Publications by authors named "Luca Pierantoni"

26 Publications

  • Page 1 of 1

COVID-19 and lung ultrasound: reasons why paediatricians can support adult COVID-19 units during critical epidemiologic periods.

J Ultrasound 2021 May 28. Epub 2021 May 28.

Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.

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http://dx.doi.org/10.1007/s40477-021-00591-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8159720PMC
May 2021

Reversing the Humidity Response of MoS- and WS-Based Sensors Using Transition-Metal Salts.

ACS Appl Mater Interfaces 2021 May 5;13(19):23201-23209. Epub 2021 May 5.

Catalan Institute of Nanoscience and Nanotechnology (ICN2), CSIC and BIST, Campus UAB, Bellaterra, 08193 Barcelona, Spain.

Two-dimensional materials, such as transition-metal dichalcogenides (TMDs), are attractive candidates for sensing applications due to their high surface-to-volume ratio, chemically active edges, and good electrical properties. However, their electrical response to humidity is still under debate and experimental reports remain inconclusive. For instance, in different studies, the impedance of MoS-based sensors has been found to either decrease or increase with increasing humidity, compromising the use of MoS for humidity sensing. In this work, we focus on understanding the interaction between water and TMDs. We fabricated and studied humidity sensors based on MoS and WS coated with copper chloride and silver nitrate. The devices exhibited high chemical stability and excellent humidity sensing performance in relative humidity between 4 and 80%, with response and recovery times of 2 and 40 s, respectively. We have systematically investigated the humidity response of the materials as a function of the type and amount of induced metal salt and observed the reverse action of sensing mechanisms. This phenomenon is explained based on a detailed structural analysis of the samples considering the Grotthuss mechanism in the presence of charge trapping, which was represented by an appropriate lumped-element model. Our findings open up a possibility to tune the electrical response in a facile manner and without compromising the high performance of the sensor. They offer an insight into the time-dependent performance and aging of the TMD-based sensing devices.
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http://dx.doi.org/10.1021/acsami.1c03691DOI Listing
May 2021

Passive Immunoprophylaxis against Respiratory Syncytial Virus in Children: Where Are We Now?

Int J Mol Sci 2021 Apr 2;22(7). Epub 2021 Apr 2.

Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola Hospital, 40138 Bologna, Italy.

Respiratory syncytial virus (RSV) represents the main cause of acute respiratory tract infections in children worldwide and is the leading cause of hospitalization in infants. RSV infection is a self-limiting condition and does not require antibiotics. However hospitalized infants with clinical bronchiolitis often receive antibiotics for fear of bacteria coinfection, especially when chest radiography is performed due to similar radiographic appearance of infiltrate and atelectasis. This may lead to unnecessary antibiotic prescription, additional cost, and increased risk of development of resistance. Despite the considerable burden of RSV bronchiolitis, to date, only symptomatic treatment is available, and there are no commercially available vaccines. The only licensed passive immunoprophylaxis is palivizumab. The high cost of this monoclonal antibody (mAb) has led to limiting its prescription only for high-risk children: infants with chronic lung disease, congenital heart disease, neuromuscular disorders, immunodeficiencies, and extreme preterm birth. Nevertheless, it has been shown that the majority of hospitalized RSV-infected children do not fully meet the criteria for immune prophylaxis. While waiting for an effective vaccine, passive immune prophylaxis in children is mandatory. There are a growing number of RSV passive immunization candidates under development intended for RSV prevention in all infants. In this review, we describe the state-of-the-art of palivizumab's usage and summarize the clinical and preclinical trials regarding the development of mAbs with a better cost-effectiveness ratio.
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http://dx.doi.org/10.3390/ijms22073703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038138PMC
April 2021

Epidemiology, Clinical Features and Prognostic Factors of Pediatric SARS-CoV-2 Infection: Results From an Italian Multicenter Study.

Front Pediatr 2021 16;9:649358. Epub 2021 Mar 16.

Universitarian-Hospital Department, Ospedale Bambino Gesù IRCCS, Rome, Italy.

Many aspects of SARS-CoV-2 infection in children and adolescents remain unclear and optimal treatment is debated. The objective of our study was to investigate epidemiological, clinical and therapeutic characteristics of pediatric SARS-CoV-2 infection, focusing on risk factors for complicated and critical disease. The present multicenter Italian study was promoted by the Italian Society of Pediatric Infectious Diseases, involving both pediatric hospitals and general pediatricians/family doctors. All subjects under 18 years of age with documented SARS-CoV-2 infection and referred to the coordinating center were enrolled from March 2020. As of 15 September 2020, 759 children were enrolled (median age 7.2 years, IQR 1.4; 12.4). Among the 688 symptomatic children, fever was the most common symptom (81.9%). Barely 47% of children were hospitalized for COVID-19. Age was inversely related to hospital admission ( < 0.01) and linearly to length of stay ( = 0.014). One hundred forty-nine children (19.6%) developed complications. Comorbidities were risk factors for complications ( < 0.001). Viral coinfections, underlying clinical conditions, age 5-9 years and lymphopenia were statistically related to ICU admission ( < 0.05). Complications of COVID-19 in children are related to comorbidities and increase with age. Viral co-infections are additional risk factors for disease progression and multisystem inflammatory syndrome temporarily related to COVID-19 (MIS-C) for ICU admission.
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http://dx.doi.org/10.3389/fped.2021.649358DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007917PMC
March 2021

Heterodyne phase shifting method in scanning probe microscopy.

J Opt Soc Am A Opt Image Sci Vis 2021 Mar;38(3):378-386

The present paper describes a novel implementation of the continuous phase shifting method (PSM), named heterodyne holography, in a scanning probe microscope configuration, able to retrieve the complex scattered field in on-axis configuration. This can be achieved by acquiring a continuous sequence of holograms at different wavelengths in just a single scan through the combination of scanning interference microscopy and a low-coherent signal acquired in the frequency domain. This method exploits the main advantages of the phase shifting technique and avoids some limits relative to off-axis holography in providing quantitative phase imaging.
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http://dx.doi.org/10.1364/JOSAA.415042DOI Listing
March 2021

Doctors' shortage in adults COVID-19 units: a call for pediatricians.

Eur J Pediatr 2021 Jul 16;180(7):2315-2318. Epub 2021 Feb 16.

Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Bologna, Italy.

Since its first description in China, SARS-CoV-2 has been spreading all over the world causing millions of 31 infections and hundreds of thousands of deaths. The massive raise of cases all over the world even during the current second wave is leading to unprecedented pressures on healthcare services. Growing evidence is highlighting that COVID-19 is a systemic condition that requires doctors with multiple expertise. Paediatricians are trained in these skills. Considering the issue of staff shortage that is facing every country in the world, and the complexity of COVID-19, pediatricians may represent an important source of ready and skilled specialists that can quickly translate the pediatric practice in the COVID-19 care. In conclusion, we highlight through our experience several parallels between the pediatric clinical practice and clinical conditions described in patients with COVID-19 as well as the diagnostic tools and the measures taken in 39 patients with COVID-19. What is Known: • The massive raise of cases all over the world is leading to unprecedented pressures on healthcare services. • Growing evidence is highlighting that COVID-19 is a systemic condition that requires doctors with multiple expertise. What is New: • Pediatricians are trained daily in these skills. • Considering the issue of staff shortage that is facing every country in the world, and the complexity of COVID-19, pediatricians may represent an important source of ready and skilled specialists that can quickly translate the pediatric practice in the COVID-19 care.
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http://dx.doi.org/10.1007/s00431-021-03995-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885982PMC
July 2021

Parents' Perception of Food Insecurity and of Its Effects on Their Children in Italy Six Months after the COVID-19 Pandemic Outbreak.

Nutrients 2020 Dec 31;13(1). Epub 2020 Dec 31.

Pediatric Emergency Unit, Scientific Institute for Research and Healthcare (IRCCS), Sant'Orsola University Hospital, 40138 Bologna, Italy.

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic and subsequent containment measures are causing an increase in food insecurity (FI) worldwide, with direct consequences on children's nutrition. We aimed to investigate the effects of the lockdown imposed in Italy on FI and changes in eating habits and body weight in the pediatric population 6 months after the beginning of the pandemic through a cross-sectional online survey proposed to parents of children <18 and living in Italy. Among 5811 respondents, most of whom were Italian, living in Northern Italy, and with a wealthy household economy, 8.3% reported that their families were at risk of FI before the appearance of SARS-CoV-2 and, alarmingly, this percentage increased to 16.2% after the pandemic began, with households from Southern Italy being more at risk. Moreover, 27.3% of the parents reported that their children were eating more; an increase in "junk food" consumption was also found; 31.8% of the respondents declared an increase in children's weight; weight loss prevailed among adolescents. Since the SARS-CoV-2 pandemic is again requiring restrictions, our findings might serve as a warning to politicians to promote healthy lifestyles and provide assistance to the groups in need.
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http://dx.doi.org/10.3390/nu13010121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7824075PMC
December 2020

Treatment of children with COVID-19: position paper of the Italian Society of Pediatric Infectious Disease.

Ital J Pediatr 2020 Sep 24;46(1):139. Epub 2020 Sep 24.

Universitarian-Hospital Department Ospedale Bambino Gesù IRCCS, Rome, Italy.

A statement of consensus was formulated after reviewing available literature on pediatric treatment strategies for COVID-19 by the Steering and Scientific Committee of the Italian Society of Infectious Pediatric Diseases in connection with the Italian Society of Paediatrics.
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http://dx.doi.org/10.1186/s13052-020-00900-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7512208PMC
September 2020

COVID-19 in children and adolescents in Europe: a multinational, multicentre cohort study.

Lancet Child Adolesc Health 2020 09 25;4(9):653-661. Epub 2020 Jun 25.

Department of Paediatric and Adolescent Medicine, National Reference Centre for Childhood Tuberculosis, Wilhelminenspital, Vienna, Austria.

Background: To date, few data on paediatric COVID-19 have been published, and most reports originate from China. This study aimed to capture key data on children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across Europe to inform physicians and health-care service planning during the ongoing pandemic.

Methods: This multicentre cohort study involved 82 participating health-care institutions across 25 European countries, using a well established research network-the Paediatric Tuberculosis Network European Trials Group (ptbnet)-that mainly comprises paediatric infectious diseases specialists and paediatric pulmonologists. We included all individuals aged 18 years or younger with confirmed SARS-CoV-2 infection, detected at any anatomical site by RT-PCR, between April 1 and April 24, 2020, during the initial peak of the European COVID-19 pandemic. We explored factors associated with need for intensive care unit (ICU) admission and initiation of drug treatment for COVID-19 using univariable analysis, and applied multivariable logistic regression with backwards stepwise analysis to further explore those factors significantly associated with ICU admission.

Findings: 582 individuals with PCR-confirmed SARS-CoV-2 infection were included, with a median age of 5·0 years (IQR 0·5-12·0) and a sex ratio of 1·15 males per female. 145 (25%) had pre-existing medical conditions. 363 (62%) individuals were admitted to hospital. 48 (8%) individuals required ICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2-11, range 1-34), 19 (3%) inotropic support, and one (<1%) extracorporeal membrane oxygenation. Significant risk factors for requiring ICU admission in multivariable analyses were being younger than 1 month (odds ratio 5·06, 95% CI 1·72-14·87; p=0·0035), male sex (2·12, 1·06-4·21; p=0·033), pre-existing medical conditions (3·27, 1·67-6·42; p=0·0015), and presence of lower respiratory tract infection signs or symptoms at presentation (10·46, 5·16-21·23; p<0·0001). The most frequently used drug with antiviral activity was hydroxychloroquine (40 [7%] patients), followed by remdesivir (17 [3%] patients), lopinavir-ritonavir (six [1%] patients), and oseltamivir (three [1%] patients). Immunomodulatory medication used included corticosteroids (22 [4%] patients), intravenous immunoglobulin (seven [1%] patients), tocilizumab (four [1%] patients), anakinra (three [1%] patients), and siltuximab (one [<1%] patient). Four children died (case-fatality rate 0·69%, 95% CI 0·20-1·82); at study end, the remaining 578 were alive and only 25 (4%) were still symptomatic or requiring respiratory support.

Interpretation: COVID-19 is generally a mild disease in children, including infants. However, a small proportion develop severe disease requiring ICU admission and prolonged ventilation, although fatal outcome is overall rare. The data also reflect the current uncertainties regarding specific treatment options, highlighting that additional data on antiviral and immunomodulatory drugs are urgently needed.

Funding: ptbnet is supported by Deutsche Gesellschaft für Internationale Zusammenarbeit.
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http://dx.doi.org/10.1016/S2352-4642(20)30177-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7316447PMC
September 2020

Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020.

Euro Surveill 2020 05;25(18)

The members of the Italian SITIP-SIP SARS-CoV-2 paediatric infection study group are listed at the end of this article.

Data on features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents are scarce. We report preliminary results of an Italian multicentre study comprising 168 laboratory-confirmed paediatric cases (median: 2.3 years, range: 1 day-17.7 years, 55.9% males), of which 67.9% were hospitalised and 19.6% had comorbidities. Fever was the most common symptom, gastrointestinal manifestations were frequent; two children required intensive care, five had seizures, 49 received experimental treatments and all recovered.
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http://dx.doi.org/10.2807/1560-7917.ES.2020.25.18.2000600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219028PMC
May 2020

Single-dose of ondansetron for vomiting in children and adolescents with acute gastroenteritis-an updated systematic review and meta-analysis.

Eur J Pediatr 2020 Jul 7;179(7):1007-1016. Epub 2020 May 7.

Department of Medical and Surgical Sciences (DIMEC), Pediatric Emergency Unit, St. Orsola Hospital, University of Bologna, via Massarenti 9, 40138, Bologna, Italy.

This review aimed to meta-analyze evidence of efficacy and safety of one single dose of ondansetron for vomiting in children and adolescents with acute gastroenteritis. Database searches of MEDLINE (PubMed), Scopus (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up to November 2019 were performed. Only randomized clinical trials versus placebo were considered. Fixed and random effect models were used for the analyses of pooled data. Thirteen randomized clinical trials (2146 patients) were finally included. One single dose of ondansetron showed to produce (1) higher chance of vomiting cessation within 8 h (RR 1.41, 95% CI 1.19-1.68; low-quality evidence); (2) lower chances of oral rehydration therapy failure (RR 0.43, 95% CI 0.34-0.55; high-quality evidence), intravenous hydration needs (RR 0.44, 95% CI 0.34-0.57; high-quality evidence), and hospitalization rates within 8 h (RR 0.49, 95% CI 0.32-0.75; high-quality evidence); and (3) no statistically significant differences in return visits to emergency department (RR 1.14, 95% CI 0.74-1.76; high-quality evidence) compared with placebo. Further studies are necessary to better assess long term efficacy and safety of ondansetron in this context.Conclusions: Mixed evidence was found via few studies about the efficacy and safety of a single dose of ondansetron in the pediatric population.What is known:• Ondansetron use for vomiting in pediatric acute gastroenteritis is increasing worldwide.• Actual convictions come from studies evaluating one and more than one dose of the drug.What is new:• This is the first review to collect data about the effects of one single dose of ondansetron on strong and temporally homogeneous clinical outcomes.• This study supports the use of one dose of ondansetron in pediatric acute gastroenteritis.• Further studies are necessary to assess its long-term efficacy and safety.
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http://dx.doi.org/10.1007/s00431-020-03653-0DOI Listing
July 2020

Modeling and Electrochemical Characterization of Electrodes Based on Epoxy Composite with Functionalized Nanocarbon Fillers at High Concentration.

Nanomaterials (Basel) 2020 Apr 28;10(5). Epub 2020 Apr 28.

INFN-Laboratori Nazionali di Frascati, via E. Fermi 40, 00044 Frascati, Italy.

This paper deals with the electrochemical characterization and the equivalent circuit modeling of screen-printed electrodes, modified by an epoxy composite and loaded with carbon nanotubes (CNTs), pristine and functionalized NH, and graphene nanoplates (GNPs). The fabrication method is optimized in order to obtain a good dispersion even at high concentration, up to 10%, to increase the range of investigation. Due to the rising presence of filler on the surface, the cyclic voltammetric analysis shows an increasing of (i) electrochemical response and (ii) filler concentration as observed by the scanning electron microscopy (SEM). Epoxy/CNTs-NH and epoxy/GNPs, at 10% of concentration, show the best electrochemical behavior. Furthermore, epoxy/CNTs-NH show a lower percolation threshold than epoxy/CNT, probably due to the direct bond created by amino groups. Furthermore, the electrochemical impedance spectroscopy (EIS) is used to obtain an electrical equivalent circuit (EEC). The EEC model is a remarkable evolution of previous circuits present in the literature, by inserting an accurate description of the capacitive/inductive/resistive characteristics, thus leading to an enhanced knowledge of phenomena that occur during electrochemical processes.
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http://dx.doi.org/10.3390/nano10050850DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712193PMC
April 2020

Advanced numerical investigation of the heat flux in an array of microbolometers.

Sci Rep 2019 Jul 31;9(1):11078. Epub 2019 Jul 31.

IHP Microelectronics, Im Technologiepark 25, 15236, Frankfurt (Oder), Germany.

The investigation of the thermal properties of an array of microbolometers has been carried out by mean of two independent numerical analysis, respectively the Direct-Simulation Monte Carlo (DSMC) and the classic diffusive approach of the Fourier's equation. In particular, the thermal dissipation of a hot membrane placed in a low-pressure cavity has been studied for different values of the temperature of the hot body and for different values of the pressure of the environment. The results for the heat flux derived from the two approaches have then been compared and discussed.
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http://dx.doi.org/10.1038/s41598-019-47472-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6668448PMC
July 2019

Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis.

BMC Pulm Med 2018 Dec 7;18(1):191. Epub 2018 Dec 7.

Pediatric Emergency Unit, Department of Medical and Surgical Sciences (DIMEC), St. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40138, Bologna, Italy.

Background: Guidelines currently do not recommend the routine use of chest x-ray (CXR) in bronchiolitis. However, CXR is still performed in a high percentage of cases, mainly to diagnose or rule out pneumonia. The inappropriate use of CXR results in children exposure to ionizing radiations and increased medical costs. Lung Ultrasound (LUS) has become an emerging diagnostic tool for diagnosing pneumonia in the last decades. The purpose of this study was to assess the diagnostic accuracy and reliability of LUS for the detection of pneumonia in hospitalized children with bronchiolitis and to evaluate the agreement between LUS and CXR in diagnosing pneumonia in these patients.

Methods: We enrolled children admitted to our hospital in 2016-2017 with a diagnosis of bronchiolitis and undergone CXR because of clinical suspicion of concomitant pneumonia. LUS was performed in each child by a pediatrician blinded to the patient's clinical, laboratory and CXR findings. An exploratory analysis was done in the first 30 patients to evaluate the inter-observer agreement between a pediatrician and a radiologist who independently performed LUS. The diagnosis of pneumonia was established by an expert clinician based on the recommendations of the British Thoracic Society guidelines.

Results: Eighty seven children with bronchiolitis were investigated. A final diagnosis of concomitant pneumonia was made in 25 patients. Sensitivity and specificity of LUS for the diagnosis of pneumonia were 100% and 83.9% respectively, with an area under-the-curve of 0.92, while CXR showed a sensitivity of 96% and specificity of 87.1%. When only consolidation > 1 cm was considered consistent with pneumonia, the specificity of LUS increased to 98.4% and the sensitivity decreased to 80.0%, with an area under-the-curve of 0.89. Cohen's kappa between pediatrician and radiologist sonologists in the first 30 patients showed an almost perfect agreement in diagnosing pneumonia by LUS (K 0.93).

Conclusions: This study shows the good accuracy of LUS in diagnosing pneumonia in children with clinical bronchiolitis. When including only consolidation size > 1 cm, specificity of LUS was higher than CXR, avoiding the need to perform CXR in these patients. Added benefit of LUS included high inter-observer agreement.

Trial Registration: Identifier: NCT03280732 . Registered 12 September 2017 (retrospectively registered).
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http://dx.doi.org/10.1186/s12890-018-0750-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286612PMC
December 2018

Gastrointestinal presentation of Kawasaki disease: A red flag for severe disease?

PLoS One 2018 4;13(9):e0202658. Epub 2018 Sep 4.

Department of Pediatrics, University of Bologna, S.Orsola-Malpighi Hospital, Bologna, Italy.

Background: Kawasaki disease (KD) is a febrile systemic vasculitis of unknown etiology and the main cause of acquired heart disease among children in the developed world. To date, abdominal involvement at presentation is not recognized as a risk factor for a more severe form of the disease.

Objective: To evaluate whether presenting abdominal manifestations identify a group at major risk for Intravenous immunoglobulin (IVIG)-resistance and coronary lesions.

Methods: Retrospective study of KD patients diagnosed between 2000 and 2015 in 13 pediatric units in Italy. Patients were divided into 2 groups according to the presence or absence of abdominal manifestations at onset. We compared their demographic and clinical data, IVIG-responsiveness, coronary ectasia/aneurysms, laboratory findings from the acute and subacute phases.

Results: 302 patients (181 boys) were enrolled: 106 patients with, and 196 patients without presenting abdominal features. Seasonality was different between the groups (p = 0.034). Patients with abdominal manifestations were younger (p = 0.006) and more frequently underwent delayed treatment (p = 0.014). In the acute phase, patients with abdominal presentation had higher platelet counts (PLT) (p = 0.042) and lower albuminemia (p = 0.009), while, in the subacute phase, they had higher white blood cell counts (WBC) and PLT (p = 0.002 and p < 0.005, respectively) and lower red blood cell counts (RBC) and hemoglobin (Hb) (p = 0.031 and p 0.009). Moreover, the above mentioned group was more likely to be IVIG-resistant (p < 0.005) and have coronary aneurysms (p = 0.007). In the multivariate analysis, presenting abdominal manifestations, age younger than 6 months, IVIG- resistance, delayed treatment and albumin concentration in the acute phase were independent risk factors for coronary aneurysms (respectively p<0.005, <0.005, = 0.005 and 0.009).

Conclusions: This is the first multicenter report demonstrating that presenting gastrointestinal features in KD identify patients at higher risk for IVIG-resistance and for the development of coronary aneurysms in a predominantly Caucasian population.

Clinical Trial Registration: 8/20014/O/OssN.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202658PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122791PMC
April 2019

Follow-up at the corrected age of 24 months of preterm newborns receiving continuous infusion of fentanyl for pain control during mechanical ventilation.

Pain 2017 May;158(5):840-845

Neonatal Intensive Care Unit and Neonatology, Ospedale Sant'Orsola-Malpighi, Bologna, Italy.

The neurodevelopmental impact of fentanyl given to preterm newborns for pain control is still unknown. The aim of this study was to assess the neurodevelopmental impact of 2 regimens of fentanyl administration by a prospective follow-up evaluation. In our previous multicenter, double-blind, randomized controlled trial, 131 mechanically ventilated newborns (gestational age ≤32 weeks) were randomized to fentanyl (continuous infusion of fentanyl + open label boluses of fentanyl) or placebo (continuous infusion of placebo + open label boluses of fentanyl). Infant development was evaluated using Griffiths Mental Developmental Scales (Griffiths, 1996) until 24 months of corrected age by trained psychologists who were not aware of the group allocation. 106/131 infants survived at discharge; 3 died after discharge, 25 were lost to follow-up (12 in the fentanyl and 13 in the placebo group). Seventy-eight patients were evaluated at 2 years of corrected age. Children in the fentanyl group, compared with those in the placebo group, obtained significantly lower Griffiths general developmental quotient (mean [SD]: 89.95 [13.64] vs 97.18 [12.72], P = 0.024) together with the scores on the eye-hand coordination (mean [SD]: 89.09 [12.13] vs 99.19 [13.19], P = 0.002) and performance skills (mean [SD]: 79.71 [15.80] vs 90.09 [15.28], P = 0.009) scales. After adjustment for clinical confounders (gestational age, CRIB score, and sex) only eye-hand co-ordination was associated with fentanyl infusion. This study demonstrates that continuous infusion of fentanyl in very preterm infants, given at 1 mcg·kg·h during mechanical ventilation, is associated with a significant decrease in eye and hand co-ordination skills. Longer follow-up is needed to evaluate the impact on future motor, cognitive, and behavioral functions.
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http://dx.doi.org/10.1097/j.pain.0000000000000839DOI Listing
May 2017

Vertically aligned CNT-Cu nano-composite material for stacked through-silicon-via interconnects.

Nanotechnology 2016 Aug 7;27(33):335705. Epub 2016 Jul 7.

SMIT Center, School of Mechanical Engineering and Automation and Institute of NanomicroEnergy, Jiading Campus, Shanghai University, 201800 Shanghai, People's Republic of China. Electronics Materials and Systems Laboratory, Department of Microtechnology and Nanoscience, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden.

For future miniaturization of electronic systems using 3D chip stacking, new fine-pitch materials for through-silicon-via (TSV) applications are likely required. In this paper, we propose a novel carbon nanotube (CNT)/copper nanocomposite material consisting of high aspect ratio, vertically aligned CNT bundles coated with copper. These bundles, consisting of hundreds of tiny CNTs, were uniformly coated by copper through electroplating, and aspect ratios as high as 300:1 were obtained. The resistivity of this nanomaterial was found to be as low as ∼10(-8) Ω m, which is of the same order of magnitude as the resistivity of copper, and its temperature coefficient was found to be only half of that of pure copper. The main advantage of the composite TSV nanomaterial is that its coefficient of thermal expansion (CTE) is similar to that of silicon, a key reliability factor. A finite element model was set up to demonstrate the reliability of this composite material and thermal cycle simulations predicted very promising results. In conclusion, this composite nanomaterial appears to be a very promising material for future 3D TSV applications offering both a low resistivity and a low CTE similar to that of silicon.
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http://dx.doi.org/10.1088/0957-4484/27/33/335705DOI Listing
August 2016

Efficacy and safety of continuous infusion of fentanyl for pain control in preterm newborns on mechanical ventilation.

J Pediatr 2013 Sep 10;163(3):645-51.e1. Epub 2013 Apr 10.

Neonatology and Neonatal Intensive Care Unit, Department of Women's, Child's and Adolescent's Health, Sant'Orsola-Malpighi Hospital, Bologna, Italy.

Objective: To evaluate the analgesic superiority and the safety equivalence of continuous fentanyl infusions versus fentanyl boluses in preterm infants on mechanical ventilation.

Study Design: In this multicenter, double-blind, randomized controlled trial, mechanically ventilated newborns (≤ 32(+6) weeks gestational age) were randomized to fentanyl (continuous infusion of fentanyl plus open-label boluses of fentanyl) or placebo (continuous infusion of placebo plus open-label boluses of fentanyl). The primary endpoint was analgesic efficacy, as evaluated by the Echelle Douleur Inconfort Nouveau-Né (EDIN) and Premature Infant Pain Profile scales. Safety variables were evaluated as well.

Results: Sixty-four infants were allocated to the fentanyl group, and 67 were allocated to the placebo group. The need for open-label boluses of fentanyl was similar in the 2 groups (P = .949). EDIN scores were comparable in the 2 groups; 65 of 961 (6.8%) EDIN scores were >6 in the fentanyl group and 91 of 857 (10.6%) in the placebo group (P = .003). The median Premature Infant Pain Profile score was clinically and statistically higher in the placebo group compared with the fentanyl group on days 1, 2, and 3 of treatment (P < .05). Mechanical ventilation at age 1 week was required in 27 of 64 infants in the fentanyl group (42.2%), compared with 17 of 67 infants in the placebo group (25.4%) (P = .042). The first cycle of mechanical ventilation was longer and the first meconium passage occurred later in the fentanyl group (P = .019 and .027, respectively).

Conclusion: In very preterm infants on mechanical ventilation, continuous fentanyl infusion plus open-label boluses of fentanyl does not reduce prolonged pain, but does reduce acute pain and increase side effects compared with open-label boluses of fentanyl alone.
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http://dx.doi.org/10.1016/j.jpeds.2013.02.039DOI Listing
September 2013

Neonatal respiratory morbidity in twins versus singletons after elective prelabor caesarean section.

Eur J Obstet Gynecol Reprod Biol 2013 Feb 6;166(2):156-60. Epub 2012 Dec 6.

Department of Obstetrics and Gynaecology, S. Orsola-Malpighi University Hospital, Bologna, Italy.

Objective: To compare the rate of neonatal respiratory morbidity in singletons versus twins delivered by pre-labour caesarean section.

Study Design: Uncomplicated pregnancies delivered by prelabor caesarean section at 34+0 to 37+6 weeks' gestation were retrospectively selected. For both singletons and twins caesarean delivery was undertaken electively only after amniocentesis and if the lecithin/sphingomyelin ratio was ≥2. Neonatal respiratory morbidity was compared in twins versus singletons.

Results: 241 singletons and 100 twin neonates were included. Overall neonatal respiratory morbidity was comparable between the two groups (25/241 (11.7%) versus 7/100 (7%), p=.331). Between 34+0 and 36+6 weeks, however, the risk was higher among singleton than twins (15/46 (32.6%) versus 6/72 (8.3%), p<.001). At multiple regression, dichorionicity, gestational age at delivery ≥37 weeks and female sex independently decreased the risk of neonatal respiratory morbidity.

Conclusion: The risk of neonatal respiratory morbidity after elective caesarean section seems lower among twins, especially prior to 37+0 weeks.
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http://dx.doi.org/10.1016/j.ejogrb.2012.10.020DOI Listing
February 2013

Analgesic and sedative drugs in newborns requiring respiratory support.

J Matern Fetal Neonatal Med 2012 Oct;25 Suppl 4:88-90

UO Neonatal Intensive Care, Ospedale Infermi Rimini, Italy.

Infants receiving respiratory assistance may feel pain due to underlying disease or ventilation itself. Pain control during neonatal respiratory care reduces morbidity. This article summarizes the main scientific evidence about the use of drugs during ventilatory assistance, and provides some practical suggestions on pain management in neonates with respiratory support.
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http://dx.doi.org/10.3109/14767058.2012.715036DOI Listing
October 2012

A multichannel model for the self-consistent analysis of coherent transport in graphene nanoribbons.

ACS Nano 2011 Aug 12;5(8):6109-18. Epub 2011 Jul 12.

Dipartimento di Ingegneria Biomedica Elettronica e Telecomunicazioni, Università Politecnica delle Marche, Via Brecce Bianche, 60100 Ancona, Italy.

In this contribution, we analyze the multichannel coherent transport in graphene nanoribbons (GNRs) by a scattering matrix approach. We consider the transport properties of GNR devices of a very general form, involving multiple bands and multiple leads. The 2D quantum transport over the whole GNR surface, described by the Schrödinger equation, is strongly nonlinear as it implies calculation of self-generated and externally applied electrostatic potentials, solutions of the 3D Poisson equation. The surface charge density is computed as a balance of carriers traveling through the channel at all of the allowed energies. Moreover, formation of bound charges corresponding to a discrete modal spectrum is observed and included in the model. We provide simulation examples by considering GNR configurations typical for transistor devices and GNR protrusions that find an interesting application as cold cathodes for X-ray generation. With reference to the latter case, a unified model is required in order to couple charge transport and charge emission. However, to a first approximation, these could be considered as independent problems, as in the example.
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http://dx.doi.org/10.1021/nn2011333DOI Listing
August 2011

Mapping of an anthocyanin-regulating MYB transcription factor and its expression in red and green pear, Pyrus communis.

Plant Physiol Biochem 2010 Dec 30;48(12):1020-6. Epub 2010 Sep 30.

Department of Fruit Tree and Woody Plant Sciences (DCA), University of Bologna, viale Fanin 46, 40127 Bologna, Italy.

'Max Red Bartlett' is a red bud mutation of the yellow pear (Pyrus communis L.) cultivar 'Williams' (known as 'Bartlett' in North America). Anthocyanins are the most important pigments for red colour in fruits. Synthesis of anthocyanins is mediated by a number of well-characterized enzymes that include chalcone synthase (CHS), flavanone-3-hydroxylase (F3H), dihydroflavonol-4-reductase (DFR), anthocyanidin synthase (ANS), and UDP-glucose:flavonoid-3-O-glucosyltransferase (UFGT). Expression of the genes encoding these five enzymes was examined in pear fruit skin in order to elucidate the molecular mechanism for red coloration. In addition, the gene PcMYB10, encoding an R2R3 MYB transcription factor involved in anthocyanin biosynthetic pathway regulation, was isolated from both 'Williams' and 'Max Red Bartlett'. Analysis of the deduced amino acid sequence suggests that this gene is an ortholog of anthocyanin regulators known in other plant species. Its expression level was significantly higher in 'Max Red Bartlett' (red pear) compared with the original yellow variety 'Williams'. Although the map position of PcMYB10 corresponds to that of MdMYBa and MdMYB10, which control pigmentation of apple fruit skin, PcMYB10 is not directly responsible for red versus yellow colour in the two pear varieties, as the mutation underlying this difference maps to a different region of the pear genome.
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http://dx.doi.org/10.1016/j.plaphy.2010.09.002DOI Listing
December 2010

Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant.

Acta Paediatr 2010 Dec;99(12):1807-11

Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.

Aim:   Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV).

Methods:   Chart data of infants with a birth weight <1500 gr or GA <32weeks undergoing InSurE in the period 2002-2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO(2) >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure.

Results: Six of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001).

Conclusions:   BiPAP reduced the need for MV after InSurE failure.
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http://dx.doi.org/10.1111/j.1651-2227.2010.01910.xDOI Listing
December 2010

Effect of posture on brain hemodynamics in preterm newborns not mechanically ventilated.

Neonatology 2010 29;97(3):212-7. Epub 2009 Oct 29.

Neonatology Unit, Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.

Background: Changes in head posture influence brain hemodynamics. Optimal positioning has been recommended as 1 of 10 potentially better practices to reduce the incidence of brain injury in preterm newborns.

Objectives: The aim of this study was to evaluate by near-infrared spectroscopy (NIRS) the effect of different head and body positions and the influence of gestational age (GA) and nasal continuous positive airway pressure on brain hemodynamics in very preterm newborns.

Methods: 24 stable preterm newborns were studied by NIRS in 6 different postures including head rotation and head inclination in both supine and prone positions. Changes in normalized tissue hemoglobin index (nTHI) and tissue oxygenation index (TOI) were measured after posture variations.

Results: No statistically significant changes in nTHI and in TOI were found in the 6 postures. nTHI variations, expression of cerebral blood volume variations, were influenced by GA. A reduction in nTHI, with a stable TOI, in the less mature infants (with GA < or = 26 weeks), occurred on head rotation; nTHI increased again when the head was derotated.

Conclusions: Hemodynamic changes after posture variations depend on GA. Head rotation in newborns with GA < or = 26 weeks produced a reduction in nTHI with stable TOI. Possible physiopathological mechanisms are discussed.
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http://dx.doi.org/10.1159/000253149DOI Listing
August 2010

Changes in cerebral hemodynamics and amplitude integrated EEG in an asphyxiated newborn during and after cool cap treatment.

Brain Dev 2009 Jun 22;31(6):442-4. Epub 2008 Jul 22.

Institute of Neonatology, University of Bologna, Via Massarenti 11, Bologna, Italy.

Amplitude integrated EEG (aEEG) and Near Infrared Spectroscopy (NIRS) were applied in a newborn with a moderate hypoxic-ischemic encephalopathy before, during and after brain cooling. At 2h of life a selective head cooling with mild systemic hypothermia was started and maintained for 72h. aEEG background pattern improved from severely abnormal to normal during the first 17h of life. NIRS revealed a reduction in cerebral blood volume (CBV) during hypothermia that recovered during the rewarming period, whereas brain oxygenation remained stable. As brain cooling is supposed to reduce delayed hyperemia and help to maintain neuronal metabolism following cerebral insults, aEEG and NIRS monitoring may be useful during hypothermic treatment in order to document changes in CBV and brain oxygenation possibly reflecting the efficacy of hypothermia.
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http://dx.doi.org/10.1016/j.braindev.2008.06.003DOI Listing
June 2009