A Multicenter Retrospective Survey regarding Diabetic Ketoacidosis Management in Italian Children with Type 1 Diabetes

We conducted a retrospective survey in pediatric centers belonging to the Italian Society for Pediatric Diabetology and Endocrinology. The following data were collected for all new-onset diabetes patients aged 0-18 years: DKA (pH < 7.30), severe DKA (pH < 7.1), DKA in preschool children, DKA treatment according to ISPAD protocol, type of rehydrating solution used, bicarbonates use, and amount of insulin infused. Records (n = 2453) of children with newly diagnosed diabetes were collected from 68/77 centers (87%), 39 of which are tertiary referral centers, the majority of whom (n = 1536, 89.4%) were diagnosed in the tertiary referral centers. DKA was observed in 38.5% and severe DKA in 10.3%. Considering preschool children, DKA was observed in 72%, and severe DKA in 16.7%. Cerebral edema following DKA treatment was observed in 5 (0.5%). DKA treatment according to ISPAD guidelines was adopted in 68% of the centers. In the first 2 hours, rehydration was started with normal saline in all centers, but with different amount. Bicarbonate was quite never been used. Insulin was infused starting from third hour at the rate of 0.05-0.1 U/kg/h in 72% of centers. Despite prevention campaign, DKA is still observed in Italian children at onset, with significant variability in DKA treatment, underlying the need to share guidelines among centers

Delineation uncertainties of tumour volumes on MRI of head and neck cancer patients

Background: During the last decade, radiotherapy using MR Linac has gone from research to clinical implementation for different cancer locations. For head and neck cancer (HNC), target delineation based only on MR images is not yet standard, and the utilisation of MRI instead of PET/CT in radiotherapy planning is not well established. We aimed to analyse the inter-observer variation (IOV) in delineating GTV (gross tumour volume) on MR images only for patients with HNC. Material/methods: 32 HNC patients from two independent departments were included. Four clinical oncologists from Denmark and four radiation oncologists from Australia had independently contoured primary tumour GTVs (GTV-T) and nodal GTVs (GTV-N) on T2-weighted MR images obtained at the time of treatment planning. Observers were provided with sets of images, delineation guidelines and patient synopsis. Simultaneous truth and performance level estimation (STAPLE) reference volumes were generated for each structure using all observer contours. The IOV was assessed using the DICE Similarity Coefficient (DSC) and mean absolute surface distance (MASD). Results: 32 GTV-Ts and 68 GTV-Ns were contoured per observer. The median MASD for GTV-Ts and GTV-Ns across all patients was 0.17 cm (range 0.08–0.39 cm) and 0.07 cm (range 0.04–0.33 cm), respectively. Median DSC relative to a STAPLE volume for GTV-Ts and GTV-Ns across all patients were 0.73 and 0.76, respectively. A significant correlation was seen between median DSCs and median volumes of GTV-Ts (Spearman correlation coefficient 0.76, p < 0.001) and of GTV-Ns (Spearman correlation coefficient 0.55, p < 0.001). Conclusion: Contouring GTVs in patients with HNC on MRI showed that the median IOV for GTV-T and GTV-N was below 2 mm, based on observes from two separate radiation departments. However, there are still specific regions in tumours that are difficult to resolve as either malignant tissue or oedema that potentially could be improved by further training in MR-only delineation

Corrigendum: The silent epidemic of diabetic ketoacidosis at diagnosis of type 1 diabetes in children and adolescents in italy during the covid-19 pandemic in 2020(Front. Endocrinol., (2022), 13, (878634), 10.3389/fendo.2022.878634)

[This corrects the article .]

The Silent Epidemic of Diabetic Ketoacidosis at Diagnosis of Type 1 Diabetes in Children and Adolescents in Italy During the COVID-19 Pandemic in 2020

Aim/HypothesisTo compare the frequency of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes in Italy during the COVID-19 pandemic in 2020 with the frequency of DKA during 2017-2019. MethodsForty-seven pediatric diabetes centers caring for &gt;90% of young people with diabetes in Italy recruited 4,237 newly diagnosed children with type 1 diabetes between 2017 and 2020 in a longitudinal study. Four subperiods in 2020 were defined based on government-imposed containment measures for COVID-19, and the frequencies of DKA and severe DKA compared with the same periods in 2017-2019. ResultsOverall, the frequency of DKA increased from 35.7% (95%CI, 33.5-36.9) in 2017-2019 to 39.6% (95%CI, 36.7-42.4) in 2020 (p=0.008), while the frequency of severe DKA increased from 10.4% in 2017-2019 (95%CI, 9.4-11.5) to 14.2% in 2020 (95%CI, 12.3-16.4, p&lt;0.001). DKA and severe DKA increased during the early pandemic period by 10.4% (p=0.004) and 8% (p=0.002), respectively, and the increase continued throughout 2020. Immigrant background increased and high household income decreased the probability of presenting with DKA (OR: 1.55; 95%CI, 1.24-1.94; p&lt;0.001 and OR: 0.60; 95 CI, 0.41-0.88; p=0.010, respectively). Conclusions/InterpretationThere was an increase in the frequency of DKA and severe DKA in children newly diagnosed with type 1 diabetes during the COVID-19 pandemic in 2020, with no apparent association with the severity of COVID-19 infection severity or containment measures. There has been a silent outbreak of DKA in children during the pandemic, and preventive action is required to prevent this phenomenon in the event of further generalized lockdowns or future outbreak

Fracture toughness of vinyl ester composites reinforced with sawdust and postcured in microwaves

A commercial vinyl ester resin supplied by Hetron Chemical Pty. was reinforced with varying percentages by weight of sawdust. The sawdust particles were sieved into 3 different sizes, which were <300 μm, 300–425 μm, and 425–1180 μm, respectively, with a view to increase its fracture toughness for civil and structural applications. The sawdust used varied from 0% w/t to 15% w/t in step of 5% w/t. For higher w/t% of sawdust, the mixture would be too sticky to be mixed and cast. The cast composites were cured in ambient conditions and then postcured in microwave irradiation. They were then tested for fracture toughness using short bar tests. The values of fracture toughness of the composites increased with increasing particulate size, and this is due to the size distribution of the filler. It was found that the optimum amount of sawdust (425–1180 μm) was 15% w/t, with which the increase in fracture toughness was 126% as compared to neat resin and the reduction in cost was 15%. Furthermore, the optimum amount of sawdust (300–425 μm) was also 15% w/t, with which the increase in fracture toughness was 28.3% as compared to neat resin and the reduction in cost was again 15%

A pilot study on the flexural properties of vinyl ester composites filled with glass powder

Vinyl ester resin was filled with of glass powder with a view to increasing the flexural strength of the composites for civil and structural applications by a research Centre on composites, University of Southern Queensland (USQ). In order to reduce costs, the Centre wishes to fill as much glass powder as possible to the resin subject to maintaining sufficient strength of the composites in civil and structural applications. This project varies the percentage by weight of the glass powder in the composites, which are then subjected to flexural tests. The flexural strength and strain of the glass powder filled vinyl ester composites decreased with increasing filler content but the flexural modulus was highest at 20 w/t % of glass powder. Scanning Electron Microscope (SEM) was used to analyze the fractured samples and it was found that the fractured surfaces examined were correlated with the flexural properties

Optimum percentage of fly ash reinforcement in vinyl ester composites

The previous work of another group of researchers found that the modulus of tension, flexural and compression increased with increasing percentage by volume of fly ash. They also documented that the viscosity of the composite increased exponentially with increasing percentage by volume of the filler. The viscosity increased sharply when the percentage by volume of reinforcer is between 35 to 50%. They failed to mention the highest percentage by weight of fly ash that could be added to the resin to get highest mechanical properties while still ensuring that the composite could be cast into moulds with ease. This project attempts to find out the optimum percentage by weight of slg in vinyl ester resin as far as yield strength, tensile strength, Young’s modulus and Poisson’s ratio of the composite are taken into account. The research found that 33% by weight of filler is a favourable and convenient percentage by weight of slg to use because up to this percentage by weight of reinforcement, the mechanical properties like modulus of tension are increasing with the increase in percentage by weight of filler, while at the same time the viscosity is not high enough to prevent ease of casting the composite into moulds

Tensile tests of phenol formaldehyde SLG reinforced composites: pilot study

Phenol formaldehyde was filled with Envirospheres SLG to increase the strength and impact toughness of the composite for structural applications by the Centre of Excellence in Engineered Fiber Composites (CEEFC), University of Southern Queensland (USQ). In order to reduce costs, the Centre wishes to fill as much SLG as possible subject to maintaining sufficient strength and impact toughness of the composites in structural applications. This project varies the percentages by weight of the SLG in the composites which are then subjected to tensile tests. The results show that composite with 10 % by weight of the SLG produces the highest yield, tensile strengths and Young’s modulus combined with a reasonable fluidity for casting