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Fautrel B, Mitrovic S, De Matteis A, Bindoli S, Antón J, Belot A, Bracaglia C, Constantin T, Dagna L, Di Bartolo A, Feist E, Foell D, Gattorno M, Georgin-Lavialle S, Giacomelli R, Grom AA, Jamilloux Y, Laskari K, Lazar C, Minoia F, Nigrovic PA, Oliveira Ramos F, Ozen S, Quartier P, Ruscitti P, Sag E, Savic S, Truchetet ME, Vastert SJ, Wilhelmer TC, Wouters C, Carmona L, De Benedetti F. EULAR/PReS recommendations for the diagnosis and management of Still's disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still's disease. Ann Rheum Dis 2024:ard-2024-225851. [PMID: 39317417 DOI: 10.1136/ard-2024-225851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/07/2024] [Indexed: 09/26/2024]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD) are considered the same disease, but a common approach for diagnosis and management is still missing. METHODS In May 2022, EULAR and PReS endorsed a proposal for a joint task force (TF) to develop recommendations for the diagnosis and management of sJIA and AOSD. The TF agreed during a first meeting to address four topics: similarity between sJIA and AOSD, diagnostic biomarkers, therapeutic targets and strategies and complications including macrophage activation syndrome (MAS). Systematic literature reviews were conducted accordingly. RESULTS The TF based their recommendations on four overarching principles, highlighting notably that sJIA and AOSD are one disease, to be designated by one name, Still's disease.Fourteen specific recommendations were issued. Two therapeutic targets were defined: clinically inactive disease (CID) and remission, that is, CID maintained for at least 6 months. The optimal therapeutic strategy relies on early use of interleukin (IL-1 or IL-6 inhibitors associated to short duration glucocorticoid (GC). MAS treatment should rely on high-dose GCs, IL-1 inhibitors, ciclosporin and interferon-γ inhibitors. A specific concern rose recently with cases of severe lung disease in children with Still's disease, for which T cell directed immunosuppressant are suggested. The recommendations emphasised the key role of expert centres for difficult-to-treat patients. All overarching principles and recommendations were agreed by over 80% of the TF experts with a high level of agreement. CONCLUSION These recommendations are the first consensus for the diagnosis and management of children and adults with Still's disease.
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Affiliation(s)
- Bruno Fautrel
- Rheumatology, CEREMAIA Reference Center (ERN RITA) , Sorbonne Université - AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM UMR-S 1136, Team 5, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- CRI-IMIDIATE Clinical Research Network, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Mitrovic
- Rheumatology, CEREMAIA Reference Center (ERN RITA) , Sorbonne Université - AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Arianna De Matteis
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Sara Bindoli
- Rheumatology, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- CSUR Enfermedades Autoinmunes y Autoinflamatorias, ERN RITA, Barcelona, Spain
| | - Alexandre Belot
- Department of Paediatric Nephrology, Rheumatology, Dermatology, Hôpital Femme-Mère Enfant, Université Claude Bernard-Lyon 1, Bron, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm UMR 1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
- National Reference Centres for Rheumatism & AutoImmune diseaSes in children (RAISE) and Autoinflammatory diseases & Amyloidosis (CEREMAIA), ERN RITA RECONNECT, Lyon, France
| | - Claudia Bracaglia
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Tamàs Constantin
- Unit of Paediatric Rheumatology, Semmelweis University, Budapest, Hungary
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Eugen Feist
- Rheumatology and Clinical Immunology, HELIOS Fachklinik Vogelsang/Gommern, Vogelsang, Sachsen-Anhalt, Germany
| | - Dirk Foell
- Department of Rheumatology and Clinical Immunology, Children Hospital, University of Muenster, Muenster, Germany
| | - Marco Gattorno
- UOSD Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sophie Georgin-Lavialle
- Internal Medicine, CEREMAIA Reference Center (ERN RITA), Tenon Hospital , Sorbonne Université, AP-HP, Paris, France
| | - Roberto Giacomelli
- Università Campus Bio-Medico di Roma Facoltà Dipartimentale di Medicina e Chirurgia, Roma, Italy
| | - Alexei A Grom
- Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yvan Jamilloux
- Internal Medicine, CEREMAIA Reference Center (ERN RITA), Croix Rousse Hospital, Hospices Civils de Lyon - Université Claude Bernard - Lyon 1, Lyon, France
| | - Katerina Laskari
- Rheumatology Unit, 1st Dept. of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Calin Lazar
- Department of Pediatric Rheumatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napocca, Romania
| | - Francesca Minoia
- Pediatria e Immunoreumatologia, IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Peter A Nigrovic
- Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Immunology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Filipa Oliveira Ramos
- Unidade de Reumatologia Pediátrica, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Pierre Quartier
- Pediatric Immuno-Hematology and Rheumatology Unit, RAISE Reference Center (ERN RECONNECT), Hopital universitaire Necker-Enfants malades, Paris, France
- IMAGINE Institute, Université de Paris, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Piero Ruscitti
- Division of Rheumatology, Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila, L'Aquila, Abruzzo, Italy
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Sinisa Savic
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Clinical Immunology and Allergy, NIHR-Leeds Biomedical research centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marie-Elise Truchetet
- Rhumatologie, CHU Bordeaux, Bordeaux, France
- ImmunoConcEpT, UMR 5164, Université de Bordeaux, CNRS, Bordeaux, France
- Centre de Référence Maladies Autoimmunes et Systémiques rares Est / Sud Ouest (RESO), RECONNECT ERN, FHU ACRONIM, CHU Bordeaux, Bordeaux, France
| | - Sebastiaan J Vastert
- Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
- Department of Pediatric Rheumatology, Centre for Rare Immune Deficiency, Autoimmune and Autoinflammatory Diseases, UZ Leuven, Leuven, Belgium
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Fabrizio De Benedetti
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
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Parentelli AS, Lopes AA, Fellahi S, Savey L, Bastard JP, Georgin-Lavialle S. C-reactive protein is more suitable than Serum Amyloid A to monitor crises and attack-free periods in Systemic Auto-Inflammatory Diseases. Eur J Intern Med 2024; 127:91-96. [PMID: 38724309 DOI: 10.1016/j.ejim.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND With their broad presentations and no global biomarker to discriminate crises and attack-free periods, Systemic Auto-Inflammatory Diseases (SAID) are difficult to manage. This study assessed Serum Amyloid A (SAA), C-reactive protein (CRP) and serum calprotectin as potential biomarkers to monitor patients with SAID. METHOD SAA (already studied in Familial Mediterranean Fever (FMF)), CRP and serum calprotectin were measured on SAID adult patients from Juvenile Inflammatory Rheumatism (JIR) cohort during their follow-up visits between 2020 and 2022. Crises and attack-free periods were clinically determined. RESULTS 96 measures, mainly from FMF (43 %) and Unclassified SAID (USAID) (37 %) patients were included. Using ROC curves, a threshold with sensitivity and specificity of/over 75 % was determined for SAA (9 mg/L) and CRP (9 mg/L) but not for serum calprotectin, not investigated further. With this threshold, the results were similar in FMF and USAID patients' subgroups. SAA and CRP showed a positive correlation with crises and attack-free periods in SAID patients (r = 0.4796, p < 0.001 and r = 0.5525, p < 0.001, respectively) as in FMF and USAID patients, with no significant difference between both markers in diagnosis value and ROC curves Area Under Curve (AUC) (p = 0.32). Only the CRP results were not influenced by obesity. CONCLUSION SAA and CRP can discriminate crisis and attack-free periods in our cohort of SAID patients mainly composed of FMF and USAID patients. However, only CRP can be used regardless of body mass index. It is the first report of common biomarkers for all SAID, including USAID patients, with CRP widely accessible in routine worldwide.
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Affiliation(s)
| | - Anne-Aurélie Lopes
- Service des urgences pédiatriques, AP-HP, Centre Hospitalo-universitaire Necker-Enfants-Malades, 149 Rue de Sèvres, Université de Paris, 75015 Paris, France
| | - Soraya Fellahi
- Sorbonne Université-Inserm, Centre de Recherche Saint-Antoine UMR S_938, 75012 Paris, Institut Hospitalo-Universitaire de Cardio-Métabolisme et Nutrition (ICAN), Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de biochimie-pharmacologie-biologie moléculaire-génétique médicale, Créteil, France
| | - Léa Savey
- Assistance publique-hôpitaux de Paris, hôpital Tenon, Centre de référence adulte de la fièvre méditerranéenne familiale, service de médecine interne, F-75020 Paris, France
| | - Jean-Philippe Bastard
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Département de biochimie-pharmacologie-biologie moléculaire-génétique médicale, Créteil, France; FHU-SENEC, INSERM U955 and Université Paris Est (UPEC), UMR U955, Faculté de Santé, Créteil, France
| | - Sophie Georgin-Lavialle
- Assistance publique-hôpitaux de Paris, hôpital Tenon, Centre de référence adulte de la fièvre méditerranéenne familiale, service de médecine interne, F-75020 Paris, France
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Didriksson I, Lengquist M, Spångfors M, Leffler M, Sievert T, Lilja G, Frigyesi A, Friberg H, Schiopu A. Increasing plasma calprotectin (S100A8/A9) is associated with 12-month mortality and unfavourable functional outcome in critically ill COVID-19 patients. J Intensive Care 2024; 12:26. [PMID: 38982551 PMCID: PMC11232228 DOI: 10.1186/s40560-024-00740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Calprotectin (S100A8/A9) is a pro-inflammatory mediator primarily released from neutrophils. Previous studies have revealed associations between plasma calprotectin, disease severity and in-hospital mortality in unselected COVID-19 patients. OBJECTIVE We aimed to assess whether plasma calprotectin dynamics during the first week of intensive care are associated with mortality and functional outcome in critically ill COVID-19 patients. METHODS This prospective study included 498 COVID-19 patients admitted to six intensive care units (ICUs) in Sweden between May 2020 and May 2021. Blood samples were collected on ICU admission and on day 7. The primary outcome was 12-month mortality. Secondary outcomes were functional outcome of survivors at 3 and 12 months, and the need for invasive mechanical ventilation (IMV) or continuous renal replacement therapy (CRRT) during the ICU stay. Functional outcome was assessed by the Glasgow Outcome Scale Extended (GOSE, range 1-8, with < 5 representing an unfavourable outcome). Associations between plasma calprotectin and outcomes were examined in binary logistic regression analyses adjusted for age, sex, BMI, hypertension, smoking, and creatinine. RESULTS High plasma calprotectin on admission and day 7 was independently associated with increased 12-month mortality. Increasing calprotectin from admission to day 7 was independently associated with higher mortality at 12 months [OR 2.10 (95% CI 1.18-3.74), p = 0.012], unfavourable functional outcome at 3 months [OR 2.53 (95% CI 1.07-6.10), p = 0.036], and the use of IMV [OR 2.23 (95% CI 1.10-4.53), p = 0.027)] and CRRT [OR 2.07 (95% CI 1.07-4.00), p = 0.031)]. A receiver operator characteristic (ROC) model including day 7 calprotectin and age was a good predictor of 12-month mortality [AUC 0.79 (95% CI 0.74-0.84), p < 0.001]. Day 7 calprotectin alone predicted an unfavourable functional outcome at 3 months [AUC 0.67 (95% CI 0.58-0.76), p < 0.001]. CONCLUSION In critically ill COVID-19 patients, increasing calprotectin levels after admission to the ICU are associated with 12-month mortality and unfavourable functional outcome in survivors. Monitoring plasma calprotectin dynamics in the ICU may be considered to evaluate prognosis in critical COVID-19. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.
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Affiliation(s)
- Ingrid Didriksson
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden.
- Intensive and Perioperative Care Unit, Skåne University Hospital, Malmö, Sweden.
| | - Maria Lengquist
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Intensive and Perioperative Care Unit, Skåne University Hospital, Lund, Sweden
| | - Martin Spångfors
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Anaesthesia, and Intensive Care Unit, Kristianstad Hospital, Kristianstad, Sweden
| | - Märta Leffler
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Intensive and Perioperative Care Unit, Skåne University Hospital, Malmö, Sweden
| | - Theodor Sievert
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
| | - Gisela Lilja
- Department of Neurology, Skåne University Hospital, Lund, Sweden
| | - Attila Frigyesi
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Intensive and Perioperative Care Unit, Skåne University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesiology and Intensive Care, Lund University, Lund, Sweden
- Intensive and Perioperative Care Unit, Skåne University Hospital, Malmö, Sweden
| | - Alexandru Schiopu
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
- Nicolae Simionescu Institute of Cellular Biology and Pathology, Bucharest, Romania
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Zhang H, Ma X, Liu W, Wang Z, Zhang Z, Chen G, Zhang Y, Wang T, Yu T, Zhang Y. Causal relationship between serum metabolites and juvenile idiopathic arthritis: a mendelian randomization study. Pediatr Rheumatol Online J 2024; 22:51. [PMID: 38724970 PMCID: PMC11080266 DOI: 10.1186/s12969-024-00986-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is a condition that occurs when individuals under the age of 16 develop arthritis that lasts for more than six weeks, and the cause is unknown. The development of JIA may be linked to serum metabolites. Nevertheless, the association between JIA pathogenesis and serum metabolites is unclear, and there are discrepancies in the findings across studies. METHODS In this research, the association between JIA in humans and 486 serum metabolites was assessed using genetic variation data and genome-wide association study. The identification of causal relationships was accomplished through the application of univariate Mendelian randomization (MR) analysis. Various statistical methods, including inverse variance weighted and MR-Egger, were applied to achieve this objective. To ensure that the findings from the MR analysis were trustworthy, a number of assessments were carried out. To ensure the accuracy of the obtained results, a range of techniques were utilised including the Cochran Q test, examination of the MR-Egger intercept, implementation of the leave-one-out strategy, and regression analysis of linkage disequilibrium scores. In order to identify the specific metabolic pathways associated with JIA, our primary objective was to perform pathway enrichment analysis using the Kyoto Encyclopedia of Genes and Genomes. RESULTS Two-sample summary data MR analyses and sensitivity analyses showed that five metabolites were significantly causally associated with JIA, including two risk factors-kynurenine (odds ratio [OR]: 16.39, 95% confidence interval [CI]: 2.07-129.63, p = 5.11 × 10- 6) and linolenate (OR: 16.48, 95% CI: 1.32-206.22, p = 0.030)-and three protective factors-3-dehydrocarnitine (OR: 0.32, 95% CI: 0.14-0.72, p = 0.007), levulinate (4-oxovalerate) (OR: 0.40, 95% CI: 0.20-0.80, p = 0.010), and X-14,208 (phenylalanylserine) (OR: 0.68, 95% CI: 0.51-0.92, p = 0.010). Furthermore, seven metabolic pathways, including α-linolenic acid metabolism and pantothenate and CoA biosynthesis, are potentially associated with the onset and progression of JIA. CONCLUSION Five serum metabolites, including kynurenine and 3-dehydrocarnitine, may be causally associated with JIA. These results provide a theoretical framework for developing effective JIA prevention and screening strategies.
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Affiliation(s)
- Han Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiao Ma
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wanlu Liu
- Shanxian Central Hospital, Heze, Shandong Province, China
| | - Ze Wang
- Department of Neurology, Qingdao Haici Hospital, Qingdao, China
| | - Zian Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
| | - GuanHong Chen
- Shanxian Central Hospital, Heze, Shandong Province, China
| | - Yingze Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Orthopedics, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Tianrui Wang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China.
| | - Tengbo Yu
- Qingdao Municipal Hospital, Qingdao, China.
| | - Yongtao Zhang
- Department of Orthopedics, Affiliated Hospital of Qingdao University, Qingdao, China.
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Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 11:20. [PMID: 38255334 PMCID: PMC10814770 DOI: 10.3390/children11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient's history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | - Adele Fiordelisi
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | | | - Massimo Resti
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
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