Search Results (350)

The incorporation of recycled concrete fines (F), limestone (L), and ground granulated blast-furnace slag (S) as Portland cement constituents in accordance with EN 197-6 requires the determination of naturally occurring radionuclides to ensure radiological safety from a radiation protection standpoint. This study carried out a radiological assessment of eight cement types with varying proportions of L, F, and S additions, including anhydrous cements and mortars cured for 2 and 28 days. The activity concentrations of ²²⁶Ra, ²³²Th, and ⁴⁰K were determined by gamma-ray spectrometry using HPGe detectors and radiochemical separation. In addition, the ²²²Rn emanation fractions were measured by the accumulation method using an AlphaGuard detector. Finally, annual effective doses were calculated using the RESRAD-BUILD software for a standard dwelling of 35 m² occupied by an adult and an infant. Among the individual materials, S exhibited the highest activity in the uranium decay series (113 ± 24 Bq kg⁻¹ of ²³⁸U), while L and F showed comparably lower values. Cements containing S additions (CEM II/C-M, CEM VI (S-L), and CEM VI (S-F)) were higher than the reference average value for building materials of 50 Bq kg⁻¹, although all mortars remained below this value. Principal component analysis revealed significant correlations between S content, SiO₂, Al₂O₃, and ²³²Th. The maximum annual effective dose reached 0.32 mSv for infants (CEM VI (S-L)), with the dose due to ²²²Rn inhalation being predominant. All cements studied are radiologically safe, confirming their suitability for use within the objectives of the circular economy. Full article

Background: Pregnancy after solid organ transplantation carries increased maternal and fetal risks, compounded by the teratogenicity, nephrotoxicity, and metabolic effects of available immunosuppressive agents. Belatacept, a calcineurin inhibitor-sparing T-cell costimulation blocker with favorable renal and metabolic profiles, has emerged as an alternative; however, evidence regarding its safety during pregnancy remains scarce. Methods: A scoping review was conducted per PRISMA-ScR recommendations. PubMed, Google Scholar, Web of Science, Scopus, and the Cochrane Library were searched (January 2015–March 2025), supplemented by citation searching, for studies reporting pregnancy outcomes in solid organ transplant recipients receiving belatacept. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools. Results: Three studies (one case series and two case reports) encompassing 21 pregnancies among 15 recipients were included, predominantly in kidney transplant recipients; several recipients contributed more than one pregnancy, so pregnancy-level outcomes are not statistically independent. Sixteen pregnancies resulted in live birth and five ended in miscarriage, at least four of which occurred in pregnancies with periconception mycophenolate exposure. No congenital malformations were reported among live-born infants, although the number of exposures is far too small to characterize teratogenic risk. Stable allograft function was reported in 14 of 19 pregnancies with available follow-up, with no rejection episodes during belatacept exposure. Maternal complications included preeclampsia (8 of 16 in the case series), gestational diabetes, cytomegalovirus reactivation, and acute kidney injury. Low birth weight (<2500 g) was reported in all live births, predominantly in the context of preterm delivery. Conclusions: The published cases have not identified congenital malformations to date, but the number of documented exposures is far too small to characterize teratogenic risk, and the overall certainty of evidence is very low. Because no comparative studies were available, maternal and neonatal outcomes cannot be assumed equivalent to those of conventional immunosuppression. Belatacept cannot be recommended for routine use during pregnancy; clinical decisions must remain individualized, and preconception counseling and prospective multicenter registries are urgently needed. Full article

Background and Aim: Pediatric ERCP remains significantly less studied compared to its application in adults, particularly in infants, due to the limited procedural volume. This study aims to evaluate the indications, procedural specifics, technical success rates, and adverse events associated with pediatric ERCP at a tertiary care center over an 18-year period, with specific attention to patients weighing less than 10 kg. Methods: A retrospective analysis of all ERCPs performed on patients under 18 years of age at ISMETT between 2005 and 2023. Demographic data, indications, procedural specifics, outcomes, and adverse events were collected and reported. Subgroup analyses focusing on initial ERCP procedures were performed and stratified by weight and indication type. Results: 194 ERCPs were performed on 84 patients. Acute or chronic pancreatitis was the most common indication. Technical success was high across weight groups. Adverse events occurred only in patients ≥ 10 kg (7%), predominantly post-ERCP pancreatitis. No adverse events were reported in the <10 kg group. In the “first-ERCP” subgroup, pancreatic indications were associated with a higher adverse event rate than biliary indications, although the estimate was imprecise owing to the small number of events. Conclusions: In our experience as a specialized center, pediatric ERCPs have proven to be safe and effective, even in infants < 10 kg. Pancreatic indications appeared to carry a higher risk for adverse events than biliary indications, although this estimate was imprecise. Full article

Background/objective: Postpartum depression (PPD) is a significant public health issue affecting about 19% of mothers globally. It has well-documented impacts on maternal well-being, mother–infant relationships, and child developmental outcomes. At the same time, the level of vitamin D deficiency in women of reproductive age is very high (affecting 60–87 percent of pregnant women globally). The review aims to synthesize current evidence and highlight priority research areas to improve maternal mental health outcomes. Methods: A systematic literature search of PubMed, Scopus, and Google Scholar (2015–2026) was conducted, followed by narrative synthesis of mechanistic, observational, and interventional evidence. Results: Adequate vitamin D status may contribute to a reduced risk of postpartum depression through multiple interacting pathways, including serotonin synthesis and metabolism (via tryptophan hydroxylase 2 (TPH2) and monoamine oxidase-A (MAO-A) regulation), neuroplasticity via brain-derived neurotrophic factor (BDNF) signaling, and suppression of the pro-inflammatory cytokine cascade. Dose–response meta-analyses and large prospective cohort studies indicate consistent negative relationships between maternal vitamin D levels and postpartum depressive and anxiety symptoms with optimal serum 25-hydroxyvitamin D (25(OH)D) levels of 90–110 nmol/L. Conclusions: There is still limited evidence on the intervention; it is still methodologically diverse, and only a few randomized controlled trials have been carried out on specifically postpartum populations. Full article

Background/Objectives: Hardikar syndrome (HDKR) is an X-linked dominant disorder caused by pathogenic variants in the Mediator complex subunit 12 (MED12) gene, predominantly affecting females. It is characterized by multisystem congenital anomalies involving the foregut, biliary tract, craniofacial structures, eyes, skeleton, and genitourinary system, with generally preserved neurodevelopment. Only 34 cases have been reported to date, and most exhibit multiple congenital anomalies. We describe a female infant who presented with progressive cholestatic liver disease and complex hepatobiliary malformations, including an absent gallbladder and paucity of bile ducts, with unremarkable prenatal imaging. The clinical course was notable for hepatosplenomegaly, markedly elevated total bile acids, portal hypertension with esophageal varices, and eventual liver failure. Methods: Whole-exome sequencing (WES) was performed to investigate the underlying genetic etiology, followed by parental segregation analysis using Sanger sequencing to confirm and characterize the identified variant. Results: WES identified a novel de novo intronic heterozygous variant in MED12 (c.3868-5C>G). Unlike most previously reported cases, the predominant and early manifestation in our case was severe hepatobiliary disease with limited additional anomalies, suggesting possible phenotypic variability within the MED12-related Hardikar syndrome spectrum. The identified MED12 variant is classified as a variant of uncertain significance (VUS). Conclusions: This case underscores the diagnostic utility of WES in infants with unexplained cholestasis, highlights the importance of considering noncoding variants, and illustrates the value of reporting well-characterized patients carrying novel VUS, thereby contributing to the growing body of clinical and molecular evidence on MED12-related Hardikar syndrome. Full article

The Enterobacteriaceae family is a significant source of foodborne pathogens and represents a severe threat to human and animal health. These bacteria can penetrate the dairy supply chain through direct contact with cattle and the livestock environment and can survive production processes. Escherichia coli (E. coli), one of the most diffuse bacteria in raw and processed milk, exposes consumers to the risk of contaminated milk. As a result of this exposition, several milk-borne illness outbreaks have been reported worldwide, underscoring the urgent need for effective detection and prevention measures. Conventional analysis methods are effective but have significant limitations, including the requirement of pre-treatment and pre-enrichment steps. Thus, the need for advanced detection techniques that can accurately identify these pathogens without pre-treatment steps is critical. In this work, a proof-of-concept biosensor based on a spoon-shaped optical biochip was developed to detect E. coli via surface plasmon resonance (SPR) phenomena and was combined with a polyclonal antibody layer against E. coli as a molecular recognition element (MRE). The proposed label-free biosensing strategy, achieved by exploiting simple SPR spoon-shaped biochips, exhibits a remarkable detection limit (6.8 colony-forming units, CFU/mL) and high specificity towards other interfering bacteria belonging to the Enterobacteriaceae family. In addition, tests on commercial milk samples were carried out, achieving recovery values of 95% and 102% for whole milk and infant milk, respectively. The proposed spoon-shaped biosensor enables label-free biosensing without the need for microfluidic systems. It provides a rapid response (10 min), paving the way for its use as a point-of-care test (POCT) in real-world settings. Full article

The presence of Fusarium mycotoxins is an intractable problem in cereal production, with T-2 and HT-2 posing a particular issue in oats. This study assesses the prevalence of Fusarium mycotoxins in unprocessed and de-hulled oats and oat food products and quantifies the bioaccessibility of T-2, HT-2 and HT-2-glucoside from oat porridge in vitro. Twenty unprocessed food oat samples were de-hulled and mycotoxins quantified in unprocessed grains, hulls and groats using LC-MS/MS. Seventy-seven oat food products (40 porridge samples, 10 granola and muesli samples, 11 oat biscuits, 11 oatcakes, 5 infant cereals) were analysed for mycotoxins. Two oat porridge samples were tested for bioaccessibility using Infogest 2.0 method followed by faecal microbiota incubations. T-2/HT-2 and their glucosides were the most prevalent mycotoxins in unprocessed food oats (85–100%). DON was also highly prevalent (70%) while DON-glucoside, NIV, ZEN and their glucoside were less frequently detected. Reduction of 89–100% was achieved by de-hulling oats for most mycotoxins except DON-glucoside (77% reduction). Oat food samples were also frequently contaminated with T-2+HT-2 (prevalence porridge 90%, granola and muesli 40%, oat biscuits 36%, oatcakes 73%) while no mycotoxins were detectable in infant cereal foods. Upon in vitro digestion, 73–82% of free and glucosylated T-2/HT-2 were readily bioaccessible, underlining their importance for human dietary exposure. The study highlights that T-2/HT-2 contamination is prevalent in oats and carry-over into food products cannot be completely avoided, potentially leading to mycotoxin exposure in oat food consumers. Full article

Background: Among infants undergoing cardiac surgery, AKI may affect as many as 40% of this population and carries an unfavorable prognosis. A range of contributors has been implicated, including early age, cyanotic physiology, and extended time on cardiopulmonary bypass (CPB). Nadir-indexed oxygen delivery (DO₂) is an important determinant for early detection of hypoperfusion and anaerobic metabolism during CPB. This study aimed to explore the relationship between nadir DO₂ during pediatric CPB and postoperative acute kidney injury. Methods: Between 1 October 2024 and 1 December 2024, we enrolled 40 children who underwent cardiac surgery with CPB [median age 6 months (IQR 4–8), median weight 5.5 kg (IQR 5–7 kg)] into an observational cohort. DO₂ was tracked intraoperatively for every patient, and pre- as well as intraoperative variables were examined for independent links to AKI. Postoperative outcomes were then compared between patients who did and did not develop AKI. Results: In our patient population (n = 40), 16 patients (40%) developed AKI according to the pRIFLE criteria (75% risk; 18.7% injury; 6.2% failure; no patient was in the loss or end-stage renal disease categories). Lower nadir DO₂ values were associated with postoperative AKI in this exploratory pilot cohort. ROC analysis identified an exploratory nadir DO₂ threshold of 360 mL/min/m² (sensitivity 70%, specificity 80%) associated with postoperative AKI. Because this threshold was both derived and evaluated within the same cohort without validation, it should be regarded only as a preliminary, hypothesis-generating observation with no implication of clinical applicability and requires validation in larger independent cohorts. Conclusions: In this exploratory pilot cohort, lower nadir DO₂ during cardiopulmonary bypass was independently associated with postoperative AKI. An exploratory ROC-derived threshold of 360 mL/min/m² was identified; however, this threshold should be considered hypothesis-generating rather than clinically validated. The consistency of findings across both dichotomous and continuous DO₂ analyses strengthens the robustness of the observed association, although larger prospective studies are required to externally validate this threshold, which at present carries no implication of clinical applicability. Full article

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis and hospitalization in infants worldwide. In 2024, the Piedmont region introduced universal immunoprophylaxis with Nirsevimab for all infants experiencing their first RSV season. We carried out a multicenter retrospective observational study across the three pediatric units of ASL TO4 (Ivrea, Ciriè, Chivasso), comparing bronchiolitis-related hospitalizations during the 2023–2024 season (pre-Nirsevimab) with those from the 2024–2025 season (post-Nirsevimab). The primary outcome was the proportion of RSV-positive hospitalizations. Secondary outcomes included age at admission, need for respiratory support, PICU/NICU transfer, and length of stay. Immunization coverage was assessed using the regional electronic registry. Immunization coverage exceeded 88% across all centers (overall 90.4%). A total of 179 bronchiolitis hospitalizations were recorded (134 pre- vs. 45 post-Nirsevimab). RSV-positive admissions showed a reduction from 70.9% to 55.6% after implementation (OR 0.52; 95% CI 0.24–1.09). Center-specific analyses suggested reductions in Ciriè (OR 2.48; 95% CI 1.41–4.39) and Chivasso (OR 2.28; 95% CI 1.09–4.77), with a similar trend observed in Ivrea. In a supplementary denominator-based analysis restricted to infants younger than 12 months, RSV-related hospitalization incidence decreased from 42.0 to 10.3 per 1000 infants between seasons (OR 4.23; 95% CI 2.64–6.78; p < 0.0001). Disease severity remained unchanged between seasons in terms of respiratory support, length of stay, and PICU/NICU transfers. Age at admission increased significantly during the post-intervention season (mean 118.3 vs. 160.9 days; Welch’s two-sample t-test, p = 0.026). Among 15 immunized infants hospitalized in 2024–2025, 6 were RSV-positive, none required intensive care, and only two needed high-flow nasal cannula (HFNC). Universal Nirsevimab prophylaxis was associated with a trend toward reduction in RSV-related hospitalizations at the aggregate level, although the overall comparison did not reach statistical significance. Center-specific analyses suggested reductions in RSV-positive admissions in some participating units. A supplementary denominator-based analysis among infants younger than 12 months showed a lower incidence of RSV-related hospitalizations during the post-implementation season. No evidence of increased severity among breakthrough cases was observed. High coverage demonstrated the feasibility of implementation and its potential public health value. Continued longitudinal surveillance over additional RSV seasons is essential to better define the durability of protection and long-term epidemiological impact. Full article

Cytomegalovirus (CMV) remains one of the most relevant congenital and early-life infections in pediatrics because of its high global seroprevalence, lifelong latency, and potential for reactivation or reinfection. Biologically, the virus poses a particular threat during pregnancy, when maternal primary infection carries a substantially higher risk of transplacental transmission than non-primary infection, with fetal and neonatal consequences that vary according to gestational timing and host vulnerability. In children, CMV infection is common in the first years of life and may contribute to a broad spectrum of outcomes, ranging from asymptomatic infection to severe multisystem disease, neurodevelopmental impairment, and sensorineural hearing loss. Clinically, the document highlights the importance of timely maternal diagnosis, differentiation between primary and recurrent infection, and integration of prenatal, neonatal, radiological, and audiological assessment. Attention is given to symptomatic and asymptomatic newborns, preterm infants, and infants exposed through breast milk. The availability of antiviral strategies in pregnancy and infancy strengthens the rationale for early identification and risk stratification. Universal newborn screening emerges as a potentially valuable approach to improve case detection, enable prompt follow-up, and reduce long-term disability. Overall, a multidisciplinary and early-intervention framework is essential to optimize prevention, diagnosis, treatment, and long-term outcomes in pediatric CMV infections. Full article

Background: Linear growth during childhood is a key indicator of health status and child development, and liquid cow’s milk has been proposed as a potentially relevant dietary component for this outcome. In this systematic review, we aimed to synthesize the available evidence on the association between liquid cow’s milk consumption and linear growth outcomes in infants and children aged 6 months to 12 years. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Observational and experimental studies published in peer-reviewed journals, with no language restrictions, were included if they assessed habitual liquid cow’s milk consumption as the main exposure and reported linear growth outcomes such as height, growth velocity, or height-for-age z-scores. Searches were performed in PubMed (MEDLINE) and Scopus from database inception to 15 January 2026. Study selection, data extraction, and risk-of-bias assessment were carried out systematically. Due to methodological heterogeneity among the included studies, results were synthesized narratively. Results: Twelve studies conducted across diverse geographic and socioeconomic contexts were included. Most studies reported positive associations between liquid cow’s milk consumption and indicators of linear growth, including greater height, higher growth velocity, or improved height-for-age z-scores. Experimental studies showed significant increases in linear growth among children who received milk regularly, whereas some observational studies reported non-significant associations or results dependent on statistical adjustment. One study assessing complete cow’s milk exclusion observed deceleration in linear growth. Overall, the risk of bias was predominantly moderate. Conclusions: Habitual consumption of liquid cow’s milk during childhood appears to be predominantly associated with favorable linear growth outcomes, although variability exists according to study design, age at exposure, milk type, and exposure assessment. Further research using more robust designs is warranted to clarify the magnitude of the association, potential mechanisms, and implications for weight-related outcomes. Full article

Background/Objectives: White–Sutton syndrome (WHSUS; OMIM 616364) is a rare neurodevelopmental disorder caused by pathogenic variants in the POGZ gene and characterized by developmental delay, intellectual disability, speech impairment, autism spectrum features, and dysmorphic traits. Although most reported cases are sporadic, inherited forms are exceptionally rare. We describe a familial case of WHSUS involving an affected mother and two children carrying a heterozygous POGZ nonsense variant, highlighting marked intra-familial phenotypic variability and expanding the clinical spectrum of the disorder. Methods: Clinical evaluation included multidisciplinary assessments. Genetic testing was performed using clinical exome sequencing (CES) with a virtual neurodevelopmental disorder (NDD) gene panel, followed by Sanger confirmation and segregation analysis in family members. The POGZ transcript reference NM_015100.3 was used for variant nomenclature and verified with the Mutalyzer tool. CNV detection from NGS data was performed using the Alissa CNV caller (Agilent) and visualized via IGV; the Xp11.22 microduplication was confirmed by chromosomal microarray (aCGH) and parental segregation analyses. Results: CES identified the heterozygous pathogenic POGZ variant c.1522C>T (p.Arg508*) in the female proband (III₆), an infant presenting with global developmental delay, hypotonia, speech impairment, gait abnormalities, and characteristic dysmorphic features. Segregation analysis demonstrated maternal inheritance and confirmed the presence of the variant in her affected brother (III₄), who also carries a de novo 1.79 kb microduplication at Xp11.22, while the maternal grandparents tested negative, indicating a de novo origin in the mother. The mother exhibited an attenuated phenotype, including mild neuropsychiatric and gastrointestinal manifestations. The variant is predicted to undergo nonsense-mediated decay (NMD), consistent with a moderate clinical presentation; however, experimental validation was not performed. Conclusions: This report documents a rare familial occurrence of WHSUS with highly variable expressivity. Our findings broaden the phenotypic and molecular characterization of POGZ-related disorders and emphasize the importance of comprehensive segregation studies and early genomic diagnosis. While experimental data link POGZ deficiency to DNA repair defects, no longitudinal clinical studies have demonstrated increased cancer risk in WHSUS; therefore, formal malignancy screening guidelines cannot be established at present, and this issue deserves future study in larger cohorts or registries. Full article

Background: Accurate endotracheal tube (ETT) insertion depth is critical in infants and young children, where tracheal malposition carries significant risk. Formula-based depth estimation is widely used at the bedside, but the performance of published formulas in children under two years of age admitted to a general PICU remains poorly characterized. Methods: A retrospective, single-center study was conducted at the PICU of King Saud Medical City, Riyadh. A total of 115 patients aged 1–24 months requiring orotracheal intubation were included. ETT depth was predicted using five established formulas: height-based [(H/10)+5], weight-based [W+6], ETT size-based [ETT×3], Lee weight-based [5.5+0.5W], and Lee height-based [3+0.1H]. Agreement between predicted and radiographically confirmed insertion depth was assessed using Lin’s concordance correlation coefficient (CCC), Bland–Altman analysis, and clinical classification of predictions. Results: None of the five formulas achieved acceptable concordance (CCC < 0.75 for all). The height-based formula performed best among published formulas, with negligible bias and the highest proportion of clinically acceptable predictions. Both Lee formulas showed near-universal systematic underestimation and are not suitable for this age group. Over half of all intubations resulted in non-ideal ETT position on the first post-intubation chest X-ray. Novel cohort-derived regression equations outperformed all published formulas, with the weight-based equation (Depth = 0.385 × Weight + 9.145) emerging as the strongest predictor of insertion depth. Conclusions: No published formula achieved reliable concordance with radiographic ETT depth in children aged 1–24 months. The cohort-derived weight-based formula represents a more accurate bedside tool for this population and warrants prospective external validation. Post-intubation radiographic verification remains essential. Full article

This work presents an intrinsic optical fiber sensor based on plasmonic phenomena in modified plastic optical fibers (POFs). The sensing area is achieved by replacing the polymethyl methacrylate (PMMA) core with a molecularly imprinted polymer (MIP) containing gold nanorods (GNRs). Thus, in the sensing area, the MIP acts as both a selective recognition element and an optically sensitive guiding medium where plasmonic phenomena occur. This optical–chemical configuration has been developed as a proof-of-concept for the detection of furfural in aqueous solution. The proposed sensor achieves a limit of detection (LOD) of 27 pM, demonstrates high selectivity for the analyte of interest, and is applicable even in real-world scenarios, as demonstrated by experimental results (a commercially available infant milk). The proposed sensor presents a significant enhancement of the sensor response, of about six orders of magnitude, compared to a conventional configuration where the same (or a similar) mixture of MIP/GNRs is spun over the exposed PMMA of a D-shaped POF area for comparison. Notably, even if this study has been carried out via a proof-of-concept in furfural detection, this substantial improvement is achieved while preserving a simple, portable, and cost-effective optical setup, highlighting the potential of this sensing strategy for the development of highly selective sensors by changing the MIP template. Full article

Background: Inherited Epidermolysis Bullosa (EB) is a wide group of rare genetic disorders characterized by mucocutaneous fragility and blister formation. In neonates with EB, pain control is particularly complex because painful skin lesions coexist with developmental vulnerability, repeated handling, and the need for frequent wound care. Traditional opioid use carries a risk of adverse effects such as respiratory depression. Tramadol, a centrally acting weak opioid with a dual mechanism of action, may offer a safer alternative. Methods: This retrospective observational study analyzed neonates with different EB subtypes admitted to our tertiary neonatal care center between January 2020 and October 2022. Genetic diagnosis was confirmed via next-generation sequencing. Pain was assessed using the Neonatal Infant Pain Scale (NIPS). Tramadol was administered intravenously (1–2 mg/kg bolus or 0.1–0.2 mg/kg/h infusion) before daily wound dressings, then transitioned to oral dosing when appropriate. Pain scores before and after tramadol administration were compared. Results: Six neonates with various EB subtypes were included. All patients received tramadol for procedural pain control. No significant differences in NIPS scores were observed before and after tramadol administration (p = 0.997), indicating adequate pain control, although baseline pain scores were low, limiting interpretation of analgesic efficacy. No immediate adverse events were observed during hospitalization or reported during follow-up. Conclusions: Scheduled tramadol administration appears to be a safe and effective option for pain management in neonates with EB, with no observed hemodynamic or respiratory complications. Given the scarcity of data in this population, our findings highlight the need for multicenter studies to establish standardized analgesia protocols for EB neonates. Full article