Current hospital policies on breastfeeding: a survey from Italy

BACKGROUND

The availability of an appropriate newborn feeding policy is an essential component of the promotion of breastfeeding in health facilities. The Italian Society of Neonatology (SIN) and the Italian Society of Paediatrics (SIP) have run an online survey among Maternity Hospitals to explore the existing breastfeeding policies and their characteristics.

METHODS

Between February and April 2023, an online survey was carried out among 110 Italian maternity hospitals with a Neonatal Intensive Care Unit (NICU).

RESULTS

Forty-nine Maternity Hospitals completed the online questionnaire. Twenty out of 49 (40.8%) reported to have a breastfeeding policy. When a policy is available, its quality appears to be suboptimal because of lack of inclusion of a family representative in the policy working group, limited options for translating breastfeeding policy into minority languages, lack of periodic assessment of their implementation.

CONCLUSION

Currently, only a limited number of Italian Maternity Hospitals have developed a breastfeeding policy. Additional efforts are needed for their improvement as well as implementation.

From asking to observing. Behavioural measures of socio-emotional and motivational skills in large-scale assessments

Socio-emotional and motivational skills are routinely measured using self-reports in large-scale educational assessments. Measures exploiting test-takers' behaviour during the completion of questionnaires or cognitive tests are increasingly used as alternatives to self-reports in the economics of education literature. We compute behavioural measures of socio-emotional and motivational skills using data from the Programme for International Student Assessment (PISA). We find that these measures capture important aspects of students' academic profiles: some are importantly associated with contemporaneous performance and educational attainment and most measures have a high degree of stability over time. However, these measures are only limitedly correlated among themselves and have low correlations with self-report measures of the same constructs. This is likely a reflection of the fact that behavioural measures are representations of the test taker current 'state', rather than descriptions of the participant view of their own 'trait' like the self-report measures. Moreover, the low correlation across measures suggests that they capture different behavioural responses to the test-taking situation. These differences are still limitedly understood because the measures are constructed ex-post using collateral information collected during the administration of assessments rather than developed ex ante in line with theoretical models of human cognition and affect.

Performance decline in a low-stakes test at age 15 and educational attainment at age 25: Cross-country longitudinal evidence

INTRODUCTION

Educational attainment is associated with important life outcomes including labour market performance, health status, well-being, civic and political participation. An important question is whether it is possible to identify early those students who lack the achievement motivation that is needed to complete a higher education degree.

METHODS

Longitudinal follow-ups of representative samples of participants in the 2000 and 2003 Programme for International Student Assessment (PISA) from Australia, Denmark and Switzerland (N = 3110; 1130; and 1962; age = 15 to 27; % females 51%, 51%, 49%; ethnicity/race unknown) were used to identify the association between a measure of effort on a cognitively demanding low-stake task at age 15 - performance decline during the test - and educational attainment at age 25-27.

RESULTS

A one SD difference in performance decline was associated with a 5-6 percentage point difference in the probability of obtaining tertiary-level qualifications (r = -0.15 in Australia; -0.11 in Denmark and -0.11 in Switzerland). We find no evidence of differences in this relationship across genders, socio-economic status and baseline levels of ability in the three countries. The association between performance decline and educational attainment is homogeneous across these groups. Self-reported measures of achievement motivation were not predictive of educational attainment in the three countries.

CONCLUSIONS

Our work contributes new longitudinal evidence to the body of research in education employing behavioural measures of motivation and engagement. It can be used to understand the potential long-term consequences of disparities in students' preparation to sustain effort over cognitively demanding tasks.

Synergies of THESEUS with the large facilities of the 2030s and guest observer opportunities

The proposed THESEUS mission will vastly expand the capabilities to monitor the high-energy sky. It will specifically exploit large samples of gamma-ray bursts to probe the early universe back to the first generation of stars, and to advance multi-messenger astrophysics by detecting and localizing the counterparts of gravitational waves and cosmic neutrino sources. The combination and coordination of these activities with multi-wavelength, multi-messenger facilities expected to be operating in the 2030s will open new avenues of exploration in many areas of astrophysics, cosmology and fundamental physics, thus adding considerable strength to the overall scientific impact of THESEUS and these facilities. We discuss here a number of these powerful synergies and guest observer opportunities.

The importance of respecting accreditation indicators to improve quality of care

Issue

The health and social-care facilities (HSF) of the Lombardy Region provide services specifically conceived for fragile populations, including elderly, disabled, addicts etc. Through its Accreditation Units, the Agency for Health Protection (ATS) in the Metropolitan City of Milan is responsible for overseeing authorization and accreditation indicators of HSFs in all afferent districts. Assessed requirements include the qualitative standard (presence of mandatory professional figures) and the quantitative standard (guaranteed weekly minimum time of care per patient) of operating staff, based on current legislation.

Description of the problem

These standards are evaluated at site-inspection by examining staff qualifications and by matching staff working hours to actual daily presence of patients, randomly selecting a recent past week. The resulting standards may thus not be fully representative of the whole year. In 2019, the Health and Social-care facilities Accreditation Unit of ATS began a retrospective quali-quantitative analysis of health service staffing data for 2017 and 2018. Data were extrapolated from two main databases: “Scheda Struttura”, a data collection tool regarding work hours, qualifications, waiting lists etc. compiled yearly by HSF managers; and economic data detailing reimbursements by the regional health service, based on effective daily presence of patients at the HSF.

Results

Preliminary results relating to 2017 showed that around 4% of HSFs do not guarantee qualitative staffing standards, and almost 30% do not guarantee quantitative staffing standards throughout the year.

Lessons

The proposed tool is useful for emphasizing potentially critical situations and may help define the annual inspection schedule with the aim of continuously improving quality of care among regional HSFs.

Key messages

Data management tools can help local health authorities monitor and identify facilities at risk of falling below the defined standards of care. Qualitative and quantitative analysis of health service staffing is useful for emphasizing potentially critical situations and may help define the annual inspection schedule.

Activation of 574 new Alzheimer’s special care unit beds in the Metropolitan City of Milan

Issue

Dementia is among the main causes of disability and dependency in the elderly. It was defined a public health priority by the WHO. The health and social-care system of the Lombardy region (SSR) plays a key role in implementing assistance and care pathways specifically designed for fragile populations, including those affected by dementia and Alzheimer's disease, its most common form.

Description of the Problem

The SSR provides residential care options especially conceived for dementia patients, known as Alzheimer's special care units (ASCU). However, waiting lists are concerning, and distribution of these facilities is inconsistent throughout the region. In 2018 there were 981 accredited and SSR-covered ASCU beds in the Metropolitan City of Milan (MCM), translating in 1.26 beds/1000 people aged ≥ 65. With regional legislation (DGR 1046/2018), the SSR proposed activation of new ASCU beds in all territories with less than 2 beds/1000 people aged ≥ 65. The MCM Agency for Health Protection (ATS) thus analyzed the distribution of ASCU beds in afferent districts, defining specific needs for each district. The aim was to fund and activate 574 new ASCU beds homogenously among previously accredited and SSR-covered residential care facilities, reaching the targeted 2 ASCU beds/1000 people aged ≥ 65. Applicant facilities had to respond to specific personnel, technological, therapeutic and structural requirements.

Results

Preliminary results indicate 29 residential care facilities applied for evaluation in 2019. The ATS received and evaluated all applications. Following site-inspection, 8 facilities were deemed inappropriate.

Lessons

In 2019, 21 residential care facilities were approved for funding and activation of 558 new ASCU beds. Residual beds will be funded in 2020. Main messages: Activation of new ASCU beds in 2019 and 2020 increased specialized long-term care beds for dementia patients by almost 60%, allowing a more homogenous distribution among MCM districts.

Key messages

The health and social-care system of the Lombardy region proposed activation of new Alzheimer’s special care units beds in all territories with less than 2 beds/1000 people aged ≥ 65. Activation of 574 new Alzheimer’s special care units beds increased by almost 60%, allowing a more homogenous distribution among Metropolitan City of Milan districts.

Eculizumab treatment in patients with COVID-19: preliminary results from real life ASL Napoli 2 Nord experience

OBJECTIVE

SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2)-related pneumonia, referred to as COVID-19 (Coronavirus Disease 19), is a public health emergency as it carries high morbidity, mortality, and has no approved specific pharmacological treatments. In this case series, we aimed to report preliminary data obtained with anti-complement C5 therapy with eculizumab in COVID-19 patients admitted to intensive care unit (ICU) of ASL Napoli 2 Nord.

PATIENTS AND METHODS

This is a case series of patients with a confirmed diagnosis of SARS-CoV2 infection and severe pneumonia or ARDS who were treated with up to 4 infusions of eculizumab as an off-label agent. Patients were also treated with anticoagulant therapy with Enoxaparin 4000 IU/day via subcutaneous injection, antiviral therapy with Lopinavir 800 mg/day + Ritonavir 200 mg/day, hydroxychloroquine 400 mg/day, ceftriaxone 2 g/day IV, vitamine C 6 g/day for 4 days, and were on Non-Invasive Ventilation (NIV).

RESULTS

We treated four COVID-19 patients admitted to the intensive care unit because of severe pneumonia or ARDS. All patients successfully recovered after treatment with eculizumab. Eculizumab induced a drop in inflammatory markers. Mean C Reactive Protein levels dropped from 14.6 mg/dl to 3.5 mg/dl and the mean duration of the disease was 12.8 days.

CONCLUSIONS

Eculizumab has the potential to be a key player in treatment of severe cases of COVID-19. Our results support eculizumab use as an off-label treatment of COVID-19, pending confirmation from the ongoing SOLID-C19 trial.

Classification and reporting of severity experienced by animals used in scientific procedures: FELASA/ECLAM/ESLAV Working Group report

Directive 2010/63/EU introduced requirements for the classification of the severity of procedures to be applied during the project authorisation process to use animals in scientific procedures and also to report actual severity experienced by each animal used in such procedures. These requirements offer opportunities during the design, conduct and reporting of procedures to consider the adverse effects of procedures and how these can be reduced to minimize the welfare consequences for the animals. Better recording and reporting of adverse effects should also help in highlighting priorities for refinement of future similar procedures and benchmarking good practice. Reporting of actual severity should help inform the public of the relative severity of different areas of scientific research and, over time, may show trends regarding refinement. Consistency of assignment of severity categories across Member States is a key requirement, particularly if re-use is considered, or the safeguard clause is to be invoked. The examples of severity classification given in Annex VIII are limited in number, and have little descriptive power to aid assignment. Additionally, the examples given often relate to the procedure and do not attempt to assess the outcome, such as adverse effects that may occur. The aim of this report is to deliver guidance on the assignment of severity, both prospectively and at the end of a procedure. A number of animal models, in current use, have been used to illustrate the severity assessment process from inception of the project, through monitoring during the course of the procedure to the final assessment of actual severity at the end of the procedure (Appendix 1).

Moderate intensity sports and exercise is associated with glycaemic control in women with gestational diabetes

AIM

To assess the association of regular, unsupervised sports and exercise during pregnancy, by intensity level, with glycaemic control in women with gestational diabetes (GDM).

METHODS

Prospective cohort study of 971 women who, shortly after being diagnosed with GDM, completed a Pregnancy Physical Activity Questionnaire assessing moderate and vigorous intensity sports and exercise in the past 3 months. Self-monitored capillary glucose values were obtained for the 6-week period following the questionnaire, with optimal glycaemic control defined≥80% values meeting the targets<5.3mmol/L for fasting and <7.8mmol/L 1-hour after meals. Logistic regression estimated the odds of achieving optimal control; linear regression estimated activity level-specific least square mean glucose, as well as between-level mean glucose differences.

RESULTS

For volume of moderate intensity sports and exercise ([MET×hours]/week), the highest quartile, compared to the lowest, had significantly increased odds of optimal control (OR=1.82 [95% CI: 1.06-3.14] P=0.03). There were significant trends for decreasing mean 1-hour post breakfast, lunch and dinner glycaemia with increasing quartile of moderate activity (all P<0.05). Any participation in vigorous intensity sports and exercise was associated with decreased mean 1-hour post breakfast and lunch glycaemia (both P<0.05). No associations were observed for fasting.

CONCLUSION

Higher volumes of moderate intensity sports and exercise, reported shortly after GDM diagnosis, were significantly associated with increased odds of achieving glycaemic control. Clinicians should be aware that unsupervised moderate intensity sports and exercise performed in mid-pregnancy aids in subsequent glycaemic control among women with GDM.

The Kaiser Permanente Northern California research program on genes, environment, and health (RPGEH) pregnancy cohort: study design, methodology and baseline characteristics

Background

Exposures during the prenatal period may have lasting effects on maternal and child health outcomes. To better understand the effects of the in utero environment on children’s short- and long-term health, large representative pregnancy cohorts with comprehensive information on a broad range of environmental influences (including biological and behavioral) and the ability to link to prenatal, child and maternal health outcomes are needed. The Research Program on Genes, Environment and Health (RPGEH) pregnancy cohort at Kaiser Permanente Northern California (KPNC) was established to create a resource for conducting research to better understand factors influencing women’s and children’s health. Recruitment is integrated into routine clinical prenatal care at KPNC, an integrated health care delivery system. We detail the study design, data collection, and methodologies for establishing this cohort. We also describe the baseline characteristics and the cohort’s representativeness of the underlying pregnant population in KPNC.

Methods

While recruitment is ongoing, as of October 2014, the RPGEH pregnancy cohort included 16,977 pregnancies (53 % from racial and ethnic minorities). RPGEH pregnancy cohort participants consented to have blood samples obtained in the first trimester (mean gestational age 9.1 weeks ± 4.2 SD) and second trimester (mean gestational age 18.1 weeks ± 5.5 SD) to be stored for future use. Women were invited to complete a questionnaire on health history and lifestyle. Information on women’s clinical and health assessments before, during and after pregnancy and women and children’s health outcomes are available in the health system’s electronic health records, which also allows long-term follow-up.

Discussion

This large, racially- and ethnically-diverse cohort of pregnancies with prenatal biospecimens and clinical data is a valuable resource for future studies on in utero environmental exposures and maternal and child perinatal and long term health outcomes. The baseline characteristics of RPGEH Pregnancy Cohort demonstrate that it is highly representative of the underlying population living in the broader community in Northern California.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-016-1150-2) contains supplementary material, which is available to authorized users.

Isolation and identification of cultivable Bifidobacterium spp. from the faeces of 5 baby common marmosets (Callithrix jacchus L.)

Ninety-two bifidobacterial strains were obtained from the faeces of 5 baby common marmosets, three known species Bifidobacterium aesculapii, Bifidobacterium callithricos and Bifidobacterium reuteri and 4 novel putative bifidobacterial species were retrieved. The occurrence of bifidobacteria in non-human primate babies is described for the first time.

Focal cerebral ischemia impairs motivation in a progressive FR schedule of reinforcement in mice

Characterization of functional outcome in animal stroke models is essential to improve preclinical drug screenings. Operant procedures showed promising results for the identification of long-lasting functional deficits. In particular, a suppression of lever-pressing in high ratio schedules has been consistently found in rodent models of ischemic stroke. In the present work, we attempted to replicate these isolated observations, by submitting C57Bl/6J mice to a progressive fixed-ratio schedule of reinforcement three weeks after MCAO or sham surgery. Results showed a significant lever-pressing impairment in the MCAO group. Motivational factors (longer post-reinforcement pause, lesser appeal for food rewards) seemed accountable for the deficit, while motor abilities appeared preserved. These findings resemble fatigue-like states experienced by stroke survivors and may be used as long-term measures of behavioral outcome following experimental stroke.

Post-partum weight loss and glucose metabolism in women with gestational diabetes: the DEBI Study

AIMS

Women with gestational diabetes are at high risk for developing diabetes; post-partum weight loss may reduce the risk of diabetes. We evaluated the association of post-partum weight change with changes in glucose, insulin and homeostasis model assessment of insulin resistance in a subsample (n = 72) of participants from Diet Exercise and Breastfeeding Intervention (DEBI), a randomized pilot trial of lifestyle intervention for women with gestational diabetes.

METHODS

Glucose and insulin were measured fasting and 2 h after an oral glucose tolerance test at 6 weeks and 12 months post-partum. Women were categorized by weight change (lost > 2 kg vs. maintained/gained) between 6 weeks and 12 months post-partum.

RESULTS

Compared with women who maintained or gained weight, women who lost > 2 kg experienced significantly lower increases in fasting glucose [age-adjusted means: 0.1 mmol/l (95% CI -0.03 to 0.3) vs. 0.4 mmol/l (95% CI 0.3-0.6); P < 0.01] and 2-h insulin [10.0 pmol/l (95% CI -56.9 to 76.9) vs. 181.2 pmol/l (95% CI 108.3-506.9); P < 0.01] and a significant reduction in 2-h glucose [-0.9 mmol/l (95% CI -1.4 to -0.3) vs. 0.3 mmol/l (95% CI -0.3 to 0.9); P < 0.01]. In multiple linear regression models adjusted for age, Hispanic ethnicity, medication use, meeting the Institute of Medicine's recommendations for gestational weight gain, breastfeeding and randomized group, a 1-kg increase in weight was significantly associated with increases in fasting and 2-h glucose (P < 0.05), but was not associated with insulin or homeostasis model assessment of insulin resistance.

CONCLUSIONS

In women with gestational diabetes, modest post-partum weight loss may be associated with improvements in glucose metabolism.

Bifidobacterium aesculapii sp. nov., from the faeces of the baby common marmoset (Callithrix jacchus)

Six Gram-positive-staining, microaerophilic, non-spore-forming, fructose-6-phosphate phosphoketolase-positive bacterial strains with a peculiar morphology were isolated from faecal samples of baby common marmosets (Callithrix jacchus). Cells of these strains showed a morphology not reported previously for a bifidobacterial species, which resembled a coiled snake, always coiled or ring shaped or forming a 'Y' shape. Strains MRM 3/1(T) and MRM 4/2 were chosen as representative strains and characterized further. The bacteria utilized a wide range of carbohydrates and produced urease. Glucose was fermented to acetate and lactate. Strain MRM 3/1(T) showed a peptidoglycan type unique among members of the genus Bifidobacterium. The DNA base composition was 64.7 mol% G+C. Almost-complete 16S rRNA, hsp60, clpC and rpoB gene sequences were obtained and phylogenetic relationships were determined. Comparative analysis of 16S rRNA gene sequences showed that strains MRM 3/1(T) and MRM 4/2 had the highest similarities to Bifidobacterium scardovii DSM 13734(T) (94.6%) and Bifidobacterium stellenboschense DSM 23968(T) (94.5%). Analysis of hsp60 showed that both strains were closely related to B. stellenboschense DSM 23968(T) (97.5% similarity); however, despite this high degree of similarity, our isolates could be distinguished from B. stellenboschense DSM 23968(T) by low levels of DNA-DNA relatedness (30.4% with MRM 3/1(T)). Strains MRM 3/1(T) and MRM 4/2 were located in an actinobacterial cluster and were more closely related to the genus Bifidobacterium than to other genera in the family Bifidobacteriaceae. On the basis of these results, strains MRM 3/1(T) and MRM 4/2 represent a novel species within the genus Bifidobacterium, for which the name Bifidobacterium aesculapii sp. nov. is proposed; the type strain is MRM 3/1(T) ( = DSM 26737(T) = JCM 18761(T)).

Setups for in vitro assessment of RFID interference on pacemakers

The aim of this study is to propose setups for in vitro assessment of RFID (radiofrequency identification) interference on pacemakers (PM). The voltage induced at the input stage of the PM by low-frequency (LF) and high-frequency (HF) RFID transmitters has been used to quantify the amount of the interference. A commercial PM was modified in order to measure the voltage at its input stage when exposed to a sinusoidal signal at 125 kHz and 13.56 MHz. At both frequencies, two antennas with different dimensions (diameter = 10 cm and 30 cm, respectively) were used to generate the interfering field, and the induced voltage was measured between the lead tip and the PM case (unipolar voltage), and between the tip and ring electrodes (bipolar voltage). The typical lead configurations adopted in similar studies or proposed by international standards, as well as lead paths closer to actual physiological implants were tested. At 125 kHz, the worst-case condition differs for the two antennas: the 10 cm antenna induced the highest voltage in the two-loop spiral configuration, whereas the 30 cm antenna in the 225 cm(2) loop configuration. At 13.56 MHz, the highest voltage was observed for both the antennas in the 225 cm(2) loop configuration. Bipolar voltages were found to be lower than the unipolar voltages induced in the same configurations, this difference being not as high as one could expect from theoretical considerations. The worst-case scenario, in terms of the induced voltage at the PM input stage, has been identified both for LF and HF readers, and for two sizes of transmitting antennas. These findings may provide the basis for the definition of a standard implant configuration and a lead path to test the EMI effects of LF and HF RFID transmitters on active implantable devices.

Patient-specific finite element analysis of carotid artery stenting: a focus on vessel modeling

Finite element analysis is nowadays a well-assessed technique to investigate the impact of stenting on vessel wall and, given the rapid progression of both medical imaging techniques and computational methods, the challenge of using the simulation of carotid artery stenting as procedure planning tool to support the clinical practice can be approached. Within this context, the present study investigates the impact of carotid stent apposition on carotid artery anatomy by means of patient-specific finite element analysis. In particular, we focus on the influence of the vessel constitutive model on the prediction of carotid artery wall tensional state of lumen gain and of vessel straightening. For this purpose, we consider, for a given stent design and CA anatomy, two constitutive models for the CA wall, that is, a hyperelastic isotropic versus a fiber-reinforced hyperelastic anisotropic model. Despite both models producing similar patterns with respect to stress distribution, the anisotropic model predicts a higher vessel straightening and a more evident discontinuity of the lumen area near the stent ends as observed in the clinical practice. Although still affected by several simplifications, the present study can be considered as further step toward a realistic simulation of carotid artery stenting.

Sex ratio variations among the offspring of women with diabetes in pregnancy

AIMS

It has long been hypothesized that natural selection would favour a reproductive strategy biased towards females under adverse circumstances in order to maximize the number of surviving grandchildren. An excess of daughters in women with Type 1 diabetes and a greater likelihood of gestational diabetes in women carrying male fetuses have also been reported. This study aims to compare the sex ratio across categories of maternal glycaemia.

METHODS

Among 288,009 mother-infant pairs delivering at Kaiser Permanente Northern California in 1996-2008, sex ratios were calculated for the following categories: pregravid diabetes, gestational diabetes, mild pregnancy hyperglycaemia (defined as an abnormal screening but normal diagnostic test for gestational diabetes) and normoglycaemia. Odds ratios for delivering a male were estimated with logistic regression; normoglycaemic pregnancies comprised the reference.

RESULTS

Women with pregravid diabetes delivered the fewest males (ratio male/female = 1.01), followed by women with normoglycaemic pregnancies and those with an abnormal screening only (both sex ratios = 1.05); women with gestational diabetes delivered the most males (sex ratio = 1.07). Odds ratio estimates suggested the same pattern, but none attained statistical significance.

CONCLUSIONS

The crude sex ratios in this cohort suggest a possible gradient by category of maternal glycaemia. Women with gestational diabetes, a condition characterized by excessive fuel substrates, appear to deliver more males. Women with pregravid diabetes delivered the fewest males, possibly reflecting the unfavourable state of chronic disease.

The impact of land use/land cover changes on land degradation dynamics: a Mediterranean case study

In the last decades, due to climate changes, soil deterioration, and Land Use/Land Cover Changes (LULCCs), land degradation risk has become one of the most important ecological issues at the global level. Land degradation involves two interlocking systems: the natural ecosystem and the socio-economic system. The complexity of land degradation processes should be addressed using a multidisciplinary approach. Therefore, the aim of this work is to assess diachronically land degradation dynamics under changing land covers. This paper analyzes LULCCs and the parallel increase in the level of land sensitivity to degradation along the coastal belt of Sardinia (Italy), a typical Mediterranean region where human pressure affects the landscape characteristics through fires, intensive agricultural practices, land abandonment, urban sprawl, and tourism concentration. Results reveal that two factors mainly affect the level of land sensitivity to degradation in the study area: (i) land abandonment and (ii) unsustainable use of rural and peri-urban areas. Taken together, these factors represent the primary cause of the LULCCs observed in coastal Sardinia. By linking the structural features of the Mediterranean landscape with its functional land degradation dynamics over time, these results contribute to orienting policies for sustainable land management in Mediterranean coastal areas.

Predicting significant hyperbilirubinaemia using birth weight

BACKGROUND

A recent study proposed a risk factor scoring system for prediction of hyperbilirubinaemia that assigned increased risk to infants of higher birth weight.

OBJECTIVE

To investigate this novel finding in a large, retrospective cohort analysis.

METHODS

105 384 newborns (> or =2000 g and > or =36 weeks) were analysed, and the effect of higher birth weight on total serum bilirubin (TSB) > or =342 micromol/l was reported using logistic regression to control for gestational age, scalp injury diagnosis, maternal diabetes, method of delivery and other confounders.

RESULTS

The odds ratio for the effect of an additional 500 g of birth weight on TSB > or =342 micromol/l declined with increasing gestational age from 1.55 (95% CI 1.28 to 1.87) at 36 weeks to 1.30 (95% CI 1.12 to 1.50) at 37 weeks and 1.14 (95% CI 1.01 to 1.29) at 38 weeks. There was no association for infants > or =39 weeks.

CONCLUSION

Higher birth weight predicts TSB > or =342 micromol/l in 36-38 week infants, but not in infants > or =39 weeks. Further research should explore the causal mechanism for the association in less-mature infants.

The O3-Vet project: a veterinary electronic patient record based on the web technology and the ADT-IHE actor for veterinary hospitals

A veterinary electronic patient record, compliant with the IT standards (HL7, DICOM and IHE), was developed at the School of Veterinary Medicine, University of Milan (Italy) in order to improve the veterinary hospital workflows, making the stored clinical data more homogenous and sharable, thereby increasing the integration with current and future software applications. The system was developed by open-source software in order to reduce the implementation and maintenance costs and to make the system sharable with other veterinary hospitals or research centers without additional costs. The system was tested from May to October 2006. Results show that the majority of the veterinarians involved in the test agreed on the advantages obtained by the use of application software concerning the availability of all the useful clinical data [71.4%], the quality of the diagnostic procedures [78.58%] and the efficiency [85.58%] of hospital activities.

Heart Transplantation in Older Candidates

Over the last few years significant changes have occurred in both donor and recipient profiles for heart transplantation (HTX). New therapeutic approaches to chronic heart failure have created a novel class of patients aged between 61 and 70 years. Although they are older than the conventional upper limit, they may undergo HTX using marginal donors. We retrospectively reviewed the outcomes of suboptimal donor implants in older recipients to examine negative prognostic factor.

METHODS

Among 272 patients who underwent HTX at our institution from May 1994 to December 2005, 75 (26.5%) were 61 to 72 years (group 1). The remaining 197 (73.5%) denoted as group 2 ranged in age from 18 to 60 years. The Sex distribution, cause of end-stage heart failure, preoperative pulmonary hypertension, pre-HTX clinical status and mean follow-up did not show any significant difference between the two groups. However, group 1 patients had their organs retrieved from marginal donors (89%) vs group 2 (29%; P < .005). They were deceased mainly due to cerebrovascular events, (namely, 82% vs 27%, respectively, P < .005).

RESULTS

All analyzed variables-actuarial survival, perioperative mortality, 12-month acute rejection freedom, 100-month chronic rejection freedom, infection freedom, neoplasia freedom, chronic renal failure freedom-did not show any significant difference.

CONCLUSION

Advances in chronic heart failure medical therapy have generated a new class of HTX candidates aged between 61 and 70 years who benefitted from transplantation of organs retrieved from suboptimal donors.

[Silica carcinogenicity: description of a clinical case]

BACKGROUND

Until the early 1980's there was a general consensus that no relationship existed between occupational silica exposure and lung cancer, in spite of a number of reports to the contrary. Confirmation arrived later from animal experiments and in 1997 the IARC modified its carcinogenic agents classification to include silica in group 1, human carcinogens. This fact brought about a change in insurance practice regarding occupational diseases due to silica, with greater attention dedicated to pneumoconiosis-related lung cancers.

OBJECTIVE

To describe a clinical case of lung cancer due to occupational exposure to silica in a worker of a ceramics industry already receiving compensation for silicosis.

METHODS

Diagnosis and recognition of the occupational origin of the disease were achieved via assessment of exposure to silica in the past and review of the medical examinations over the years.

RESULTS

The pathogenesis and the causative relationship between pneumoconiosis and cancer is debated and lung cancer was recognized as an occupational disease.

CONCLUSIONS

It is concluded that a causative relationship can exist more due to the presence of silicosis than due to occupational exposure to silica.

Acute rejection after liver transplantation: Is there a specific immunological pattern?

The aim of the study was to assess various T-cell subsets and cytokine secretion patterns both in liver tissue and in the peripheral blood of 24 liver transplant patients to assess possible specific immunological involvement in early acute rejection episodes after liver transplantation. Particularly, we studied CD4+ CD7+, CD8+ CD38+, and CD4+ CD25+ T cells by flow cytometry, as well as contemporaneously, interleukin (IL)-2 and IL-10 secretion by ELISpot to determine possible Th1-like immune responses and the immunomodulation expressed by Treg cells in acute liver rejection, respectively. As a control group we included patients transplanted without acute rejection. Early acute rejection within the first 4 weeks was proven histologically in 42% of patients. It was associated with a greater expression of CD4+ CD7+ and CD8+ CD38+ T cells in the liver than in the blood (P < .001). A contemporaneous reduced expansion of liver Treg cells was evident in patients with acute rejection (P < .001). Our data suggested that a preferential Th1-like immune mechanism operated in local fashion as characterized by a decreased presence in the liver and blood of Treg cells.

Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia

AIMS/HYPOTHESIS

Gestational diabetes mellitus (GDM) is a risk factor for perinatal complications. In several countries, the criteria for the diagnosis of GDM have been in flux, the American Diabetes Association (ADA) thresholds recommended in 2000 being lower than those of the National Diabetes Data Group (NDDG) that have been in use since 1979. We sought to determine the extent to which infants of women meeting only the ADA criteria for GDM are at increased risk of neonatal complications.

MATERIALS AND METHODS

In a multiethnic cohort of 45,245 women who did not meet the NDDG criteria and were not treated for GDM, we conducted nested case-control studies of three complications of GDM that occurred in their infants: macrosomia (birthweight >4,500 g, n = 494); hypoglycaemia (plasma glucose <2.2 mmo/l, n = 488); and hyperbilirubinaemia (serum bilirubin > or =342 micromol/l (20 mg/dl), n = 578). We compared prenatal glucose levels of the mothers of these infants and mothers of 884 control infants.

RESULTS

Women with GDM by ADA criteria only (two or more glucose values exceeding the threshold) had an increased risk of having an infant with macrosomia (odds ratio OR = 3.40, 95% CI = 1.55-7.43), hypoglycaemia (OR = 2.61, 95% CI = 0.99-6.92) or hyperbilirubinaemia (OR = 2.22, 95% CI = 0.98-5.04). Glucose levels 1 h after the 100-g glucose challenge that exceeded the ADA threshold were particularly strongly associated with each complication.

CONCLUSIONS/INTERPRETATION

These results lend support to the ADA recommendations and highlight the importance of the 1-h glucose measurement in a diagnostic test for GDM.

Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure?

BACKGROUND

Adhesions can result in serious clinical complications and make ileostomy closure, which is relatively simple procedure into a complicated and prolonged one. The use of sodium hyaluronate and carboxymethyl cellulose membrane (Seprafilm) was proven to significantly reduce the postoperative adhesions at the site of application. The aim of this study was to assess the incidence and severity of adhesions around a loop ileostomy and to analyze the length of time and morbidity for mobilization at the time of ileostomy closure with and without the use of Seprafilm.

METHODS

Twenty-nine surgeons from 15 institutions participated in this multicenter prospective randomized study. 191 patients with loop ileostomy construction were randomly assigned to either receive Seprafilm under the midline incision and around the stoma (Group I), only under the midline incision (Group II), or not to receive Seprafilm (Group III). At ileostomy closure, adhesions were quantified and graded; operative morbidity was also measured.

RESULTS

All 3 groups were comparable relative to gender, mean age and number of patients with prior operations (26, 25 and 19, respectively). Group II patients were significantly more likely to have pre-existing adhesions than Group III patients (30.6% vs. 14.1%, p = 0.025). At stoma mobilization, significantly more patients in Group III than in Group I had adhesions around the stoma (95.2% vs. 82.3%, p = 0.021). Mean operative times were 27, 25, and 28 minutes, respectively (p = 0.38), with significant differences among sites. There was no significant difference in the number of patients needing myotomy or enterotomy (29, 27 and 24 patients, respectively), nor in the number of postoperative complications (7, 9 and 7 patients, respectively).

CONCLUSIONS

When consistently applied, Seprafilm significantly decreased adhesion formation around the stoma but not operative times without any increase in the need for myotomy or enterotomy. These findings were not seen in the overall study population possibly due to the large number of surgeons using a variety of application techniques.

Transplantation and young surgeons in Italy

The relation between young surgeons and transplantation has always been a "love and hate" one. Until a few years ago this branch of surgery was seen as pioneering, with extreme and and extensive training, and was reserved to few elected members. Nowadays things are different. In this article we try to understand the true reasons that young Italian surgeons avoid transplantation surgery.

Segmental colitis associated with diverticula: a 7-year follow-up study

BACKGROUND AND STUDY AIMS

We performed a long-term follow-up study of patients with segmental colitis associated with diverticula, in order to clarify the natural history of this disease.

PATIENTS AND METHODS

We identified 15 patients who were diagnosed as having segmental colitis associated with diverticula during 1997. We assessed these patients by means of periodic follow-up visits from 1997 to 2004.

RESULTS

Eight of the 15 patients had no clinical recurrence during follow-up. Five patients had sporadic recurrences that were clinically mild (on average, one in 5 years), which responded to topical therapy and often to self-medication. Only two patients were diagnosed during the follow-up period as having Crohn's disease; notably, these were the only patients who did not have hematochezia as the main symptom at onset.

CONCLUSION

The course of this disease appears to be substantially benign.

Transanal rectocele repair using EndoGIA: short-term results of a prospective study

BACKGROUND

The surgical treatment of symptomatic rectocele may be carried out by means of endorectal techniques. Results depend on a correct etiologic evaluation of associated diseases. We report the preliminary results of an original endorectal technique applied to selected patients.

METHODS

Fifteen women (median age, 57 years; range, 38-73 years) underwent transanal rectocele resection by a 60 mm endo-GIA and subsequent plication of the anterior rectal wall. All patients had a primary isolated anterior medium sublevator rectocele with obstructed defecation symptoms. They were prospectively evaluated by questionnaire, defecation diary, clinical examination, defecography and anal manometry were performed preoperatively. All patients had less than three weekly bowel motions. Postoperative follow-up included clinical examination and symptoms questionnaire with defecation diary at one week, one month and three months; defecography was performed at three months.

RESULTS

The time required to repair the rectocele was approximately 20 min. The mean time spent in hospital after the operation was 37 h. Postoperative pain was low or moderate in all cases, one patient had acute urinary retention, 11 had minor rectal bleeding, and 5 had temporary urgency. Abolition of excessive straining, feeling of incomplete evacuation, enemas and self-digitations was achieved in all patients; stool frequency at three months was 7 per week in 10 patients, 5-6 per week in 3 patients and 4-6 in 2 patients (p<0.001). Defecography at three months did not show any rectocele recurrence.

CONCLUSIONS

Transanal rectocele repair with linear stapler applied in selected patients is safe and easy to perform. Short-term results are safisfactory. Complete investigations of impaired defecation and selection of patients are needed to achieve satisfactory results.

[Adverse reaction following suspected inhalation of nickel tetracarbonyl: case report]

BACKGROUND

Nickel tetracarbonyl (Ni(CO)4) is a highly toxic chemical that is produced as an intermediate compound in the Mond process of nickel refining. Occupational poisoning due to Ni(CO)4 is not frequent, and up to now about 300 cases have been reported in the medical literature worldwide.

OBJECT

A clinical case is reported of an industrial worker who developed clinical symptoms of respiratory distress probably due to accidental exposure to Ni(CO), METHODS: Clinical examination, chest X-ray data, history of exposure to nickel in the presence of carbon monoxide (CO) from a production plant that was located close to the reactor containing nickel, led to diagnosis of respiratory distress due occupational poisoning.

RESULTS

Patient history, clinical symptoms that were characteristic of Ni(CO)4 poisoning: mild transient initial symptoms followed within 24 hours by more severe life-threatening events environmental data, history of exposure to nickel near a carbon monoxide (CO) production plant that was located close to the nickel containing reactor, indicated a putative causal relationship between diagnosis and exposure to nickel tetracarbonyl.

CONCLUSIONS

The accident that without adequate respiratory therapy might have had fatal consequences, could have been avoided if the rules of technical and procedural prevention had been carefully observed.

A supernova origin for dust in a high-redshift quasar

Interstellar dust plays a crucial role in the evolution of the Universe by assisting the formation of molecules, by triggering the formation of the first low-mass stars, and by absorbing stellar ultraviolet-optical light and subsequently re-emitting it at infrared/millimetre wavelengths. Dust is thought to be produced predominantly in the envelopes of evolved (age >1 Gyr), low-mass stars. This picture has, however, recently been brought into question by the discovery of large masses of dust in the host galaxies of quasars at redshift z > 6, when the age of the Universe was less than 1 Gyr. Theoretical studies, corroborated by observations of nearby supernova remnants, have suggested that supernovae provide a fast and efficient dust formation environment in the early Universe. Here we report infrared observations of a quasar at redshift 6.2, which are used to obtain directly its dust extinction curve. We then show that such a curve is in excellent agreement with supernova dust models. This result demonstrates a supernova origin for dust in this high-redshift quasar, from which we infer that most of the dust at high redshifts probably has the same origin.

IgE antibodies of fish allergic patients cross-react with frog parvalbumin

BACKGROUND

The major allergens in fish are parvalbumins. Important immunoglobulin (Ig)E cross-recognition of parvalbumins from different fish species has been shown. Recently frog parvalbumin alpha has been found to be responsible for a case of IgE-mediated anaphylaxis triggered by the ingestion of frog meat. The aim of this study was to investigate whether IgE antibodies of fish allergic persons cross-react with frog parvalbumin and to appreciate its clinical relevance.

METHODS

The sera of 15 fish allergic patients and one fish and frog allergic patient were tested by IgE-immunoblotting against frog muscle extract. Sera were tested against recombinant parvalbumin alpha and beta from Rana esculenta. Skin prick tests were performed in selected patients with recombinant frog parvalbumin. Ca(2+) depletion experiments and inhibition studies with purified cod and frog recombinant parvalbumin were done to characterize the cross-reactive pattern.

RESULTS

Fourteen of the sera tested had IgE antibodies recognizing low molecular weight components in frog muscle extract. Calcium depletion experiments or inhibition of patient sera with purified cod parvalbumin led to a significant or complete decrease in IgE binding. When tested against recombinant parvalbumins, three of 13 sera reacted with alpha parvalbumin and 11 of 12 reacted with beta parvalbumin from R. esculenta. Skin prick tests performed with recombinant frog parvalbumin were positive in fish allergic patients. Inhibition studies showed that a fish and frog allergic patient was primarily sensitized to fish parvalbumin.

CONCLUSION

Cod parvalbumin, a major cross-reactive allergen among different fish species, shares IgE binding epitopes with frog parvalbumin. This in vitro cross-reactivity seems to be also clinically relevant. Parvalbumins probably represent a new family of cross-reactive allergens.

Suboptimal kidney: the experience of a single transplant unit

Not all kidneys are suitable for transplantation. In 2001 in Italy, only 1530 of 1748 organs were transplanted. This difference (-12.5%) not only represents organs harvested from marginal donors considered not suitable, but also kidneys that, although collected from standard donors, had a vascular, parenchymal, or urologic anomaly that made them unsuitable for transplantation. In our center, we established a procedure that defined the characteristics of suboptimal kidneys and allowed us to specifically select the appropriate recipient. We considered as suboptimal all organs with complex arterial anomalies (more than 2 arteries although on a single patch or separated such as to need a double anastomosis or a bench reconstruction); organs with noticeable parenchymal damage (macroscopic sclerosis areas or sutured polar branches accidentally damaged during removal), and organs with complex anomalies of the excretory tract (complete double district). The organs were not considered as suboptimal if they had venous anomalies revised on the bench or if they had a double artery with a single patch <2.5 cm. Such organs were transplanted to recipients who were between 55 and 60 years of age with a body weight of at least 20% less than the donor, and female.