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Desai S, Chen IY, Hom C, Doran E, Nguyen DD, Benca RM, Lott IT, Mander BA. Insomnia Symptoms Are Associated with Measures of Functional Deterioration and Dementia Status in Adults with Down Syndrome at High Risk for Alzheimer's Disease. J Alzheimers Dis 2024; 100:613-629. [PMID: 38875029 PMCID: PMC11307085 DOI: 10.3233/jad-220750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 06/16/2024]
Abstract
Background While obstructive sleep apnea (OSA) and insomnia symptoms in neurotypical populations are associated with Alzheimer's disease (AD), their association with dementia in adults with Down syndrome (DS) remains less clear, even though these symptoms are prevalent and treatable in DS. Understanding their associations with AD-related dementia status, cognitive impairment, and functional deterioration may lead to interventions to slow decline or disease progression in adults with DS. Objective To characterize differences in OSA and insomnia symptom expression by dementia status, and to determine which sleep factors support dementia diagnosis. Methods Multimodal consensus conference was used to determine dementia status in 52 adults with DS (52.2 ± 6.4 years, 21 women). Cognitive impairment, adaptive behavior skills, and symptoms of OSA and insomnia were quantified using validated assessments for adults with DS and their primary informants. Results A sex by dementia status interaction demonstrated that older women with DS and dementia had more severe terminal insomnia but not OSA symptoms relative to older women with DS who were cognitively stable (CS). Greater insomnia symptom severity was associated with greater functional impairments in social and self-care domains adjusting for age, sex, premorbid intellectual impairment, and dementia status. Conclusions Insomnia symptoms are more severe in women with DS with dementia than in women with DS and no dementia, and regardless of dementia status or sex, more severe insomnia symptoms are associated with greater impairment in activities of daily living. These findings underscore the potential importance of early insomnia symptom evaluation and treatment in women with DS at risk of developing AD.
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Affiliation(s)
- Shivum Desai
- Department of Pediatrics, University of California, Irvine, CA, USA
- Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Ivy Y. Chen
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Christy Hom
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Eric Doran
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Dana D. Nguyen
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Ruth M. Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Psychiatry and Behavioral Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Ira T. Lott
- Department of Pediatrics, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
| | - Bryce A. Mander
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, USA
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
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Onnivello S, Locatelli C, Pulina F, Ramacieri G, Marcolin C, Antonaros F, Vione B, Catapano F, Lanfranchi S. Cross-sectional developmental trajectories in the adaptive functioning of children and adolescents with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 144:104641. [PMID: 38141379 DOI: 10.1016/j.ridd.2023.104641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/11/2023] [Accepted: 11/28/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Persons with Down syndrome (DS) reveal adaptive functioning (AF) difficulties. Studies on AF in DS have focused mainly on describing the profile (i.e., strengths in socialization, and weaknesses in communication), while less is known about age-related differences. This study aimed to elucidate how AF changes with age in children and adolescents with DS, taking a cross-sectional developmental trajectory approach. Moreover, the contribution of both chronological age (CA) and mental age (MA) on AF development was explored. METHOD This study involved 115 children and adolescents (between 3 and 16 years old) with DS. Parents were interviewed about their children's AF on communication, daily living and socialization skills. Children and adolescents with DS were assessed on their developmental level. RESULTS While participants' standard scores on AF decreased linearly over time, their age-equivalent scores increased with linear or segmented patterns, depending on the skill considered. CA and MA were related to daily living skills and socialization to much the same degree, while MA correlated more strongly than CA with communication. CONCLUSION This study contributes to the understanding of how AF develops in children and adolescents with DS, showing that CA and MA both contribute to shaping the skills involved.
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Affiliation(s)
- Sara Onnivello
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
| | - Chiara Locatelli
- Neonatology Operating Unit, IRCCS A.O.U. of Bologna, Policlinic of Sant'Orsola, Italy
| | - Francesca Pulina
- Department of Developmental Psychology and Socialization, University of Padova, Italy
| | - Giuseppe Ramacieri
- Department of Medical and Surgical Science (DIMEC), University of Bologna, Italy; Specialist School of Child Neuropsychiatry, University of Bologna, Italy
| | - Chiara Marcolin
- Department of Developmental Psychology and Socialization, University of Padova, Italy
| | - Francesca Antonaros
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Beatrice Vione
- Department of Medical and Surgical Science (DIMEC), University of Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Francesca Catapano
- Department of Medical and Surgical Science (DIMEC), University of Bologna, Italy
| | - Silvia Lanfranchi
- Department of Developmental Psychology and Socialization, University of Padova, Italy.
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Lo Barco T, Offredi F, Castino E, Proietti J, Cossu A, Fiorini E, Fontana E, Cantalupo G, Dalla Bernardina B, Darra F. Adaptive behaviour in adolescents and adults with Dravet syndrome. Dev Med Child Neurol 2022; 65:838-846. [PMID: 36316303 DOI: 10.1111/dmcn.15448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022]
Abstract
AIM To explore the feasibility of using an adaptive behaviour profile (ABP) assessment generated from a well-known measure-the Vineland Adaptive Behavior Scales, Second Edition (VABS-II)-as an instrument for outcome measures in adolescents and adults with Dravet syndrome. METHOD We administered the VABS-II to 35 adolescents and adults with Dravet syndrome (15 males; mean age 24 years, SD 8 years, range: 12-46 years) and collected epilepsy history and neurological features at the time of assessment. We conducted a cross-sectional analysis of VABS-II raw scores and performed cluster analysis to identify different subgroups. We then explored possible relationships between clinical and epilepsy features, ABPs, and age. RESULTS Most participants obtained the minimum standard scores in the various VABS-II subdomains, while the raw score analysis outlined interindividual and intraindividual differences among skills. We found two subpopulations: one with a 'lower' ABP and one with a 'higher' ABP, corresponding respectively to individuals in whom myoclonic seizures or generalized spike-and-wave activity were present ('complete phenotype') or absent ('incomplete phenotype') on electroencephalography. INTERPRETATION This study further delineates the natural history of Dravet syndrome. The assessment of an ABP through the VABS-II raw score analysis provides a means by which to illustrate profiles of adaptive behaviour in adolescents and adults with Dravet syndrome but shows limitations related to poor sensitivity in measuring fine clinical details. There is a need for new and more specific tools to monitor patients with developmental and epileptic encephalopathies.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Offredi
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Eva Castino
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Jacopo Proietti
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Alberto Cossu
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fiorini
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Elena Fontana
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Bernardo Dalla Bernardina
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,Research Center for Pediatric Epilepsies Verona, Verona, Italy
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Goeldner C, Kishnani PS, Skotko BG, Casero JL, Hipp JF, Derks M, Hernandez MC, Khwaja O, Lennon-Chrimes S, Noeldeke J, Pellicer S, Squassante L, Visootsak J, Wandel C, Fontoura P, d’Ardhuy XL, De La Torre Fornell R, Glue P, Hoover-Fong J, Uhlmann S, Malagón Valdez J, Marshall A, Martinón-Torres F, Redondo-Collazo L, Rodriguez-Tenreiro C, Marquez Chin V, Michel Reynoso AG, Mitchell EA, Slykerman RF, Wouldes T, Loveday S, Moldenhauer F, Novell R, Ochoa C, Rafii MS, Rebillat AS, Sanlaville D, Sarda P, Shankar R, Pulsifer M, Evans CL, Silva AM, McDonough ME, Stanley M, McCary LM, Vicari S, Wilcox W, Zampino G, Zuddas A. A randomized, double-blind, placebo-controlled phase II trial to explore the effects of a GABAA-α5 NAM (basmisanil) on intellectual disability associated with Down syndrome. J Neurodev Disord 2022; 14:10. [PMID: 35123401 PMCID: PMC8903644 DOI: 10.1186/s11689-022-09418-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background There are currently no pharmacological therapies to address the intellectual disability associated with Down syndrome. Excitatory/inhibitory imbalance has been hypothesized to contribute to impairments in cognitive functioning in Down syndrome. Negative modulation of the GABAA-α5 receptor is proposed as a mechanism to attenuate GABAergic function and restore the excitatory/inhibitory balance. Methods Basmisanil, a selective GABAA-α5 negative allosteric modulator, was evaluated at 120 mg or 240 mg BID (80 or 160 mg for 12–13 years) in a 6-month, randomized, double-blind, placebo-controlled phase II trial (Clematis) for efficacy and safety in adolescents and young adults with Down syndrome. The primary endpoint was based on a composite analysis of working memory (Repeatable Battery for the Assessment of Neuropsychological Scale [RBANS]) and independent functioning and adaptive behavior (Vineland Adaptive Behavior Scales [VABS-II] or the Clinical Global Impression-Improvement [CGI-I]). Secondary measures included the Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P), Clinical Evaluation of Language Fundamentals (CELF-4), and Pediatric Quality of Life Inventory (Peds-QL). EEG was conducted for safety monitoring and quantitatively analyzed in adolescents. Results Basmisanil was safe and well-tolerated; the frequency and nature of adverse events were similar in basmisanil and placebo arms. EEG revealed treatment-related changes in spectral power (increase in low ~ 4-Hz and decrease in high ~ 20-Hz frequencies) providing evidence of functional target engagement. All treatment arms had a similar proportion of participants showing above-threshold improvement on the primary composite endpoint, evaluating concomitant responses in cognition and independent functioning (29% in placebo, 20% in low dose, and 25% in high dose). Further analysis of the individual measures contributing to the primary endpoint revealed no difference between placebo and basmisanil-treated groups in either adolescents or adults. There were also no differences across the secondary endpoints assessing changes in executive function, language, or quality of life. Conclusions Basmisanil did not meet the primary efficacy objective of concomitant improvement on cognition and adaptive functioning after 6 months of treatment, despite evidence for target engagement. This study provides key learnings for future clinical trials in Down syndrome. Trial registration The study was registered on December 31, 2013, at clinicaltrials.gov as NCT02024789. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09418-0.
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Onnivello S, Colaianni S, Pulina F, Locatelli C, Marcolin C, Ramacieri G, Antonaros F, Vione B, Piovesan A, Lanfranchi S. Executive functions and adaptive behaviour in individuals with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:32-49. [PMID: 34750907 PMCID: PMC9299024 DOI: 10.1111/jir.12897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND Previous research has explored executive functions (EFs) and adaptive behaviour in children and adolescents with Down syndrome (DS), but there is a paucity of research on the relationship between the two in this population. This study aims to shed light on the profile of EFs and adaptive behaviour in DS, exploring the differences by age and investigating the relationship between these two domains. METHOD Parents/caregivers of 100 individuals with DS from 3 to 16 years old participated in the study. The sample was divided into preschoolers (3-6.11 years old) and school-age children (7-16 years old). Parents/caregivers completed either the Preschool Version of the Behaviour Rating Inventory of Executive Function (for children 2-6.11 years old) or the Second Edition of the same Inventory (for individuals 7 + years old). Adaptive behaviour was assessed with the Vineland Adaptive Behaviour Scale - Interview, Second Edition. RESULTS Findings suggest that individuals with DS have overall difficulties, but also patterns of strength and weakness in their EFs and adaptive behaviour. The preschool-age and school-age children's EF profiles differed slightly. While both age groups showed Emotional Control as a relative strength and Working Memory as a weakness, the school-age group revealed further weaknesses in Shift and Plan/Organise. As concerns adaptive behaviour, the profiles were similar in the two age groups, with Socialisation as a strength, and Communication and Daily Living Skills as weaknesses, but with a tendency for preschoolers to obtain intermediate scores for the latter. When the relationship between EFs and adaptive behaviour was explored, Working Memory predicted Communication in the younger group, while in the older group the predictors varied, depending on the adaptive domains: Working Memory was a predictor of Communication, Inhibit of Daily Living Skills, and Inhibit and Shift of Socialisation. CONCLUSION As well as elucidating the EF profiles and adaptive behaviour in individuals with DS by age, this study points to the role of EFs in adaptive functioning, providing important information for targeted interventions.
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Affiliation(s)
- S. Onnivello
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - S. Colaianni
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - F. Pulina
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - C. Locatelli
- Neonatology UnitSt. Orsola‐Malpighi PolyclinicBolognaItaly
| | - C. Marcolin
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
| | - G. Ramacieri
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - F. Antonaros
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - B. Vione
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - A. Piovesan
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Unit of Histology, Embryology and Applied BiologyUniversity of BolognaBolognaItaly
| | - S. Lanfranchi
- Department of Developmental Psychology and SocialisationUniversity of PadovaPadovaItaly
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6
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Locatelli C, Onnivello S, Antonaros F, Feliciello A, Filoni S, Rossi S, Pulina F, Marcolin C, Vianello R, Toffalini E, Ramacieri G, Martelli A, Procaccini G, Sperti G, Caracausi M, Pelleri MC, Vitale L, Pirazzoli GL, Strippoli P, Cocchi G, Piovesan A, Lanfranchi S. Is the Age of Developmental Milestones a Predictor for Future Development in Down Syndrome? Brain Sci 2021; 11:655. [PMID: 34069813 PMCID: PMC8157296 DOI: 10.3390/brainsci11050655] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 01/23/2023] Open
Abstract
Down Syndrome (DS) is the most common genetic alteration responsible for intellectual disability, which refers to deficits in both intellectual and adaptive functioning. According to this, individuals with Down Syndrome (DS) reach developmental milestones (e.g., sitting, walking, and babbling) in the same order as their typically developing peers, but later in life. Since developmental milestones are the first blocks on which development builds, the aims of the current study are to: (i) expand the knowledge of developmental milestone acquisition; and (ii) explore the relationship between developmental milestone acquisition and later development. For this purpose 105 children/adolescents with DS were involved in this study, divided in two groups, Preschoolers (n = 39) and School-age participants (n = 66). Information on the age of acquisition of Sitting, Walking, Babbling, and Sphincter Control was collected, together with cognitive, motor, and adaptive functioning. Sitting predicted later motor development, but, with age, it became less important in predicting motor development in everyday life. Babbling predicted later language development in older children. Finally, Sphincter Control emerged as the strongest predictor of motor, cognitive, language, and adaptive skills, with its role being more evident with increasing age. Our data suggest that the age of reaching the milestones considered in the study has an influence on successive development, a role that can be due to common neural substrates, the environment, and the developmental cascade effect.
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Affiliation(s)
- Chiara Locatelli
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Sara Onnivello
- Department of Developmental Psychology and Socialization, University of Padova, via Venezia 8, 35131 Padova, Italy; (S.O.); (F.P.); (C.M.); (R.V.); (S.L.)
| | - Francesca Antonaros
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Agnese Feliciello
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Sonia Filoni
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
- Specialisation School in Anesthesia, Intensive Care and Pain Care, University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41125 Modena, Italy
| | - Sara Rossi
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Francesca Pulina
- Department of Developmental Psychology and Socialization, University of Padova, via Venezia 8, 35131 Padova, Italy; (S.O.); (F.P.); (C.M.); (R.V.); (S.L.)
| | - Chiara Marcolin
- Department of Developmental Psychology and Socialization, University of Padova, via Venezia 8, 35131 Padova, Italy; (S.O.); (F.P.); (C.M.); (R.V.); (S.L.)
| | - Renzo Vianello
- Department of Developmental Psychology and Socialization, University of Padova, via Venezia 8, 35131 Padova, Italy; (S.O.); (F.P.); (C.M.); (R.V.); (S.L.)
| | - Enrico Toffalini
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy;
| | - Giuseppe Ramacieri
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Anna Martelli
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Giulia Procaccini
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Giacomo Sperti
- IRCCS, St. Orsola-Malpighi Polyclinic, via Massarenti 11, 40138 Bologna, Italy; (C.L.); (A.F.); (S.F.); (S.R.); (A.M.); (G.P.); (G.S.)
| | - Maria Caracausi
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Maria Chiara Pelleri
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Lorenza Vitale
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Gian Luca Pirazzoli
- Medical Department, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy;
| | - Pierluigi Strippoli
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Guido Cocchi
- Neonatology Unit, St. Orsola-Malpighi Polyclinic, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, via Massarenti 9, 40138 Bologna, Italy;
| | - Allison Piovesan
- Unit of Histology, Embryology and Applied Biology, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, via Belmeloro 8, 40126 Bologna, Italy; (F.A.); (G.R.); (M.C.); (M.C.P.); (L.V.); (P.S.)
| | - Silvia Lanfranchi
- Department of Developmental Psychology and Socialization, University of Padova, via Venezia 8, 35131 Padova, Italy; (S.O.); (F.P.); (C.M.); (R.V.); (S.L.)
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