Short-term Outcomes in Infants after General Anesthesia with Low-dose Sevoflurane/Dexmedetomidine/Remifentanil versus Standard-dose Sevoflurane (the TREX Trial).

Background: The Trial Remifentanil DEXmedetomidine (TREX) trial aimed to determine whether, in children less than 2 yr old, low-dose sevoflurane/dexmedetomidine/remifentanil anesthesia is superior to standard-dose sevoflurane anesthesia in terms of global cognitive function at 3 yr of age. The aim of the current secondary analyses was to compare incidence of intraoperative hypotension and bradycardia, postoperative pain, time to recovery, need for treatment of intraoperative hypotension and bradycardia, incidence of light anesthesia and need for treatment, need for postoperative pain medications, and morbidity and mortality outcomes at 5 days between the two arms.

Methods: This phase III randomized active controlled, parallel group, assessor blinded, multicenter, superiority trial was performed in 20 centers in Australia, Italy, and the United States.

Effects of in-utero exposure to chemotherapy on fetal brain growth.

Objective: Children exposed to chemotherapy in the prenatal period demonstrate normal neurocognitive development at 3 years but concerns regarding fetal brain growth remain high considering its vulnerability to external stimuli. Our aim was to evaluate the impact of in-utero chemotherapy exposure on brain growth and its effects on neurodevelopmental outcome.

Methods: The protocol was approved by the local ethics committee.

Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy.

Background: Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile acids (TSBA) concentration, alone or in combination with serum aminotransferases, have been the most often used biomarkers for the diagnosis of intrahepatic cholestasis of pregnancy in clinical practice. Serum bile acid profile, composed of primary or secondary, conjugated or non-conjugated bile acids, may provide more specific disease information.

Skin lesions and traditional folk practices: a medico-legal perspective.

The correct assessment of signs of abuse on the skin is a challenge of utmost importance for both clinical and forensic applications. This review aims to investigate how differing cultural behaviors influence the perception of abuse, focusing on the need for a multidisciplinary approach and investigation. A literature search for articles that discussed folk practices from a forensic perspective was performed; articles with reference to abuse in the description of the main folk healing techniques and with reference to the differential diagnosis between physical abuse and skin injuries due to folk healing techniques were selected.

Correction to: Clinical evaluation of two different protein content formulas fed to full-term healthy infants: a randomized controlled trial.

Following the publication of the original article [1], it was brought to our attention that the authors' names and surnames were erroneously interchanged.

Clinical evaluation of two different protein content formulas fed to full-term healthy infants: a randomized controlled trial.

Background: A high early protein intake is associated with rapid postnatal weight gain and altered body composition. We aimed to evaluate the safety of a low-protein formula in healthy full-term infants.

Methods: A randomized controlled trial was conducted.

Diabetes, cardiovascular diseases and risk of erectile dysfunction: a brief narrative review of the literature.

In this narrative review we have briefly revised the main epidemiological evidences on the relation between erectile dysfunction (ED) and cardiovascular risk factors and diseases. There are consistent epidemiological evidences which link ED and cardiovascular diseases, diabetes or cholesterol levels. Most of studies which have taken into account in the analysis of the relation between ED and hypertension, cardiovascular diseases, smoking and weight (or body mass index) have shown that these factors have an independent role on the risk of ED.

Quantitative ultrasound and dual-energy x ray absorptiometry in bone status assessment of ex-preterm infants.

Preterm infants are at increased risk of low bone mass. Quantitative ultrasound (QUS) is a non-invasive method for assessment of bone status. The application of QUS in a cohort of ex-preterm infants was investigated.

Epileptic seizures, epilepsy and epileptic syndromes in newborns: a nosological approach to 94 new cases by the 2001 proposed diagnostic scheme for people with epileptic seizures and with epilepsy.

Purpose: To assess the advantages of the 2001 ILAE proposed diagnostic scheme for classification of newborns with epileptic seizures over the 1989 ILAE classification.

Method: Clinical features, seizure semiology and duration, neurological evaluation, ictal and interictal EEG, brain imaging and outcome at the end of the neonatal period (44 weeks post-conceptional age) of 94 newborns with EEG confirmed seizures were analyzed. The 2001 ILAE classification was applied where possible.

Nasopharyngeal teratoma and diaphragmatic hernia: a non random association?

We describe a female affected by diaphragmatic hernia and nasopharyngeal teratoma. The case is compared with one already reported and possible diagnoses discussed. These cases appear to represent a new syndrome.

Transient hyperoxia and residual cerebrovascular effects in the newborn rat.

Unrestricted use of oxygen in the delivery room after preterm birth has been associated with reduced cerebral blood flow (CBF) 2 h later. To further investigate residual cerebrovascular effects of transient hyperoxia, we developed a newborn rat model in which laser-Doppler flowmetry (LDF) and near-infrared spectroscopy (NIRS) were used to monitor changes in cerebral perfusion. The hypothesis to be tested was that hyperoxic exposure limits cerebral vasodilation in response to increase in carbon dioxide tension (Pco(2)).

A newborn rat model for the study of cerebral hemodynamics by near-infrared spectroscopy and laser-Doppler flowmetry in the immature brain.

An animal model for the study of cerebrovascular physiology in the immature brain was developed. Twelve 3- to 5-day-old rat pups were maintained on spontaneous breathing under light anesthesia for either 1 or 2 h. Transcutaneous carbon dioxide tension and arterial oxygen saturation were monitored.

Effect of changes in inspired oxygen tension on indexes of oxygenation in ventilated neonates.

Objective: Several indexes are used to quantify the severity of hypoxemia, including the arterial to alveolar oxygen ratio (a/APO(2)), the alveolar-arterial difference P(a-a)o(2), the ratio Pao(2)/Fio(2), and the oxygenation index (OI = mean airway pressure x Pao(2)/Fio(2)). This study was carried out to test how stable these indexes are when small changes in Fio(2) are made in ventilated neonates.

Design: Open prospective clinical study.

[Prevention of hypotension in spinal anaesthesia carried out for caesarean section].

After describing the most commonly applied obstetric indications for caesarean section and the respective percentages reported in countries that are comparable with Italy in terms of health care standards, the clinical reasons and requirements on the basis of which it is considered that spinal anaesthesia is first choice compared to general anaesthesia in obstetrical surgery are outlined. This evidence is confirmed by the spinal anaesthesia/general anaesthesia ratio encountered in the major national and international Obstetric Hospitals. Maternal hypotension remains the most frequent and clinically important complication consequent on spinal anaesthesia in pregnant women at term.

Cerebral vasoreactivity to arterial carbon dioxide tension in preterm infants: the effect of ibuprofen.

Cerebral vasoreactivity to CO(2), calculated by linear regression of total cerebral hemoglobin, measured by near infrared spectroscopy, and corresponding PaCO(2), in infants <32 weeks' gestation, was found to be unaffected by the administration of ibuprofen, which was given on the first postnatal day as prophylaxis against patent ductus arteriosus.

Liver function tests and glucose and lipid metabolism in growth-restricted fetuses.

Objective: To assess hematologic and biochemical blood variables in growth-restricted fetuses and relate them to biophysical measurements.

Methods: Blood was sampled from 22 growth-restricted fetuses. All had normal karyotypes and no congenital infections.