Background In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research.

Objectives: To determine whether in infants with bronchiolitis admitted to a pediatric intensive care unit (PICU) the starting rate for high-flow nasal cannula (HFNC) therapy set by the attending physicians upon clinical judgment meets patients' peak inspiratory flow (PIF) demands and how it influences respiratory mechanics and breathing effort.Methodology: We simultaneously obtained respiratory flow and esophageal pressure data from 31 young infants with moderate-to-severe bronchiolitis before and after setting the HFNC rate at 1 L/kg/min (HFNC-1), 2 L/kg/min (HFNC-2) or upon clinical judgment and compared data for PIF, respiratory mechanics, and breathing effort.Results: Before HFNC oxygen therapy started, 16 (65%) infants had a PIF less than 1 L/kg/min (normal-PIF) and 15 (45%) had a PIF more than or equal to 1 L/kg/min (high-PIF). Normal-PIF-infants had higher airway resistance (p < .001) and breathing effort indexes (e.g., pressure rate product per min [PTP/min], p = .028) than high-PIF-infants. Starting the HFNC rate upon clinical judgment (1.20-2.05 L/kg/min) met all infants' PIFs. In normal-PIF-infants, the clinically judged flow rate increased PIF (p = .081) and tidal volume (p = .029), reduced airway resistance (p = .011), and intrinsic positive end-expiratory pressure (p = .041), whereas, in both high-PIF and normal-PIF infants, it decreased respiratory rate (p < .001) and indexes of breathing effort such as PTP/min (in normal-PIF infants, p = .004; in high-PIF infants, p = .001).The 2 L/kg/min but not 1 L/kg/min rate induced similar effects. Conclusions:The wide PIF distribution in our PICU population of infants with bronchiolitis suggests two disease phenotypes whose therapeutic options might differ. An initial flow rate of nearly 2 L/kg/min meets patients' flow demands and improves respiratory mechanics and breathing effort.

The aim of this study is to monitor type I interferon (IFN) activation in the cervical mucosa of Human Papillomavirus (HPV)-infected and uninfected women attending a routine gynaecologic clinic. The expression of three IFN-induced genes (MxA coding for human Mixovirus resistance protein A, ISG15 Interferon Stimulated Gene coding for a 15 kDa ubiquitin-like protein and UBP43 coding for the ISG15 isopeptidase) was determined as the mRNA copy number in cervical cells, normalized to the mRNA ones of the beta-glucuronidase gene. Type-specific HPV-DNA load was concurrently determined in the HPV-positive samples. Out of 127 samples tested, 54 were sufficient for both DNA and RNA extraction. The type-specific HPV-DNA copy numbers in the 34 HPV-positive samples varied widely. No significant association was found between copy numbers of MxA, ISG15, UBP43 and HPV status or viral load. However, despite a marked inter-individual variability, ISG15 expression was significantly higher when low-risk HPV infections were compared with HPV-negative samples, while high-risk HPV infections had very low ISG15 levels. The lack of ISG15 activation in high-risk HPV-infected cervical cells could be due to the lack of p53-mediated induction or to HPV-directed specific inhibition of type I IFN pathways. This study approach might be of value in clarifying the role of type I IFN activation in determining the clearance or persistence of HPV infections.

High-flow humidified nasal cannula (HFNC) is often\ud used to relieve respiratory distress in children with acute\ud pulmonary disease, although its effects on respiratory mechanics\ud have not been objectively studied. The purpose of this study was\ud to test the feasibility of measuring pharyngeal (PP) and\ud esophageal (Pes) pressures of young children on HFNC oxygen\ud therapy through a specifically designed new monitoring,\ud acquisition, and elaboration system (MAES). Through MAES we\ud recorded and elaborated Pes and PP tracings obtained through\ud esophageal and pharyngeal catheters in a group of young children\ud hospitalized in a Pediatric Intensive Care Unit because of\ud respiratory distress. All traces were recorded during spontaneous\ud breathing and on HFNC 1 and 2 L/kg/min. To determine the\ud onset and the end of inspiration, the Pes and PP signals were\ud synchronized with the inspiratory flow obtained by a flow\ud transducer placed in the HFNC circuit. Direct measurement of\ud inspiratory flow by a face mask pneumotachograph also allowed\ud for inspiratory tidal volume (TV) measurement which was used\ud together with Pes curve to build Campbell’s diagram as well as\ud the static lung and chest wall recoil curves required for pressure\ud time product (PTP) evaluation. Using MAES we were able to\ud obtain: time interval between the beginning of inspiratory effort\ud and inspiration (Tdelay), TV, intrinsic positive end expiratory\ud pressure (PEEPi), total inspiratory Pes variation (ΔPes),\ud transpulmonary pressure at end of inspiration (Ptpei), dynamic\ud lung compliance (CLdyn), total lung resistance (RLtot) along with\ud all the relevant components of the inspiratory work of breathing\ud (WOB) and PTP. We believe that this new system will allow\ud clinicians for a bedside monitoring of respiratory distress in\ud infants treated with HFNC and to modify flow rates accordingly.\ud Index Terms—biological system modeling, biomedica