly a CNS' response. The subsequent synthesis of cytokines may drive microglia polarization by different ways. So, via an indirect route microglia detects and responds to immune-to-brain signaling. Conclusion: This review summarizes current evidence about the potential mechanisms of the interaction among diet, neuroinflammation and AD.

Background Chronic intestinal pseudo-obstruction (CIPO) represents the most severe form of gastrointestinal dysmotility with debilitating and potentially lethal consequences. Symptoms can be non-specific, and result in this condition being diagnosed incorrectly or too late with consequences for morbidity and even mortality. Purpose The present article aims to provide pediatric and adult gastroenterologists with an up to date review about clinical features, diagnosis and therapeutic options for CIPO. Although pediatric and adult CIPO share many clinical aspects distinctive features can be identified. There is no single diagnostic test or pathognomonic finding of CIPO, thus a stepwise approach including radiology, endoscopy, laboratory, manometry, and histopathology should be considered in the diagnostic work-up. Treatment of patients with CIPO is challenging and requires a multidisciplinary effort with participation of appropriately experienced gastroenterologists, pathologists, dieticians, surgeons, psychologists, and other subspecialists based on the presence of comorbidities. Current treatment options invariably involve surgery and specialized nutritional support, especially in children. Medical therapies are mainly aimed to avoid complications such as sepsis or intestinal bacterial overgrowth and, where possible, restore intestinal propulsion. More efficacious therapeutic options are eagerly awaited for such difficult patients.

Background Colonic dilation is common in children with intractable functional constipation (FC). Our aim was to describe the association between segmental colonic dilation and colonic dysmotility in children with FC. Methods We performed a retrospective study on 30 children with intractable FC (according to the Rome III criteria) who had undergone colonic manometry and contrast enema within a 12-month time period. Colonic diameter was measured at 5 cm intervals from the anal verge up to the splenic flexure. Moreover, the distance between the lateral margins of the pedicles of vertebra L2 was measured to provide a ratio (colonic diameter or length/distance between the lateral margins; “standardized colon size” [SCS]). All manometry recordings were visually inspected for the presence of high-amplitude propagating contractions (HAPCs); a parameter for colonic motility integrity. The intracolonic location of the manometry catheter sensors was assessed using an abdominal X-ray. Key Results Colonic segments with HAPCs had a significantly smaller median diameter than colonic segments without HAPCs (4.08 cm vs 5.48 cm, P

Author(s): Lu, PL; Moore-Clingenpeel, M; Yacob, D; Di Lorenzo, C; Mousa, HM | Abstract: BackgroundThe cost of hospital care for adults with gastroparesis (GP) is increasing. Our objective was to evaluate the cost of hospital care for children with GP.MethodsUsing the Pediatric Health Information System, we selected hospitalizations with a diagnosis of GP (ICD-9 536.3), dyspepsia and other specified disorders of function of stomach (DYS, 536.8) and unspecified functional disorder of stomach (UFD, 536.9) from 2004 to 2013. We recorded dates of hospitalization, demographics, costs, and length of stay (LOS).Key resultsFrom 2004 to 2013, 4015 patients were admitted for GP (54.2% female, median age 8 years). Total cost of hospitalization for GP increased 5.8 fold from $6 185 390 to $35 654 075 (p = 0.0001). Cost per hospitalization did not change. Cost of initial hospitalization was highest in patients 0-5 years and lowest in patients 16-21 years (p l 0.0001). Number of hospitalizations each year for GP increased from 252 to 1310 (p l 0.0001) and unique patients hospitalized increased from 174 to 723 (p l 0.0001). Number of hospitalizations and unique patients for DYS/UFD also increased (p l 0.0001). LOS for GP did not change with time. Females and younger GP patients had more repeat hospitalizations (p l 0.0001, p l 0.0001).Conclusions a inferencesThe financial burden of hospitalization for pediatric GP has increased dramatically from 2004 to 2013, driven by a rise in number of hospitalizations and unique patients hospitalized each year. Cost and LOS per hospitalization remain stable. Unlike in adults, hospitalizations for DYS/UFD have also increased, suggesting that the increase in hospitalizations for GP is not secondary to changing diagnostic practices.

Background Children with intractable functional constipation (FC) may eventually require surgery. However, guidelines regarding the surgical management of children with intractable FC are lacking. The aim of this study was to describe the surgical management of FC in children. Methods A retrospective chart review was performed of children with FC (according to the Rome III criteria) who underwent ileostomy, colostomy or (sub)total colectomy at a tertiary hospital. Treatment success was defined as no longer fulfilling the Rome III-FC-criteria or having a functional ostomy. In addition, a self-developed questionnaire was administered to parents by telephone to assess postsurgical satisfaction (yes-no question and rated on a scale of 1–10). Key Results Thirty-seven patients (68% female) were included; median age at first surgery was 12 years (range 1.6–17.6). The initial surgical procedure consisted of ileostomy (n=21), colostomy (n=10), sigmoid resection (n=5) and subtotal colectomy (n=1). Success criteria were fulfilled by 85% of the patients. Postsurgical satisfaction of parents was 91% with a median postoperative satisfaction score of 8 (range 2-10), and 97% would opt for the same procedure(s) if necessary. Thirty patients (81%) experienced stoma problems, with 12 patients (32%) requiring stoma-revisions. Other complications occurred in 16 patients (43%). Conclusions & Inferences Surgery can improve symptoms in children with intractable FC. Despite morbidity and complications, parental satisfaction is high. Prospective, high-quality research is necessary to develop guidelines for the diagnostic work-up and surgical management in children with intractable FC.

Background Over the last few years, the study of the colon and anorectal function has experienced great technical advances that have facilitated the performance of the tests and have allowed a more detailed characterization of reflexes and motor patterns. As a result, we have achieved a much better understanding of the pathophysiology of children with defecation problems. Anorectal and colonic manometry are now commonly used in all major pediatric referral centers as diagnostic tools and to guide the management of children with intractable constipation and fecal incontinence, particularly when a surgical intervention is being considered. Purpose This review highlights some of the recent advances in pediatric colon and anorectal motility testing including indications and preparation for the studies, and how to perform and interpret the tests. This update has been endorsed by the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Background There is little published evidence of efficacy for the most commonly used treatments. Thus, there is an urgent need to conduct clinical trials on existing and novel therapies. Purpose In order to address these issues the Rome Foundation and members of the Pediatric Committee of the European Medicines Agency formed a subcommittee on clinical trials to develop guidelines for the design of clinical trials in children with irritable bowel syndrome (IBS). The following recommendations are based on evidence from published data when available and expert opinion. Key recommendations The subcommittee recommends randomized, double-blind, placebo-controlled, parallel-group, clinical trials to assess the efficacy of new drugs. The combined endpoints for abdominal pain are a decrease in intensity of at least 30% compared with baseline and to meet or exceed the Reliable Change Index (RCI) for the sample. Stool consistency is measured with the Bristol Stool Scale Form (BSFS). The subcommittee recommends as entry criteria for abdominal pain a weekly average of worst abdominal pain in past 24 h of at least 3.0 on a 0–10 point scale or at least 30 mm in 100 mm Visual Analog Scale. For stool endpoints the committee recommends an average stool consistency lower than 3 in the BSFS during the run-in period for clinical trials on IBS-C and an average stool consistency greater than 5 in the BSFS during the run-in period for clinical trials on IBS-D. Changes in stool consistency are the primary endpoints for both IBS with diarrhea (IBS-D) and IBS with constipation (IBS-C).

Previous structural neuroimaging studies suggest that patients with chronic migraine (CM) with and without medication overuse have abnormal structural changes within the cerebellum. In humans, cerebellum exerts a suppressive effect on the contralateral motor cortical response through a cerebello-thalamo-cortical pathway. We recruited 10 patients affected from CM without medication overuse and 10 heathy volunteers (HVs). After a conditioning single pulse high-voltage electrical stimulation delivered over the posterior surface of the mastoid processes, a TMS pulse was delivered over the contralateral motor cortex with 5, 7, 10, and 15 ms interstimulus interval (ISI) in random order. Motor cortical excitability changes were evaluated by amplitude changes of EMG responses from the FDI muscle to motor cortical stimulation. In HVs, suppression occurred at ISI of 5 ms and lasted few milliseconds. In CM patients, conditioning electric stimulation over the cerebellum did not reduce the size of MEPs to test TMS of the motor cortex at conditioning-test intervals of 5 ms. Here, we found neurophysiological evidence for dysfunctional cerebello-thalamo-cortical inhibitory pathway in CM. Whether these functional abnormalities are due to primary abnormal cerebellar inhibitory dysfunction or are secondary to a disrupted cerebellar-thalamic-cortical connectivity, remains to be determined.

The neurophysiological mechanisms underlying clinical efficacy of botulinum toxin type A (BTX-A) treatment of chronic migraine (CM) are still debated widely. We assessed the cephalic, and extra-cephalic effects of BTX-A injection in a group of 13 CM patients, by simultaneously recording the blink reflex (nBR), the trigemino-cervical reflex (nTCR), and the pain-related evoked potential (PREP) following stimulation of the right supraorbital nerve, and by recording the non-noxious somatosensory evoked potentials (SSEPs). Neurophysiological measurements were recorded before, and 1 month and 3 months after BTX-A. At month 3, BTX-A significantly reduced the mean headache days, severity of headache, and tablet intake. A significant increase in pain threshold was noted 3 months after treatment compared to baseline. We found that the initial nBR and nTCR lack of habituation was replaced by normal habituating response at 3 months. There were no variations in the initial PREP and SSEP after BTX-A, despite a trend for an increased habituation for PREP and lack of SSEP amplitudes. Our findings suggest that the responsiveness to a single session of BTX-A may be related to the blockage of sensitization of the nociceptive neurons in the dorsal horn, without an evident involvement of cortical circuitries.

Potassium polyaspartate (KPPA) is a food additive used for wine stabilization. KPAA was included in the list of additives allowed in EU, with the Commission Regulation (EU) 2017/1399, having received a positive opinion by EFSA (European Food Safety Authority) in 2016. KPAA is rich in negative charges, which are essential for its enological function consisting in binding positive ions in order to reduce wine instability. Concerns were raised on the fact that the same binding properties could be responsible for a reduction of microelement bioavailability in humans. For this reason and for the protection of consumers' health, the binding properties of potassium polyaspartate versus three minerals (calcium, iron, magnesium) was assayed using the Size-Exclusion Chromatography (SEC). Aliquots obtained by SEC were analysed for their content in polyaspartate (by microbiuret method) and bound minerals (by ICP-OES method). The results obtained by this research shows that, when potassium polyaspartate is added to wine, the negative charges of the additive are saturated, as expected by the specific role of KPAA in tartaric stabilization. In conclusions, the effect on mineral bioavailability must be considered negligible.

Table grapes are largely produced and consumed in the Mediterranean area. Furthermore, in the last years, the commercial interest in table grapes and other non-alcoholic grape products has notably increased worldwide. In addition to the nutritional aspects, polyphenol compounds in fresh grapes could exert positive effects on human health. The aim of this study was the characterization of the phenolic pattern of sixteen grape varieties and the evaluation of the associated antioxidant capacity and anti-inflammatory activity at gastric level. The methods used were: 1) Folin-Cocalteau's assay for the quantification of total polyphenol content; 2) High-Performance Liquid Chromatography (HPLC) coupled with Diode-Array Detector (DAD) to perform the quantitative analysis of grapes phenolic fraction 3) DPPH (1,1,-diphenil-2-picrylhydrazyl) spectrophotometric assay for the assessment of radical scavenging activity; 4) assessment of IL-8 release from human gastric epithelial cells to evaluate the anti-inflammatory activity of grape extracts. Some grapes, including seedless varieties, showed that the phenolic pattern was highly correlated with the biological activities, and, in particular, with peel and seeds portion. These results suggest that selected grape varieties could represent, also for consumers who do not drink wine, a source of healthy compounds potentially able to counteract oxidative stress and gastric inflammation.

La brucelosis canina, producida por Brucella canis, es una enfermedad asociada a problemas reproductivos y de carácter zoonótico. Estas bacterias son excretadas en orina, leche, fetos o semen de los animales infectados y la transmisión ocurre por contacto vía sexual, oral, nasal o conjuntival. El diagnóstico de rutina se realiza por serología, pero la confirmación requiere aislamiento del cultivo bacterial, lo cual es costoso y requiere laboratorios con nivel 3 de bioseguridad. Las técnicas moleculares son una posibilidad reconocida para determinar el ADN bacterial, con alta especificidad y sensibilidad. Este reporte evaluó como prueba de aplicación clínica una técnica de PCR desarrollada para cultivos bacteriales. A una hembra canina asintomática, con historia previa de la enfermedad, amamantando una camada sana de 4 días de nacidos, se le realizó la prueba serológica rápida en placa con 2β-mercaptoetanol, hemocultivo y PCR, de leche y de sangre. Todas las pruebas fueron positivas a Brucella canis. Este es el primer reporte de diagnóstico en leche por PCR, lo que corrobora que animales clínicamente asintomáticos eliminan la bacteria por esta vía, lo que constituye un riesgo de infección para los neonatos y el riesgo zoonótico para veterinarios, propietarios del animal o personas que intervengan en el parto si no se toman medidas higiénicas preventivas., Canine brucellosis is a disease caused by Brucella canis that is associated to reproductive problems in dogs, and it is also known as zoonosis. These bacteria are excreted in urine, milk, fetus or semen of infected animals, and the transmission occurs via sexual, oral, nasal or conjunctival contact. Diagnosis is usually done through serology but confirmation requires isolation of bacterial culture, a costly process that requires laboratory biosafety level 3. Molecular techniques are a valid method to determine the bacterial DNA, offering high specificity and sensitivity. This study reports the evaluation of a PCR test usually applied to isolates, as a test for clinical use. A healthy female canine with a history of previous brucellosis, feeding her 4-day old healthy newborns, was submitted to a rapid serologic test with 2β-mercaptoethanol, haemoculture and PCR, of milk and blood. All the tests resulted positive to Brucella canis. This is the first report of a positive result to B. canis by PCR and it confirms that clinically healthy individuals shed the bacterium through milk, representing a risk of infection for neonates and humans., Facultad de Ciencias Veterinarias

Abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) following bacterial acute gastroenteritis (AGE) have been demonstrated in adults and children. An adult study demonstrated AP-FGIDs resulting from an outbreak of viral AGE. Viral AGEs are common in children. Thus, the demonstration of AP-FGIDs occurring after a viral infection in children could constitute a significant finding. The aim of the study was to investigate the development of FGIDs following an episode of acute rotavirus gastroenteritis in children. This is the first pediatric multicenter study designed to assess postviral AP-FGIDs.: It is a cohort study. Inclusion criteria of the study are children ages 4 to 18 years with history of AGE secondary to rotavirus. Sample size is 44 exposed and 44 controls (unidirectional alpha of 0.05, power of 0.80). Children consulting at 2 hospitals (Chicago, IL, and Naples, Italy) for AGE (2002-2004) who tested positive for rotavirus were randomly contacted by telephone2 years after the episode. Each exposed child who visited the emergency department or outpatient site for acute trauma or well-child visit within 4 weeks of the index case was matched with a control of the same age and sex. Gastrointestinal symptoms and disability were evaluated with a validated pediatric questionnaire.: Eighty-eight patients (46 boys, mean age 5.3 years) were recruited. Contacted patients presented with AGE in 2002 (9), 2003 (11), and 2004 (24). Seven (16%) exposed patients and 3 (7%) controls reported AP-FGIDs (P = 0.31).: Our study suggests that rotavirus infection does not seem to place children at increased risk for AP-FGIDs at long-term follow-up. Larger, prospective studies should be conducted to evaluate whether rotavirus gastroenteritis leads to AP-FGIDs in children.

We are reporting some results and future planning of the Magnetic and Electric fields Monitoring Project. The principal purpose of the project is to create a network of observatories for monitoring the electromagnetic signals in the 0.001 Hz-100 kHz frequency bands in Central Italy. These bands include both natural and artificial signals. The technological objectives of the project are the development of new instrumentation and the know-how transfer to the industry. These instruments were tested in the Geomagnetic Observatory of L'Aquila, the first station of the network. Here we show some examples of the developed electric and magnetic sensors. These instruments are designed for the automatic long-term recording of the electromagnetic fields in a wide band of frequency. The preliminary results of the first operating station of the network are shown taking into account, in the signal elaboration, the single station approach. Here we are reporting some examples concerning the calculation of the ground electric resistivity profile, the evaluation of the magnetic induction vectors and the study of the magnetic sources by the eigenvectors calculation. When all the stations of the network will be in operation, the use of an innovative technique, the wideband interferometry will be proposed. Combining the simultaneous observations of the electromagnetic field measured in each station, we will be able to obtain detailed information about the investigated electromagnetic sources.

The MEM Project (Magnetic and Electric fields Monitoring) was activated in the INGV Observatory of L’Aquila since 2004. The principal purpose of the project is to create in Central Italy a network of observatories to monitoring the electromagnetic signals in the frequency band [0.001 Hz - 100 kHz]. This band includes natural signals (magnetic pulsations of magnetospheric origin, Earth-ionosphere resonance mode signals, atmospheric noise, and so on) and artificial signals (power line emissions, VLF radio transmissions, and so on). The innovative characteristic of the project is the approach chosen to study the complex problem concerning the representation of the spatial and temporal distributions of the electromagnetic fields in the band of interest. Both the distributions can be represented by some parameters containing the locations and the characteristics of the sources of the electromagnetic signals. When all the stations will be in operation the wide-band interferometry will be applied. Combining the simultaneous observations of the electromagnetic field measured in the stations of the network, we will be able to obtain detailed information about the investigated electromagnetic sources. A new measurement system has been developed to fulfil these requirements focusing on the automation of the measurements. The system is designed for long term recording of the electromagnetic fields in a wide frequency band. In the frequency band [1Hz - 100 kHz] the three components of the magnetic field and the three components of atmospheric electric field are processed in real time using DSP (Digital Signal Processing) techniques. In the frequency band [0.001 - 25]Hz the two components of the telluric field and the three components of the magnetic field are recorded as sampled (100Hz). One of the main scientific objectives of the MEM project is the long term monitoring of the geodynamical processes, such as the earthquakes, by the calculation of the Poynting vector, and the analysis of the magnetic transfer functions and impedance tensor. In the next years this kind of analysis can be useful to underline the possible correlation between the geodynamical processes and the local magnetic field anomalies.

We are reporting the technological and scientific objectives of the MEM project. The MEM project has been activated in the INGV Observatory of L'Aquila to create in Central Italy a network of observatories in order to monitoring the electromagnetic signals in the frequency band [0.001 Hz–100 kHz]. Some examples of the instrumentation developed in the frame of the project are reported. An innovative technique, based on the wide band interferometry is proposed to obtain detailed information concerning the several detected electromagnetic sources. Moreover, data from each station will be elaborated to investigate different sectors as the structure of ground electric conductibility, the electromagnetic phenomena connected with seismic activity, the separation of the electromagnetic fields originated in the Earth's interior and the electromagnetic phenomena originated in the magnetosphere, in the ionosphere and in the Earth-ionosphere cavity.

Experts reviewed the literature to determine whether partially whey hydrolysed formulas (HF) offer benefits in the dietary management of frequent gastrointestinal symptoms and allergy prevention. Compared with standard cow’s milk-based formulas, partially whey HF confer a limited protective effect against allergic disease in high-risk infants, particularly atopic dermatitis, but not respiratory allergies. No randomised clinical trials have been published on partially whey HF in infants with colicky symptoms. The group did not find sufficient evidence to support the use of partially whey HF in regurgitation, although recent data suggest that a thickened partially whey HF may be more effective. Partially whey HF, fortified with prebiotics and/or probiotics, with high levels of sn-2 palmitate in the fat blend or without palm oil, provide some benefit in functional constipation. Conclusion: Overall, partially whey HF may offer a useful alternative to intact protein in the dietary management of common functional gastrointestinal symptoms.

Top of pageAbstract OBJECTIVE: A systematic review of the published literature was performed to assess the prevalence, incidence, natural history, and comorbid conditions of functional constipation in children. METHODS: Articles were identified through electronic searches in Medline, Embase, Cochrane Central Library, Cinhal and PsychInfo databases. Study selection criteria included: (1) epidemiology studies of general population, (2) on the prevalence of constipation without obvious organic etiology, (3) in children from 0 to 18 yr old, and (4) published in English and full manuscript form. RESULTS: Eighteen studies met our inclusion criteria. The prevalence of childhood constipation in the general population ranged from 0.7% to 29.6% (median 8.9; inter quartile range 5.3–17.4). The prevalence of constipation defined as defecation frequency of

We have previously found that co-immunisation with ovalbumin (OVA) and the body fluid of the helminth Ascaris suum inhibited an OVA-specific delayed type hypersensitivity (DTH) response by reducing OVA-specific CD4+ T lymphocyte proliferation via an IL-4 independent mechanism. In the present study, we determined whether parasite infections themselves could induce similar changes to peripheral immunisation by examining the modulation of OVA-specific immune responses during acute and chronic helminth infections. Surprisingly, an acute infection with Trichinella spiralis, but not a chronic infection with Heligmosomoides polygyrus, inhibited the OVA-specific DTH reaction. Correspondingly, the T helper 1 (Th1) OVA-specific response was decreased in mice infected with T. spiralis, but not with H. polygyrus. Inhibition of the Th1 response may be a result of a shift in the Th1/Th2 balance as although both H. polygyrus and T. spiralis infected mice induced a Th2 OVA-specific response, that exhibited by T. spiralis was more potent. Furthermore, although IL-10 secretion upon OVA restimulation was similarly increased by both infections, production of this immunoregulatory cytokine may play a role in the suppression of immune responses observed with T. spiralis infection depending on the context of its release. Interestingly, analysis of the OVA-specific T lymphocyte division by carboxyfluorescein diacetate succinimidyl ester (CFSE) staining revealed that gastro-intestinal infection with the acute helminth T. spiralis, but not with chronic H. polygyrus, inhibited the systemic immune response by significantly inhibiting the antigen-specific T cell proliferation during the primary response, a mechanism similar to that observed when A. suum parasite extracts were directly mixed with the OVA during immunisation in our previous studies.

Anorectal disorders such as dyssynergic defecation, fecal incontinence, levator ani syndrome, and solitary rectal ulcer syndrome are common, and affect both the adult and pediatric populations. Although they are treated with several treatment approaches, over the last two decades, biofeedback therapy using visual and verbal feedback techniques has emerged as an useful option. Because it is safe, it is commonly recommended. However, the clinical efficacy of biofeedback therapy in adults and children is not clearly known, and there is a lack of critical appraisal of the techniques used and the outcomes of biofeedback therapy for these disorders. The American Neurogastroenterology and Motility Society and the European Society of Neurogastroenterology and Motility convened a task force to examine the indications, study performance characteristics, methodologies used, and the efficacy of biofeedback therapy, and to provide evidence-based recommendations. Based on the strength of evidence, biofeedback therapy is recommended for the short-term and long-term treatment of constipation with dyssynergic defecation (Level I, Grade A), and for the treatment of fecal incontinence (Level II, Grade B). Biofeedback therapy may be useful in the short-term treatment of Levator Ani Syndrome with dyssynergic defecation (Level II, Grade B), and solitary rectal ulcer syndrome with dyssynergic defecation (Level III, Grade C), but the evidence is fair. Evidence does not support the use of biofeedback for the treatment of childhood constipation (Level 1, Grade D)

Background and purpose Ketogenesis is a physiological phenomenon due to starvation or a ketogenic diet (KD), a drastic restricted carbohydrate dietary regimen that induces lipid metabolism and ketone body synthesis. Two patients whose migraines disappeared only during, and not outside, cycles of very-low-calorie KD performed to reduce their weight were recently observed. To confirm our observation, in a dietitian clinical setting two parallel groups of migraineurs, one receiving a 1-month very-low-calorie KD prescription followed by a 5-month standard low-calorie diet (SD) and the other a 6-month SD, were followed. Methods Ninety-six overweight female migraineurs were enrolled in a diet clinic and blindly received a KD (n = 45) or an SD (n = 51) prescription. Mean monthly attack frequency, number of days with headaches and tablet intake were assessed before and 1, 2, 3 and 6 months after diet initiation. Results In the KD group, the baseline attack frequency (2.9 attacks per month), number of days with headaches (5.11 days per month) and tablet intake (4.91 doses per month) were significantly reduced after the first month of diet (respectively 0.71, 0.91, 0.51; overall, KD versus baseline, P

Our aim was to analyse the patterns of ileal contractions in children. We reviewed the charts of 23 children who had ileal manometry studies (16 males), mean age 7 years (range 2 months to 17 years). We positioned the manometry catheters with 4-8 recording sites, 5 or 15 cm apart, through ileostomies fashioned for clinically indicated reasons. We studied six additional children with persistent faecal soiling following endorectal pull through for Hirschsprung's disease; the catheters were positioned through the anus and colon into the ileum. We recorded phasic and tonic intermittent contractions in all the subjects, clustered contractions (rate 5-9 min-1, duration 20-120 s) in 19 subjects with ileostomies and four with endorectal pull throughs. In 13 children there were prolonged propagated contractions, > 60 mmHg in amplitude, > 15 s in duration, propagating at rates of 2-6 cm s-1 over at least 20 cm. The migrating motor complex was rare; in 55 h of fasting recording there were two phase III sequences. There are four distinctive features of ileal manometry recordings in children: random intermittent contractions, clustered contractions, prolonged propagated contractions and tonic contractions. The features of ileal motility differ from motility in the proximal small bowel.

We previously reported that a short-lasting period of ketogenic diet (KD) regimen can help to prevent migraine and can normalize its interictally abnormal cortical hyperresponsivity. Here, we aimed to verify whether cerebral cortex is the primary site of KD-related changes or if the latter are the expression of ketones ability to modulate brainstem subcortical structures. We simultaneously recorded the nociceptive specific blink (nBR, a marker of the brainstem trigeminal activity) and cortical pain-related evoked potentials (PREP) elicited by the stimulation of right the supraorbital division of the trigeminal nerve in 18 migraine without aura patients before and after 1-month of KD, during ketogenesis. We measured nBR R2 component as well as PREP amplitude habituations over 2 blocks of 5 averaged responses. We confirmed the ability of 1-month KD of significantly decreasing mean attack frequency and duration. KD significantly induced normalization of the interictally reduced PREP habituation (pre: +1.8, post: −9.1), while nBR habituation remained unchanged. Here, we provided evidence that the clinical efficacy of a short-lasting KD regimen in migraine can be principally due to a general normalization of the interictal cortical dysfunction, and not to a direct modulation of the subcortical brainstem activation.

Objective To evaluate the long-term efficacy of sacral nerve stimulation (SNS) in children with constipation and describe patient benefit and parent satisfaction. Methods Using a prospective patient registry, we identified patients 2 years. We compared symptoms, medical treatment, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), and Fecal Incontinence Severity Index (FISI) before SNS and at follow-up. We contacted parents to administer the Glasgow Children's Benefit Inventory (GCBI) and a parent satisfaction questionnaire. Key Results We included 25 children (52% male, median age 10 years): 16 had functional constipation, six anorectal malformation, two tethered spinal cord, and one Hirschsprung's disease. Defecation frequency did not change after SNS but patients reporting fecal incontinence decreased from 72% to 20% (P

Background Cluster headache (CH) patients often receive unsatisfactory treatment and may explore illicit substances as alternatives. We aimed to explore this use of illicit drugs for CH treatment. Methods We invited CH patients from an Internet-based self-help group to complete a questionnaire regarding their therapeutic use of illicit substances. Results Of the 54 respondents, 29 were classified as chronic and 39 were drug-resistant cases. Fifty patients had previously tried subcutaneous sumatriptan, 40 had tried O2, and 48 had tried at least one prophylactic treatment. All 54 patients specified that they were dissatisfied with conventional treatments. Thirty-four patients had used cannabinoids, 13 cocaine, 8 heroin, 18 psilocybin, 12 lysergic acid amide (LSA), and 4 lysergic acid diethylamide (LSD). Discussion Some patients with intractable CH decided to try illicit drugs concomitantly with cessation of medical care. Most of these patients found suggestions for illicit drug use on the Internet. Many patients seemed to underestimate the judicial consequences of, and had an overestimated confidence in the safety of, such illicit treatments. Physicians are often not informed by patients of their choice to use illicit drugs. This leads to questions regarding the true nature of the physician-patient relationship among dissatisfied CH patients.

Ketogenic diet (KD) is a dietetic regimen that mimics fasting in producing ketone bodies, which seems to have a potential role in treating migraine. From animal and human models emerges that KD might affects CNS at multiple levels: it is able to normalize cortical dysexcitability and to reduce cortical spreading depression velocity of propagation, which mechanisms are potentially of interest in migraine pathophysiology.

Background Neurophysiological investigations have demonstrated that there are distinctive fluctuations in the brain’ se lectric signals between the ictal and interictal periods of recurrent migraine. Whether structural plasticity of the brain is also an important feature of episodic migraine remains unresolved. Aim We therefore investigated the possibility that there are fluctuations over time in whole brain grey matter morphometry of patients affected by episodic migraine without aura (MO). Method Twenty-four patients with untreated MO underwent MRI scans (3-Tesla Siemens Verio) during (n = 10) or between attacks (n = 14) and were compared to a group of 15 healthy volunteers (HV). We then performed voxelbased-morphometry (VBM) analysis of structural T1-weighted MRI scans to determine if changes in brain structure were observed over the course of the migraine cycle. Results During the interictal phase, MO patients had a significantly lower grey matter (GM) density within the right inferior parietal lobule, right temporal inferior gyrus, right superior temporal gyrus, and left temporal pole than did HV. During attacks, GM density increased within the left temporal pole, bilateral insula, and right lenticular nuclei, but no areas exhibited decreased GM density. Conclusion The morphometric GM changes between ictal and interictal phases reported in the present study suggest that abnormal structural plasticity may be an important mechanism of migraine pathology. Given the functional neuroanatomy of these areas, our findings suggest that migraine is a condition associated with global dysfunction of multisensory integration and memory processing. No conflict of interest.