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Background/Objectives: The water footprint (WF) provides information on the impact of individual foods on water consumption, but to better direct food production toward water saving, we need to understand how to reduce the WF of our diets while keeping it healthy. In this study, we compared the WF of healthy diets based on national food-based dietary guidelines with the aim of highlighting changes in dietary patterns that could reduce water requirements without compromising nutritional adequacy. Methods: Three 2000 kcal/day dietary patterns were elaborated following the Italian, Spanish, and American dietary guidelines, and their total, green, blue, and grey WFs were calculated. Results: The Italian dietary pattern showed the lowest total WF (2806 L per capita/day), with the American and Spanish patterns being 8% and 10.5% higher, respectively. The food groups contributed differently to the total WF. In the USA, animal foods were the main contributor (56% versus 41% in Spain and 38% in Italy). The contribution of plant foods was higher in Italy (61%) than in Spain (54%) and the USA (38%). The distribution of the total WF between WFgreen, WFblue, and WFgrey was similar across the dietary patterns. Within each food group, and mainly in the animal-origin food group, the type of product significantly modulated the WF. Conclusions: Different diets can be equally nutritionally sustainable but have different impacts on environmental sustainability. The comparison of their WFs can be the starting point to promote dialogue between nutritionists, operators in the environmental sector, and the agri-food industry to ensure a healthy and balanced approach.

Diets including foods with low glycemic index have been proposed to reverse the rising incidence of obesity and type 2 diabetes. Unfortunately, many common starchy staple foods have a high glycemic index. Several strategies for producing foods with low glycemic index have been proposed, but their application by the food industry is limited by the difficulty and cost of measuring GI in vivo. The aim of the present study was to develop a simple and reliable protocol to assess glucose release after in vitro digestion, and to use it to compare commercial starchy foods. To this purpose, a final starch digestion step was included in the INFOGEST in vitro digestion protocol by adding the enzyme amyloglucosidase, which mimicked the action of brush border enzymes. Glucose release was evaluated in five starchy foods (flour, bread, crackers, and durum wheat pasta and gluten‐free pasta), available on the market in two forms produced by the same company, one standard and one rich in fiber (> 6 g/100 g). Glucose release was evaluated 0, 30, 60, and 120 min after the addition of amyloglucosidase. In all foods, glucose release at T0 was very low, confirming that starch digestion by amylases is incomplete. Excluding flours, the lowest and highest amounts of glucose release (28.29 and 49.36 g/50 g of available carbohydrates) were detected in durum wheat pasta and gluten‐free pasta, respectively, confirming the high glycemic index previously detected in many gluten‐free products. Notably, when glucose release was expressed as g/50 g of available carbohydrate, the impact of fiber content was negligible. Although the in vitro assessment of glucose release should not be confused with the glycemic index, the herein reported protocol can help predict the impact of foods on glycemia, facilitating the formulation of healthier products. A simple and reliable protocol has been developed to evaluate glucose release after in vitro digestion and compare some commercial starchy foods available on the market in two forms produced by the same company, one of which is rich in fiber. Excluding flours, the lowest and highest amounts of glucose release were detected in durum wheat pasta and gluten‐free pasta, respectively, confirming the high glycemic index previously detected in many gluten‐free products. Notably, when glucose release was expressed as g/50 g of available carbohydrate, the impact of fiber content was negligible. This protocol can help predict the impact of foods on glycemia, facilitating the formulation of healthier products.

The authority of bioethics as a field of inquiry and of bioethicists as scholars with a distinctive expertise is being questioned on various fronts. Sarah Franklin’s 2019 Nature commentary ‘Ethical research – the long and bumpy road from shirked to shared’ is the latest example . In this paper, we respond to these challenges by focusing on two key issues. First, we discuss the theory and practice of bioethics. We argue that both of these endeavours are fundamental components of this field of inquiry and that bioethics cannot be reduced to the contribution that it makes to the production of biopolicy, as Franklin suggests. Second, we contend that bioethicists have distinctive skills and knowledge that place them at an epistemic advantage in discussing normative questions. Hence, we reject views that deny the specific contribution that bioethicists can bring to assessing the ethics and governance of science and technology. We conclude by arguing that—despite formal and substantive differences between disciplines—philosophers, social scientists and other scholars should join forces and engage in critical friendships rather than turf wars to move towards the just governance of science and technology.

Pediatric burns represent a significant public health problem. We analyzed the characteristics of pediatric burns in a reference center, in order to identify better strategies for prevention and care. Burn patients admitted to the pediatric departments of our hospital from January 2020 to June 2022 were retrospectively evaluated. Age, gender, the etiology of injuries, the total burn surface area (TBSA), the degree of burns, the length of hospital stay (LOS), concomitant SARS-CoV-2 infection, and burn surface microbial colonization were analyzed. Forty-seven patients were included in the analysis (M:F = 1:0.67). Most of the cases involved patients between 0 and 4 years of age (83%). Hot liquid burns accounted for 79% of cases, flame burns for 9%, thermal burns for 6%, scald burns for 4% and chemical burns for 2%. Mean TBSA was 14 ± 11%. A second-degree lesion was detected in 79% of patients and third-degree in 21%. Mean LOS was 17 days. No additional infection risks or major sequelae were reported in patients with SARS-CoV-2 infection. Fifteen different species of bacteria plus C. parapsilosis were isolated, while no anaerobic microorganisms were detected. In the light of our experience, we recommend a carefully planned and proactive management strategy, always multidisciplinary, to ensure the best care for the burned child.

Introduction Atelectasis is a well-documented complication in pediatric patients undergoing general anesthesia. Its incidence varies significantly based on surgical procedures and anesthesia techniques. Inhalation induction, commonly used to avoid the discomfort of venipuncture, is suspected to cause higher rates of respiratory complications, including atelectasis, compared to intravenous induction. This study aimed to evaluate the impact of inhalation versus intravenous anesthesia induction on atelectasis formation in pediatric patients, as assessed by lung ultrasound (LUS). Methods This propensity score-matched observational study was conducted at a tertiary pediatric hospital in Milan, Italy. Inclusion criteria were children ≤ 18 years undergoing elective surgery with general anesthesia. Patients were divided into inhalation and intravenous induction groups. LUS was performed before and after anesthesia induction to assess lung aeration. The primary endpoint was the global LUS score post-induction, with secondary endpoints including the incidence and distribution of atelectasis. Results Of the 326 patients included, 65% underwent inhalation induction and 35% intravenous induction. The global LUS score was significantly higher in the inhalation group (12.0 vs. 4.0, p  < 0.001). After propensity score matching (for age, presence of upper respiratory tract infection, duration of induction, and PEEP levels at induction), average treatment effect (ATE) of mask induction was 5.89 (95% CI, 3.21–8.58; p  < 0.001) point on LUS global score and a coefficient of 0.35 (OR 1.41) for atelectasis. Discussion Inhalation induction is associated with a higher incidence of atelectasis in pediatric patients also when we adjusted for clinically relevant covariates. Trial registration ClinicalTrials.gov identifier: NCT06069414.

Objectives: Bronchiolitis remains a major cause of morbidity and mortality in children under 24 months. During the first year of the pandemic, non-pharmacological interventions resulted in a significant reduction of bronchiolitis cases. Early in 2021, a rebound of bronchiolitis was reported with a description of out-of-season outbreaks. In this study, we prospectively evaluated the impact of bronchiolitis in two Italian University centers located in different geographical areas, aiming to compare two post-pandemic bronchiolitis seasons (2021/22 and 2022/23) in terms of severity, outcomes, microbiology and temporal distribution. Methods: This was a bicentric prospective observational cohort study. All consecutive children under 24 months of age assessed in the participating institutions during the specified seasons and receiving a clinical diagnosis of bronchiolitis were included. Results: A total of 900 patients were enrolled. Patients in the second season were globally younger and had comorbidities less often. Temporal distribution changed between the two seasons. Of the patients, 56% were tested for RSV; 60% of these was positive. Patients with RSV were globally younger (3.5 months vs. 4.9, p < 0.001), more often had a need for any kind of respiratory and fluid support and more often needed ward or PICU admission. At the end of the ED visit, 430 patients were discharged home, 372 (41.3%) were admitted to an inpatient ward and 46 (5.1%) to a pediatric intensive care unit. Conclusions: The 2022/23 post-COVID bronchiolitis was mostly similar to that of 2021/22, and was in line with pre-pandemic expectations.

VATS (video assisted thoracoscopic surgery) is routinely and successfully performed in minor and major complex thoracic procedures. This technique has been recently introduced for the treatment of severe forms of idiopathic scoliosis (IS) with the aim to repair the deformity, reduce morbidity and to prevent its progression in patients with skeletal immaturity. This study aims to present VATS in anterior vertebral body tethering (AVBT) approach to support the pediatric orthopedic surgeons during vertebral body fixation. Surgical and anesthesiologic tips and tricks are reported to assure a safe procedure. The study includes preadolescents with IS and a grade of scoliosis >40° that had a high probability of deterioration due to remaining growth (December 2018 to April 2021). Skeletal immaturity of enrolled patients was assessed by Sanders classification and Risser sign. Patients had a Risser score between 0 and 1 and a Sanders score >2 and <5. AVBT technique using VATS was performed by a senior pediatric surgeon assisting the pediatric orthopedic surgeon. Twenty-three patients have been submitted to VATS AVBT in the period of study (age range 9–14 years). The patients had a classified deformity Lenke 1A or B convex right and all types of curves were treated. In all patients, the vertebrae submitted to tethering surgery ranged from D5 to D12; mean curve correction was 43%. Three postoperative complications occurred: one late postoperative bleeding requiring a chest tube positioning on 12th postoperative day; one screw dislodged and needed to be removed; one child showed worsening of the scoliosis and needed a posterior arthrodesis. Initial results of VATS AVBT in growing patients with spinal deformities are encouraging. An appropriate selection of patients and a pediatric dedicated multidisciplinary surgical approach decrease intraoperative complications, time of operation and postoperative sequelae and guarantee an optimal outcome.

Background Surgery for severe scoliosis (SS) is usually performed in the prone position. Changes in respiratory mechanics related to position and positive end expiratory pressure (PEEP) titration during anesthesia of SS are understudied. We aimed to investigate the effect of prone position and PEEP on the respiratory mechanics of scoliotic children undergoing spine surgery. Methods Prospective, crossover study performed in two pediatric hospitals (Montevideo, Uruguay-Centro Hospitalario Pereira Rossell- and Milano, Italy-Vittore Buzzi Children’s Hospital). Shortly after intubation, pulmonary mechanics measurements were performed using inspiratory and expiratory breath holds during volume-controlled ventilation with a set tidal volume (TV) of 8 ml/kg and a respiratory rate adjusted to maintain normocapnia. Measurements of peak (PIP), plateau (P PLAT ) and total PEEP (tPEEP) were obtained at three levels of applied PEEP: 0 (ZEEP), 5, and 10 cmH 2 O both in supine (baseline) and prone positions. Driving pressure (∆P: P PLAT –tPEEP) was calculated to obtain static respiratory system compliance (Crs: TV/∆P). Crs and pressures were analyzed using a mixed linear regression model with a random subject effect in their relationship with position and PEEP. Results Sixty-nine patients were enrolled. Crs was negatively associated with Cobb angle in all the cohorts. Only in secondary scoliosis, it was positively associated with body mass index. Crs was also negatively correlated with the prone position and positively correlated with increasing PEEP levels. The interaction between PEEP and position was studied and showed no significance. Conclusions Crs is influenced by the severity of scoliosis and the nutritional status during spine surgery. The addition of PEEP improves Crs and reduces ∆P in the supine position, but both worsen in the prone position. These changes can be related to the effects of position on chest wall compliance. Key point summary Question: This study investigates the effect of prone position and the application of PEEP on respiratory mechanics in children undergoing spinal surgery for severe scoliosis. Findings: Respiratory system compliance was affected by the severity of scoliosis and the nutritional status, and it improved with application of PEEP, while decreased during prone position. Meaning: Application on low-moderate PEEP level during scoliosis surgery is useful to counteract atelectasis formation due to lung compression following the primary disease and diaphragm elevation during prone position.

Optimal preoxygenation is critical in emergency medicine to prevent desaturation during airway management, especially in high-risk populations. Identifying the most effective preoxygenation device across diverse patient groups remains a clinical priority. To compare the efficacy of 3 preoxygenation devices-nonrebreather mask (NRM), bag-valve mask (BVM), and BVM with positive end-expiratory pressure (BVM plus PEEP)-in lung-healthy volunteers. This crossover randomized clinical trial was conducted from May 26 to 31, 2024, at Eurac Research, Bolzano, Italy. Volunteer participants included lung-healthy adults with normal weight (NM), adults with overweight or obesity (OW-OB), and children aged 6 to 12 years. Preoxygenation using each device (NRM, BVM, BVM plus PEEP) with 15 L/min of oxygen for a duration of 3 minutes in a randomized order. The primary outcome was expiratory oxygen concentration (Feo2) at the end of preoxygenation. Secondary outcomes included ventilation in dependent lung regions assessed using electrical impedance tomography, noninvasive continuous monitoring of oxygenation status (oxygenation reserve index [ORI]) at the end of preoxygenation, and the time taken for ORI to return to baseline values. The study included 53 participants, 39 male (74%) and 14 female (26%), of whom 16 were adults with NW (mean [SD] age, 36 [11] years), 18 were adults with OW-OB (mean [SD] age, 45 [11] years), and 19 were children (mean [SD] age, 8 [3] years). Mean (SD) Feo2 at the end of preoxygenation was higher with BVM and BVM plus PEEP compared with NRM in adults with NW (72.1% [5.9%] and 75.6% [4.3%], respectively, vs 52.5% [6.1%]; P < .001), adults with OW-OB (65.8% [10.4%] and 73.0% [6.4%], respectively, vs 51.9% [6.1%]; P < .001), and children (64.6% [13.4%] and 67.5% [10.2%], respectively, vs 38.5% [7.5%]; P < .001). Ventilation in dependent lung regions was higher with BVM plus PEEP than NRM in adults with NW (BVM plus PEEP, 51.9 [9.3] vs NRM, 47.0 [5.7]; P = .03) and children (BVM plus PEEP, 53.0 [7.3] vs NRM, 47.7 [7.0]; P = .002). ORI at the end of preoxygenation was higher with BVM plus PEEP than with NRM in adults with OW-OB (BVM plus PEEP, 0.79 [0.13] vs NRM, 0.73 [0.13]; P < .001). Additionally, the mean (SE) time for ORI to return to baseline was longer with BVM plus PEEP compared with NRM in both adults with OW-OB (BVM plus PEEP, 196 [74] seconds vs NRM, 158 [53] seconds; P = .01) and children (BVM plus PEEP, 115 [59] seconds vs NRM, 62 [36] seconds; P < .001). In this crossover randomized clinical trial, preoxygenation with PEEP was more effective than preoxygenation without PEEP, resulting in higher Feo2 values and improved ventilation in dependent lung regions. These findings suggest that BVM plus PEEP should be prioritized for preoxygenation in emergency settings. ClinicalTrials.gov Identifier: NCT06370689.