Vitamin D status in cord blood and newborns: ethnic differences

BACKGROUND: A deficiency in vitamin D (25OHD) is common throughout the world in both adults and children, being related to skin pigmentation, sun exposure, dietary intake and obesity. Limited data are available for the neonatal age. The aim of the study is to understand the differences in 25OHD levels with respect to skin colour and ethnicity in newborns. METHODS: We randomly enrolled 62 neonates, born at term and appropriate for gestational age. Thirty two were born from Italian mothers with fair skin (FS) and 30 from non-Caucasian mothers (North African, African, Asian and Latin American): 10 with light olive/light brown (LOB) and 20 with medium brown/black skin (MBB). Vitamin D was measured in the cord blood at birth and in neonatal serum during metabolic screening. RESULTS: 25OHD levels were (mean ± SD) 21.4 ± 11 ng/ml in cord blood and 14.9 ± 7 ng/ml in serum after birth. 25OHD values were higher in cord blood (p < 0.01) and neonatal serum (p < 0.001) in subjects supplemented with Vitamin D. Newborn FS showed higher vitamin D levels in cord blood when compared to LOB and MBB (p < 0.01), and higher levels in neonatal serum when compared to LOB (p < 0.01). In cord blood, 25OHD levels were higher in Italian newborns than in North African (p < 0.004) and African (p < 0.01). In neonatal serum, 25OHD levels were higher in Italian infants only when compared with North African infants (p < 0.03). CONCLUSIONS: The present study shows a high prevalence of vitamin D insufficiency and deficiency in newborns with significant differences observed to be due to ethnicity, skin colour and maternal supplementation during the pregnancy

Assessment of on-road emissions of refuse collection vehicles

One of the most challenging issues for building sustainable cities is the improvement of municipal solid waste (MSW) management, which requires a substantial effort to reduce its production and improve its collection, transport and treatment systems. Modern (Euro VI) heavy-duty vehicles have significantly lower emissions compared to older vehicles. However, there are still concerns regarding the emissions of refuse collection vehicles in cities, because they use engines designed for long haulage trucks and consequently not optimised for low speed stop and start driving. The very low average speeds and the frequent stops represent difficult conditions to cope with from the emission reduction perspective. In fact, for short periods, where the exhaust gas temperature is low for the aftertreatment devices (cold start, some city conditions), the emissions are relatively high. In an effort to provide insight on the optimal future planning and renewal of the Milan waste collection vehicle fleet, the Joint Research Centre (JRC) of the European Commission (EC), in collaboration with the Azienda Milanese Servizi Ambientali (AMSA), initiated an on-road emission testing campaign. The aim of this extensive experimental study, performed both under real and laboratory controlled operating conditions was to identify the actual emission levels of the waste collection vehicles, comparing two different engine technologies (diesel and natural gas fuelled engines) and assess the environmental efficiency of the different engines solutions. For this purpose, we tested a Diesel Euro VI step C and a Compressed Natural Gas (CNG) Euro VI step C refuse collection heavy-duty vehicle both in the laboratory and on the road using a cycle similar to the in-service conformity (ISC) trips for this type of vehicles (N3). The vehicles were also tested using actual refuse collection cycles. The idea was to directly compared the two vehicles’ engine technology to evaluate the performance and the pollutant emissions under realistic and controlled operating conditions in order to support a fleet renewal initiative in the city of Milan. Particle and gaseous pollutants were measured using a Portable Emissions Measurement System (PEMS). Additionally, in the laboratory we used laboratory grade gaseous, particle number and FTIR (Fourier-transform infrared spectroscopy) systems to measure the emissions and check the proper operation of the PEMS. The present work summarizes the results of the aforementioned experimental activity lead on two vehicles (one Diesel and one Compressed Natural Gas), which were tested in three different phases using a portable emission measurement system. The first phase included a similar In-Service Conformity test (ISC_LIKE) and a city simulation cycle (CITY_SIM), the second part involved real world operation in the city of Milan, whilst a third phase was dedicated to the comparison lab test in confined conditions. This report will address only the road comparison, while the laboratory tests and the relative comparison together with the real world findings will be object of a future report. Focusing on CITY_MILAN cycle, which is the most representative of the real in-use conditions, THC calculated emission factors were two orders of magnitude lower in Diesel engine (0.79 mg/kWh) than in CNG (73.49 mg/kWh), even if we have to consider a different limit for CNG engines. Continuing with the analysis of “Urban” routes, CNG truck showed NOX emission nearly 4 times higher than the Diesel (755.31 mg/kWh vs 157.10 mg/kWh), exceeding the reference limits. The CNG engine PN levels were 3 times higher than in Diesel one. Including also the regeneration events in the Diesel vehicle, the emissions increased the PN significantly, but it still remained below the limit of 6×10^11 particle/kWh. In the metropolitan cycle (CITY_MILAN) CNG truck has a CO emission reduction of -85 % compared to the Diesel one, with respectively 40.92 and 320.30 mg/kWh. Nevertheless, CO emissions of both tested vehicles appear to be at very low levels, abundantly below the reference limits (4000 mg/kWh). This trends did not vary significantly among the different routes. In general, Diesel technology presented important advantages with regards to the NOX, PN, CO2 emissions as compared to the CNG engine, while the CNG vehicle provided a better CO emission behaviour. This trade off needs to be carefully analysed prior to decide if a fleet should be shifted towards either technology, mainly because is based only to a limited comparison between the two considered vehicles. Therefore, the conclusions drawn in this report are only valid for the tested vehicles and they cannot be extrapolated or generalised for a larger fleet of vehicles.JRC.C.4 - Sustainable Transpor

Sublingual immunotherapy for asthma.

BACKGROUND: Asthma is a common long-term respiratory disease affecting approximately 300 million people worldwide. Approximately half of people with asthma have an important allergic component to their disease, which may provide an opportunity for targeted treatment. Sublingual immunotherapy (SLIT) aims to reduce asthma symptoms by delivering increasing doses of an allergen (e.g. house dust mite, pollen extract) under the tongue to induce immune tolerance. However, it is not clear whether the sublingual delivery route is safe and effective in asthma. OBJECTIVES: To assess the efficacy and safety of sublingual immunotherapy compared with placebo or standard care for adults and children with asthma. SEARCH METHODS: We identified trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/) and reference lists of all primary studies and review articles. The search is up to date as of 25 March 2015. SELECTION CRITERIA: We included parallel randomised controlled trials (RCTs), irrespective of blinding or duration, that evaluated sublingual immunotherapy versus placebo or as an add-on to standard asthma management. We included both adults and children with asthma of any severity and with any allergen-sensitisation pattern. We included studies that recruited participants with asthma, rhinitis, or both, providing at least 80% of trial participants had a diagnosis of asthma. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results for included trials, extracted numerical data and assessed risk of bias, all of which were cross-checked for accuracy. We resolved disagreements by discussion.We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study participants as the unit of analysis; we analysed continuous data as mean differences (MDs) or standardised mean differences (SMDs) using random-effects models. We rated all outcomes using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) and presented results in the 'Summary of findings' table. MAIN RESULTS: Fifty-two studies met our inclusion criteria, randomly assigning 5077 participants to comparisons of interest. Most studies were double-blind and placebo-controlled, but studies varied in duration from one day to three years. Most participants had mild or intermittent asthma, often with co-morbid allergic rhinitis. Eighteen studies recruited only adults, 25 recruited only children and several recruited both or did not specify (n = 9).With the exception of adverse events, reporting of outcomes of interest to this review was infrequent, and selective reporting may have had a serious effect on the completeness of the evidence. Allocation procedures generally were not well described, about a quarter of the studies were at high risk of bias for performance or detection bias or both and participant attrition was high or unknown in around half of the studies.One short study reported exacerbations requiring a hospital visit and observed no adverse events. Five studies reported quality of life, but the data were not suitable for meta-analysis. Serious adverse events were infrequent, and analysis using risk differences suggests that no more than 1 in 100 are likely to suffer a serious adverse event as a result of treatment with SLIT (RD 0.0012, 95% confidence interval (CI) -0.0077 to 0.0102; participants = 2560; studies = 22; moderate-quality evidence).Within secondary outcomes, wide but varied reporting of largely unvalidated asthma symptom and medication scores precluded meaningful meta-analysis; a general trend suggested SLIT benefit over placebo, but variation in scales meant that results were difficult to interpret.Changes in inhaled corticosteroid use in micrograms per day (MD 35.10 mcg/d, 95% CI -50.21 to 120.42; low-quality evidence), exacerbations requiring oral steroids (studies = 2; no events) and bronchial provocation (SMD 0.69, 95% CI -0.04 to 1.43; very low-quality evidence) were not often reported. This led to many imprecise estimates with wide confidence intervals that included the possibility of both benefit and harm from SLIT.More people taking SLIT had adverse events of any kind compared with control (OR 1.70, 95% CI 1.21 to 2.38; low-quality evidence; participants = 1755; studies = 19), but events were usually reported to be transient and mild.Lack of data prevented most of the planned subgroup and sensitivity analyses. AUTHORS' CONCLUSIONS: Lack of data for important outcomes such as exacerbations and quality of life and use of different unvalidated symptom and medication scores have limited our ability to draw a clinically useful conclusion. Further research using validated scales and important outcomes for patients and decision makers is needed so that SLIT can be properly assessed as clinical treatment for asthma. Very few serious adverse events have been reported, but most studies have included patients with intermittent or mild asthma, so we cannot comment on the safety of SLIT for those with moderate or severe asthma. SLIT is associated with increased risk of all adverse events

A survey of clinical features of allergic rhinitis in adults

Background: Allergic rhinitis (AR) has high prevalence and substantial socio-economic burden. Material/Methods: The study included 35 Italian Centers recruiting an overall number of 3383 adult patients with rhinitis (48% males, 52% females, mean age 29.1, range 18\u201345 years). For each patient, the attending physician had to fill in a standardized questionnaire, covering, in particular, some issues such as the ARIA classification of allergic rhinitis (AR), the results of skin prick test (SPT), the kind of treatment, the response to treatment, and the satisfaction with treatment. Results: Out of the 3383 patients with rhinitis, 2788 (82.4%) had AR: 311 (11.5%) had a mild intermittent, 229 (8.8%) a mild persistent, 636 (23.5%) a moderate-severe intermittent, and 1518 (56.1%) a moderate-severe persistent form. The most frequently used drugs were oral antihistamines (77.1%) and topical corticosteroids (60.8%). The response to treatment was judged as excellent in 12.2%, good in 41.3%, fair in 31.2%, poor in 14.5%, and very bad in 0.8% of subjects. The rate of treatment dissatisfaction was significantly higher in patients with moderate-to-severe AR than in patients with mild AR (p<0.0001). Indication to allergen immunotherapy (AIT) was significantly more frequent (p<0.01) in patients with severe AR than with mild AR. . Conclusions: These fndings confirm the appropriateness of ARIA guidelines in classifying the AR patients and the association of severe symptoms with unsuccessful drug treatment. The optimal targeting of patients to be treated with AIT needs to be reassessed

Non-Celiac Gluten/Wheat Sensitivity: Clinical Characteristics and Microbiota and Mycobiota Composition by Response to the Gluten Challenge Test

The aims of this observational “proof-of-concept” study were to analyze the clinical/psychological characteristics and gut microbiota/mycobiota composition of individuals with suspected non-celiac gluten/wheat sensitivity (NCGS/WS) according to responses to the double-blind-placebo-controlled (DBPC) crossover gluten challenge test. Fifty individuals with suspected NCGS/WS were subjected to the DBPC challenge test; anthropometric measurements, psychometric questionnaires, and fecal samples were collected. Twenty-seven (54%) participants were gluten responsive (NCGS), and 23 were placebo responsive, with an order effect. NCGS individuals displayed a significantly lower risk of eating disorders and a higher mental health score when compared to placebo-responsive participants, confirmed by multiple logistic regression analyses (OR = 0.87; 95% CI 0.76–0.98, p = 0.021, and OR = 1.30; 95% CI 1.06–1.59, p = 0.009, respectively). Principal coordinate analyses based on microbiota composition showed a separation by the DBPC response (p = 0.039). For Bacteroides (p = 0.05) and Parabacteroides (p = 0.007), the frequency of amplicon sequence variants was lower, and that for Blautia (p = 0.009) and Streptococcus (p = 0.004) was higher in NCGS individuals at multiple regression analyses. No difference in the mycobiota composition was detected between the groups. In conclusion, almost half of the individuals with suspected gluten sensitivity reported symptoms with placebo; they showed lower mental health scores, increased risk for eating disorders, and a different gut microbiota composition.</jats:p

Maternal vitamin D supplementation and dietary intake during pregnancy in Italian and migrants.

<p>Data are expressed as frequencies or as mean±SD and number (%).</p><p>Maternal vitamin D supplementation and dietary intake during pregnancy in Italian and migrants.</p