Search Results (13)

Background: Inherited metabolic disorders (IEMs) can be represented in children and adolescents by psychiatric disorders. The early diagnosis of IEMs is crucial for clinical outcome and treatment. The aim of this review is to analyze the most recurrent and specific psychiatric features related to IEMs in pediatrics, based on the onset type and psychiatric phenotypes. Methods: Following the PRISMA Statement, a systematic literature review was performed using a predefined algorithm to find suitable publications in scientific databases of interest. After removing duplicates and screening titles and abstracts, suitable papers were analyzed and screened for inclusion and exclusion criteria. Finally, the data of interest were retrieved from the remaining articles. Results: The results of this study are reported by type of symptoms onset (acute and chronic) and by possible psychiatric features related to IEMs. Psychiatric phenomenology has been grouped into five main clinical manifestations: mood and anxiety disorders; schizophrenia-spectrum disorders; catatonia; eating disorders; and self-injurious behaviors. Conclusions: The inclusion of a variety of psychiatric manifestations in children and adolescents with different IEMs is a key strength of this study, which allowed us to explore the facets of seemingly different disorders in depth, avoiding possible misdiagnoses, with the related delay of early and appropriate treatments. Full article

Background and Objectives: Surgery remains the only possible curative treatment for advanced gastric cancer (AGC). Peritoneal metastases are estimated to occur in approximately 55–60% AGC patients. Greater omentum is the most common metastatic area in AGC. At present, omentectomy alone or bursectomy are usually carried out during gastric cancer surgery. We performed a meta-analysis in order to evaluate long-term and short-term outcomes among AGC patients, who have undergone radical gastrectomy with or without complete omentectomy (CO). Materials and Methods: We performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed by use of RevMan (Computer program) Version 5.4. Results: The eight included studies covered an approximately 20 years long study period (2000–2018). Almost all included studies were retrospective ones and originated from Asian countries. Meta-analysis indicated gastrectomy without CO as significantly associated with longer 3-year (RR: 0.94, 95% CI: 0.90–0.98, p = 0.005) and 5-year overall survivals (OS) (RR: 0.93, 95% CI: 0.88–0.98, p = 0.007). Moreover, we found longer operative time (MD: 24.00, 95% CI: −0.45–48.45, p = 0.05) and higher estimated blood loss (MD: 194.76, 95% CI: 96.40–293.13, p = 0.0001) in CO group. Conclusions: Non-complete omentectomy (NCO) group had a statistically greater rate in 3-year and 5-year OSs than the CO group, while the CO group had significantly longer operative time and higher estimated blood loss than the NCO group. Further randomized, possibly multi-center trials may turn out of paramount importance in confirming our results. Full article

Newborn screening (NBS) for inborn errors of metabolism is one of the most advanced tools for secondary prevention in medicine, as it allows early diagnosis and prompt treatment initiation. The expanded newborn screening was introduced in Italy between 2016 and 2017 (Law 167/2016; DM 13 October 2016; DPCM 12-1-2017). A total of 1,586,578 infants born in Italy were screened between January 2017 and December 2020. For this survey, we collected data from 15 Italian screening laboratories, focusing on the metabolic disorders identified by tandem mass spectrometry (MS/MS) based analysis between January 2019 and December 2020. Aminoacidemias were the most common inborn errors in Italy, and an equal percentage was observed in detecting organic acidemias and mitochondrial fatty acids beta-oxidation defects. Second-tier tests are widely used in most laboratories to reduce false positives. For example, second-tier tests for methylmalonic acid and homocysteine considerably improved the screening of CblC without increasing unnecessary recalls. Finally, the newborn screening allowed us to identify conditions that are mainly secondary to a maternal deficiency. We describe the goals reached since the introduction of the screening in Italy by exchanging knowledge and experiences among the laboratories. Full article

3-Methylglutaconic aciduria type I (MGCA1) is an inborn error of the leucine degradation pathway caused by pathogenic variants in the AUH gene, which encodes 3-methylglutaconyl-coenzyme A hydratase (MGH). To date, MGCA1 has been diagnosed in 19 subjects and has been associated with a variable clinical picture, ranging from no symptoms to severe encephalopathy with basal ganglia involvement. We report the case of a 31-month-old female child referred to our center after the detection of increased 3-hydroxyisovalerylcarnitine levels at newborn screening, which were associated with increased urinary excretion of 3-methylglutaconic acid, 3-hydroxyisovaleric acid, and 3-methylglutaric acid. A next-generation sequencing (NGS) panel for 3-methylglutaconic aciduria failed to establish a definitive diagnosis. To further investigate the strong biochemical indication, we measured MGH activity, which was markedly decreased. Finally, single nucleotide polymorphism array analysis disclosed the presence of two microdeletions in compound heterozygosity encompassing the AUH gene, which confirmed the diagnosis. The patient was then supplemented with levocarnitine and protein intake was slowly decreased. At the last examination, the patient showed mild clumsiness and an expressive language disorder. This case exemplifies the importance of the biochemical phenotype in the differential diagnosis of metabolic diseases and the importance of collaboration between clinicians, biochemists, and geneticists for an accurate diagnosis. Full article

Guanidinoacetate methyltransferase deficiency (GAMT-D) is one of three cerebral creatine (Cr) deficiency syndromes due to pathogenic variants in the GAMT gene (19p13.3). GAMT-D is characterized by the accumulation of guanidinoacetic acid (GAA) and the depletion of Cr, which result in severe global developmental delay (and intellectual disability), movement disorder, and epilepsy. The GAMT knockout (KO) mouse model presents biochemical alterations in bodily fluids, the brain, and muscles, including increased GAA and decreased Cr and creatinine (Crn) levels, which are similar to those observed in humans. At the behavioral level, only limited and mild alterations have been reported, with a large part of analyzed behaviors being unaffected in GAMT KO as compared with wild-type mice. At the cerebral level, decreased Cr and Crn and increased GAA and other guanidine compound levels have been observed. Nevertheless, the effects of Cr deficiency and GAA accumulation on many neurochemical, morphological, and molecular processes have not yet been explored. In this review, we summarize data regarding behavioral and cerebral GAMT KO phenotypes, and focus on uncharted behavioral alterations that are comparable with the clinical symptoms reported in GAMT-D patients, including intellectual disability, poor speech, and autistic-like behaviors, as well as unexplored Cr-induced cerebral alterations. Full article

We aimed to assess if the same cognitive batteries can be used cross-nationally to monitor the effect of Phenylketonuria (PKU). We assessed whether a battery, previously used with English adults with PKU (AwPKU), was also sensitive to impairments in Italian AwPKU. From our original battery, we selected a number of tasks that comprehensively assessed visual attention, visuo-motor coordination, executive functions (particularly, reasoning, planning, and monitoring), sustained attention, and verbal and visual memory and learning. When verbal stimuli/or responses were involved, stimuli were closely matched between the two languages for psycholinguistic variables. We administered the tasks to 19 Italian AwPKU and 19 Italian matched controls and compared results from with 19 English AwPKU and 19 English matched controls selected from a previously tested cohort. Participant election was blind to cognitive performance and metabolic control, but participants were closely matched for age and education. The Italian AwPKU group had slightly worse metabolic control but showed levels of performance and patterns of impairment similar to the English AwPKU group. The Italian results also showed extensive correlations between adult cognitive measures and metabolic measures across the life span, both in terms of Phenylalanine (Phe) levels and Phe fluctuations, replicating previous results in English. These results suggest that batteries with the same and/or matched tasks can be used to assess cognitive outcomes across countries allowing results to be compared and accrued. Future studies should explore potential differences in metabolic control across countries to understand what variables make metabolic control easier to achieve. Full article

Phenylketonuria (PKU) management is aimed at preventing neurocognitive and psychosocial dysfunction by keeping plasma phenylalanine concentrations within the recommended target range. It can be questioned, however, whether universal plasma phenylalanine target levels would result in optimal neurocognitive outcomes for all patients, as similar plasma phenylalanine concentrations do not seem to have the same consequences to the brain for each PKU individual. To better understand the inter-individual differences in brain vulnerability to high plasma phenylalanine concentrations, we aimed to identify untreated and/or late-diagnosed PKU patients with near-normal outcome, despite high plasma phenylalanine concentrations, who are still alive. In total, we identified 16 such cases. While intellectual functioning in these patients was relatively unaffected, they often did present other neurological, psychological, and behavioral problems. Thereby, these “unusual” PKU patients show that the classical symptomatology of untreated or late-treated PKU may have to be rewritten. Moreover, these cases show that a lack of intellectual dysfunction despite high plasma phenylalanine concentrations does not necessarily imply that these high phenylalanine concentrations have not been toxic to the brain. Also, these cases may suggest that different mechanisms are involved in PKU pathophysiology, of which the relative importance seems to differ between patients and possibly also with increasing age. Further research should aim to better distinguish PKU patients with respect to their cerebral effects to high plasma phenylalanine concentrations. Full article

Lab-on-chip are analytical systems which, compared to traditional methods, offer significant reduction of sample, reagent, energy consumption and waste production. Within this framework, we report on the development and testing of an optoelectronic platform suitable for the on-chip detection of fluorescent molecules. The platform combines on a single glass substrate hydrogenated amorphous silicon photosensors and a long pass interferential filter. The design of the optoelectronic components has been carried out taking into account the spectral properties of the selected fluorescent molecule. We have chosen the [Ru(phen)₂(dppz)]²⁺ which exhibits a high fluorescence when it is complexed with nucleic acids in double helix. The on-glass optoelectronic platform, coupled with a microfluidic network, has been tested in detection of double-stranded DNA (dsDNA) reaching a detection limit as low as 10 ng/µL. Full article

A lab-on-chip system, integrating an all-glass microfluidics and on-chip optical detection, was developed and tested. The microfluidic network is etched in a glass substrate, which is then sealed with a glass cover by direct bonding. Thin film amorphous silicon photosensors have been fabricated on the sealed microfluidic substrate preventing the contamination of the micro-channels. The microfluidic network is then made accessible by opening inlets and outlets just prior to the use, ensuring the sterility of the device. The entire fabrication process relies on conventional photolithographic microfabrication techniques and is suitable for low-cost mass production of the device. The lab-on-chip system has been tested by implementing a chemiluminescent biochemical reaction. The inner channel walls of the microfluidic network are chemically functionalized with a layer of polymer brushes and horseradish peroxidase is immobilized into the coated channel. The results demonstrate the successful on-chip detection of hydrogen peroxide down to 18 μM by using luminol and 4-iodophenol as enhancer agent. Full article

This work presents a miniaturized lab-on-chip system suitable for monitoring the activity of living cells through the on-chip detection of their bioluminescence emission. The system integrates amorphous silicon diodes, acting as temperature and light sensors, and indium tin oxide film, acting as heater, on a single glass substrate. During its operation, the glass is thermally and optically coupled to the investigated cells and electrically connected to an electronic board, which controls the lab-on-chip temperature and monitors the sensor photocurrents. The proposed lab-on-chip is particularly attractive for the development of portable cell-based biosensors useful for biological activity monitoring as well as for cell cytotoxicity evaluation. Full article

The periodic stabilized regime is the condition where the temperature of each point of a certain environment varies following a periodic law. This phenomenon occurs in many practical applications, such as passive or ancient buildings not equipped with Heating, Ventilating and Air Conditioning HVAC systems and located in latitudes where the temperature greatly varies with Earth’s daily cycles. Despite that, the study of transient phenomena is often simplified, i.e., considering negligible the thermal response of the indoor microclimate. An exact solution to enclosures whose microclimate is free to evolve under a periodic stabilized regime does not exist nowadays, also from an analytical point of view. The aim of this study is to parametrically analyze the thermal variations inside a room when a transient periodic temperature is applied on one side. The phenomenon has been numerically studied through Computational Fluid Dynamics (CFD) and analytically validated using a function that reproduces the daily variation of the outdoor temperature. The results of this research would lay the groundwork to develop analytical correlations to solve and predict the thermal behavior of environments subject to a periodic stabilized regime. Full article

Proper lighting is vital to improve, from an artistic point of view, the surface expanse and decorative detailing of architectural heritage buildings considered valuable. When properly lit, monumental buildings can become to onlookers an essential part of the city. Nowadays, for design planners dealing with the improvement of buildings, whose architectural design should be valorized, the real challenge is to combine the lighting artistic requirements with scrupulous economic management in order to limit the energy demand and to respect the environment. For these reasons, this case study examines the lighting of the monumental façade and the cloister of St. Peter in Chains situated in the Faculty of Engineering of Sapienza University of Rome. The present lighting installation, characterized by metal halides, compact fluorescent and halogen lamps, is compared with an alternative scenario presenting LED lamps and scenographic lighting of the monumental façade. Such comparison is based on the evaluation of the lighting levels for different visual tasks and on energy and maintenance issues; the first analysis was performed through the software DIALux Evo 4.0, whereas the second was performed using ecoCALC. This study leads to the conclusion that the lighting levels of the solution presenting LED lamps are better than those of the present solution, and they comply with current standards. Finally, the higher costs of LED lamp installations and the scenographic lighting of the monumental façade are balanced by lower maintenance costs, with a payback period of seven years. Full article

While planning a double-hole road tunnel with a length higher than one km, it is important to pay attention to the safety factor if an accident occurs. If there is a power outage, in order to avoid critical situations that could jeopardize the safety of the people present (facilitating the stream coming out from the tunnel and the arrival of the emergency personnel), it is really important to guarantee uninterrupted lighting of roadways, mandatory emergency lay-bys, and ways of escape. Uninterrupted service of the lighting systems supply must be guaranteed, in accordance with the current regulations, through the exertion of UPS (Uninterruptible Power Supply) and power units. During tunnel construction, such devices represent a cost that must be amortized. In this case study, which takes into consideration a section of a road tunnel characterized by emergency lay-bys and ways of escape, emergency and security lighting were planned and installation and management costs were evaluated. The goal of this research was the creation of a cash flow thanks to the energy generated by photovoltaic panels, in a way that the service life of the system (25 years) coincided with the amortization of the costs of the backup electrical equipment installation (complying with the regulations). The possibility of over-dimensioning the UPS and providing it with a proper photovoltaic panel surface (235 kW_p) to generate and exchange electric energy with the grid was taken into consideration. Full article