Characterization and treatment of enuresis in overactive bladder patients. / Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva.

OBJECTIVE: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. MATERIALS AND METHODS: A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created -primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a > 50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. RESULTS: 152 OAB patients were included. 109 of them (71.7%) had enuresis -29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). CONCLUSIONS: Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.

OBJETIVOS: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. RESULTADOS: Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). CONCLUSIONES: La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.

Caracterización y tratamiento de la enuresis en pacientes con vejiga hiperactiva / Characterization and treatment of enuresis in overactive bladder patients

Objetivos: Definir los tipos de enuresis de los pacientes con vejiga hiperactiva (VH) y estudiar su respuesta al tratamiento vesical diurno. Material y métodos. Estudio prospectivo y multicéntrico: pacientes con VH y enuresis, tratados con anticolinérgicos o neuromodulación durante 3 meses (2019-2021). Recogimos variables obtenidas del calendario miccional, cuestionario PLUTSS (Pediatric Lower Urinary Tract Score System), y relacionadas con la enuresis. Generamos 2 grupos de estudio: enuresis primaria (EP) y enuresis secundaria (ES). Consideramos respuesta parcial enurética (RPE) a la reducción del valor de enuresis inicial en más de un 50% y respuesta completa (RCE) el 100%. Finalmente realizamos un análisis multivariante para detectar factores predictivos independientes de RCE. Resultados. Incluimos 152 pacientes con VH, 109 de los cuales presentaban enuresis (71,7%): 29 ES (26,7%) y 80 EP (73,3%). El valor PLUTSS fue mayor en pacientes con EP que en ES (20,8 vs. 17,2, p= 0,001.) La RPE y la RCE fueron significativamente mayores en el grupo de ES (55,2% vs. 15%, p= 0,000 en RPE y 48,3% vs. 5%, p= 0,000 en RCE). En el análisis multivariante se identificó que los pacientes con ES tienen una probabilidad de responder al tratamiento vesical diurno 50 veces superior que los pacientes con EP (OR 49,79, IC95% 6,73-36,8). Conclusiones. La mayoría de niños con VH tienen una EP y no secundaria, por lo que generalmente la enuresis de estos pacientes no responde al tratamiento vesical diurno. Es importante caracterizar el tipo de enuresis de los niños con VH para plantear su tratamiento de forma adecuada.(AU)

Objective: To define the types of overactive bladder (OAB) patient enuresis and study daytime bladder treatment response. Materials and methods. A prospective, multi-center study of OAB patients with enuresis treated with anticholinergics or neuromodulation over 3 months from 2019 to 2021 was carried out. Variables achieved from the voiding calendar and PLUTSS (Pediatric Lower Urinary Tract Score System), as well as enuresis-related variables, were collected. Two study groups were created – primary enuresis (PE) and secondary enuresis (SE). Partial enuretic response (PER) was defined as a >50% reduction in baseline enuresis, and complete enuretic response (CER) as a 100% reduction. A multivariate analysis was eventually conducted to detect CER independent predictive factors. Results. 152 OAB patients were included. 109 of them (71.7%) had enuresis – 29 (26.7%) SE and 80 (73.3%) PE. PLUTSS score was higher in PE patients than in SE patients (20.8 vs. 17.2; p= 0.001). PER and CER were significantly higher in the SE group (55.2% vs. 15%; p= 0.000 in PER, and 48.3% vs. 5%; p= 0.000 in CER). In the multivariate analysis, SE patients demonstrated to have a 50-fold increased probability of responding to daytime bladder treatment than PE patients (OR: 49.79; 95%CI: 6.73-36.8). Conclusions. Most OAB children have PE and not SE, which explains why enuresis does not typically respond to daytime bladder treatment. Characterizing the type of enuresis in OAB children is important to adequately approach treatment.(AU)

Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study. / Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico.

OBJECTIVE: To determine whether sacral transcutaneous electrical nerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs). MATERIALS AND METHODS: A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3 months. Symptom progression was assessed using the voiding calendar and the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS), excluding questions 3 and 4 -referring to enuresis- so that progression of daytime symptoms only (LUTS variable) was analyzed. RESULTS: 66 patients -50% of whom were female- were included, with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1 baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions (8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume in the voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresis was the only variable refractory to S-TENS. Complication rate was 3% (2 patients with dermatitis in the S-TENS application area). CONCLUSIONS: S-TENS is effective and safe in the short-term in patients with OB refractory to Achs. Further studies assessing long-term efficacy and potential relapses are required.

OBJETIVOS: Determinar si la electroterapia nerviosa transcutánea a nivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractarios a fármacos anticolinérgicos (Ach). MATERIAL Y METODOS: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fue evaluada utilizando el calendario miccional y el cuestionario PLUTSS (Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo sus preguntas 3 y 4 (referidas a la enuresis) para analizar solamente la evolución de la sintomatología diurna (variable LUTS). RESULTADOS: Fueron incluidos 66 pacientes (50% niñas), con una edad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1 inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones (8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina en los registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). La enuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicación del TENS-S). CONCLUSIONES: El TENS-S es efectivo y seguro a corto plazo en pacientes con VH refractarios a los Ach. Deben realizarse estudios para evaluar la eficacia a largo plazo y posibles recaídas.

Eficacia de la electroestimulación transcutánea sacra en pacientes con vejiga hiperactiva refractarios a fármacos anticolinérgicos. Estudio prospectivo y multicéntrico / Efficacy of sacral transcutaneous electrical nerve stimulation in patients with overactive bladder refractory to anticholinergic treatment: a prospective multi-center study

Objetivos: Determinar si la electroterapia nerviosa transcutánea anivel sacro (TENS-S) es un tratamiento efectivo en pacientes refractariosa fármacos anticolinérgicos (Ach).Material y métodos: Estudio prospectivo y multicéntrico: pacientes con VH refractaria a Ach tratados con TENS-S entre 2018-2021. El TENS-S se aplicó durante 3 meses. La evolución sintomática fueevaluada utilizando el calendario miccional y el cuestionario PLUTSS(Pediatric Lower Urinary Tract Symptoms Score), pero excluyendo suspreguntas 3 y 4 (referidas a la enuresis) para analizar solamente laevolución de la sintomatología diurna (variable LUTS).Resultados: Fueron incluidos 66 pacientes (50% niñas), con unaedad media de 9,5 años (rango: 5-15). El TENS-S disminuyó significativamente el PLUTSS (19,1 inicial vs 9,5 final, p< 0,001) y el LUTS (13,1inicial vs 4,8 final, p< 0,001). Además, redujo el número de micciones(8,5 inicial vs 6,4 final, p< 0,001) y aumentó el volumen de orina enlos registros miccionales (214 ml inicial vs 258 ml final, p< 0,001). Laenuresis fue la única variable refractaria al TENS-S. La tasa de complicaciones fue del 3% (2 pacientes, dermatitis en el área de aplicacióndel TENS-S). Conclusiones: El TENS-S es efectivo y seguro a corto plazo enpacientes con VH refractarios a los Ach. Deben realizarse estudios paraevaluar la eficacia a largo plazo y posibles recaídas.(AU)

Objective: To determine whether sacral transcutaneous electricalnerve stimulation (S-TENS) is an effective treatment in patients refractory to anticholinergic drugs (Achs).Materials and methods. A prospective multi-center study of patients with overactive bladder (OB) refractory to Achs treated with S-TENS from 2018 to 2021 was carried out. S-TENS was applied over 3months. Symptom progression was assessed using the voiding calendarand the Pediatric Lower Urinary Tract Symptoms Score (PLUTSS),excluding questions 3 and 4 –referring to enuresis– so that progressionof daytime symptoms only (LUTS variable) was analyzed. Results: 66 patients –50% of whom were female– were included,with a mean age of 9.5 years (range: 5-15). S-TENS significantly lowered PLUTSS (19.1 baseline vs. 9.5 final, p< 0.001) and LUTS (13.1baseline vs. 4.8 final, p< 0.001). It also reduced the number of mictions(8.5 baseline vs. 6.4 final, p< 0.001), while increasing urine volume inthe voiding records (214 ml baseline vs. 258 ml final, p< 0.001). Enuresiswas the only variable refractory to S-TENS. Complication rate was 3%(2 patients with dermatitis in the S-TENS application area).Conclusions: S-TENS is effective and safe in the short-term inpatients with OB refractory to Achs. Further studies assessing long-termefficacy and potential relapses are required.(AU)

Use of magnetic double J stents in pediatric patients. / Uso de los catéteres doble J magnéticos en pacientes pediátricos.

OBJECTIVE: Traditionally, double J stent removal in pediatric patients has required cystoscopy under general anesthesia. Magnetic stents allow for double J stent removal without the need for anesthesia. This work describes our initial experience with these stents. MATERIAL AND METHODS: A prospective cohort study of patients under 14 years of age carrying magnetic double J stents from 2018 to 2021 was performed. Variables assessed included baseline diagnosis, surgical procedure, placement success rate, complications associated with use, and need for general anesthesia at removal. RESULTS: 23 stents (4.8 Fr, 15 cm-20 cm) were placed in 21 patients, 62% of whom were male. Mean age was 5.01 years (3 months-13 years). Indications for placement included Anderson-Hynes dismembered pyeloplasty (34.8%), endoscopic dilatation of the ureteropelvic junction (UPJ) (21.8%), cystoscopic dilatation of the ureterovesical junction (UVJ) (17.4%), endoscopic lithotripsy (13.1%), renal trauma (4.3%), suspected retroiliac ureter (4.3%), and cystoscopic drainage of pyonephrosis (4.3%). Mean time of stent use was 4.2 weeks. 3 complications (13%) associated with the double J stent - 1 urinary tract infection (UTI), 1 stent obstruction, and 1 distal stent migration - were recorded. 95.5% of magnetic stents were successfully removed without anesthesia. CONCLUSIONS: Magnetic double J stents can be regarded as an effective alternative to conventional double J stents, since they avoid an additional surgical procedure with general anesthesia in pediatric patients.

OBJETIVOS: Tradicionalmente los catéteres doble J precisan de cistoscopia bajo anestesia general para su retirada en pacientes pediátricos. Los catéteres imantados permiten la retirada del doble J sin necesidad de anestesia. Mediante este trabajo describimos nuestra experiencia inicial con dichos catéteres. MATERIAL Y METODOS: Se ha realizado un estudio de cohorte prospectivo, de pacientes menores de 14 años portadores de doble J imantado desde 2018 a 2021. Las variables estudiadas han sido el diagnóstico inicial, el procedimiento quirúrgico realizado, la tasa de éxito en la colocación, las complicaciones derivadas de su uso y la necesidad de anestesia general en la retirada. RESULTADOS: Se han colocado 23 catéteres (4,8 Fr, 15-20 cm) en 21 pacientes, media de edad de 5,01 años (3 meses-13 años), el 62% varones. Las indicaciones para la colocación han sido: 34,8% tras pieloplastia desmembrada Anderson-Hynes, 21,8% tras dilataciones endoscópicas de la unión pielo-ureteral (UPU), 17,4% tras dilataciones cistoscópicas de la unión uretero-vesical (UUV), 13,1% tras litotricia endoscópica, 4,3% tras traumatismo renal, 4,3% sospecha de uréter retroilíaco y 4,3% tras drenaje cistoscópico de pionefrosis. La media de tiempo de uso de los catéteres ha sido de 4,2 semanas. Registramos tres complicaciones (13%) relacionadas con el doble J: una infección del tracto urinario (ITU), una obstrucción del catéter y una migración distal del catéter. El 95,5% de los imantados se retiraron con éxito sin anestesia. CONCLUSIONES: El doble J magnético puede considerarse una alternativa eficaz a los doble J clásicos, que puede evitar un procedimiento extra con anestesia general en los pacientes pediátricos.

Uso de los catéteres doble J magnéticos en pacientes pediátricos / Use of magnetic double J stents in pediatric patients

Objetivos: Tradicionalmente los catéteres doble J precisan de cistoscopia bajo anestesia general para su retirada en pacientes pediátricos.Los catéteres imantados permiten la retirada del doble J sin necesidadde anestesia. Mediante este trabajo describimos nuestra experienciainicial con dichos catéteres.Material y métodos: Se ha realizado un estudio de cohorte prospectivo, de pacientes < 14 años portadores de doble J imantado desde 2018 a 2021. Las variables estudiadas han sido el diagnóstico inicial, el procedimiento quirúrgico realizado, la tasa de éxito en la colocación, las complicaciones derivadas de su uso y la necesidad de anestesia general en la retirada.Resultados: Se han colocado 23 catéteres (4,8 Fr, 15-20 cm) en 21pacientes, media de edad de 5,01 años (3 meses-13 años), el 62% varo-nes. Las indicaciones para la colocación han sido: 34,8% tras pieloplastiadesmembrada Anderson-Hynes, 21,8% tras dilataciones endoscópicas dela unión pielo-ureteral (UPU), 17,4% tras dilataciones cistoscópicas dela unión uretero-vesical (UUV), 13,1% tras litotricia endoscópica, 4,3%tras traumatismo renal, 4,3% sospecha de uréter retroilíaco y 4,3% trasdrenaje cistoscópico de pionefrosis. La media de tiempo de uso de loscatéteres ha sido de 4,2 semanas. Registramos tres complicaciones (13%)relacionadas con el doble J: una infección del tracto urinario (ITU), unaobstrucción del catéter y una migración distal del catéter. El 95,5% delos imantados se retiraron con éxito sin anestesia.Conclusiones: El doble J magnético puede considerarse una alternativa eficaz a los doble J clásicos, que puede evitar un procedimientoextra con anestesia general en los pacientes pediátricos.

Objective: Traditionally, double J stent removal in pediatric patients has required cystoscopy under general anesthesia. Magnetic stents allowfor double J stent removal without the need for anesthesia. This workdescribes our initial experience with these stents.Materials and methods: A prospective cohort study of patientsunder 14 years of age carry-ing magnetic double J stents from 2018 to2021 was performed. Variables assessed included baseline diagnosis,surgical procedure, placement success rate, complications associatedwith use, and need for general anesthesia at removal.Results: 23 stents (4.8 Fr, 15 cm-20 cm) were placed in 21 patients,62% of whom were male. Mean age was 5.01 years (3 months-13 years).Indications for placement included An-derson-Hynes dismembered py-eloplasty (34.8%), endoscopic dilatation of the ureteropelvic junction(UPJ) (21.8%), cystoscopic dilatation of the ureterovesical junction(UVJ) (17.4%), endoscopic lithotripsy (13.1%), renal trauma (4.3%),suspected retroiliac ureter (4.3%), and cystoscopic drainage of pyone-phrosis (4.3%). Mean time of stent use was 4.2 weeks. 3 com-plications(13%) associated with the double J stent – 1 urinary tract infection (UTI),1 stent obstruction, and 1 distal stent migration – were recorded. 95.5%of magnetic stents were suc-cessfully removed without anesthesia.Conclusions: Magnetic double J stents can be regarded as an effec-tive alternative to conven-tional double J stents, since they avoid an ad-ditional surgical procedure with general anesthe-sia in pediatric patients.

Feed-out rate used as a tool to manage the aerobic deterioration of corn silages in tropical and temperate climates.

There is an increasing recognition throughout the world that many of the feeding problems of dairy herds are linked to the presence of aerobically deteriorated parts on a silo face, causing farmers to pose questions on what amount of silage should be removed daily to feed their animals. Since an adequate feed-out rate helps to prevent silage spoilage, a simple tool is needed to manage the aerobic deterioration of corn silages during feed-out. The aims of this study were to develop an unloading rate index, which we have called the mass feed-out rate (MFR), expressed in kilograms of fresh matter silage unloaded daily per square meter of silo face, to better predict the aerobic deterioration of silage and to offer management solutions to help prevent spoilage, through a survey on 97 commercial dairy farms in Italy and Brazil. Silages were sampled and analyzed for their main microbial, fermentative, and nutritional characteristics, whereas silage temperatures were measured in the core and peripheral areas of the silo working face. Moreover, a detailed questionnaire on silo management and silage utilization was administered to the farmers during each farm visit. The size and silage density of the silos presented a wide variability in the 2 countries, thus indicating that different management practices were adopted during corn harvesting, silo filling, and silage compaction. The differences between pH and temperature in the peripheral areas and in the core of the silage (dpH and dT, respectively) were tested as a single indicator to identify any aerobic deteriorated areas on the silo face, associated with the yeast and mold counts. Both indicators correctly identified aerobic deterioration in 86.6% and 93.8% of the studied silos, respectively. The lactic acid and ethanol increased as the MFR increased, whereas the starch, dT, and the yeast and mold counts decreased with increasing MFR. A daily removal rate of over 250 kg of silage/m2 markedly reduced the risk of spoilage in corn silages at a farm level in both temperate and tropical environments. The new MFR index can substitute for the commonly used linear feed-out rate as it includes the silage density and can be obtained from 1 single recording.

Dairy farm management practices and the risk of contamination of tank milk from Clostridium spp. and Paenibacillus spp. spores in silage, total mixed ration, dairy cow feces, and raw milk.

The occurrence of Paenibacillus and Clostridium spores in silage is of great concern for dairy producers because their spores can contaminate milk and damage processed milk and semi-hard cheeses. Spoiled silage is considered to be the main contamination source of the total mixed ration (TMR), feces of dairy cows, and consequently bulk tank milk via the contamination of cow teats by dirt during milking. The presence of an anaerobic and facultative anaerobic sporeformer population in different matrices (soil, corn silage, other feeds, TMR, feces, and milk) and its transmission pathway has been studied on 49 dairy farms by coupling plate count data with 16S-DNA identification. The different matrices have shown a high variability in the anaerobic and facultative anaerobic spore count, with the highest values being found in the aerobically deteriorated areas of corn silages. Clostridium tyrobutyricum, Paenibacillus macerans, and Paenibacillus thermophilus were detected in all the matrices. The TMR spore count was influenced by the amount of spoiled corn silage in the TMR and by the care taken when cleaning the spoiled silage before feed-out. Most of the farms that prevent the presence of visible moldy silage in the silo and carefully clean to remove molded spots were able to maintain their TMR spore counts below 4.0 log spores/g. When a level of 4.5 log spores/g of TMR was exceeded, the feces presented a greater contamination than 3.0 log spores/g. Moreover, the higher the number of spores in the feces was, the higher the number of spores in the milk. Most of the farms that presented a feces contamination greater than 5.0 log spores/g had a higher milk spore contamination than 1,000 spores/L. Careful animal cleaning and good milking practices have been found to be essential to maintain low levels of contamination in bulk tank milk, but it has emerged that only by coupling these practices with a correct silage management and cleaning during TMR preparation can the contamination of milk by spores be kept at a low level. It has been found that aerobically deteriorated silage has a great capacity to contaminate TMR and consequently to increase the risk of milk spore contamination, even when routine milking practices are adopted correctly.

Allergen-specific IgE: comparison between skin prick test and serum assay in real life.

BACKGROUND: The most common sensitizing allergens in in the area of Liguria region (Northwestern Italy) are pollens, mainly Parietaria and cypress, house dust mites, i.e. Dermatophagoides, and pets. IgE assessment is a crucial step in allergy diagnosis. It may be performed by skin prick test (SPT) or serum IgE (sIgE) assay. Therefore, this study compared these two methods in a real-life setting. METHODS: This retrospective study included 793 subjects, who were referred to the Allergy Department for respiratory allergy during 2014. Inclusion criteria were i) documented diagnosis of allergic rhinitis (AR), and/or allergic asthma, and/or allergic conjunctivitis. SPT and sIgE assay were performed for 5 allergens, such as Dermatophagoides pteronyssinus (D1), cat (E1), Parietaria officinalis (W19), cypress (T23), and dog (E5), as they are the most common in our geographic area. RESULTS: Using a positive SPT result as the target condition, remarkably high and statistically significant values of AUC, ranging from 0.84 to 0.94, were found. On the basis of the Youden index the following optimal classification threshold values were also computed: D1 = 0.22, E1 = 0.26, W19 = 0.61, T23 = 0.25, E5 = 0.34. These values allowed to define a set of sensitivity/specifity estimates ranging from 0.75 to 0.93 and from 0.83 to 0.93, respectively. CONCLUSIONS: The present study shows that SPT and sIgE are two tests that are rather concordant, but with different sensitivity and specificity distinct for each allergen. In clinical practice, both tests should be used depending on clinical history features and obtained findings.

[Laparoscopic repair of inguinal hernia and communicating hydrocele in children. Our experience in the last years]. / Reparación laparoscópica de la hernia inguinal e hidrocele en edad pediátrica. Nuestra experiencia en los últimos años.

INTRODUCTION: Laparoscopic inguinal hernia and hydrocele repair has become an alternative to the more frequently used inguinal approach. We describe our experience with the laparoscopic technique. MATERIAL AND METHODS: Retrospective study of laparoscopic inguinal hernia and hydrocele repair performed during the period between 2003-2016. We included patients < 14 years, with communicating hydrocele and/or indirect inguinal hernia diagnosis (N = 39). We have studied two cohorts; group A patients with indirect inguinal hernia (N = 31) and group B patients with communicating hydrocele (N = 8). We used intraperitoneal laparoscopic approach, performing herniorrhaphy of the internal inguinal orifice without resection of the hernial sac. The main outcome measurements were surgical indication and postoperative complications. RESULTS: The indication for laparoscopic repair was bilateral defects (46.2%), unilateral defects (28.2%), defects associated with umbilical hernia (23.1%) and associated with another pathology (2.6%). In group A the rate of complications that required new admission was 3.2% and the recurrence rate was 9.7%. In group B, was 12.5% ​​and 12.5% respectively. We have not observed a significant relationship with respect to patient age, laterality or suture used and the rate of complications in any of the groups. CONCLUSIONS: Despite the limitations of our study given the small sample size and retrospective nature, the complication rate (15%) is higher than that published in the literature. This makes us take a step back to reassess our indications and technique, and not forget that the laparoscopic approach is not a technique without risks and requires a learning curve.

OBJETIVOS: La reparación laparoscópica de la hernia inguinal e hidroceles en la edad pediátrica, se ha convertido en una alternativa a la herniorrafia inguinal clásica. Describimos nuestra experiencia en las intervenciones realizadas con dicha técnica. MATERIAL Y METODOS: Estudio retrospectivo de las reparaciones laparoscópicas de hernia inguinal e hidrocele realizadas en el periodo 2003-2016. Se han incluido pacientes <14 años, diagnosticados de hidrocele comunicante y/o de hernia inguinal indirecta (N=39), divididos en dos cohortes: grupo A pacientes con hernia inguinal indirecta y grupo B pacientes con hidrocele comunicante. Se ha empleado el abordaje laparoscópico intraperitoneal, y anillorrafia del orificio inguinal interno sin resección del saco herniario. Las variables principales estudiadas han sido la indicación quirúrgica y las complicaciones postquirúrgicas. RESULTADOS: Las indicaciones quirúrgicas han sido los defectos bilaterales (46,2%), defectos unilaterales (28,2%), defectos asociados a hernia umbilical (23,1%) y asociados a otra patología (2,6%). En el grupo A la tasa de complicaciones que precisaron de ingreso fue de 3,2% y la tasa de recurrencias fue de 9,7%; mientras que en el B han sido del 12,5% y del 12,5% respectivamente. No hay una relación significativa respecto a la edad, la lateralidad o la sutura utilizada y la tasa de complicaciones en ninguno de los grupos. CONCLUSIONES: A pesar de las limitaciones del estudio, el porcentaje total de complicaciones (15,3%) es más elevado que el publicado en la literatura. Esto nos hace reflexionar y no olvidar que el abordaje laparoscópico no es una técnica exenta de riesgos y requiere de una curva de aprendizaje.

Reparación laparoscópica de la hernia inguinal e hidrocele en edad pediátrica. Nuestra experiencia en los últimos años / No disponible

Objetivos: La reparación laparoscópica de la hernia inguinal e hidroceles en la edad pediátrica, se ha convertido en una alternativa a la herniorrafia inguinal clásica. Describimos nuestra experiencia en las intervenciones realizadas con dicha técnica. Material y métodos: Estudio retrospectivo de las reparaciones laparoscópicas de hernia inguinal e hidrocele realizadas en el periodo 2003-2016. Se han incluido pacientes < 14 años, diagnosticados de hidrocele comunicante y/o de hernia inguinal indirecta (N=39), divididos en dos cohortes: grupo A pacientes con hernia inguinal indirecta y grupo B pacientes con hidrocele comunicante. Se ha empleado el abordaje laparoscópico intraperitoneal, y anillorrafia del orificio inguinal interno sin resección del saco herniario. Las variables principales estudiadas han sido la indicación quirúrgica y las complicaciones postquirúrgicas. Resultados: Las indicaciones quirúrgicas han sido los defectos bilaterales (46,2%), defectos unilaterales (28,2%), defectos asociados a hernia umbilical (23,1%) y asociados a otra patología (2,6%). En el grupo A la tasa de complicaciones que precisaron de ingreso fue de 3,2% y la tasa de recurrencias fue de 9,7%; mientras que en el B han sido del 12,5% y del 12,5% respectivamente. No hay una relación significativa respecto a la edad, la lateralidad o la sutura utilizada y la tasa de complicaciones en ninguno de los grupos. Conclusiones: A pesar de las limitaciones del estudio, el porcentaje total de complicaciones (15,3%) es más elevado que el publicado en la literatura. Esto nos hace reflexionar y no olvidar que el abordaje laparoscópico no es una técnica exenta de riesgos y requiere de una curva de aprendizaje

Introduction: Laparoscopic inguinal hernia and hydrocele repair has become an alternative to the more frequently used inguinal approach. We describe our experience with the laparoscopic technique. Material and methods: Retrospective study of laparoscopic inguinal hernia and hydrocele repair performed during the period between 20032016. We included patients <14 years, with communicating hydrocele and / or indirect inguinal hernia diagnosis (N = 39). We have studied two cohorts; group A patients with indirect inguinal hernia (N = 31) and group B patients with communicating hydrocele (N = 8). We used intraperitoneal laparoscopic approach, performing herniorrhaphy of the internal inguinal orifice without resection of the hernial sac. The main outcome measurements were surgical indication and postoperative complications. Results: The indication for laparoscopic repair was bilateral defects (46.2%), unilateral defects (28.2%), defects associated with umbilical hernia (23.1%) and associated with another pathology (2.6%). In group A the rate of complications that required new admission was 3.2% and the recurrence rate was 9.7%. In group B, was 12.5% and 12.5% respectively. We have not observed a significant relationship with respect to patient age, laterality or suture used and the rate of complications in any of the groups. Conclusions: Despite the limitations of our study given the small sample size and retrospective nature, the complication rate (15%) is higher than that published in the literature. This makes us take a step back to reassess our indications and technique, and not forget that the laparoscopic approach is not a technique without risks and requires a learning curve

Prescriptive appropriateness using inhalant and food allergen panels: a comparison between General Practitioners' and Allergists' prescription in Genoa (Italy).

SUMMARY: Background. Prescriptive appropriateness is an actual claim in healthcare, and it also concerns in vitro tests used in the allergy work-up, such as the serum allergen-specific IgE (sIgE) assay. In the Liguria Region, two panels were defined (for inhaled and food allergens) including 12 allergens. Their composition changed over time. Objectives. The aims of the present retrospective study were: i) to evaluate the percentage of positive tests, and ii) to compare the findings of sIgE assay on the basis of the general practictioners' (GPs) or specialist' prescription, considering both the old panels and the new panels. Methods. This retrospective study considered a population of adult patients, which consisted of 2368 subjects (68% females; mean age 50 years; age range: 10-103 years). Serum sIgE were measured by ImmunoCap system. Results. The percentages of positive tests were very low for food allergens and low for inhaled ones (ranging between 5% to 35%). There was change of prevalent prescriptor with new panels. Conclusions. This study underlines the relevance of prescriptive appropriateness in the allergy work-up. The sIgE assay should be limited to those allergens that have a clinical relevance, based on clinical history.

Automatic bionalyzer using an integrated amperometric biosensor for the determination of L-malic acid in wines.

A new automatic bioanalyzer for L-malic acid using an integrated amperometric biosensor as detector is reported for the first time in this work. The biosensor is constructed by gold film sputtering deposition on a stainless steel disk electrode and co-immobilization of the enzymes malate dehydrogenase (MDH) and diaphorase (DP) together with the redox mediator tetrathiafulvalene (TTF) by means of dialysis membrane. The analytical performance of the biosensor was evaluated when it was used as amperometric detector in three different analytical methodologies: stirred solutions, semiautomatic FIA system and automatic bioanalyzer. The bienzyme biosensor exhibited great analytical performance in terms of sensitivity, selectivity and reproducibility of the measurements and its usefulness was demonstrated by analyzing wine reference materials with certified content of L-malic acid. The attractive analytical and operational characteristics demonstrated by the automatic bioanalyzer make it a promising simple, rapid and field-based tool for routine wine and fruit control.

Hypertonic saline monotherapy in children with perennial allergic rhinitis: a pilot study.

Perennial allergic rhinitis (PAR) is very common in children and has a relevant impact on their families. House dust mites (HDM) are the most relevant cause of PAR. The present pilot study aimed to evaluate whether hypertonic saline (3%) nasal spray as monotherapy is able to improve: nasal symptom severity and parental perception of rhinitis control, sleep, and school performance in HDM-mono-sensitized children with PAR. Globally, 25 children (13 males and 12 females; mean age 9.5±3.1 years) were treated for 3 weeks. They were visited at baseline, at the end of treatment, and after a 2-week follow-up. Hypertonic saline significantly reduced total symptom score, and improved the perception, according to their parents, of rhinitis control, sleep, and school performance. In conclusion, the present pilot study provided the first evidence that 3% hypertonic saline monotherapy was able to relieve nasal symptoms and parental perception of PAR impact as well as being safe and well tolerated.

Serum allergen-specific IgE, allergic rhinitis severity, and age.

BACKGROUND: Allergic rhinitis (AR) is characterized by an IgE-mediated reaction. Aging usually induces a progressive decline of immune system function. There is common belief that both allergic symptoms severity and serum IgE production decline during aging. OBJECTIVE: This study aimed to evaluate the possible impact of age on: i) serum allergen-specific IgE levels in a large sample of subjects, and ii) AR symptom severity in a group of mono-allergic patients. METHODS: Serum allergen-specific IgE to birch, Bet v 1, Parietaria, and Dermatophagoides pteronyssinus were measured by immunofluorometric assay (IFMA) in a sample of 8098 subjects. AR symptom severity was assessed by visual analogue scale (VAS) in a sub-group of 531 mono-allergic patients. RESULTS: The analysis of variance showed that IgE to Bet v 1, birch, and Dermatophagoides pteronyssinus significantly decreased considering the age, whereas IgE to Parietaria did not significantly decline in respect of the age. Considering the global sample of mono-allergic patients, elderly subjects (over 65 years old) tended to have lower IgE levels, but had significantly lower VAS rating, and significantly less sensitizations than adult subjects (18-65 years old). In both adult and elderly patients VAS strongly correlated with IgE values. CONCLUSIONS: Allergen-specific IgE levels tend to reduce with aging, but with differences between types of allergy. The IgE decrease is usually associated with reduced AR symptom severity. Elderly AR patients seem to have a different phenotype/endotype in comparison with adult AR ones, characterized by milder symptoms, lower IgE production, and less sensitizations. However, a close positive relationship between IgE values and VAS scores is shared by both adult and elderly AR patients, confirming the close link between allergy and symptoms that persists also in the elderly.

Design of an accurate wireless data logger for vibration analysis with Android interface.

In this work a new accurate wireless data logger using the Android interface was developed to monitor vibrations at low-cost. The new data logger is completely autonomous and extremely reduced in size. This instrument enables data collection wirelessly and the ability to display it on any tablet or smartphone with operating system Android. The prototype allows the monitoring of any industrial system with minimal investment in material and installation costs. The data logger is capable of making 12.8 kSPS enough to sample up to 5 kHz signals. The basic specification of the data logger includes a high resolution 1-axis piezoelectric accelerometer with a working range of ±30 G. In addition to the acceleration measurements, temperature can also be recorded. The data logger was tested during a 6-month period in industrial environments. The details of the specific hardware and software design are described. The proposed technology can be easily transferred to many other areas of industrial monitoring.

The error in neonatal intensive care: a multicenter prospective study.

AIM: During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice. METHODS: Through an anonymous "detection sheet" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization. RESULTS: The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28% of patients) and more than a 16 (10% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P<0.01); 48% and 53% of the errors in the NICU and Subintensive CU were related to medication administration. CONCLUSION: The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.

Ultrasound-assisted dyeing of cellulose acetate.

The possibility of reducing the use of auxiliaries in conventional cellulose acetate dyeing with Disperse Red 50 using ultrasound technique was studied as an alternative to the standard procedure. Dyeing of cellulose acetate yarn was carried out by using either mechanical agitation alone, with and without auxiliaries, or coupling mechanical and ultrasound agitation in the bath where the temperature range was maintained between 60 and 80 °C. The best results of dyeing kinetics were obtained with ultrasound coupled with mechanical agitation without auxiliaries (90% of bath exhaustion value at 80 °C). Hence the corresponding half dyeing times, absorption rate constants according to Cegarra-Puente modified equation and ultrasound efficiency were calculated confirming the synergic effect of sonication on the dyeing kinetics. Moreover the apparent activation energies were also evaluated and the positive effect of ultrasound added to mechanical agitation was evidenced by the lower value (48 kJ/mol) in comparison with 112 and 169 kJ/mol for mechanical stirring alone with auxiliaries and without, respectively. Finally, the fastness tests gave good values for samples dyed with ultrasound technique even without auxiliaries. Moreover color measurements on dyed yarns showed that the color yield obtained by ultrasound-assisted dyeing at 80 °C of cellulose acetate without using additional chemicals into the dye bath reached the same value yielded by mechanical agitation, but with remarkably shorter time.

Update of recommendations for Analgosedation in pediatric intensive care unit.

Effective and adequate therapy to control pain and stress are essential in managing children in Pediatric Intensive Care Unit (PICU) undergoing painful invasive procedures, this should be, but is not yet, one of our main aims. Aware that this difficult mission must be pursued in a systematic, multimodal and multitasking way, the Studying Group on Analgosedation in PICU from the Italian Society of Neonatal and Paediatric Anesthesia and Intensive Care (SARNePI) is providing its recommendations.