A Structured Training for Trans Anal Irrigation in Pediatric Patients Improves Outcomes and Reduce Failures: Results of an Interventional Multicenter Prospective Study.

BACKGROUND: Continence issues due to organic causes including previous colorectal surgery or neurological issues might benefit from Transanal irrigation (TAI) that proved to be highly effective but with a number of limitations including a relatively high discontinuation rates. Our study was aimed at evaluating the efficacy of an advanced protocol tailored to each patient to prevent dropout and increase satisfaction, independence, and quality of life. MATERIALS AND METHODS: This was a prospective, interventional, multicenter, nonrandomized study involving children aged 4-18 years with bowel dysfunction unresponsive to conventional treatments who required TAI. TAI was performed in accordance to the best standards of care with a total irrigation volume that was determined based on low emission X-Ray barium enemas performed at the very beginning of the study. All patients underwent training and assessments of continence, patients' perspectives and quality of life were performed at different timepoints from enrollment (T0) up to 6 months since TAI was introduced (T3). RESULTS: A total of 78 patients were enrolled. Male to female ratio was 1.4:1. Mean age at enrollment was 106.1 ± 42.8 months. Discontinuation was reported by 3 patients (3.8 %). Continence, satisfaction and a number of other outcome measures increased from baseline (T0) to the last visit (T3). In particular, mean Rintala total score increased linearly from 7.8 to 14.8 during the study period (T0 to T3 timepoints). On a multivariate analysis, the only parameter that proved to be inversely associated with continence as well as with other outcome measures was the use of laxatives at enrollment and during the study. CONCLUSIONS: This study has demonstrated the high efficacy of this innovative patient-tailored TAI protocol across all assessed scores. Of note, given the negative impact of laxatives, our findings suggest limiting their use in this patient population to further increase the efficacy of the procedure.

Cochlear implantation in single-sided deafness: a single-center experience of 138 cases.

OBJECTIVES: Assess the outcomes in patients who underwent cochlear implant (CI) for single-sided deafness (SSD). METHODS: All patients affected by SSD who underwent CI at Gruppo Otologico, Piacenza, from October 2012 to May 2022 with at least 6 months of follow-up were selected in the study group. The analysis included subjective and objective measures performed pre-operative and up to 24 months after surgery. Hearing threshold on both sides was evaluated with a weighted four-frequency average (PTA [0.5 kHz + 1 kHz + 2 kHz + 4 kHz]/4) on pure tone audiometry and speech audiometry (Speech Discrimination Score, SDS). The Speech Spatial and Qualities of Hearing scale (SSQ Questionnaire) for binaural hearing benefits and sound localization, the Tinnitus Handicap Inventory Questionnaire (THI) and Dizziness Handicap Inventory Questionnaire (DHI) were used for subjective assessment. RESULTS: Data from 138 patients, 69 males and 69 females, (mean age 49 years, range 17-77 years) underwent CI for SSD were examined. Single-sided hearing deprivation average before undergoing CI surgery was 2.5 years (range 3 months-35 years). There was a significant reduction of THI and DHI scores compared to pre-operative scores alongside a referred improvement in social, physical, and emotional well-being through the SSQ questionnaire. CONCLUSIONS: To the best of our knowledge, this paper descried the largest cohort of SSD who underwent CI in a single institution. According to our findings CI in patients affected by SSD represents a valuable tool for an overall improvement of tinnitus and dizziness but also quality of life, after at least 6 months of follow-up. Further studies are desirable to improve rehabilitation pathways and possibly set new standards of care of this condition.

Hiperplasia endotelial papilar intravascular (tumor Masson) de localización ginecológica / Intravascular papillary endothelial hyperplasia (Masson's tumour) of gynaecological origin

La hiperplasia papilar endotelial intravascular o tumor de Masson es una lesión vascular no neoplásica de carácter reactivo. Se caracteriza por ser un tumor poco frecuente, clínicamente inespecífico y con localizaciones descritas muy diversas. Resulta fundamental tenerlo en consideración dentro del diagnóstico diferencial de los tumores vasculares malignos como el angiosarcoma, cuyo pronóstico es muy diferente. Para lograr su diagnóstico definitivo el estudio anatomopatológico resulta primordial. El tratamiento de elección es la exéresis quirúrgica asegurando márgenes libres de enfermedad. El presente caso reportado supone un hecho excepcional, al ser un tumor de Masson de localización pélvica, cuyo diagnóstico fue un hallazgo casual propiciado por el estudio de estadificación quirúrgica de un adenocarcinoma de ovario.

Intravascular papillary endothelial hyperplasia or Masson's tumour is a non-neoplastic vascular lesion of reactive character. It is a rare diagnosis, clinically non-specific and with diverse locations. It is essential to take it into consideration and make a differential diagnosis with malignant vascular tumours such as angiosarcoma. Pathological study is fundamental for diagnosis. Treatment consists of complete resection of the tumour, including sufficiently wide margins to avoid recurrence.The case reported is an exceptional event, because of the pelvic location of the Masson's tumour that was diagnosed as part of the surgical staging of an ovarian cancer.

Perforación intestinal tras ablación por radiofrecuencia de mioma uterino. Reporte de caso y revisión bibliográfica / Intestinal perforation after transvaginal radiofrequency ablation of uterine leiomyoma. Case report and literature review

El mioma uterino es la tumoración pélvica más frecuentemente diagnosticada en mujeres en edad reproductiva. En los últimos años se ha producido una búsqueda de tratamientos mínimamente invasivos que permitan conservar el útero. La ablación por radiofrecuencia vía transvaginal permite el tratamiento de los miomas uterinos de forma segura y efectiva.Presentamos un inusual caso clínico de perforación intestinal tras la ablación por radiofrecuencia de dos miomas y presentamos una revisión de la literatura existente en relación a esta complicación de la técnica.

Uterine leiomyoma are the most common pelvic tumours diagnosed in women of reproductive age. In recent years, the search for minimally invasive treatment that allows women to preserve their uterus has resulted in transvaginal radiofrequency ablation. This procedure is safe and effective.We present a case report of intestinal perforation after transvaginal radiofrequency ablation of two uterine leiomyomas. Finally, we present a review of the literature in relation to this complication of the technique.

Genomic characterisation of Escherichia coli isolates co-producing NDM-5 and OXA-1 from hospitalised patients with invasive infections.

OBJECTIVES: Carbapenems are one of the last-report therapeutic choices to treat infections due to multidrug-resistant (MDR) micro-organisms. For this reason, the spread of carbapenemase-producing Enterobacteriaceae represents a serious health-public problem. Here we describe isolates co-producing blaNDM-5 and blaOXA-1. METHODS: Three Escherichia coli isolates obtained from patients with invasive infections were analysed by phenotypic antibiotic susceptibility testing and whole-genome sequencing (WGS). RESULTS: All of the isolates were resistant to carbapenems, most ß-lactam antibiotics, piperacillin/tazobactam, amoxicillin/clavulanic acid and ciprofloxacin, remaining susceptible to amikacin, fosfomycin, colistin and tigecycline. The isolates belonged to sequence types ST44, ST405 and ST167 and co-harboured the blaNDM-5 and blaOXA-1 genes. Two of the isolates also harboured extended-spectrum ß-lactamase (ESBL) genes (blaCTX-M-15 and blaTEM-1b). The blaNDM-5 gene was probably carried chromosomally even if different plasmids were identified. Various virulence genes were also identified. CONCLUSION: Our results highlight that continuous surveillance is essential to monitor the spread of clinically important MDR pathogens.

In vitro inhibitory effect of two commercial probiotics on chromogenic actinomycetes.

PURPOSE: Black extrinsic discoloration is a common clinical and aesthetic problem. This study aims to evaluate the potential in vitro antagonistic activity of two commercial probiotics, Streptococcus salivarius M18 and Lactobacillus reuteri ProDentis, against microorganisms associated with black stains. METHODS: Streptococcus salivarius M18 and Lactobacillus reuteri were tested against Aggregatibacter actinomycetemcomitans and Actinomyces naeslundiiusing their cell-free fermentative broth in a planktonic growth inhibition test. RESULTS: Both probiotic cell-free supernatants showed the ability to reduce the pathogenic bacteria growth in a dose-dependent way. Streptococcus salivarius M18 showed a stronger antimicrobial activity than Lactobacillus reuteri ProDentis against the two indicator strains used. A. naeslundi was less susceptible to the probiotic activity of both S. salivarius and L. reuteri compared to A. actinomycetemcomitans. CONCLUSIONS: The obtained results demonstrate a potent antagonistic ability of probiotics to reduce the growth of microorganisms associated with black tooth stains. Therefore, these strains could be evaluated for a therapeutic use against dental pigmentations.

Correlation between tcdB gene PCR cycle threshold and severe Clostridium difficile disease.

A retrospective study, including all samples tested for Clostridium difficile from 2015 to 2018, was conducted. 222 and 199 patients were respectively classified as having a mild/moderate or severe disease. A CT ≤ 26 was significantly associated with severe disease. Furthermore, low CT values were significantly associated to older patients and leukocytosis.

Prenatal diagnosis, natural history, postnatal treatment and outcome of 222 cases of spina bifida: experience of a tertiary center.

OBJECTIVES: To report on the prenatal ultrasonographic diagnosis of spina bifida (SB) and its natural history, treatment and long-term outcome in a large tertiary referral center. METHODS: All cases of SB diagnosed between February 1980 and December 2015 in the Obstetric Prenatal Diagnosis Day Unit of the Obstetrics and Gynecology Department at the Catholic University of the Sacred Heart, Rome, were reviewed. All infants with an open defect were delivered by elective Cesarean section and underwent early repair of the spinal defect. A ventriculoperitoneal (VP) shunt and/or third ventriculostomy was performed when needed. Complete postnatal follow-up was carried out by our multidisciplinary team in the majority of cases. The cohort was analyzed in two groups: Group 1 included patients referred between February 1980 and December 1999; Group 2 included patients referred between January 2000 and December 2015. RESULTS: There was a total of 222 cases of SB with a prenatal diagnosis rate of 94.6% (n = 210), with the majority of defects being meningomyeloceles (n = 142 (64.0%)), affecting the lumbosacral level (n = 110 (49.5%)) and being ≥ 2 cm in size (n = 163/195 (83.6%)). There were 174 (78.4%) live births, with more terminations in Group 2 (26.1%) than in Group 1 (10.8%; P = 0.003). Postnatal surgical repair was conducted in 157 cases (99.4% of eligible cases), with death of an infant who was operated on occurring more often in Group 1 (14.1%) than in Group 2 (4.2%; P = 0.03). VP shunt placement was required in 60.3% of infants operated on after January 2000. Long-term follow-up was available for 136 children (111 with open defects and 25 with closed defects). Infants born since 2000 with an open defect had normal ambulation or a mild defect in 50% of cases and normal or mild deficit of sphincter function in 37.8% of cases. An intelligence quotient of ≥ 70 was observed in the majority of children (81.4%; 35/43 cases). Worse motor function was associated with progressive prenatal ventriculomegaly, level of lesion and VP shunt placement. CONCLUSIONS: We describe the prenatal diagnosis, natural history and long-term outcome of a large contemporary cohort of SB fetuses and infants. In an era of pioneering fetal surgical techniques for in-utero SB repair, it is important to acknowledge that advances in conventional neonatology and pediatric neurosurgery have allowed increased life expectancy and improved quality of life in patients with SB. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Obesity in pregnancy as a model to identify women at risk for later metabolic syndrome.

The aim of our study is to identify - in a cohort of obese women - cardiovascular and clinical risk factors in women with previous complicated pregnancies and protective factors in women with previous physiological pregnancies. A total of 135 nonpregnant obese women referring to Policlinico Gemelli in Rome were prospectively collected in 2009-2010. Thirty-two women matched inclusion criteria: 16 reported a previous physiological pregnancy and 16 reported previous obstetric complications. A clinical, instrumental and laboratory evaluation has been performed for each patient. Statistical analysis was performed using StatView Software. Values are expressed as mean ± standard error (SEM). All tests were two-tailed with a confidence level of 95% (p < .05). Statistically significant reduced flow-mediated dilatation (p = .0338), increased serum values of vascular cell adhesion molecule (p = .0154) and higher systolic blood pressure values (p = .0427) have been detected in obese women with previous complicated pregnancies due to gestational diabetes and/or hypertension. In conclusion, obese patients with previous complicated pregnancies develop signs of endothelial dysfunction in the postpartum period. Future research should focus on the early identification of possible molecular mechanisms implicated in the development of glyco-metabolic and cardiovascular diseases in obese patients, since they are at higher risk of metabolic syndrome.

Valoración del esquema diagnóstico y perfil de respuesta de anticuerpos frente a antígenos recombinantes en enfermedad de Chagas congénita / Assessment of the diagnostic scheme and antibody response profile against recombinant antigens in congenital Chagas disease

INTRODUCCIÓN En Argentina se estima que el número de infectados con T.cruzi es de 1600000 personas. El esquema diagnóstico propone la búsqueda del T.cruzi por métodos de concentración, como el microhematocrito en todo hijo de madre con enfermedad de Chagas. En aquellos con parasitemia negativa debe realizarse un estudio serológico luego del momento de desaparición de los anticuerpos maternos. Son escasos los estudios de antígenos recombinantes valorando su utilidad para el diagnóstico de la infección congénita y no han sido estudiados como marcadores de curación en niños. OBJETIVOS Evaluar la aplicación del esquema diagnóstico para la enfermedad de Chagas en centros de salud de referencia de la República Argentina. Valorar la utilidad de la cinética de anticuerpos específicos para diferentes antígenos recombinantes como instrumento de diagnóstico y seguimiento de la enfermedad de Chagas congénita. MÉTODOS Estudio de cohorte de recién nacidos de madre con enfermedad de Chagas. RESULTADOS Se detectaron dificultades en el seguimiento a largo plazo de los pacientes. La serología convencional negativizó en todos los casos a los nueve meses o antes (un solo paciente negativizó a los 10 meses). Los pacientes infectados presentan menor peso, talla y perímetro cefálico que los pacientes sanos. Respecto a los anticuerpos frente a antígenos recombinantes, se pudo observar que los anticuerpos contra TSSA negativizan antes que el Lisado de T.cruzi, tanto en niños infectados sometidos a tratamiento como en niños sanos, nacidos de madres con enfermedad de Chagas. También se pudo observar que los niños tratados antes de los 2 meses de vida negativizan los anticuerpos contra TSSA y Lisado de T.cruzi como los niños sanos nacidos de madres infectadas. DISCUSIÓN Con este estudio queda en evidencia la necesidad de una red de asistencia social sólida, que permita continuar el seguimiento de los pacientes a largo plazo. La utilización del microhematocrito (MH) para la detección del Chagas congénito demostró ser altamente sensible y eficaz.

Invasive Candidiasis in Brescia, Italy: Analysis of Species Distribution and Antifungal Susceptibilities During Seven Years.

The aims of this study were to evaluate the epidemiology of nosocomial candidemia in a large teaching hospital in Brescia, Italy, and the in vitro antifungal susceptibility of isolates. We analyzed 196 isolates causing fungemia in patients admitted in our hospital, between January 2009 and December 2015. Strains were identified by VITEK 2 and MALDI-TOF MS. MICs were determined by Sensititre Yeast OneTM. The resistance was defined by using the revised CLSI breakpoints/epidemiological cutoff values to assign susceptibility or wild type to systemic antifungal agents. Most infections were caused by Candida albicans (60%), Candida parapsilosis (15%), Candida glabrata (12%) and Candida tropicalis (6%). The susceptibility rate for fluconazole was 96.5%. Non-Candida species isolates exhibited full susceptibilities to echinocandins according to CLSI breakpoints. Amphotericin B demonstrated excellent activity against all Candida species. Local epidemiological and antifungal susceptibility studies are necessary in order to improve empirical treatment guidelines.

Distribution of Cr and Pb in artificial sea water and their sorption in marine sediments: an example from experimental mesocosms.

The uptake of two heavy metals (chromium and lead) in sediments in experimental mesocosms under exposure to different metal concentrations was evaluated by monitoring their concentrations over time both in seawater and in sediment. Two separate experiments under laboratory-controlled conditions were carried out for the two metals. Sediments were collected from a protected natural area characterized by low anthropic influence and were placed in mesocosms that were housed in aquaria each with seawater at a different metal concentration. At pre-established time intervals, seawater and sediment samples were collected from each mesocosm for chemical analyses. Quantification of chromium and lead concentration in seawater and sediment samples was carried out by atomic absorption spectrometer with graphite furnace. Low doses of chromium and lead (<1 mg L-1) do not entail an uptake in sediments and waters. At doses ≥1 mg L-1, evolution of concentrations over time shows significant differences between these two metals: (i) chromium absorption from seawater is twice faster than lead; (ii) lead accumulates in considerable amount in sediments. The different behaviour of the two investigated heavy metals could be ascribed to different interactions existing between metal ions and different components of sediment.

Holmium Intraductal Laser Lithotripsy of Biliary Stones in Liver Grafts.

BACKGROUND: Biliary stones after liver transplantation (LT) rarely occur but a focus on those complications and their treatment is needed. PATIENTS AND METHODS: In total, 390 adult patients who underwent an LT from July 2004 to July 2014 entered the study. Biliary complications and notably biliary stones after LT were identified. RESULTS: In total, 365 LT were analyzed. Biliary stones were identified in 14 patients (3.8%). Predictive factors for the onset of biliary stones after LT were hepatocellular diseases (P = .038; OR = 9.7) and biliary stenosis (P = .000; OR = 11.9). Treatments consisted of percutaneous transhepatic procedures (4 patients), endoscopic retrograde procedures (9 patients), and in open surgery (1 case); in 2 cases, due to a failure of previous treatments, holmium intraductal laser lithotripsy (HILL) was used: the first patient, a 35-year-old woman developed multiple intrahepatic biliary stones after LT. Percutaneous transhepatic cholangiography (PTC) was ineffective and a HILL was performed, clearing the right common bile duct but leaving residual stones in the left duct. The patient underwent a retransplantation due to recurrent hepatitis C virus infection but died 3 months later because of graft failure. The second patient, a 42-year-old 14 years after retransplantation, developed biliary sludge and stones; after several attempts with PTC and endoscopic retrograde cholangiopancreatography, a HILL was performed. All stones except one big one were treated. The patient is alive and well. CONCLUSIONS: When usual treatments are unsuccessful and biliary stones are large, their fragmentation and treatment could be done with HILL, a promising procedure after LT.

Gapped Surface States in a Strong-Topological-Insulator Material.

A three-dimensional strong-topological insulator or semimetal hosts topological surface states which are often said to be gapless so long as time-reversal symmetry is preserved. This narrative can be mistaken when surface state degeneracies occur away from time-reversal-invariant momenta. The mirror invariance of the system then becomes essential in protecting the existence of a surface Fermi surface. Here we show that such a case exists in the strong-topological-semimetal Bi(4)Se(3). Angle-resolved photoemission spectroscopy and ab initio calculations reveal partial gapping of surface bands on the Bi(2)Se(3) termination of Bi(4)Se(3)(111), where an 85 meV gap along Γ̅K̅ closes to zero toward the mirror-invariant Γ̅M̅ azimuth. The gap opening is attributed to an interband spin-orbit interaction that mixes states of opposite spin helicity.

Prognostic evaluation of biofeedback response in patients treated for anorectal malformation.

PURPOSE: Functional bowel outcome in patients with anorectal malformation often is poor. For fecal incontinence resulting from sphincter dysfunction, biofeedback (BFB) training appears to be effective. The aim of study was to investigate the bowel function in incontinent children treated for ARM, using a clinical score, a manometric and pelvic magnetic resonance evaluation, in order to establish predictive parameters of response after BFB. METHODS: 25 children (median age of 6.5 years) with true fecal incontinence were evaluated by clinical score, anorectal manometry and magnetic resonance imaging (MRI). According to these evaluations patients were divided in 4 groups: group 1 (favorables manometry and MRI); group 2 (favorable manometry and unfavorable MRI); group 3 (unfavorable manometry and favorable MRI); group 4 (unfavorables manometry and MRI). All groups started a cycle of BFB and six months after end of BFB, were reevaluated by clinical score and manometry. RESULTS: The overall response to BFB was excellent in 44%, discrete in 40% and poor in 16%; a better response was found in groups 1 and 2 than groups 3 and 4. The differences between groups before BFB proportionally correlated with values after BFB; a correlation with genitourinary and spinal anomalies was found. CONCLUSIONS: Our results showed that BFB is an effective for fecal incontinence when the assessment pretreatment (functional and morphologic) is favorable; the manometry can evaluate the potential sphincterial recovery after BFB with a further prognostic benefit if correlated to morphologic evaluation with MRI.

Pilot study on the effects of high molecular weight sodium hyaluronate in the treatment of chronic pharyngitis.

Although several therapeutic approaches are available at present for the treatment of chronic pharyngitis, new therapeutic strategies acting on pharyngeal mucous function should be investigated in order to improve symptoms and quality of life. High-molecular weight hyaluronate performs important functions on mucociliary clearance, tissues hydration, defense against micro-organisms, and on tissue repair as well, but at present there is no clinical evidence of its exogenous use in patients with chronic pharyngitis. Our open, randomized controlled study was carried out to investigate efficacy, and tolerability of exogenous high molecular weight sodium hyaluronate (SH) at the dosage of 9 mg three times a day for a period of 30 days, in patients with chronic pharyngitis. Results show significant improvements of symptoms and cytology in active group (A, n = 10) vs. control group (B, n = 10). Good compliance and no adverse events were reported in group A. In conclusion, SH was effective and safe in patients with chronic pharyngitis.

The lipid theory in the pathogenesis of calcific aortic stenosis.

AIMS: Biologically active phenomena, triggered by atherogenesis and inflammation, lead to aortic valve (AV) calcification. Lipids play an important role in activating the cell signaling leading to AV bone deposition. This review, based on evidence from animal and human studies, mainly focused on the involvement of lipids and atherogenic phenomena in the pathogenesis of calcific aortic stenosis (AS). DATA SYNTHESIS: The role of elevated low density lipoproteins for the risk of both vascular atherosclerosis and AS has been elucidated. Lipid disorders act synergistically with other risk factors to increase prevalence of calcific AS. Atherosclerosis is also involved in the pathogenesis of bone demineralization, a typical hallmark of aging, which is associated with ectopic calcification at vascular and valvular levels. Animal studies have recently contributed to demonstrate that lipids play an important role in AS pathogenesis through the activation of molecular cell signalings, such as Wnt/Lrp5 and RANK/RANKL/Osteprotegerin, which induce the transition of valvular myofibroblasts toward an osteogenic phenotype with consequent valvular bone deposition. Although all these evidence strongly support the lipid theory in AS pathogenesis, lipids lowering therapies failed to demonstrate in controlled trials a significant efficacy to slow AS progression. Encouraging results from animal studies indicate that physical activity may counteract the biological processes inducing AV degeneration. CONCLUSIONS: This review indicates a robust interplay between lipids, inflammation, and calcific AS. This new pathophysiological scenario of such an emerging valvular disease paves the way to the next challenge of cardiovascular research: "prevent and care aortic valve stenosis".