Association between oral and fecal microbiome dysbiosis and treatment complications in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation.

The oral and gastrointestinal mucosae represent the main targets of the toxic effect of chemo and/or radiotherapy administered during the conditioning regimen before hematopoietic stem cell transplant (HSCT). These harmful consequences and the immunological complications that may occur after the transplant (such as Graft versus Host Disease, GvHD) are responsible for the clinical symptoms associated with mucositis during the aplasia phase, like pain, nausea, vomiting, and diarrhea. These toxicities could play a critical role in the oral and gastrointestinal microbiomes during the post-transplant phase, and the degree of microbial dysbiosis and dysregulation among different bacterial species could also be crucial in intestinal mucosa homeostasis, altering the host's innate and adaptive immune responses and favoring abnormal immune responses responsible for the occurrence of GvHD. This prospective pediatric study aims to analyze longitudinally oral and gut microbiomes in 17 pediatric patients who received allogeneic HSCT for malignant and non-malignant diseases. The oral mucositis was mainly associated with an increased relative abundance of Fusobacteria, and Prevotella species, while Streptococcus descendants showed a negative correlation. The fecal microbiome of subjects affected by cutaneous acute GvHD (aGvHD) correlated with Proteobacteria. Oral mucosal microbiota undergoes changes after HSCT, Fusobacteria, and Prevotella represent bacterial species associated with mucositis and they could be the target for future therapeutic approaches, while fecal microbiome in patients with acute GvHD (aGvHD) revealed an increase of different class of Proteobacteria (Alphaproteobacteria and Deltaproteobacteria) and a negative correlation with the class of Gammaproteobacteria.

Is the fast-track process efficient and safe for older adults admitted to the emergency department?

BACKGROUND: The efficiency of the fast-track (FT) process in the management of patients in Emergency Departments is well demonstrated, but there is a lack of research focused on older adults. The aim of our study was to verify whether the FT process is efficient and safe for older adults admitted to ED. METHODS: Observational case-control single-centre study. RESULTS: Five hundred four cases and 504 controls were analysed. The mean age was 75 years, and there was a predominance of women. In total 96% of subjects were classified with a "less-urgent" tag. The length of stay was significantly lower in the fast-track group than in the control group (median 178 min, interquartile range 184 min, and 115 min, interquartile range 69 min, respectively, p < 0.001), as well as the time spent between the ED physician's visit and patient discharge (median 78 min, interquartile range 120 min, and median 3 min, interquartile range 6 min, respectively, p < 0.001). There weren't any increases in the number of unplanned readmissions within 48 h, 7 days and 30 days. CONCLUSIONS: The fast-track appears to be an efficient and safe strategy to improve the management of older adults admitted to the ED with minor complaints.

Current practice and recent advances in pediatric pain management.

BACKGROUND: Differently from the adult patients, in pediatric age it is more difficult to assess and treat efficaciously the pain and often this symptom is undertreated or not treated. In children, selection of appropriate pain assessment tools should consider age, cognitive level and the presence of eventual disability, type of pain and the situation in which it is occurring. Improved understanding of developmental neurobiology and paediatric analgesic drugs pharmacokinetics should facilitate a better management of childhood pain. AIM: The objective of this review is to discuss current practice and recent advances in pediatric pain management. METHODS: Using PubMed we conducted an extensive literature review on pediatric pain assessment and commonly used analgesic agents from January 2000 to January 2012. CONCLUSIONS: A multimodal analgesic regimen provides better pain control and functional outcome in children. Cooperation and communication between the anaesthesiologist, surgeon, and paediatrician are essential for successful anaesthesia and pain management.

A neural network approach for on-line fault detection of nitrogen sensors in alternated active sludge treatment plants.

In this paper, an effective strategy for fault detection of nitrogen sensors in alternated active sludge treatment plants is proposed and tested on a simulated set-up. It is based on two predictive neural networks, which are trained using a historical set of data collected during fault-free operation of a wastewater treatment plant and their ability to predict reduced (ammonium) and oxidized (nitrates and nitrites) nitrogen is tested. The neural networks are also characterized by good generalization ability and robustness with respect to the influent variability with time and weather conditions. Then, simulations have been carried out imposing different kinds of fault on both sensors, as isolated spikes, abrupt bias and increased noise. Processing of residuals, based on the difference between measured concentration values and neural networks predictions, allows a quick revealing of the fault as well as the isolation of the corrupted sensor.

Effects of sex on auditory brainstem responses in infancy and early childhood.

The effects of sex on I-III, III-V and I-V interwave intervals and I, III, V ABR waves latency values have been studied in 171 normal children born at term, 94 males and 77 females, aged between 2 and 720 days. The obtained data confirm that latency values decrease progressively with age, and show that there is a statistically significant difference in wave III and V latency values and in III-V and I-V intervals between males and females. Moreover, these differences seem to increase with age. The authors also discuss the possible underlying mechanisms and claim that even in infancy, sex-related variability should be taken into account.

Influences of birthweight upon brainstem maturation as reflected by auditory brainstem response (ABR) evaluation.

The authors have studied auditory brainstem responses (ABR) in 49 preterm (Group A) and in 54 fullterm (Group B) newborns, classified according to the birthweight related to conceptional age, in order to verify the influences of this latter parameter upon ABR. In Group A newborns, 4 recording sessions were performed, while only 3 in Group B, to evaluate data obtained at the same extra-uterine age. The obtained data show that birthweight related to conceptional age seems to play a major role on the development of ABR, since no significant differences were detected between preterm and fullterm newborns, provided the birthweight was appropriate for conceptional age (ACA). On the contrary, small for conceptional age (SCA) newborns showed an abnormal ABR pattern at birth, which tended to normalize at the following recording sessions. The authors conclude that birthweight related to conceptional age represents an important factor in the development of auditory brainstem responses and that the audiological diagnosis has to be very cautious in SCA newborns, regardless if they are pre- or fullterm.

Auditory brainstem responses in the full-term newborn: changes in the first 58 hours of life.

The authors have studied auditory brainstem responses (ABR) in 33 full-term newborns at 0-9, 10-30, 31-58 h, in order to evaluate changes in the first hours after birth, particularly in relation to different repetition rates and recording procedures. The data obtained show that the characteristic newborn 3-peak tracing is observed in almost all the cases at the third recording session while, at the first, wave I is absent in two-thirds of the cases. The most reliable waves at birth are waves III, V and N II, which is often present even when other vertex-positive peaks are absent. Latency values of the considered peaks tend to decrease in a statistically significant way and this decrease is almost complete at the second recording session (30 h), while V-I interval values decrease, especially when the 9 stimuli/s repetition is employed. Stimulus repetition rate affects ABR replicability and synchronization, but it hardly influences latency values. Contralaterally recorded potentials are often absent at birth and become evident 58 h later. The authors conclude that the maturational processes probably affect both peripheral and central auditory structures in the first hours after birth. In this period, increasing repetition rates seem to have a greater effect on wave replicability than on latency values.