Investigation of chronic diarrhoea in infancy.

Diarrhoea in infants and young children is defined as >200g/day of stools, and occurs when there is an imbalance between intestinal fluids absorption and secretion. This may be caused by either a decreased absorption (osmotic diarrhoea) or an increased secretion (secretory diarrhoea). Chronic diarrhoea defines intestinal loss of water and electrolytes with increased stool frequency, reduced consistency and larger volume over more than 14days. This disorder in children shows a wide range of aetiologies depending on the age. The knowledge of common and rare aetiologies is important to optimize the diagnostic approach. A stepwise approach, starting with a comprehensive history, physical examination, inspection and collection of stool samples, helps to devise appropriate diagnostic and therapeutic management. In this article we discuss the pathophysiology, aetiology and possible approach to chronic diarrhoea in infancy

Stroke care in Italy: An overview of strategies to manage acute stroke in COVID-19 time

Purpose: To analyse structural and non-structural modifications of acute stroke care pathways undertaken at healthcare institutions across the regions of Italy due to the coronavirus disease 2019 (COVID-19) pandemic. Methods: Research on National decrees specific for the pandemic was carried out. The stroke pathways of four Italian regions from North to South, such as Lombardy, Veneto, Lazio and Campania, were analysed before and after the pandemic outbreak. Findings: On 29 February 2020, the Italian Minister of Health issued national guidelines on how to address the COVID-19 emergency. Stroke management was affected and required changes, basically resulting in the need to prioritise the ongoing COVID-19 emergency. In the most affected regions, the closure of departments and hospitals led to a complete reorganisation of previously functioning stroke networks. With the closure of several Stroke Units and Stroke Centres, the transportation time to hospital lengthened significantly, especially for the outlying populations. Discussion: The COVID-19 pandemic outbreak has been spreading rapidly in Italy and placing an overwhelming burden on healthcare systems. In response to this, political and healthcare decision-makers worked together to develop and implement efforts to sustain the national healthcare system while fighting the pandemic. Stroke care pathways changed during the pandemic and different organisational models were applied in the most affected regions. Conclusions: Stroke treatment pathways will need to be redesigned so to guarantee that severe and acute disease patients do not lose their rights to the access and delivery of care during the COVID-19 pandemics

Atopy patch test are useful to predict oral tolerance in children with gastrointestinal symptoms related to non-IgE-mediated cow's milk allergy.

Atopy patch tests (APTs) have been proposed for the diagnostic approach in children with non-IgE-mediated cow's milk allergy and gastrointestinal symptoms. We aimed to investigate the benefit of APTs in predicting oral tolerance in these patients. We prospectively evaluated 172 subjects with a sure diagnosis of non-IgE-mediated CMA and gastrointestinal symptoms (97 boys, 56.4%; age, 6.37 m; range, 212 m). At diagnosis, 113/172 (65.7%) children had positive APTs to cow's milk proteins (CMP). After 12 months of exclusion, diet APTs were repeated immediately before OFC. APTs significantly correlated (P < 0.001) with the OFC outcome (r 0.579). Diagnostic accuracy was sensitivity of 67.95%, specificity of 88.3%, PPV of 82.81%, NPV of 76.85%, and a +LR of 5.80. APTs are a valuable tool in the follow-up of children with non-IgE-mediated CMA-related gastrointestinal symptoms by contributing in determining whether an OFC can safely be undertaken

Natural deep eutectic solvents as thermostabilizer for Humicola insolens cutinase

As a new generation of green solvents, deep eutectic solvents (DESs) are considered a promising alternative to current harsh organic solvents and find application in many chemical processing methods such as extraction and synthesis. DESs, normally formed by two or more components via various hydrogen bond interactions, offer high potential as medium for biocatalysis reactions where they can improve efficiency by enhancing substrate solubility and the activity and stability of the enzymes. In the current study, the stabilization of Humicola insolens cutinase (HiC) in natural deep eutectic solvents (NADESs) was assessed. The best hydrogen bond donor among sorbitol, xylitol, erythritol, glycerol and ethylene glycol, and the best acceptor among betaine, choline chloride, choline acetate, choline dihydrogen citrate and tetramethylammonium chloride, were selected, evaluating binding energies and molecular orientations through molecular docking simulations, and finally used to prepare NADES aqueous solutions. The effects of component ratio and NADES concentration on HiC thermostability at 90 degrees C were also investigated. The choline dihydrogen citrate:xylitol, in a 1:1 ratio with a 20 wt% concentration, was selected as the best combination in stabilizing HiC, increasing its half-life three-fold

TIBIO-FIBULAR BONE TRANSPOSITION FOR THE TREATMENT OF ONCOLOGICAL PERIPROSTHETIC INFECTION OF THE KNEE WITH MASSIVE BONE LOSS

Chronic periprosthetic joint infection (PJI) is one of the most relevant complications in orthopaedic surgery, especially in the case of limb reconstruction with megaprostheses after malignant tumoral resection. This is the report of a case of a 35-year-old patient, affected by a chronic PJI around a knee megaprosthesis implanted after the resection of an osteosarcoma of the distal femur. “En bloc” resection and limb reconstruction with an expandable megaprothesis of the knee were performed at the age of 5 years old (1989). PJI occurred after the definitive megaprosthesis implantation (2002), and became chronic over the years. In 2019, due to a massive recrudescence of the infection and the severe femoral bone loss, the patient underwent a wide intercalary resection and a thigh stump reconstruction by transposition of the fibula and the distal third of the tibia in order to avoid a hip disarticulation. Although complex, the proposed treatment allowed improved outcomes in a young patient with high function requests, justifying the global surgical invasiveness

Eumelanin Graphene-Like Integration: The Impact on Physical Properties and Electrical Conductivity

The recent development of eumelanin pigment-based blends integrating "classical" organic conducting materials is expanding the scope of eumelanin in bioelectronics. Beyond the achievement of high conductivity level, another major goal lays in the knowledge and feasible control of structure/properties relationship. We systematically investigated different hybrid materials prepared by in situ polymerization of the eumelanin precursor 5,6-dihydroxyindole (DHI) in presence of various amounts of graphene-like layers. Spectroscopic studies performed by solid state nuclear magnetic resonance (ss-NMR), x-ray photoemission, and absorption spectroscopies gave a strong indication of the direct impact that the integration of graphene-like layers into the nascent polymerized DHI-based eumelanin has on the structural organization of the pigment itself, while infrared, and photoemission spectroscopies indicated the occurrence of negligible changes as concerns the chemical units. A tighter packing of the constituent units could represent a strong factor responsible for the observed improved electrical conductivity of the hybrid materials, and could be possible exploited as a tool for electrical conductivity tuning

The controversial role of food allergy in infantile colic: evidences and clinical management.

Food allergies (FAs) are an increasing problem in Western countries, affecting up to 10% of young children. FAs are frequently associated with gastrointestinal manifestations. The role of FAs as a potential causative factor for infantile colic (IC) is still controversial. We report the most recent evidence on the pathogenesis, clinical and diagnostic aspects of FA-induced infantile colic (IC) and suggest a stepwise diagnostic approach. We selected articles on clinical and immunologic features, pathogenesis and management of FAs and IC from of 1981 to 2015. Original and review articles were identified through selective searches performed on PubMed, using the following terms: colic, infantile colic, food allergy and infantile colic, infantile colic treatment. The possible relationship between FAs and IC derives from the presence of dysmotility with visceral hypersensitivity and dysbiosis, demonstrated in both conditions, and the clinical response to dietary interventions. Unfortunately, the design of the studies, poor characterization of atopy and different dietary approaches limit the understanding of the importance of FAs in subjects with IC. The role of FAs in IC subjects without other symptoms of atopy remains controversial. However, where there is a suspicion of FAs, a short trial with an extensively hydrolyzed cow's proteins formula or, if breast fed, with maternal elimination diet may be considered a reasonable option

IENE 9 project: developing a culturally competent and compassionate LGBT + curriculum in health and social care education

Introduction The IENE projects (2008–2022) aim to promote a model for developing intercultural dialogue and enhance the ability to provide culturally competent and compassionate care for the health and social care professionals at national and European levels. The IENE 9 project, named “Developing a culturally competent and compassionate LGBT + curriculum in health and social care education,” builds on the work developed in the previous IENE projects and emphasizes the importance of addressing LGBT + issues in health and social care education. Method Through an innovative Massive Open Online Course (MOOC), professionals will learn the skills to work toward building an LGBT + inclusive health and social care system. Result Notwithstanding the progress made in recent years on LGBT + issues, research indicates that too little attention has been given to LGBT + needs in health and social care settings, and these remain substantial issues that are often ignored. Conclusion This letter to the editor aims to present the IENE 9 project given that greater efforts are needed to improve professionals’ skills regarding sexual and gender minority population. We strive to continue our efforts in promoting the well-being and mental health of LGBT + people in health and social care education

Crashworthiness of a composite bladder fuel tank for a tilt rotor aircraft

The fulfilment of the crash is a demanding requirement for a Tiltrotor. Indeed, such a kind of aircraft, being a hybrid between an airplane and a helicopter, inherits the requirements mainly from helicopters (EASA CS 29) due to its hovering ability. In particular, the fuel storage system must be designed in such a manner that it is crash resistant, under prescribed airworthiness requirements, in order to avoid the fuel leakage during such an event, preventing fire and, thus, increasing the survival chances of the crew and the passengers. The present work deals with the evaluation of crashworthiness of the fuel storage system of a Tiltrotor (bladder tank), and, in particular, it aims at describing the adopted numerical approach and some specific results. Crash resistance requirements are considered from the earliest design stages, and for this reason they are mainly addressed from a numerical point of view and by simulations that treat both single components and small/medium size assemblies. The developed numerical models include all the main parts needed for simulating the structural behavior of the investigated wing section: the tank, the structural components of the wing, the fuel sub-systems (fuel lines, probes, etc.) and the fuel itself. During the crash event there are several parts inside the tanks that can come into contact with the tank structure; therefore, it is necessary to evaluate which of these parts can be a damage source for the tank itself and could generate fuel loss. The SPH approach has been adopted to discretise fuel and to estimate the interaction forces with respect to the tank structure. Experimental data were used to calibrate the fuel tank and foam material models and to define the acceleration time-history to be applied. Thanks to the optimized foam’s configuration, the amount of dissipated impact energy is remarkable, and the evaluation of tanks/fuel system stress distribution allows estimating any undesired failure due to a survivable crash event