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1.
J Pediatr Gastroenterol Nutr ; 72(5): 728-735, 2021 05 01.
Article in English | MEDLINE | ID: mdl-33399329

ABSTRACT

OBJECTIVES: Mucosal healing (MH) and histological healing (HH) have been recently proposed as a novel treatment target for inflammatory bowel disease (IBD). The aim of the present study was to evaluate real-life achievement of such outcomes in a cohort of pediatric patients with IBD treated with anti-TNF-alpha (ATA) agents. METHODS: A retrospective analysis was performed on patients affected by IBD who received ATA and were followed up at two referral centers. Incidence and cumulative rates for MH and HH for each group were calculated. RESULTS: Of 170 (105 Crohn's disease [CD] and 65 ulcerative colitis [UC]) patients, 78 with CD and 56 with UC underwent endoscopic re-assessment during the study period. MH was achieved by 32 CD (41%) and 30 UC (53.6%) patients; 26 CD (33.3%) and 22 UC (39.3%) patients achieved HH. MH incidence rate was 19.1/1000 and 47/1000 person-months, whereas HH incidence rate was 15.5/1000 and 34.7/1000 person-months for CD and UC, respectively. Remission at the end of induction was associated with higher MH and HH rates (HR: 2.43, P = 0.049 and HR: 2.94, P = 0.046, respectively) in CD. In UC, adalimumab was associated with lower MH and HH rates (HR: 0.16, P = 0.004 and HR: 0.07, P = 0.003). CONCLUSIONS: We reported a real-life experience arising from a large cohort of pediatric IBD who received ATA scheduled treatment. Less than half of patients with CD and only a little >50% of UC patients achieved MH. Microscopical inflammation was observed in 18.8% CD and 26.7% UC patients who achieved MH. Overall, MH and HH rates appear lower compared to previously published data.


Subject(s)
Colitis, Ulcerative , Inflammatory Bowel Diseases , Child , Colitis, Ulcerative/drug therapy , Humans , Inflammatory Bowel Diseases/drug therapy , Necrosis , Retrospective Studies , Tumor Necrosis Factor Inhibitors
2.
Cereb Cortex ; 30(11): 6039-6050, 2020 10 01.
Article in English | MEDLINE | ID: mdl-32582916

ABSTRACT

Protocadherin-19 (PCDH19) is a calcium dependent cell-adhesion molecule involved in neuronal circuit formation with prevalent expression in the limbic structures. PCDH19-gene mutations cause a developmental encephalopathy with prominent infantile onset focal seizures, variably associated with intellectual disability and autistic features. Diagnostic neuroimaging is usually unrevealing. We used quantitative MRI to investigate the cortex and white matter in a group of 20 PCDH19-mutated patients. By a statistical comparison between quantitative features in PCDH19 brains and in a group of age and sex matched controls, we found that patients exhibited bilateral reductions of local gyrification index (lGI) in limbic cortical areas, including the parahippocampal and entorhinal cortex and the fusiform and lingual gyri, and altered diffusivity features in the underlying white matter. In patients with an earlier onset of seizures, worse psychiatric manifestations and cognitive impairment, reductions of lGI and diffusivity abnormalities in the limbic areas were more pronounced. Developmental abnormalities involving the limbic structures likely represent a measurable anatomic counterpart of the reduced contribution of the PCDH19 protein to local cortical folding and white matter organization and are functionally reflected in the phenotypic features involving cognitive and communicative skills as well as local epileptogenesis.


Subject(s)
Limbic System/physiopathology , Protocadherins/genetics , Spasms, Infantile/genetics , Spasms, Infantile/physiopathology , Adolescent , Adult , Brain Mapping/methods , Child , Child, Preschool , Female , Humans , Infant , Magnetic Resonance Imaging/methods , Male , Mutation , White Matter/physiopathology , Young Adult
3.
J Environ Manage ; 296: 113365, 2021 Oct 15.
Article in English | MEDLINE | ID: mdl-34351287

ABSTRACT

The removal of dyes from wastewater is an important topic in environmental applications. Methylene blue (MB) is one of the most worrisome compounds, as it is widespread and used in many industrial activities. Adsorption represents an effective technique for the removal of this contaminant. Thermo plasma expanded graphite (TPEG) is an industrial material characterized by a fibrous morphology, a very low density and overlapped graphene layers. TPEG has a higher specific surface compared to conventional thermo-expanded graphite and it can establish effective attractive forces with charged pollutants. These properties make TPEG a very promising adsorbent material. In the present work, TPEG was tested in an innovative multilayer column system to treat MB contaminated solutions. Several batch experiments were carried out by varying pH, initial MB concentration and temperature. The optimal adsorption performance was assessed at pH 11, around which the TPEG assumed the maximum negative charge. Based on these results, the adsorption mechanism appeared to be related mainly to electrostatic interactions. At room temperature, the greatest amount of MB adsorbed on TPEG was detected by treating solutions with an initial concentration of 30 mgMB/L. The temperature increase from 20 to 40 °C caused an enhanced adsorption capacity when concentrations higher than 10 mgMB/L were treated. The adsorption trends were accurately described by a pseudo-second order kinetic law and the adsorption isotherms at 20 and 40 °C were found to follow both the features of Freundlich and Langmuir models. The adsorption capacity was estimated to reach threshold values around 95 mgMB/gTPEG and 265 mgMB/gTPEG at 20 and 40°C, respectively. The Gibbs energy change (ΔG°) was calculated to about -7.80 kJ/mol, which proved that the process is spontaneous from a thermodynamic point of view. Finally, it was verified that TPEG can be efficiently reused 5 times after a simple chemical regeneration phase with HCl.


Subject(s)
Graphite , Water Pollutants, Chemical , Water Purification , Adsorption , Hydrogen-Ion Concentration , Kinetics , Methylene Blue , Thermodynamics
4.
Epilepsia ; 61(2): 216-227, 2020 02.
Article in English | MEDLINE | ID: mdl-31876960

ABSTRACT

OBJECTIVE: To profile European trends in pediatric epilepsy surgery (<16 years of age) between 2008 and 2015. METHODS: We collected information on volumes and types of surgery, pathology, and seizure outcome from 20 recognized epilepsy surgery reference centers in 10 European countries. RESULTS: We analyzed retrospective aggregate data on 1859 operations. The proportion of surgeries significantly increased over time (P < .0001). Engel class I outcome was achieved in 69.3% of children, with no significant improvement between 2008 and 2015. The proportion of histopathological findings consistent with glial scars significantly increased between the ages of 7 and 16 years (P for trend = .0033), whereas that of the remaining pathologies did not vary across ages. A significant increase in unilobar extratemporal surgeries (P for trend = .0047) and a significant decrease in unilobar temporal surgeries (P for trend = .0030) were observed between 2008 and 2015. Conversely, the proportion of multilobar surgeries and unrevealing magnetic resonance imaging cases remained unchanged. Invasive investigations significantly increased, especially stereo-electroencephalography. We found different trends comparing centers starting their activity in the 1990s to those whose programs were developed in the past decade. Multivariate analysis revealed a significant variability of the proportion of the different pathologies and surgical approaches across countries, centers, and age groups between 2008 and 2015. SIGNIFICANCE: Between 2008 and 2015, we observed a significant increase in the volume of pediatric epilepsy surgeries, stability in the proportion of Engel class I outcomes, and a modest increment in complexity of the procedures.


Subject(s)
Epilepsy/surgery , Neurosurgery/trends , Neurosurgical Procedures/trends , Adolescent , Age Factors , Child , Child, Preschool , Electroencephalography , Epilepsy/epidemiology , Epilepsy/pathology , Europe/epidemiology , Female , Humans , Magnetic Resonance Imaging , Male , Neurosurgery/statistics & numerical data , Neurosurgical Procedures/statistics & numerical data , Retrospective Studies , Seizures/epidemiology , Temporal Lobe/diagnostic imaging , Temporal Lobe/surgery , Treatment Outcome
5.
J Sep Sci ; 43(5): 886-895, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31849166

ABSTRACT

Pharmaceuticals constitute one of the most important emerging classes of environmental pollutants. A three-phase solvent system of water, water containing 0.1% of formic acid and acetonitrile was successfully used to separate, by liquid chromatography with mass spectrometry (LC-MS), polarity-matched pharmaceuticals, that is, carbamazepine, clarithromycin, and erythromycin, as well as amoxicillin and metformin. Despite of polarity similarities, these pharmaceuticals were completely resolved in the analytical run time of 15 min. The optimized three-phase solvent system based-method was validated for the simultaneous analysis of six matched-polarity pharmaceuticals in wastewater samples. Good linearity (coefficient of determination more than 0.993) and precision (relative standard deviation less than 15.66%) were achieved. Recovery of analytes from the wastewater was between 0.70 and 1.18. Limits of detections ranged from 0.0001 to 0.5114 µg/L. No significant matrix effect, evaluated by post extraction addition, was observed in the electrospray ionization (ESI) source. Then, this methodology has been successfully applied to environmental study of pharmaceutical residues occurring in influent and effluent wastewater samples, from the main wastewater treatment plant in Potenza (Basilicata, Southern Italy).


Subject(s)
Amoxicillin/isolation & purification , Carbamazepine/isolation & purification , Clarithromycin/isolation & purification , Erythromycin/isolation & purification , Metformin/isolation & purification , Water Pollutants, Chemical/isolation & purification , Amoxicillin/chemistry , Carbamazepine/chemistry , Chromatography, Liquid , Clarithromycin/chemistry , Erythromycin/chemistry , Metformin/chemistry , Particle Size , Solvents/chemistry , Surface Properties , Tandem Mass Spectrometry , Wastewater/chemistry , Water Pollutants, Chemical/chemistry
6.
Epilepsia ; 60(11): 2255-2262, 2019 11.
Article in English | MEDLINE | ID: mdl-31630399

ABSTRACT

OBJECTIVE: To assess the long-term efficacy and tolerability of stiripentol (STP) as an adjunctive treatment in different forms of refractory epilepsies. METHODS: The medical records of all individuals consecutively treated with STP as add-on therapy for refractory epilepsies, irrespective of their being focal, generalized, or both, and followed at Meyer Children's Hospital between January 2007 and May 2018, were reviewed. The drug scheme administration consisted of a starting dose of STP of 10-15 mg/kg/d with increments every week, up to a maximum of 50 mg/kg/d, based on both age and weight. Etiology of epilepsy was codified as structural, genetic, infectious, immune, metabolic, and unknown. Responders were defined as patients who achieved a seizure frequency reduction of ≥50%. Retention rate was defined as the probability of continuing STP without additional therapy. Tolerability was assessed by reporting adverse events. RESULTS: A total of 132 individuals aged from 5 months to 43 years received add-on STP, including 30 patients with Dravet syndrome (DS). The median follow-up was 14.8 months (range = 4 months-18 years, interquartile range = 25.72). Twenty-nine individuals (22%) received more than two antiepileptic drugs. Benzodiazepines, mainly clobazam, were the most commonly used add-on drugs. Sixty-six patients (50%) were responders, and 13 of them (9.8%) were seizure-free. Responder rate was higher in the genetic etiology group (57%), especially in DS (18/30; 60%), and in patients with refractory focal onset epilepsy without bilateral tonic-clonic seizures (5/15; 33%). The median relapse-free survival was 27 months in the 66 responders. The median time to STP failure was 24.6 months in all 132 individuals. SIGNIFICANCE: This study confirms the long-term efficacy of add-on STP treatment in patients with different types of refractory epilepsies, including focal onset epilepsy without bilateral tonic-clonic seizures. Further confirmations based on prospectively designed studies are required to confirm STP efficacy in focal epilepsy.


Subject(s)
Anticonvulsants/administration & dosage , Dioxolanes/administration & dosage , Drug Resistant Epilepsy/diagnosis , Drug Resistant Epilepsy/drug therapy , Adolescent , Adult , Child , Child, Preschool , Drug Therapy, Combination , Female , Humans , Infant , Male , Prospective Studies , Retrospective Studies , Time Factors , Treatment Outcome , Young Adult
7.
Epilepsia ; 60(4): 689-706, 2019 04.
Article in English | MEDLINE | ID: mdl-30866059

ABSTRACT

OBJECTIVE: Copy number variations (CNVs) represent a significant genetic risk for several neurodevelopmental disorders including epilepsy. As knowledge increases, reanalysis of existing data is essential. Reliable estimates of the contribution of CNVs to epilepsies from sizeable populations are not available. METHODS: We assembled a cohort of 1255 patients with preexisting array comparative genomic hybridization or single nucleotide polymorphism array based CNV data. All patients had "epilepsy plus," defined as epilepsy with comorbid features, including intellectual disability, psychiatric symptoms, and other neurological and nonneurological features. CNV classification was conducted using a systematic filtering workflow adapted to epilepsy. RESULTS: Of 1097 patients remaining after genetic data quality control, 120 individuals (10.9%) carried at least one autosomal CNV classified as pathogenic; 19 individuals (1.7%) carried at least one autosomal CNV classified as possibly pathogenic. Eleven patients (1%) carried more than one (possibly) pathogenic CNV. We identified CNVs covering recently reported (HNRNPU) or emerging (RORB) epilepsy genes, and further delineated the phenotype associated with mutations of these genes. Additional novel epilepsy candidate genes emerge from our study. Comparing phenotypic features of pathogenic CNV carriers to those of noncarriers of pathogenic CNVs, we show that patients with nonneurological comorbidities, especially dysmorphism, were more likely to carry pathogenic CNVs (odds ratio = 4.09, confidence interval = 2.51-6.68; P = 2.34 × 10-9 ). Meta-analysis including data from published control groups showed that the presence or absence of epilepsy did not affect the detected frequency of CNVs. SIGNIFICANCE: The use of a specifically adapted workflow enabled identification of pathogenic autosomal CNVs in 10.9% of patients with epilepsy plus, which rose to 12.7% when we also considered possibly pathogenic CNVs. Our data indicate that epilepsy with comorbid features should be considered an indication for patients to be selected for a diagnostic algorithm including CNV detection. Collaborative large-scale CNV reanalysis leads to novel declaration of pathogenicity in unexplained cases and can promote discovery of promising candidate epilepsy genes.


Subject(s)
Epilepsy/genetics , Comorbidity , DNA Copy Number Variations , Epilepsy/complications , Genetic Predisposition to Disease , Genotype , Humans , Phenotype
8.
Eur J Pediatr ; 178(6): 913-921, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30944985

ABSTRACT

Several studies have shown the efficacy of psychological interventions in reducing preoperative anxiety in children undergoing surgery. This study aims to investigate the effectiveness of a specific non-pharmacological technique, the relaxation-guided imagery, in reducing both preoperative anxiety and postoperative pain in a sample of 60 children (6-12 years old) undergoing minor surgery who were randomly assigned to the experimental group (N = 30) or the control group (N = 30). The first group received the relaxation-guided imagery, before the induction of general anesthesia; the second group received standard care. The levels of preoperative anxiety and postoperative pain were assessed using, respectively, the modified Yale Preoperative Anxiety Scale and the Face, Legs, Activity, Cry, and Consolability Scale. The results showed a statistically significant difference between groups, with less anxiety and less pain for children included in the experimental group (p < .001; p < .001).Conclusion: Results suggest that relaxation-guided imagery reduces preoperative anxiety and postoperative pain in children. Future studies should focus on developing protocols and studying the eventual reduction of administered drugs for anesthesia and pain. What is Known: • Literature suggests the usefulness of relaxation-guided imagery in reducing anxiety and pain in the perioperative period. • Stronger evidences are needed to support the application of relaxation-guided imagery as routine care in pediatric surgery. What is New: • To our knowledge, this is the first randomized study to investigate the efficacy of relaxation-guided imagery in reducing preoperative anxiety and postoperative pain within a single pediatric sample. • The present study provides stronger evidence in an area that is lacking in research.


Subject(s)
Anxiety/therapy , Imagery, Psychotherapy/methods , Pain, Postoperative/therapy , Relaxation Therapy/methods , Anxiety/diagnosis , Anxiety/psychology , Child , Female , Humans , Male , Pain, Postoperative/psychology , Preoperative Care/psychology , Relaxation Therapy/psychology , Treatment Outcome
9.
Epilepsia ; 59(5): 1004-1010, 2018 05.
Article in English | MEDLINE | ID: mdl-29663335

ABSTRACT

OBJECTIVE: To assess long-term efficacy and tolerability of lacosamide (LCM) as adjunctive treatment through a retrospective study in children and adolescents with refractory epilepsies. METHODS: All patients consecutively treated with LCM as add-on for refractory focal and generalized epilepsy and followed at the Neuroscience Center of Excellence of the Meyer Children's Hospital of Florence between January 2011 and September 2015 were included in the study. Responder rate, relapse-free survival, and retention rate were calculated. Tolerability was assessed by reporting adverse events. RESULTS: A total of 88 individuals (41 female) aged 4 months to 18 years (median 10.5 years; mean ± SD 10.6 ± 4.8 years) received add-on LCM treatment for refractory epilepsy. Thirty-four patients (38.6%) were responders with a median time to relapse of 48 months. Nine (26.4%) of the 34 responders were seizure-free. For all 88 patients, the probability of remaining on LCM without additional therapy was 74.4% at 6 months, 47.7% at 12 months, 27.9% at 24 months, 18.0% at 48 months, and 8.2% at 72 months of follow-up. No statistically significant differences in relapse and retention time were observed with regard to epilepsy and seizure types, duration and course of epilepsy, number and type of antiepileptic drugs (AEDs; sodium channel blockers vs others) used in add-on. The most frequent adverse events were dermatological (4/11) and behavioral (3/11). SIGNIFICANCE: This study documents a real-world progressive and significant loss of LCM efficacy over time in a pediatric population. Further prospective studies on larger populations are required to confirm the remarkable loss of LCM efficacy over time.


Subject(s)
Anticonvulsants/therapeutic use , Drug Resistant Epilepsy/drug therapy , Lacosamide/therapeutic use , Adolescent , Child , Child, Preschool , Drug Therapy, Combination/methods , Female , Humans , Infant , Kaplan-Meier Estimate , Male , Progression-Free Survival , Retrospective Studies
10.
Epilepsia ; 59(2): 297-314, 2018 02.
Article in English | MEDLINE | ID: mdl-29270989

ABSTRACT

OBJECTIVE: To estimate the comparative efficacy among antiepileptic drugs in the pediatric population (0-18 years). METHODS: Using the Embase and MEDLINE databases, we updated to February 2017 the search strategy of the National Institute for Health and Care Excellence guidelines for epilepsy. We only included randomized clinical trials conducted in children and mixed-age populations. According to the PRISMA network meta-analysis guideline, the study-level quality assessment was made with the Cochrane risk-of-bias tool. Three investigators independently selected articles. The efficacy outcome was considered to be seizure freedom or ≥50% seizure reduction. RESULTS: We selected 46 randomized clinical trials. A total of 5652 individuals were randomized to 22 antiepileptic drugs and placebo. The point estimates of carbamazepine and lamotrigine efficacy showed their superiority with respect to all comparator antiepileptic drugs for the treatment of newly diagnosed focal epilepsy. In refractory focal epilepsy, levetiracetam (odds ratio [OR] = 3.3, 95% credible interval [CrI] = 1.3-7.6) and perampanel (OR = 2.5, 95% CrI = 1.1-5.8) were more effective compared to placebo. Ethosuximide and valproic acid were both superior to lamotrigine against absence seizures. The OR point estimate showed the superiority of adrenocorticotropic hormone over all comparators in infantile spasms. A wide heterogeneity in the length of follow-up was observed among the studies. SIGNIFICANCE: This network meta-analysis suggests that the quality of studies should be improved through the use of comparative designs, relevant outcomes, appropriate follow-up length, and more reliable inclusion criteria.


Subject(s)
Anticonvulsants/therapeutic use , Epilepsy/drug therapy , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adrenocorticotropic Hormone/therapeutic use , Carbamazepine/therapeutic use , Child , Child, Preschool , Drug Resistant Epilepsy/drug therapy , Epilepsies, Partial/drug therapy , Epilepsy, Absence/drug therapy , Ethosuximide/therapeutic use , Hormones/therapeutic use , Humans , Infant , Lamotrigine , Levetiracetam , Network Meta-Analysis , Nitriles , Odds Ratio , Piracetam/analogs & derivatives , Piracetam/therapeutic use , Pyridones/therapeutic use , Spasms, Infantile/drug therapy , Treatment Outcome , Triazines/therapeutic use , Valproic Acid/therapeutic use
11.
Clin Exp Rheumatol ; 36(5): 929-933, 2018.
Article in English | MEDLINE | ID: mdl-30148444

ABSTRACT

OBJECTIVES: Juvenile idiopathic arthritis (JIA) may affect natural growth. The aim of the study has been to assess auxological parameters of JIA patients, receiving different anti-rheumatic treatments. METHODS: This is a retrospective study; JIA patients were recruited from the Rheumatology Unit of Anna Meyer Children's University Hospital of Florence, Italy from March 1996 to June 2016. RESULTS: Two hundred and thirty-two patients were included in the current study. The best result in terms of catch-up growth occurred in systemic JIA patients. All JIA categories showed standard deviation score (SDS) gain for height except those belonging to enthesitis related arthritis category. Patients treated with disease-modifying anti-rheumatic drugs (DMARDs) only maintained constant growth during study follow-up. Patients who needed biologic therapy showed an impaired growth during pre-DMARDs treatment and an increased growth velocity mostly during biologic therapy. Body mass index (BMI) decreased in almost all JIA categories. The best BMI reduction was observed among patient receiving biologic drugs. CONCLUSIONS: Patients with JIA followed in our centre had a gain of height SDS and lost BMI SDS in 5 years of follow-up. We observed a stable and good pattern of growth in patients treated with DMARDs and an increased growth velocity during biologic treatment.


Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Juvenile/drug therapy , Biological Products/therapeutic use , Body Height , Body Mass Index , Child Development , Age Factors , Antirheumatic Agents/adverse effects , Arthritis, Juvenile/diagnosis , Arthritis, Juvenile/physiopathology , Biological Products/adverse effects , Child , Child, Preschool , Female , Humans , Infant , Italy , Male , Retrospective Studies , Time Factors , Treatment Outcome
12.
Article in English | MEDLINE | ID: mdl-29596026

ABSTRACT

The post-management of landfills represents an important challenge for landfill gas treatment. Traditional systems (energy recovery, flares, etc.) present technical problems in treating flow with low methane (CH4) concentrations. The objective of this study was to isolate methanotrophic bacteria from a field-scale biofilter in order to study the bacteria in laboratories and evaluate the environmental factors that mostly influence Microbial Aerobic Methane Oxidation (MAMO). The soil considered was sampled from the biofilter located in the landfill of Venosa (Basilicata Region, Italy) and it was mainly composed of wood chips and compost. The results showed that methanotrophic microorganisms are mainly characterized by a slow growth and a significant sensitivity to CH4 levels. Temperature and nitrogen (N) also have a very important role on their development. On the basis of the results, biofilters for biological CH4 oxidation can be considered a viable alternative to mitigate CH4 emissions from landfills.


Subject(s)
Bacteria/growth & development , Environment , Methane/analysis , Methane/metabolism , Soil/chemistry , Waste Disposal Facilities , Humans , Italy , Laboratories , Oxidation-Reduction , Refuse Disposal/methods , Soil Microbiology , Temperature , Wood/chemistry
13.
Bull Environ Contam Toxicol ; 101(6): 698-704, 2018 Dec.
Article in English | MEDLINE | ID: mdl-29992459

ABSTRACT

Lab-scale experiments on three soil matrices featured by increasing granulometry (sea sand, silica sand and gravel) were carried out in order to evaluate the adsorption capability and the removal efficiency of a new graphene-based material. Soil samples, firstly contaminated with different quantities of used lubricant oil up to final concentrations of 12.5, 25.0, 50.0 g kg-1, were treated with an opportune amount of thermally expanded graphite (TEG) (i.e. 1/10, 1/20, 1/40 as TEG/pollutant ratio). Results show that the removal efficiency of TEG is directly correlated to the contamination level of the soil. The best removal efficiency (87.04%) was obtained during the treatment of gravel samples at the maximum contamination level by using the highest dosage of TEG. A good removal efficiency (80.83%) was also achieved using lower TEG/pollutant ratio. Moreover, TEG at ratio 1/10 showed worse removal efficiencies in treating sea (81.17%) and silica sand (63.52%) than gravel. In this study, also the thermal regeneration was investigated in order to evaluate a possible reuse of TEG with subsequent technical and economic advantages. TEG-technique proves to be technologically and economically competitive with other currently used technologies, revealing the best choice for the remediation of hydrocarbon-contaminated soils.


Subject(s)
Graphite/chemistry , Hydrocarbons/chemistry , Soil Pollutants/chemistry , Soil/chemistry , Adsorption , Environmental Pollution/analysis , Environmental Restoration and Remediation/methods , Hot Temperature
14.
Epilepsy Behav ; 75: 151-157, 2017 10.
Article in English | MEDLINE | ID: mdl-28866334

ABSTRACT

OBJECTIVE: The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. METHODS: A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. RESULTS: Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. SIGNIFICANCE: This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome.


Subject(s)
Epilepsy/surgery , Practice Patterns, Physicians'/trends , Seizures/surgery , Adolescent , Child , Child, Preschool , Epilepsy/etiology , Female , Follow-Up Studies , Health Care Surveys , Humans , Infant , Italy , Male , Retrospective Studies , Seizures/etiology , Temporal Lobe/surgery , Treatment Outcome
15.
BMC Infect Dis ; 16(1): 725, 2016 12 01.
Article in English | MEDLINE | ID: mdl-27903240

ABSTRACT

BACKGROUND: The central-line associated bloodstream infections (CLABSI) are the most common healthcare-associated infections in childhood. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. The present survey is the first prospective study monitoring for 6 months the occurrence of central-line associated bloodstream infections in all departments of an Italian tertiary care children's university hospital. METHODS: The study involved all children aged less than 18 years admitted to Meyer Children's University Hospital, Florence, Italy who had a central line access between the October 15th, 2014 and the April 14th, 2015. CLABSI were defined according to the Center for Disease Control and Prevention criteria. CLABSI incidence rates with 95% confidence limits were calculated and stratified for the study variables. For each factor the relative risk and 95% confidence intervals were evaluated. Statistical analysis was performed using the statistical software SPSS for Windows, version 22.0 (SPSS Inc., Chicago, IL), p < 0.05 was considered statistically significant. RESULTS: CLABSI rate was 3.73/1000 (95% CI: 2.54-5.28) central line-days. A higher CLABSI incidence was seen with female gender (p = 0.045) and underlying medical conditions (excepting prematurity, surgical diseases and malignancy) (p = 0.06). In our study 5 infections, were caused by extended-spectrum ß-lactamase producing organisms and in one case by carbapenem-resistant Klebsiella pneumoniae. CONCLUSIONS: Our study confirms the spreading of multi-resistant pathogens as causes of healthcare associated infections in children. An increased incidence rate of CLABSI in our study was related to underlying medical conditions. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas.


Subject(s)
Catheter-Related Infections/epidemiology , Catheterization, Central Venous/adverse effects , Bacteremia/epidemiology , Central Venous Catheters/adverse effects , Child , Child, Preschool , Cross Infection/epidemiology , Female , Hospitals, University/statistics & numerical data , Humans , Incidence , Infant , Italy/epidemiology , Male , Prospective Studies , Risk Factors , Sex Distribution , Tertiary Healthcare/statistics & numerical data
16.
Am J Obstet Gynecol ; 213(6): 839.e1-8, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26232509

ABSTRACT

OBJECTIVE: This study investigated whether birthweight is linked to an increased risk of the development of systemic sclerosis. STUDY DESIGN: This was a multicenter case-control study with perinatal data that were obtained from 332 cases with systemic sclerosis and 243 control subjects. Birthweight was treated as a dichotomous variable (<2500 g vs ≥2500 g); low birthweight was defined as a weight <2500 g; small for gestational age was defined as birthweight <10th percentile for gestational age adjusted for sex. The relationship between systemic sclerosis and both low birthweight and small for gestational age was expressed with the crude (univariate analysis) and adjusted (multivariate analysis) odds ratio (OR). RESULTS: Significantly increased ORs were observed in the univariate analysis for low birthweight (OR, 2.59; 95% confidence interval [CI], 1.39-5.05) and small for gestational age (OR, 2.60; 95% CI, 1.34-5.32) subjects. Similarly increased risks were confirmed for both conditions in the multivariate analysis (OR, 3.93; 95% CI, 1.92-8.07; and OR, 2.58; 95% CI, 1.28-5.19), respectively. CONCLUSION: Low birthweight and small for gestational age at birth are risk factors for the adult onset of systemic sclerosis.


Subject(s)
Birth Weight , Scleroderma, Systemic/epidemiology , Age of Onset , Case-Control Studies , Female , Humans , Infant, Low Birth Weight , Infant, Newborn , Infant, Small for Gestational Age , Italy/epidemiology , Male , Maternal Age , Middle Aged , Multivariate Analysis , Pregnancy , Risk Factors
17.
Sleep Breath ; 19(3): 1057-64, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25631640

ABSTRACT

PURPOSE: Advanced medical technology has resulted in an increased survival rate of children suffering from congenital central hypoventilation syndrome. After hospitalization, these technology-dependent patients require special home care for assuring ventilator support and the monitoring of vital parameters mainly during sleep. The daily challenges associated with caring for these children can place primary caregivers under significant stress, especially at night. Our study aimed at investigating how this condition affects mothers and fathers by producing poor sleep quality, high-level diurnal sleepiness, anxiety, and depression. METHODS: The study included parents of 23 subjects with congenital central hypoventilation syndrome and 23 healthy subjects. All parents filled out the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Epworth Sleepiness Scale (ESS), Beck Depression Inventory (BDI-II), and Beck Anxiety Inventory (BAI). RESULTS: A comparison between the two groups showed that parents of patients had poorer sleep quality, greater sleepiness, and higher BDI-II scores compared to that of parents of healthy subjects (respectively, PSQI score 6.5 vs 3.8, ESS score 6.2 vs 4.3, BDI-II score 8.4 vs 5.7). Specifically, mothers of patients showed poorer sleep quality and higher BDI-II scores compared to that of mothers of controls (respectively, PSQI score 7.5 vs 3.8, BDI-II score 9.3 vs 5.9), whereas fathers of patients showed greater levels of sleepiness with respect to fathers of healthy children (respectively, ESS score 6.8 vs 4.0). These differences emerged in parents of younger children. CONCLUSIONS: Congenital central hypoventilation syndrome impacts the family with different consequences for mothers and fathers. Indeed, while the patients' sleep is safeguarded, sleeping problems may occur in primary caregivers often associated with other psychological disorders. Specifically, this disease affects sleep quality and mood in the mothers and sleepiness levels in the fathers.


Subject(s)
Cost of Illness , Fathers/psychology , Hypoventilation/congenital , Mothers/psychology , Sleep Apnea, Central/psychology , Sleep Apnea, Central/therapy , Sleep Wake Disorders/psychology , Sleep Wake Disorders/therapy , Adolescent , Anxiety/psychology , Child , Child, Preschool , Depression/psychology , Disorders of Excessive Somnolence/psychology , Female , Home Nursing/psychology , Humans , Hypoventilation/psychology , Hypoventilation/therapy , Infant , Male , Respiration, Artificial/psychology , Sleep Deprivation/psychology , Surveys and Questionnaires
18.
Article in English | MEDLINE | ID: mdl-26267428

ABSTRACT

In this study an experimental study on a biological methane oxidation column presented with the aim to calibrate a mathematical model developed in an earlier study. The column was designed to reproduce at lab-scale a real biofilter trying to consider the more probable landfill boundary conditions. Although the methane oxidation efficiency in the column was lower than the expected (around 35%), an appropriate model implementation showed an acceptable agreement between the outcomes data of the model simulation and the experimental data (with Theil's Inequality Coefficient value of 0.08). A calibrated model allows a better management of the biofilter performance in terms of methane oxidation.


Subject(s)
Methane/chemistry , Models, Theoretical , Biofuels , Calibration , Filtration , Oxidation-Reduction
19.
Article in English | MEDLINE | ID: mdl-26267602

ABSTRACT

The aim of this work is the evaluation of the efficiency of such a biofilter, through the application of a mathematical model which describes the biological oxidation process. This mathematical model is able to predict the efficiency of the system under varying operating conditions. Literature data have been used in order to build the model. The factors that mostly affect the process and which actually regulate the entire process have been highlighted in this work. Specifically, it was found that temperature, flow and methane concentration are the most important parameters that influence the system. The results obtained from the mathematical model showed also that the biofilter system is simple to implement and manage and allows the achievement of high efficiency of methane oxidation. In the optimal conditions for temperature (between 20-30°C), residence time (between 0.7-0.8 h) and methane molar fraction (between 20-25%) the efficiency of methane oxidation could be around 50%.


Subject(s)
Methane/chemistry , Models, Theoretical , Filtration , Oxidation-Reduction , Sensitivity and Specificity , Temperature
20.
J Pediatr ; 164(2): 389-92.e1, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24252793

ABSTRACT

OBJECTIVE: To determine whether a simplified, 1-day/week regimen of trimethoprim/sulfamethoxazole is sufficient to prevent Pneumocystis (jirovecii [carinii]) pneumonia (PCP). Current recommended regimens for prophylaxis against PCP range from daily administration to 3 consecutive days per week dosing. STUDY DESIGN: A prospective survey of the regimens adopted for the PCP prophylaxis in all patients treated for childhood cancer at pediatric hematology-oncology centers of the Associazione Italiana Ematologia Oncologia Pediatrica. RESULTS: The 20 centers participating in the study reported a total of 2466 patients, including 1093 with solid tumor and 1373 with leukemia/lymphoma (or primary immunodeficiency; n = 2). Of these patients, 1371 (55.6%) received the 3-day/week prophylaxis regimen, 406 (16.5%) received the 2-day/week regimen, and 689 (27.9%), including 439 with leukemia/lymphoma, received the 1-day/week regimen. Overall, only 2 cases of PCP (0.08%) were reported, both in the 2-day/week group. By intention to treat, the cumulative incidence of PCP at 3 years was 0.09% overall (95% CI, 0.00-0.40%) and 0.51% for the 2-day/week group (95% CI, 0.10%-2.00%). Remarkably, both patients who failed had withdrawn from prophylaxis. CONCLUSION: A single-day course of prophylaxis with trimethoprim/sulfamethoxazole may be sufficient to prevent PCP in children with cancer undergoing intensive chemotherapy regimens. This simplified strategy might have implications for the emerging need for PCP prophylaxis in other patients subjected to the increased use of biological and nonbiological agents that induce higher levels of immune suppression, such as those with rheumatic diseases.


Subject(s)
Hematologic Neoplasms/complications , Pneumocystis carinii/isolation & purification , Pneumonia, Pneumocystis/prevention & control , Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage , Anti-Infective Agents/administration & dosage , Child , Dose-Response Relationship, Drug , Drug Administration Schedule , Follow-Up Studies , Humans , Incidence , Italy/epidemiology , Pneumonia, Pneumocystis/epidemiology , Pneumonia, Pneumocystis/etiology , Prospective Studies , Treatment Outcome
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