The cerebellum monitors errors and entrains executive networks.

Frontal midline θ (Fmθ) activity occurs in medial prefrontal cortices (mPFC), when expected and actual outcomes conflict. Cerebellar forward models could inform the mPFC about this mismatch. To verify this hypothesis we correlated the mPFC activation during a visuomotor tracking task (VM) with performance accuracy, in control and cerebellum-lesioned participants. Additionally, purely visual (V), motor (M) and a motor plus visual tasks (V + M) were performed. An Independent Component, with a mid-frontal topography scalp map and equivalent dipole location in the dorsal anterior cingulate cortex accounted for Fmθ. In control participants Fmθ power increased during VM, when the error level crossed a threshold, but not during V + M, M and V. This increase scaled with tracking error. Fmθ power failed to increase during VM in cerebellar participants, even at highest tracking errors. Thus, in control participants, activation of mPFC is induced when a continuous monitoring effort for online error detection is required. The presence of a threshold error for enhancing Fmθ, suggests the switch from an automatic to an executive tracking control, which recruits the mPFC. Given that the cerebellum stores forward models, the absence of Fmθ increases during tracking errors in cerebellar participants indicates that cerebellum is necessary for supplying the mPFC with prediction error-related information. This occurs when automatic control falters, and a deliberate correction mechanism needs to be triggered. Further studies are needed to verify if this alerting function also occurs in the context of the other cognitive and non-cognitive functions in which the cerebellum is involved.

[Obesity and Eating Disorders. Indications for the different levels of care. An Italian Expert Consensus Document]. / Documento di Consensus. Obesità e Disturbi dell'Alimentazione Indicazioni per i diversi livelli di trattamento.

This paper is an Italian Expert Consensus Document on multidimensional treatment of obesity and eating disorders. The Document is based on a wide survey of expert opinion. It presents, in particular, considerations regarding how clinicians go about choosing the most appropriate site of treatment for a given patient suffering from obesity and/or eating disorders: outpatient, partial hospitalization, residential rehabilitation centre, inpatient hospitalization. In a majority of instances obesity and eating disorders are long-term diseases and require a multiprofessional team-approach. In determining an initial level of care or a change to a different level of care, it is essential to consider together the overall physical condition, medical complications, disabilities, psychiatric comorbidity, psychology, behaviour, family, social resources, environment, and available services. We first created a review manuscript, a skeleton algorithm and two rating scales, based on the published guidelines and the existing research literature. As the second point we highlighted a number of clinical questions that had to be addressed in the specific context of our National Health Service and available specialized care units. Then we submitted eleven progressive revisions of the Document to the experts up to the final synthesis that was approved by the group. Of course, from point to point, some of the individual experts would differ with the consensus view. The document can be viewed as an expert consultation and the clinical judgement must always be tailored to the particular needs of each clinical situation. We will continue to revise the Document periodically based on new research information and on reassessment of expert opinion to keep it up-to-date. The Document was not financially sponsored.

Assessment of efficacy of a bivalent BTV-2 and BTV-4 inactivated vaccine by vaccination and challenge in cattle.

The efficacy of a bivalent inactivated vaccine against bluetongue virus (BTV) serotypes 2 (BTV-2) and 4 (BTV-4) was evaluated in cattle by general and local examination, serological follow-up, and challenge. Thirty-two 4-month-old calves were randomly allocated into 2 groups of 16 animals each. One group was vaccinated subcutaneously (s/c) with two injections of bivalent inactivated vaccine at a 28-day interval, and the second group was left unvaccinated and used as control. Sixty-five days after first vaccination, 8 vaccinated and 8 unvaccinated calves were s/c challenged with 1 mL of 6.2 Log10 TCID50/mL of an Italian field isolate of BTV serotype 2, while the remaining 8 vaccinated and 8 unvaccinated animals were challenged by 1 mL of 6.2 Log10 TCID50/mL of an Italian field isolate of BTV serotype 4. Three additional calves were included in the study and used as sentinels to confirm that no BTV was circulating locally. At the time of the challenge, only one vaccinated animal did not have neutralizing antibodies against BTV-4, while the remaining 15 showed titres of at least 1:10 for either BTV-2 or BTV-4. However, the BTV-2 component of the inactivated vaccine elicited a stronger immune response in terms of both the number of virus neutralization (VN) positive animals and antibody titres. After challenge, no animal showed signs of disease. Similarly, none of the vaccinated animals developed detectable viraemia while bluetongue virus serotype 2 and 4 titres were detected in the circulating blood of all unvaccinated animals, commencing on day 3 post-challenge and lasting 16 days. It is concluded that administration of the bivalent BTV-2 and BTV-4 inactivated vaccine resulted in a complete prevention of detectable viraemia in all calves when challenged with high doses of BTV-2 or BTV-4.

An inactivated vaccine for the control of bluetongue virus serotype 16 infection in sheep in Italy.

Because no suitable products are at the moment available to safely control the spread of BTV-16 in Europe, an inactivated vaccine was produced from the reference field isolate of bluetongue virus serotype 16. One group of six sheep was vaccinated subcutaneously with the inactivated vaccine twice, on days 0 and 28, whereas a second group of eight sheep was inoculated with saline solution and used as mock-vaccinated control animals. Seventy-eight days after the first vaccination, all sheep were inoculated subcutaneously with a suspension containing 10(6.3) TCID(50) of a virulent reference BTV-16 isolate. Apart from a transient inflammatory reaction at the injection site, no adverse effects were reported following vaccination. All vaccinated animals developed high titres (7.3-9.3log(2)(ED50%/50 microl)) of virus-specific neutralising antibodies and were resistant to challenge with BTV-16. Conversely, following challenge, control animals developed hyperthermia and long lasting high-titre viraemia.

[Evaluation of nutritional state of patients with esophageal cancer treated by total parenteral nutrition]. / Valutazione dello stato di nutrizione di pazienti portatori di carcinoma dell'esofago, sottoposti a nutrizione parenterale totale.

Six patients with carcinoma of the esophagus (proximal and middle one-third) underwent intravenous artificial nutrition (TPN) both during preoperative radiation therapy and during the periods preceding radical surgery. From admission on, their conditions were evaluated and followed according to an established pattern of assessment of the nutritional state. Besides a certain improvement of the nutritional state at the level both of the muscular and adipose tissues, the results showed the reliability and the reproducibility of the serial anthropometric indexes adopted. With regard to the biochemical indexes most commonly utilized for evaluating the nutritional state, the results confirmed the doubts already casted about the reliability of a great part of these indexes when applied to this specific kind of patients.

[Occult child abuse (opinions, considerations, personal observations)]. / Il maltrattamento occulto del bambino (opinioni, considerazioni, osservazioni personali).

At the beginning of the statement the authors point out some lesser aspects of child's ill-treatment (previously suggested by them in other occasions) as expressions of very strict educational systems which strongly limit childrens' freedom or impose them several extrascholastic activities (such as: athletics, music with participation in competitive examination, studies of foreign languages, Latin and so on) where the child must excel in (composex of the "leader-child"). Then these authors suggest using the term "abuse" to mean lexically every excessive, undue, arbitrary use and not only "sexual". They point out the seriousness of abuse as far as juvenile exploitation is concerned both in case of manual labour and prostitution. But the pay particularly attention to the problem of sport when it is gone in for too intensively (as athletics). These authors infact sum up the harms that sport can cause when it is gone in for during the age under the stabilized puberty. Physical harms may occur especially during the practice of risky sports such as: Alpine skiing, cycling on the road, swimming combined with diving, fencing, boxing) and during tiring condition, while psychic harms can entail a fall in scholastic performances, irritability, insomnia, anxiety. The authors depreciate the behaviour of those parents who stimulate their children' aggressiveness during competitions and scold them when their performances are insufficient, or give them forbidden stimulants of hormonal anabolic drugs instead of taking care of their children in order to keep away from the arms mentioned above. However, after all these observations and considerations about competitive sports in juvenile age, these authors can firmly state that all this could be meant as an important aspects of the juvenile exploitation that must be taken in great consideration.

[Interactions between drugs and food in pediatric age]. / Interazioni tra farmaci e nutrienti in età pediatrica.

Interactions between food and drugs represent a very interesting chapter even in paediatric field, although this subject has not been very treated so far. We have tried to locate common points between pharmacology and elementary metabolism, in order to divide drug-food interactions into five great categories, according to the scheme suggested by Vannucci and Capriati. This scheme is based on the phases in which the interactions take place: 1) before gastroenteric absorption; 2) during gastroenteric absorption; 3) during distribution and storage in tissues; 4) during process of bio-transformation; 5) during excretion. If we want rationally to give a drug, we must exactly know its pharmacokinetic, particularly in paediatrics. In fact, we can avoid detrimental interactions drug-food merely adjusting the pharmacologic dosage to the particular diet of the considered child and vice versa.

[Sensitization to house dust mites and juvenile atopic dermatitis]. / Sensibilizzazione agli acari della polvere domestica e dermatite atopica infantile.

The etiopathogenetic bases of atopic dermatitis are still much discussed and controversial. Nevertheless most of the Authors agree upon the pathogenetic role of an IgE mediated hypersensitivity mechanisms with respect to many alimentary and/or environmental allergens. We have looked for the IgE mediated sensitization to the house dust mites by means of skin tests (prick) and/or haematic dosage of specific IgE (F.A.S.T.) in a group of 40 children aged less than 6 with atopic dermatitis. We have divided the examined children into three groups according to their age and found out a high percentage of dust mites sensitization in the children of the oldest age group. This datum could give credit to the hypothesis of a pathogenetic role developed by the allergy to dust mites in the keeping of eczematous lesions. From the anamnestic search emerge both the leading role developed by dust mites on the development of allergic breathing pathology in the subjects with atopic dermatitis and the finding out of a settled exordium of breathing manifestations due to dust mites at an older age in comparison with the age in which the cutaneous disease manifests itself. These observations lead us to recommend a very accurate environmental cleaning since the first manifestations of atopic dermatitis prescinding from the checking of a demonstrated IgE mediated house dust mites hypersensitivity.

[Herpesvirus simplex disease in the newborn infant. Clinical aspects, diagnosis, prophylaxis, therapy]. / La malattia da HVS nel neonato. Clinica, diagnosi, profilassi, terapia.

Herpes Simplex virus infection (Particularly by HVS2) is one of the most important disease transmitted by mother to newborn because of the seriousness of symptoms and the high incidence of genital infection of pregnants. Transmission of congenital HVS infection occurs usually by contact with infected genital secretions during the birth process, but there is evidence that transplacenter transmission also may occur. Emphasis must be placed then on prophylaxis of genital infection of pregnants and of their partners. Specific Immunoglobulins with high antibody titre are recommended for prophylaxis. An anti HVS2 vaccine without oncogen property os still at experimental stage. This prophylaxis is inadequate for the newborn of infected mother: this one must be treated with newer antiviral agents (Acyclovir), even is absence of herpetic lesion and other symptoms.

[Correlations of the response to the prick test and blood levels of specific IgE in children]. / Correlazione tra risposte del prick test e livelli ematici di IgE specifiche in età pediatrica.

A good correlation between intensity of prick test result and haematic levels of specific IgE is a fundamental presupposition to affirm that both diagnostic methods are equivalent to demonstrate a condition of IgE-mediate hypersensitivity. Using a retrospective analysis of our data, we intended to examine the degree of this correlation for the most common food and inhalant allergens. The comparison between prick test results and specific IgE haematic levels for all considered allergens-shows a good concordance of F.A.S.T. for prick negative results and a sharp discordance of F.A.S.T. for prick positive results. Both food and inhalant allergens are equally involved in the discordance between the tests. Therefore, we cannot exclude the possibility of clashing results between prick test reaction and specific IgE haematic levels, even in further analysis would be necessary to obtain more reliable verifications.

[Catering services in schools for children (critique and operative proposals)]. / A proposito di refezione collettiva nelle scuole per bambini (critiche e proposte operative).

Several protests by pupils' parents against bad-quality of food given in school-meal--widely and minutely reported by local press--advised Autors to give due emphasis on some deficiencies in school-meal administration, rightly denounced by relatives. To cut down health troubles, Authors suggest to commit school-meal's management to catering firms for their great experience in field of collective meal. In fact they have implements and competence to check properly: -education and skill of staff attached to school-meal and distribution; -places, structures, tools used to get meals; -victualling, carriage, storage and condition of food maintenance; -the fancy diets, appropriately diversified by age. Authors think that each school should have places, structures and tools to prepare and take meals and should engage a sole firm both for cooking and serving school-meal.

[Urinary tract infections in premature infants: considerations on the reliability of bladder catheterization and other methods of urine collection for bacteriological study]. / Infezione delle vie urinarie nell'immaturo: osservazioni sulla attendibilità del cateterismo vescicale e di altri metodi di raccolta delle urine per lo studio batteriologico.

The collection of urine by the use of adhesive plastic bags even if simple is not unfailing procedure for making diagnosis of urinary tract infection (U.T.I.) because of contamination with bacteria located on the external genitals. This is particularly true in the case of the premature baby. Therefore this method of urine's collection has been considered not enough satisfactory in symptomless cases since an early diagnosis of U.T.I. in this premature babies is extremely important. The Authors suggest that after a first positive test response by urine's collection with adhesive plastic bags is extremely important to collect the urine with a catheter specimen in the females and with sterile test tube in the males. Using these criteria, satisfactory results have been obtained. To prevent possible bladder urine contamination by catheter use, antibiotic treatment had been applied for few days after specimen collection. The non catheter specimen collection of the urine remains of course, one of the most important test to detect pyuria during U.T.I.

[Clinical manifestations of spasmophilia in developing age]. / Le manifestazioni cliniche della spasmofilia in età evolutiva.

82 children (47 male and 35 female), aged between 2 and 12 years, with signs and symptoms consistent with spasmophilia, were investigated with an emg technique to better define boundaries of tetanic syndrome. In all subjects an ischaemic test was performed to the upper limb and the spontaneous emg activity from thenar eminence was recorded both during and after ischaemia. Moreover a clinical examination, with particular attention to objective signs of spasmophilia, were performed and serum electrolytes determined. Electromyographic spontaneous activity was noticed in 46 children (24 female, 22 male), 31 of them were hypocalcemic. The frequency of the various clinical manifestations is reported and correlated with emg and humoral findings. Significant difference between sexes in the incidence of tetanic syndrome where not noticed. More frequent symptoms for spasmophilia are tensive headache and cramps, abdominal spasms, psycomotos instability and anxiety; Chvostek's sign is frequent but no specific. The other symptoms assume relevance only if present in association. The role of electromyographic criteria in the detection of tetanic syndrome is stressed.

[Food contamination: a problem of pediatric interest]. / Contaminanti alimentari: un problema di interesse pediatrico.

The application of technology in the production, processing, preservation and transport of food has led to a well known consequence: the presence in the foods of undesirable substances and chemicals, that is to say "the contaminants of feeding". In this study the authors report the main groups of contaminants as the mycotoxins, nitrates, pesticides, methylmercury, lead, cadmium etc., relating for everyone of them the harmful effects for the health of human being, of which they have come to know mostly for some episodes of acute poisoning occurred in several countries in the world. They relate also the hypothetical effects of a chronic exposure to low levels of contamination, mostly if the fetuses and infants come to be exposed to these contaminants for the peculiar embryo genetic and evolutive situation that characterizes them.

[Food allergy in children. Diagnostic difficulties, doubts and digressions]. / Allergia alimentare nel bambino. Difficoltà diagnostiche, dubbi, divagazioni.

It is very difficult to diagnose an alimentary allergy especially because of: the difference among individuals in their physical, psychic and humoral reactions to the environment; weakness and variability of these reactions during the puberty; limited reliability in the results of certain kind of research (i.e. false positiveness and negativeness, discordance between laboratory results and the results of the challenge, neutralization of diagnostic antigenic extracts and/or the presence in these extracts of lectin, etc.); the bad compliance of some therapies and their restricted efficaciousness, particularly in the little children. Moreover: the superimposition of the clinical manifestations of alimentary allergy and pseudoallergy with those of allergy, the possibility of an association between the alimentary and the respiratory allergy, the acquisition on behalf of the allergic child of other kinds of allergy, false polyallergy, the allergy might change its seats and in consequence also its manifestations. The authors, apart a short account of the different diagnostic methods, lay stress on the challenge as the most reliable. They discuss upon the dose of a nourishment that can be given to the patient without risk, besides they suggest to take into account the type and the seriousness of the clinical manifestations in fixing this dose.

[Sinusitis in children. Personal case study]. / Le sinusiti nel bambino. Casistica personale.

The presence of sinusitis has been found out 85 times out of 278 cases of acute relapsing respiratory diseases in children between 4 and 12 years of age. The maxilla sinuses have been those most frequently stricken; the frontal sinuses come next and last at a distance the sphenoidal sinus. A close relationship between the entity of basic respiratory pathology and the presence and seriousness of the sinusitis has been observed. There also seems to be a rather close relationship between the frequency of the presence of sinusitis in children with respiratory pathology either relapsing or chronic and climatic environmental situation. A damp climate with persistent fog together with industrial atmospheric pollution seems to favour the considered pathology in an undisputed way.

[Headache in childhood with special reference to migraine. Discussion of a personal case material of 94 subjects]. / Le cefalee dell'infanzia con particolare riguardo all'emicrania. Discussione di una casistica personale di 94 soggetti.

After having characterized epidemiologically, etiopathogenetically diagnostically, prognostically and psychologically the childhood headache, the A.A. refer data relative to 94 children of age in between 6 and 16 years, of which 51 females and 43 males, suffering for migraine (diagnosed by Bille's criteria). The ratio between migraine and sex, age, relationships, clinical symptomatology, onset time, crisis appearance frequency and causing factors have been studied. The relations between migraine and spasmophilia have been treated with particular remark in our casuistry, since similar studies don't appear in the literature. The work ends with some informations about migraine's common therapy, our particular one and the results that we obtained.

[IgA deficiency in pediatrics]. / Deficit di IgA in pediatria.

To evaluate the IgA deficiency we have considered 368 children, admitted to "Day hospital" for different pathologies: 64 of them had serum IgA levels lower than the normal values for their age according to Ellis and Robbin. The age of the children with this deficiency was included from 4 months up to 8 years: 39 were boys, 25 were girls. In 54 cases the IgA deficiency was "partial" that is: the IgA value found out was lower than the normal for the age, but higher than 5 mg%. In 10 cases the IgA deficiency was "severe" (the IgA value was lower than 5 mg%). Six cases, among the 29 ones with intestinal diseases, had a severe deficiency, whereas among the 22 cases with respiratory diseases 3 had a "severe" deficiency. The 2 patients with urinary disease had a partial deficiency; only one case of the remaining 11 with different pathologies had a "severe" deficiency. Among the carriers of serum IgA deficiency an high incidence of chronic pathology has been found out (83%). Nevertheless the percentage of IgA deficiency extrapolated from the all case histories doesn't differ very much (64 cases among 368 = 17.39%) considering only those patients with chronic relapsing pathology (53 cases among 275 = 18.2%). Therefore it seems that the IgA deficiency could be considered a chronicizing factor in the examinated pathology even if in few cases. Anyway the frequency of IgA deficiency has reached major values (29/54; 45.3%) in the patients with enteric diseases. The frequency of IgA deficiency is smaller but still important in those patients with respiratory diseases (22/64: 34.3%).(ABSTRACT TRUNCATED AT 250 WORDS)

[Short near-fainting in children with or without loss of conscience]. / Malesseri fugaci del bambino con o senza perdita di coscienza.

Short near-faints with or without loss of consciousness have different etiologies and pathogenesis and, according to these, they recur with various frequency. This subject was reported on several publications and here is again examined with the contribute of personal experience and the description of distinct cases. The following causes were examined: vagal hypertonia, digestive troubles (gastroesophageal reflux), metabolic troubles (cyclic ketosis, hypoglycemia and hypocalcemia with peculiar clinic manifestations). Among the neurological causes were examined: epilepsy, benign paroxysmal vertigos and, particularly, the so called breath-holding spells and the migraine, about that were reported a few examples of "migraine accompagnée". Among the cardiovascular causes (ischaemic cerebral crisis), -particular attention was dedicated to orthostatic hypotension syncope. A short hint about hysteria ends the exposition of psychical causes of short near-faints.

Bluetongue serotype 2 and 9 modified live vaccine viruses as causative agents of abortion in livestock: a retrospective analysis in Italy.

The recent outbreak caused by Schmallenberg virus, which affected sheep, goats and cattle in Europe, highlighted the importance of having a robust surveillance plan capable of monitoring abortions and malformations in the livestock offspring. In this context, bluetongue viruses (BTVs) represented and represent one of the major threats to the European livestock industry. Aiming to improve the understanding on BTV cross placental transmission and serotype involvement, in this retrospective study foetal spleens and/or brains of 663 ovines, 429 bovines, 155 goats and 17 buffaloes were tested for the presence of BTV by virus isolation. BTV vaccine strains were isolated from 31 foetuses (2.4%; 95% CI: 1.7-3.4%): 24 (3.6%; 95% CI: 2.4-5.3%) from ovine foetal tissues; 6 (1.4%; 95% CI: 0.6-3.0%) from bovine foetal tissues and 1 (0.6%; 95% CI: 0.2-3.5%) from the spleen of a caprine foetus. All foetuses were from animals vaccinated with either BTV-2 or BTV-2, and BTV-9 modified live vaccines (MLVs) produced by Onderstepoort Biological Products (OBP), South Africa. Among the 31 isolated vaccine strains, serotype 9 (n = 28) was more frequently isolated (P < 0.05) than serotype 2 (n = 3). In two cases infectious vaccine strains were found in the foetal tissues 2 months after the vaccine administration. Other pathogens known to be causative agents of abortion in ruminants were not detected nor isolated. This study demonstrates, for the first time, that BTV-2 and BTV-9 vaccine strains are able to cross the placental barrier of sheep, cattle and goats. BTV-2 and BTV-9 vaccine strains are able to infect foetuses and cause abortions or malformations depending on the period of pregnancy at the time of vaccination.