We confirm that fermentation of wheat flour with sourdough lactobacilli and fungal proteases is capable of abolishing the T cell immunogenicity of gluten in coeliac patients. Our data also validate the short-term oral challenge as a useful tool for testing the efficacy of novel therapeutic approaches.

AimTo investigate the effectiveness of IgM-enriched immunoglobulins (IgM-eIVIG) in reducing short-term mortality of neonates with proven late-onset sepsis.MethodsAll VLBW infants from January 2008 to December 2012 with positive blood culture beyond 72 hours of life were enrolled in a retrospective cohort study. Newborns born after June 2010 were treated with IgM-eIVIG, 250 mg/kg/day iv for three days in addition to standard antibiotic regimen and compared to an historical cohort born before June 2010, receiving antimicrobial regimen alone. Short-term mortality (i.e. death within 7 and 21 days from treatment) was the primary outcome. Secondary outcomes were: total mortality, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia at discharge.Results79 neonates (40 cases) were enrolled. No difference in birth weight, gestational age or SNAP II score (disease severity score) were found. Significantly reduced short-term mortality was found in treated infants (22% vs 46%; p = 0.005) considering all microbial aetiologies and the subgroup affected by Candida spp. Secondary outcomes were not different between groups.ConclusionThis hypothesis-generator study shows that IgM-eIVIG is an effective adjuvant therapy in VLBW infants with proven sepsis. Randomized controlled trials are warranted to confirm this pilot observation.

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Takotsubo syndrome (TS) is a transient, reversible, stress-induced heart failure syndrome. 1 Although TS frequently is described in adults, it rarely is reported in grown-up patients with congenital heart disease. [2][3][4] We report the case of a 43-year-old woman with operated pulmonary atresia and ventricular septal defect who was admitted for acute chest pain and dyspnea lasting for 2 hours.The patient was born with pulmonary atresia and major aortopulmonary collateral arteries and underwent multiple surgical interventions: systemic to pulmonary McGoon shunt at 3 months, right Blalock-Taussig shunt at 8 months, and left Blalock-Taussig shunt and left pulmonary artery reconstruction 2 years later. At 35 years, she underwent surgical repair with ventricular septal defect closure, unifocalization by 24-mm homograft, and ascending aorta replacement with a 26-mm Hemashield aortic graft. One year later, stenting of the right pulmonary artery was performed. At presentation, she was on aspirin 100 mg daily and sotalol 160 mg twice daily for occasional episodes of atrial fibrillation.A few minutes before the onset of symptoms, the patient was having an angry debate. Physical examination evidenced poor clinical conditions, pale skin, tachycardia, and tachypnea. Oxygen saturation was 60% on room air, 68% on oxygen 18 L/min, and blood pressure was 140/ 80 mm Hg.

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