Physical Therapy for Fecal Incontinence in Children with Pelvic Floor Dyssynergia.

OBJECTIVES: To determine the efficacy of physical therapy (PT) for fecal incontinence in children with pelvic floor dyssynergia (PFD). STUDY DESIGN: Retrospective chart review of children with PFD completing >1 PT session for fecal incontinence at a quaternary children's hospital. The frequency of fecal incontinence (primary outcome), constipation-related medication use, number of bowel movements (in those with <3 per week at baseline) and pelvic floor muscle (PFM) function were captured at baseline and at the final PT visit. Outcomes were categorized as excellent (complete continence), good (>50% decrease in fecal incontinence frequency), fair (not worsening but <50% fecal incontinence frequency decrease), and poor (more frequent fecal incontinence). Compliance with PT was determined by the percentage of attended PT appointments. RESULTS: Children included met the following primary outcomes: 27 (42.2%) excellent, 24 (37.5%) good, 11 (17.1%) fair, and 2 (3.1%) poor. Factors associated with an excellent or good outcome included improved PFM functioning and good (≥70% PT attendance) compliance. Children with a history of surgically corrected tethered spinal cord were more likely to have a fair outcome (P = .015). Use of constipation-related medications decreased (1.9 ± 0.7 vs 1.5 ± 0.9, P = .005). Weekly bowel movement frequency increased (1.6 ± 0.6 vs 6.4 ± 4.8, P < .001) in those with infrequent bowel movements (n = 26) at baseline. CONCLUSIONS: Pelvic floor PT is effective in the majority of children with fecal incontinence related to PFD. Factors associated with PT efficacy include improved PFM functioning, good compliance with PT, and history of tethered cord.

Effects of Alberta Family Integrated Care (FICare) on Preterm Infant Development: Two Studies at 2 Months and between 6 and 24 Months Corrected Age.

Preterm infants are at increased risk for developmental delays. Family integrated care (FICare) is a novel care delivery model that integrates parents into their infant's care in the neonatal intensive care unit. Two follow-up studies are presented to identify effects of Alberta FICare™ on the development of preterm infants born between 32 and 34 weeks of gestation. Data for Study 1 were collected at an age of 2 months, and between 6 and 24 months for Study 2. In Study 1, Ages and Stages Questionnaires (ASQ) and maternal psychosocial distress measures were completed by 330 mothers of 387 infants (FICare, n = 223; standard care, n = 164). Study 2 utilised an additional measure, the Parent-Child Interaction Teaching Scale, with 50 mothers of 61 infants (FICare, n = 30; standard care, n = 31). For Study 1, there was no effect of Alberta FICare™ on the ASQ domains of communication, problem solving, or personal-social at an age of 2 months. For Study 2, the risk of communication delay was significantly lower for infants in Alberta FICare™ compared with standard care. Results from Study 2 suggest a possible protective effect of Alberta FICare™ for the risk of communication delays between 6 and 24 months. Further investigation into the effect of Alberta FICare™ on parent-child interactions and implications for long-term development is warranted.

Petrobactin is the primary siderophore synthesized by Bacillus anthracis str. Sterne under conditions of iron starvation.

The siderophores of Bacillus anthracis are critical for the pathogen's proliferation and may be necessary for its virulence. Bacillus anthracis str. Sterne cells were cultured in iron free media and the siderophores produced were isolated and purified using a combination of XAD-2 resin, reverse-phase FPLC, and size exclusion chromatography. A combination of 1H and 13C NMR spectroscopy, UV spectroscopy and ESI-MS/MS fragmentation were used to identify the primary siderophore as petrobactin, a catecholate species containing unusual 3,4-dihydroxybenzoate moieties, previously only identified in extracts of Marinobacter hydrocarbonoclasticus. A secondary siderophore was observed and structural analysis of this species is consistent with that reported for bacillibactin, a siderophore observed in many species of bacilli. This is the first structural characterization of a siderophore from B. anthracis, as well as the first characterization of a 3,4-DHB containing catecholate in a pathogen.