Recommendations on complementary feeding for healthy, full-term infants

Weaning (or introduction of complementary feeding) is a special and important moment in the growth of a child, both for the family and the infant itself, and it can play a major role in the child's future health. Throughout the years, various weaning modes have come in succession, the latest being baby-led weaning; the timing for introducing foods and the requirements of which sort of nutrient for weaning have also changed over time. Furthermore, the role played by nutrition, especially in the early stages of life, for the onset of later non-communicable disorders, such as diabetes, obesity or coeliac disease has also been increasingly highlighted. Members of Italian Society of Gastroenterology, Hepathology and Pediatric Nutrition (SIGENP) and the Italian Society of Allergology and Pediatric Immunology (SIAIP) Emilia Romagna here propose a practical approach for pediatricians to deal with daily practice. The four main areas for discussion were weaning in relation with the onset of allergic diseases, coeliac disease, diabetes and metabolic syndrome, the nutrition requirements to take into account for assessing the diet of infants under one year of age and about the practice of baby-led weaning focusing on limits and benefits, respectively

Common, low-frequency, rare, and ultra-rare coding variants contribute to COVID-19 severity

The combined impact of common and rare exonic variants in COVID-19 host genetics is currently insufficiently understood. Here, common and rare variants from whole-exome sequencing data of about 4000 SARS-CoV-2-positive individuals were used to define an interpretable machine-learning model for predicting COVID-19 severity. First, variants were converted into separate sets of Boolean features, depending on the absence or the presence of variants in each gene. An ensemble of LASSO logistic regression models was used to identify the most informative Boolean features with respect to the genetic bases of severity. The Boolean features selected by these logistic models were combined into an Integrated PolyGenic Score that offers a synthetic and interpretable index for describing the contribution of host genetics in COVID-19 severity, as demonstrated through testing in several independent cohorts. Selected features belong to ultra-rare, rare, low-frequency, and common variants, including those in linkage disequilibrium with known GWAS loci. Noteworthily, around one quarter of the selected genes are sex-specific. Pathway analysis of the selected genes associated with COVID-19 severity reflected the multi-organ nature of the disease. The proposed model might provide useful information for developing diagnostics and therapeutics, while also being able to guide bedside disease management. © 2021, The Author(s)

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice

webBPMN: A Language to Design Web Applications Regulated by Workflows

In recent years many web applications regulated by workflows were developerd in order to permit the collaboration between many stakeholders during the execution of Business Processes. Generally, these kind of systems are implemented using web technologies in order to be easily designed, implemented and to be available in different operative systems and platform. Standard general purpose Business Process Modeling languages such as BPMN can be used to design the workflow of these systems, but they lack in the definition of which web technology has to be used to implemented each single business activity. In this paper, we propose a novel business process modeling notation named webBPMN including elements that can be used to model web applications regulated by workflows. We experimented the notation designing the Business Process of the internship web application of the University of Camerino

The reduction of selenium(IV) by hydrogen sulfide in aqueous solutions

The rates for the reduction of Se(IV) by sulfides were measured in NaCl solutions as a function of pH (2-10), temperature (10-40°C) and ionic strength (I=0.01-1M). The pseudo first-order rate constant (logk 1) showed a complex dependence on pH with values decreasing from pH 2 to a minimum at pH 4.5, then increasing from pH 5.5 to a maximum near pH 8 and decreasing again at pH higher than 8. The values of the overall kinetic constant (k) calculated from the values of k 1/[H 2S] T can be determined from equations: logk=-0.15pH-1355.5/T+0.44I0.5+7.74 for the pH range 2-4.5 (σ=±0.16), logk=0.28pH-1090.9/T+0.60I0.5+4.68 for the pH range 5.5-7.6 (σ=±0.10) and logk=-0.50pH-1572.1/T+0.45I0.5+12.67 for the pH range 7.7-10 (σ=±0.05), from 10 to 40°C and from 0.01 to 1M ionic strength. The effect of pH and ionic strength on the reaction suggests that the reactions in natural waters are due to the following interactions: H2SeO3+H2S↔products HSeO3-+H2S↔products HSeO3-+HS-↔products while under strong alkaline conditions (pH>9) a fourth contribution by SeO32-+HS-↔products is also possible. The overall rate expression over the entire pH range investigated can be determined from (H 2A=H 2SeO 3; HA=HSeO 3 -; A=SeO 3 2-) k=(kH2S-H2A[H+]3+kH2S-HAKHA[H+]2+kHS-HAKHAK1s[H+]+kHS-AKHAKAK1s)/{([H+]2+KHA[H+]+KAKHA)([H+]+K1s)} where kH2S-H2A=2409±566M-1min-1, kH2S-HA=464±233M-1min-1, k HS-HA=4190±573M -1min -1 and k HS-A=650±382M -1min -1 and K HA, K A and K 1s are the dissociation constants of selenous acid and hydrogen sulfide. Kinetic runs in natural freshwater samples and natural seawater have confirmed results obtained in simple NaCl solutions suggesting that this reaction may play an important role under anoxic and hypoxic conditions. Sulfide concentrations under these conditions may range from micromolar to millimolar level and Se(IV) half times are in the order of a few hours to minutes, respectively. © 2011 Elsevier Ltd

Famiglia, scuola e biblioteca insieme nella prevenzione del tabagismo: un progetto pilota per l'infanzia

Il rapporto del Ministero della Salute del 2018, sulla prevenzione e sul controllo del tabagismo, dichiara che l’abitudine a fumare sigarette inizia a 11 anni quando già fumano il 3,7% dei ragazzi e il 2,5Þlle ragazze. Le percentuali aumentano in modo considerevole tra i 13 e i 15 e sempre più in voga è l’utilizzo delle sigarette elettroniche, soprattutto tra i ragazzi. Il fumo attivo rappresenta la principale causa evitabile e prevenibile di malattia e di morte, dunque la prevenzione del tabagismo è un obiettivo prioritario da perseguire attraverso attività di educazione alla salute. Più gli interventi sono precoci, più hanno un impatto maggiore, e la fascia di età minima che consente elaborazioni cognitive ed emotive adeguate rispetto agli stimoli sul tabagismo è quella dai 4 ai 6 anni. Gli elementi fulcro dell’educazione sono la famiglia, la scuola e la comunità (individuata per questa fascia d’età nell’istituzione bibliotecaria) che condividono il compito di far sì che i bambini acquisiscano comportamenti e stili di vita individuali e sociali improntati al rispetto della qualità della vita. Il progetto, rivolto a bambini dai 4 ai 6 anni, si articola su tre livelli paralleli: famiglia, scuola, biblioteca, le principali comunità educanti per questa fascia d’età. Il progetto prevede incontri di sensibilizzazione e formazione sul tema del tabagismo - usufruendo della metodologia della Medicina Narrativa - per insegnanti, genitori e bibliotecari, focus group, attività e laboratori per tutti i partecipanti. In particolare, nei percorsi didattici pensati per i bambini verranno utilizzati materiali di recupero, sia a scuola che in biblioteca. Per gli adulti si pensa di creare una piattaforma online dove interagire anche al termine del progetto. Trattandosi di un progetto pilota da avviare, i risultati attesi riguardano, nel breve perido, gli esiti del monitoraggio del progetto rivolto agli adulti. Sono previsti questionari pre e post formazione/attività in merito all’utilità del progetto, alla sua efficacia educativa e al supporto previsto per i fumatori che richiedono un aiuto per smettere. Per quanto riguarda i risultati nel lungo periodo, sarebbe interessante ed opportuno seguire i bambini fino al compimento dei 25-30 anni di età per valutare l’effettiva ricaduta del progetto, prevedendo un confronto con un gruppo di controllo. Il progetto si presenta come un sistema di rete in cui famiglia, scuola e comunità (biblioteca) collaborano insieme in un percorso di educazione alla salute. L’OCSE (Organizzazione per la Cooperazione e per lo Sviluppo Economico) sostiene che i bambini hanno bisogno di sviluppare un set di competenze cognitive, emotive e sociali per vivere al meglio la vita nella società mutevole in cui ci troviamo. Noi ci proponiamo di farlo iniziando a piccoli passi. Gli interventi precoci sono fondamentali: i genitori svolgono un ruolo importante, così come le interazioni tra pari a scuola e in ambienti extra-scolastici. Promuovere stili di vita sani, individuali e collettivi, è ciò che si prefigge il progetto pilota

Geraniol pharmacokinetics, bioavailability and its multiple effects on the liver antioxidant and xenobiotic-metabolizing enzymes

Geraniol is a natural monoterpene showing anti-inflammatory, antioxidant, neuroprotective and anticancer effects. No pharmacokinetic and bioavailability data on geraniol are currently available. We therefore performed a systematic study to identify the permeation properties of geraniol across intestinal cells, and its pharmacokinetics and bioavailability after intravenous and oral administration to rats. In addition, we systematically investigated the potential hepatotoxic effects of high doses of geraniol on hepatic phase I, phase II and antioxidant enzymatic activities and undertook a hematochemical analysis on mice. Permeation studies performed via HPLC evidenced geraniol permeability coefficients across an in vitro model of the human intestinal wall for apical to basolateral and basolateral to apical transport of 13.10 ± 2.3 Ã\u97 10-3and 2.1 ± 0.1·Ã\u97 10-3cm/min, respectively. After intravenous administration of geraniol to rats (50 mg/kg), its concentration in whole blood (detected via HPLC) decreased following an apparent pseudo-first order kinetics with a half-life of 12.5 ± 1.5 min. The absolute bioavailability values of oral formulations (50 mg/kg) of emulsified geraniol or fiber-adsorbed geraniol were 92 and 16%, respectively. Following emulsified oral administration, geraniol amounts in the cerebrospinal fluid of rats ranged between 0.72 ± 0.08 μg/mL and 2.6 ± 0.2 μg/mL within 60 min. Mice treated with 120 mg/kg of geraniol for 4 weeks showed increased anti-oxidative defenses with no signs of liver toxicity. CYP450 enzyme activities appeared only slightly affected by the high dosage of geraniol

Cow's milk protein allergy in children: a practical guide

<p>Abstract</p> <p>A joint study group on cow's milk allergy was convened by the Emilia-Romagna Working Group for Paediatric Allergy and by the Emilia-Romagna Working Group for Paediatric Gastroenterology to focus best practice for diagnosis, management and follow-up of cow's milk allergy in children and to offer a common approach for allergologists, gastroenterologists, general paediatricians and primary care physicians.</p> <p>The report prepared by the study group was discussed by members of Working Groups who met three times in Italy. This guide is the result of a consensus reached in the following areas. Cow's milk allergy should be suspected in children who have immediate symptoms such as acute urticaria/angioedema, wheezing, rhinitis, dry cough, vomiting, laryngeal edema, acute asthma with severe respiratory distress, anaphylaxis. Late reactions due to cow's milk allergy are atopic dermatitis, chronic diarrhoea, blood in the stools, iron deficiency anaemia, gastroesophageal reflux disease, constipation, chronic vomiting, colic, poor growth (food refusal), enterocolitis syndrome, protein-losing enteropathy with hypoalbuminemia, eosinophilic oesophagogastroenteropathy. An overview of acceptable means for diagnosis is included. According to symptoms and infant diet, three different algorithms for diagnosis and follow-up have been suggested.</p

Multiple abdominal nodules in a patient with ulcerative proctitis: a case of peritoneal splenosis

A 40-year old gardener was referred for ulcerative proctitis treated with topical mesalamine with rapid improvement of symptoms. Eighteen years before he had had a splenectomy for traumatic splenic rupture. At the end of 2010, he was admitted to another hospital because of abdominal pain. Computerized tomography (CT) scan and magnetic resonance imaging revealed multiple abdominal nodules but a definite diagnosis was not made. While being examined for the proctitis, the patient was admitted to our unit due to worsening of the abdominal pain. After another CT scan, a laparoscopy was performed: several reddish-blue nodules on the peritoneal wall were observed and biopsies were performed. Histological examination was consistent with splenosis. After the procedure, we observed an improvement in the abdominal pain. Splenosis is an acquired condition defined as autotransplantation of viable splenic tissue throughout different sites of the body. It occurs after splenic rupture via trauma or surgery. Splenosis is a benign condition that is usually found incidentally unless symptomatic. Since on radiographic examination it can mimic a neoplasia, extensive workup is usually needed. The diagnostic method of choice is nuclear scintigraphy. Splenosis usually occurs in the abdominal and pelvic cavities but patients have been described with splenosis in other intrathoracic, hepatic and subcutaneous sites. Splenosis is usually asymptomatic and treatment is not necessary. Most patients who have an exploratory laparotomy or laparoscopy for abdominal pain, such as in our patient, experience no more pain after the procedure, regardless of whether the splenic nodules have been completely removed or not. The reason for this spontaneous improvement is not known

An Asymptomatic, Iatrogenic Hemobilia Detected by Contrast Enhanced Ultrasound of the Gallbladder

Hemorrhage within the biliary system (hemobilia), is an infrequent complication that can arise during percutaneous procedures involving the liver. The clinical diagnosis of hemobilia is often challenging, as symptoms are quite unspecific and often display a late onset. In such cases, sonography of the gallbladder can play a crucial role in the early detection of hemobilia. A case report is provided of a 72-year-old man who underwent a sonography-guided percutaneous biopsy of a 22-mm focal lesion, within the eighth segment of the liver. In this patient, asymptomatic active hemobilia was promptly identified through contrast-enhanced ultrasound (CEUS) which was performed immediately after the invasive procedure. Crucially, this postprocedural complication may have gone undiagnosed without an early postprocedure grayscale visual analysis and CEUS evaluation, since the patient was completely asymptomatic. In conclusion, a grayscale sonogram of the gallbladder is suggested and should be considered before and immediately after percutaneous invasive procedures of the liver. In the instances where suspicion of hemobilia arises, CEUS can be used to assess the presence of active bleeding. Implementing this type of imaging protocol may possibly reveal a higher frequency of hemobilia than is commonly reported