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Context: The 2019 American Association of Clinical Endocrinologists guidelines suggested peak GH-cutoffs to glucagon test (GST) of ≤3 and ≤1 µg/L in the diagnosis of permanent GH deficiency (GHD) during the transition phase., Objective: The aim of the study was to evaluate the accuracy of GST compared to insulin tolerance test (ITT) in the definition of GHD at adult height achievement., Patients and Methods: Ninety-seven subjects with childhood-onset GHD (median age, 17.39 years) underwent ITT, GST, and IGF-1 testing; 44 subjects were idiopathic (isolated GHD), 35 moderate organic GHD (0-2 hormone deficiencies) and 18 severe organic GHD (≥3 hormone deficiencies)., Results: Bland and Altman analysis showed a high consistency of GH peak measures after ITT and GST. Receiver operating characteristic analysis identified 7.3 μg/L as the optimal GH peak cutoff to GST [95% confidence interval (CI) 4.15-8.91; sensitivity 95.7%, specificity 88.2%, positive predictive value (PPV) 88.0%, negative predictive value (NPV) 95.7%] able to correctly classify 91.8% of the entire cohort while 5.8 μg/L was the best GH peak cutoff able to correctly classify 91.4% of moderate organic GHD patients (95% CI 3.16-7.39; sensitivity 96.0%, specificity 80.0%, PPV 92.3%, NPV 88.9%). Patients with ≥3 hormone deficiencies showed a GH peak <5 μg/L at ITT and <5.8 μg/L at GST but 1. The optimal cutoff for IGF-1 was -1.4 SD score (95% CI -1.94 to 0.77; sensitivity 75%, specificity 94%, PPV 91.7%, NPV 81.0%) that correctly classified 85.1% of the study population., Conclusion: A GH peak to GST <5.8 μg/L represents an accurate diagnostic cutoff for young adults with childhood-onset GHD and high pretest probability of permanent GHD., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Background : Respiratory tract infections (RTIs) are a leading cause of pediatric emergency department (PED) visits, especially in children under five. These infections are primarily viral, complicating diagnosis and management. This study assesses the impact of point-of-care (POC) rapid diagnostic tests for respiratory viruses on clinical and economic outcomes in a PED setting. Materials and Methods: A retrospective analysis of 1396 POC tests for RSV, adenovirus, and influenza A/B was conducted in the PED of the Giannina Gaslini Institute, Genoa, Italy, from December 2022 to April 2024. Demographics, blood tests, admissions, and readmission rates were evaluated. Statistical analyses were performed using appropriate tests for categorical and continuous variables. Results: Of the tests, 31.5% were positive for at least one virus. Positive patients were younger and had higher hospitalization rates (50.7% vs. 39.9%) but fewer blood tests (38.2% vs. 51.7%). Economic analysis indicated lower costs for virus-positive patients. RSV-positive patients showed a significant association with higher hospitalization rates (67.8%) and readmission within 72 h. Conclusions: POC testing significantly improves patient management in PEDs by enabling rapid diagnoses, reducing unnecessary tests and hospitalizations, and guiding appropriate treatment. This approach supports better resource allocation, crucial during peak seasons, and has implications for reducing antibiotic use and resistance. Further research is warranted to explore long-term impacts on patient outcomes and healthcare efficiency.

Background : Celiac disease (CD) is the most common multisystemic autoimmune disorder affecting the pediatric population. However, little data is available regarding SARS-CoV-2 vaccination coverage in pediatric patients with CD. This study aims to evaluate the adherence to national recommendations for SARS-CoV-2 vaccination in children and adolescents with CD and its variation over time. Methods : We retrospectively analyzed medical charts and electronic registry records of SARS-CoV-2 vaccination of patients aged 0-19 years diagnosed with CD in a tertiary center. The vaccination coverage was evaluated according to age groups (young children, children, and adolescents), considering the patients' eligibility for vaccination at different times. Results : Among the 172 patients enrolled, 44.8% received at least one dose of the SARS-CoV-2 vaccine, showing no significant differences compared to the Italian population of similar age. Vaccination coverage demonstrated a progressive reduction after an initial peak (up to 65.5% in December 2021) concomitant with a gradual extension of vaccinable eligibility and falling SARS-CoV-2 infections. Histological diagnosis and the presence of other associated autoimmune diseases were associated with higher levels of adherence to vaccination. Conclusions : Adherence to the SARS-CoV-2 vaccination in young Italian children with CD was very low, while it was better in adolescents and patients with other associated autoimmune diseases. Vaccine hesitancy remains a concern, particularly among those diagnosed using the biopsy-sparing approach. Hesitancy increased during the pandemic period, suggesting the need for ongoing efforts to improve adherence to SARS-CoV-2 vaccination recommendations.

Context: Since the COVID-19 outbreak, the number of girls with suspected precocious puberty has increased., Objective: To compare the incidence of idiopathic central precocious puberty (ICPP) during COVID-19 with that of the previous 4 years., Methods: Anthropometric, biochemical, and radiological parameters were collected between January 2016 and June 2021 from 133 girls who met the Rapidly Progressive ICPP criteria (RP-ICPP)., Results: We found a higher incidence of RP-ICPP between March 2020 and June 2021 (group 2) compared with January 2016 through March 2020 (group 1) (53.5% vs 41.1%); 2021 showed the highest annual incidence ( P < .05). Group 1 and group 2 differed in age at diagnosis (7.96 ± 0.71 vs 7.61 ± 0.94; P < .05), mean Tanner stage (2.86 ± 0.51 vs 2.64 ± 0; P < .05), and in the time between the appearance of thelarche and diagnosis (0.93 ± 0.75 vs 0.71 ± 0.62 years, P < .05). There was an increase in the number of girls aged <8 years in group 2 and a significantly higher number of girls aged >8 years was found in group 1 (42 in group 1 vs 20 in group 2, P < 0.05). Overall body mass index SD score showed higher values ​​in group 2 (1.01 ± 1.23 vs 0.69 ± 1.15; P = .18), which spent an average of 1.94 ± 1.81 hours per day using electronic devices; 88.5% of this group stopped any physical activity., Conclusions: A spike in new diagnoses of idiopathic (1.79-fold higher) and RP-CPP coincided with the COVID-19 pandemic. The incidence of RP-ICPP was 1.3-fold higher during COVID-19 with a trend toward an increase in body mass index SD score. The expanding use of digital devices and the reduction of daily physical activity represent possible risk factors., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

Context: Rapid-onset obesity with central hypoventilation, hypothalamic dysfunction, and autonomic dysregulation with neural crest tumors (ROHHAD-NET) syndrome pathophysiology remains elusive. Acquired neuroimmunological dysfunction has been proposed as a possible pathogenetic pathway., Objective: The aim of our study was to characterize lymphocyte subpopulations subsets in peripheral blood (PB) and to evaluate a panel of proinflammatory cytokines/chemokines in ROHHAD(NET) patients vs controls., Methods: We included 11 ROHHAD(NET) patients, 7 ROHHAD and 4 ROHHAD-NET, selected by clinical criteria. Controls were 11 simple obese children, matched for age and sex. Flow cytometric analysis and enzyme-linked immunosorbent assay were performed on PB and serum samples of the 2 groups., Results: Analysis revealed that T lymphocytes are significantly increased in ROHHAD(NET) patients ( P = .04) with a prevalence of CD4-T cells ( P = .03) and a lower number of activated CD8-T cells ( P = .02). With regard to regulatory subset, patients displayed increased regulatory B cells ( P = .05) and type-1 regulatory T cells ( P = .03). With regard to CD8-T cells, a lower number of T effector memory was observed ( P = .02). In contrast, among CD4-T cells, we found a higher number of T naive ( P = .04) and T effector ( P = .0008). Interleukin-8 (IL-8) levels and monocyte chemotactic protein-1 were increased in patients vs controls ( P = .008 and P = .01, respectively). Furthermore, IL-8 levels were higher in the subgroup with neural tumor ( P = .0058) (ROHHAD-NET) than in patients without neural tumor (ROHHAD). Soluble HLA-G was significantly lower in patients vs controls ( P = .03)., Conclusion: Our findings contribute to support the hypothesis of immune dysregulation, which may underlie this complex, often fatal disease. Because ROHHAD(NET) syndrome is an ultra-rare disease, multicentric studies are needed to improve the effect of our data in the management of this condition., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society.)

Introduction: SARS-CoV-2 infection in the pediatric population can be associated with a multiorgan inflammatory syndrome called children's multisystem inflammatory syndrome (MIS-C). The kidneys can be affected by a broad spectrum of possible injuries, whose pathogenetic mechanisms are still unclear. Case report: We report the case of a 5-year-old boy with severe cardiac involvement in the context of MIS-C. After two weeks of hospitalization, an abdominal ultrasound showed massive bladder "debris", followed by the onset of normoglycemic glycosuria. Over time, there was a progressive increase in glycosuria, and the presence of a mat of amorphous phosphate crystals was evidenced on urinary sediment. Together with the findings of hypo-uricemia, increased urinary uric acid, and globally increased urinary amino acids, a clinical picture of kidney proximal tubular damage with secondary Fanconi-like syndrome took shape., Discussion: This case report describes the case of a patient with MIS-C with cardiac and kidney involvement characterized by proximal tubular damage, which slowly improved but still persisted at the 8-month follow-up. The pathogenesis of the damage is unclear and probably multifactorial., Competing Interests: The authors GMG declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Orsi, Pepino, Rossoni, Serafino, Caorsi, Volpi, Palmieri, Faragli, Lugani, Bigatti, Ghiggeri, Verrina, La Porta and Angeletti.)

Neurobiological studies of the model species, Aplysia californica (Mollusca, Gastropoda, Euopisthobranchia), have helped advance our knowledge of the neural bases of different forms of learning, including sensitization, a non-associative increase in withdrawal behaviors in response to mild innocuous stimuli. However, our understanding of the natural context for this learning has lagged behind the mechanistic studies. Previous studies, which exclusively used artificial stimuli, such as electric shock, to produce sensitization, left open the question of which stimuli might cause sensitization in nature. Our laboratory first addressed this question by testing for short and long-term sensitization after predatory attack by a natural predator, the spiny lobster. In the present study, we tested for sensitization after attack by a very different predator, the predacious sea-slug, Navanax inermis (Mollusca, Gastropoda, Euopisthobranchia). Unlike the biting and prodding action of lobster attack, Navanax uses a rapid strike that sucks and squeezes its prey in an attempt to swallow it whole. We found that Navanax attack to the head of Aplysia caused strong immediate sensitization of head withdrawal, and weaker, delayed, sensitization of tail-mantle withdrawal. By contrast, attack to the tail of Aplysia resulted in no sensitization of either reflex. We also developed an artificial attack stimulus that allowed us to mimick a more consistently strong attack. This artificial attack produced stronger but qualitatively similar sensitization: Strong immediate sensitization of head withdrawal and weaker sensitization of tail-mantle withdrawal after head attack, immediate sensitization in tail-mantle withdrawal, but no sensitization of head withdrawal after tail attack. We conclude that Navanax attack causes robust site-specific sensitization (enhanced sensitization near the site of attack), and weaker general sensitization (sensitization of responses to stimuli distal to the attack site). We also tested for long-term sensitization (lasting longer than 24 h) after temporally-spaced delivery of four natural Navanax attacks to the head of subject Aplysia. Surprisingly, these head attacks, any one of which strongly sensitizes head withdrawal in the short term, failed to sensitize head-withdrawal in the long term. Paradoxically, these repeated head attacks produced long-term sensitization in tail-mantle withdrawal. These experiments and observations confirm that Navanax attack causes short, and long-term sensitization of withdrawal reflexes of Aplysia. They add site-specific sensitization as well as paradoxical long-term sensitization of tail-mantle withdrawal to a short list of naturally induced learning phenotypes in this model species. Together with previous observations of sensitization after lobster attack, these data strongly support the premise that sensitization in Aplysia is an adaptive response to sub-lethal predator attack., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Despite recent technical advances, interventional cardiac catheterization is still challenging in neonatal age and no specific data concerning early outcome are so far published in literature., Methods: Neonatal trans-catheter cardiac interventions performed in high-volume Italian referral centers were retrospectively analyzed. Primary outcomes were procedural major adverse events, in-hospital mortality and procedural failure. Secondary outcomes were minor adverse events and need for blood transfusion., Results: From January 2000 to December 2017, 1423 newborns (mean weight 3.0 ± 0.6 kg, range 1.0-5.8; median age 2.0 days) underwent interventional cardiac catheterization. Overall, global procedure adverse event rate and in-hospital mortality were 10.2% and 5.2%, respectively. At multi-variable analysis, primary composite outcome was significantly related to low-weight (<2.5 kg) (p < 0.01) and younger age (≤7 days) (p < 0.01) at the procedure, prematurity (p < 0.01), uni-ventricular physiology (p < 0.01), associated genetic syndromes (p < 0.01) and procedure risk category (p < 0.01). No relationship between volume of activity of any single center and procedure outcome was found. Over time, a trend toward an increased number of procedures and their complexity was recorded. Trans-catheter management of cardiac malformations with critical, duct-dependent pulmonary blood flow by arterial duct stenting or right ventricular outflow tract stenting showed the highest increase., Conclusions: Interventional cardiac catheterization is relatively safe and feasible in neonatal age. Peri-natal age, low weight, uni-ventricular physiology and genetic syndromes still significantly contribute to procedural morbidity and in-hospital mortality of this approach., Competing Interests: Declaration of competing interest None of the authors declares any conflict of interest regarding this paper, (Copyright © 2020 Elsevier B.V. All rights reserved.)

A comprehensive description of morbidity and mortality as well as risk factors of interventional cardiac catheterization performed in neonatal age was reported in our paper recently published on the International Journal of Cardiology ( IJCA28502; PII: S0167-5273(20)30384-3; DOI: 10.1016/j.ijcard.2020.04.013 ). Eight Italian high-volume centres of Paediatric Cardiology were involved in this observational, retrospective data collection and analysis. In this dataset, clinical and procedural characteristics of 1423 newborns submitted to 1551 interventional cardiac catheterization procedures were analyzed. Primary outcomes were considered procedure and in-hospital mortality as well as major adverse event and procedural failure rates. Secondary outcomes were considered minor adverse events and need for blood transfusion. Targets of this data analysis were: 1) to evaluate the overall major risk factors of interventional cardiac catheterization; 2) to identify the most hazardous interventional procedures; 3) to assess possible trends of individual procedures as well as their outcome over time; 4) to find possible relationships between the volume activity of any centre and the procedure and follow-up outcome. In particular, this Data in Brief companion paper aims to report the specific statistic highlights of the multivariable analysis (binary logistic regression) used to assess the impact of any potential risk factors on the type of procedure over a short-term follow-up., (© 2020 The Authors.)

Previous research on sensitization in Aplysia was based entirely on unnatural noxious stimuli, usually electric shock, until our laboratory found that a natural noxious stimulus, a single sublethal lobster attack, causes short-term sensitization. We here extend that finding by demonstrating that multiple lobster attacks induce long-term sensitization (≥24 h) as well as similar, although not identical, neuronal correlates as observed after electric shock. Together these findings establish long- and short-term sensitization caused by sublethal predator attack as a natural equivalent to sensitization caused by artificial stimuli., (© 2014 Mason et al.; Published by Cold Spring Harbor Laboratory Press.)