@article {10761, title = {Causes of Treatment Failure in Children With Inflammatory Bowel Disease Treated With Infliximab: A Pharmacokinetic Study.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {68}, year = {2019}, month = {2019 Jan}, pages = {37-44}, abstract = {

OBJECTIVES: Anti-tumor necrosis factor antibodies have led to a revolution in the treatment of inflammatory bowel diseases (IBD); however, a sizable proportion of patients does not respond to therapy. There is increasing evidence suggesting that treatment failure may be classified as mechanistic (pharmacodynamic), pharmacokinetic, or immune-mediated. Data regarding the contribution of these factors in children with IBD treated with infliximab (IFX) are still incomplete. The aim was to assess the causes of treatment failure in a prospective cohort of pediatric patients treated with IFX.

METHODS: This observational study considered 49 pediatric (median age 14.4) IBD patients (34 Crohn disease, 15 ulcerative colitis) treated with IFX. Serum samples were collected at 6, 14, 22 and 54 weeks, before IFX infusions. IFX and anti-infliximab antibodies (AIA) were measured using enzyme linked immunosorbent assays. Disease activity was determined by Pediatric Crohn{\textquoteright}s Disease Activity Index or Pediatric Ulcerative Colitis Activity Index.

RESULTS: Clinical remission, defined as a clinical score <10, was obtained by 76.3\% of patients at week 14 and by 73.9\% at week 54. Median trough IFX concentration was higher at all time points in patients achieving sustained clinical remission. IFX levels during maintenance correlated also with C-reactive protein, albumin, and fecal calprotectin. After multivariate analysis, IFX concentration at week 14 >3.11 μg/mL emerged as the strongest predictor of sustained clinical remission. AIA concentrations were correlated inversely with IFX concentrations and directly with adverse reactions.

CONCLUSIONS: Most cases of therapeutic failure were associated with low serum drug levels. IFX trough levels at the end of induction are associated with sustained long-term response.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000002112}, author = {Naviglio, Samuele and Lacorte, Doriana and Lucaf{\`o}, Marianna and Cif{\`u}, Adriana and Favretto, Diego and Cuzzoni, Eva and Silvestri, Tania and Pozzi Mucelli, Martina and Radillo, Oriano and Decorti, Giuliana and Fabris, Martina and Bramuzzo, Matteo and Taddio, Andrea and Stocco, Gabriele and Alvisi, Patrizia and Ventura, Alessandro and Martelossi, Stefano} } @article {10764, title = {Changing Epidemiology of Liver Involvement in Children With Celiac Disease.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {68}, year = {2019}, month = {2019 Apr}, pages = {547-551}, abstract = {

OBJECTIVES: Available data indicate that liver involvement is present in a significant proportion of children with celiac disease (CD) at the diagnosis (elevated transaminases 15\%-57\%, autoimmune liver disease 1\%-2\%). We sought to evaluate prevalence, clinical course, and risk factors for liver involvement in a large cohort of children with CD.

METHODS: Children (age 0-18 years) diagnosed with CD from March 2010 to April 2016 were enrolled. Liver involvement was considered to be present when alanine transaminase (ALT) levels were >40 U/L (hypertransaminasemia [HTS]). Patients with HTS were re-evaluated after at least 12 months of a gluten-free diet.

RESULTS: CD was diagnosed in 806 patients during the study period; of these, ALT levels were available for 700 patients (86.9\%), and were elevated in 27 (3.9\%, HTS group); median ALT and aspartate transaminase levels in the HTS group were 57 U/L (interquartile range 49-80 U/L) and 67 U/L (interquartile range 53-85 U/L), respectively. Younger age, malabsorption symptoms, and low hemoglobin or ferritin were significantly more common in the HTS group at univariate analysis. At multivariate analysis, only age <=4.27 years correlated with risk of liver involvement (odds ratio 3.73; 95\% confidence interval: 1.61-8.66). When retested on a gluten-free diet, all but 3 patients normalized ALT levels; of these, 1 was diagnosed with sclerosing cholangitis.

CONCLUSIONS: Liver involvement in celiac children is now less frequent than previously reported, possibly due to changing CD epidemiology. Younger age is the only risk factor. Associated autoimmune liver disease is rare.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000002209}, author = {Benelli, Elisa and Naviglio, Samuele and De Leo, Luigina and Stera, Giacomo and Giangreco, Manuela and Ronfani, Luca and Villanacci, Vincenzo and Martelossi, Stefano and Ventura, Alessandro and Not, Tarcisio} } @article {10844, title = {Retrospective study showed that palpitations with tachycardia on admission to a paediatric emergency department were related to cardiac arrhythmias.}, journal = {Acta Paediatr}, volume = {108}, year = {2019}, month = {2019 Feb}, pages = {328-332}, abstract = {

AIM: This retrospective study reviewed the prevalence and long-term prognosis of children aged 0-18 with palpitations who were admitted to the emergency department (ED) of an Italian paediatric hospital.

METHODS: We examined all admissions to the ED of the IRCCS Burlo Garofolo between January 2009 and December 2015 by selecting triage diagnoses of palpitations. The hospital discharge cards were reviewed to assess vital parameters, physical examinations, diagnostic tests, cardiology consultations and final diagnoses.

RESULTS: Of the 142 803 patients who attended our ED for any reason, 96 (0.07\%) complained of palpitations. Despite this low prevalence, it was noteworthy that 13.5\% had a real underlying arrhythmic cause and needed medical assistance. Over half (52.1\%) were women and the mean age was 12.7 years. At the long-term follow-up, at a mean of 47 {\textpm} 23 months, 53.8\% of patients with a cardiac arrhythmia had received medical therapy and 46.1\% had undergone trans-catheter ablation for supraventricular tachycardia. A heart rate above 146 beats per minute or palpitations for more than an hour was statistically related to a cardiac arrhythmia.

CONCLUSION: Palpitations were an infrequent cause of admission to our ED, but 13.5\% who displayed them had an underlying cardiac arrhythmia.

}, issn = {1651-2227}, doi = {10.1111/apa.14486}, author = {Bobbo, Marco and Amoroso, Stefano and Tamaro, Gianluca and Gesuete, Valentina and D{\textquoteright}agata Mottolese, Biancamaria and Barbi, Egidio and Ventura, Alessandro} } @article {10416, title = {Anti-transglutaminase 6 Antibody Development in Children With Celiac Disease Correlates With Duration of Gluten Exposure.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {66}, year = {2018}, month = {2018 Jan}, pages = {64-68}, abstract = {

OBJECTIVES: Antibodies against transglutaminase 6 (anti-TG6) have been implicated in neurological manifestations in adult patients with genetic gluten intolerance, and it is unclear whether autoimmunity to TG6 develops following prolonged gluten exposure. We measured the anti-TG6 in children with celiac disease (CD) at the diagnosis time to establish a correlation between these autoantibodies and the duration of gluten exposure. We investigated a correlation between anti-TG6 and the presence of neurological disorders.

METHODS: Anti-TG6 (IgA/IgG) were measured by ELISA in sera of children with biopsy-proven CD and of children experiencing gastrointestinal disorders. CD patients positive for anti-TG6 were retested after 2 years of gluten-free diet (GFD).

RESULTS: We analyzed the sera of 274 CD children and of 121 controls. Anti-TG6 were detected in 68/274 (25\%) CD patients and in 19/121 (16\%) controls, with significant difference between the 2 groups (P = 0.04). None of the CD patients and of the controls testing positive for anti-TG6 were experiencing neurological disorders. Eleven of 18 (61\%) CD patients with other autoimmune diseases were positive for anti-TG6. In CD patients, a significant correlation between the gluten exposure before the CD diagnosis and anti-TG6 concentration was found (P = 0.006 for IgA; P < 0.0001 for IgG). After GFD anti-TG6 concentrations were significantly reduced (P < 0.001). No significant correlation was observed between anti-TG6 and anti-TG2 serum concentrations.

CONCLUSIONS: Anti-TG6 are more prevalent in children with untreated CD in the absence of overt neurological disorders. The synthesis of the anti-TG6 is related to a longer exposure to gluten before the CD diagnosis, and the autoimmunity against TG6 is gluten dependent and disappeared during GFD.

}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000001642}, author = {De Leo, Luigina and Aeschlimann, Daniel and Hadjivassiliou, Marios and Aeschlimann, Pascale and Salce, Nicola and Vatta, Serena and Ziberna, Fabiana and Cozzi, Giorgio and Martelossi, Stefano and Ventura, Alessandro and Not, Tarcisio} } @article {10778, title = {Fecal Calprotectin to Detect Inflammatory Bowel Disease in Juvenile Idiopathic Arthritis.}, journal = {J Rheumatol}, volume = {45}, year = {2018}, month = {2018 Oct}, pages = {1418-1421}, abstract = {

OBJECTIVE: This study aimed to test fecal calprotectin (FC) as a screening tool to identify inflammatory bowel disease (IBD) among patients with juvenile idiopathic arthritis (JIA).

METHODS: FC level < 100 g/kg was considered normal. Patients with 2 consecutive FC dosage >= 100 g/kg underwent endoscopic evaluation.

RESULTS: There were 113 patients with JIA enrolled. FC was raised in 7 patients out of 113. All patients had IBD. In 3/7 patients, high FC levels were the only sign consistent with IBD.

CONCLUSION: FC is a useful, economical, and noninvasive diagnostic tool to identify JIA patients with underlying IBD.

}, issn = {0315-162X}, doi = {10.3899/jrheum.171200}, author = {Ferrara, Giovanna and Pastore, Serena and Sancin, Lara and Torelli, Lucio and Radillo, Oriano and Bramuzzo, Matteo and Bibalo, Chiara and Tommasini, Alberto and Ventura, Alessandro and Taddio, Andrea} } @article {10436, title = {High-Throughput Sequencing of microRNAs in Glucocorticoid Sensitive Paediatric Inflammatory Bowel Disease Patients.}, journal = {Int J Mol Sci}, volume = {19}, year = {2018}, month = {2018 May 08}, abstract = {

The aim of this research was the identification of novel pharmacogenomic biomarkers for better understanding the complex gene regulation mechanisms underpinning glucocorticoid (GC) action in paediatric inflammatory bowel disease (IBD). This goal was achieved by evaluating high-throughput microRNA (miRNA) profiles during GC treatment, integrated with the assessment of expression changes in GC receptor (GR) heterocomplex genes. Furthermore, we tested the hypothesis that differentially expressed miRNAs could be directly regulated by GCs through investigating the presence of GC responsive elements (GREs) in their gene promoters. Ten IBD paediatric patients responding to GCs were enrolled. Peripheral blood was obtained at diagnosis (T0) and after four weeks of steroid treatment (T4). MicroRNA profiles were analyzed using next generation sequencing, and selected significantly differentially expressed miRNAs were validated by quantitative reverse transcription-polymerase chain reaction. In detail, 18 miRNAs were differentially expressed from T0 to T4, 16 of which were upregulated and 2 of which were downregulated. Out of these, three miRNAs (miR-144, miR-142, and miR-96) could putatively recognize the 3\’UTR of the GR gene and three miRNAs (miR-363, miR-96, miR-142) contained GREs sequences, thereby potentially enabling direct regulation by the GR. In conclusion, we identified miRNAs differently expressed during GC treatment and miRNAs which could be directly regulated by GCs in blood cells of young IBD patients. These results could represent a first step towards their translation as pharmacogenomic biomarkers.

}, keywords = {Adolescent, Biomarkers, Child, Female, Gene Expression Regulation, Glucocorticoids, High-Throughput Nucleotide Sequencing, Humans, Inflammatory Bowel Diseases, Male, MicroRNAs, Receptors, Glucocorticoid, Transcriptome}, issn = {1422-0067}, doi = {10.3390/ijms19051399}, author = {De Iudicibus, Sara and Lucaf{\`o}, Marianna and Vitulo, Nicola and Martelossi, Stefano and Zimbello, Rosanna and De Pascale, Fabio and Forcato, Claudio and Naviglio, Samuele and Di Silvestre, Alessia and Gerdol, Marco and Stocco, Gabriele and Valle, Giorgio and Ventura, Alessandro and Bramuzzo, Matteo and Decorti, Giuliana} } @article {10795, title = {How to predict response to anti-tumour necrosis factor agents in inflammatory bowel disease.}, journal = {Expert Rev Gastroenterol Hepatol}, volume = {12}, year = {2018}, month = {2018 Aug}, pages = {797-810}, abstract = {

INTRODUCTION: Anti-tumor necrosis factor (TNF) agents have changed the therapeutic approach to inflammatory bowel disease (IBD). However, a considerable proportion of patients either do not primarily respond or lose response to treatment. Despite the long-standing experience in the use of these drugs, still there is the need of identifying the possible predictors of efficacy. Areas covered: We critically review the current knowledge on predictors of response to anti-TNF therapy - both those available in clinical practice and those still under investigation. Multiple factors are involved in treatment success, including disease phenotype and severity, adherence to medications, and pharmacogenomic, pharmacokinetic, and immunologic factors. Literature search was conducted in PubMed using keywords {\textquoteright}inflammatory bowel disease,{\textquoteright} {\textquoteright}Crohn{\textquoteright}s disease,{\textquoteright} and {\textquoteright}ulcerative colitis,{\textquoteright} matched with {\textquoteright}antitumor necrosis factor,{\textquoteright} {\textquoteright}biologic therapy,{\textquoteright} {\textquoteright}clinical response,{\textquoteright} {\textquoteright}predictors,{\textquoteright} and {\textquoteright}efficacy,{\textquoteright} Relevant articles were selected for review. Expert commentary: While the role of several factors in clinical practice is clearly established, other investigational markers have been proposed, mostly in small studies, yet for many of them little external validation exists. Therapeutic drug monitoring is emerging as a pivotal strategy to guide decisions in clinical practice. In the near future, novel markers could improve our ability to direct treatment and personalize therapy.

}, keywords = {Antibodies, Monoclonal, Biological Therapy, Gastrointestinal Agents, Humans, Inflammatory Bowel Diseases, Patient Selection, Prognosis, Treatment Outcome, Tumor Necrosis Factor-alpha}, issn = {1747-4132}, doi = {10.1080/17474124.2018.1494573}, author = {Naviglio, Samuele and Giuffrida, Paolo and Stocco, Gabriele and Lenti, Marco Vincenzo and Ventura, Alessandro and Corazza, Gino Roberto and Di Sabatino, Antonio} } @article {10443, title = {Immunohistologic analysis of the duodenal bulb: a new method for celiac disease diagnosis in children.}, journal = {Gastrointest Endosc}, volume = {88}, year = {2018}, month = {2018 Sep}, pages = {521-526}, abstract = {

BACKGROUND AND AIMS: Anti-tissue transglutaminase antibodies (anti-tTG) have simplified celiac disease (CD) diagnosis. However, in atypical forms of CD, intestinal biopsy sampling is still required. This prospective study investigates whether histologic analysis of the duodenal bulb combined with intestinal IgA anti-tTG deposit immunoassay makes CD diagnosis possible in at-risk children with low concentrations of serum anti-tTG.

METHODS: Histologic and intestinal IgA anti-tTG deposit immunoassays were used.

RESULTS: Two hundred forty-five symptomatic children positive for serum anti-tTG (>7 U/mL) were enrolled and~divided into 3 groups: extensive duodenal atrophy (n~= 209), with IgA anti-tTG deposits throughout the duodenum and high serum anti-tTG concentrations (157 {\textpm} 178 U/mL); bulb duodenal atrophy (n~= 22), with widespread IgA anti-tTG deposits in 9 and in the bulb alone in 13 and low serum anti-tTG concentrations (13.9~{\textpm} 8.7 U/mL); and normal duodenum (n~= 14), with widespread IgA anti-tTG deposits in 8 and in the bulb alone in 6 and low serum anti-tTG concentrations (10.6 {\textpm} 6.2 U/mL). All patients in the first 2 groups were diagnosed with CD and 8 from the third group. All improved after 1 year of gluten-free diet. Bulb duodenal analysis led to a 12\% (30/245) increase in CD diagnosis. No CD-related lesions were observed in the 30 control subjects.

CONCLUSIONS: In children at risk for CD, bulb duodenum biopsy sampling is essential to identify villous atrophy and detect IgA anti-tTG deposits even in absence of intestinal lesions. These mucosal autoantibodies could well represent a new standard for diagnosing CD.

}, keywords = {Adolescent, Autoantibodies, Celiac Disease, Child, Child, Preschool, Duodenum, Female, Humans, Immunoglobulin A, Immunohistochemistry, Infant, Male, Prospective Studies, Transglutaminases}, issn = {1097-6779}, doi = {10.1016/j.gie.2018.05.014}, author = {De Leo, Luigina and Villanacci, Vincenzo and Ziberna, Fabiana and Vatta, Serena and Martelossi, Stefano and Di Leo, Grazia and Zanchi, Chiara and Bramuzzo, Matteo and Giudici, Fabiola and Ventura, Alessandro and Not, Tarcisio} } @article {10429, title = {A Klinefelter boy with congenital adrenal hyperplasia: too much or too little androgens?}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Apr 03}, pages = {43}, abstract = {

BACKGROUND: The simultaneous occurrence of Klinefelter Syndrome (KS) and Congenital Adrenal Hyperplasia (CAH) is an exceptional event: there are just three case reports (two children and a 51 years old man) describing males affected by both KS and 21OHD (21-hydroxylase deficiency) CAH, the first causing androgen deficiency, the latter leading to androgen excess.

CASE REPORT: We report the 4th case of association of KS and CAH in a young man with CAH with good androgen control and with normal secondary sex characteristics, whose Klinefelter syndrome was diagnosed because of reduced testicular volume. He was the first reported case of association of KS and CAH who started androgen replacement therapy in the pubertal age and whose pubertal development was described and followed up step by step.

CONCLUSION: In a boy with CAH and small testicular volume, it{\textquoteright}s important to consider that hypogonadism may be masked by the adrenal androgens excess and a karyotype should be performed once testicular adrenal rests have been ruled out.

}, keywords = {Adolescent, Adrenal Hyperplasia, Congenital, Androgens, Follow-Up Studies, Hormone Replacement Therapy, Humans, Klinefelter Syndrome, Male, Rare Diseases, Risk Assessment, Testis}, issn = {1824-7288}, doi = {10.1186/s13052-018-0485-x}, author = {Zanella, Giada and Tornese, Gianluca and Mascheroni, Elisabetta and Faleschini, Elena and Ventura, Alessandro and Barbi, Egidio} } @article {10422, title = {Multiple successful pregnancies in a woman with biliary atresia and native liver.}, journal = {Eur J Obstet Gynecol Reprod Biol}, volume = {221}, year = {2018}, month = {2018 02}, pages = {194-195}, issn = {1872-7654}, doi = {10.1016/j.ejogrb.2017.12.010}, author = {Matarazzo, Lorenza and Assandro, Paola and Martelossi, Stefano and Maggiore, Giuseppe and Ventura, Alessandro} } @article {10825, title = {Ocular Manifestations of Paediatric Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.}, journal = {J Crohns Colitis}, volume = {12}, year = {2018}, month = {2018 Jun 28}, pages = {870-879}, abstract = {

Background and Aims: Ocular extraintestinal manifestations [O-EIMs] are known complications of Crohn{\textquoteright}s disease [CD], ulcerative colitis [UC], and inflammatory bowel disease unclassified [IBD-U]. However, data on their prevalence in children are scarce and there are no clear recommendations on what follow-up should be offered. We aimed to review available data on O-EIMs in children.

Methods: In January 2018, we performed a systematic review of published English literature using PubMed and EMBASE databases and disease-specific queries.

Results: Fifteen studies [7467 patients] reported data on O-EIMs prevalence in children. Overall prevalence of O-EIMs was 0.62-1.82\%. Uveitis was the most common O-EIM. Meta-analysis showed that children with CD are at increased risk of O-EIMs as compared with children with UC and IBD-U (odds ratio [OR] 2.70, 95\% confidence interval [CI] 1.51-4.83). Five studies [357 patients] reported data on ophthalmological screening in asymptomatic children: mild asymptomatic uveitis was identified in a variable proportion of patients [1.06-23.1\%], more frequently in male patients with CD and colonic involvement. No evidence of ocular complications from untreated uveitis was detected. A total of 23 case reports [24 patients] were identified.

Conclusions: Data on O-EIMs in children are scarce. Prevalence of O-EIMs is lower than in adults but may be underestimated because of the possibility of asymptomatic uveitis; however, the long-term significance of this condition is unknown. Children with CD may be at increased risk of O-EIMs. No recommendations on routine ophthalmological examination can be made, but a low threshold for ophthalmological referral should be maintained. Larger studies in paediatric IBD populations are needed.

}, keywords = {Adolescent, Cataract, Child, Child, Preschool, Colitis, Ulcerative, Crohn Disease, Eye Diseases, Humans, Prevalence, Uveitis}, issn = {1876-4479}, doi = {10.1093/ecco-jcc/jjy029}, author = {Ottaviano, Giorgio and Salvatore, Silvia and Salvatoni, Alessandro and Martelossi, Stefano and Ventura, Alessandro and Naviglio, Samuele} } @article {10510, title = {Role of the Long Non-Coding RNA Growth Arrest-Specific 5 in Glucocorticoid Response in Children with Inflammatory Bowel Disease.}, journal = {Basic Clin Pharmacol Toxicol}, volume = {122}, year = {2018}, month = {2018 Jan}, pages = {87-93}, abstract = {

Glucocorticoids (GCs) are widely employed in inflammatory, autoimmune and neoplastic diseases, and, despite the introduction of novel therapies, remain the first-line treatment for inducing remission in inflammatory bowel disease (IBD). Given the high incidence of suboptimal response, associated with a significant number of side-effects, that are particularly severe in paediatric patients, the identification of subjects that are most likely to respond poorly to GCs is extremely important. Recent evidence suggests that the long non-coding RNA (lncRNA) GAS5 could be a potential marker of GC resistance. To address this issue, we evaluated the association between the lncRNA GAS5 and the efficacy of steroids, in terms of inhibition of proliferation, in two cell lines derived from colon and ovarian cancers, to confirm the sensitivity and specificity of these lncRNAs. These cells showed a different sensitivity to GCs and revealed differential expression of GAS5 after treatment. GAS5 was up-regulated in GC-resistant cells and accumulated more in the cytoplasm compared to the nucleus in response to the drug. The functions of GAS5 were assessed by silencing, and we found that GAS5 knock-down reduced the proliferation during GC treatment. Furthermore, for the first time, we measured GAS5 levels in 19 paediatric IBD patients at diagnosis and after the first cycle of GCs, and we demonstrated an up-regulation of the lncRNA in patients with unfavourable steroid response. Our preliminary results indicate that GAS5 could be considered a novel pharmacogenomic marker useful for the personalization of GC therapy.

}, keywords = {Biomarkers, Cell Line, Tumor, Cell Proliferation, Child, Drug Resistance, Female, Gene Knockdown Techniques, Glucocorticoids, Humans, Inflammatory Bowel Diseases, Male, Patient Selection, Pharmacogenomic Testing, Precision Medicine, RNA, Long Noncoding, RNA, Small Interfering, Treatment Outcome, Up-Regulation}, issn = {1742-7843}, doi = {10.1111/bcpt.12851}, author = {Lucaf{\`o}, Marianna and Di Silvestre, Alessia and Romano, Maurizio and Avian, Alice and Antonelli, Roberta and Martelossi, Stefano and Naviglio, Samuele and Tommasini, Alberto and Stocco, Gabriele and Ventura, Alessandro and Decorti, Giuliana and De Iudicibus, Sara} } @article {10848, title = {Teaching pain recognition through art: the Ramsay-Caravaggio sedation scale.}, journal = {Ital J Pediatr}, volume = {44}, year = {2018}, month = {2018 Jan 31}, pages = {20}, abstract = {

BACKGROUND: Clinical observation is a key component of medical ability, enabling immediate evaluation of the patient{\textquoteright}s emotional state and contributing to a clinical clue that leads to final decision making. In medical schools, the art of learning to look can be taught using medical humanities and especially visual arts. By presenting a Ramsay sedation score (RSS) integrated with Caravaggio{\textquoteright}s paintings during a procedural sedation conference for pediatric residents, we want to test the effectiveness of this approach to improve the quality of learning.

METHODS: In this preliminary study, we presented videos showing sedated pediatric patients in the setting of a procedural sedation lesson to two randomized groups of residents, one attending a lesson on RSS explained through the masterpieces of Caravaggio, the other without artistic support. A week later we tested their learning with ten multi-choice questions focused on theoretical questions about sedation monitoring and ten more questions focused on recognizing the appropriate RSS viewing the videos. The primary outcome was the comparison of the total number of RSS layers properly recognized in both groups. We also evaluated the appreciation of the residents of the use of works of art integrated with the lesson.

RESULTS: Eleven students were randomized to each group. Two residents in the standard lesson did not attend the test. The percentage of correct answers on the theoretical part was similar, 82\% in the art group and 89\% in the other (p > 0.05). No difference was found in the video recognition part of the RSS recognition test. Residents exposed to paintings shown great appreciation for the integration of the lesson with the Caravaggio{\textquoteright}s masterpieces.

CONCLUSIONS: Adding artwork to a standard medical conference does not improve the performance of student tests, although this approach has been greatly appreciated by residents.

}, keywords = {Clinical Competence, Conscious Sedation, Deep Sedation, Education, Medical, Graduate, Female, Hospitals, University, Humans, Internship and Residency, Italy, Male, Medicine in the Arts, Monitoring, Physiologic, Pain Measurement, Paintings, Pediatrics, Video Recording}, issn = {1824-7288}, doi = {10.1186/s13052-018-0453-5}, author = {Poropat, Federico and Cozzi, Giorgio and Magnolato, Andrea and Monasta, Lorenzo and Borrometi, Fabio and Krauss, Baruch and Ventura, Alessandro and Barbi, Egidio} } @article {10417, title = {An unusual unilateral breast enlargement in a prepubertal girl.}, journal = {Arch Dis Child}, volume = {103}, year = {2018}, month = {2018 May}, pages = {451}, issn = {1468-2044}, doi = {10.1136/archdischild-2017-313215}, author = {Pavan, Matteo and Faleschini, Elena and Tornese, Gianluca and Zandon{\`a}, Lorenzo and Ventura, Alessandro} } @article {10530, title = {Bilateral Finger Swelling in an Adolescent.}, journal = {J Pediatr}, volume = {188}, year = {2017}, month = {2017 09}, pages = {299}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2017.04.064}, author = {Naviglio, Samuele and Mazzolai, Michele and Ventura, Alessandro} } @article {10528, title = {Children with cancer: a survey on the experience of Italian primary care pediatricians.}, journal = {Ital J Pediatr}, volume = {43}, year = {2017}, month = {2017 May 25}, pages = {48}, abstract = {

BACKGROUND: Cancer is the second cause of death in children and its diagnosis can be difficult, due to the presence of vague and non-specific symptoms. The primary care pediatrician is often involved in the diagnostic process, but no longer in child care once the treatment started. Care models involving both primary care pediatricians and oncologic referral centre highlighted a higher family satisfaction when they worked together. We conducted a survey on primary care pediatricians involved in childhood cancer in order to describe the actual situation.

METHODS: We conducted a retrospective survey enrolling primary care pediatricians from a north-eastern area of Italy. They received a questionnaire that consisted in two parts: the first one aimed to assess the physician{\textquoteright}s seniority and experience and the second one pertained to each case of cancer and explored the relationship between the pediatrician, the family and the referral centre, and pediatricians degree of satisfaction and emotional impact.

RESULTS: We obtained data from 79 pediatricians who described 150 cancer cases. In 99 cases the primary care pediatrician had visited the child at the onset of symptoms and had referred him to the hospital. In 89 cases, he understood the severity of the disease. In 53.3\% of cases the pediatrician was informed by the referral centre. The relationship between the pediatrician and child{\textquoteright}s family improved in 38\% of cases and this was related with their participation to the multidisciplinary meetings on child health.

CONCLUSIONS: Primary pediatricians{\textquoteright} sharing in the management of their patients with cancer was not satisfactory. Development of specific protocols targeted to an integrated care is needed to increase primary pediatricians{\textquoteright} involvement and families{\textquoteright} satisfactions.

}, keywords = {Child, Child, Preschool, Cross-Sectional Studies, Disease-Free Survival, Female, Humans, Italy, Male, Needs Assessment, Neoplasms, Outcome Assessment (Health Care), Pediatricians, Practice Patterns, Physicians{\textquoteright}, Prevalence, Primary Health Care, Retrospective Studies, Risk Assessment, Survival Analysis}, issn = {1824-7288}, doi = {10.1186/s13052-017-0365-9}, author = {Minute, Marta and Cozzi, Giorgio and Plotti, Chiara and Montanari, Giuseppe and Pecile, Paolo and Zanazzo, Giulio Andrea and Ventura, Alessandro and Barbi, Egidio} } @article {8483, title = {Describing Kawasaki shock syndrome: results from a retrospective study and literature review.}, journal = {Clin Rheumatol}, volume = {36}, year = {2017}, month = {2017 Jan}, pages = {223-228}, abstract = {

Kawasaki shock syndrome (KSS) is a rare manifestation of Kawasaki disease (KD) characterized by systolic hypotension or clinical signs of poor perfusion. The objectives of the study are to describe the main clinical presentation, echocardiographic, and laboratory findings, as well as the treatment options and clinical outcomes of KSS patients when compared with KD patients. This is a retrospective study. All children referred to two pediatric rheumatology units from January 1, 2012, to December 31, 2014, were enrolled. Patients were divided into patients with or without KSS. We compared the two groups according to the following variables: sex, age, type of KD (classic, with less frequent manifestations, or incomplete), clinical manifestations, cardiac involvement, laboratory findings, therapy administered, response to treatment, and outcome. Eighty-four patients with KD were enrolled. Of these, five (6~\%) met the criteria for KSS. Patients with KSS had higher values of C-reactive protein (p = 0.005), lower hemoglobin levels (p = 0.003); more frequent hyponatremia (p = 0.004), hypoalbuminemia (p = 0.004), and coagulopathy (p = 0.003); and increase in cardiac troponins (p = 0.000). Among the KSS patients, three had a coronary artery involvement, but none developed a permanent aneurysm. Intravenous immunoglobulin resistance was more frequent in the KSS group, although not significantly so (3/5, 60~\% vs. 23/79, 30~\%, P = NS). None of the five cases was fatal, and all recovered without sequelae. KSS patients are more likely to have higher rates of cardiac involvement. However, most cardiovascular abnormalities resolved promptly with therapy.

}, keywords = {C-Reactive Protein, Child, Child, Preschool, Echocardiography, Female, Heart Failure, Hemoglobins, Humans, Immunoglobulins, Intravenous, Male, Mucocutaneous Lymph Node Syndrome, Retrospective Studies, Shock, Syndrome}, issn = {1434-9949}, doi = {10.1007/s10067-016-3316-8}, author = {Taddio, Andrea and Rossi, Eleonora Dei and Monasta, Lorenzo and Pastore, Serena and Tommasini, Alberto and Lepore, Loredana and Bronzetti, Gabriele and Marrani, Edoardo and Mottolese, Biancamaria D{\textquoteright}Agata and Simonini, Gabriele and Cimaz, Rolando and Ventura, Alessandro} } @article {10504, title = {Multicentric Case-Control Study on Azathioprine Dose and Pharmacokinetics in Early-onset Pediatric Inflammatory Bowel Disease.}, journal = {Inflamm Bowel Dis}, volume = {23}, year = {2017}, month = {2017 04}, pages = {628-634}, abstract = {

BACKGROUND: Early-onset inflammatory bowel disease (IBD) is generally aggressive, with a high probability of complications and need of surgery. Despite the introduction of highly effective biological drugs, treatment with azathioprine continues to be important even for early-onset IBD; however, in these patients azathioprine response seems to be reduced. This study evaluated azathioprine doses, metabolite concentrations, and their associations with patients{\textquoteright} age in children with IBD treated at 6 tertiary pediatric referral centers.

METHODS: Azathioprine doses, metabolites, and clinical effects were assessed after at least 3 months of therapy in 17 early-onset (age < 6 yr, cases) and 51 nonearly-onset (aged > 12 and <18 yrs, controls) patients with IBD. Azathioprine dose was titrated on therapeutic efficacy (response and adverse effects). Azathioprine metabolites and thiopurine methyltransferase activity were determined by high-performance liquid chromatography with ultra violet-vis detection (HPLC-UV) methods.

RESULTS: Frequency of patients in remission was similar among early-onset and control groups, respectively (82\% and 84\%, P value = 0.72). Early-onset patients required higher doses of azathioprine (median 2.7 versus 2.0 mg{\textperiodcentered}kg{\textperiodcentered}d, P value = 1.1 {\texttimes} 10). Different doses resulted in comparable azathioprine active thioguanine nucleotide metabolite concentrations (median 263 versus 366 pmol/8 {\texttimes} 10 erythrocytes, P value = 0.41) and methylmercaptopurine nucleotide concentrations (median 1455 versus 1532 pmol/8 {\texttimes} 10 erythrocytes, P value = 0.60). Lower ratios between thioguanine nucleotide metabolites and azathioprine doses were found in early-onset patients (median 98 versus 184 pmol/8 {\texttimes} 10 erythrocytes{\textperiodcentered}mg{\textperiodcentered}kg{\textperiodcentered}d, P value = 0.017). Interestingly, early-onset patients presented also higher thiopurine methyltransferase activity (median 476 versus 350 nmol methylmercaptopurine/mg hemoglobin/h, P-value = 0.046).

CONCLUSIONS: This study demonstrated that patients with early-onset IBD present increased inactivating azathioprine metabolism, likely because of elevated activity of the enzyme thiopurine methyltransferase.

}, keywords = {Adolescent, Age of Onset, Antimetabolites, Azathioprine, Case-Control Studies, Child, Child, Preschool, Chromatography, High Pressure Liquid, Dose-Response Relationship, Drug, Erythrocytes, Female, Guanine Nucleotides, Humans, Inflammatory Bowel Diseases, Male, Mercaptopurine, Methyltransferases, Thioguanine}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000001051}, author = {Stocco, Gabriele and Martelossi, Stefano and Arrigo, Serena and Barabino, Arrigo and Aloi, Marina and Martinelli, Massimo and Miele, Erasmo and Knafelz, Daniela and Romano, Claudio and Naviglio, Samuele and Favretto, Diego and Cuzzoni, Eva and Franca, Raffaella and Decorti, Giuliana and Ventura, Alessandro} } @article {10548, title = {Ocular Involvement in Children with Inflammatory Bowel Disease.}, journal = {Inflamm Bowel Dis}, volume = {23}, year = {2017}, month = {2017 06}, pages = {986-990}, abstract = {

BACKGROUND: Data on ocular manifestations of inflammatory bowel disease (IBD) in children are limited. Some authors have reported a high prevalence of asymptomatic uveitis, yet the significance of these observations is unknown and there are no recommendations on which ophthalmologic follow-up should be offered.

METHODS: Children with IBD seen at a single referral center for pediatric gastroenterology were offered ophthalmologic evaluation as part of routine care for their disease. Ophthalmologic evaluation included review of ocular history as well as slit-lamp and fundoscopic examination. Medical records were also reviewed for previous ophthalmologic diagnoses or complaints.

RESULTS: Data from 94 children were included (52 boys; median age 13.4 yr). Forty-six patients had a diagnosis of Crohn{\textquoteright}s disease, 46 ulcerative colitis, and 2 IBD unclassified. Intestinal disease was in clinical remission in 70\% of the patients; fecal calprotectin was elevated in 64\%. One patient with Crohn{\textquoteright}s disease had a previous diagnosis of clinically manifest uveitis (overall uveitis prevalence: 1.06\%; incidence rate: 0.3 per 100 patient-years). This patient was also the only one who was found to have asymptomatic uveitis at slit-lamp examination. A second patient had posterior subcapsular cataract associated with corticosteroid treatment. No signs of intraocular complications from previous unrecognized uveitis were observed in any patient.

CONCLUSIONS: Children with IBD may have asymptomatic uveitis, yet its prevalence seems lower than previously reported, and it was not found in children without a previous diagnosis of clinically manifest uveitis. No ocular complications from prior unrecognized uveitis were observed.

}, keywords = {Adolescent, Child, Child, Preschool, Feces, Female, Humans, Inflammatory Bowel Diseases, Italy, Leukocyte L1 Antigen Complex, Male, Remission Induction, Uveitis}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000001079}, author = {Naviglio, Samuele and Parentin, Fulvio and Nider, Silvia and Rassu, Nicol{\`o} and Martelossi, Stefano and Ventura, Alessandro} } @article {10573, title = {A premenarcheal girl with urogenital bleeding.}, journal = {Arch Dis Child}, volume = {102}, year = {2017}, month = {2017 May}, pages = {472}, issn = {1468-2044}, doi = {10.1136/archdischild-2016-311730}, author = {Lora, Angela and Scrimin, Federica and Taddio, Andrea and Ventura, Alessandro and Barbi, Egidio} } @article {10477, title = {Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain.}, journal = {Acta Paediatr}, volume = {106}, year = {2017}, month = {2017 Apr}, pages = {586-593}, abstract = {

AIM: The aim of this study was to quantify the prevalence of somatic pain in a paediatric emergency department (ED).

METHODS: We conducted a prospective observational study using patients admitted to the ED of an Italian children{\textquoteright}s hospital between December 2014 and February 2015. We enrolled children aged 7-17 who turned up at the ED complaining of pain. Patients and parents were asked to fill in a questionnaire to allow the analysis of the patients{\textquoteright} medical history and provide contact details for follow-up. We divided the enrolled patients into four groups: post-traumatic pain, organic pain, functional pain and somatic pain. The questionnaire was used to define pain characteristics and to generate an impairment score.

RESULTS: Of the 713 patients who met inclusion criteria, 306 (42.9\%) were enrolled in the study. Of these, 135 (44.0\%) suffered from post-traumatic pain, 104 (34.0\%) from organic pain, 41 (13.4\%) from functional pain and 26 (8.6\%) from somatic pain. Somatic pain patients had endured pain longer, had missed more school days and had suffered severe functional impairment.

CONCLUSION: This study highlighted that somatic pain was a significant contributor to paediatric emergency room visits and should be suspected and diagnosed in children reporting pain.

}, keywords = {Adolescent, Child, Emergency Service, Hospital, Female, Humans, Italy, Male, Medically Unexplained Symptoms, Pain, Prospective Studies}, issn = {1651-2227}, doi = {10.1111/apa.13741}, author = {Cozzi, Giorgio and Minute, Marta and Skabar, Aldo and Pirrone, Angela and Jaber, Mohamad and Neri, Elena and Montico, Marcella and Ventura, Alessandro and Barbi, Egidio} } @article {10478, title = {A Teenager with Sudden Unilateral Breast Enlargement.}, journal = {J Pediatr}, volume = {182}, year = {2017}, month = {2017 03}, pages = {394}, keywords = {Bullying, Child, Gynecomastia, Hematoma, Humans, Male, Wounds, Nonpenetrating}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2016.11.044}, author = {Pellegrin, Maria Chiara and Naviglio, Samuele and Cattaruzzi, Elisabetta and Barbi, Egidio and Ventura, Alessandro} } @article {10516, title = {A young goalkeeper with buttock pain and fever.}, journal = {BMJ}, volume = {357}, year = {2017}, month = {2017 06 08}, pages = {j2400}, keywords = {Adolescent, Buttocks, Fever, Humans, Male, Musculoskeletal Pain, Pyomyositis}, issn = {1756-1833}, doi = {10.1136/bmj.j2400}, author = {Moressa, Valentina and Pastore, Serena and Naviglio, Samuele and Ventura, Alessandro} } @article {8512, title = {Carbamazepine-induced thrombocytopenic purpura in a child: Insights from a genomic analysis.}, journal = {Blood Cells Mol Dis}, volume = {59}, year = {2016}, month = {2016 Jul}, pages = {97-9}, issn = {1096-0961}, doi = {10.1016/j.bcmd.2016.05.001}, author = {Abate, Maria Valentina and Stocco, Gabriele and Devescovi, Raffaella and Carrozzi, Marco and Pierobon, Chiara and Valencic, Erica and Lucaf{\`o}, Marianna and Di Silvestre, Alessia and d{\textquoteright}Adamo, Pio and Tommasini, Alberto and Decorti, Giuliana and Ventura, Alessandro} } @article {8509, title = {A Child with Severe Developmental Delay and Growth Retardation.}, journal = {J Pediatr}, volume = {175}, year = {2016}, month = {2016 Aug}, pages = {241-241.e1}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2016.05.006}, author = {Rossetto, Elena and Matarazzo, Lorenza and Maschio, Massimo and Taddio, Andrea and Costa, Paola and Ventura, Alessandro} } @article {8523, title = {Decline in Lung Function in Childhood Asthma.}, journal = {N Engl J Med}, volume = {375}, year = {2016}, month = {2016 Aug 18}, pages = {e13}, keywords = {Anti-Inflammatory Agents, Asthma, Female, Humans, Lung, Male}, issn = {1533-4406}, doi = {10.1056/NEJMc1608228$\#$SA2}, author = {Bibalo, Cristina and Longo, Giorgio and Ventura, Alessandro} } @article {8329, title = {Differential expression of GAS5 in rapamycin-induced reversion of glucocorticoid resistance.}, journal = {Clin Exp Pharmacol Physiol}, volume = {43}, year = {2016}, month = {2016 Jun}, pages = {602-5}, abstract = {

This study evaluates the association between the long noncoding RNA GAS5 levels and the anti-proliferative effect of the glucocorticoid (GC) methylprednisolone (MP) alone and in combination with rapamycin in peripheral blood mononuclear cells (PBMCs) obtained from healthy donors. The effect of MP, rapamycin, and MP plus rapamycin was determined in 17 healthy donors by labelling metabolically active cells with [methyl-3H] thymidine and the expression levels of GAS5 gene were evaluated by real-time RT-PCR TaqMan analysis. We confirmed a role for GAS5 in modulating GC response: poor responders presented higher levels of GAS5 in comparison with good responders. Interestingly, when PBMCs were treated with the combination of rapamycin plus MP, the high levels of GAS5 observed for each drug in the MP poor responders group decreased in comparison with rapamycin (P value~=~0.0134) or MP alone (P value~=~0.0193). GAS5 is involved in GC resistance and co-treatment of rapamycin with GCs restores GC effectiveness in poor responders through the downregulation of the long noncoding RNA. GAS5 could be considered a biomarker to personalize therapy and a novel therapeutic target useful for the development of new pharmacological approaches to restore GC sensitivity.

}, issn = {1440-1681}, doi = {10.1111/1440-1681.12572}, author = {Lucaf{\`o}, Marianna and Bravin, Vanessa and Tommasini, Alberto and Martelossi, Stefano and Rabach, Ingrid and Ventura, Alessandro and Decorti, Giuliana and De Iudicibus, Sara} } @article {8305, title = {Fecal Calprotectin: Diagnostic Accuracy of the Immunochromatographic CalFast Assay in a Pediatric Population.}, journal = {J Clin Lab Anal}, year = {2016}, month = {2016 Feb 15}, abstract = {

BACKGROUND: Fecal calprotectin is a noninvasive marker for bowel diseases and it is high valuable to follow disease activity in Crohn{\textquoteright}s disease (CD) and ulcerative colitis (UC). In this study, we evaluated the diagnostic performance of the recently introduced immunochromatographic assay CalFast in comparison to the well-known ELISA tests for calprotectin assay to obtain a rapid diagnosis of bowel inflammation in pediatric patients.

METHODS: CalFast was tested in parallel to the classic ELISA tests CalPrest and PhiCal (gold standards for the calprotectin determination) on 148 fecal samples from pediatric subjects including 104 healthy subjects, 29 with CD, and 15 with UC.

RESULTS: In this study, the sensitivity and specificity of CalFast, CalPrest, and PhiCal were 86.4\%, 88.6\%, and 93.2\% and 86.6\%, 74\%, and 64.4\%, respectively. The area under the curve, obtained from receiver operating characteristic analysis, indicated the lack of significant difference among all the kits used.

CONCLUSION: The immunochromatographic assay demonstrated good diagnostic predictive values, comparable to those of the ELISA methods, and may represent a valid alternative in order to save operators{\textquoteright} time. The test, in fact, has a short turnaround time and does not need a specific ELISA instrumentation.

}, issn = {1098-2825}, doi = {10.1002/jcla.21886}, author = {Radillo, Oriano and Pascolo, Lorella and Martelossi, Stefano and Dal Bo, Sara and Ventura, Alessandro} } @article {8298, title = {Isolation of the left innominate artery: a question of connection.}, journal = {J Cardiovasc Med (Hagerstown)}, year = {2016}, month = {2016 Jan 23}, issn = {1558-2035}, doi = {10.2459/JCM.0000000000000363}, author = {Gesuete, Valentina and Sanabor, Daniela and Benettoni, Alessandra and Bobbo, Marco and Ventura, Alessandro} } @article {8524, title = {Lack of Evidence of Rotavirus-Dependent Molecular Mimicry as a Trigger of Celiac Disease.}, journal = {Clin Exp Immunol}, year = {2016}, month = {2016 Aug 22}, abstract = {

New data suggest the involvement of Rotavirus (RV) in triggering autoimmunity in celiac disease (CD) by molecular mimicry between the human-transglutaminase protein and the dodecapeptide (260-271 aa) of the RV protein VP7 (pVP7). To assess the role of RV in the onset of CD, we measured the anti-pVP7 antibodies in the sera of children with CD and of control groups. We analysed serum samples of 118 biopsy proven CD patients and 46 patients with potential-CD; 32 children with other gastrointestinal diseases; 107 no-CD children and 107 blood donors. By ELISA assay, we measured IgA-IgG antibodies against the synthetic peptides pVP7, the human transglutaminase-derived peptide (476-487 aa) which shows an homology with VP7 protein and a control peptide. The triple-layered RV particles (TLPs), containing the VP7 protein, and the double-layered RV-particles (DLPs), lacking the VP7 protein were also used as antigens in ELISA assay. Antibody reactivity to the RV-TLPs was positive in 22/118 (18\%) CD patients and in both paediatric (17/107, 16\%) and adult (29/107, 27\%) control groups, without showing a statistically significant difference among them (p=0.6, p=0.1). Biopsy-proven CD patients as well as the adult control group demonstrated a high positive antibody reactivity against both pVP7 (34/118, 29\% CD patients; 66/107, 62\% adult controls) and control synthetic peptides (35/118, 30\% CD patients; 56/107, 52\% adult controls) suggesting a non-specific response against RV pVP7. We show that children with CD do not have higher immune reactivity to RV, thus questioning the molecular mimicry mechanism as a triggering factor of CD. This article is protected by copyright. All rights reserved.

}, issn = {1365-2249}, doi = {10.1111/cei.12855}, author = {Ziberna, Fabiana and De Lorenzo, Giuditta and Schiavon, Valentina and Arnoldi, Francesca and Quaglia, Sara and De Leo, Luigina and Vatta, Serena and Martelossi, Stefano and Burrone, Oscar R and Ventura, Alessandro and Not, Tarcisio} } @article {8500, title = {Macrocephaly and palmoplantar pitting.}, journal = {Arch Dis Child}, year = {2016}, month = {2016 Jun 28}, issn = {1468-2044}, doi = {10.1136/archdischild-2016-310771}, author = {Rabach, Ingrid and Salis, Simona and Bruno, Irene and Ventura, Alessandro} } @article {8507, title = {A Spotted Bone.}, journal = {J Pediatr}, volume = {176}, year = {2016}, month = {2016 Sep}, pages = {220-220.e1}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2016.05.069}, author = {Perin, Silvia and Rabach, Ingrid and Pascolo, Paola and Dibello, Daniela and Ventura, Alessandro} } @article {8494, title = {Thalidomide for inflammatory bowel disease: Systematic review.}, journal = {Medicine (Baltimore)}, volume = {95}, year = {2016}, month = {2016 Jul}, pages = {e4239}, abstract = {

BACKGROUND: Thalidomide is an immunomodulatory drug used in the experimental treatment of refractory Crohn disease and ulcerative colitis. We aimed to review the existing evidence on the efficacy and safety of thalidomide in the treatment of inflammatory bowel diseases.

METHODS: CENTRAL, MEDLINE, LILACS, POPLINE, CINHAL, and Web of Science were searched in March 2016. Manual search included conference and reference lists. All types of studies, except single case reports, were included. Outcomes evaluated were: induction of remission; maintenance of remission; steroid reduction; effect on penetrating Crohn disease; endoscopic remission; adverse events.

RESULTS: The research strategies retrieved 722 papers. Two randomized controlled trials and 29 uncontrolled studies for a total of 489 patients matched the inclusion criteria. Thalidomide induced a clinical response in 296/427 (69.3\%) patients. Clinical remission was achieved in 220/427 (51.5\%) cases. Maintenance of remission was reported in 128/160 (80.0\%) patients at 6 months and in 96/133 (72.2\%) at 12 months. Reduction in steroid dosage was reported in 109/152 (71.7\%) patients. Fistulas improved in 49/81 (60.5\%) cases and closed in 28/81 (34.6\%). Endoscopic improvement was observed in 46/66 (69.7\%) and complete mucosal healing in 35/66 (53.0\%) patients. Cumulative incidence of total adverse events and of those leading to drug suspension was 75.6 and 19.7/1000 patient-months, respectively. Neurological disturbances accounted for 341/530 (64.3\%) adverse events and were the most frequent cause of drug withdrawal.

CONCLUSION: Existing evidence suggests that thalidomide may be a valid treatment option for patients with inflammatory bowel diseases refractory to other first- and second-line treatments.

}, issn = {1536-5964}, doi = {10.1097/MD.0000000000004239}, author = {Bramuzzo, Matteo and Ventura, Alessandro and Martelossi, Stefano and Lazzerini, Marzia} } @article {8319, title = {Thiopurine Biotransformation and Pharmacological Effects: Contribution of Oxidative Stress.}, journal = {Curr Drug Metab}, volume = {17}, year = {2016}, month = {2016}, pages = {542-9}, abstract = {

BACKGROUND: Thiopurine antimetabolites are important agents for the treatment of severe diseases, such as acute lymphoblastic leukemia and inflammatory bowel disease. Their pharmacological actions depend on biotransformation into active thioguanine-nucleotides; intracellular metabolism is mediated by enzymes of the salvage pathway of nucleotide synthesis and relies on polymorphic enzymes involved in thiopurines{\textquoteright} catabolism such as thiopurine-S-methyl transferase. Given the enzymes involved in thiopurines{\textquoteright} metabolism, it is reasonable to hypothesize that these drugs are able to induce significant oxidative stress conditions, possibly altering their pharmacological activity.

METHODS: A systemic search of peer-reviewed scientific literature in bibliographic databases has been carried out. Both clinical and preclinical studies as well as mechanistic studies have been included to shed light on the role of oxidative stress in thiopurines{\textquoteright} pharmacological effects.

RESULTS: Sixty-nine papers were included in our review, allowing us to review the contribution of oxidative stress in the pharmacological action of thiopurines. Thiopurines are catabolized in the liver by xanthine oxidase, with potential production of reactive oxidative species and azathioprine is converted into mercaptopurine by a reaction with reduced glutathione, that, in some tissues, may be facilitated by glutathione- S-transferase (GST). A clear role of GSTM1 in modulating azathioprine cytotoxicity, with a close dependency on superoxide anion production, has been recently demonstrated. Interestingly, recent genome-wide association studies have shown that, for both azathioprine in inflammatory bowel disease and mercaptopurine in acute lymphoblastic leukemia, treatment effects on patients{\textquoteright} white blood cells are related to variants of a gene, NUDT15, involved in biotransformation of oxidated nucleotides.

CONCLUSIONS: Basing on previous evidences published in literature, oxidative stress may contribute to thiopurine effects in significant ways that, however, are still not completely elucidated.

}, issn = {1875-5453}, author = {Pelin, Marco and De Iudicibus, Sara and Londero, Margherita and Spizzo, Riccardo and Dei Rossi, Sveva and Martelossi, Stefano and Ventura, Alessandro and Decorti, Giuliana and Stocco, Gabriele} } @article {3592, title = {5-Aminoimidazole-4-carboxamide ribonucleotide-transformylase and inosine-triphosphate-pyrophosphatase genes variants predict remission rate during methotrexate therapy in patients with juvenile idiopathic arthritis.}, journal = {Rheumatol Int}, volume = {35}, year = {2015}, month = {2015 Apr}, pages = {619-27}, abstract = {

For children with juvenile idiopathic arthritis (JIA) who fail to respond to methotrexate, the delay in identifying the optimal treatment at an early stage of disease can lead to long-term joint damage. Recent studies indicate that relevant variants to predict methotrexate response in JIA are those in 5-aminoimidazole-4-carboxamide ribonucleotide-transformylase (ATIC), inosine-triphosphate-pyrophosphatase (ITPA) and solute-liquid-carrier-19A1 genes. The purpose of the study was, therefore, to explore the role of these candidate genetic factors on methotrexate response in an Italian cohort of children with JIA. Clinical response to methotrexate was evaluated as clinical remission stable for a 6-month period, as ACRPed score and as change in Juvenile Arthritis Disease score. The most relevant SNPs for each gene considered were assayed on patients{\textquoteright} DNA. ITPA activity was measured in patients{\textquoteright} erythrocytes. Sixty-nine patients with JIA were analyzed: 52.2 \% responded to therapy (ACRPed70 score), while 37.7 \% reached clinical remission stable for 6 months. ATIC rs2372536 GG genotype was associated with improved clinical remission (adjusted p value = 0.0090). For ITPA, rs1127354 A variant was associated with reduced clinical remission: (adjusted p value = 0.028); this association was present even for patients with wild-type ITPA and low ITPA activity. These preliminary results indicate that genotyping of ATIC rs2372536 and ITPA rs1127354 variants or measuring ITPA activity could be useful to predict methotrexate response in children with JIA after validation by further prospective studies on a larger patient cohort.

}, issn = {1437-160X}, doi = {10.1007/s00296-014-3131-y}, author = {Pastore, Serena and Stocco, Gabriele and Moressa, Valentina and Zandon{\`a}, Luigi and Favretto, Diego and Malus{\`a}, Noelia and Decorti, Giuliana and Lepore, Loredana and Ventura, Alessandro} } @article {7765, title = {An adolescent with an altered state of mind.}, journal = {BMJ}, volume = {350}, year = {2015}, month = {2015}, pages = {h299}, keywords = {Adolescent, Cannabinoids, Designer Drugs, Hallucinations, Humans, Male, Substance-Related Disorders}, issn = {1756-1833}, doi = {10.1136/bmj.h299}, author = {Naviglio, Samuele and Papanti, Duccio and Moressa, Valentina and Ventura, Alessandro} } @article {3621, title = {"Blaschkoid dyspigmentation" in a child: don{\textquoteright}t forget fibroblast chromosomal analysis.}, journal = {J Pediatr}, volume = {166}, year = {2015}, month = {2015 Feb}, pages = {490-90.e1}, keywords = {Abnormalities, Multiple, Child, Preschool, Chromosomes, DNA, Female, Fibroblasts, Humans, Phenotype, Pigmentation Disorders}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2014.10.028}, author = {Gortani, Giulia and Faletra, Flavio and Bruno, Irene and Berti, Irene and Ventura, Alessandro} } @article {8024, title = {A brain and heart connection: X-linked periventricular heterotopia.}, journal = {J Pediatr}, volume = {166}, year = {2015}, month = {2015 Mar}, pages = {776}, keywords = {Adolescent, Brain, Diagnosis, Differential, DNA Mutational Analysis, Epilepsy, Female, Filamins, Humans, Magnetic Resonance Imaging, Mutation, Periventricular Nodular Heterotopia}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2014.11.037}, author = {Naviglio, Samuele and Bruno, Irene and Zanus, Caterina and Faletra, Flavio and Ventura, Alessandro} } @article {7757, title = {A case of Rubinstein-Taybi syndrome associated with growth hormone deficiency in childhood.}, journal = {Clin Endocrinol (Oxf)}, volume = {83}, year = {2015}, month = {2015 Sep}, pages = {437-9}, issn = {1365-2265}, doi = {10.1111/cen.12748}, author = {Tornese, Gianluca and Marzuillo, Pierluigi and Pellegrin, Maria Chiara and Germani, Claudio and Faleschini, Elena and Zennaro, Floriana and Grandone, Anna and Miraglia Del Giudice, Emanuele and Perrone, Laura and Ventura, Alessandro} } @article {8079, title = {Coeliac disease in the ERA of the new ESPGHAN and BSPGHAN guidelines: a prospective cohort study.}, journal = {Arch Dis Child}, year = {2015}, month = {2015 Nov 17}, abstract = {

OBJECTIVE: To evaluate the consequences of the last European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) guidelines for the diagnosis of coeliac disease (CD) by means of a prospective study.

DESIGN: Prospective cohort study.

SETTING: Institute for Maternal and Child Health IRCCS Burlo Garofolo (Trieste, Italy).

PATIENTS: Children diagnosed with CD without a duodenal biopsy (group 1), following the last ESPGHAN and BSPGHAN guidelines, and children diagnosed with a duodenal biopsy, matched for sex, age and year of diagnosis (group 2), were prospectively enrolled over a 3-year period. All patients were put on a gluten-free diet (GFD) and were followed up for clinical conditions and laboratory testing at 6 months every year since diagnosis (median follow up: 1.9 years).

OUTCOME MEASURES: Resolution of symptoms, body mass index, laboratory testing (haemoglobin, anti-transglutaminase IgA), adherence to a GFD, quality of life, and supplementary post-diagnosis medical consultations.

RESULTS: 51 out of 468 (11\%) patients were diagnosed without a duodenal biopsy (group 1; median age 2.1 years) and matched to 92 patients diagnosed with a biopsy (group 2; median age 2.4 years). At the end of follow-up the two groups were statistically comparable in terms of clinical and nutritional status, anti-transglutaminase IgA antibody titres, quality of life, adherence to a GFD, and number of supplementary medical consultations.

CONCLUSIONS: On the basis of this prospective study, diagnosis of CD can be reliably performed without a duodenal biopsy in approximately 11\% of cases. At least during a medium-term follow-up, this approach has no negative consequences relating to clinical remission, adherence to diet, and quality of life of children with CD.

}, issn = {1468-2044}, doi = {10.1136/archdischild-2015-309259}, author = {Benelli, Elisa and Carrato, Valentina and Martelossi, Stefano and Ronfani, Luca and Not, Tarcisio and Ventura, Alessandro} } @article {7780, title = {Different presentations of mevalonate kinase deficiency: a case series.}, journal = {Clin Exp Rheumatol}, volume = {33}, year = {2015}, month = {2015 May-Jun}, pages = {437-42}, abstract = {

OBJECTIVES: We aimed to raise awareness among paediatricians and physicians about this often misunderstood condition.

METHODS: We discussed the clinical profiles associated with late or wrong diagnosis of mevalonate kinase deficency (MKD) in a single centre case series.

RESULTS: We analysed the most common challenges and pitfalls that a clinician might face during the diagnostic process. Five main clinical profiles were characterised.

CONCLUSIONS: We propose a new perspective on MKD, suggesting that the presentation of this disease can vary from patient to patient.

}, keywords = {Age Factors, Bacterial Infections, Child, Child, Preschool, Diagnosis, Differential, Diagnostic Errors, Female, Genetic Predisposition to Disease, Humans, Infant, Inflammatory Bowel Diseases, Male, Mevalonate Kinase Deficiency, Phenotype, Predictive Value of Tests, Recurrence, Risk Factors, Sepsis, Vasculitis, Young Adult}, issn = {0392-856X}, author = {De Pieri, Carlo and Taddio, Andrea and Insalaco, Antonella and Barbi, Egidio and Lepore, Loredana and Ventura, Alessandro and Tommasini, Alberto} } @article {3619, title = {Dysplastic bone marrow changes during maintenance therapy for acute leukemia.}, journal = {J Pediatr Hematol Oncol}, volume = {37}, year = {2015}, month = {2015 Mar}, pages = {156-7}, abstract = {

We describe the case of an 8-year-old girl with common precursor B-cell acute lymphoblastic leukemia who presented with severe pancytopenia during maintenance therapy with methotrexate and 6-mercaptopurine. The bone marrow smear showed moderate hypocellularity and trilinear dysplastic changes consistent with a diagnosis of drug toxicity, with no evidence of lymphoblasts. Flow cytometric immunophenotyping was negative for leukemic cells. Blood cell counts normalized after treatment with folinic acid. Maintenance therapy was gradually restarted and she remained well at follow-up visits. Myelotoxicity from methotrexate and 6-mercaptopurine may represent an unpredictable incident during an otherwise uneventful maintenance therapy, and may occur independently of other organ toxicities.

}, keywords = {6-Mercaptopurine, Antineoplastic Combined Chemotherapy Protocols, Bone Marrow Diseases, Child, Disease Management, Female, Follow-Up Studies, Humans, Methotrexate, Precursor B-Cell Lymphoblastic Leukemia-Lymphoma, Prognosis}, issn = {1536-3678}, doi = {10.1097/MPH.0000000000000295}, author = {Chinello, Matteo and Naviglio, Samuele and Shardlow, Alison and Severino, Alessandro and Ventura, Alessandro and Locasciulli, Anna} } @article {3479, title = {Early onset bilateral anterior uveitis preceding a late manifestation of juvenile idiopathic arthritis: a case report.}, journal = {Ocul Immunol Inflamm}, volume = {23}, year = {2015}, month = {2015 Feb}, pages = {102-5}, keywords = {Adolescent, Arthritis, Juvenile, Female, Humans, Time Factors, Tomography, Optical Coherence, Uveitis, Anterior}, issn = {1744-5078}, doi = {10.3109/09273948.2013.863941}, author = {Parentin, Fulvio and Matarazzo, Lorenza and Lepore, Loredana and Pensiero, Stefano and Ventura, Alessandro} } @article {7708, title = {Effect of Thalidomide on Clinical Remission in Children and Adolescents with Ulcerative Colitis Refractory to Other Immunosuppressives: Pilot Randomized Clinical Trial.}, journal = {Inflamm Bowel Dis}, volume = {21}, year = {2015}, month = {2015 Aug}, pages = {1739-49}, abstract = {

BACKGROUND: In a randomized controlled trial, thalidomide has shown to be effective in refractory Crohn{\textquoteright}s disease in children. This pilot study aimed at evaluating thalidomide in refractory pediatric ulcerative colitis (UC).

METHODS: Double-blind, placebo-controlled randomized clinical trial on thalidomide 1.5 to 2.5 mg/kg/day in children with active UC despite multiple immunosuppressive treatments. In an open-label extension, nonresponders to placebo received thalidomide for an additional 8 weeks; all responders were followed up for a minimum of 52 weeks.

RESULTS: Twenty-six children with refractory UC were randomized to thalidomide or placebo. Clinical remission at week 8 was achieved by significantly more children treated with thalidomide {10/12 (83.3\%) versus 2/11 (18.8\%); risk ratio, 4.5 (95\% confidence interval [CI], 1.2-16.4); P = 0.005; number needed to treat, 1.5}. Of the nonresponders to placebo who were switched to thalidomide, 8 of 11 (72.7\%) subsequently reached remission at week 8 (risk ratio, 4.0 [95\% CI, 1.1-14.7]; number needed to treat, 2.45; P = 0.01). Clinical remission in the thalidomide group was 135.0 weeks (95\% CI, 32-238), compared with 8.0 weeks (95\% CI, 2.4-13.6) in the placebo group (P < 0.0001). Cumulative incidence of severe adverse events was 3.1 per 1000 patient-weeks. Peripheral neuropathy and amenorrhea were the most frequent adverse events.

CONCLUSIONS: In this pilot randomized controlled trial on cases of UC refractory to immunosuppressive therapy, thalidomide compared with placebo resulted in improved clinical remission at 8 weeks of treatment and in longer term maintenance of remission. These findings require replication in larger clinical studies evaluating both thalidomide efficacy and safety.

}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000000437}, author = {Lazzerini, Marzia and Martelossi, Stefano and Magazz{\`u}, Giuseppe and Pellegrino, Salvatore and Lucanto, Maria Cristina and Barabino, Arrigo and Calvi, Angela and Arrigo, Serena and Lionetti, Paolo and Lorusso, Monica and Mangiantini, Francesca and Fontana, Massimo and Zuin, Giovanna and Palla, Gabriella and Maggiore, Giuseppe and Bramuzzo, Matteo and Pellegrin, Maria Chiara and Maschio, Massimo and Villanacci, Vincenzo and Manenti, Stefania and Decorti, Giuliana and De Iudicibus, Sara and Paparazzo, Rossella and Montico, Marcella and Ventura, Alessandro} } @article {7697, title = {Efficacy of intravenous immunoglobulin therapy in giant cell hepatitis with autoimmune hemolytic anemia: A multicenter study.}, journal = {Clin Res Hepatol Gastroenterol}, year = {2015}, month = {2015 Jun 29}, abstract = {

BACKGROUND AND OBJECTIVE: Giant cell hepatitis with autoimmune hemolytic anemia (GCH-AHA) is a rare disease of infancy, of possible autoimmune mechanism with poor prognosis due to its scarce response to immunosuppressive drugs. The aim of this retrospective multicenter study was to evaluate the efficacy and safety of intravenous immunoglobulin (IVIg) treatment in inducing and maintaining remission of the liver disease, in patients with GCH-AHA.

METHODS: Seven children with GCH-AHA, four newly diagnosed, and three in relapse, being treated with different therapies, received one to three IVIg infusions (0.5 to 2g/kg) in association with other immunosuppressive drugs. Subsequently five of them received monthly sequential IVIg infusions (mean 13.4, range 7-24).

RESULTS: IVIg infusions as first-line therapy associated with prednisone and other immunosuppressive drugs significantly (P=0.04) reduced the aminotransferase activity in all patients and normalized prothombin activity in the only patient with severe liver dysfunction. Sequential monthly IVIg infusions determined a steroid-sparing effect and allowed a complete or partial remission in all patients, although with temporary efficacy, since relapse of the hemolytic anemia and/or of liver disease occurred in all patients. IVIg infusions were associated with mild side effects in two patients.

CONCLUSIONS: IVIg infusion can be safely and effectively administered in patients with severe GCH-AHA at diagnosis, or in case of relapse, in association with other immunosuppressive drugs. Repeated IVIg infusions may help maintain remission, however, due to their temporary efficacy, they should not be routinely employed.

}, issn = {2210-741X}, doi = {10.1016/j.clinre.2015.03.009}, author = {Marsalli, Giulia and Nastasio, Silvia and Sciveres, Marco and Calvo, Pier Luigi and Ramenghi, Ugo and Gatti, Simona and Albano, Veronica and Lega, Sara and Ventura, Alessandro and Maggiore, Giuseppe} } @article {7761, title = {Extremely large air distension of the bowel.}, journal = {Lancet}, volume = {385}, year = {2015}, month = {2015 Jun 13}, pages = {2399}, keywords = {Adolescent, Air, Biopsy, Female, Hirschsprung Disease, Humans, Intestine, Large, Rectum}, issn = {1474-547X}, doi = {10.1016/S0140-6736(14)61901-2}, author = {Pavan, Matteo and Ventura, Giovanna and Maschio, Massimo and Ventura, Alessandro} } @article {7781, title = {Failure of interferon-γ pre-treated mesenchymal stem cell treatment in a patient with Crohn{\textquoteright}s disease.}, journal = {World J Gastroenterol}, volume = {21}, year = {2015}, month = {2015 Apr 14}, pages = {4379-84}, abstract = {

Mesenchymal stem cells (MSC) are cells of stromal origin which exhibit unlimited self-renewal capacity and pluripotency in vitro. It has recently been observed that MSC may also exert a profound immunosuppressive and anti-inflammatory effect both in vitro and in vivo with consequent potential use in autoimmune disorders. We present the case of a patient suffering from childhood-onset, multidrug resistant and steroid-dependent Crohn{\textquoteright}s disease who underwent systemic infusions of MSC, which led to a temporary reduction in CCR4, CCR7 and CXCR4 expression by T-cells, and a temporary decrease in switched memory B-cells, In addition, following MSC infusion, lower doses of steroids were needed to inhibit proliferation of the patient{\textquoteright}s peripheral blood mononuclear cells. Despite these changes, no significant clinical benefit was observed, and the patient required rescue therapy with infliximab and subsequent autologous hematopoietic stem cell transplantation. The results of biological and in vitro observations after MSC use and the clinical effects of infusion are discussed, and a brief description is provided of previous data on MSC-based therapy in autoimmune disorders.

}, issn = {2219-2840}, doi = {10.3748/wjg.v21.i14.4379}, author = {Taddio, Andrea and Tommasini, Alberto and Valencic, Erica and Biagi, Ettore and Decorti, Giuliana and De Iudicibus, Sara and Cuzzoni, Eva and Gaipa, Giuseppe and Badolato, Raffaela and Prandini, Alberto and Biondi, Andrea and Ventura, Alessandro} } @article {7762, title = {Genetic determinants for methotrexate response in juvenile idiopathic arthritis.}, journal = {Front Pharmacol}, volume = {6}, year = {2015}, month = {2015}, pages = {52}, abstract = {

Juvenile idiopathic arthritis (JIAs) is the most common chronic rheumatic disease of childhood and is an important cause of disability. The folic acid analog methotrexate is the first choice disease-modifying anti-rheumatic drug in this disease, however, 35-45\% of patients fail to respond. Molecular elements, such as variants in genes of pharmacological relevance, influencing response to methotrexate in JIA, would be important to individualize treatment strategies. Several studies have evaluated the effects of candidate genetic variants in the complex pathway of genes involved in methotrexate pharmacodynamics and pharmacokinetics, however, results are still contrasting and no definitive genetic marker of methotrexate response useful for the clinician to tailor therapy of children with JIA has been identified. Recently, genome-wide approaches have been applied, identifying new potential biological processes involved in methotrexate response in JIA such as TGF-beta signaling and calcium channels. If these genomic results are properly validated and integrated with innovative analyses comprising deep sequencing, epigenetics, and pharmacokinetics, they will greatly contribute to personalize therapy with methotrexate in children with JIA.

}, issn = {1663-9812}, doi = {10.3389/fphar.2015.00052}, author = {Pastore, Serena and Stocco, Gabriele and Favretto, Diego and De Iudicibus, Sara and Taddio, Andrea and d{\textquoteright}Adamo, Pio and Malus{\`a}, Noelia and Addobbati, Riccardo and Decorti, Giuliana and Lepore, Loredana and Ventura, Alessandro} } @article {7776, title = {Legius syndrome: case report and review of literature.}, journal = {Ital J Pediatr}, volume = {41}, year = {2015}, month = {2015}, pages = {8}, abstract = {

A 8-month-old child was referred to our Dermatologic Unit for suspected Neurofibromatosis type 1 (NF 1), because of the appearance, since few days after birth, of numerous caf{\'e}-au-lait spots (seven larger than 5 mm); no other sign evocative of NF 1 was found. Her family history was remarkable for the presence of multiple caf{\'e}-au-lait spots in the mother, the grandfather and two aunts. The family had been already examined for NF 1, but no sign evocative of the disease was found. We then suspected Legius syndrome, a dominant disease characterized by a mild neurofibromatosis 1 phenotype. The diagnosis was confirmed by the finding of a mutation in SPRED1 gene, a feedback regulator of RAS/MAPK signaling. Here, we discuss the differential diagnosis of caf{\`e}-au-lait spots and we briefly review the existing literature about Legius syndrome.

}, issn = {1824-7288}, doi = {10.1186/s13052-015-0115-9}, author = {Benelli, Elisa and Bruno, Irene and Belcaro, Chiara and Ventura, Alessandro and Berti, Irene} } @article {7745, title = {Orofacial granulomatosis in children: think about Crohn{\textquoteright}s disease.}, journal = {Dig Liver Dis}, volume = {47}, year = {2015}, month = {2015 Apr}, pages = {338-41}, abstract = {

BACKGROUND: The term orofacial granulomatosis is conventionally used to describe patients with granulomatous lesions affecting the orofacial tissues, in absence of intestinal lesions. Lip swelling and facial swelling are the most common clinical signs. Despite the fact that histologically it is not distinguishable from Crohn{\textquoteright}s disease, and that both diseases have a chronic/recurrent course, the relationship between orofacial granulomatosis and Crohn{\textquoteright}s disease is still debated.

METHODS: Herein we present five cases of orofacial granulomatosis.

RESULTS: All patients presented concomitant Crohn{\textquoteright}s disease, supporting the hypothesis that orofacial granulomatosis and Crohn{\textquoteright}s disease may be one single disease. Thalidomide was effective in inducing remission of oral and intestinal symptoms in all five cases and could be considered a valid treatment opportunity for these patients.

CONCLUSIONS: Orofacial granulomatosis and Crohn{\textquoteright}s disease may be part of the same disease; both may respond to thalidomide.

}, keywords = {Adolescent, Biopsy, Child, Colonoscopy, Crohn Disease, Diagnosis, Differential, Female, Granulomatosis, Orofacial, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1878-3562}, doi = {10.1016/j.dld.2014.12.012}, author = {Lazzerini, Marzia and Martelossi, Stefano and Cont, Gabriele and Bersanini, Chiara and Ventura, Giovanna and Fontana, Massimo and Zuin, Giovanna and Ventura, Alessandro and Taddio, Andrea} } @article {8075, title = {Patients{\textquoteright} Induced Pluripotent Stem Cells to Model Drug Induced Adverse Events: A Role in Predicting Thiopurine Induced Pancreatitis?}, journal = {Curr Drug Metab}, volume = {17}, year = {2015}, month = {2015}, pages = {91-8}, abstract = {

Induced pluripotent stem cells (iPSC) can be produced from adult cells by transfecting them with a definite set of pluripotency-associated genes. Under adequate growth conditions and stimulation iPSC can differentiate to almost every somatic lineage in the body. Patients{\textquoteright} derived iPSC are an innovative model to study mechanisms of adverse drug reactions in individual patients and in cell types that cannot be easily obtained from human subjects. Proof-of concept studies with known toxicants have been performed for liver, cardiovascular and central nervous system cells: neurons obtained from iPSC have been used to elucidate the mechanism of chemotherapy-induced peripheral neuropathy by evaluating the effects of neurotoxic drugs such as vincristine. However, no study has been performed yet on pancreatic tissue and drug induced pancreatitis. Thiopurines (azathioprine and mercaptopurine) are immunosuppressive antimetabolite drugs, commonly used to treat Crohn{\textquoteright}s disease. About 5\% of Crohn{\textquoteright}s disease patients treated with thiopurines develop pancreatitis, a severe idiosyncratic adverse event; these patients have to stop thiopurine administration and may require medical treatment, with significant personal and social costs. Molecular mechanism of thiopurine induced pancreatitis (TIP) is currently unknown and no fully validated biomarker is available to assist clinicians in preventing this adverse event. Hence, in this review we have reflected upon the probable research applications of exocrine pancreatic cells generated from patient specific iPS cells. Such pancreatic cells can provide excellent insights into the molecular mechanism of TIP. In particular three hypotheses on the mechanism of TIP could be explored: drug biotransformation, innate immunity and adaptative immunity.

}, issn = {1875-5453}, author = {Stocco, Gabriele and Lanzi, Gaetana and Yue, Fengming and Giliani, Silvia and Sasaki, Katsunori and Tommasini, Alberto and Pelin, Marco and Martelossi, Stefano and Ventura, Alessandro and Decorti, Giuliana} } @article {3526, title = {A pneumonia that does not improve.}, journal = {Arch Dis Child Educ Pract Ed}, volume = {100}, year = {2015}, month = {2015 Feb}, pages = {18, 55}, keywords = {Airway Obstruction, Bronchoscopy, Child, Preschool, Foreign Bodies, Humans, Pneumonia, Radiography, Thoracic}, issn = {1743-0593}, doi = {10.1136/archdischild-2014-306343}, author = {Naviglio, Samuele and Chinello, Matteo and Ventura, Alessandro} } @article {7766, title = {Relapse and metastasis of atypical teratoid/rhabdoid tumor in a boy with neurofibromatosis type 1 treated with recombinant human growth hormone.}, journal = {Neuropediatrics}, volume = {46}, year = {2015}, month = {2015 Apr}, pages = {126-9}, abstract = {

Even though no increased recurrence rate seems to be reported in patients with brain tumors receiving recombinant human growth hormone (rhGH) replacement, in some patients multiple risk factors could put at higher risk for recurrence. In such cases, the decision to start rhGH therapy should be very cautious. A boy with neurofibromatosis type 1 developed an atypical teratoid/rhabdoid tumor (AT/RT) of right cerebellum, treated with surgery, radiotherapy, and chemotherapy. After 3 years of remission, he started rhGH for growth hormone deficiency, having a negative magnetic resonance imaging (MRI) scan. Ten weeks after starting therapy, the boy became symptomatic and MRI showed relapse of AT/RT in the right cerebellum and a new lesion in the brainstem. The boy died of progressive disease. In this case, the connection between AT/RT recurrence and the beginning of rhGH therapy, with a negative pretreatment MRI, cannot be excluded. Additional caution should be used for rhGH in patients with multiple risk factors.

}, keywords = {Brain Stem Neoplasms, Cerebellar Neoplasms, Child, Human Growth Hormone, Humans, Magnetic Resonance Imaging, Male, Neurofibromatosis 1, Recombinant Proteins, Recurrence, Rhabdoid Tumor, Risk Factors, Teratoma}, issn = {1439-1899}, doi = {10.1055/s-0034-1393706}, author = {Tornese, Gianluca and Faleschini, Elena and Matarazzo, Lorenza and Bibalo, Cristina and Zanazzo, Giulio Andrea and Rabusin, Marco and Tonini, Giorgio and Zennaro, Floriana and Ventura, Alessandro} } @article {7687, title = {Reply to Thalidomide Treatment of Pediatric Ulcerative Colitis: A New Use for an Old Drug.}, journal = {Inflamm Bowel Dis}, volume = {21}, year = {2015}, month = {2015 Aug}, pages = {1752-3}, keywords = {Crohn Disease, Female, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1536-4844}, doi = {10.1097/MIB.0000000000000451}, author = {Lazzerini, Marzia and Martelossi, Stefano and Ventura, Alessandro} } @article {7779, title = {Role of oxidative stress mediated by glutathione-s-transferase in thiopurines{\textquoteright} toxic effects.}, journal = {Chem Res Toxicol}, volume = {28}, year = {2015}, month = {2015 Jun 15}, pages = {1186-95}, abstract = {

Azathioprine (AZA), 6-mercaptopurine (6-MP), and 6-thioguanine (6-TG) are antimetabolite drugs, widely used as immunosuppressants and anticancer agents. Despite their proven efficacy, a high incidence of toxic effects in patients during standard-dose therapy is recorded. The aim of this study is to explain, from a mechanistic point of view, the clinical evidence showing a significant role of glutathione-S-transferase (GST)-M1 genotype on AZA toxicity in inflammatory bowel disease patients. To this aim, the human nontumor IHH and HCEC cell lines were chosen as predictive models of the hepatic and intestinal tissues, respectively. AZA, but not 6-MP and 6-TG, induced a concentration-dependent superoxide anion production that seemed dependent on GSH depletion. N-Acetylcysteine reduced the AZA antiproliferative effect in both cell lines, and GST-M1 overexpression increased both superoxide anion production and cytotoxicity, especially in transfected HCEC cells. In this study, an in vitro model to study thiopurines{\textquoteright} metabolism has been set up and helped us to demonstrate, for the first time, a clear role of GST-M1 in modulating AZA cytotoxicity, with a close dependency on superoxide anion production. These results provide the molecular basis to shed light on the clinical evidence suggesting a role of GST-M1 genotype in influencing the toxic effects of AZA treatment.

}, issn = {1520-5010}, doi = {10.1021/acs.chemrestox.5b00019}, author = {Pelin, Marco and De Iudicibus, Sara and Fusco, Laura and Taboga, Eleonora and Pellizzari, Giulia and Lagatolla, Cristina and Martelossi, Stefano and Ventura, Alessandro and Decorti, Giuliana and Stocco, Gabriele} } @article {7778, title = {A Shining Scrotal Fountain.}, journal = {J Pediatr}, volume = {167}, year = {2015}, month = {2015 Jul}, pages = {205.e1}, keywords = {Child, Edema, Humans, Male, Penile Diseases, Scrotum}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2015.04.011}, author = {Copertino, Marco and Benelli, Elisa and Gregori, Massimo and Barbi, Egidio and Ventura, Alessandro} } @article {8059, title = {Sirolimus Therapy in Congenital Hyperinsulinism: A Successful Experience Beyond Infancy.}, journal = {Pediatrics}, volume = {136}, year = {2015}, month = {2015 Nov}, pages = {e1373-6}, abstract = {

Congenital hyperinsulinism (CHI) due to diffuse involvement of the pancreas is a challenging and severe illness in children. Its treatment is based on chronic therapy with diazoxide and/or octreotide, followed by partial pancreatectomy, which is often not resolutive. Sirolimus, a mammalian target of rapamycin inhibitor, was reported to be effective in treating CHI in infants. We report here the case of an 8-year-old boy affected by a severe form of CHI due to a biallelic heterozygous ABCC8 mutation who responded to sirolimus with a dramatic improvement in his glucose blood level regulation and quality of life, with no serious adverse events after 6 months of follow-up. To the best of our knowledge, this is the first report of a successful intervention in an older child. It provides a promising basis for further studies comparing sirolimus with other treatments, particularly in older children.

}, issn = {1098-4275}, doi = {10.1542/peds.2015-1132}, author = {Minute, Marta and Patti, Giuseppa and Tornese, Gianluca and Faleschini, Elena and Zuiani, Chiara and Ventura, Alessandro} } @article {8084, title = {Splenic Infarction in Acute Infectious Mononucleosis.}, journal = {J Emerg Med}, year = {2015}, month = {2015 Oct 22}, abstract = {

BACKGROUND: The evaluation of a febrile patient with acute abdominal pain represents a frequent yet possibly challenging situation in the emergency department (ED). Splenic infarction is an uncommon complication of infectious mononucleosis, and may have a wide range of clinical presentations, from dramatic to more subtle. Its pathogenesis is still incompletely understood, yet it may be associated with the occurrence of transient prothrombotic factors.

CASE REPORT: We report the case of a 14-year-old boy who presented with fever, sore throat, left upper quadrant abdominal pain, and splenomegaly, with no history of recent trauma. Laboratory tests revealed a markedly prolonged activated partial thromboplastin time and positive lupus anticoagulant. Abdominal ultrasonography showed several hypoechoic areas in the spleen consistent with multiple infarctions. Magnetic resonance imaging eventually confirmed the diagnosis. He was admitted for observation and supportive treatment, and was discharged in good condition after 7~days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous splenic infarction should be considered in the differential list of patients presenting with left upper quadrant abdominal pain and features of infectious mononucleosis; the diagnosis, however, may not be straightforward, as clinical presentation may also be subtle, and abdominal ultrasonography, which is often used as a first-line imaging modality in pediatric EDs, has low sensitivity in this scenario and may easily miss it. Furthermore, although treatment is mainly supportive, close observation for possible complications is necessary.

}, issn = {0736-4679}, doi = {10.1016/j.jemermed.2015.09.019}, author = {Naviglio, Samuele and Abate, Maria Valentina and Chinello, Matteo and Ventura, Alessandro} } @article {7755, title = {Subcutaneous panniculitis-like T-cell lymphoma presenting with diffuse cutaneous edema in a 2-year-old child.}, journal = {J Pediatr Hematol Oncol}, volume = {37}, year = {2015}, month = {2015 May}, pages = {329-30}, keywords = {Child, Preschool, Edema, Humans, Lymphoma, T-Cell, Male, Panniculitis, Skin Diseases}, issn = {1536-3678}, doi = {10.1097/MPH.0000000000000312}, author = {Chinello, Matteo and Naviglio, Samuele and Remotti, Daniele and Locasciulli, Anna and Ventura, Alessandro} } @article {7747, title = {Three cases of Bartonella quintana infection in children.}, journal = {Pediatr Infect Dis J}, volume = {34}, year = {2015}, month = {2015 May}, pages = {540-2}, abstract = {

We present 3 children affected by B. quintana infection treated at the IRCCS Burlo Garofolo of Trieste between March and April 2013. B. quintana infection is rare but it should be suspected in patients with fever and lymphadenopathy who do not respond to conventional antibiotic treatment. All patients had a complete recovery without sequelae or relapses.

}, issn = {1532-0987}, doi = {10.1097/INF.0000000000000666}, author = {Magnolato, Andrea and Pederiva, Federica and Spagnut, Giulia and Maschio, Massimo and Ventura, Alessandro and Taddio, Andrea} } @article {7749, title = {Treatment of asthma based on symptoms.}, journal = {J Pediatr}, volume = {166}, year = {2015}, month = {2015 May}, pages = {1324-5}, keywords = {Asthma, Female, Humans, Male, Spirometry}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2015.01.029}, author = {Bibalo, Cristina and Longo, Giorgio and Ventura, Alessandro} } @article {7777, title = {A young soccer player with sudden pain after kicking the ball.}, journal = {BMJ}, volume = {350}, year = {2015}, month = {2015}, pages = {h1944}, keywords = {Adolescent, Athletic Injuries, Emergency Medicine, Fractures, Bone, Humans, Ilium, Male, Soccer}, issn = {1756-1833}, doi = {10.1136/bmj.h1944}, author = {Lega, Sara and Rabach, Ingrid and Barbi, Egidio and Ventura, Alessandro} } @article {3556, title = {Association between orofacial granulomatosis and Crohn{\textquoteright}s disease in children: systematic review.}, journal = {World J Gastroenterol}, volume = {20}, year = {2014}, month = {2014 Jun 21}, pages = {7497-504}, abstract = {

AIM: To review pediatric cases of orofacial granulomatosis (OFG), report disease characteristics, and explore the association between OFG and Crohn{\textquoteright}s disease.

METHODS: We conducted a systematic review according to the PRISMA guidelines. We searched Medline, LILACS, Virtual Health Library, and Web of Knowledge in September 2013 for cases of OFG in the pediatric age range (< 18 years), with no language limitations. All relevant articles were accessed in full text. The manual search included references of retrieved articles. We extracted data on patients{\textquoteright} characteristics, disease characteristics, association with other diseases, and treatment. We analyzed the data and reported the results in tables and text.

RESULTS: We retrieved 173 reports of OFG in children. Mean age at onset was 11.1 {\textpm} 3.8 years (range: 2.0-18 years). Prevalence in males was significant higher than in females (P < 0.001), with a male:female ratio of 2:1. Gastrointestinal signs or symptoms were present in 26.0\% of children at the time of OFG diagnosis. Overall, 70/173 (40.4\%) children received a concomitant diagnosis of Crohn{\textquoteright}s disease. In about half (51.4\%) of the cases the onset of OFG anticipated the diagnosis of Crohn{\textquoteright}s disease, with a mean time between the two diagnoses of 13.1 {\textpm} 11.6 mo (range: 3-36 mo). Overall, 21/173 (12.1\%) of the children with OFG had perianal disease, while 11/173 (6.4\%) had a family history of Crohn{\textquoteright}s disease. Both perianal disease and a family history of Crohn{\textquoteright}s disease were significantly associated with a higher risk of Crohn{\textquoteright}s disease diagnosis in children with OFG [relative risk (RR) = 3.10, 95\% confidence interval (CI): 2.46-3.90; RR = 2.74, 95\%CI: 2.24-3.36, P < 0.0001 for both). Treatment of OFG included steroids (70.8\% of children) and other immunosuppressive drugs (42.7\%), such as azathioprine, thalidomide and infliximab.

CONCLUSION: High prevalence of Crohn{\textquoteright}s disease in children with OFG suggests that OFG may be a subtype of Crohn{\textquoteright}s disease.

}, keywords = {Adolescent, Age of Onset, Child, Child, Preschool, Crohn Disease, Female, Granulomatosis, Orofacial, Humans, Immunosuppressive Agents, Male, Prevalence, Risk Factors, Steroids, Treatment Outcome}, issn = {2219-2840}, doi = {10.3748/wjg.v20.i23.7497}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Ventura, Alessandro} } @article {3571, title = {Clinical significance of hyper-IgA in a paediatric laboratory series.}, journal = {Arch Dis Child}, volume = {99}, year = {2014}, month = {2014 Dec}, pages = {1114-6}, abstract = {

The causes of extremely elevated IgA, whether isolated or associated with an increase in other classes of immunoglobulin, are poorly defined in paediatrics. We reviewed the diagnostic significance of very high IgA levels (greater than 3 SD above the mean for age) in a cohort of patients referred to a tertiary care children{\textquoteright}s hospital. Hyper-IgA was found in 91 of 6364 subjects (1.4\%) and in 68 cases was not associated with an increased IgG and/or IgM level. Most subjects with hyper-IgA (73.5\%) had a severe immune defect, a chronic rheumatic disease or inflammatory bowel disease, while these conditions were very rare in a control group with normal IgA values (8\%). Although our results may in part reflect the experience of a tertiary care centre, we suggest that hyper-IgA in children should always arouse suspicion of a serious disease.

}, keywords = {Adolescent, Child, Child, Preschool, Female, Hospitals, Pediatric, Humans, Hypergammaglobulinemia, Immunoglobulin A, Infant, Italy, Male, Tertiary Care Centers}, issn = {1468-2044}, doi = {10.1136/archdischild-2014-306607}, author = {Copetti, Valentina and Pastore, Serena and De Pieri, Carlo and Radillo, Oriano and Taddio, Andrea and Ventura, Alessandro and Tommasini, Alberto} } @article {3564, title = {Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients.}, journal = {Arch Dis Child}, volume = {99}, year = {2014}, month = {2014 Dec}, pages = {1087-90}, abstract = {

OBJECTIVE: Hand fractures are common in childhood, and radiography is the standard diagnostic procedure. US has been used to evaluate bone injuries, mainly in adults for long-bone trauma; there are only a few studies about hand fractures in children. The purpose of this study was to evaluate and confirm the safety and applicability of the US diagnostic procedure in comparison to X-ray diagnosis.

STUDY DESIGN: This cross-sectional study involved a convenience sample of young patients (between 2 and 17 years old) who were taken to the emergency department due to hand trauma. After clinical assessment, patients with a suspected hand fracture first underwent X-ray, and subsequently US examination by two different operators; a radiologist experienced in US and a trained emergency physician in "double-blind" fashion. US and radiographic findings were then compared, and sensitivity as well as specificity was calculated.

RESULTS: A total of 204 patients were enrolled in the study. Seventy-nine fractures of phalanges or metacarpals were detected by standard radiography. When US imaging was performed by an expert radiologist, 72 fractures were detected with sensitivity and a specificity of 91.1\% and 97.6\%, respectively. Sensitivity and specificity were found to be (respectively) 91.5\% and 96.8\% when US was performed by the ED physicians.

CONCLUSIONS: US imaging showed excellent sensitivity and specificity results in the diagnosis of hand fractures in children. The study also showed a great agreement between the results of the US carried out by the senior radiologist and those carried out by the paediatric emergency physician, suggesting that US can be performed by an ED physician, allowing a rapid and accurate evaluation in ED and could become the first diagnostic approach whenever a hand fracture is suspected.

}, keywords = {Adolescent, Child, Child, Preschool, Cross-Sectional Studies, Double-Blind Method, Emergency Service, Hospital, Female, Fractures, Bone, Hand Bones, Humans, Italy, Male, Sensitivity and Specificity}, issn = {1468-2044}, doi = {10.1136/archdischild-2013-305678}, author = {Neri, Elena and Barbi, Egidio and Rabach, Ingrid and Zanchi, Chiara and Norbedo, Stefania and Ronfani, Luca and Guastalla, Veronica and Ventura, Alessandro and Guastalla, Pierpaolo} } @article {3517, title = {A girl with photosensitivity and hepatic steatosis.}, journal = {J Pediatr}, volume = {165}, year = {2014}, month = {2014 Jul}, pages = {201-201.e1}, keywords = {Child, Diagnosis, Differential, Fatty Liver, Female, Humans, Photosensitivity Disorders, Protoporphyria, Erythropoietic}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2014.02.056}, author = {Pavan, Matteo and Gortani, Giulia and Rubinato, Elisa and Faletra, Flavio and Pastore, Serena and Ventura, Alessandro} } @article {3475, title = {Hemophagocytic lymphohistiocytosis in total parenteral nutrition dependent children: description of 5 cases and practical tips for management.}, journal = {J Pediatr Hematol Oncol}, volume = {36}, year = {2014}, month = {2014 Oct}, pages = {e440-2}, abstract = {

Although total parenteral nutrition (TPN) is mandatory in children with intestinal failure, this treatment is not risk free. The main complications of TPN include catheter-related sepsis, thrombosis, hepatic cholestasis and cirrhosis, metabolic bone disease, and, rarely, reactive hemophagocytic lymphohistiocytosis (HLH). The pathogenesis of HLH in patients with TPN is not known, although some authors hypothesized that it can result from the activation of macrophages because of "fat overload." We reported 5 cases of HLH that occurred in patients with 4 different underlying disorders, all requiring TPN for a long term. In our series, an underlying immunological defect or a serious infection (sepsis) can have triggered HLH. Therefore, it could be reasonable to hypothesize that besides TPN in itself, minor immune defects and infections may act together by overcoming a threshold of immune stimulation, which ultimately leads to HLH.

}, keywords = {Child, Preschool, Fatty Acids, Female, Humans, Infant, Intestinal Diseases, Lymphohistiocytosis, Hemophagocytic, Male, Parenteral Nutrition, Total, Steroids, Treatment Outcome}, issn = {1536-3678}, doi = {10.1097/MPH.0b013e31829f381b}, author = {Pastore, Serena and Barbieri, Francesca and Di Leo, Grazia and Valencic, Erica and Tommasini, Alberto and Ventura, Alessandro} } @article {3569, title = {Multiple Ileo-Ileal Intussusceptions Caused by Eosinophilic Enteropathy.}, journal = {J Pediatr Gastroenterol Nutr}, year = {2014}, month = {2014 Jul 2}, issn = {1536-4801}, doi = {10.1097/MPG.0000000000000479}, author = {Bramuzzo, Matteo and Martelossi, Stefano and Villanacci, Vincenzo and Maschio, Massimo and Costa, Stefano and Ventura, Alessandro} } @article {3516, title = {Pharmacogenetics of azathioprine in inflammatory bowel disease: a role for glutathione-S-transferase?}, journal = {World J Gastroenterol}, volume = {20}, year = {2014}, month = {2014 Apr 7}, pages = {3534-41}, abstract = {

Azathioprine is a purine antimetabolite drug commonly used to treat inflammatory bowel disease (IBD). In vivo it is active after reaction with reduced glutathione (GSH) and conversion to mercaptopurine. Although this reaction may occur spontaneously, the presence of isoforms M and A of the enzyme glutathione-S-transferase (GST) may increase its speed. Indeed, in pediatric patients with IBD, deletion of GST-M1, which determines reduced enzymatic activity, was recently associated with reduced sensitivity to azathioprine and reduced production of azathioprine active metabolites. In addition to increase the activation of azathioprine to mercaptopurine, GSTs may contribute to azathioprine effects even by modulating GSH consumption, oxidative stress and apoptosis. Therefore, genetic polymorphisms in genes for GSTs may be useful to predict response to azathioprine even if more in vitro and clinical validation studies are needed.

}, keywords = {6-Mercaptopurine, Animals, Apoptosis, Azathioprine, Glutathione, Glutathione Transferase, Humans, Immunosuppressive Agents, Inflammatory Bowel Diseases, Oxidative Stress, Pharmacogenetics, Polymorphism, Genetic}, issn = {2219-2840}, doi = {10.3748/wjg.v20.i13.3534}, author = {Stocco, Gabriele and Pelin, Marco and Franca, Raffaella and De Iudicibus, Sara and Cuzzoni, Eva and Favretto, Diego and Martelossi, Stefano and Ventura, Alessandro and Decorti, Giuliana} } @article {3498, title = {Severe inflammatory bowel disease associated with congenital alteration of transforming growth factor beta signaling.}, journal = {J Crohns Colitis}, volume = {8}, year = {2014}, month = {2014 Aug}, pages = {770-4}, abstract = {

Transforming growth factor beta is a pleiotropic cytokine which plays a central role in the homeostasis of the immune system. A complex dysregulation of its signaling occurs in Loeys-Dietz syndrome, a monogenic disorder caused by mutations of transforming growth factor beta receptors type 1 or type 2, characterized by skeletal involvement, craniofacial abnormalities, and arterial tortuosity with a strong predisposition for aneurysm and dissection. In addition, several immunologic abnormalities have been described in these patients, including an increased risk of allergic disorders as well as eosinophilic gastrointestinal disorders. The occurrence of inflammatory bowel disorders has been also reported, but it is poorly documented. We describe two unrelated children with Loeys-Dietz syndrome affected by severe chronic inflammatory colitis appearing at an early age. The intestinal disease presented similar features in both patients, including a histopathological picture of non-eosinophilic chronic ulcerative colitis, striking elevation of inflammatory markers, and a distinctly severe clinical course leading to failure to thrive, with resistance to multiple immunosuppressive treatments. One of the patients also presented autoimmune thyroiditis. Our report confirms that chronic ulcerative colitis may be associated with Loeys-Dietz syndrome. This finding suggests that an alteration of transforming growth factor beta signaling may by itself predispose to inflammatory colitis in humans, and represent an invaluable model to understand inflammatory bowel diseases.

}, keywords = {Child, Preschool, Colon, Colonoscopy, Female, Humans, Infant, Inflammatory Bowel Diseases, Loeys-Dietz Syndrome, Male, Signal Transduction, Transforming Growth Factor beta}, issn = {1876-4479}, doi = {10.1016/j.crohns.2014.01.013}, author = {Naviglio, Samuele and Arrigo, Serena and Martelossi, Stefano and Villanacci, Vincenzo and Tommasini, Alberto and Loganes, Claudia and Fabretto, Antonella and Vignola, Silvia and Lonardi, Silvia and Ventura, Alessandro} } @article {3511, title = {Use of placebo in a trial of thalidomide for pediatric Crohn disease--reply.}, journal = {JAMA}, volume = {311}, year = {2014}, month = {2014 Mar 26}, pages = {1251-2}, keywords = {Crohn Disease, Female, Humans, Immunosuppressive Agents, Male, Thalidomide}, issn = {1538-3598}, doi = {10.1001/jama.2014.1278}, author = {Lazzerini, Marzia and Martelossi, Stefano and Ventura, Alessandro} } @article {1796, title = {Amenorrhea in women treated with thalidomide: report of two cases and literature review.}, journal = {Inflamm Bowel Dis}, volume = {19}, year = {2013}, month = {2013 Jan}, pages = {E10-1}, keywords = {Adolescent, Amenorrhea, Colitis, Ulcerative, Crohn Disease, Female, Humans, Review Literature as Topic, Thalidomide}, issn = {1536-4844}, doi = {10.1002/ibd.22845}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Martelossi, Stefano and Magazz{\`u}, Giuseppe and Pellegrino, Salvatore and Ventura, Alessandro} } @article {1992, title = {More on prolonged pacifier usage and risk of dental problems: an Italian survey of current clinical practice.}, journal = {J Pediatr Nurs}, volume = {28}, year = {2013}, month = {2013 Sep-Oct}, pages = {421}, keywords = {Female, Guidelines as Topic, Humans, Male, Pacifiers, Sudden Infant Death}, issn = {1532-8449}, doi = {10.1016/j.pedn.2012.10.001}, author = {De Cunto, Angela and Minen, Federico and Ventura, Alessandro} } @article {1994, title = {Is treatment with hydroxychloroquine effective in surfactant protein C deficiency?}, journal = {Arch Bronconeumol}, volume = {49}, year = {2013}, month = {2013 May}, pages = {213-5}, abstract = {

We present the case of two twin brothers with surfactant protein C deficiency who were treated with hydroxychloroquine for three years, with apparent success. The exact physiopathology of this disease is not known and there is no specific treatment for it. There is merely news from a few previous descriptions in the literature about the use of hydroxychloroquine for surfactant protein C deficiency with satisfactory results. Two years after the treatment was withdrawn, the twins were evaluated once again: they presented no new infections, growth and general state were normal and chest CT showed a notable additional reduction in the interstitial pneumopathy. These data seem to cast some doubt on the efficacy of hydroxychloroquine, and they suggest that the clinical improvement was simply the natural evolution of the disease.

}, keywords = {Disease Progression, Diseases in Twins, Dyspnea, Failure to Thrive, Humans, Hydroxychloroquine, Infant, Newborn, Male, Pulmonary Alveolar Proteinosis, Pulmonary Surfactant-Associated Protein C, Respiratory Insufficiency, Tomography, X-Ray Computed, Twins, Monozygotic}, issn = {1579-2129}, doi = {10.1016/j.arbres.2012.08.005}, author = {Rabach, Ingrid and Poli, Furio and Zennaro, Floriana and Germani, Claudio and Ventura, Alessandro and Barbi, Egidio} } @article {1836, title = {Type 1 diabetes mellitus and celiac disease: usefulness of gluten-free diet.}, journal = {Acta Diabetol}, volume = {50}, year = {2013}, month = {2013 Oct}, pages = {821-2}, issn = {1432-5233}, doi = {10.1007/s00592-011-0316-7}, author = {Pascolo, Paola and Faleschini, Elena and Tonini, Giorgio and Ventura, Alessandro} } @article {1977, title = {Acute and recurrent pancreatitis in children: exploring etiological factors.}, journal = {Scand J Gastroenterol}, volume = {47}, year = {2012}, month = {2012 Dec}, pages = {1501-4}, abstract = {

OBJECTIVE: Etiologies of acute pancreatitis (AP) in children are more variable than in adults, including drugs, traumas, infections and multisystem disorders as well as biliary anomalies. While causes of pancreatitis have been extensively analyzed, different series reported different causes. The aims of this study were: 1) to assess the etiological factors of acute and recurrent pancreatitis in a pediatric population from a tertiary care hospital; 2) to assess the usefulness of imaging studies in diagnosing etiologies of pancreatitis.

MATERIAL AND METHODS: Thirty-four children (median age 11 years, 23 males) with AP and 11 with recurrent pancreatitis were retrospectively studied to assess etiology of pancreatitis in children.

RESULTS: The most common etiologies of AP were medications (11/34) and biliary tract diseases (9/34), whereas systemic diseases accounted for a small percentage of case. Among patients with recurrent episodes, biliary anomalies were the most common cause (6/11), whereas only 2 out of 11 patients with recurrent pancreatitis presented a hereditary cause.

CONCLUSIONS: This study highlights that etiologies of AP in children are variable. Epidemiology of AP could be influenced by single center{\textquoteright}s characteristics. Anatomic anomalies should be ruled out and genetic causes should be considered in recurrent cases.

}, keywords = {Adolescent, Azathioprine, Biliary Tract, Biliary Tract Diseases, Carrier Proteins, Child, Child, Preschool, Cholangiography, Cholangiopancreatography, Endoscopic Retrograde, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Immunosuppressive Agents, Magnetic Resonance Imaging, Male, Pancreatitis, Recurrence, Retrospective Studies, Tomography, X-Ray Computed}, issn = {1502-7708}, doi = {10.3109/00365521.2012.729084}, author = {Minen, Federico and De Cunto, Angela and Martelossi, Stefano and Ventura, Alessandro} } @article {1873, title = {Acute febrile cholestatic jaundice in children: keep in mind Kawasaki disease.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {55}, year = {2012}, month = {2012 Oct}, pages = {380-3}, abstract = {

Kawasaki disease (KD) is characterized by persistent fever in addition to 4 of 5 signs of mucocutaneous inflammation. Although gastrointestinal involvement does not belong to the classic diagnostic criteria, it has been often associated with KD onset. We reviewed patients who were admitted for febrile cholestatic jaundice between 2003 and 2010 in 2 tertiary pediatric care centers. KD was the second most frequent cause (21\%) after viral infections. Considering the relative high frequency of this condition, a high index of suspicion of KD should be maintained in patients presenting with febrile cholestatic jaundice.

}, keywords = {Child, Child, Preschool, Diagnosis, Differential, Female, Fever, Humans, Infant, Jaundice, Obstructive, Male, Mucocutaneous Lymph Node Syndrome, Virus Diseases}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31825513de}, author = {Taddio, Andrea and Pellegrin, Maria Chiara and Centenari, Chiara and Filippeschi, Irene Pellegrini and Ventura, Alessandro and Maggiore, Giuseppe} } @article {1798, title = {Association between BclI polymorphism in the NR3C1 gene and in vitro individual variations in lymphocyte responses to methylprednisolone.}, journal = {Br J Clin Pharmacol}, volume = {73}, year = {2012}, month = {2012 Apr}, pages = {651-5}, abstract = {

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: In vitro lymphocyte steroid sensitivity has been suggested as a useful tool to predict in vivo response to glucocorticoid treatment in different inflammatory chronic diseases. A correlation between genetic polymorphisms and clinical response to glucocorticoids has been demonstrated in these patients.

WHAT THIS STUDY ADDS: The BclI polymorphism in the glucocorticoid receptor (NR3C1) gene is associated with higher methylprednisolone potency in vitro. The combined evaluation of the in vitro sensitivity to methylprednisolone and BclI polymorphism could represent an aid for physicians to adjust therapy a priori. AIM To evaluate the association between the in vitro sensitivity of peripheral blood mononuclear cells (PBMCs) to methylprednisolone (MP) and the presence of genetic polymorphisms involved in glucocorticoid (GC) response.

METHODS: In vitro MP inhibition of the proliferation of lymphocytes stimulated with concanavalin A was determined. Non linear regression of dose-response data was performed computing the MP concentration required to reduce proliferation to 50\% (IC(50) ). The maximum inhibition achievable at the highest MP concentration (I(max) ) was also calculated. Moreover, the Taqman technique was used to analyze the BclI polymorphism in the NR3C1 gene and the Leu155His polymorphism in the NALP1 gene.

RESULTS: A significant association between the BclI mutated genotype and an increased in vitro sensitivity to GCs was observed.

CONCLUSIONS: The a priori evaluation of the BclI polymorphism, associated with a lymphocyte proliferation assay, could represent a useful diagnostic tool for the optimization of steroid treatment.

}, keywords = {Adaptor Proteins, Signal Transducing, Adolescent, Adult, Apoptosis Regulatory Proteins, Cyclin D1, Dose-Response Relationship, Drug, Female, Genotype, Glucocorticoids, Humans, Lymphocytes, Male, Methylprednisolone, Middle Aged, Polymorphism, Single Nucleotide, Receptors, Glucocorticoid, Young Adult}, issn = {1365-2125}, doi = {10.1111/j.1365-2125.2011.04130.x}, author = {Cuzzoni, Eva and De Iudicibus, Sara and Bartoli, Fiora and Ventura, Alessandro and Decorti, Giuliana} } @article {1951, title = {A child with edema, lower limb deformity, and recurrent diarrhea.}, journal = {J Pediatr}, volume = {161}, year = {2012}, month = {2012 Dec}, pages = {1177}, keywords = {Bone Retroversion, Capsule Endoscopy, Child, Preschool, Diarrhea, Edema, Humans, Knee Joint, Lymphangiectasis, Intestinal, Lymphedema, Male, Recurrence}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2012.06.022}, author = {Gortani, Giulia and Maschio, Massimo and Ventura, Alessandro} } @article {1865, title = {A child with severe pneumomediastinum and ABCA3 gene mutation: a puzzling connection.}, journal = {Arch Bronconeumol}, volume = {48}, year = {2012}, month = {2012 Apr}, pages = {139-40}, keywords = {Anemia, ATP-Binding Cassette Transporters, Child, Preschool, Dyspnea, Genetic Predisposition to Disease, Heterozygote, Humans, Intensive Care, Leukocytosis, Male, Mediastinal Emphysema, Mutation, Missense, Point Mutation, Pulmonary Emphysema, Respiratory Tract Infections, Subcutaneous Emphysema, Tomography, X-Ray Computed}, issn = {1579-2129}, doi = {10.1016/j.arbres.2011.11.008}, author = {Copertino, Marco and Barbi, Egidio and Poli, Furio and Zennaro, Floriana and Ferrari, Maurizio and Carrera, Paola and Ventura, Alessandro} } @article {1861, title = {Dealing with abdominal pain in children affected by systemic lupus erythematosus.}, journal = {Semin Arthritis Rheum}, volume = {41}, year = {2012}, month = {2012 Feb}, pages = {e3-4}, keywords = {Abdominal Pain, Female, Humans, Lupus Erythematosus, Systemic, Male}, issn = {1532-866X}, doi = {10.1016/j.semarthrit.2011.05.002}, author = {Taddio, Andrea and Ros{\'e}, Carlos and Lepore, Loredana and Ventura, Alessandro} } @article {1785, title = {Delayed diagnosis of glycogen storage disease type III.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Jan}, pages = {122-4}, keywords = {Delayed Diagnosis, Diagnostic Errors, Glycogen Storage Disease Type I, Glycogen Storage Disease Type III, Humans, Infant, Liver, Male}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e318228d806}, author = {Minen, Federico and Cont, Gabriele and De Cunto, Angela and Martelossi, Stefano and Ventura, Alessandro and Maggiore, Giuseppe and Faletra, Flavio and Gasparini, Paolo and Cassandrini, Denise} } @article {1935, title = {The dietary paradox in food allergy: yesterday{\textquoteright}s mistakes, today{\textquoteright}s evidence and lessons for tomorrow.}, journal = {Curr Pharm Des}, volume = {18}, year = {2012}, month = {2012}, pages = {5782-7}, abstract = {

During the last decades the prevalence of food allergy has significantly increased among children and antigen avoidance still remains the standard care for the management of this condition. Most reactions are IgE-mediated with a high risk of anaphylaxis requiring emergency medications in case of inadvertent ingestion. Recent studies showed that continuous administration of the offending food, rather than an elimination diet, could promote the development and maintenance of oral tolerance. Indeed, intestinal transit of food proteins and their interaction with gut-associated lymphoid tissue (GALT) is the essential prerequisite for oral tolerance. On the contrary, low-dose cutaneous exposure to environmental foods in children with atopic dermatitis and altered skin barrier facilitates allergic sensitization. The timing and the amount of cutaneous and oral exposure determine whether a child will have allergy or tolerance. Furthermore, previous preventive strategies such as the elimination diet during pregnancy and breastfeeding, prolonged exclusive breastfeeding and delayed weaning to solid foods did not succeed in preventing the development of food allergy. On the other hand, there could be an early narrow window of immunological opportunity to expose children to allergenic foods and induce natural tolerance. Finally, the gradual exposure to the offending food through special protocols of specific oral tolerance induction (SOTI) may be a promising approach to a proactive treatment of food allergy.

}, keywords = {Anaphylaxis, Antigens, Breast Feeding, Child, Dermatitis, Atopic, Female, Food Hypersensitivity, Humans, Immunoglobulin E, Pregnancy, Time Factors}, issn = {1873-4286}, author = {Badina, Laura and Barbi, Egidio and Berti, Irene and Radillo, Oriano and Matarazzo, Lorenza and Ventura, Alessandro and Longo, Giorgio} } @article {1810, title = {Exhaled nitric oxide as a guide to management of asthma in pregnancy.}, journal = {Lancet}, volume = {379}, year = {2012}, month = {2012 Feb 25}, pages = {708; author reply 708-9}, keywords = {Asthma, Breath Tests, Female, Glucocorticoids, Humans, Nitric Oxide, Pregnancy, Pregnancy Complications}, issn = {1474-547X}, doi = {10.1016/S0140-6736(12)60300-6}, author = {Bibalo, Chiara and Badina, Laura and Longo, Giorgio and Ventura, Alessandro} } @article {1853, title = {Managing children under 36 months of age with febrile urinary tract infection: a new approach.}, journal = {Pediatr Nephrol}, volume = {27}, year = {2012}, month = {2012 Apr}, pages = {611-5}, abstract = {

BACKGROUND: Recent guidelines on urinary tract infection (UTI) agree on reducing the number of invasive procedures. None of these has been validated by a long-term study. We describe our 11-years experience in the application of a diagnostic protocol that uses a reduced number of invasive procedures.

METHODS: We reviewed retrospectively the records of 406 children aged between 1 and 36 months at their first UTI. All patients underwent renal ultrasound (RUS). Children with abnormal RUS and those with UTI recurrences underwent voiding cystourethrography (VCUG) and dimercaptosuccinic acid (DMSA) renal scans.

RESULTS: RUS after the first UTI was pathological in 7.4\% children; 4.4 \% had a second UTI. We performed 48 VCUG: 14 patients (29\%) had vesicoureteral reflux (VUR), 12 of which showed an abnormal RUS while 2 had recurrent UTI. After DMSA renal scan renal damage appeared in only 6 of them (12.5\%); all these children showed grade IV VUR.

CONCLUSIONS: The application of our guidelines leads to a decrease in invasive examinations without missing any useful diagnoses or compromising the child{\textquoteright}s health.

}, keywords = {Anti-Bacterial Agents, Child, Preschool, Female, Humans, Infant, Male, Pediatrics, Recurrence, Retrospective Studies, Urinary Tract Infections}, issn = {1432-198X}, doi = {10.1007/s00467-011-2087-3}, author = {Pennesi, Marco and L{\textquoteright}erario, Ines and Travan, Laura and Ventura, Alessandro} } @article {1848, title = {Pathergy as a cause of false-positive tuberculin skin test.}, journal = {Pediatr Infect Dis J}, volume = {31}, year = {2012}, month = {2012 Jan}, pages = {104}, keywords = {Adolescent, Behcet Syndrome, False Positive Reactions, Female, Humans, Hypersensitivity, Needles, Skin, Skin Tests, Tuberculin Test, Tuberculosis, Gastrointestinal}, issn = {1532-0987}, doi = {10.1097/INF.0b013e31823627ad}, author = {Pastore, Serena and Naviglio, Samuele and Ventura, Alessandro} } @article {1818, title = {Should cardiac involvement be included in the criteria for diagnosis of Churg Strauss syndrome?}, journal = {J Pediatr}, volume = {160}, year = {2012}, month = {2012 Apr}, pages = {707}, keywords = {Adolescent, Churg-Strauss Syndrome, Heart Diseases, Humans, Male}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2011.09.057}, author = {Amaddeo, Alessandro and Ventura, Alessandro and Marchetti, Federico and Benettoni, Alessandra and Londero, Margherita} } @article {1813, title = {Slow growth: do not forget the thyroid.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {54}, year = {2012}, month = {2012 Mar}, pages = {438; author reply 438}, keywords = {Constipation, Female, Humans, Hypothyroidism, Male, Thyroid Function Tests}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e3182431edc}, author = {Tornese, Gianluca and Tonini, Giorgio and Ventura, Alessandro} } @article {1827, title = {Successful induction of oral tolerance in Netherton syndrome.}, journal = {Allergol Immunopathol (Madr)}, volume = {40}, year = {2012}, month = {2012 Sep-Oct}, pages = {316-7}, keywords = {Allergens, Alopecia, Child, Preschool, Desensitization, Immunologic, Disease-Free Survival, Eczema, Female, Food Hypersensitivity, Hair Follicle, Humans, Immune Tolerance, Immunoglobulin E, Infant, Newborn, Mouth, Netherton Syndrome, Treatment Outcome}, issn = {1578-1267}, doi = {10.1016/j.aller.2011.07.005}, author = {Pastore, Serena and Gorlato, Gaia and Berti, Irene and Barbi, Egidio and Ventura, Alessandro} } @article {1794, title = {Ages of celiac disease: from changing environment to improved diagnostics.}, journal = {World J Gastroenterol}, volume = {17}, year = {2011}, month = {2011 Aug 28}, pages = {3665-71}, abstract = {

From the time of Gee{\textquoteright}s landmark writings, the recent history of celiac disease (CD) can be divided into many ages, each driven by a diagnostic advance and a deeper knowledge of disease pathogenesis. At the same time, these advances were paralleled by the identification of new clinical patterns associated with CD and by a continuous redefinition of the prevalence of the disease in population. In the beginning, CD was considered a chronic indigestion, even if the causative food was not known; later, the disease was proven to depend on an intolerance to wheat gliadin, leading to typical mucosal changes in the gut and to a malabsorption syndrome. This knowledge led to curing the disease with a gluten-free diet. After the identification of antibodies to gluten (AGA) in the serum of patients and the identification of gluten-specific lymphocytes in the mucosa, CD was described as an immune disorder, resembling a chronic "gluten infection". The use of serological testing for AGA allowed identification of the higher prevalence of this disorder, revealing atypical patterns of presentation. More recently, the characterization of autoantibodies to endomysium and to transglutaminase shifted the attention to a complex autoimmune pathogenesis and to the increased risk of developing autoimmune disorders in untreated CD. New diagnostic assays, based on molecular technologies, will introduce new changes, with the promise of better defining the spectrum of gluten reactivity and the real burden of gluten related-disorders in the population. Herein, we describe the different periods of CD experience, and further developments for the next celiac age will be proposed.

}, keywords = {Autoantibodies, Celiac Disease, Diet, Gluten-Free, Gliadin, Glutens, History, 19th Century, History, 20th Century, History, 21st Century, History, Ancient, History, Medieval, Humans, Transglutaminases}, issn = {2219-2840}, doi = {10.3748/wjg.v17.i32.3665}, author = {Tommasini, Alberto and Not, Tarcisio and Ventura, Alessandro} } @article {1596, title = {Compliance with the gluten-free diet: the role of locus of control in celiac disease.}, journal = {J Pediatr}, volume = {158}, year = {2011}, month = {2011 Mar}, pages = {463-466.e5}, abstract = {

OBJECTIVES: To verify whether subjects with celiac disease (CD) have a different locus of control (LoC) compared with healthy subjects, and to evaluate the relationship between LoC and compliance with a prescribed gluten-free diet (GFD) and quality of life (QoL).

STUDY DESIGN: We studied 156 subjects on a GFD (mean age, 10 years) and 353 healthy controls (mean age, 12 years). All subjects completed tests on the Nowicki-Strickland Locus of Control Scale; the subjects with CD also completed a questionnaire to measure compliance with dietary treatment and the disease{\textquoteright}s impact on QoL.

RESULTS: There was no difference in LoC values between patients with CD and controls. Subjects with CD with good dietary compliance had a more internal LoC compared with those who were not compliant (P = .01). Patients who reported a satisfactory QoL had a more internal LoC compared with those who reported negative affects on QoL due to CD (P = .01).

CONCLUSIONS: Our study confirms the usefulness of the LoC concept for identifying those patients who might be at risk for dietary transgression. Given the enhanced, psychological, and social well being that can result from adherence to a GFD, educational and psychological support can help internalize the LoC in those patients at risk for dietary transgression.

}, keywords = {Adolescent, Age Factors, Case-Control Studies, Celiac Disease, Child, Diet, Gluten-Free, Female, Humans, Internal-External Control, Italy, Male, Patient Compliance, Quality of Life}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.08.034}, author = {Bellini, Anna and Zanchi, Chiara and Martelossi, Stefano and Di Leo, Grazia and Not, Tarcisio and Ventura, Alessandro} } @article {1741, title = {Cryptic genetic gluten intolerance revealed by intestinal antitransglutaminase antibodies and response to gluten-free diet.}, journal = {Gut}, volume = {60}, year = {2011}, month = {2011 Nov}, pages = {1487-93}, abstract = {

BACKGROUND AND OBJECTIVE: Antitransglutaminase (anti-TG2) antibodies are synthesised in the intestine and their presence seems predictive of future coeliac disease (CD). This study investigates whether mucosal antibodies represent an early stage of gluten intolerance even in the absence of intestinal damage and serum anti-TG2 antibodies.

METHODS: This study investigated 22 relatives of patients with CD genetically predisposed to gluten intolerance but negative for both serum anti-TG2 antibodies and intestinal abnormalities. Fifteen subjects were symptomatic and seven were asymptomatic. The presence of immunoglobulin A anti-TG2 antibodies in the intestine was studied by creating phage-antibody libraries against TG-2. The presence of intestinal anti-TG2 antibodies was compared with the serum concentration of the intestinal fatty acid-binding protein (I-FABP), a marker for early intestinal mucosal damage. The effects of a 12-month gluten-free diet on anti-TG2 antibody production and the subjects{\textquoteright} clinical condition was monitored. Twelve subjects entered the study as controls.

RESULTS: The intestinal mucosa appeared normal in 18/22; 4 had a slight increase in intraepithelial lymphocytes. Mucosal anti-TG2 antibodies were isolated in 15/22 subjects (68\%); in particular symptomatic subjects were positive in 13/15 cases and asymptomatic subjects in 2/7 cases (p=0.01). No mucosal antibodies were selected from the controls{\textquoteright} biopsies. There was significant correlation between the presence of intestinal anti-TG2 antibodies and positive concentrations of I-FABP (p=0.0008). After a gluten-free diet, 19/22 subjects underwent a second intestinal biopsy, which showed that anti-TG2 antibodies had disappeared in 12/15 (p=0.002), while I-FABP decreased significantly (p<0.0001). The diet resolved both extraintestinal and intestinal symptoms.

CONCLUSIONS: A new form of genetic-dependent gluten intolerance has been described in which none of the usual diagnostic markers is present. Symptoms and intestinal anti-TG2 antibodies respond to a gluten free-diet. The detection of intestinal anti-TG2 antibodies by the phage-antibody libraries has an important diagnostic and therapeutic impact for the subjects with gluten-dependent intestinal or extraintestinal symptoms. Clinical trial number NCT00677495.

}, keywords = {Adolescent, Adult, Antibodies, Anti-Idiotypic, Asymptomatic Diseases, Celiac Disease, Child, Child, Preschool, Diet, Gluten-Free, Fatty Acid-Binding Proteins, Female, Genetic Predisposition to Disease, GTP-Binding Proteins, Health Status, Humans, Intestinal Mucosa, Male, Middle Aged, Peptide Library, Transglutaminases, Young Adult}, issn = {1468-3288}, doi = {10.1136/gut.2010.232900}, author = {Not, Tarcisio and Ziberna, Fabiana and Vatta, Serena and Quaglia, Sara and Martelossi, Stefano and Villanacci, Vincenzo and Marzari, Roberto and Florian, Fiorella and Vecchiet, Monica and Sulic, Ana-Marija and Ferrara, Fortunato and Bradbury, Andrew and Sblattero, Daniele and Ventura, Alessandro} } @article {1724, title = {Gastroesophageal reflux disease at any cost: a dangerous paediatric attitude.}, journal = {Acta Paediatr}, volume = {100}, year = {2011}, month = {2011 Oct}, pages = {e178-80}, keywords = {Diagnostic Errors, Gastroesophageal Reflux, Humans, Inappropriate Prescribing, Infant, Infant, Newborn, Male, Proton Pump Inhibitors, Spasms, Infantile}, issn = {1651-2227}, doi = {10.1111/j.1651-2227.2011.02315.x}, author = {Taddio, Andrea and Bersanini, Chiara and Basile, Lucio and Fontana, Massimo and Ventura, Alessandro} } @article {1652, title = {Genetic predictors of glucocorticoid response in pediatric patients with inflammatory bowel diseases.}, journal = {J Clin Gastroenterol}, volume = {45}, year = {2011}, month = {2011 Jan}, pages = {e1-7}, abstract = {

BACKGROUND: Glucocorticoids (GCs) are used in moderate-to-severe inflammatory bowel diseases (IBD) but their effect is often unpredictable.

AIM: To determine the influence of 4 polymorphisms in the GC receptor [nuclear receptor subfamily 3, group C, member 1 (NR3C1)], interleukin-1β (IL-1β), and NACHT leucine-rich-repeat protein 1 (NALP1) genes, on the clinical response to steroids in pediatric patients with IBD.

METHODS: One hundred fifty-four young IBD patients treated with GCs for at least 30 days and with a minimum follow-up of 1 year were genotyped. The polymorphisms considered are the BclI in the NR3C1 gene, C-511T in IL-1β gene, and Leu155His and rs2670660/C in NALP1 gene. Patients were grouped as responder, dependant, and resistant to GCs. The relation between GC response and the genetic polymorphisms considered was examined using univariate, multivariate, and Classification and Regression Tree (CART) analysis.

RESULTS: Univariate analysis showed that BclI polymorphism was more frequent in responders compared with dependant patients (P=0.03) and with the combined dependant and resistant groups (P=0.02). Moreover, the NALP1 Leu155His polymorphism was less frequent in the GC responsive group compared with resistant (P=0.0059) and nonresponder (P=0.02) groups. Multivariate analysis comparing responders and nonresponders confirmed an association between BclI mutated genotype and steroid response (P=0.030), and between NALP1 Leu155His mutant variant and nonresponders (P=0.033). An association between steroid response and male sex was also observed (P=0.034). In addition, Leu155His mutated genotype was associated with steroid resistance (P=0.034). Two CART analyses supported these findings by showing that BclI and Leu155His polymorphisms had the greatest effect on steroid response (permutation P value=0.046). The second CART analysis also identified age of disease onset and male sex as important variables affecting response.

CONCLUSIONS: These results confirm that genetic and demographic factors may affect the response to GCs in young patients with IBD and strengthen the importance of studying high-order interactions for predicting response.

}, keywords = {Adolescent, Child, Drug Resistance, Female, Follow-Up Studies, Genotype, Glucocorticoids, Humans, Inflammatory Bowel Diseases, Male, Multivariate Analysis, Polymorphism, Genetic, Receptors, Glucocorticoid, Regression Analysis, Retrospective Studies, Sex Factors, Treatment Outcome}, issn = {1539-2031}, doi = {10.1097/MCG.0b013e3181e8ae93}, author = {De Iudicibus, Sara and Stocco, Gabriele and Martelossi, Stefano and Londero, Margherita and Ebner, Egle and Pontillo, Alessandra and Lionetti, Paolo and Barabino, Arrigo and Bartoli, Fiora and Ventura, Alessandro and Decorti, Giuliana} } @article {1742, title = {Molecular mechanism of glucocorticoid resistance in inflammatory bowel disease.}, journal = {World J Gastroenterol}, volume = {17}, year = {2011}, month = {2011 Mar 7}, pages = {1095-108}, abstract = {

Natural and synthetic glucocorticoids (GCs) are widely employed in a number of inflammatory, autoimmune and neoplastic diseases, and, despite the introduction of novel therapies, remain the first-line treatment for inducing remission in moderate to severe active Crohn{\textquoteright}s disease and ulcerative colitis. Despite their extensive therapeutic use and the proven effectiveness, considerable clinical evidence of wide inter-individual differences in GC efficacy among patients has been reported, in particular when these agents are used in inflammatory diseases. In recent years, a detailed knowledge of the GC mechanism of action and of the genetic variants affecting GC activity at the molecular level has arisen from several studies. GCs interact with their cytoplasmic receptor, and are able to repress inflammatory gene expression through several distinct mechanisms. The glucocorticoid receptor (GR) is therefore crucial for the effects of these agents: mutations in the GR gene (NR3C1, nuclear receptor subfamily 3, group C, member 1) are the primary cause of a rare, inherited form of GC resistance; in addition, several polymorphisms of this gene have been described and associated with GC response and toxicity. However, the GR is not self-standing in the cell and the receptor-mediated functions are the result of a complex interplay of GR and many other cellular partners. The latter comprise several chaperonins of the large cooperative hetero-oligomeric complex that binds the hormone-free GR in the cytosol, and several factors involved in the transcriptional machinery and chromatin remodeling, that are critical for the hormonal control of target genes transcription in the nucleus. Furthermore, variants in the principal effectors of GCs (e.g. cytokines and their regulators) have also to be taken into account for a comprehensive evaluation of the variability in GC response. Polymorphisms in genes involved in the transport and/or metabolism of these hormones have also been suggested as other possible candidates of interest that could play a role in the observed inter-individual differences in efficacy and toxicity. The best-characterized example is the drug efflux pump P-glycoprotein, a membrane transporter that extrudes GCs from cells, thereby lowering their intracellular concentration. This protein is encoded by the ABCB1/MDR1 gene; this gene presents different known polymorphic sites that can influence its expression and function. This editorial reviews the current knowledge on this topic and underlines the role of genetics in predicting GC clinical response. The ambitious goal of pharmacogenomic studies is to adapt therapies to a patient{\textquoteright}s specific genetic background, thus improving on efficacy and safety rates.

}, keywords = {Drug Resistance, Glucocorticoids, Humans, Inflammatory Bowel Diseases, P-Glycoproteins, Polymorphism, Genetic, Receptors, Glucocorticoid, Signal Transduction, Transcription, Genetic}, issn = {2219-2840}, doi = {10.3748/wjg.v17.i9.1095}, author = {De Iudicibus, Sara and Franca, Raffaella and Martelossi, Stefano and Ventura, Alessandro and Decorti, Giuliana} } @article {1685, title = {Refractory iron-deficiency anaemia in a child with portal cavernoma.}, journal = {Gut}, volume = {60}, year = {2011}, month = {2011 Mar}, pages = {317, 377}, keywords = {Anemia, Iron-Deficiency, Antihypertensive Agents, Child, Hemangioma, Cavernous, Humans, Hypertension, Portal, Ileal Diseases, Male, Propranolol, Vascular Neoplasms}, issn = {1468-3288}, doi = {10.1136/gut.2009.184697}, author = {Pastore, Serena and Londero, Margherita and Cont, Gabriele and Di Leo, Grazia and Ventura, Alessandro} } @article {1786, title = {Safety and efficacy of high-dose acarbose treatment for dumping syndrome.}, journal = {J Pediatr Gastroenterol Nutr}, volume = {53}, year = {2011}, month = {2011 Jul}, pages = {113-4}, abstract = {

Dumping syndrome (DS) is a complication of Nissen fundoplication. Dietary strategies can ameliorate symptoms, but this approach is not always foolproof. Limited evidence reports the efficacy of acarbose for children who are unresponsive to feeding manipulations. We report 8 patients with DS aged between 7 and 24 months. In 4 of 8 nutritional strategies failed, and acarbose treatment was started. The initial dose was 25 mg for meals, and increased until postprandial glucose was stable. In 3 of 4 children the final dose was higher than previously reported, without adverse effects. Acarbose is useful to treat DS in cases of failure of dietary strategies.

}, keywords = {Acarbose, Child, Preschool, Dumping Syndrome, Female, Humans, Hyperglycemia, Hypoglycemic Agents, Infant, Male, Postprandial Period, Treatment Outcome}, issn = {1536-4801}, doi = {10.1097/MPG.0b013e31820ae6d1}, author = {De Cunto, Angela and Barbi, Egidio and Minen, Federico and Ventura, Alessandro} } @article {1816, title = {Thromboembolism in pediatric inflammatory bowel disease: systematic review.}, journal = {Inflamm Bowel Dis}, volume = {17}, year = {2011}, month = {2011 Oct}, pages = {2174-83}, abstract = {

BACKGROUND: Several studies suggest an increased risk of venous and arterial thromboembolism (TE) in adults with inflammatory bowel disease (IBD) compared to the general population. We performed a systematic review of studies on incidence and characteristic of TE in children with IBD.

METHODS: We searched Medline, LILACS, EMBASE, POPLINE, CINHAL, and reference lists of identified articles, without language restrictions, in August 2010.

RESULTS: Population studies suggest that there is an increased risk of TE in children with IBD compared to controls. TE occurred in children with IBD in all age ranges, mostly (82.8\%) during active disease, and more frequently in children with ulcerative colitis (odds ratio [OR] 3.7, 95\% confidence interval [CI] 1.8-7.6). At least one specific risk factor for TE was recognized in 50\% of cases; two risk factors were present in 24\%. Out of 92 published cases of TE in children with IBD, 54.3\% occurred in cerebral site, 26\% in the limbs, 13\% in the abdominal vessels, and the remaining in the retina and lungs. After a first episode of TE, an early recurrence was observed in 11.4\% of children, a late recurrence in 10\%. A number of different therapeutic schemes were used. Overall mortality was 5.7\% and was mostly associated with cerebral TE.

CONCLUSIONS: Population studies are needed to clarify the risk of TE in children with IBD, the relative weight of other risk factors, the characteristics of the events, and to define guidelines of therapy and prophylaxis.

}, keywords = {Adult, Child, Humans, Inflammatory Bowel Diseases, Risk Factors, Thromboembolism}, issn = {1536-4844}, doi = {10.1002/ibd.21563}, author = {Lazzerini, Marzia and Bramuzzo, Matteo and Maschio, Massimo and Martelossi, Stefano and Ventura, Alessandro} } @article {1763, title = {Two lumens, one diagnosis.}, journal = {J Pediatr}, volume = {159}, year = {2011}, month = {2011 Sep}, pages = {511}, keywords = {Capsule Endoscopy, Child, Preschool, Gastrointestinal Hemorrhage, Humans, Male, Meckel Diverticulum, Recurrence}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2011.04.041}, author = {Pastore, Serena and Gortani, Giulia and Maschio, Massimo and Di Leo, Grazia and Ventura, Alessandro} } @article {1764, title = {Usefulness of wireless capsule endoscopy for detecting inflammatory bowel disease in children presenting with arthropathy.}, journal = {Eur J Pediatr}, volume = {170}, year = {2011}, month = {2011 Oct}, pages = {1343-7}, abstract = {

Inflammatory bowel disease (IBD) is a cause of chronic intestinal inflammation in children. In a subset of patients affected by IBD, arthropathy may be the leading presenting sign. In the past years, remarkable advances in gastrointestinal endoscopy techniques have been achieved; recently, the development of capsule endoscopy (CE) provided a non-invasive method for the complete endoscopic evaluation, including small bowel assessment. We report three children suffering from IBD but presenting with articular complaints in whom CE was a useful tool for detecting gut inflammation. Patients were investigated with the wireless CE: PillCam SB2 (Given Imaging, Yoqneam, Israel) capsule, the second-generation capsule, was used in our paediatric patients. Three patients were initially evaluated for arthropathy. Enteropathic arthritis was suspected for gastrointestinal symptoms and/or persistence of inflammatory markers elevation. In one of these children, conventional endoscopy was refused by parents, while in the other two children, CE was proposed as first-line diagnostic tool. In all patients, CE revealed to be safe and provided information that led to diagnosis. Paediatric rheumatologists should consider CE as a valid, non-invasive tool, eventually first level diagnostic approach in order to evaluate the presence of IBD in children presenting with chronic articular complaints.

}, keywords = {Adolescent, Arthritis, Juvenile, Capsule Endoscopy, Child, Colitis, Ulcerative, Colon, Crohn Disease, Diagnosis, Differential, Follow-Up Studies, Humans, Inflammatory Bowel Diseases, Intestine, Small, Male, Predictive Value of Tests, Sensitivity and Specificity, Severity of Illness Index, Treatment Outcome}, issn = {1432-1076}, doi = {10.1007/s00431-011-1505-7}, author = {Taddio, Andrea and Simonini, Gabriele and Lionetti, Paolo and Lepore, Loredana and Martelossi, Stefano and Ventura, Alessandro and Cimaz, Rolando} } @article {1626, title = {Anti transglutaminase antibodies cause ataxia in mice.}, journal = {PLoS One}, volume = {5}, year = {2010}, month = {2010}, pages = {e9698}, abstract = {

BACKGROUND: Celiac disease (CD) is an autoimmune gastrointestinal disorder characterized by the presence of anti-transglutaminase 2 (TG2) and anti-gliadin antibodies. Amongst the neurological dysfunctions associated with CD, ataxia represents the most common one.

METHODS: We analyzed by immunohistochemistry, the anti-neural reactivity of the serum from 20 CD patients. To determine the role of anti-TG2 antibodies in ataxia, two anti-TG2 single chain variable fragments (scFv), isolated from a phage-display IgA antibody library, were characterized by immunohistochemistry and ELISA, and injected in mice to study their effects on motor coordination. We found that 75\% of the CD patient population without evidence of neurological involvement, has circulating anti-neural IgA and/or IgG antibodies. Two anti-TG2 scFvs, cloned from one CD patient, stained blood vessels but only one reacted with neurons. This anti-TG2 antibody showed cross reactivity with the transglutaminase isozymes TG3 and TG6. Intraventricular injection of the anti-TG2 or the anti-TG2/3/6 cross-reactive scFv provoked transient, equally intensive ataxia in mice.

CONCLUSION: The serum from CD patients contains anti-TG2, TG3 and TG6 antibodies that may potentially cause ataxia.

}, keywords = {Adult, Animals, Antibodies, Ataxia, Autoimmune Diseases, Brain, Celiac Disease, Female, Gliadin, Humans, Isoenzymes, Male, Mice, Mice, Inbred C57BL, Middle Aged, Motor Skills, Rats, Rats, Sprague-Dawley, Transglutaminases}, issn = {1932-6203}, doi = {10.1371/journal.pone.0009698}, author = {Boscolo, Sabrina and Lorenzon, Andrea and Sblattero, Daniele and Florian, Fiorella and Stebel, Marco and Marzari, Roberto and Not, Tarcisio and Aeschlimann, Daniel and Ventura, Alessandro and Hadjivassiliou, Marios and Tongiorgi, Enrico} } @article {1671, title = {A child with pain after mild trauma.}, journal = {J Pediatr}, volume = {157}, year = {2010}, month = {2010 Oct}, pages = {693}, keywords = {Antigens, CD, Antigens, CD31, Antigens, CD34, Antigens, Differentiation, Myelomonocytic, Biopsy, Child, Factor VIII, Fingers, Hand Injuries, Hemangioendothelioma, Humans, Immunohistochemistry, Injury Severity Score, Male, Osteolysis, Pain, Pain Measurement, S100 Proteins, Vascular Neoplasms}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.04.028}, author = {Londero, Margherita and Pastore, Serena and Zanazzo, Giulio A and Bruno, Irene and Ventura, Alessandro} } @article {1673, title = {Decreased cholesterol levels reflect a consumption of anti-inflammatory isoprenoids associated with an impaired control of inflammation in a mouse model of mevalonate kinase deficiency.}, journal = {Inflamm Res}, volume = {59}, year = {2010}, month = {2010 May}, pages = {335-8}, abstract = {

OBJECTIVE: The aim of this study was to evaluate, in a mouse model of mevalonate kinase deficiency (MKD), the possible link between inflammatory symptoms and serum cholesterol levels.

MATERIALS AND METHODS: Balb/c mice were treated with alendronate and bacterial muramyl dipeptide. Body temperature, interleukin-1 beta (IL-1 beta) secretion and serum cholesterol levels were measured.

RESULTS: An increased production of the pro-inflammatory cytokine IL-1 beta (p < 0.05) and a rise in body temperature (p < 0.05) was observed, while, in parallel, serum cholesterol concentration significantly decreased (p < 0.05). These effects were completely reversed when animals were treated with exogenous isoprenoids.

CONCLUSIONS: In the mouse model of MKD, the inflammatory response is associated with a reduction in cholesterol levels, and hence this parameter could be used as an indicator of isoprenoid consumption. In addition, plant derived isoprenoids could represent candidate treatments for this disease.

}, keywords = {Animals, Anti-Inflammatory Agents, Cholesterol, Disease Models, Animal, Inflammation, Interleukin-1beta, Male, Mevalonate Kinase Deficiency, Mice, Mice, Inbred BALB C, Random Allocation, Terpenes}, issn = {1420-908X}, doi = {10.1007/s00011-010-0168-6}, author = {Marcuzzi, Annalisa and Decorti, Giuliana and Pontillo, Alessandra and Ventura, Alessandro and Tommasini, Alberto} } @article {1653, title = {Fasting increases tobramycin oral absorption in mice.}, journal = {Antimicrob Agents Chemother}, volume = {54}, year = {2010}, month = {2010 Apr}, pages = {1644-6}, abstract = {

The pharmacokinetics of the aminoglycoside tobramycin was evaluated after oral administration to fed or fasting (15 h) mice. As expected, under normal feeding conditions, oral absorption was negligible; however, fasting induced a dramatic increase in tobramycin bioavailability. The dual-sugar test with lactulose and l-rhamnose confirmed increased small bowel permeability via the paracellular route in fasting animals. When experiments aimed at increasing the oral bioavailability of hydrophilic compounds are performed, timing of fasting should be extremely accurate.

}, keywords = {Administration, Oral, Animals, Anti-Bacterial Agents, Biological Availability, Fasting, Injections, Intramuscular, Injections, Intravenous, Intestinal Absorption, Lactulose, Male, Mice, Mice, Inbred BALB C, Rhamnose, Tobramycin}, issn = {1098-6596}, doi = {10.1128/AAC.01172-09}, author = {De Leo, Luigina and Di Toro, Nicola and Decorti, Giuliana and Malus{\`a}, Noelia and Ventura, Alessandro and Not, Tarcisio} } @article {1629, title = {Hepatic glycogenosis in an adolescent with diabetes.}, journal = {J Pediatr}, volume = {157}, year = {2010}, month = {2010 Dec}, pages = {1042}, keywords = {Adolescent, Diabetes Mellitus, Type 1, Female, Glycogen Storage Disease, Humans, Liver Diseases}, issn = {1097-6833}, doi = {10.1016/j.jpeds.2010.06.018}, author = {Bua, Jenny and Marchetti, Federico and Faleschini, Elena and Ventura, Alessandro and Bussani, Rossana} } @article {1665, title = {Therapeutic strategy in p47-phox deficient chronic granulomatous disease presenting as inflammatory bowel disease.}, journal = {J Allergy Clin Immunol}, volume = {125}, year = {2010}, month = {2010 Apr}, pages = {943-946.e1}, keywords = {Age of Onset, Anti-Bacterial Agents, Antibodies, Monoclonal, Child, Drug Therapy, Combination, Gene Deletion, Granulomatous Disease, Chronic, Humans, Inflammatory Bowel Diseases, Male, NADPH Oxidase, Steroids, Treatment Outcome, Vidarabine}, issn = {1097-6825}, doi = {10.1016/j.jaci.2010.01.035}, author = {Freudenberg, Folke and Wintergerst, Uwe and Roesen-Wolff, Angela and Albert, Michael H and Prell, Christine and Strahm, Brigitte and Koletzko, Sibylle and Ehl, Stephan and Roos, Dirk and Tommasini, Alberto and Ventura, Alessandro and Belohradsky, Bernd H and Seger, Reinhard and Roesler, Joachim and G{\"u}ng{\"o}r, Tayfun} } @article {1711, title = {The universe of immune deficiencies in Crohn{\textquoteright}s disease: a new viewpoint for an old disease?}, journal = {Scand J Gastroenterol}, volume = {45}, year = {2010}, month = {2010 Oct}, pages = {1141-9}, abstract = {

Crohn{\textquoteright}s disease (CD) is generally considered a multifactorial disorder, since different genetic and environmental factors are thought to play a role in its pathogenesis. Recently, genome wide linkage studies allowed to identify the association of several loci with the increased risk of CD, although it is still unclear how they interact with environmental factors in causing the disease. The fact that many CD-risk-related genes are involved in the function of phagocytes seems in agreement with the well known role of these cells in CD histopathology. Functional defects in cytokine production or in clearance of bacteria in CD patients have recently been reported. Growing evidence that CD could arise from primary phagocyte immunodeficiency is also coming from the study of cases with early onset in infancy. We review such evidences starting from selected cases and discuss the clinical implications of these findings.

}, keywords = {Biological Markers, Crohn Disease, Cytokines, Evidence-Based Medicine, Granulomatous Disease, Chronic, Hematopoietic Stem Cell Transplantation, Humans, Immunosuppressive Agents, Phagocytes, Treatment Outcome, Wiskott-Aldrich Syndrome}, issn = {1502-7708}, doi = {10.3109/00365521.2010.492529}, author = {Tommasini, Alberto and Pirrone, Angela and Palla, Gabriella and Taddio, Andrea and Martelossi, Stefano and Crovella, Sergio and Ventura, Alessandro} } @article {1706, title = {Usefulness of the measurement of azathioprine metabolites in the assessment of non-adherence.}, journal = {J Crohns Colitis}, volume = {4}, year = {2010}, month = {2010 Nov}, pages = {599-602}, abstract = {

Azathioprine is a thiopurine immunosuppressive antimetabolite used to chronically treat inflammatory bowel disease and autoimmune hepatitis. Azathioprine treatment is a long-term therapy and therefore it is at risk for non-adherence, which is considered an important determinant of treatment inefficacy. Measurement of 6-thioguanine and 6-methylmercaptopurine nucleotides has been recently suggested as a screener for non-adherence detection. We describe four young patients in which non-adherence to azathioprine therapy was detected only through the measurement of drug metabolite concentrations, and the criterion for non-adherence was undetectable metabolite levels. After the identification of non-adherence, patients and their families were approached and the importance of a correct drug administration was thoroughly enlightened and discussed; this allowed obtaining a full remission in all subjects. Our observations support the use of undetectable metabolite levels as indicators of non-adherence to therapy in azathioprine treated patients. The additional level of medical supervision given by this assay allows getting a better adherence to medical treatment, which results in an improvement in the response to therapy; these benefits may justify the costs associated with the assay.

}, keywords = {6-Mercaptopurine, Adolescent, Azathioprine, Child, Child, Preschool, Female, Guanine Nucleotides, Hepatitis, Autoimmune, Humans, Immunosuppressive Agents, Inflammatory Bowel Diseases, Male, Medication Adherence, Thionucleotides, Young Adult}, issn = {1876-4479}, doi = {10.1016/j.crohns.2010.04.003}, author = {Stocco, Gabriele and Londero, Margherita and Campanozzi, Angelo and Martelossi, Stefano and Marino, Sara and Malus{\`a}, Noelia and Bartoli, Fiora and Decorti, Giuliana and Ventura, Alessandro} }