Scale of human mobility in the southern Andes (Argentina and Chile): A new framework based on strontium isotopes.

OBJECTIVES: The goal of this article is to assess the scale of human paleomobility and ecological complementarity between the lowlands and highlands in the southern Andes during the last 2,300 years. By providing isotope results for human bone and teeth samples, we assess a hypothesis of "high residential mobility" suggested on the basis of oxygen isotopes from human remains. METHODS: We develop an isotopic assessment of human mobility in a mountain landscape combining strontium and oxygen isotopes. We analyze bone and teeth samples as an approach to life-history changes in spatial residence. Human samples from the main geological units and periods within the last two millennia are selected. RESULTS: We present a framework for the analysis of bioavailable strontium based on the combination of the geological data with isotope results for rodent samples. The 87 Sr/86 Sr values from human samples indicate residential stability within geological regions along life history. When comparing strontium and oxygen values for the same human samples, we record a divergent pattern: while δ18 O values for samples from distant regions overlap widely, there are important differences in 87 Sr/86 Sr values. CONCLUSIONS: Despite the large socio-economic changes recorded, 87 Sr/86 Sr values indicate a persisting scenario of low systematic mobility between the different geological regions. Our results suggest that strontium isotope values provide the most germane means to track patterns of human occupation of distinct regions in complex geological landscapes, offering a much higher spatial resolution than oxygen isotopes in the southern Andes.

Repeated injections of intradetrusor onabotulinumtoxinA as adjunctive treatment of children with neurogenic bladder.

AIM: To evaluate the effects of repeated injections of onabotulinumtoxinA in children with neurogenic bladders refractory to conventional treatment. PATIENTS AND METHODS: A total of 26 children with neurogenic bladder were prospectively studied. Some patients received up to four repeat injections. Patients were reinjected if they showed improvement in voiding diary, score of urinary incontinence and/or urodynamic studies; otherwise, augmentation cystoplasty was indicated. RESULTS: Of the 26 patients, 12 were reinjected a second time, 6 patients were reinjected a third time and 2 patients received a repeat injection for the fourth time. Six months after the first, second and third injection, the urinary incontinence score 0 (dry) was 50, 77 and 75 %, respectively. After each injection, the mean bladder capacity in voiding diary and the mean maximum cystometric capacity increased. The mean detrusor pressure at the end of filling decreased. Only compliance after the first injection improved significantly. Detrusor overactivity (n: 4), improved during 3 months and reappeared in three children after the first injection, but at greater cystometric volumes. In the fourth case, it reappeared 11 months after the third injection. Five patients underwent cystoplasty. CONCLUSION: After treatment with onabotulinumtoxinA, urinary continence achieved was 50-77 %. There were favorable changes in urodynamic variables, but they were insufficient. Detrusor overactivity was attenuated, but did not disappear completely.

Ureteral replacement with appendix in pediatric renal transplantation.

Ureteral necrosis is an uncommon complication following RT which can adversely affect outcome. Even though authors agree that the native ureter ought to be preserved, there are cases in which graft function can only be salvaged by ureteral substitution. The scant references in the literature on the use of the appendix for left ureteral replacement in children prompted us to report the following two cases in whom the technique was employed and to assess the evolution of graft function in these patients.

Outcome of renal transplant in patients with abnormal urinary tract.

PURPOSE: To determine whether surgical procedures of the lower urinary tract in patients with uropathies affect evolution of the graft in renal transplantation. METHODS: 156 kidney transplantations were performed in 150 patients with end-stage renal failure due to urologic disorders. The patients were classified into three groups: A, patients who did not require surgery in the lower urinary tract; B, required surgery and preserved adequate bladder function, and C, required surgery due to vesical dysfunction. RESULTS: Graft survival rates at 1 year were 93.38% in group A, 95.45% in group B and 93% in group C. Rates at 5 years post-transplantation were 82.45, 79.85 and 86.58% for each group, respectively (not significant). Complications were vesicoureteral stenosis: 2 in group A, 3 in B and 1 in C; vesicoureteral reflux: 1 in group A, 1 in B and 10 in C; distal ureteral necrosis: 2 cases in group A, 2 in B and 1 in C; upper urinary tract infection: 12, 23.1 and 42.2% in each group, respectively. CONCLUSION: Children with reconstructed urinary tract may be good candidates for kidney transplantation despite the higher frequency of urinary infections. Thus, careful and strict post-surgical urologic follow-up is mandatory.

High flow priapism: diagnosis and treatment in pediatric population.

PURPOSE: To present three cases of arterial high flow priapism (HFP) and propose a management algorithm for this condition. MATERIALS AND METHODS: We studied three children with post-traumatic arterial HFP (two patients with perineal trauma and one with penis trauma). RESULTS: Spontaneous resolution was observed in all the patients. The time of resolution by a return to a completely flaccid penis was different: 14, 27 and 36 days in each case. CONCLUSIONS: Absence of long-term damaging effects of arterial HFP on erectile tissue combined with the possibility of spontaneous resolution associated with blunt perineal trauma are suggestive signs for the introduction of an observation period in the management algorithm of HFP. Such a period may help to avoid unnecessary surgical intervention. Thus, these cases reinforce the decision to manage these patients conservatively and avoid angiographic embolization as a first therapeutic choice.

Physiological and genetic characterization of heat stress effects in a common bean RIL population.

Heat stress is a major abiotic stress factor reducing crop productivity and climate change models predict increasing temperatures in many production regions. Common bean (Phaseolus vulgaris L.) is an important crop for food security in the tropics and heat stress is expected to cause increasing yield losses. To study physiological responses and to characterize the genetics of heat stress tolerance, we evaluated the recombinant inbred line (RIL) population IJR (Indeterminate Jamaica Red) x AFR298 of the Andean gene pool. Heat stress (HS) conditions in the field affected many traits across the reproductive phase. High nighttime temperatures appeared to have larger effects than maximum daytime temperatures. Yield was reduced compared to non-stress conditions by 37% and 26% in 2016 and 2017 seasons, respectively. The image analysis tool HYRBEAN was developed to evaluate pollen viability (PolVia). A significant reduction of PolVia was observed in HS and higher viability was correlated with yield only under stress conditions. In susceptible lines the reproductive phase was extended and defects in the initiation of seed, seed fill and seed formation were identified reducing grain quality. Higher yields under HS were correlated with early flowering, high pollen viability and effective seed filling. Quantitative trait loci (QTL) analysis revealed a QTL for both pod harvest index and PolVia on chromosome Pv05, for which the more heat tolerant parent IJR contributed the positive allele. Also, on chromosome Pv08 a QTL from IJR improved PolVia and the yield component pods per plant. HS affected several traits during the whole reproductive development, from floral induction to grain quality traits, indicating a general heat perception affecting many reproductive processes. Identification of tolerant germplasm, indicator traits for heat tolerance and molecular tools will help to breed heat tolerant varieties to face future climate change effects.

Multi-isotopic and morphometric evidence for the migration of farmers leading up to the Inka conquest of the southern Andes.

We present isotopic and morphometric evidence suggesting the migration of farmers in the southern Andes in the period AD 1270-1420, leading up to the Inka conquest occurring ~ AD 1400. This is based on the interdisciplinary study of human remains from archaeological cemeteries in the Andean Uspallata Valley (Argentina), located in the southern frontier of the Inka Empire. The studied samples span AD 800-1500, encompassing the highly dynamic Late Intermediate Period and culminating with the imperial expansion. Our research combines a macro-regional study of human paleomobility and migration based on a new strontium isoscape across the Andes that allows identifying locals and migrants, a geometric morphometric analysis of cranio-facial morphology suggesting separate ancestral lineages, and a paleodietary reconstruction based on stable isotopes showing that the migrants had diets exceptionally high in C4 plants and largely based on maize agriculture. Significantly, this migration influx occurred during a period of regional demographic increase and would have been part of a widespread period of change in settlement patterns and population movements that preceded the Inka expansion. These processes increased local social diversity and may have been subsequently utilized by the Inka to channel interaction with the local societies.

Transforming growth factor-beta1 in congenital ureteropelvic junction obstruction: diagnosis and follow-up.

OBJECTIVE: To assess the role of transforming growth factor-beta1 (TGF-beta1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIALS AND METHODS: We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-beta1 and other markers were measured pre-, intra- and postoperatively. RESULTS: The mean bladder urine TGF-beta1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL +/- 16.8 vs. 35.8 pg/mL +/- 16.2; p = 0.0001). The mean renal pelvic urine TGF-beta1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL +/- 43.9 vs. 92.5 pg/mL +/- 16.8; p = 0.036). Postoperative mean TGF-beta1 concentration was significantly lower than preoperative TGF-beta1 (48.7 pg/mL +/- 13.1 vs. 92.5 pg/mL +/- 16.8; p = 0.0001). CONCLUSION: TGF-beta1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-beta1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.

The Negative Core Beliefs Inventory: Development and Psychometric Properties.

Although the core belief construct is central in A. T. Beck's cognitive theory, little empirical research has been conducted to date to establish its psychometric properties as well as the way it explains manifestations of psychopathology. The aims of this study were to develop and provide the first evidence of validity and reliability of a new measure of core beliefs that quantifies negative core beliefs about the self (nCB-S) and negative core beliefs about others (nCB-O). Results indicated that this measure has adequate internal consistency and test-retest reliability. Factor analyses confirmed that nCB-S and nCB-O fall on separate dimensions, and they provided preliminary evidence that nCB-S can be separated further into (a) helplessness/inferiority, (b) helplessness/vulnerability, (c) unlovability, and (d) worthlessness. Consistent with expectations, the scores on the nCB-S and nCB-O scales correlated positively with reports of negative experiences in childhood, attachment styles, anxiety, and depression. These preliminary results suggest that core beliefs can be measured in a reliable and valid manner and that the instrument proposed in this article can be used in studies designed to validate aspects of A. T. Beck's cognitive theory.

Comparative, Prospective, Case-Control Study of Open versus Laparoscopic Pyeloplasty in Children with Ureteropelvic Junction Obstruction: Long-term Results.

INTRODUCTION: We compare open pyeloplasty (OP) versus laparoscopic pyeloplasty (LP) in children in a multicenter, prospective, case-control study. MATERIALS AND METHODS: From May 2007 to March 2009, a program was established at Hospital Garrahan, the reference center, to perform LP with a mentoring surgeon that would attend the institution once a month. Every new case of ureteropelvic junction obstruction (UPJO) diagnosed in the reference institution was offered to participate in the study. If the patient was enrolled, it was scheduled for LP. The following patient diagnosed with UPJO was operated on with open technique and served as a case-control. In three other facilities, patients were only offered LP and had a matched control open case at the reference institution. The first end point of the study was patient recovery: analgesia requirement and length of hospitalization (LOH). The second end point of the study was resolution of UPJO in long-term follow-up for the two techniques. Demographic data, surgical time, perioperative complications, analgesia requirement, analgesia score during hospitalization, LOH, and outcome were recorded. Both groups received the same postoperative indications for pain control. Parents were asked to assess pain in their children every 4 h postoperatively and to complete a pain scale chart to which the nurses were blinded. RESULTS: Fifteen OP and 15 LP were compared. Groups were similar with regard to sex, age, weight, and laterality. Mean surgical time was longer in LP than in OP group (mean 188 versus 65 min) (p < 0.01). Hospitalization was shorter for LP group with a mean of 1.9 versus 2.5 days for OP group (p < 0.05). Postoperative analgesia requirement was significantly higher in the OP group with a mean use of morphine of 1.7 versus 0.06 mg/kg in the LP group (p < 0.05). Pain scores were similar in both the groups. At a mean follow-up of 58 months there were no failures. CONCLUSION: In this prospective comparative cohort, LP was a longer procedure than OP. Both procedures had the same efficacy and complication rates, but patients undergoing LP needed fewer narcotics for pain control and had a shorter hospitalization.

Pseudoaneurisma de artéria femoral comum em paciente covid19: relato de caso / Pseudoaneurysm of the common femoral artery in a covid-19 patient: case report / Pseudoaneurisma de la arteria femoral común en un paciente con covid-19: estudio de caso

Introdução: O pseudoaneurisma pode ser definido como um hematoma pulsátil resultante de uma laceração de uma artéria em que há extravasamento de sangue contido pelos tecidos circunvizinhos. Dessa forma, cria-se uma comunicação entre a artéria e uma cavidade, que receberá fluxo sistólico. As principais etiologias incluem traumas, pós procedimento, pós cirurgia vascular e infecções. Objetivo: Relatar o caso de uma paciente com pseudoaneurisma de artéria femoral, durante quadro de COVID-19. Método: Relato de caso baseado na análise de prontuário médico, exames de imagem e revisão da literatura. Relato de caso: Apresentamos uma paciente do sexo feminino, com 79 anos, com diagnóstico de pseudoaneurisma em Artéria Femoral Comum após realização de cateterismo arterial e durante quadro de COVID-19. No pós operatório, paciente evoluiu com deiscência e necrose da ferida operatória. Conclusão: A escolha cirúrgica foi eficaz e relativamente segura. Uso de aparato cirúrgico específico para a paciente positiva para COVID-19 foi necessário. A evolução complicada da ferida operatória possui associação ao crescimento de bactérias multirresistentes devido à internação e ao estado geral grave pós COVID-19.(AU)

Introduction: The pseudoaneurysm can be defined as a pulsatile hematoma resulting from a laceration of an artery in which there is extravasation of blood contained by the surrounding tissues. This creates a communication between the artery and a cavity, which will receive systolic flow. The main etiologies include trauma, post-procedure, post-vascular surgery and infections. Objective: To report the case of a patient with pseudoaneurysm of the femoral artery, during COVID-19. Materials and Methods: Case report based on medical record analysis, imaging tests and literature review. Case report: We present a female patient, aged 79, diagnosed with pseudoaneurysm in Common Femoral Artery after arterial catheterization and during COVID-19. In the postoperative period, the patient evolved with dehiscence and necrosis of the operative wound. Conclusion: The surgical choice was effective and relatively safe. Use of specific surgical apparatus for the patient positive for COVID-19 was necessary. The complicated evolution of the surgical wound is associated with the growth of multidrug-resistant bacteria due to hospitalization and severe general condition after COVID-19.(AU)

Introducción: El pseudoaneurisma se puede definir como un hematoma pulsátil resultante de la laceración de una arteria en la que hay extravasación de sangre contenida por los tejidos circundantes. De esta forma, se crea una comunicación entre la arteria y una cavidad, que recibirá el flujo sistólico. Las principales etiologías incluyen trauma, post-procedimiento, post-cirugía vascular e infecciones. Objetivo: Reportar el caso de un paciente con pseudoaneurisma de la arteria femoral durante la COVID-19. Método: Reporte de caso basado en análisis de historias clínicas, pruebas de imagen y revisión de la literatura. Caso clínico: Presentamos una paciente de 79 años diagnosticada de pseudoaneurisma en la arteria femoral común tras cateterismo arterial y durante la COVID-19. En el postoperatorio la paciente evolucionó con dehiscencia y necrosis de la herida quirúrgica. Conclusión: La elección quirúrgica fue efectiva y relativamente segura. Fue necesario el uso de aparato quirúrgico específico para el paciente COVID-19 positivo. La complicada evolución de la herida quirúrgica se asocia al crecimiento de bacterias multirresistentes por la hospitalización y el grave estado general tras la COVID-19.(AU)

Initial urological evaluation and management of children with neurogenic bladder due to myelomeningocele.

INTRODUCTION: The proactive management of children with myelomeningocele (MMC) has contributed to decreasing their progression to end-stage renal disease, thanks to early urological evaluation and timing implementation of treatments. OBJECTIVE: To demonstrate that early urological evaluation of the urinary tract in MMC shows functional alterations in most cases, and that it requires medical intervention, even when in some cases the complementary imaging studies do not show any abnormalities. MATERIAL AND METHODS: A retrospective study including 60 patients aged <1 year with MMC who were followed by a multidisciplinary team. All of them underwent renal/bladder ultrasound, videourodynamic studies, renal scintigraphy/dimercaptosuccinic acid (DMSA), and laboratory tests for kidney function. The studied variables were: bladder capacity and pressure, presence of overactivity, vesicoureteral reflux (VUR), urinary dilations and abnormalities on renal scintigraphy/DMSA. All the patients received clean intermittent catheterization (CIC). RESULTS: See Summary Table all the patients showed alterations in at least some of the assessed urodynamic variables: reduced cystometric capacity, 21.6%; detrusor overactivity, 55%; end filling detrusor pressure >20 cm H2O, 43.3%; inefficient bladder voiding, 98.3%; indirect dyssynergic patterns, 28.8%. The high-risk videourodynamic findings were observed in 28 cases (46.6%). DMSA was abnormal in 30%. Renal impairment was detected in 6.6% of cases. A total of 66% of cases received oxybutynin. DISCUSSION: Almost all the children in this sample population showed urinary dysfunction, and approximately half of them had high-risk videourodynamic findings. Although many cases showed reflex urinary contractions, almost the entire sample had inefficient bladder voiding. An important limitation of this work was the lack of simultaneity in obtaining each of the requested studies. CONCLUSIONS: In the initial urological evaluation of patients with myelomeningocele, almost all the urodynamic studies showed abnormalities and one-third showed abnormal DMSA, which led to therapeutic actions being initiated, although imaging studies were normal in a great number of patients. CIC alone, starting immediately after birth, is not sufficient. To eliminate or decrease upper tract damage, oxybutynin should be started in addition.

Policy Implications of Achievement Testing Using Multilevel Models: The Case of Brazilian Elementary Schools.

Large-scale educational assessment has been established as source of descriptive, evaluative and interpretative information that influence educational policies worldwide throughout the last third of the twentieth century. In the 1990s the Brazilian Ministry of Education developed the National Basic Education Assessment System (SAEB) that regularly measures management, resource and contextual school features and academic achievement in public and private institutions. In 2005, after significant piloting and review of the SAEB, a new sampling strategy was taken and Prova Brasil became the new instrument used by the Ministry to assess skills in Portuguese (reading comprehension) and Mathematics (problem solving), as well as collecting contextual information concerning the school, principal, teacher, and the students. This study aims to identify which variables are predictors of academic achievement of fifth grade students on Prova Brasil. Across a large sample of students, multilevel models tested a large number of variables relevant to student achievement. This approach uncovered critical variables not commonly seen as significant in light of other achievement determinants, including student habits, teacher ethnicity, and school technological resources. As such, this approach demonstrates the value of MLM to appropriately nuanced educational policies that reflect critical influences on student achievement. Its implications for wider application for psychology studies that may have relevant impacts for policy are also discussed.

Synergistic roles of climate warming and human occupation in Patagonian megafaunal extinctions during the Last Deglaciation.

The causes of Late Pleistocene megafaunal extinctions (60,000 to 11,650 years ago, hereafter 60 to 11.65 ka) remain contentious, with major phases coinciding with both human arrival and climate change around the world. The Americas provide a unique opportunity to disentangle these factors as human colonization took place over a narrow time frame (~15 to 14.6 ka) but during contrasting temperature trends across each continent. Unfortunately, limited data sets in South America have so far precluded detailed comparison. We analyze genetic and radiocarbon data from 89 and 71 Patagonian megafaunal bones, respectively, more than doubling the high-quality Pleistocene megafaunal radiocarbon data sets from the region. We identify a narrow megafaunal extinction phase 12,280 ± 110 years ago, some 1 to 3 thousand years after initial human presence in the area. Although humans arrived immediately prior to a cold phase, the Antarctic Cold Reversal stadial, megafaunal extinctions did not occur until the stadial finished and the subsequent warming phase commenced some 1 to 3 thousand years later. The increased resolution provided by the Patagonian material reveals that the sequence of climate and extinction events in North and South America were temporally inverted, but in both cases, megafaunal extinctions did not occur until human presence and climate warming coincided. Overall, metapopulation processes involving subpopulation connectivity on a continental scale appear to have been critical for megafaunal species survival of both climate change and human impacts.

Cross-cultural validation of a behavioral screener for executive functions: Guidelines for clinical use among Colombian children with and without ADHD.

Garcia-Barrera, Kamphaus, and Bandalos (2011) derived a 25-item executive functioning screener from the Behavior Assessment System for Children (BASC), measuring 4 latent executive constructs: problem solving, attentional control, behavioral control, and emotional control. The current study included a cross-cultural examination of this screener in Colombian children with and without attention-deficit/hyperactivity disorder (ADHD). BASC teacher ratings were collected for Colombian children ages 6-11 years (848 healthy children [53% boys] and 155 children with ADHD [76% boys]). To examine the psychometric properties of the screener, a multistep procedure was implemented, including (a) confirmatory factor analysis (CFA) and factorial invariance testing across gender, age group (6-8 years, 9-11 years), and ADHD status to replicate and extend the original derivation; (b) item response theory (IRT) analysis to evaluate the information provided by individual items; and (c) given IRT results, a repeated CFA and invariance testing after the exclusion of 1 item from the problem-solving factor. The 24-item 4-factor model fit was adequate for controls and for ADHD participants. Results support the use of the 24-item executive functioning screener in a cross-cultural context. In turn, in supplemental material, normative data for the Colombian sample are reported along with bilingual guidelines (i.e., Spanish/English) for implementing the screener in clinical practice. Even though the screener is useful when examining executive functions, it was not designed as a diagnostic measure for developmental disorders such as ADHD; as such, it should only inform about status of executive functioning.

The use of polyacrylate-polyalcohol copolymer hydrogel in the endoscopic treatment of primary vesicoureteral reflux in children.

BACKGROUND/PURPOSE: It is still under discussion which is the best tissue augmenting substance for the endoscopic treatment of children with vesicoureteral reflux (VUR). We describe our preliminary experience (September 2009-November 2011) with polyacrylate-polyalcohol copolymer hydrogel (PPCH). METHODS: This is an observational, descriptive, prospective study which included 81 female and male patients (age 1-14 years) diagnosed with unilateral (n=45) and bilateral (n=36) primary VUR comprising a total of 117 refluxing renal units (RRU). Complex cases were excluded from the study. All patients were clinically and radiologically evaluated and those who met the inclusion criteria were treated endoscopically with a single subureteral injection of PPCH by a single surgeon. 11 patients (13.5%) had a pathological 99mTc-DMSA before treatment. The volume of injected product was measured in all cases. Results were considered successful if 6months postinjection, conventional voiding cystourethrogram (VCUG) revealed VUR was cured (Grade 0). Follow-up ranged from 7 to 32months. RESULTS: The overall resolution rate based on the number of RRUs studied was 92.3% (108/117). The mean injected volume of PPCH per patient was 0.6ml. One patient with obstructive anuria required vesicoureteral reimplantation. Other complications were persistent, self-limiting hematuria (n=2); lumbar pain (n=4) and urinary tract infection with normal VCUG (n=4). CONCLUSIONS: Our short term data show PPCH provides a high level of reflux resolution in selected patients. Long term follow-up is required.

Normative data of the Barratt Impulsiveness Scale 11 (BIS-11) for Brazilian adults.

OBJECTIVE: The Barratt Impulsiveness Scale (BIS-11) is a valid and reliable instrument, and one of the most often used tools to assess impulsivity. This study assesses the performance of a large sample of adults by using a version of BIS-11 adapted to Brazilian Portuguese. METHODS: We assessed 3,053 adults from eight Brazilian states. Internal consistencies and performance data were presented for two correction criteria of BIS-11: original and the two-factor score. RESULTS: The associations between age, sex, region, and education and the BIS-11 scores present very small effect sizes. Therefore, we provided a percentile rank parameter for the different BIS-11 subscores considering the whole sample. Given the internal consistency of the two correction systems, we found that only the two-factor system fulfills the psychometric criteria of Cronbach's alpha (cutoff value of at least 0.6). CONCLUSION: Our results support the use of the Brazilian adaptation of BIS-11 in different regions of the country as a measure of impulsivity. Since high impulsiveness is a characteristic of several dysfunctional behaviors, the establishment of normative parameters is of utmost relevance and should be extended to other age ranges and populations in future studies.

Multicenter survey of endoscopic treatment of vesicoureteral reflux using polyacrylate-polyalcohol bulking copolymer (Vantris).

OBJECTIVE: To evaluate an outcome of endoscopic correction of vesicoureteral reflux (VUR) using Vantris (Promedon, Cordoba, Argentina) in terms of its effectiveness and morbidity in a multicenter study. MATERIALS AND METHODS: From 2009 to 2013, 611 patients (210 boys and 401 girls) with a mean age of 3.56 years (range, 1 month-18 years) were treated at 7 centers worldwide endoscopically with Vantris injection. VUR was unilateral in 413 and bilateral in 198 patients comprising 809 renal refluxing units (RRUs). Of these, primary VUR was present in 674 RRUs (83.3%) and 135 (16.7%) were complex cases. Reflux was grades I-V in 24 (2.96%), 123 (15.2%), 451 (55.8%), 158 (19.5%), and 53 (6.6%) RRUs respectively. The follow-up continued from 6 to 54 months. RESULTS: Reflux resolved in 759 RRUs (93.8%) after first Vantris injection, in 26 (3.1%) after second, and in 6 (0.7%) after third injection, respectively. VUR improved to grade I after 1 or 2 injections in 5 ureters (0.6%), which needed no further treatment. Thirteen ureters (1.6%) failed endoscopic correction and required ureteral reimplantation. Vesicoureteral junction obstruction requiring ureteral reimplantation developed in 6 ureters (0.7%) and in 4 (0.5%) required stent insertion. Twenty-three patients (3.8%) suffered afebrile urinary tract infection. Seven (1.2%) developed febrile urinary tract infection. None of the studied patients demonstrated VUR recurrence on voiding cystourethrography. CONCLUSION: The results of this multicenter survey confirm that endoscopic subureteral Vantris injection is a simple, safe, and effective outpatient procedure for treating all grades of VUR.

Laparoscopic Mitrofanoff procedure using single 'U-Stitch' anastomosis: a way to make it simple.

OBJECTIVE: to describe and incorporate a modification of the fully laparoscopic Mitrofanoff (LM) procedure with the aim of diminishing operative time and technical difficulties, and to reproduce functional results. PATIENTS AND METHODS: Retrospective review of six patients with voiding dysfunction with indication for clean intermittent catheterization who did not require bladder augmentation and who underwent a fully LM procedure between January and November 2011. RESULTS: The mean operative time was 183.3 min with a mean hospital stay of 6.15 days. No complications were recorded during the surgical procedure. Postoperative hematuria is the most frequent complication associated with this technique. One patient presented appendicovesical anastomotic leak that resolved spontaneously after 8 days with abdominal drainage. There were no other postoperative complications on an average 6.8-month follow up. CONCLUSION: We believe fully LM is a feasible and reproducible approach. The U-Stitch appendix implantation technique reduces total operative time and makes the procedure technically easier.

Pharmacotherapy in pediatric neurogenic bladder intravesical botulinum toxin type a.

When the neurogenic bladder is refractory to anticholinergics, botulinum toxin type A is used as an alternative. The neurotoxin type A reduces bladder pressure and increases its capacity and wall compliance. Additionally, it contributes to improving urinary continence and quality of life. This novel therapy is ambulatory with a low incidence of adverse effects. Due to its transitory effect, it is necessary to repeat the injections in order to sustain its therapeutic effect. In these review article we talk about Mechanism of Action, Indications, effects, administration and presentations of the Botulinum Neurotoxin Type A in pediatric patients. Also, we make references to controversial issues surrounding its use. A bibliographic search was done selecting articles and revisions from Pubmed. The key words used were botulinum toxin A, neurogenic bladder, and children. The search was limited to patients younger than 18 years of age and reports written in English in the past ten years.