Failure to thrive: the importance of measuring the electrolytes.

Diabetes insipidus (DI) is characterized by hypoosmotic polyuria related to deficiency of arginine-vasopressin (AVP) secretion (centraldiabetesinsipidus, CDI) or renalinsensitivity to AVP (nephrogenicdiabetesinsipidus, NDI). We report a case of a child with congenital NDI.

Pediatric urolithiasis.

Urolithiasis is a well-known condition that can affect any part of the urinary tract. With a rate of 3-5% the incidence of upper urinary tract for long has been higher in adults (1-3), but recently it has increased among children reaching 3,3% . Indeed, more than 1% of all urinary stones are seen in patients aged less than 18 years (4). Pediatric urolithiasis is endemic in Turkey and Far East and it is probably due to malnutrition and racial factors (5). The spontaneous stone passage is more likely in children than in adults, indeed ureteral calculi spontaneously pass into 41-63% of children (1). Rate of stone passage depends on size and stone location in the urinary system. Stones sized less than 5 mm have a passage rate ranging from 40% to 98%, whilst stones > 5 mm have between 55% and 50% (6). In the last decade, the use of alpha blockers has proven well efficacious in helping spontaneous passage of distal ureteric stones in adults (7-9). The latest EAU guidelines support their use in adults while remain vague about their use in children because of unclear safety and efficacy (4). In search of evidence supporting or not the use of medical expulsive therapy in children we reviewed the literature dealing with the management of urolithiasis in pediatric patients. The primary aim of the present study was to evaluate the efficacy of medical expulsive therapy (MET), defined as stone expulsion rate, with a-blockers compared to a control group. The secondary aim was to assess the safety, defined as side effects rate, of MET compared to a control group.

Cardiac dysfunction in children with essential obesity: preliminary data.

Obesity in children has been recognized as a major underlying factor of the pathogenesis of several diseases and a reduced life expectancy. This study aims to verify if clinical parameters, such as waist circumference and/or body mass index and biohumoral and inflammatory parameters can help predict cardiac structural and functional alterations, through an echocardiogram test in obese children and adolescents. Children were prospectively enrolled at the AUOC outpatients' department of Emergency Paediatrics, University Hospital, Messina, from June to December 2017. Clinical, metabolic parameters and an inflammation marker (HMGB1) were evaluated and a transthoracic echocardiogram was carried out. Twenty-two obese subjects were prospectively enrolled.HMGB1 values were 12.6 ± 2ng/ml, significantly higher compared to a previously studied healthy control group. A significant positive correlation was found both between total cholesterol levels and HMGB1 values (r=0.846, p=0.000) and between LDL cholesterol and HMBG1 values (r=0.663, p=0.001). No correlation was found between clinical, biohumoral and echocardiograph parameters. In obese children cardiac parameters obtained from echocardiogram tests may be in the normal range. However, other parameters may be altered in the early phase, showing that infantile obesity can compromise myocardial functions, even in the absence of comorbidities. Furthermore, the evaluation of concentrations of HMBG1 could explain how an initial inflammation can trigger the condition of meta-inflammation.

Local therapy with ozone in the management of the exit site in a patient undergoing peritoneal dialysis.

The natural history of children with end stage renal disease is dialysis until a transplant can be done. There are two types of dialysis: hemodialysis and peritoneal dialysis (1). Peritoneal dialysis is preferred in young children because getting the vascular access for hemodialysis is challenging (2). Catheters should be surgically placed in a paramedian or lateral abdominal region with an extremity located in Douglas' pouch.

Hemodialysis in children: how, when and why.

End-stage renal diseases requiring chronic dialysis are rare in childhood and adolescence, but they are associated with high mortality and impaired quality of life (1, 2). The most common disease that causes chronic kidney disease (CKD) is primary glomerular disease (GD), followed by congenital abnormalities of the kidney and urinary tract, cystic, hereditary or congenital disorders and, more rarely, secondary GD. However, patients with secondary GD, urologic disorders, and metabolic diseases have greater mortality risk than patients with primary GD (3). Here, we focused on the different options of treatment available, and specifically we compared peritoneal dialysis and hemodialysis, showing pros and cons between them.

Analysis of radioprotection and antimutagenic effects of Ilex paraguariensis infusion and its component rutin.

DNA repair pathways, cell cycle checkpoints, and redox protection systems are essential factors for securing genomic stability. The aim of the present study was to analyze the effect of Ilex paraguariensis (Ip) infusion and one of its polyphenolic components rutin on cellular and molecular damage induced by ionizing radiation. Ip is a beverage drank by most inhabitants of Argentina, Paraguay, Southern Brazil, and Uruguay. The yeast Saccharomyces cerevisiae (SC7Klys 2-3) was used as the eukaryotic model. Exponentially growing cells were exposed to gamma rays (γ) in the presence or absence of Ip or rutin. The concentrations used simulated those found in the habitual infusion. Surviving fractions, mutation frequency, and DNA double-strand breaks (DSB) were determined after treatments. A significant increase in surviving fractions after gamma irradiation was observed following combined exposure to γ+R, or γ+Ip. Upon these concomitant treatments, mutation and DSB frequency decreased significantly. In the mutant strain deficient in MEC1, a significant increase in γ sensitivity and a low effect of rutin on γ-induced chromosomal fragmentation was observed. Results were interpreted in the framework of a model of interaction between radiation-induced free radicals, DNA repair pathways, and checkpoint controls, where the DNA damage that induced activation of MEC1 nodal point of the network could be modulated by Ip components including rutin. Furthermore, ionizing radiation-induced redox cascades can be interrupted by rutin potential and other protectors contained in Ip.

Analysis of radioprotection and antimutagenic effects of Ilex paraguariensis infusion and its component rutin

DNA repair pathways, cell cycle checkpoints, and redox protection systems are essential factors for securing genomic stability. The aim of the present study was to analyze the effect of Ilex paraguariensis (Ip) infusion and one of its polyphenolic components rutin on cellular and molecular damage induced by ionizing radiation. Ip is a beverage drank by most inhabitants of Argentina, Paraguay, Southern Brazil, and Uruguay. The yeast Saccharomyces cerevisiae (SC7Klys 2-3) was used as the eukaryotic model. Exponentially growing cells were exposed to gamma rays (γ) in the presence or absence of Ip or rutin. The concentrations used simulated those found in the habitual infusion. Surviving fractions, mutation frequency, and DNA double-strand breaks (DSB) were determined after treatments. A significant increase in surviving fractions after gamma irradiation was observed following combined exposure to γ+R, or γ+Ip. Upon these concomitant treatments, mutation and DSB frequency decreased significantly. In the mutant strain deficient in MEC1, a significant increase in γ sensitivity and a low effect of rutin on γ-induced chromosomal fragmentation was observed. Results were interpreted in the framework of a model of interaction between radiation-induced free radicals, DNA repair pathways, and checkpoint controls, where the DNA damage that induced activation of MEC1 nodal point of the network could be modulated by Ip components including rutin. Furthermore, ionizing radiation-induced redox cascades can be interrupted by rutin potential and other protectors contained in Ip.

Individual Muscle use in Hamstring Exercises by Soccer Players Assessed using Functional MRI.

This study used functional magnetic resonance imaging (fMRI) to compare individual muscle use in exercises aimed at preventing hamstring injuries. Thirty-six professional soccer players were randomized into 4 groups, each performing either Nordic hamstring, flywheel leg curl, Russian belt or conic-pulley exercise. MRIs were performed before and immediately after a bout of 4 sets of 8 repetitions. Pre-post exercise differences in contrast shift (T2) were analyzed for the long (BFLh) and short head (BFSh) of biceps femoris, semitendinosus (ST), semimembranosus (SM) and gracilis (GR) muscles. Flywheel leg curl increased (P<0.001) T2 of GR (95%), ST (65%), BFSh (51%) and BFLh (14%). After the Nordic hamstring, GR (39%), ST (16%) and BFSh (14%) showed increased T2 (P<0.001). Russian belt and conic-pulley exercise produced subtle (P<0.02) T2 increases of ST (9 and 6%, respectively) and BFLh (7 and 6%, respectively). Russian belt increased T2 of SM (7%). Among exercises examined, flywheel leg curl showed the most substantial hamstring and GR muscle use. However, no single exercise executed was able to increase T2 of all hamstring and synergist muscles analyzed. It is therefore suggested that multiple exercises must be carried out to bring in, and fully activate all knee flexors and hip extensors.

Safety and prolonged efficacy of Botulin Toxin A in primary hyperhidrosis.

BACKGROUND: Hyperhidrosis is a condition characterized by generalized or localized hyperfunction of the eccrine sweat glands with a deep negative impact on patient's quality of life. OBJECTIVES: To evaluate the efficacy and the safety of Botulin Toxin A (BTX-A) intradermal injection in the treatment of primary axillary and palmar hyperhidrosis, investigating symptoms-free period, and the subjective improving of quality life. MATERIALS AND METHODS: 50 consecutive patients with primary hyperhidrosis were evaluated detecting age, gender, hyperhidrosis onset period, disease duration and years of treatment with BTX-A, Minor's iodine test, Hyperhidrosis Disease Severity Scale (HDSS), Dermatology Life Quality Index (DLQI). RESULTS: The treatment is significantly effective both for axillae and palms: the majority of the patients improved their HDSS and Minor's scores from a value of 4 in the two tests, to values of 1 (HDSS) and 0 (Minor test). Patients reported a duration of symptoms relief from 4 to 12 months, with a mean of 5.68 months; specifically, we have observed that the axillary group experienced a longer symptoms-free period (mean RFS 7.2 months) than the palmar group (mean: RFS 4.27 months). CONCLUSIONS: Authors suggest that BTX-A is a safe, easy, and fast procedure for the treatment of primary axillary and palmar hyperhidrosis.

Drug cutaneous side effect: focus on skin ulceration.

Skin ulcers are defined as tissue loss interesting the deeper layers of the dermis and hypodermis, with low tendency to spontaneous healing. They cause disability related to pain, risk of infection and amputation, chronic management, requiring working absence with notably economic burden. The major cause is often related to underlying vascular disease, infections, tumors, autoimmunity, trauma, even if literature occasionally reported several cases of drug inducing skin ulceration. Most of drugs involved are chemotherapy agents and more recently molecular target therapies. Evidences supporting these drugs as the major cause of skin ulcers include delay of onset after therapy initiation, improvement after withdrawal of the drug, recurrence after its reintroduction and, sometimes, simultaneous occurrence of other skin lesions that have previously been reported to be associated with these agents. Attention should be reserved to patients undergoing antineoplastic agents, especially if previously affected by predisposing comorbidities, considering such side effect as possible differential diagnosis for skin ulceration in neoplastic patients.

Melanoma detection in Italian pigmented lesion clinics.

AIM: Accuracy in melanoma detection is important to recognize early curable melanomas and to minimize the unnecessary excision of benign lesions. The aim of this paper was to evaluate melanoma screening accuracy of Italian pigmented lesion clinics in terms of number needed to excise (NNE), melanoma thickness, and number of melanomas diagnosed during patient follow-up. METHODS: Information on all skin tumors excised in 2011 were extracted from the databases of the participating centers. Information whether the lesion was excised at the baseline examination or during patient follow-up was recorded, as well as the overall number of patients examined in each center in 2011. RESULTS: After e-mail solicitation, 22 of 40 centers agreed to participate. A total of 8229 excised lesions were collected. The overall number of examined patients was 86.564, thus 9.5% of screened patients had a lesion removed. Of the excised lesions, 866 were diagnosed as melanoma (1% of examined patients) and 5311 (88.9%) were melanocytic nevi. Three NNE were calculated giving values of 7.9 excised lesions to find 1 melanoma, 7.1 melanocytic lesions to find 1 melanoma, and 3.7 lesions to find 1 skin malignancy. The median melanoma thickness was 0.6 mm, with only 15.1% of melanomas ≥ 1 mm of thickness. Melanomas detected over time were 96 (11.1%; mean thickness, 0.3 mm), with 15.6% of lesions excised after short-term follow-up and 84.4% after long-term follow-up. CONCLUSION: The NNE values comparable to those achieved in specialized clinical settings and the high number of early melanomas diagnosed at the baseline examination or during patient follow-up indicate a high level of accuracy in melanoma screening achieved by Italian pigmented lesion clinics.

Match performance comparison in top English soccer leagues.

The purpose of this study was to compare motions of soccer players in the English Premier (1st) and Championship (2nd) League. A total of 26 449 observations were obtained from players during 4 seasons (2006-2010) in the 2 leagues. Time-motions of all players (attackers, central defenders, central midfielders, wide defenders, wide midfielders) were recorded during each match using the Prozone® System, (Leeds, UK), and categorized by speed intensity. Number of actions, total distance and the mean distance covered at each speed intensity were measured. Players in the Championship league covered a total match distance of 11.1±0.9 km compared with 10.8±1.0 km for players from the Premiership (p<0.001). Championship players also covered greater distances during jogging, running, high-speed running, and sprinting. Premiership players covered more distance walking. Players in the Soccer League Championship had more instances of each condition. Although these differences were statistically significant, they were negligible in practical terms, suggesting match-related activities do not explain the general superiority of Premiership players over Championship players in England.

Match-to-match variability of high-speed activities in premier league soccer.

The aim of the present investigation was to determine the between-match variability of high-speed running activities completed by a large sample of elite players over an extended period of time. A further aim of the study was to determine the influence of playing position on the magnitude of this variability. Observations on individual match performance measures were undertaken on 485 outfield players (median of 10 games per player; range=2-57) competing in the English Premier League from 2003/2004 to 2005/2006 using a computerised tracking system (Prozone, Leeds, England). High-speed activities selected for analysis included total high-speed running distance (THSR), high-speed running (HSR), total sprint distance (TSD) and the total number of sprints undertaken. Total high-speed running distance in possession and without possession of the ball was also analysed. Match-to-match variability was generally high across all variables with a mean CV of 16.2+/-6.4% (95% CI=15.6-16.7%) and 30.8+/-11.2% (95% CI=29.9-31.7%) reported for HSR and TSD covered during a game. This variability was generally higher for central players (midfielders and defenders) and lower for wide midfielders and attackers. Greater variability was also noted when the team were in possession of the ball (approximately 30%) than when they did not have possession (approximately 23%). The findings of the present study indicate that match-to-match variability in performance characteristics of elite soccer players is high. This inherent variability means that research requires large sample sizes in order to detect real systematic changes in performance characteristics.

Analysis of high intensity activity in Premier League soccer.

The aim of the present investigation was to provide a detailed analysis of the high intensity running activity completed by elite soccer players during match-play. A further aim of the study was to evaluate the importance of high intensity running activity to overall team success. Observations on individual match performance measures were undertaken on 563 outfield players (median of 8 games per player; range=1-57) competing in the English Premier League from 2003/2004 to 2005/2006 using a computerised tracking system (Prozone, Leeds, England). High intensity activities selected for analysis included total high intensity running distance (THIR), total sprint distance (TSD) and the number and type of sprints undertaken. Total high intensity running distance in possession and without possession of the ball was also analysed. The THIR was dependant upon playing position with wide midfield (1,049+/-106 m) and central defenders (681+/-128 m) completing the highest and lowest distance respectively (p<0.001). High intensity activity was also related to team success with teams finishing in the bottom five (919+/-128 m) and middle ten (917+/-143 m) league positions completing significantly more THIR compared with teams in the top five (885+/-113 m) (p=0.003). The THIR and TSD also significantly declined during the 2nd half with the greatest decrements observed in wide midfield and attacking players (p<0.05). Both positional differences in high intensity activity and the observed change in activity throughout the game were also influenced by team success (p<0.05). The results of the present study indicate that high intensity activity in elite soccer match-play is influenced by both playing position and previous activity in the game. These activity patterns are also dependant upon success of the team. This may indicate that overall technical and tactical effectiveness of the team rather than high levels of physical performance per se are more important in determining success in soccer.

Activity profile of elite goalkeepers during football match-play.

AIM: The purpose of this study was to analyse the activities of a goalkeeper during a match and to identify the distances covered at different velocities between the first and second halves. METHODS: Sixty-two goalkeepers belonging to 28 teams in the English Premier League were monitored over 109 matches using the Prozone(R) system. All values are averages and standard deviations. Pearson product moment correlation was used to examine selected bivariate correlation. To analyze the differences in averages, the paired Student t-test was used. The analyses were performed using SPSS (v.13.0; SPSS, Inc. Chicago, IL). The significance level was set at P<0.05. RESULTS: Mean total distance covered by the goalkeeper during the match was 5 611+/-613 m. There were no differences between distances covered in the first and second halves. The distance covered at high-intensity was 56+/-34 m, while the distance covered sprinting was 11+/-12 m. The average number of high speed actions was 10+/-6, with a total range between 0 and 40. The goalkeeper walked during 73% of the match, while spending just 2% moving at high-intensity. CONCLUSION: The goalkeeper's physical activity was not as great as that of the field players, but the high-intensity actions carried out will be very decisive in the final result of the match.

Do aspartate and asparagine acute supplementation influence the onset of fatigue in intense exercise?

AIM: Oxaloacetic acid represents a fundamental intermediary in the metabolism of energy substrate. Asparagine and aspartate constitute precursor compounds of this substance. Therefore, they could affect tricarbossilic acids cycle. Besides, it was suggested that supplementation with aspartate and asparagine determines a muscular glycogen sparing during strenuous physical exercise, even if the real effectiveness remain controversial. The aim of the present pilot study was to evaluate the hypothesis that a supplementation with oxaloacetate precursors, precisely aspartate and asparagine, could improve sport performance during high intensity endurance exercise. METHODS: We recruited 15 male trained athletes, aged from 20 to 30 years (mean age: 24.13+/-3.87 years), practicing triathlon. We administered them placebo or aspartate (7 g) and asparagine (7 g) mixture, using a double blind technique, before performing an exhaustion stress test on cycloergometer carried out to 90% of each athlete's maximum oxygen consumption, previously determined. RESULTS: We evaluated lactatemia through earlobe punctures at the end of warming up, at the maximum effort and at recovery time (3 min, 5 min, 10 min, 15 min, 30 min). Furthermore, subjects were submitted to three blood samples from brachial artery in order to assess the glycemia (before the exercise, at the end of the exercise, and 30 min after the end of the exercise). CONCLUSION: The analysis of these parameters and the results of the ergometric tests after amino acids assumption indicate that acute supplementation with aspartate and asparagine do not significantly affect physical performance in athletes practicing high intensity exercises, and that acute administration of aspartate does not cause a sparing of muscle glycogen concentration.

Nitric oxide test during cardiac catheterization decreases the serum concentrations of S100B protein in adult patients with idiopathic pulmonary hypertension.

OBJECTIVE: Cardiac catheterization (CC) is a life-threatening procedure in adult patients. Complicated by idiopathic arterial pulmonary hypertension (IPAH), there is a potential risk of central nervous system (CNS) damage. We measured serum levels of a well-established brain damage marker, namely S100B, collected before, during and after CC in adult patients in whom the nitric oxide (NO) test had been performed. MATERIAL AND METHODS: In 12 adult patients who had undergone CC for IPAH diagnosis, we recorded clinical and standard monitoring procedures (laboratory variables and echocardiographic patterns) and serum concentrations of S100B before (time 0), during (time 1) and after the NO test (time 2) and at 24 h after (time 3) the procedure in samples obtained from the systemic and pulmonary circulation. Patients were subdivided into NO test responders (n=6) and non-responders (n=6). Neurological evaluation was performed at admission and at discharge from hospital. RESULTS: Adult patients subjected to CC showed no overt neurological injury at discharge from hospital. No significant differences (p > 0.05 for all) in S100B serum levels between groups at times 0, 1 and 3 have been shown independently from the sampling site. It was noteworthy that the concentration of protein in the responders group at time 2 was significantly decreased (p < 0.05, for all) compared to the responder group and to baseline values. A significant correlation was found between arterial oxygen partial pressure and individual S100B concentration in the pulmonary and systemic bloodstream in the entire study group (R = -0.66 and R = 0.71, respectively; p < 0.05, for both). CONCLUSIONS: The data suggest that S100B protein assessment, as well as the NO test, may be useful when monitoring possible CNS damage during CC in patients with IPAH, and may also be valuable in relation to brain functions, especially when performed as an emergency procedure in severely hypoxic patients.

[Analysis of a putative protection against free radicals by grape derivatives (Vitis vinifera L. Cv. Tannat) in Saccharomyces cerevisiae]. / Exploración del efecto protector frente a radicales libres de derivados de la uva (Vitis vinifera L. Cv. Tannat) en Saccharomyces cerevisiae.

The aim of this work was to analyse a possible genome protection provided by a grape derivative (Tannat wine) in yeast cell populations exposed to H2O2. Haploid and diploid strains of Saccharomyces cerevisiae were used as eukaryotic model. Cell samples were exposed to H2O2 in a nutrient medium. Chromosomal DNA was analysed after isolation and separation by pulsed field electrophoresis. Double strand breaks were determined by laser densitometry and application of Poisson distribution. Both haploid and diploid cells showed H2O2 dose dependent DNA fractionation, as well as an increase of lethal -and mutation- events. Upon combination of the Tannat wine and H2O2 a significant decrease of double strand breaks was observed, in association with an increase in surviving fractions. No mutagenic effect was observed after wine exposure. Part of the observations regarding protective wine effect were simulated by exposure to high concentrations of alpha-tocopherol. Present results indicate that a grape derivative could act as a genome protector increasing cell survival probabilities. Among others, the involved molecular targets could be components of transduction redox cascades as well as DNA repair enzymes.

Evolution of physiological and haematological parameters with training load in elite male road cyclists: a longitudinal study.

AIM: The aim of this study was to describe and evaluate physiological parameters as a control tool for the monitoring of training in a group of elite cyclists during one season of training. METHODS: The study is divided into two periods (winter or ''volume'' mesocycle and spring or ''intensity'' mesocycle) between the tests that they carried out in the laboratory, consisting of a ramp test to exhaustion (work load increases 25 W X min(-1)) and a maximal lactate steady state (MLSS) test on a cycle ergometer. Macronutrients and hematological variables were recorded during the test periods as were the volume and the intensity of training sessions during the whole period of the study. RESULTS: The physiological data were similar to those previously reported for professional cyclists (approximately 450 Watts, approximately 78 mL x kg(-1) x min(-1)) and the values for the MLSS also agree with previous studies (approximately 250 Watts). Subjects improved the first ventilatory threshold (VT(1)) (approximately 52% to approximately 60% VO(2max)) and the second ventilatory threshold (VT(2)) (approximately 82% to approximately 87% VO(2max)) after the first period of training even though its low intensity focused on the performance of VT(1) (77% training in ''zone 1'', under VT(1)). The MLSS improved after the first period (approximately 225 to approximately 250 Watts) and remained high in the second (approximately 255 Watts). High levels of creatine kinase (approximately 230 U x L(-1)) and urea (37 mg x L(-1)) were found, also a decrease in hemoglobin values (approximately 15.4 to approximately 14.7g x dL(-1)). CONCLUSION: The high level reached by the subjects after the first period of training suggests that two effort tests could be enough to plan training. On the other hand, the decrease in some red blood cell and nutrition parameters suggests that there should be greater control over them during the season.