Foreign body ingestion (FBI) in children requires early identification to prevent adverse outcomes and may necessitate endoscopic or surgical intervention. This study aims to develop a nomogram that identifies children who require urgent surgical or endoscopic intervention by using the patient's medical history and clinical parameters collected at admission. This study is a retrospective review (01/2015-12/2020) of a multicenter case series of children admitted for FBI. Data from 5864 records from 24 hospitals in Italy were analyzed. Logistic regression models were used to establish the probability of requiring surgical or endoscopic intervention based on patient history and clinical characteristics. The nomogram representing the results from the multivariable model was reported to examine the propensity for surgery/endoscopy. The study identified a significant association between intervention and various factors, including type of foreign body (blunt: reference category, disk battery (odds ratio OR:4.89), food bolus (OR:1.88), magnets (OR:2.61), sharp-pointed (OR:1.65), unknown (OR:1.02)), pre-existing diseases or conditions (OR 3.42), drooling (OR 10.91), dysphagia (OR 5.58), vomiting (OR 3.30), retrosternal pain (OR 5.59), abdominal pain (OR 1.58), hematemesis (OR 2.82), food refusal/poor feeding (OR 2.99), and unexplained crying (OR 2.01). The multivariable regression model showed good calibration and discrimination ability, with an area under the ROC curve of 0.77. This study developed the first nomogram to predict the probability of the need for surgical or endoscopic intervention in children with FBI, based on the information collected at admission. The nomogram will aid clinicians in identifying children who require early intervention to prevent adverse outcomes.

The concept of the exposome encompasses all the factors influencing human health throughout the life course. The exposome induces epigenetic changes, such as DNA methylation, which influence gene expression and impact overall health. Several recent studies have explored how repetitive elements (REs) in the genome can be activated in response to environmental stimuli. However, most of these investigations have assumed that altered RE methylation is always detrimental to individual health. The MAMELI project proposes an alternative hypothesis: that some REs are plastic entities capable of responding physiologically to environmental stimuli without compromising genome stability. This hypothesis suggests that the ability of DNA to adapt to environmental triggers could be monitored and used as an indicator of health resilience. To test this hypothesis, the MAMELI project will enroll 6,200 participants from the city of Legnano (Italy) and will be conducted in three main phases: i) A total of 200 healthy participants will undergo DNA methylation analysis through third-generation sequencing at two time points: T0 (baseline) and T1 (6 months after T0). This phase aims to identify a set of REs (“differential REs”) whose methylation changes in response to the exposome without affecting genome stability; ii) This phase will include 2,700 subjects (the original 200 participants from the discovery phase plus 2,500 additional subjects). The goal will be to develop a predictive algorithm (the MAMELI algorithm) that links the exposome to RE methylation status, creating a “RE methylation signature” reflecting the environmental impact on DNA methylation; iii) In this phase, the MAMELI algorithm will be applied to a separate cohort of 3,500 participants to compare the measured RE methylation signature with values predicted by the algorithm. Additionally, an intervention study will be embedded within the cohort to assess the reversibility of RE methylation following lifestyle changes. The MAMELI project offers a novel perspective in the field of epigenetics and environmental health, demonstrating how the epigenome can act as a sensor for environmental changes and how this interaction can be harnessed for disease prevention. If validated, the MAMELI algorithm could become a powerful tool for identifying individuals at risk and developing personalized interventions to improve global health outcomes.

Background: The metabolism of plasma amino acid (AA) in children with autism spectrum disorder (ASD) has been extensively investigated, yielding inconclusive results. This study aims to characterize the metabolic alterations in AA profiles among early-diagnosed children with ASD and compare the findings with those from non-ASD children. Methods: We analyzed plasma AA profiles, measured by ion exchange chromatography, from 1242 ASD children (median age = 4 years; 81% male). Additionally, we studied AA profiles from 488 children, matched for age and free of ASD (control group). Principal component and cluster analysis were employed to explore potential associations within the ASD group and to identify subgroups. Results: We observed lower plasma levels of glutamine in children with ASD compared to non-ASD children (p < 0.001). Six essential, two conditionally essential, and four non-essential AA were found to be increased in children with ASD. The clustering analysis revealed two groups, labeled Neurological (NEU) and Nutritional (NUT), which included a majority of ASD children (94% and 78%, respectively). The NEU group exhibited high levels of taurine, aspartate, glutamic acid, and ornithine, while the NUT group showed elevated levels of branched-chain AA. Conclusions: In children with ASD, we identified some heterogeneous AA patterns that may serve as biochemical signatures of neurological impairment in some individuals, while in others they may indicate nutritional dysregulation.

Intercellular communication has been transformed by the discovery of extracellular vesicles (EVs) and their cargo, including microRNAs (miRNAs), which play crucial roles in intercellular signaling. These EVs were previously disregarded as cellular debris but are now recognized as vital mediators of biological information transfer between cells. Furthermore, they respond not only to internal stimuli but also to environmental and lifestyle factors. Identifying EV-borne oncomiRs, a subset of miRNAs implicated in cancer development, could revolutionize our understanding of how environmental and lifestyle exposures contribute to oncogenesis. To investigate this, we studied the plasma levels of EV-borne oncomiRs in a population of 673 women and 238 men with a body mass index > 25 kg/m² (SPHERE population). The top fifty oncomiRs associated with the three most common cancers in women (breast, colorectal, and lung carcinomas) and men (lung, prostate, and colorectal carcinomas) were selected from the OncomiR database. Only oncomiRs expressed in more than 20% of the population were considered for statistical analysis. Using a Multivariate Adaptive Regression Splines (MARS) model, we explored the interactions between environmental/lifestyle exposures and EV oncomiRs to develop optimized predictor combinations for each EV oncomiR. This innovative approach allowed us to better understand miRNA regulation in response to multiple environmental and lifestyle influences. By uncovering non-linear relationships among variables, we gained valuable insights into the complexity of miRNA regulatory networks. Ultimately, this research paves the way for comprehensive exposome studies in the future.

Background: Newborn screening (NBS) is a preventive healthcare program aiming at identifying the inborn errors of metabolism (IEMs) in asymptomatic infants to reduce the risk of severe complications. The aim of this study was to report the first years (2016–2020) of the expanded NBS program in the Lombardy region, Italy. Methods: Dried blood spots were collected from newborns’ heels at 48–72 h after birth. FIA-MS/MS was performed to evaluate specific biochemical markers. Genetic confirmation was achieved via Sanger or NGS on newborns and reported to a clinical reference center (CRC). Results: A total of 343,507 newborns were tested; 1414/343,507 resulted as positive to NBS and were reported to the CRC. A total of 209 newborns were diagnosed with IEMs: 206 infants received a diagnosis of IEM through NBS, confirmed by genetic analysis; three neonates were not positive to NBS but were subsequentially diagnosed with IEMs. A total of 1208/343,507 were false positive cases. Twenty-seven types of IEMs were diagnosed in 209 patients: 111 newborns were affected by aminoacidemias, 11 by urea cycle disorders, 27 by organic acidemias, 34 by fatty acid oxidation disorders, and 26 by secondary conditions. Conclusions: We report here for the first time the IEM incidence and distribution in the Lombardy region in the first five years of NBS.

Background The concept of the exposome encompasses all the factors influencing human health throughout the life course. The exposome induces epigenetic changes, such as DNA methylation, which influence gene expression and impact overall health. Several recent studies have explored how repetitive elements (REs) in the genome can be activated in response to environmental stimuli. However, most of these investigations have assumed that altered RE methylation is always detrimental to individual health. The MAMELI project proposes an alternative hypothesis: that some REs are plastic entities capable of responding physiologically to environmental stimuli without compromising genome stability. This hypothesis suggests that the ability of DNA to adapt to environmental triggers could be monitored and used as an indicator of health resilience. Methods To test this hypothesis, the MAMELI project will enroll 6,200 participants from the city of Legnano (Italy) and will be conducted in three main phases: i) A total of 200 healthy participants will undergo DNA methylation analysis through third-generation sequencing at two time points: T0 (baseline) and T1 (6 months after T0). This phase aims to identify a set of REs (“differential REs”) whose methylation changes in response to the exposome without affecting genome stability; ii) This phase will include 2,700 subjects (the original 200 participants from the discovery phase plus 2,500 additional subjects). The goal will be to develop a predictive algorithm (the MAMELI algorithm) that links the exposome to RE methylation status, creating a “RE methylation signature” reflecting the environmental impact on DNA methylation; iii) In this phase, the MAMELI algorithm will be applied to a separate cohort of 3,500 participants to compare the measured RE methylation signature with values predicted by the algorithm. Additionally, an intervention study will be embedded within the cohort to assess the reversibility of RE methylation following lifestyle changes. Discussion The MAMELI project offers a novel perspective in the field of epigenetics and environmental health, demonstrating how the epigenome can act as a sensor for environmental changes and how this interaction can be harnessed for disease prevention. If validated, the MAMELI algorithm could become a powerful tool for identifying individuals at risk and developing personalized interventions to improve global health outcomes.