Developmental trajectories of late preterm infants and predictors of academic performance.

BACKGROUND: The trajectories of late preterm development from infancy to kindergarten reading and math, and predictors of academic resilience and risk are unknown. METHODS: Sample included 1200 late preterm infants (LPIs) from the Early Childhood Longitudinal Study, Birth Cohort. Objective measurements of development at 9 and 24 months (Bayley-SFR) and reading and math academic achievement at preschool and kindergarten were standardized; trajectories of late preterm development from 9 months to kindergarten reading and math were identified using latent class growth analysis. Multinomial logistic regression [aOR, 95% CI] identified predictors of academic resilience and risk. RESULTS: Four trajectory groups were observed for reading and three for math. More optimal trajectories (in reading and math) and academic resilience were associated with experiencing sensitive parenting and preschool attendance. Suboptimal (at-risk) trajectories (in reading or math) and an increased odds of academic risk were associated with

A Bayesian approach for exploring person × environment interaction within the environmental sensitivity meta-framework.

BACKGROUND: For investigating the individual-environment interplay and individual differences in response to environmental exposures as captured by models of environmental sensitivity including Diathesis-stress, Differential Susceptibility, and Vantage Sensitivity, over the last few years, a series of statistical guidelines have been proposed. However, available solutions suffer of computational problems especially relevant when sample size is not sufficiently large, a common condition in observational and clinical studies. METHOD: In the current contribution, we propose a Bayesian solution for estimating interaction parameters via Monte Carlo Markov Chains (MCMC), adapting Widaman et al. (Psychological Methods, 17, 2012, 615) Nonlinear Least Squares (NLS) approach. RESULTS: Findings from an applied exemplification and a simulation study showed that with relatively big samples both MCMC and NLS estimates converged on the same results. Conversely, MCMC clearly outperformed NLS, resolving estimation problems and providing more accurate estimates, particularly with small samples and greater residual variance. CONCLUSIONS: As the body of research exploring the interplay between individual and environmental variables grows, enabling predictions regarding the form of interaction and the extent of effects, the Bayesian approach could emerge as a feasible and readily applicable solution to numerous computational challenges inherent in existing frequentist methods. This approach holds promise for enhancing the trustworthiness of research outcomes, thereby impacting clinical and applied understanding.

Maternal dispositional mindfulness and mother-child relationship: The mediating role of emotional control during parenting.

BACKGROUND: The literature supports the role of parental dispositional mindfulness on parent-child relationship quality. However, little is known about the connection between these two aspects. OBJECTIVE: The aim of this study was to investigate whether emotion regulation during parenting, that is, the ability to control negative emotions, mediated the association between parental dispositional mindfulness and parent-child relationship quality. The study also explored the moderation role of child age on the association between parental dispositional mindfulness and parent's ability to control negative emotions during parenting. METHODS: Participants were 635 mothers of children aged between 12 months and 5 years. Mothers completed self-report questionnaires to measure maternal dispositional mindfulness, mother-child relationship quality and maternal control of negative emotions during parenting. RESULTS: Results showed that maternal ability to control negative emotions during parenting partially mediated the association between maternal dispositional mindfulness and mother-child relationship quality. Moreover, the moderation role of child age indicated that the association between maternal dispositional mindfulness and maternal ability to control negative emotions during parenting was stronger for older children's mothers. CONCLUSION: Dispositional mindfulness has a protective role for the quality of parenting and the mother-child relationship. Theoretical and practical implications are discussed.

The interplay between parenting and environmental sensitivity in the prediction of children's externalizing and internalizing behaviors during COVID-19.

The interplay of parenting and environmental sensitivity on children's behavioral adjustment during, and immediately after, the COVID-19 lockdown restrictions was investigated in two longitudinal studies involving Italian preschoolers (Study 1, N = 72; 43% girls, Myears = 3.82(1.38)) and primary school children (Study 2, N = 94; 55% girls, Myears = 9.08(0.56)). Data were collected before and during the first-wave lockdown (Studies 1 and 2) and one month later (Study 1). Parental stress and parent-child closeness were measured. Markers of environmental sensitivity in children were temperamental fearfulness and Sensory Processing Sensitivity. Results showed little change in externalizing and internalizing behaviors over time, but differences emerged when considering parenting and children's environmental sensitivity. In preschoolers, greater parenting stress was related to a stronger increase in internalizing and externalizing behaviors, with children high in fearful temperament showing a more marked decrease in externalizing behaviors when parenting stress was low. In school-aged children, parent-child closeness emerged as a protective factor for internalizing and externalizing behaviors during COVID-19, with children high in Sensory Processing Sensitivity showing a marked decrease in internalizing behaviors when closeness was high. Implications for developmental theory and practice in times of pandemic are discussed.

CT-guided radiofrequency ablation of painful intra-articular osteoid osteoma in children: Is there a concern for cartilage damage?

OBJECTIVE: To evaluate the safety and efficacy of computed tomography-guided percutaneous radiofrequency ablation (PRFA) in the management of uncommon and technically challenging intra-articular osteoid osteoma in children. MATERIAL AND METHODS: From December 2018 to September 2022, 16 children with intra-articular osteoid osteoma, including ten boys and six girls, were treated at two tertiary centers with percutaneous CT-guided RF ablation using a straight monopolar electrode. The procedures were carried out under general anesthesia. Post-procedural clinical outcomes and adverse events were assessed through clinical follow-up. RESULTS: Technical success was achieved in all of the participating patients. Clinical success with relief of symptomatology throughout the period of follow-up was achieved in 100% of the patients. No persistence or recurrence of pain occurred during the follow-up period. No immediate or delayed adverse effects were observed. CONCLUSION: PRFA is shown to be technically feasible. Clinical improvement can be achieved with a high rate of success in the treatment of children with difficult-to-treat intra-articular osteoid osteomas.

MRI radiomics-based machine learning for classification of deep-seated lipoma and atypical lipomatous tumor of the extremities.

PURPOSE: To determine diagnostic performance of MRI radiomics-based machine learning for classification of deep-seated lipoma and atypical lipomatous tumor (ALT) of the extremities. MATERIAL AND METHODS: This retrospective study was performed at three tertiary sarcoma centers and included 150 patients with surgically treated and histology-proven lesions. The training-validation cohort consisted of 114 patients from centers 1 and 2 (n = 64 lipoma, n = 50 ALT). The external test cohort consisted of 36 patients from center 3 (n = 24 lipoma, n = 12 ALT). 3D segmentation was manually performed on T1- and T2-weighted MRI. After extraction and selection of radiomic features, three machine learning classifiers were trained and validated using nested fivefold cross-validation. The best-performing classifier according to previous analysis was evaluated and compared to an experienced musculoskeletal radiologist in the external test cohort. RESULTS: Eight features passed feature selection and were incorporated into the machine learning models. After training and validation (74% ROC-AUC), the best-performing classifier (Random Forest) showed 92% sensitivity and 33% specificity in the external test cohort with no statistical difference compared to the radiologist (p = 0.474). CONCLUSION: MRI radiomics-based machine learning may classify deep-seated lipoma and ALT of the extremities with high sensitivity and negative predictive value, thus potentially serving as a non-invasive screening tool to reduce unnecessary referral to tertiary tumor centers.

Parental relationships, emotion regulation and orthorexia: A study on adolescent athletes.

Background: This study seeks to further our understanding of the factors associated with adolescent athletes and disordered eating, by expanding current research into a less-explored eating disorder known as orthorexia. Aim: The aim of the study is to explore the impact of parents' relationships and emotional regulation on the orthorexia nervosa (ON) tendencies of adolescent athletes. Methods: The participants were 303 adolescents, ranging from 15 to 17 years old, of which 139 participated in competitive sport, and 164 did not. Three self-report questionnaires were administered to assess orthorexia (ORTO-15), relationship with parents (Inventory of Parent and Peer Attachment) and emotion regulation (Emotion Regulation Questionnaire). Results: The results highlight that those who practice sports report higher levels of orthorexia, inadequate relationships with parents, as well as greater emotional regulation difficulties. Furthermore, inadequate parents' relationship predicts orthorexia while expressive emotional regulation mediates this relationship. Conclusion: These findings highlight how ON tendencies in athletes are linked to poor management of emotions combined with inadequate relationships with parents in terms of communication and affection. Implications for practice and support for athletes are discussed.

Investigating sensitivity through the lens of parents: validation of the parent-report version of the Highly Sensitive Child scale.

Children differ in their environmental sensitivity (ES), which can be measured observationally or by self-report questionnaire. A parent-report scale represents an important tool for investigating ES in younger children but has to be psychometrically robust and valid. In the current multistudy, we validated the parent-report version of the Highly Sensitive Child (HSC-PR) scale in Italian children, evaluating its factorial structure (Study 1, N = 1,857, 6.2 years, age range: 2.6-14 years) through a multigroup Confirmatory Factory Analysis in preschoolers (n = 1,066, 4.2 years) and school-age children (n = 791, 8.8 years). We then investigated the HSC-PR relationship with established temperament traits (Study 2, N = 327, 4.3 years), before exploring whether the scale moderates the effects of parenting stress on children's emotion regulation (Study 3, N = 112, 6.5 years). We found support for a bi-factor structure in both groups, though in preschoolers minor adaptations were suggested for one item. Importantly, the HSC-PR did not fully overlap with common temperament traits and moderated the effects of parenting stress on children emotion regulation. To conclude, the HSC-PR performs well and appears to capture ES in children.

Protective and risk activities for emotional and behavioural well-being of children and adolescents during the COVID-19 lockdown.

BACKGROUND: The lockdown imposed to contain the COVID-19 pandemic brought deep changes in the daily life of Italian children and adolescents, increasing the time spent at home. This study aims to explore how activities that children and adolescents carried out at home during the lockdown were related to their emotional and behavioural well-being. METHOD: Parents completed an anonymous online survey on how much time their children and adolescents dedicated to social networks, solitary screen time, play time and to a series of parent-child dyadic activities. They also reported on their offspring's emotional difficulties and behavioural problems. RESULTS: The use of social networks had a negative impact on children's emotional difficulties, while it promoted well-being in adolescents. Pertaining to solitary screen activities, these were associated with more behavioural problems in both children and adolescents. Regarding parent-child dyadic activities, get along with the parent was associated with less emotional difficulties and behavioural problems in children and with less behavioural problems in adolescents. Furthermore, for adolescents, the more they talked with the parent, the less behavioural problems they evidenced. CONCLUSION: The current study may help to identify activities that could be promoted and those that should be limited to effectively menage home time, in order to ultimately safeguard the emotional and behavioural well-being of children and adolescents.

Role of percutaneous CT-guided radiofrequency ablation in treatment of intra-articular, in close contact with cartilage and extra-articular osteoid osteomas: comparative analysis and new classification system.

PURPOSE: We investigated procedural safety, technical and clinical outcomes of the percutaneous image-guided radiofrequency ablation (PRFA) of intra-articular (IA), intra-articular close to cartilage (IACC), and extra-articular (EA) osteoid osteomas (OO). We proposed a new radiologic classification for osteoid osteoma depending on the degree and location of sclerosis which may correlate with technical failure and/or difficulties. MATERIAL AND METHODS: According to the inclusion criteria, we enrolled consecutive patients who were referred to the investigation center from June 2018 to January 2022. After clinical and CT imaging features were suggestive for the diagnosis of OO, all the patients were treated by percutaneous CT-guided RFA with a standardized technique. Biopsy of the lesion was not performed in all patients. A retrospective analysis was conducted to assess the procedure's technical, primary clinical, and secondary clinical successes, recurrence rate, and complications. We classified all the OOs according to a new proposed classification of the site and the amount of sclerosis. RESULTS: A total number of 55 patients were enrolled in our study according to the inclusion criteria. The mean age of the enrolled patients was 24.07 ± 14.71 years (ranges from 7 to 57 years). The M/F ratio was roughly 2:1. The mean follow-up was 20.18 ± 12.60 months (ranges from 2 to 44 months). EA group included 36 patients, IA included 5 and IACC included 14 patients. Technical success was achieved in all cases of IA and IACC groups. Technical success in the EA group was 97.22% (1 technical failure). Primary clinical success was 100%, 92.85%, and 91.66% for IA, IACC, and EA groups, respectively. Accordingly, the recurrence rate was 5.88% in EA, and 7.14% in IACC, while no recurrence occurred in the IA group. No complications occurred. The secondary success rate of the 3 cases of recurrence was 100%. CONCLUSIONS: PRFA proved to be a safe procedure with a high rate of success for OO treatment even in intra-articular lesions in close contact with cartilage. This study showed that the results in terms of technical and clinical success are comparable for IA OO, IACC OO, and EA OO, even if the recurrence rate was higher in EA OO. Our proposed new classification of the degree and location of sclerosis may correlate to technical failure, but further studies with a larger number of patients are needed for validation.

Verbal - prosodic association when narrating early caregiving experiences during the adult attachment interview: differences between secure and dismissing individuals.

Previous studies reported an inconsistency between verbal extracts and emotional physiological activation in dismissing individuals when narrating their early caregiving experience at the Adult Attachment Interview (AAI). This study aimed to explore this discrepancy by analyzing the degree of concordance between verbal content and prosodic characteristics, index of physiological activation, when dismissing and secure individuals discuss negative childhood memories during the AAI. Results showed that secure participants presented a high coherence between verbal content and emotional activation, as expressed by prosody, revealing a reprocess of negative experiences that is the core feature of the development of secure working models. In contrast, dismissing participants' prosodic characteristics were discrepant with the verbal content. These individuals downplayed the nature and impact of negative experiences and emotions, but used a prosody that revealed a high emotional arousal. The difference between the two groups was more evident for participants who had experienced more rejecting parents.

Singing to infants matters: Early singing interactions affect musical preferences and facilitate vocabulary building.

This research revealed that the frequency of reported parent-infant singing interactions predicted 6-month-old infants' performance in laboratory music experiments and mediated their language development in the second year. At 6 months, infants (n = 36) were tested using a preferential listening procedure assessing their sustained attention to instrumental and sung versions of the same novel tunes whilst the parents completed an ad-hoc questionnaire assessing home musical interactions with their infants. Language development was assessed with a follow-up when the infants were 14-month-old (n = 26). The main results showed that 6-month-olds preferred listening to sung rather than instrumental melodies, and that self-reported high levels of parental singing with their infants [i] were associated with less pronounced preference for the sung over the instrumental version of the tunes at 6 months, and [ii] predicted significant advantages on the language outcomes in the second year. The results are interpreted in relation to conceptions of developmental plasticity.

Multimodal assessments of preterm temperament across the first year of life: Continuity, stability, and moderation by country of origin and infant age.

There is limited research regarding the continuity, stability, and role of country of origin in preterm infant temperament across the first year of life. This prospective longitudinal study examined patterns of mean-level continuity and individual-differences stability of select scales of temperament at 6 and 12 months in preterm infants from three countries, Chile (n = 47), United Kingdom (n = 44), and United States (n = 50). Temperament was assessed with the Infant Behavior Questionnaire and observed using the Bayley Behavior Rating Scale. Continuity and stability across infant age, country effects, and interactions of country and age on preterm infant temperament were examined. Chilean mothers rated infants higher in soothability, duration of orienting, and orientation/engagement compared with mothers from the United Kingdom and/or United States. Continuity of temperament from 6 to 12 months varied by country: Chilean mothers reported increasing smiling and laughter and activity level from 6 to 12 months, and mothers from the United Kingdom reported decreasing smiling and laughter and increasing fear from 6 to 12 months. Infant temperament was stable in all three countries. Correlations evidenced low concordance between maternal reports and examiner observations of infant temperament at 12 months. However, among Chilean infants, higher maternal reported activity level was associated with higher examiner observed orientation/engagement score.

Hay una limitada investigación acerca de la continuidad, la estabilidad y el papel del país de origen en el temperamento de infantes nacidos prematuramente a lo largo del primer año de vida. Este potencial estudio longitudinal examinó patrones de continuidad en el promedio de nivel y las diferencias individuales en cuanto a la estabilidad de selectas escalas de temperamento a los 6 y 12 meses en infantes prematuros de tres países, Chile (n = 47), Reino Unido (n = 44) y Estados Unidos (n = 50). El temperamento se evaluó con el Cuestionario de Comportamiento del Infante y el mismo se observó usando la Escala de Puntuación del Comportamiento de Bayley. Se examinaron la continuidad y la estabilidad a lo largo de la edad del infante, los efectos del país, así como las interacciones entre país y edad en el temperamento de los infantes prematuros. Las madres chilenas evaluaron a sus infantes con más altos puntajes en cuanto a posibilidad de tranquilizarlos, duración de orientarlos y la orientación/participación en comparación con madres del Reino Unidos y/o de Estados Unidos. La continuidad de temperamento de los 6 a 12 meses varió según el país: las madres chilenas reportaron aumento en la sonrisa y la risa, y el nivel de actividad de los 6 a 12 meses, y las madres del Reino Unido reportaron una disminución en la sonrisa y la risa, y un aumento en el temor de los 6 a 12 meses. El temperamento del infante fue estable en los tres países. Las correlaciones son evidencia de la concordancia entre los reportes maternos y las observaciones del examinador del temperamento del infante a los 12 meses. Sin embrago, entre los infantes chilenos, el más alto nivel de actividad reportado por las madres se asoció con un más alto puntaje del examinador en cuanto a la observada orientación/participación.

Nous n'avons que des recherches limitées sur la continuité, la stabilité et le rôle du pays d'origine dans le tempérament du bébé prématuré au fil de la première année de la vie. Cette étude longitudinale prospective a examiné les modèles de continuité au niveau moyen et la stabilité des différences individuelles de certaines échelles de tempérament à 6 et à 12 mois chez les enfants prématurés de trois pays, le Chili (n = 47), le Royaume Uni (n = 44) et les Etats-Unis d'Amérique (n = 50). Le tempérament a été évalué au moyen du Questionnaire du Comportement du Nourrisson et observé en utilisant l'Echelle de Bailey d'Evaluation du Comportement du Nourrisson. La continuité et la stabilité au travers de l'âge du nourrisson, les effets du pays et les interactions du pays et de l'âge sur le tempérament du bébé prématuré ont été examinés. Les mères chiliennes ont évalué leurs bébés plus haut pour ce qui concernait la capacité à être calmé, la durée de l'orientation et l'orientation/l'engagement par comparaison aux mères du Royaume Uni et/ou des Etats-Unis. La continuité du tempérament de 6 à 12 mois a varié par pays: les mères chiliennes ont fait état de plus de sourires et de rires et d'un niveau d'activité plus élevé de 6 à 12 mois et les mères du Royaume Uni ont fait état d'une décroissance des sourires et des rires et d'une plus grande peur de 6 à 12 mois. Le tempérament du nourrisson était stable dans les trois pays. Les corrélations ont montré une concordance faible entre les rapports maternels et les observations de l'examinateur du tempérament du nourrisson à 12 mois. Cependant, chez les enfants chiliens, un niveau d'activité plus élevé rapporté par la mère était lié à un score d'orientation/d'engagement observé plus élevé de la part de l'examinateur.

Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental Risk Factors and Implications for Children Emotion Regulation.

The COVID-19 outbreak imposed to Italian families many changes in their daily life increasing the risk of developing psychological problems. The present study explored risk factors associated with parenting stress and implications for children's emotion regulation in families with different socioeconomic risks. Parents of 2-14 years old children completed a survey reporting difficulties experienced due to the lockdown, level of household chaos, parenting stress, parent involvement in the child's daily life, and children emotion regulation competences. The general mean levels of parenting stress and children emotion regulation abilities were not at clinical level compared with Italian norms. Household chaos predicted higher levels of parenting stress, which, in turn, was associated with less effective emotion regulation in children through the mediating role of parental involvement. More stressed parents were less involved in their children's activities, decreasing children's effective emotion regulation. Only for SES no-risk families, the lockdown constraints increased parenting stress. For SES at-risk families, the impact of parenting stress and involvement on children regulation strategies was stronger, with a protective role played by parental involvement on children's negativity not evident for SES no-risk families. Dealing with the lockdown is a stressful experience for parents who have to balance personal life, work, and children upbringing, without other help. This situation potentially impairs their ability to be supportive caregivers and is consequently detrimental for children well-being. Policies should take into consideration the implications of the lockdown for families' mental health and tailor supportive interventions according to family's risk factors.

El brote de la COVID-19 impuso a las familias italianas muchos cambios en su vida cotidiana, los cuales aumentaron el riesgo de desarrollar problemas psicológicos. El presente estudio analizó los factores de riesgo asociados con el estrés de la crianza y las consecuencias para la regulación emocional de los hijos en familias con diferentes riesgos socioeconómicos. Un grupo de padres de niños de entre dos y 14 años contestó una encuesta donde informó las dificultades vividas debido al confinamiento, el nivel de caos en el hogar, el estrés en la crianza, la participación de los padres en la vida diaria de los hijos y las competencias de los hijos para regular sus emociones. Los niveles promedio generales de estrés en la crianza y las habilidades de regulación emocional en los niños no estuvieron a nivel clínico en comparación con las normas italianas. El caos en el hogar predijo niveles más altos de estrés en la crianza, el cual, a su vez, estuvo asociado con una menor regulación emocional eficaz en los niños mediante el rol mediador de la participación de los padres. Los padres más estresados participaron menos en las actividades de sus hijos, lo cual disminuyó la regulación emocional eficaz en los niños. Solo en los casos de las familias sin riesgo socioeconómico las limitaciones del confinamiento aumentaron el estrés en la crianza. Para las familias de riesgo socioeconómico, el efecto del estrés en la crianza y la participación en las estrategias de regulación emocional de los niños fue más profundo, y en el caso de las familias sin riesgo socioeconómico, no se evidenció el papel protector desempeñado por la participación de los padres en la negatividad de los niños. Lidiar con el confinamiento es una experiencia estresante para los padres que tienen que compatibilizar la vida personal, el trabajo y la educación de los niños sin ninguna otra ayuda. Esta situación puede deteriorar su capacidad de ser cuidadores comprensivos y, como consecuencia, ser perjudicial para el bienestar de los niños. Las políticas deberían tener en cuenta las consecuencias del confinamiento en la salud mental de las familias y adaptar intervenciones de apoyo de acuerdo con los factores de riesgo de las familias.

Coronavirus disease (COVID-19) in a paucisymptomatic patient: epidemiological and clinical challenge in settings with limited community transmission, Italy, February 2020.

Data concerning the transmission of the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) in paucisymptomatic patients are lacking. We report an Italian paucisymptomatic case of coronavirus disease 2019 with multiple biological samples positive for SARS-CoV-2. This case was detected using the World Health Organization protocol on cases and contact investigation. Current discharge criteria and the impact of extra-pulmonary SARS-CoV-2 samples are discussed.

Infant-directed speech as a simplified but not simple register: a longitudinal study of lexical and syntactic features.

Infant-directed speech (IDS) is a specific register that adults use to address infants, and it is characterised by prosodic exaggeration and lexical and syntactic simplification. Several authors have underlined that this simplified speech becomes more complex according to the infant's age. However, there is a lack of studies on lexical and syntactic modifications in Italian IDS during the first year of an infant's life. In the present study, 80 mother-infant dyads were longitudinally observed at 3, 6, 9, and 12 months during free-play interactions. Maternal vocal productions were subsequently coded. The results show an overall low lexical variability and syntactic complexity that identify speech to infants as a simplified register; however, the high occurrence of complex items and well-structured utterances suggests that IDS is not simple speech. Moreover, maternal IDS becomes more complex over time, but not linearly, with a maximum simplification in the second half of the first year.

It is a matter of how you say it: Verbal content and prosody matching as an index of emotion regulation strategies during the Adult Attachment Interview.

Emotional activation can be detected by the prosodic properties of the voice. This study aimed to explore the match between the valence of the words used by secure and dismissing women in describing the relationship with their parents during the Adult Attachment Interview and their emotional activation as expressed through the prosody of the voice. Contrary to what observed for secure women, a discrepancy emerged in dismissing individuals between the content of their verbal reports during the interview and the emotional activation of their voice while speaking. Negative experiences, usually cognitively minimised and normalised, were expressed with high emotional arousal, while positive descriptors, often exaggerated semantically, were expressed with neutral arousal. Therefore, the defensive inhibition strategy seems to control the content but not the prosody of narratives and prosody has the potential to allow a better understanding of the emotion regulation strategies used by individuals while discussing their caregiving histories.

Prosodic skills in children with Down syndrome and in typically developing children.

BACKGROUND: Many studies have analysed language development in children with Down syndrome to understand better the nature of their linguistic delays and the reason why these delays, particularly those in the morphosyntactic area, seem greater than their cognitive impairment. However, the prosodic characteristics of language development in children with Down syndrome have been scarcely investigated. AIMS: To analyse the prosodic skills of children with Down syndrome in the production of multi-word utterances. Data on the prosodic skills of these children were compared with data on typically developing children matched on developmental age and vocabulary size. Between-group differences and the relationships between prosodic and syntactic skills were investigated. METHODS & PROCEDURES: The participants were nine children with Down syndrome (who ranged in chronological age from 45 to 63 months and had a mean developmental age of 30 months) and 12 30-month-old typically developing children. The children in both groups had a vocabulary size of approximately 450 words. The children's spontaneous productions were recorded during observations of mother-child play sessions. OUTCOMES & RESULTS: Data analyses showed that despite their morphosyntactic difficulties, children with Down syndrome were able to master some aspects of prosody in multi-word utterances. They were able to produce single intonation multi-word utterances on the same level as typically developing children. In addition, the intonation contour of their utterances was not negatively influenced by syntactic complexity, contrary to what occurred in typically developing children, although it has to be considered that the utterances produced by children with Down syndrome were less complex than those produced by children in the control group. However, children with Down syndrome appeared to be less able than typically developing children to use intonation to express the pragmatic interrogative function. CONCLUSIONS & IMPLICATIONS: The findings are discussed considering the effects of social experience on the utterance prosodic realization.

Fractures in bone tumour prosthesis.

PURPOSE: The aim of the present narrative review is to report the different aspects related to the fractures around tumour prosthetic implants in terms of technical and medical issues. METHODS: A non systematic literature review on the topic was performed. RESULTS: Given the increased rate of limb salvage procedures and megaprostheses implanted for bone tumours, the increased number of osteoporotic periprosthetic fractures, and the burden of revision arthroplasty, the number of surgeries using endoprosthetic implants is likely to increase in the near future. Surgeons will face more frequently the complications related to tumour endoprosthetic implant. Endoprosthetic reconstruction has a higher risk of intra-operative and post-operative complications compared to conventional prosthetic replacement. CONCLUSIONS: Very rare reports and recommendations are available in literature regarding the treatment of periprosthetic fractures after megaprosthesis, and there is currently no consensus about which should be the standard management for periprosthetic fractures in this population of patients.

Bone metastases of unknown origin: epidemiology and principles of management.

UNLABELLED: Metastases are the most common malignancies involving bone; breast, prostate, lung and thyroid are the main sites of primary cancer. However, up to 30 % of patients present with bone metastases of unknown origin, where the site of the primary neoplasm cannot be identified at the time of diagnosis despite a thorough history, physical examination, appropriate laboratory testing and modern imaging technology (CT, MRI, PET). Sometimes only extensive histopathological investigations on bone specimens from biopsy can suggest the primary malignancy. At other times, a bone lesion can have such a highly undifferentiated histological appearance that a precise pathological classification on routine hematoxylin-eosin-stained section is not possible. The authors reviewed the relevant literature in an attempt to investigate the epidemiology of the histological primaries finally identified in patients with bone metastases from occult cancer, and a strategy of management and treatment of bone metastases from occult carcinomas is suggested. Lung, liver, pancreas and gastrointestinal tract are common sites for primary occult tumors. Adenocarcinoma is the main histological type, accounting for 70 % of all cases, while undifferentiated cancer accounts for 20 %. Over the past 30 years, lung cancer is the main causative occult primary for bone metastases and has a poor prognosis with an average survival of 4-8 months. Most relevant literature focuses on the need for standardized diagnostic workup, as surgery for bone lesions should be aggressive only when they are solitary and/or the occult primaries have a good prognosis; in these cases, identification of the primary tumor may be important and warrants special diagnostic efforts. However, in most cases, the primary site remains unknown, even after autopsy. Thus, orthopedic surgery has a mainly palliative role in preventing or stabilizing pathological fractures, relieving pain and facilitating the care of the patient in an attempt to provide the most appropriate therapy for the primary tumor as soon as possible. LEVEL OF EVIDENCE: 5.