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The rising concerns about global warming and environmental pollution are increasingly pushing towards the replacement of road vehicles powered by Internal Combustion Engines (ICEs). Electric Vehicles (EVs) are generally considered the best candidates for this transition, however, existing power grids and EV management systems are not yet ready for a large penetration of EVs, and the current opinion of the scientific community is that further research must be done in this field. The so-called Vehicle-to-Grid (V2G) concept plays a relevant role in this scenario by providing the communication capabilities required by advanced control and Demand-Side Management (DSM) strategies. Following this research trend, in this paper the communication requirements for the DSM of EVs in urban environments are discussed, by focusing on the mobile communication among EVs and smart grids. A specific system architecture for the DSM of EVs moving inside urban areas is proposed and discussed in terms of the required data throughput. In addition, the use of a Low-Power Wide-Area Network (LPWAN) solution—the Long-Range Wide Area Network (LoRaWAN) technology—is proposed as a possible alternative to cellular-like solutions, by testing an experimental communication infrastructure in a real environment. The results show that the proposed LPWAN technology is capable to handle an adequate amount of information for the considered application, and that one LoRa base station is able to serve up to 438 EVs per cell, and 1408 EV charging points.

Background Spinal epidural hematoma without significant trauma is a rare condition with potentially severe outcome. This case report and systematic review of the literature illustrates the clinical presentation, risk factors, evaluation, treatment and outcomes of spinal epidural hematoma without significant trauma in children. Case presentation We report one case of a 7-year-old girl who developed a neck pain after minor cervical sprain. MRI showed a right posterior epidural hematoma extending from C2/3 to T1. The hematoma was surgically evacuated, and the histopathology showed an arteriovenous malformation. Postoperative MRI showed complete evacuation of the hematoma and no residual vascular malformation. We report a second ASE with idiopathic spinal epidural hematoma of a 4½-year-old boy presenting with neck pain. MRI showed a right-sided latero-posterior subacute spinal epidural hematoma at C3–C5. Owing to the absence of any neurological deficit, the patient was treated conservatively. MRI at 3 months showed complete resolution of the hematoma. Conclusions Spinal epidural hematoma without significant trauma in children is a rare condition. It may present with unspecific symptoms. Screening for bleeding diathesis is warranted and neuroradiologic follow-up is essential to rule out vascular malformation. Whereas most children have a favorable outcome, some do not recover, and neurological follow-up is required.

Introduction Celiac disease typically presents with symptoms of malabsorption, but extraintestinal manifestations are increasingly reported. Aplastic anemia as the mode of celiac disease presentation is extremely rare in children. Case presentation We report a 2‐year‐old boy who presented with loose stools, loss of appetite, and bicytopenia with severe aregenerative normocytic anemia. Investigations, including bone marrow aspirate and biopsy, revealed aplastic anemia. Screening for malabsorption showed increased plasma concentrations of anti‐transglutaminase and anti‐gliadin antibodies. A duodenal biopsy confirmed the histologic features of celiac disease. The child received a packed red cell transfusion and was started on a gluten‐free diet, with a very good prognosis and normalization of both his blood and histological parameters. To the best of our knowledge, our report is the sixth pediatric case in the literature. Conclusion Screening for celiac disease should be performed in children with unexplained hematological abnormalities such as aplastic anemia with or without gastrointestinal symptoms.

Abstract Background: Children who experience adverse reactions to cow's milk or who have diseases predisposing them to low bone mass are often prescribed a supplementation of calcium and vitamin D3 , but adherence can be poor. Age-specific preferences for different formulations may exist and at least partially explain poor compliance. Objective: The aim of this study was to compare the preference of Swiss children at risk for low bone mass for either a single-serving sachet or a suspension containing calcium and vitamin D3. Methods: Two different commercial formulations containing calcium and vitamin D3 , either as a lemon-flavored single-serving sachet or as a banana-flavored commercial suspension, were tested for preference by means of a 5-point facial hedonic scale in children aged 4 to 7 and 8 to 11 years. A concealed random allocation procedure was used. The investigator asking about preference was blinded to the sequence. Results: A total of 40 Swiss children (13 boys and 7 girls aged 4–7 years; 11 boys and 9 girls aged 811 years) were assessed in this study. Low bone mass risks included adverse reactions to cow's milk (n = 25); cerebral palsy (4), juvenile idiopathic arthritis (4), cystic fibrosis (3), inflammatory bowel diseases (2), anorexia nervosa (1), and osteogenesis imperfecta (1). Two children (10%) aged 4 to 7 years were not able to express their preference. Twelve of the remaining 18 children (67%) aged 4 to 7 years preferred the suspension, 5 (28%) did not express a clear preference, and 1 (5%) preferred the sachet ( P < 0.002). In children aged 8 to 11 years, 15 (75%) preferred the sachet, 4 (20%) did not express a clear preference, and 1 (5%) preferred the suspension ( P < 0.001). The results were not significantly different between boys and girls or between children initially presented the suspension and those initially presented the sachet. Conclusions: In this small study, significantly more Swiss children aged 4 to 7 years who were prescribed a supplementation of calcium and vitamin D3 preferred a banana-flavored suspension compared with those who preferred a lemon-flavored single-serving sachet. However, significantly more children aged 8 to 11 years prescribed the same supplementation preferred the single-serving sachet compared with the suspension.

Objective Arterial thrombosis is one of the most reported complications of cardiac catheterisation (CC) in children. The aim of the study was to evaluate the incidence and predictors of arterial thrombosis in children with cardiac diseases (CDs). Methods During 12 consecutive months, all children aged 0–19 years undergoing CC of the femoral arteries were included in this observational study. After CC, clinical evaluation of impaired limb perfusion was performed according to local guidelines. Doppler ultrasonography was performed when decreased limb perfusion was suspected. Results 123 children (30% aged <12 months, 70% aged >12 months) underwent CC. Arterial thrombosis occurred in 14 of the 123 children (11.4%). Twelve cases (12/14=86%) of arterial thrombosis occurred in infants aged <12 months and 2 (2/14=14%) in older children. Overall younger age (p<0.01, OR (95% CI) 0.49 (0.28 to 0.86)) and low body weight (p<0.004, OR (95% CI) 0.78 (0.65 to 0.92)) were significantly associated with an increased risk of arterial thrombosis. Cyanotic CD (p=0.07, OR (95% CI) 2.87 (0.90 to 9.15)) showed a trend towards increased thrombotic risk. Conclusions Arterial thrombosis is a common complication of CC in infants. Diagnosis of CC-related arterial thrombosis remains a challenge. Well-defined clinical monitoring protocols may be valuable methods for timely detection and treatment of arterial thrombosis.

Acute hemorrhagic edema of young children is an uncommon but likely underestimated cutaneous leukocytoclastic vasculitis. The condition typically affects infants 6–24 months of age with a history of recent respiratory illness with or without course of antibiotics. The diagnosis is made in children, mostly nontoxic in appearance, presenting with nonpruritic, large, round, red to purpuric plaques predominantly over the cheeks, ears, and extremities, with relative sparing of the trunk, often with a target-like appearance, and edema of the distal extremities, ears, and face that is mostly non-pitting, indurative, and tender. In boys, the lesions sometimes involve the scrotum and, more rarely, the penis. Fever, typically of low grade, is often present. Involvement of body systems other than skin is uncommon, and spontaneous recovery usually occurs within 6–21 days without sequelae. In this condition, laboratory tests are non-contributory: total blood cell count is often normal, although leukocytosis and thrombocytosis are sometimes found, clotting studies are normal, erythrocyte sedimentation rate and C-reactive protein test are normal or slightly elevated, complement level is normal, autoantibodies are absent, and urinalysis is usually normal. Experienced physicians rapidly consider the possible diagnosis of acute hemorrhagic edema when presented with a nontoxic young child having large targetoid purpuric lesions and indurative swelling, which is non-pitting in character, and make the diagnosis either on the basis of clinical findings alone or supported by a skin biopsy study.

Catheter‐related arterial thrombosis (CAT) are increasingly recognized in infants and children. Insufficient data are available on the incidence, risk factors, treatment and outcome of these thrombotic events. This work provides consensus recommendations for future research on catheter‐related arterial thrombosis in the paediatric population. In particular, future studies should distinguish between CAT due to indwelling arterial catheters or cardiac catheterization in two different subpopulations (neonates and older children). Further studies should investigate sensitivity and specificity of clinical signs and symptoms for early screening of CAT and the most appropriate imaging modality, focusing on ultrasound due to better feasibility in the very young pediatric population. Adequately powered, well‐designed clinical trials should investigate efficacy and safety of different treatment and prevention strategies as well as the risk for and the optimal management of short‐ and long‐term complications.

Background Little information is available on ureteral or vesical involvement in Henoch–Schönlein syndrome. To determine the features of this condition we performed a formal analysis of peer-reviewed scientific literature on this topic. Methods The US National Library of Medicine database was used as the data source. All articles published as full-length articles or letters were collected. Reports published in languages other than English, French, German, Italian or Spanish were not considered. Results We analyzed 32 reports describing 35 cases (24 male and 11 female subjects aged between 3.5 and 63, median 7.0 years) with ureteral ( n  = 30), vesical ( n  = 4), or both ureteral and vesical involvement ( n  = 1). The presentation included colicky abdominal pain, macroscopic hematuria (sometimes containing blood clots), urinary tract infection or urinary retention. The diagnosis of ureteral involvement was often fortuitous. Patients with vesical involvement were managed conservatively. However, the majority of those with ureteral involvement were managed surgically. Conclusions Ureteral or vesical involvement is unusual and likely underappreciated in Henoch–Schönlein syndrome. Improved recognition and wider appreciation of this involvement can help to avoid associated morbidity. Management must be individualized for each patient. A multidisciplinary approach may be of value in planning medical treatment, surgical intervention, and follow-up.

Background: Children who experience adverse reactions to cow's milk or who have diseases predisposing them to low bone mass are often prescribed a supplementation of calcium and vitamin D 3, but adherence can be poor. Age-specific preferences for different formulations may exist and at least partially explain poor compliance. Objective: The aim of this study was to compare the preference of Swiss children at risk for low bone mass for either a single-serving sachet or a suspension containing calcium and vitamin D 3. Methods: Two different commercial formulations containing calcium and vitamin D 3, either as a lemon-flavored single-serving sachet or as a banana-flavored commercial suspension, were tested for preference by means of a 5-point facial hedonic scale in children aged 4 to 7 and 8 to 11 years. A concealed random allocation procedure was used. The investigator asking about preference was blinded to the sequence. Results: A total of 40 Swiss children (13 boys and 7 girls aged 4–7 years; 11 boys and 9 girls aged 811 years) were assessed in this study. Low bone mass risks included adverse reactions to cow's milk (n = 25); cerebral palsy (4), juvenile idiopathic arthritis (4), cystic fibrosis (3), inflammatory bowel diseases (2), anorexia nervosa (1), and osteogenesis imperfecta (1). Two children (10%) aged 4 to 7 years were not able to express their preference. Twelve of the remaining 18 children (67%) aged 4 to 7 years preferred the suspension, 5 (28%) did not express a clear preference, and 1 (5%) preferred the sachet ( P < 0.002). In children aged 8 to 11 years, 15 (75%) preferred the sachet, 4 (20%) did not express a clear preference, and 1 (5%) preferred the suspension ( P < 0.001). The results were not significantly different between boys and girls or between children initially presented the suspension and those initially presented the sachet. Conclusions: In this small study, significantly more Swiss children aged 4 to 7 years who were prescribed a supplementation of calcium and vitamin D 3 preferred a banana-flavored suspension compared with those who preferred a lemon-flavored single-serving sachet. However, significantly more children aged 8 to 11 years prescribed the same supplementation preferred the single-serving sachet compared with the suspension.