Diagnosis, treatment and prevention of pediatric obesity: consensus position statement of the Italian Society for Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics

The Italian Consensus Position Statement on Diagnosis, Treatment and Prevention of Obesity in Children and Adolescents integrates and updates the previous guidelines to deliver an evidence based approach to the disease. The following areas were reviewed: (1) obesity definition and causes of secondary obesity; (2) physical and psychosocial comorbidities; (3) treatment and care settings; (4) prevention.The main novelties deriving from the Italian experience lie in the definition, screening of the cardiometabolic and hepatic risk factors and the endorsement of a staged approach to treatment. The evidence based efficacy of behavioral intervention versus pharmacological or surgical treatments is reported. Lastly, the prevention by promoting healthful diet, physical activity, sleep pattern, and environment is strongly recommended since the intrauterine phase

Titanium dioxide nanoparticles promote arrhythmias via a direct interaction with rat cardiac tissue

BackgroundIn light of recent developments in nanotechnologies, interest is growing to better comprehend the interaction of nanoparticles with body tissues, in particular within the cardiovascular system. Attention has recently focused on the link between environmental pollution and cardiovascular diseases. Nanoparticles <50 nm in size are known to pass the alveolar¿pulmonary barrier, enter into bloodstream and induce inflammation, but the direct pathogenic mechanisms still need to be evaluated. We thus focused our attention on titanium dioxide (TiO2) nanoparticles, the most diffuse nanomaterial in polluted environments and one generally considered inert for the human body.MethodsWe conducted functional studies on isolated adult rat cardiomyocytes exposed acutely in vitro to TiO2 and on healthy rats administered a single dose of 2 mg/Kg TiO2 NPs via the trachea. Transmission electron microscopy was used to verify the actual presence of TiO2 nanoparticles within cardiac tissue, toxicological assays were used to assess lipid peroxidation and DNA tissue damage, and an in silico method was used to model the effect on action potential.ResultsVentricular myocytes exposed in vitro to TiO2 had significantly reduced action potential duration, impairment of sarcomere shortening and decreased stability of resting membrane potential. In vivo, a single intra-tracheal administration of saline solution containing TiO2 nanoparticles increased cardiac conduction velocity and tissue excitability, resulting in an enhanced propensity for inducible arrhythmias. Computational modeling of ventricular action potential indicated that a membrane leakage could account for the nanoparticle-induced effects measured on real cardiomyocytes.ConclusionsAcute exposure to TiO2 nanoparticles acutely alters cardiac excitability and increases the likelihood of arrhythmic events

Neglected Fractures of the Lateral Humeral Condyle in Children; Which Treatment for Which Condition?

Background: Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial. Methods: Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien&ndash;Dindo&ndash;Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS). Results: The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), &ldquo;in-situ&rdquo; fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2&ndash;16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement &ge;5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS. Conclusion: Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures

Maternal aggression as a model of acute social stress in the rat: a behavioral-electrocardiographic study.

Maternal aggression of lactating rats was used to induce acute social stress in a resident-intruder paradigm. Behavioral and electrocardiographic responses of male intruders were simultaneously recorded. Cardiac electrical activity was measured by means of a telemetry system which ensured preservation of intruder's behavioral repertoire. Behavioral response to maternal attack was evaluated in terms of percent time spent in passive/submissive (p/s) and active/non-submissive (a/ns) patterns. This allowed us to classify the intruders as submissive, non-submissive, and intermediates. During the test, a significant decrease of average R-R interval (R-R) compared to baseline conditions and the occurrence of arrythmias of different nature were found. Ventricular arrhythmias, including premature ventricular beats and ventricular tachycardias, were present in all the intruders while R-R fluctuations and II degree atrioventricular (A-V) blocks only appeared in submissive and intermediate rats. Most ventricular arrhythmias occurred within the upper range of heart rate and were preceded by periods of low R-R variability. These electrocardiographic events were temporally associated with a/ns behavioral patterns and were related to an increased prevalence of sympathetic activity. On the other hand, R-R fluctuations and II degree A-V blocks preceded by high R-R variability were synchronized with p/s behavior and were ascribed to a predominant inhibitory effect of vagal activation which becomes more pronounced as the level of sympathetic activity increases

Comparison between modified Dunn procedure and in situ fixation for severe stable slipped capital femoral epiphysis: A retrospective study of 29 hips followed for 2–7 years

Background and purpose — The best treatment option for severe slipped capital femoral epiphysis (SCFE) is still controversial. We compared clinical and radiographic outcomes of modified Dunn procedure (D) and in situ fixation (S) in severe SCFE. Patients and methods — We retrospectively compared D and S, used for severe stable SCFE (posterior sloping angle (PSA) > 50°) in 29 patients (15 D; 14 S). Propensity analysis and inverse probability of treatment weights (IPTW) to adjust for baseline differences were performed. Patients were followed for 2–7 years. Results — Avascular necrosis (AVN) occurred in 3 patients out of 15, after D, causing conversion to total hip replacement (THR) in 2 cases. In S, 1 hip developed chondrolysis, requiring THR 3 years after surgery. 3 symptomatic femoroacetabular impingements (FAI) occurred after S, requiring corrective osteotomy in 1 hip, and osteochondroplasty in another case. The risk of early re-operation was similar between the groups. The slippage was corrected more accurately and reliably by D. The Nonarthritic Hip Score was similar between groups, after adjusting for preoperative and postoperative variables. Interpretation — Although D was superior to S in restoring the proximal femoral anatomy, without increasing the risk of early re-operation, some concern remains regarding the potential risk of AVN in group D

CT Conversion Workflow for Intraoperative Usage of Bony Models: From DICOM Data to 3D Printed Models

This paper presents the application of a low-cost 3D printing technology in pre-operative planning and intra-operative decision-making. Starting from Computed Tomography (CT) scans, we were able to reconstruct a 3D model of the area of interest with a very simple and rapid workflow, using open-source software and an entry level 3D printer. The use of High Temperature Poly-Lactic Acid (HTPLA) by ProtoPasta allowed fabricating sterilizable models, which could be used within the surgical field. We believe that our method is an appealing alternative to high-end commercial products, being superior for cost and speed of production. It could be advantageous especially for small and less affluent hospitals that could produce customized sterilizable tools with little investment and high versatility

Cardiac effects of acute exposure to titanium dioxide nanoparticles: electrophysiological characterization

The potential adverse effects of titanium dioxide nanoparticles (TiO2-NPs) on cardiovascular system are still largely unknown. The aim of this study is to investigate the direct effects of acute exposure to TiO2-NPs on cardiac electrical function, at cellular and organ level. Single ventricular cardiomyocytes were enzymatically isolated from rat hearts, brought in patch clamp whole-cell configuration in order to measure in controls and TiO2-NPs treated cells 1) membrane capacitance (Cm), 2) membrane resting potential (Vr) and action potential duration (APD). Multiple epicardial electrograms were also recorded in vivo on the ventricular surface or rat hearts after 4h tracheal instillation of vehicle (control) or TiO2-NPs solution (2mg/Kg), during normal sinus rhythm and ventricular pacing. TiO2-NPs did not modify Cm and Vr values; however, in cells incubated with TiO2-NPs, 30 sec recordings of Vr showed a significant increase of Vr variability. The treatment with TiO2-NPs induced also a significant shortening in plateau and late phase of repolarization of APs. Electrophysiological parameters from epicardial mapping revealed that PQ, QRS and QT durations were significantly reduced, while excitability and anisotropy ratio were increased. In conclusion, the TiO2-NPs induced decrease in cellular APD and in electrographic QT intervals associated with an increase of cardiac excitability, could be responsible for a cardiac substrate more prone to arrhythmia development