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Importance: There are suggestions that school pressure may be stressful and a factor in child and adolescent mental health disturbances, but data about this association are scarce and inconclusive., Objective: To assess whether varying degrees of school interruption were associated with changes in emergency department (ED) psychiatric visits of children and adolescents before and after the COVID-19 outbreak., Design, Setting, and Participants: A cross-sectional observational study was conducted at 9 urban university hospitals in Italy. All ED visits from January 1, 2018, to December 31, 2021, for psychiatric reasons of patients younger than 18 years were examined for demographic characteristics and type of psychopathologic factors. Data analysis was conducted from July 1 to August 31, 2023., Exposure: The disruption in the usual succession of school and holiday periods brought on by the COVID-19 pandemic at different times and with various degrees of intensity., Main Outcomes and Measures: Total number of pediatric ED visits, psychiatric ED visits, and psychiatric ED visits categorized by specific reasons (eg, psychomotor agitation, suicide ideation [SI] or suicide attempt [SA], and eating disorders) on a weekly basis., Results: A total of 13 014 psychiatric ED visits (1.3% of all pediatric ED visits) were recorded (63.2% females; mean [SD] age, 13.8 [3.8] years). The number of ED psychiatric visits increased over time (incidence rate ratio [IRR], 1.19; 95% CI, 1.16-1.22 for each year). Significant increases in ED visits were observed for eating disorders (294.8%), SI (297.8%), and SA (249.1%). School opening, but not social lockdown restriction, was associated with an increase in the number of ED psychiatric visits (IRR, 1.29; 95% CI, 1.23-1.34), which was evident for females and for SI with SA. Socioeconomic status was associated with an increase in psychiatric visits for males (IRR, 1.12; 95% CI, 1.04-1.20) but not females (IRR, 1.04; 95% CI, 0.98-1.10)., Conclusions and Relevance: In this study, school opening was associated with an increased incidence of acute psychiatric emergencies among children and adolescents, suggesting that school can be a substantial source of stress with acute mental health implications.

Introduction: There have been several described imaging findings that correlate with anterior cruciate ligament (ACL) injuries . The investigators in this study observed a higher frequency of posterior translation of the lateral meniscus beyond the posterior border of the tibial plateau in patients with ACL tears. The purpose of this study was to assess the frequency and degree of posterior lateral meniscal overhang (LMO) of the lateral meniscus in patients with ACL tears compared to uninjured controls., Materials and Methods: Magnetic resonance imaging (MRI) was analyzed in 117 knees with ACL tears and compared to a control group of 89 knees without injury. Lateral meniscus diameter, LMO, knee flexion angle, and lateral tibial plateau diameter were measured and compared between the two groups. Exclusion criteria included displaced and macerated lateral meniscus tears, multi-ligamentous knee injuries, and periarticular fractures. Difference in mean lateral meniscal overhang between ACL injured and control groups was tested using a paired T-test (alpha = 0.01). Assumptions for normality and variance were tested prior to analysis., Results: In patients with ACL tears, average LMO was significantly greater compared to the control group (0.95 mm vs. 0.08 mm; p < 0.001). Additionally, measurable LMO was found in 42.7 % of patients with ACL tears compared to 4.5 % uninjured knees (p < 0.001)., Conclusion: Patients with ACL injury show higher incidence of LMO compared to uninjured controls. Future studies are necessary to better understand its clinical significance., Competing Interests: The authors have no relevant conflicts of interests to report., (© 2023 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Recent clinical studies, in both children/adolescents and adults, have shown the extreme neuropsychological heterogeneity of attention-deficit hyperactivity disorder (ADHD): specific neuropsychological deficits have been found only in a minority of individuals, with no direct correlation between discrete cognitive performances and the trajectory of clinical symptoms. Deficits in specific neuropsychological functions may be common in ADHD, but nevertheless no cognitive or neuropsychological profile may fully explain the disorder. Sex differences in the ADHD presentation, both at a neuropsychological and clinical level, also contribute to this clinical and neuropsychological heterogeneity. At a neuropsychological level, females with ADHD may show greater working memory problems, poorer vocabulary skills and worse visual spatial reasoning. Structural and functional imaging study also show discrete differences across sex; however, the great majority of clinical studies mainly or exclusively include male participants with insufficient data to draw firm conclusions on sex differences within the disorder. Here, we report the recent literature data, discussing still open research questions about the clinical presentation, neuroimaging findings, and neuropsychological functioning in ADHD with a focus on the impact of sex differences-a deeper insight in these unresolved issues may have relevant clinical and therapeutic implications for tailored, effective, and long-lasting interventions., (© 2022 The Authors. Journal of Neuroscience Research published by Wiley Periodicals LLC.)

Background : Several studies have tried to investigate the role of inflammatory biomarkers in Autism Spectrum Disorder (ASD), and their correlations with clinical phenotypes. Despite the growing research in this topic, existing data are mostly contradictory. Methods : Eighty-five ASD preschoolers were assessed for developmental level, adaptive functioning, gastrointestinal (GI), socio-communicative and psychopathological symptoms. Plasma levels of leptin, resistin, plasminogen activator inhibitor-1 (PAI-1), macrophage chemoattractant protein-1 (CCL2), tumor necrosis factor-alfa (TNF-α), and interleukin-6 (IL-6) were correlated with clinical scores and were compared among different ASD subgroups according to the presence or absence of: (i) GI symptoms, (ii) regressive onset of autism. Results : Proinflammatory cytokines (TNF-α, IL-6 and CCL2) were lower than those reported in previous studies in children with systemic inflammatory conditions. GI symptoms were not correlated with levels of inflammatory biomarkers except for resistin that was lower in ASD-GI children ( p = 0.032). Resistin and PAI-1 levels were significantly higher in the group with "regression plus a developmental delay" onset (Reg+DD group) compared to groups without regression or with regression without a developmental delay ( p < 0.01 for all). Conclusions : Our results did not highlight the presence of any systemic inflammatory state in ASD subjects neither disentangling children with/without GI symptoms. The Reg + DD group significantly differed from others in some plasmatic values, but these differences failed to discriminate the subgroups as possible distinct ASD endo-phenotypes.

Background: Gastrointestinal (GI) problems are one of the most frequent comorbidities in Autism Spectrum Disorder (ASD) but can be under-recognized due to the concomitant communication difficulties of this population. Accordingly, some associated behaviors (AB) such as verbal and motor behaviors (VB and MB, respectively) have been identified as a possible expression of an underlying GI problem and evaluated through an ad hoc questionnaire (the Associated Behaviors Questionnaire -ABQ-). The aims of this study were to investigate the presence and the type of AB in an Italian sample of ASD preschoolers, and to determine their correlations with GI problems., Methods: We included 85 ASD preschoolers (mean age 4.14 years; SD 1.08) splitted into two groups (GI and No-GI) through the GI Severity Index instrument. AB were evaluated through the ABQ that includes VB, MB and Changes in overall state (C) clusters. Specific tools were administered to evaluate the ASD core ad associated symptoms, as well as the intellective and adaptive functioning., Results: The GI group (N = 30) showed significantly higher scores in all the three ABQ areas (VB, MB and C) than the No-GI group (N = 55), with a positive correlation between GI symptoms and some specific AB as well as ABQ Total score. By dividing the whole sample in verbal and non-verbal individuals, both specific and shared AB emerged in the two groups., Conclusions: Our results alert clinicians to consider behavioral manifestations as a possible expression of GI problems in ASD subjects. Therefore, the evaluation of AB may be useful to identify the presence of GI problems in the ASD populations, and especially in non-verbal ASD children.

Objectives: The treatment of acute pain in the prehospital emergency setting remains a significant problem. We evaluated the incidence, site, and possible cause of acute pain in the prehospital period and also the current state of prehospital pain management by evaluating analgesic availability in emergency vehicles in Italy., Methods: First aid volunteers documented the presence, intensity, and site of acute pain by questionnaire for over 3 months. Emergency service operations completed a questionnaire on analgesic availability in ambulances and helicopters., Results: Pain symptoms were present in two-thirds of the patients (n = 383) and ranked as moderate to unbearable in 41.75%. Results of the analgesic availability survey indicate that 10.6% of the ambulance services carry no pain killers (including non-steroidal anti-inflammatory drugs [NSAIDs] and/or paracetamol) and 11.5% are without an opioid. The emergency helicopter survey showed a significant difference in analgesic availability compared with ambulances, with 97.6% having at least one opioid agent available (weak or strong). A wide geographical variation in the availability of analgesic agents in ambulance and helicopter services was seen., Conclusions: There is a high prevalence of pain among patients receiving prehospital emergency treatment in Italy and treatment for acute pain during emergency treatment of trauma patients is inadequate. All emergency vehicles, without distinction, should carry opioids and other analgesic drugs (NSAIDs and paracetamol) and there should be no geographic differences in the availability of pain medications.

The role of calcium-dependent protein kinases in the invasion of Toxoplasma gondii into its animal host cells was analyzed. KT5926, an inhibitor of calcium-dependent protein kinases in other systems, is known to block the motility of Toxoplasma tachyzoites and their attachment to host cells. In vivo, KT5926 blocks the phosphorylation of only three parasite proteins, and in parasite extracts only a single KT5926-sensitive protein kinase activity was detected. This activity was calcium-dependent but did not require calmodulin. In a search for calcium-dependent protein kinases in Toxoplasma, two members of the class of calmodulin-like domain protein kinases (CDPKs) were detected. TgCDPK2 was only expressed at the mRNA level in tachyzoites, but no protein was detected. TgCDPK1 protein was expressed in Toxoplasma tachyzoites and cofractionated precisely with the peak of KT5926-sensitive protein kinase activity. TgCDPK1 kinase activity was calcium-dependent but did not require calmodulin or phospholipids. TgCDPK1 was found to be inhibited effectively by KT5926 at concentrations that block parasite attachment to host cells. In vitro, TgCDPK1 phosphorylated three parasite proteins that migrated identical to the three KT5926-sensitive phosphoproteins detected in vivo. Based on these observations, a central role is suggested for TgCDPK1 in regulating Toxoplasma motility and host cell invasion.

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.

15 patients with aneurysm of ascending aorta associated with aortic valve incompetence has been treated by the replacement of the aortic valve and ascending aorta with reimplantation of the right coronary artery in 8 patients and both coronary arteries in 7. The operative mortality was 13% (2 patients). The follow up interval ranged from 6 months to three years (mean 20 months) and in all 13 patients there was an improving of functional class. A post-operative angiography was performed in 6 patients and in all of them was demonstrated the patency of the neoostia, a minimum paravalvular leak in one patient, and a pseudoaneurysm in another one. Proving the necessity of complete replacement of aneurysmal aorta, the Authors discuss the technique adopted with particular reference to the problem of reimplantation of the coronary arteries.

Because Cross-Sectional Echocardiography offers the advantage of correct spatial orientation, it is said to permit a more exact localization of the level of the outflow tract obstruction and a determination of the nature of the lesion. Our experience confirms that B-Mode Echo is more reliable in diagnosing an extensive sub-valvular narrowing, while the existence of a thin sub-valvular membrane can also be detected by M-Mode examination. The latter has moreover proven very useful in that it records indirect signs of obstruction, such as a mid-systolic closure of the aortic cusps. We therefore suggest that both methods should be employed in studying these patients.

Mitral insufficiency due to ruptured chordae tendinaee is not easily diagnosed by M-mode Echocardiography: of the several patterns that have been described, none has proven quite reliable. Two-dimensional study, on the other hand, seems to be more useful in that it permits to identify an abnormal movement of the involved leaflet which appears quite characteristic. Out of a group of 14 patients we were able to diagnose chordal rupture in 5 proven cases. Further investigation is necessary to ascertain specificity and sensitivity if this echo pattern.

Echocardiograms were performed in five patients with severe mitral porcine valve insufficiency due to the para-valvular leak in three cases and to a torn and flail cusp in two cases. We believe that diastolic fluttering of the vusps, decrease or increase of diastolic slope of either the stent or the anterior leaflet as well as decrease of the amplitude of motion of the leaflets cannot be regarded as typical diagnostic features as previously described. In our experience specific signs are only represented by a chaotic diastolic movement of one or both leaflets.