Fam134c and Fam134b shape axonal endoplasmic reticulum architecture in vivo.

Endoplasmic reticulum (ER) remodeling is vital for cellular organization. ER-phagy, a selective autophagy targeting ER, plays an important role in maintaining ER morphology and function. The FAM134 protein family, including FAM134A, FAM134B, and FAM134C, mediates ER-phagy. While FAM134B mutations are linked to hereditary sensory and autonomic neuropathy in humans, the physiological role of the other FAM134 proteins remains unknown. To address this, we investigate the roles of FAM134 proteins using single and combined knockouts (KOs) in mice. Single KOs in young mice show no major phenotypes; however, combined Fam134b and Fam134c deletion (Fam134b/cdKO), but not the combination including Fam134a deletion, leads to rapid neuromuscular and somatosensory degeneration, resulting in premature death. Fam134b/cdKO mice show rapid loss of motor and sensory axons in the peripheral nervous system. Long axons from Fam134b/cdKO mice exhibit expanded tubular ER with a transverse ladder-like appearance, whereas no obvious abnormalities are present in cortical ER. Our study unveils the critical roles of FAM134C and FAM134B in the formation of tubular ER network in axons of both motor and sensory neurons.

Spinal neuronal activity and neuroinflammatory component in a mouse model of CFA-induced vestibulodynia.

Vestibulodynia is a complex pain disorder characterized by chronic discomfort in the vulvar region, often accompanied by tactile allodynia and spontaneous pain. In patients a depressive behaviour is also observed. In this study, we have used a model of vestibulodynia induced by complete Freund's adjuvant (CFA) focusing our investigation on the spinal cord neurons and microglia. We investigated tactile allodynia, spontaneous pain, and depressive-like behavior as key behavioral markers of vestibulodynia. In addition, we conducted in vivo electrophysiological recordings to provide, for the first time to our knowledge, the characterization of the spinal sacral neuronal activity in the L6-S1 dorsal horn of the spinal cord. Furthermore, we examined microglia activation in the L6-S1 dorsal horn using immunofluorescence, unveiling hypertrophic phenotypes indicative of neuroinflammation in the spinal cord. This represents a novel insight into the role of microglia in vestibulodynia pathology. To address the therapeutic aspect, we employed pharmacological interventions using GABApentin, amitriptyline, and PeaPol. Remarkably, all three drugs, also used in clinic, showed efficacy in alleviating tactile allodynia and depressive-like behavior. Concurrently, we also observed a normalization of the altered neuronal firing and a reduction of microglia hypertrophic phenotypes. In conclusion, our study provides a comprehensive understanding of the CFA-induced model of vestibulodynia, encompassing behavioral, neurophysiological and neuroinflammatory aspects. These data pave the way to investigate spinal cord first pain plasticity in vestibulodynia.

The relationship between remotely-sensed spectral heterogeneity and bird diversity is modulated by landscape type.

To identify areas of high biodiversity and prioritize conservation efforts, it is crucial to understand the drivers of species richness patterns and their scale dependence. While classified land cover products are commonly used to explain bird species richness, recent studies suggest that unclassified remote-sensed images can provide equally good or better results. In our study, we aimed to investigate whether unclassified multispectral data from Landsat 8 can replace image classification for bird diversity modeling. Moreover, we also tested the Spectral Variability Hypothesis. Using the Atlas of Breeding Birds in the Czech Republic 2014-2017, we modeled species richness at two spatial resolutions of approx. 131 km2 (large squares) and 8 km2 (small squares). As predictors of the richness, we assessed 1) classified land cover data (Corine Land Cover 2018 database), 2) spectral heterogeneity (computed in three ways) and landscape composition derived from unclassified remote-sensed reflectance and vegetation indices. Furthermore, we integrated information about the landscape types (expressed by the most prevalent land cover class) into models based on unclassified remote-sensed data to investigate whether the landscape type plays a role in explaining bird species richness. We found that unclassified remote-sensed data, particularly spectral heterogeneity metrics, were better predictors of bird species richness than classified land cover data. The best results were achieved by models that included interactions between the unclassified data and landscape types, indicating that relationships between bird diversity and spectral heterogeneity vary across landscape types. Our findings demonstrate that spectral heterogeneity derived from unclassified multispectral data is effective for assessing bird diversity across the Czech Republic. When explaining bird species richness, it is important to account for the type of landscape and carefully consider the significance of the chosen spatial scale.

Early Antibody Dynamics in a Prospective Cohort of Children At Risk of Celiac Disease.

INTRODUCTION: The purpose of this study was to identify possible serum biomarkers predicting celiac disease (CD) onset in children at risk. METHODS: A subgroup from an ongoing, international prospective study of children at risk of CD was classified according to an early trajectory of deamidated gliadin peptides (DGPs) immunoglobulin (Ig) G and clinical outcomes (CD, potential CD, and CD autoimmunity). RESULTS: Thirty-eight of 325 children developed anti-tissue transglutaminase IgA antibody (anti-tTG IgA) seroconversion. Twenty-eight of 38 children (73.6%) showed an increase in anti-DGPs IgG before their first anti-tTG IgA seroconversion. DISCUSSION: Anti-DGPs IgG can represent an early preclinical biomarker predicting CD onset in children at risk.

Scopolamine-Induced Memory Impairment in Mice: Effects of PEA-OXA on Memory Retrieval and Hippocampal LTP.

Transient global amnesia, both persistent and transient, is a very common neuropsychiatric syndrome. Among animal models for amnesia and testing new drugs, the scopolamine test is the most widely used for transient global amnesia (TGA). This study examined the scopolamine-induced deficits in working memory, discriminative memory, anxiety, and motor activity in the presence of intranasal PEA-OXA, a dual antagonist of presynaptic α2 and H3 receptors. Male C57BL/6 mice were treated with intraperitoneal scopolamine (1 mg/kg) with or without pre-treatment (15 min) or post-treatment (15 min) with intranasal PEA-OXA (10 mg/kg). It was seen that scopolamine induced deficits of discriminative and spatial memory and motor deficit. These changes were associated with a loss of synaptic plasticity in the hippocampal dentate gyrus: impaired LTP after lateral entorhinal cortex/perforant pathway tetanization. Furthermore, hippocampal Ach levels were increased while ChA-T expression was reduced following scopolamine administration. PEA-OXA either prevented or restored the scopolamine-induced cognitive deficits (discriminative and spatial memory). However, the same treatment did not affect the altered motor activity or anxiety-like behavior induced by scopolamine. Consistently, electrophysiological analysis showed LTP recovery in the DG of the hippocampus, while the Ach level and ChoA-T were normalized. This study confirms the neuroprotective and pro-cognitive activity of PEA-OXA (probably through an increase in the extracellular levels of biogenic amines) in improving transient memory disorders for which the available pharmacological tools are obsolete or inadequate and not directed on specific pathophysiological targets.

Multiple, random spot urine sampling for estimating urinary sodium excretion.

The measurement of sodium intake may be important for the management of hypertension. Dietary surveys and 24-h urinary collection are often unreliable and/or impractical. We hypothesized that urinary sodium excretion can be accurately estimated through multiple spot urine samples from different days. All enrolled subjects were children of the coauthors of the study. Fifty-two 24-h urinary collections (4 per subject) for measuring sodium excretion and the 297 related urinary samples (1 per voiding) were collected for calculating the urinary sodium/urinary creatinine ratio in 13 children. The mean of 4 measured sodium excretions served as the individual "gold standard". Twenty-four urinary collections were used to generate the equation predicting the mean measured sodium excretion from the mean of 4 urinary sodium/urinary creatinine [= 0.016 × urinary sodium (mmol/L) / urinary creatinine (mmol/L) ratio + 3.3)]; the remaining 28 urinary collections and 153 urinary samples were used for the external validation. All subjects underwent an additional validation procedure involving 12 urinary samples randomly collected on different days 6 months apart. The performance of sodium excretion calculated from a total of over 22,000 possible means of 4 out of all the available urinary samples, randomly taken on different days, was analyzed as to precision (by means of the coefficient of variation) and as to accuracy (by means of the P30). The coefficients of variations of measured vs. calculated sodium excretion were 25.3% vs. 25.8%, and the P30 of calculated sodium excretion was 100%. The excellent performance of calculated sodium excretion was confirmed both by external validation and by samples collected 6 months apart with mean P30s, all between 86 and 100%.Conclusion: In the described experimental conditions, urinary sodium excretion was estimated with equal precision and more accurately (and practically) by the mean of 4 urinary sodium/urinary creatinine ratios from random samples from different days than by a single urinary collection. In real life, with several errors systematically affecting urinary collection, the superiority of calculated sodium excretion is likely to be even greater. What is Known: • The measurement of sodium intake with the current standards of care (dietary survey or 24-h urinary collection) is laborious and can be inaccurate. What is New: • The study provides evidence that sodium intake can be estimated equally precisely, more accurately and more practically with the urinary sodium-to-urinary creatinine ratio from 4 urine samples taken on different days than with a single urinary collection.

Don't Forget the Bones: Incidence and Risk Factors of Metabolic Bone Disease in a Cohort of Preterm Infants.

Metabolic bone disease of prematurity (MBD) is a condition of reduced bone mineral content (BMC) compared to that expected for gestational age (GA). Preterm birth interrupts the physiological process of calcium (Ca) and phosphorus (P) deposition that occurs mostly in the third trimester of pregnancy, leading to an inadequate bone mineralization during intrauterine life (IUL). After birth, an insufficient intake of Ca and P carries on this alteration, resulting in overt disease. If MBD is often a self-limited condition, in some cases it could hesitate the permanent alteration of bone structures with growth faltering and failure to wean off mechanical ventilation due to excessive chest wall compliance. Despite advances in neonatal intensive care, MBD is still frequent in preterm infants, with an incidence of 16−23% in very-low-birth-weight (VLBW, birth weight <1500 g) and 40−60% in extremely low-birth-weight (ELBW, birth weight <1000 g) infants. Several risk factors are associated with MBD (e.g., malabsorption syndrome, parenteral nutrition (PN), pulmonary bronchodysplasia (BPD), necrotizing enterocolitis (NEC), and some chronic medications). The aim of this study was to evaluate the rate of MBD in a cohort of VLBWI and the role of some risk factors. We enrolled 238 VLBWIs (107 male). 52 subjects were classified as increased risk (G1) and 186 as standard risk (G2) according to serum alkaline phosphatase (ALP) and phosphorus (P) levels. G1 subjects have lower GA (p < 0.01) and BW (p < 0.001). Moreover, they need longer PN support (p < 0.05) and invasive ventilation (p < 0.01). G1 presented a higher rate of BPD (p = 0.026). At linear regression analysis, BW and PN resulted as independent predictor of increased risk (p = 0.001, p = 0.040, respectively). Preventive strategies are fundamental to prevent chronic alteration in bone structures and to reduce the risk of short stature. Screening for MBD based on serum ALP could be helpful in clinical practice to identify subjects at increased risk.

Effect of Target Fortification on Osmolality and Microbiological Safety of Human Milk Over Time.

OBJECTIVES: The fortification of human milk can result in increased osmolality, which may be associated with adverse effects for preterm infants. To evaluate the effect of target fortification on the osmolality and microbiological safety of donor human milk and raw mature milk during the first 72 hours of storage. METHODS: We performed target fortification of 63 pasteurized donor human milk (PDHM) and 54 raw mature milk (RMM) samples in a laminar flow hood. Osmolality (mOsm/kg) was evaluated before fortification (T0), immediately after fortification (T1), at 6 (T2), 24 (T3), 48 (T4), and 72 hours (T5) after fortification. Microbiological analysis was performed at T0, T4, and T5. During the study, all samples were stored at 4°C. RESULTS: Mean osmolality at each study point for PDHM and RMM were, respectively: T0: 291.4 ±â€Š11.0 versus 288.4 ±â€Š5.6 (P = 0.06); T1: 384.8 ±â€Š16.7 versus 398.3 ±â€Š23.7; T2: 393.9 ±â€Š17.7 versus 410.1 ±â€Š27.0; T3: 397.8 ±â€Š17.6 versus 417.9 ±â€Š26.1; T4: 400.0 ±â€Š16.5 versus 420.2 ±â€Š24.9; T5: 399.6 ±â€Š16.5 versus 425.2 ±â€Š25.8 (P < 0.001 from T1 to T5). Microbiological analyses were negative at each study points for PDHM. At T0 16.1% of RMM samples had positive cultures, whereas the bacterial count remained stable thought the study. CONCLUSIONS: PDHM's osmolality increases during the first 6 hours after fortification and remains stable and safe until 72 hours. RMM's osmolality increases during the first 24 hours and remains stable and safe until 72 hours. The storage at 4°C and the manipulation of PDHM and RMM samples in a laminar flow hood seem to be safe and preserve the microbiological safety of fortified pasteurized human milk until 72 hours.

Multiple office blood pressure measurement: a novel approach to overcome the weak cornerstone of blood pressure measurement in children. Data from the SPA project.

BACKGROUND: This contribution aims to report and analyze a novel approach for office blood pressure measurement in children. METHODS: Healthy children 5 to 8 years of age were eligible. After 5 minutes rest, 10 unattended blood pressure readings were taken at 3-minute intervals using a validated automated oscillometric device. After discarding outlier values (< 5th or > 95th percentile of the recorded values), the coefficient of variation and the mean of the 10 readings were calculated. The single readings #1 to #10 were compared with this elaborated average of the 10 measurements. RESULTS: Two hundred eighty-one healthy, non-obese children (137 females, 49%), median age 5.7 (IQR 5.3-6.1) years, were analyzed. The median coefficients of variation were 7% (IQR 5-9) for systolic and 4% (IQR 3-6) for diastolic blood pressure. The first 3 measurements were significantly different from the average, while the readings #4 to #10 were not. Based on the average, only nine subjects had a systolic or diastolic blood pressure > 90th centile (n = 3 > 95th percentile). CONCLUSIONS: Although most guidelines advise three blood pressure readings, these findings suggest that in children, office blood pressure measurement might be improved by including ten measurements. In situations of time constraints, the fourth blood pressure reading might be used as a reliable approximation.

Macronutrient content of pooled donor human milk before and after Holder pasteurization.

BACKGROUND: Donor human milk (DHM) is the best alternative for preterm infants when their own mother's milk is unavailable. DHM should be pasteurized to guarantee microbiological safety; however, this process can influence the macronutrient content. The aim of this study was to investigate the effect of Holder pasteurization (HoP) on DHM macronutrient content. METHODS: Protein, lactose, lipids (g/100 ml) and energy (kcal/100 ml) of DHM pools were analysed before and after HoP (62.5 °C for 30 min) using mid-infrared spectroscopy (HM analyser Miris AB®). The mean macronutrient content before and after HoP was compared by paired t-test. The percentage decreases (Delta%) were calculated. RESULTS: The change in macronutrient content of 460 pools was determined. Protein, lipids and lactose decreased significantly after HoP (0.88 ± 0.20 vs 0.86 ± 0.20 and 2.91 ± 0.89 vs 2.75 ± 0.84 and 7.19 ± 0.41 vs 7.11 ± 0.48 respectively). The Delta% values were - 2.51 ± 13.12, - 4.79 ± 9.47 and - 0.92 ± 5.92 for protein, lipids and lactose, respectively (p ≤ 0.001). CONCLUSION: This study confirms that the macronutrient content of DHM, especially in terms of lipids and protein, is reduced after HoP. Therefore, in order to perform a tailored fortification of DHM, the clinicians need to be aware of the somewhat diminished nutrient content of DHM.

Can Basic Characteristics Estimate Body Composition in Early Infancy?

OBJECTIVES: Increasing evidence demonstrates that body composition in early life contributes to the programming of health later in life in both full-term and preterm infants. Given the important role of body composition, the increased availability of easy, noninvasive, and accurate techniques for its assessment has been recommended. The aim of the present study was to identify basic characteristics and anthropometric measurements that best correlate with body composition in infants. METHODS: Anthropometric measurements and body composition assessed by air-displacement plethysmography were assessed either at birth or at term-corrected age in 1239 infants (654 full-term, 585 preterm). The associations of sex, GA (gestational age), and weight with FFM (fat-free mass) and FM (fat mass) adjusted by length (g/cm) were investigated by multiple linear regression models. Bland-Altman tests were performed, and an equation for calculating FFM was determined. RESULTS: Preterm infants exhibited increased FM and reduced FFM compared with full-term infants (477.6 ±â€Š204 vs 259.7 ±â€Š147 g and 2583 ±â€Š494 vs 2770 ±â€Š364 g, respectively). GA, male sex, and weight were positively associated with FFM (r = 0.806, P < 0.0001; 6.1 g of average bias). GA and male sex were negatively associated with FM, whereas weight was positively associated with FM (r = 0.641, P < 0.0001; 4.9 g of average bias). CONCLUSIONS: The assessment of body composition represents the criterion standard. When body composition assessment is not feasible, the equation based on sex, GA, and anthropometric measurements can be useful in predicting body composition in both full-term and preterm infants.

Complement functional tests for monitoring eculizumab treatment in patients with atypical hemolytic uremic syndrome: an update.

BACKGROUND: Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy (TMA) characterized by platelet consumption, hemolysis, and organ damage. Eculizumab (ECU), a humanized antibody that blocks complement activity, has been successfully used in aHUS, but the best treatment schedule is not yet clear. METHODS: Here, we report our experience with ECU maintenance treatment and the interval between subsequent doses being extended based on global classical complement pathway (CCP) activity aimed at <30% for maintaining aHUS into remission. RESULTS: We report on 38 patients with aHUS, 13 children, 21 female, with a median age of 25.0 years (range 0.5-60) at disease onset treated with ECU standard schedule for a median of 2.6 months (range 0.4-24.6). Once stable TMA remission was obtained, the interval between ECU doses was extended based on complement function, with a target CCP activity of <30%. With this approach, 22 patients regularly receive ECU infusion every 28 days and 16 every 21. During a median observation period on ECU, an extended interval of 26.9 months (range 0.8-80.9), with a cumulative observation period of 1,208 months, none of the patients relapsed. CONCLUSION: Monitoring complement activity allows a safe reduction in the frequency of ECU administration in aHUS while keeping the disease in remission.

Unacylated ghrelin and obestatin: promising biomarkers of protein energy wasting in children with chronic kidney disease.

BACKGROUND: Impairment in orexigenic/anorexigenic hormone balance may be key in the pathogenesis of protein energy wasting in children with chronic kidney disease (CKD). Measurement of ghrelin and obestatin concentrations in children with CKD would help assess the potential contribution of these hormones to uremic protein energy wasting. METHODS: This was a cross-sectional case-control study. Acylated and unacylated ghrelin and obestatin were measured in 42 children on conservative treatment (CT), 20 children on hemodialysis, 48 pediatric renal transplant (RTx) recipients and 43 controls (CTR) (mean age 11.9, range 5-20 years). Weight, height and bicipital, tricipital, subscapular and suprailiac folds were measured, and the body mass index-standard deviation score (BMI-SDS), percentage of fat mass and fat-free mass were calculated. Urea and creatinine were measured and the glomerular filtration rate (GFR) calculated. RESULTS: Unacylated ghrelin level was higher in patients than controls (p = 0.0001), with the highest levels found in hemodialysis patients (p = 0.001 vs. CKD-CT, p = 0.0001 vs. RTx, p < 0.0001 vs. CTR). Obestatin level was significantly higher in patients on hemodialysis than those on conservative treatment, RTx recipients and controls (p < 0.0001 in each case). Unacylated ghrelin negatively correlated with weight-SDS (p < 0.0001), BMI-SDS (p = 0.0005) and percentage fat mass (p = 0.004) and positively correlated with percentage fat-free mass (p = 0.004). Obestatin concentration negatively correlated with weight-SDS (p = 0.007). Unacylated ghrelin and obestatin concentrations positively correlated with creatinine and urea and inversely with eGFR, even after adjustments for gender, age, puberty and BMI-SDS (p < 0.0001 for each model). CONCLUSIONS: Unacylated ghrelin and obestatin, negatively related to renal function, seem to be promising inverse indicators of nutritional status in children with CKD. Potential therapeutic implications in terms of optimization of their removal in patients on hemodialysis could be hypothesized.

Bioimpedance-based rather than weight-based ultrafiltration prescription for children on maintenance hemodialysis
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The determination of dry weight (DW) in young children on hemodialysis (HD) remains challenging. Bioimpedance analysis (BIA) is a potentially helpful means of estimating the need for ultrafiltration and monitoring body fluids in patients on renal replacement therapy, but its role has not yet been clearly defined. The aim of this paper is to share our experience of prescribing ultrafiltration on the basis of BIA parameters alone. The body weight (BW), resistance (Rx), and reactance (Xc) of a 3-year-old girl on chronic HD were recorded pre- and post-HD over a period of 16 months. The BIA parameter that best correlated with actual ultrafiltration (the difference between pre- and post-HD BW) was identified, and the equivalence between actual ultrafiltration and changes in Xc was derived to obtain the following equation: 1 ohm of Xc = 27.4 g of ultrafiltration. Finally, during 21 consecutive HD sessions, ultrafiltration was exclusively prescribed on the basis of the derived equation (BIA-based prescription) after having defined a target post-HD Xc of 45 ohm. The BIA-based prescription period was compared with 21 consecutive HD sessions in which ultrafiltration was prescribed using the conventional approach based on BW (BW-based prescription). Comparison of BIA-based and BW-based ultrafiltration prescription showed significantly fewer HD sessions complicated by hypotension (19 vs. 50%) or by the need for reinfusion (5 vs. 50%), and a better overall quality of HD sessions (86 vs. 37%). No difference in blood pressure was observed, and no acute fluid overload event was detected in either period. BIA-based ultrafiltration seems to be safe, feasible, and effective. The described approach can be particularly useful in the case of patients with problems in setting or maintaining the correct DW.
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A simple prognostic index for Shigatoxin-related hemolytic uremic syndrome at onset: data from the ItalKid-HUS network.

Shigatoxin Escherichia coli-related hemolytic uremic syndrome (eHUS) is a severe thrombotic microangiopathy (TMA) burdened by life-threatening complications and long-term sequelae. Since hemoconcentration is associated with worse outcome, we tried to develop a reliable and easy-to-calculate index for predicting complications and sequelae based on hemoglobin (Hb) at presentation. The first laboratory examinations with signs of TMA in eHUS patients were analyzed in relation to the outcomes with the receiver operating characteristic curves and their areas under the curve (AUC) for Hb and creatinine (sCr). A total of 197 eHUS patients were identified of whom 24% did not have anemia at presentation. Hb level was the best predictor of a poor outcome (AUC 0.67) but the combination of Hb with sCr, in the formula [(Hb in g/dL + (sCr in mg/dL × 2)], showed an even better AUC of 0.75. The described scoring system was also strongly associated and predictive of all complications and health care needs (8% of patients with scoring > 13 died or entered a permanent vegetative state compared with 0% of those with ≤ 13).Conclusion: The presented score is a simple and early predictor of both short- and long-term outcomes and identifies patients who should undergo rapid volume expansion to counteract hemoconcentration, the spreading of microvascular thrombosis, and the consequent increased organ damage. What is Known: • In eHUS, hemoconcentration is associated with worse short- and long-term outcome. • A prognostic index to identify patients at higher risk for complications at presentation is not available. What is New: • We developed a simple and early prognostic index for eHUS outcome with the combination of Hb and sCr at onset, in the following formula [(Hb in g/dL + (sCr in mg/dL × 2)]. • The proposed HUS Severity Score can promptly identify patients with good outcome and those with high risk of worse short- and long-term outcome.

Serum creatinine during physiological perinatal dehydration may estimate individual nephron endowment.

It is well known that the nephron endowment of healthy subjects is highly variable and that individual nephron mass has potentially important implications both in health and disease. However, nephron count is technically impossible in living subjects. Based on the observation of an increase in serum creatinine (sCr) in otherwise healthy newborns with solitary kidney during the physiological perinatal dehydration, we hypothesized that perinatal sCr might be helpful in identifying healthy subjects with a reduced nephron mass. In the framework of a study on blood pressure in babies (NeoNeph), sCr of normal Caucasian neonates was determined 48-96 h after birth and their association with a family history of arterial hypertension (AH) was analyzed. SCr was determined in 182 normal newborns (90 males) at a mean of 61 ± 8 h after birth (range 46-82). Newborns with paternal AH had a higher mean sCr (0.97 + 0.28 mg/dL) then newborns without paternal AH (0.73 + 0.28 mg/dL; p = 0.006). No differences in mean sCr were found in relation with mother or grandparent's history of AH. CONCLUSION: The association between parental AH and high sCr during perinatal dehydration supports the hypothesis that the latter is a promising tool for identifying normal subjects with a reduced nephron mass with potential important implications in prevention and in understanding the individual outcome of renal and extrarenal diseases (including AH). What is Known: • Nephron endowment of healthy subjects is highly variable and individual nephron mass has potentially important implications both in health and disease however nephron count is not feasible in living subjects. What is New: • Serum creatinine during perinatal dehydration is a possible biomarker for identifying normal subjects with a reduced nephron mass.

Role of climate in the spread of shiga toxin-producing Escherichia coli infection among children.

Haemolytic-uraemic syndrome (HUS) is a rare disease mainly affecting children that develops as a complication of shiga toxin-producing Escherichia coli (STEC) infection. It is characterised by acute kidney injury, platelet consumption and mechanical destruction of red blood cells (haemolysis). In order to test the working hypothesis that the spread of the infection is influenced by specific climatic conditions, we analysed all of the identified cases of infection occurring between June 2010 and December 2013 in four provinces of Lombardy, Italy (Milano, Monza Brianza, Varese and Brescia), in which a STEC surveillance system has been developed as part of a preventive programme. In the selected provinces, we recorded in few days a great number of cases and clusters which are unrelated for spatially distant or for the disease are caused by different STEC serotypes. In order to investigate a common factor that favoured the onset of infection, we have analysed in detail the weather conditions of the areas. The daily series of temperature, rain and relative humidity were studied to show the common climate peculiarities whilst the correlation coefficient and the principal component analysis (PCA) were used to point out the meteorological variable, maximum temperature, as the principal climate element in the onset of the infection. The use of distributed lag non-linear models (DLNM) and the climate indices characterising heat waves (HWs) has allowed to identify the weather conditions associated with STEC infection. The study highlighted a close temporal correlation between STEC infection in children and the number, duration and frequency of heat waves. In particular, if the maximum temperature is greater than 90th percentile, days classified as very hot, for 3 or more consecutive days, the risk of infection is increasing.

Accuracy of Prediction Formulae for the Assessment of Resting Energy Expenditure in Hospitalized Children.

BACKGROUND AND AIM: The resting energy expenditure (REE) of ill children is commonly estimated from prediction formulae developed in healthy children. The aim of the present study was to evaluate the accuracy of commonly employed REE prediction formulae versus indirect calorimetry in hospitalized children. METHODS: We performed a cross-sectional study of 236 infants, children, and adolescents consecutively admitted to the Intermediate Care, Nephrology, Intensive Care, Emergency, and Cystic Fibrosis Units of the De Marchi Pediatric Hospital (Milan, Italy) between September 2013 and March 2015. REE was measured by indirect calorimetry and estimated using the World Health Organization (WHO), Harris-Benedict, Schofield, and Oxford formulae. RESULTS: The mean (standard deviation) difference between the estimated and measured REE was: -1 (234) kcal/day for the WHO formula; 82 (286) kcal/day for the Harris-Benedict formula; 2 (215) kcal/day for the Schofield-weight formula; -2 (214) kcal/day for the Schofield-weight and height formula; and -5 (221) kcal/day for the Oxford formula. Even though the WHO, Schofield, and Oxford formulae gave accurate estimates of REE at the population level (small mean bias), all the formulae were not accurate enough to be employed at the individual level (large SD of bias). CONCLUSIONS: The WHO, Harris-Benedict, Schofield, and Oxford formulae should not be used to estimate REE in hospitalized children.