Kawasaki disease and cardiac involvement: an update on the state of the art.

Kawasaki disease (KD) is an acute systemic vasculitis of unknown etiology. It has a self-limiting course and so far, represents the most common cause of coronary heart disease acquired in children aged between 6 months and 5 years. The inflammatory process can involve the coronary arteries with the formation of aneurysms and thrombotic occlusions with the risk of sudden death, especially in infants. Myocardial inflammation and abnormalities of cardiac contractility can occur acutely or many years after the disease onset. Therapy must be started within 10 days after the onset of symptoms to reduce the risk of heart complications. Immunoglobulin and aspirin treatment are effective in reducing heart complications. Recent studies have shown new therapeutic strategies (corticosteroids, immunosuppressive and biological drugs) in case of ineffectiveness of treatment with immunoglobulins.

Detection of acidic paper recovery after alkaline nanoparticle treatment by 2D NMR relaxometry.

Cellulose-based artefacts are highly prone to degradation, especially in the presence of acidic compounds, which trigger the depolymerization of cellulose chains and lead to a loss in the original mechanical resistance of the material. Calcium hydroxide nanoparticles dispersed in organic solvent have been recently proposed for the deacidification of cellulose-based artworks. In this work, changes induced on paper by a deacidification treatment, following an acidification bath, were studied by nuclear magnetic resonance (NMR) relaxometry and by the so-called NMR diffraction of water trapped in the cellulose network. The deacidification treatment modifies intrachain and interchain bonds in hydrolyzed and degraded cellulose, leading to a buffered cellulose network configuration, which is similar to that characterizing the untreated reference sample in terms of relaxation parameters. Overall, calcium hydroxide nanoparticles are demonstrated effective in hindering the degradation of cellulose induced by acids and ageing in strong environmental conditions, even from the standpoint of cellulose network arrangement. It is worth noting, too, that the unilateral NMR device used for the relaxation measurements may represent a powerful tool for the preservation of cellulose-based artworks because it allows for the monitoring of the conservation status of cellulose in a completely non-invasive manner.

Seroprevalences of autoantibodies and anti-infectious antibodies among Ghana's healthy population.

Autoantibodies, which are antibodies that target self-epitopes, have considerable diagnostic, prognostic and predictive value in specific autoimmune diseases. Various infectious agents have been linked via numerous mechanisms to the formation of different autoantibodies. Therefore, estimating the prevalence of autoantibodies and anti-infectious antibodies in different populations is of high importance. Different genetic and environmental pressures, such as these found in Ghana's different geographical provinces, may affect the prevalence of autoantibodies. In this study, we assessed the seroprevalence of a diverse panel of autoantibodies and anti-infectious antibodies among the healthy Ghanaian population and investigated possible environmental and genetic predispositions for autoantibodies and autoimmunity. The sera of 406 healthy individuals were obtained from Greater Accra, Upper West, Eastern and Volta regions. Multiplexed assay and chemiluminescent immunoassay techniques were utilized to assess the presence of a panel of autoantibodies and anti-infectious antibodies. We found a high prevalence of anti-HSV-1 IgG (91-100%), anti-EBNA IgG (81-93%) and anti-EBV-VCA IgG (97-100%) antibodies. The prevalence of ANA (at least one of: anti-dsDNA; anti-chromatin; anti-ribosomal-P; anti-Ro/SSA; anti-La/SSB; anti-centromere B; anti-Sm; anti-Sm/RNP; anti-Scl-70; anti-Jo1; anti-DFS70) was estimated at 14%. An inverse association between anti-HSV-2 antibodies and ANA (p = 0.044; adjusted OR = 0.398; CI [0.162-0.975]) was found, after adjusting for differences in gender, age, and familial history of autoimmune diseases. A trend towards reduced seroprevalence of anti-dsDNA antibodies among subjects who were positive for anti-HSV-2 antibodies was also noted (p = 0.1). In conclusion, the inverse association between anti-HSV-2 antibodies and ANA positivity suggests a possible protective role of HSV-2 infection against autoimmunity.

Characterization of a population of Pelodera strongyloides (Nematoda: Rhabditidae) associated with the beetle Lucanus ibericus (Coleoptera: Lucanidae) from Georgia.

During a field survey for entomopathogenic nematodes in Georgia, in the territory of Borjomi-Kharagauli, a nematode population was isolated from the body of single dead beetle of Lucanus ibericus Motschulsky 1845 (Coleoptera: Lucanidae). Based on morphological characters and molecular analyses, the nematode species is identical to Pelodera strongyloides (Schneider, 1860, 1866), being the first record of this species in Georgia. Morphometrics of the Georgian population agree with the original description, and females differ from males by very few characters. The Georgian population of P. strongyloides was molecularly characterized by sequencing the D2 to D3 expansion domains of the 28S rRNA gene and two new molecular markers as the ITS and the mitochondrial COI gene. Phylogenetic analyses revealed that all P. strongyloides sequences grouped together along with all other Pelodera species.

The microbiome in autoimmune diseases.

The microbiome is represented by microorganisms which live in a symbiotic way with the mammalian. Microorganisms have the ability to influence different physiological aspects such as the immune system, metabolism and behaviour. In recent years, several studies have highlighted the role of the microbiome in the pathogenesis of autoimmune diseases. Notably, in systemic lupus erythematosus an alteration of the intestinal flora (lower Firmicutes/Bacteroidetes ratio) has been described. Conversely, changes to the gut commensal and periodontal disease have been proposed as important factors in the pathogenesis of rheumatoid arthritis. At the same time, other autoimmune diseases (i.e. systemic sclerosis, Sjögren's syndrome and anti-phospholipid syndrome) also share modifications of the microbiome in the intestinal tract and oral flora. Herein, we describe the role of the microbiome in the maintenance homeostasis of the immune system and then the alterations of the microorganisms that occur in systemic autoimmune diseases. Finally, we will consider the use of probiotics and faecal transplantation as novel therapeutic targets.

Season, weather and predictors of healthcare-associated Gram-negative bloodstream infections: a case-only study.

BACKGROUND: Recent studies reported seasonality in healthcare-associated infections (HCAI). The association of this phenomenon with other risk factors for HCAI is not clear. AIM: To analyse the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). METHODS: A case-only study was conducted in a teaching hospital in Brazil. The study enrolled 446 subjects with GNB-BSI diagnosed from July 2012 to June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, and weather parameters on the day of diagnosis were recorded. Factors associated with occurrence of GNB-BSI in different seasons (reference category: winter) and caused by different GNB (reference category: Escherichia coli) were analysed. Uni- and multi-variable models of multi-nomial logistic regression were used for analysis. FINDINGS: GNB-BSI diagnosed in summer was more likely to be caused by Klebsiella spp. [odds ratio (OR) 5.33; 95% confidence interval (CI) 2.04-13.96] or Acinetobacter baumannii (OR 2.69; 95% CI 1.04-6.96), and there was an association between Klebsiella spp. and spring (OR 2.86; 95% CI 1.14-7.18). Average temperature on the day of diagnosis was associated with Klebsiella spp. (OR 1.19; 95% CI 1.07-1.33) and A. baumannii (OR 1.20; 95% CI 1.07-1.34). CONCLUSION: Warm seasons and daily temperature impact on the aetiology of GNB-BSI, even in models adjusted for usual risk factors. One possible explanation for these findings is that seasonality of healthcare-associated pathogens is intrinsic to micro-organisms, and not associated with comorbidities, procedures or use of antimicrobials.

Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis.

BACKGROUND: The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis. PURPOSE: Our aim was to assess the diagnostic accuracy of arterial spin-labeling-derived cerebral blood flow to discriminate low- and high-grade tumors. DATA SOURCES: MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used. STUDY SELECTION: Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included. DATA ANALYSIS: Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed. DATA SYNTHESIS: Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43-48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95-1.74 mL/min/100 g), P < .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method. LIMITATIONS: Included tumor types, analysis method, and original data varied among included studies. CONCLUSIONS: Arterial spin-labeling-derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.

Subclinical hypothyroidism in children: is it always subclinical?

Aim of this commentary is to report current knowledges on the main clinical and metabolic abnormalities which might be observed in children with longstanding and untreated subclinical hypothyroidism (SH) and to comment the most recent views about natural evolution of thyroid function in the cases with either idiopathic or Hashimoto's thyroiditis-related SH. On the basis of these preliminary remarks, the essential guidelines for an appropriate and tailored management of SH children are also proposed.

Multimodal-3D imaging based on µMRI and µCT techniques bridges the gap with histology in visualization of the bone regeneration process.

Bone repair/regeneration is usually investigated through X-ray computed microtomography (µCT) supported by histology of extracted samples, to analyse biomaterial structure and new bone formation processes. Magnetic resonance imaging (µMRI) shows a richer tissue contrast than µCT, despite at lower resolution, and could be combined with µCT in the perspective of conducting non-destructive 3D investigations of bone. A pipeline designed to combine µMRI and µCT images of bone samples is here described and applied on samples of extracted human jawbone core following bone graft. We optimized the coregistration procedure between µCT and µMRI images to avoid bias due to the different resolutions and contrasts. Furthermore, we used an Adaptive Multivariate Clustering, grouping homologous voxels in the coregistered images, to visualize different tissue types within a fused 3D metastructure. The tissue grouping matched the 2D histology applied only on 1 slice, thus extending the histology labelling in 3D. Specifically, in all samples, we could separate and map 2 types of regenerated bone, calcified tissue, soft tissues, and/or fat and marrow space. Remarkably, µMRI and µCT alone were not able to separate the 2 types of regenerated bone. Finally, we computed volumes of each tissue in the 3D metastructures, which might be exploited by quantitative simulation. The 3D metastructure obtained through our pipeline represents a first step to bridge the gap between the quality of information obtained from 2D optical microscopy and the 3D mapping of the bone tissue heterogeneity and could allow researchers and clinicians to non-destructively characterize and follow-up bone regeneration.

Identification, synthesis and biological activity of alkyl-guanidine oligomers as potent antibacterial agents.

In the last two decades, the repertoire of clinically effective antibacterials is shrinking due to the rapidly increasing of multi-drug-resistant pathogenic bacteria. New chemical classes with innovative mode of action are required to prevent a return to the pre-antibiotic era. We have recently reported the identification of a series of linear guanidine derivatives and their antibacterial properties. A batch of a promising candidate for optimization studies (compound 1) turned out to be a mixture containing two unknown species with a better biological activity than the pure compound. This serendipitous discovery led us to investigate the chemical nature of the unknown components of the mixture. Through MS analysis coupled with design and synthesis we found that the components were spontaneously generated oligomers of the original compound. Preliminary biological evaluations eventually confirmed the broad-spectrum antibacterial activity of this new family of molecules. Interestingly the symmetric dimeric derivative (2) exhibited the best profile and it was selected as lead compound for further studies.

Neutron scattering observation of quasi-free rotations of water confined in carbon nanotubes.

The translational and orientational dynamics of water in carbon nanotubes has been studied by quasi-elastic neutron scattering from 300 down to 10 K. Results show that, reducing temperature below 200 K, part of this water behaves as a quasi-free rotor, that is, the orientational energy of such molecules becomes comparable to the rotational energy of water in the gas phase. This novel and unique dynamic behavior is related to the appearance of water molecules characterized by a coordination number of about two, which is promoted by sub-nanometer axial confinement. This peculiar molecular arrangement allows water to show an active rotational dynamics even at temperatures as low as 10 K. The translational mobility shows a behavior compatible with the rotational one.

Autoimmune comorbidities in Hashimoto's thyroiditis: different patterns of association in adulthood and childhood/adolescence.

OBJECTIVE: Hashimoto's thyroiditis (HT), the most common autoimmune thyroid disease at any age, is often associated with other autoimmune diseases. The present study was aimed to describe the type and frequency of non-thyroidal autoimmune diseases (NTADs) in HT patients and to delineate the clinical pattern of diseases clustering in pediatric/adolescent and adult age. DESIGN: Cross-sectional study. METHODS: 1053 newly diagnosed HT patients (500 adults (467 F, mean age 40.2 ± 13.7 years) and 553 children/adolescents (449 F, mean age 11.1 ± 3.0 years)) were evaluated for common NTADs by means of careful recording of medical history, physical examination and assessment of selected autoantibody profiles. RESULTS: The prevalence of associated NTADs was significantly higher in adults than that in pediatric/adolescent HT patients (P < .0001). In addition, the number of adult patients suffering from two or more associated NTADs was significantly higher than that of children/adolescent (P < 0.0001). A female prevalence was evident in both cohorts, but was significant in the adults (P < 0.0001). The epidemiological distribution of NTADs was strongly different in the two cohorts, the most frequent associated diseases being arthropathies and connective tissue diseases in adults and type 1 diabetes and coeliac disease in children/adolescents. Skin diseases were represented with similar prevalence in both cohorts, vitiligo being the most common. CONCLUSIONS: Age at HT presentation may influence autoimmune diseases clustering, favoring the association of specific NTADs in different ages of life. Moreover, the association between HT and NTADs increases with age and occurs most frequently in adults.

A new stem nematode, Ditylenchus oncogenus n. sp. (Nematoda: Tylenchida), parasitizing sowthistle from Adriatic coast dunes in southern Italy.

Morphological and molecular analyses of a stem nematode causing a severe disease on infected sowthistle (Sonchus bulbosus) plants, involving the formation of gall-like structures on infected leaves and stems, have led to the description of a new species named Ditylenchus oncogenus n. sp. Morphologically, the new species is characterized by a medium to large body size (all adults more than 1 mm in length); a delicate stylet (9.0-11.0 µm long) with minute, rounded knobs; a long post-vulval uterine sac (c. 65% of the vulva-anus distance); six incisures at the lateral fields and characteristic D. destructor-pattern of spicules (with pronounced ventral tumulus and anteriorly pointed, less sclerotized, cuticle parts present within the lamina). The results of molecular analysis of rRNA gene sequences, including the D2-D3 expansion regions of 28S rRNA, internal transcribed spacer (ITS) rRNA, partial 18S rRNA gene, the protein-coding mitochondrial gene, cytochrome oxidase c subunit I (COI), and the heat-shock protein 90 (hsp90) gene, support the new species status. The results of a host-suitability test indicated that the new species does not parasitize potato (Solanum tuberosum) tubers and broad bean (Vicia faba) seedlings. Histopathological observations on naturally infected sowthistle tissues revealed that D. oncogenus n. sp. causes floral stem neoplasia and midrib leaf gall formation on the type, and to date only known, host. The galls were characterized by extensive hyperplasia, where several necrotic cells in the neoplasic area were directly damaged by feeding of the nematode, whereas a number of adjacent cells showed typical cytological changes, such as granulated cytoplasm with hypertrophied nuclei and nucleoli.

Coping and parental role competence of mothers of preterm infant.

AIM: The study was aimed at obtaining knowledge about mothers' experiences of preterm birth. The objective of the study is to explore coping strategies and self- perceived parental competence, in mothers of infant born moderately and severely preterm and admitted to the Neonatal Intensive Care Unit (NICU). METHODS: The study involved a group of 16 mothers of moderately preterm children (weeks' gestational age: mean=34, SD=2 and birth weight: mean=2000 g, SD=200 g) and a group of 14 mothers of severely preterm children (weeks' gestational age: mean=29, SD=2 and birth weight: mean=1700 g, SD=350 g). The following instruments were used with mothers to investigate focus areas of research: Coping Orientation to the Problems Experienced-New Italian Version (COPE-NVI), to analyse coping strategies of mothers, and a Q-sort, a self report on maternal competence. RESULTS: Data did not show statistically significant differences between the two groups of mothers, both in regard to considered coping strategies (social support, avoidance, problem focused orientation, transcendent orientation, positive aptitude), and the indicators of maternal self-perceived competence (coping, scaffolding, caregiving) (Mann-Whitney U test(n1=16 and n2=14)>0.05). CONCLUSION: This study, highlighting the lack of differences between the two groups of mothers involved, seems to point out that, beyond the levels of prematurity, the condition of preterm birth itself is precisely the main stressor factor for mothers.

Idiopathic and mild subclinical hypothyroidism in childhood: clinical management.

Subclinical hypothyroidism (SH) is a common clinical problem in children and adolescents, for which there are many controversial issues regarding natural course and management. Aim of this review is to report on the state of the art regarding these controversial points of idiopathic SH in pediatric age. We included in our search only full-length articles on natural history and treatment of SH in children with no associated diseases or genetic syndromes, thus identifying only 13 papers that were suitable for our analysis. According to the results of these retrospective or longitudinal studies a persistently mild TSH elevation (between 5 and 10 mIU/L) in SH children with no underlying disease is unable to affect growth and bone maturation or body mass index (two studies) or cognitive function (one study). Moreover, the risk of a deterioration over time of thyroid function in the untreated cases with mild and idiophatic SH is only 12% (one study). Progression odds increase with increasing baseline TSH, with goiter presence and with positive anti-thyroid antibodies (two studies in children). Although no broad consensus exists on whether children with mild SH require L-T4 therapy, nevertheless, on the basis of the results of the majority of included studies, it can be concluded that L-T4 treatment is not indicated when TSH is repeatedly between 5 and 10 mIU/L and an underlying disease has been excluded. By contrast, treatment is suitable in the cases with TSH>10 mIU/L and/or an underlying disease.