Bronchiolitis – It Is Time for a Unique Definition

Bronchiolitis is the most common lower respiratory tract infections in infants. It is time to reach a unique clinical definition, encompassing the acute onset of respiratory distress with cough, tachypnoea, retraction and diffuse crackles on auscultation in infants aged less than 12 months

Th17, intestinal microbiota and the abnormal immune response in the pathogenesis of celiac disease

Celiac disease (CD) is an autoimmune enteropathy induced by the ingestion of gluten in genetically predisposed individuals who carry the HLA-DQ2 or -DQ8 alleles. The immune response is abnormal in celiac disease with small intestinal epithelial damage via CD8+CD4- intraepithelial lymphocytes. The etiology is multifactorial involving genetic and environmental factors, an abnormal immune response, and intestinal dysbiosis. The innate and acquired T-cell mediated immunity play important roles in the pathogenesis of this disease, particularly CD4+ Th17 cells, which have been shown to have critical functions in host defense against bacterial pathogens and in the inflammatory responses to deamidated gluten peptides. We review what is known about the interaction between immune system and intestinal microbiota in the pathogenesis of celiac disease

The treatment of acute bronchiolitis: past, present and future

Lower respiratory tract infections are a common cause of hospitalisation in infants. It is estimated that infants younger than 12 months with bronchiolitis account for 18% of all paediatric admission [1], representing a great burden to industrialised healthcare systems each winter. Bronchiolitis is defined as the first respiratory tract infection in infants younger than 12 months. Clinically, it can be manifested by cough, tachypnoea, apnoea, increased respiratory effort, fever, nasal congestion and rhinorrhoea. On chest auscultation, the key feature is diffuse bilateral inspiratory crackles. The most common virus detected in children with bronchiolitis is respiratory syncytial virus (RSV)info:eu-repo/semantics/publishedVersio

Celiac disease and hepatitis B virus: Celiac disease and HBV

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The era of CFTR modulators: improvements made and remaining challenges

The entry into the clinic of CFTR modulators such as TRIKAFTA has significantly improved life for ∼90% CF patients carrying one or two F508del mutations but challenges remain for rare CFTR mutations and the management of lung infections @SaraOcana1 https://bit.ly/3aRafQF

The role of posterior aortopexy in the treatment of left mainstem bronchus compression

OBJECTIVES: We reviewed the role of posterior aortopexy for left mainstem bronchus compression in infants and children. METHODS: Eighteen children with respiratory symptoms were enrolled between 2005 and 2015 for surgical decompression of the left mainstem bronchus. The children were managed from diagnosis to follow-up by a dedicated tracheal team. Primary outcomes were the complete relief of symptoms or improvement with respect to preoperative clinical status. RESULTS: The median age was 4 years (0.3-15.4) and the median weight was 13.2 kg (3, 1-40). Symptoms or indications for bronchoscopy included difficult weaning from mechanical ventilation (n = 3, 17%), difficult weaning from tracheotomy (n = 4, 22%), recurrent pneumonia (n = 4, 22%), wheezing (n = 3, 17%), atelectasis (n = 1, 5.5%), bitonal cough (n = 1, 5.5%) and stridor (n = 2, 11%). Associated malformations were present in 88.7%. The diagnosis was made by bronchoscopy and computed tomography. Indication for surgery was the presence of pulsations and reduction in the diameter of the left mainstem bronchus compression of more than 70%. Surgery was performed by left posterolateral thoracotomy. Aortopexy was done under bronchoscopic control. No early or late deaths were observed, nor were reoperations necessary. Residual malacia was observed in 8 children (44%). Median follow-up was 4.1 years (0.1-7.1). At last follow-up, 17/18 (94.4%) children showed adequate airway patency. CONCLUSIONS: The intrathoracic location of the left mainstem bronchus predisposes it to compression. Vascular anomalies represent the most frequent causes. Aortopexy has been advocated as a safe and useful method to relieve the compression, and our results confirmed these findings. Management of these patients is challenging and requires a multidisciplinary team

Marsis on-board software requirements for upgrade

The Mars Advanced Radar for Subsurface and Ionosphere Sounding (MARSIS) is an instrument for subsurface remote sensing of the Mars planet. Since its debut, many successful observations have been carried out. At this point of this fruitful mission, having acquired a good knowledge of the Mars environment, it is now necessary to improve the instrument science performances, mitigating some limitations of the on-board SW, that were required at the beginning of the mission, but which were proven to be excessive and above all limiting. The main purpose of this document is to define the requirements necessary to update the on-board SW, in order to add two new improved operative modes to the ones already in use. It is worth noting that, the existing operative modes will remain unchanged and can continue to be used after loading the updated SW. The first new operative mode (SSM) is related to the observation of Mars. It will be similar to the existing main dual channel sub surface mode (SS3). The processing for the first operative channel will remain unchanged, while calculations on the second channel will be modified to extract the most significant data from the full raw data set, discarding what is meaningless or providing poor scientific contribution. The new second operative mode (SSP), will be designed to optimize above all the observation of Phobos, which was not originally thought as a target for MARSIS, this means that a very complex on-board SW configuration is required, in order to force the radar to work properly even in this situation. Moreover, actual Phobos observation makes use of valuable SC resources for storing high quantity of useless data, that cannot be eliminated without modifications of MARSIS SW. The new operative mode will take care of removing these unnecessary data. It will also optimize adaptively the Receiver Gain during the flyby, thereby improving the dynamic range of the receiver of the recorded Science Data. At the same time data-rate on the SC OBDH bus will be strongly reduced, allowing the possibility for MARSIS, PFS and SPICAM to operate simultaneously

Mars Express Marsis phobos commanding architectures

Science objectives for the MARSIS experiment was defined more than 15 years ago in the context of the objectives of the Mars Express mission and in the more general frame of the open issues in the study of Mars at that time. The primary objective for MARSIS, was to map the distribution of water, both liquid and solid, in the upper portions of the crust of Mars. Secondary objectives defined for the MARSIS experiment included subsurface geologic probing and surface characterization of Mars. In order to achieve these ambitious scientific goals it was necessary to design an instrument with high computational capabilities, also to cope with some limitation imposed by the mission characteristics, such as the limited data-rate provided by the spacecraft and the limited available data volume. For these reasons, the on-board software is characterized by an high grade of flexibility that allow the possibility to modify the signal processing in order to face unpredictable issues arising during the mission. This capability was very useful when, after several years of Mars observation, Phobos became a scientific objective for MARSIS

Comment on Jaworska, J. et al. Consensus on the application of lung ultrasound in pneumonia and bronchiolitis in children

To the editor: [...

Bronchiolitis. Analysis of 10 consecutive epidemic seasons

Bronchiolitis is the leading cause of hospitalization in infants under 12 months. Our aims were to analyze epidemiological characteristics of infants with bronchiolitis over 10 consecutive seasons and to evaluate whether there are any clinical differences between infants hospitalized for bronchiolitis during epidemic peak months and infants in non-peak months. We enrolled consecutive enrolled 723 previously healthy term infants hospitalized at the Paediatric Emergency Department, "Sapienza" University of Rome over the period 2004-2014. Fourteen respiratory viruses were detected from nasopharyngeal aspirates by molecular methods. Clinical and demographic data were extracted from clinical charts. Viruses were detected in 351 infants (48.5%): RSV in 234 (32.4%), RV in 44 (6.1%), hBoV in 11 (1.5%), hMPV in 12 (1.6%), co-infections in 39 (5.4%), and other viruses in 11 (1.5%). Analyzing the 10 epidemic seasons, we found higher incidence for bronchiolitis every 4 years with a peak during the months December-January. Infants hospitalized during peak months had lower family history for asthma (P = 0.003), more smoking mothers during pregnancy (P = 0.036), were slightly higher breastfed (0.056), had lower number of blood eosinophils (P = 0.015) and had a higher clinical severity score (P = 0.017). RSV was detected mostly during peak months, while RV was equally distributed during the seasons. We found some variations in bronchiolitis incidence during epidemics, and discriminative characteristics in infants hospitalized for bronchiolitis during peak months and in non-peak months, that might reflect two different populations of children. Pediatr Pulmonol. 2016; 9999:XX-XX. © 2016 Wiley Periodicals, Inc