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Surgical intervention for acute testicular torsion can require either orchiopexy or orchiectomy. The decision of which surgery to perform is dependant on the amount of time that the testicle experienced ischemia and the viability of the testicle after reperfusion. It is hypothesized that (1) there is a difference in orchiectomy and orchiopexy rates between prepubertal and postpubertal males with acute testicular torsion and (2) presenting symptoms may vary between the two age groups as prepubertal males may present with atypical symptoms, which could result in delayed presentation and diagnosis. A retrospective chart review was conducted on pediatric patients who were diagnosed with acute testicular torsion between June 2010 and August 2017. Demographic and clinical characteristics were extracted: age, ethnicity, referral pattern, primary insurance status, symptoms at presentation, prior history of ipsilateral testicular pain or intermittent torsion, recent trauma to genitalia, duration of symptoms (hours), gradual vs. acute onset of symptoms, time/weekday/season at presentation, and time interval from arrival at the study institution to surgical intervention (minutes). Patients were categorized into two groups: prepubertal group (age 1–12 years) and postpubertal group (age 13–18 years). Statistical analyses were performed using R, version 3.3.1. Ninety-one patients were included in the study. The overall orchiectomy rate was 30.8%. More prepubertal males underwent orchiectomy than postpubertal males (42.4% vs. 24.1%, respectively). Prepubertal males were more likely to present with abdominal pain than postpubertal males (27.3% vs. 10.3%, respectively). Those who underwent orchiectomy were more likely to present with longer duration of symptoms, testicular swelling, and abdominal pain than those who underwent orchiopexy. The risk of orchiectomy decreased by 14% per 1-year increase in age (odds ratio [OR]: 0.86, 95% confidence interval [CI]: 0.94–1.00, p =.009). A steady decline in the proportion of patients undergoing orchiectomy was seen from 1 to 12 years of age. This study found that prepubertal males are at higher risk for orchiectomy than postpubertal males. The risk of orchiectomy decreases by 14–16% per 1-year increase in age. Prepubertal males are more likely to present with atypical symptoms and delayed presentation and diagnosis, leading to delayed surgical intervention. It is important for providers to perform a genital examination in prepubertal males who present with abdominal pain to rule out acute testicular torsion. Patients presenting with longer duration of symptoms, testicular swelling, and abdominal pain are at higher risk for orchiectomy. No correlation was found between orchiectomy rate and ethnicity, referral status, primary insurance status, and time/weekday/season at presentation. Among patients presenting to a tertiary pediatric hospital with acute testicular torsion, prepubertal males (younger than 12 years) are at higher risk for orchiectomy than postpubertal males. Prepubertal males are more likely to present with atypical symptoms which results in delayed presentation and diagnosis, leading to delayed in surgical intervention. [ABSTRACT FROM AUTHOR]

Abstract: Polysaccharides with structure and potential bioactivity similar to heparin were synthesized based on cellulose which was regioselectively sulfated, carboxylated or carboxymethylated, and chitosan that was sulfated only. Osteogenic activity of these derivatives was studied in cooperation with BMP-2 using C2C12 myoblast cells as a model system measuring alkaline phosphatase (ALP) activity and the expression of the genes Osterix, Noggin and Runx-2. It was found that highly sulfated chitosan showed the strongest osteogenic activity of all polysaccharides, but only at lower concentrations, while higher concentrations were inhibitory. By contrast, cellulose with a low or intermediate degree of sulfation showed increasing ALP activity and expression of Osterix and Noggin with rising concentrations. Lower sulfated cellulose with a high degree of carboxylation was less osteogenic, but had a positive effect on cell viability, while carboxymethylated cellulose had almost no osteogenic activity. The results indicate that regioselectively sulfated as well as carboxylated cellulose and chitosan possess an osteogenic activity, which makes them interesting candidates for application in tissue engineering of bone. [Copyright &y& Elsevier]

Abstract: Novel cellulose sulfates (CS) with a controlled degree of sulfation (DSS) were synthesized through acetosulfation as well as direct sulfation. CS containing carboxyl (CO) or carboxymethyl (CM) groups were prepared by TEMPO oxidation or by carboxymethylation with chloroacetic acid. The derivatization was characterized by nuclear magnetic resonance and Raman spectroscopy. The derivatives were investigated regarding their cytotoxicity and mitogenic activity by modulation of 3T3 fibroblast proliferation with or without exogenous FGF2. All derivatives were non-toxic for 3T3 cells. CS strongly promoted FGF2-induced proliferation, which was positively related to overall DSS. In the absence of FGF2, minute quantities of CS with intermediate degrees of sulfation exerted stronger mitogenic effects than heparin. No significant promoting effects of CO and CM on cell proliferation were found, though the structure of CO shows similarities to heparin. [Copyright &y& Elsevier]

Objectives: A common objection to using artificial neural networks in clinical decision support systems is that the reasoning behind diagnostic indications cannot be sufficiently well explained. This paper presents a method for visualizing diagnostic indications generated from an artificial neural network-based decision support algorithm (ANN-algorithm) in conditions developing over time.Methods: The main idea behind the method is first to calculate and graphically present the decision regions corresponding to the diagnostic indications given as output from the ANN-algorithm, in the space of two selected, clinically established 'display variables'. Secondly, the trajectory of time series measurement results of these, often biochemical markers, together with the respective 95% confidence intervals are superimposed on the decision regions. This will permit a nurse or clinician to grasp the diagnostic indication graphically at a glance. The indication is further presented in relation to clinical variables that the clinician is already familiar with, thus providing a sort of explanation. The predictive value of the indication is expressed by the proximity of the measurement result to the decision boundary, separating the decision regions, and by a numerically calculated individualized predictive value.Results: The method is illustrated as applied to a previously published ANN-algorithm for the early ruling-in and ruling-out of acute myocardial infarction, using monitoring of measurement results of myoglobin and troponin-I in plasma.Conclusion: The method is appropriate when there is a limited number of clinically established variables, i.e. variables which the clinician is used to taking into account in clinical reasoning. [ABSTRACT FROM AUTHOR]

Summary Introduction/background Bladder exstrophy is a rare diagnosis that presents major reconstructive challenges. To increase experience and proficiency in the care of bladder exstrophy (BE), the Multi-Institutional BE Consortium (MIBEC) was formed, with a focus on refining technical aspects of complete primary repair of bladder exstrophy (CPRE) and subsequent care. Objective Outcome measures included successful CPRE (absence of dehiscence), complications, and integrated points of technique and care over the short-term. Study design Boston Children's Hospital, Children's Hospital of Philadelphia and Children's Hospital of Wisconsin alternately served as the host, with observation, commentary and critique by visiting collaborating surgeons. CPRE with bilateral iliac osteotomy was performed at 1–3 months of age. High-definition video capture of the surgery allowed local and distant broadcast to facilitate real-time observation and teaching, and recording of all procedures. Results From February 2013 to February 2015, MIBEC participating surgeons performed CPRE on 27 consecutive patients (22 classic BE, five epispadias). There were no dehiscences in 27 patients (0%, 95% CI 0–12.5%). Thirteen girls and 14 boys underwent CPRE at a median age of 2.3 months (range 0.1–51.6). One boy had a hypospadiac urethral meatus at CPRE completion. Hydronephrosis of mild or moderate grade was present postoperatively in eight girls and two boys. Additional results, per gender, are presented in the Summary table below. Discussion Absence of dehiscence in this cohort was comparable or compared favorably with the literature. However, several girls had significant obstructive complications following CPRE. The rate of bladder outlet obstruction (BOO) in girls was increased compared with published reports. A low complication rate was noted in the boys following CPRE, which was comparable to reports in the literature, and early signs of continence and spontaneous voiding were noted in some boys and girls. Limitations included variation in patient age at presentation, thereby introducing a wide age range at CPRE. Outcome data were limited by short follow-up regarding voiding with continence. Conclusion This collaborative effort proved beneficial regarding significantly increased surgeon exposure to CPRE, refinement of CPRE technique, surgeon learning and expertise. Technical refinement of CPRE is ongoing. Summary Table Diagnosis, timing of CPRE and complications per gender. Summary Table Gender Girls Boys Classic BE/epispadias 10/3 12/2 Median age at CPRE (range) 1.9 months (0.1–51.6) 2.9 months (0.4–28.8) Successes No dehiscence 7 without complications No dehiscence 11 without complication Complications 6 girls total 5 pyelonephritis 4 urinary retention (BOO) 2 temporary CIC 1 vesicostomy 1 bladder rupture 3 boys total 1 pyelonephritis 2 urethrocutaneous fistula [ABSTRACT FROM AUTHOR]

Abstract: Two studies comparing intraduodenal infusion of a levodopa/carbidopa gel with oral treatments in advanced PD patients demonstrated improvement in UPDRS scores and in frequent clinical ratings on a global treatment response scale. Further analysis of data from these studies was performed to find predictive factors related to degree of improvement with infusion. Pearson''s correlation coefficients between measures of improvement and baseline variables were calculated. Using data from one study, a prediction model was designed and was then evaluated using the other study''s data. Correlations were found indicating that patients with more severe symptoms at baseline were most improved after infusion. [Copyright &y& Elsevier]

Cell shapes induced by cell–substratum interactions are linked with proliferation, differentiation or apoptosis of cells. To clarify the relevance of specific surface characteristics, we applied self-assembled monolayers (SAM) of alkyl silanes exhibiting a variety of terminating functional groups. We first characterised the SAMs on glass or silicon wafers by measuring wettability, layer thickness and roughness. Water contact angle data revealed that methyl (CH3), bromine (Br), and vinyl (CH=CH2) groups lead to hydrophobic surfaces, while amine (NH2) and carboxyl (COOH) functions lead to moderately wettable surfaces, and polyethylene glycol (PEG) and hydroxyl (OH) groups created wettable substrata. The surfaces were found to be molecular smooth except for one type of NH2 surface. The SDS-PAGE analysis of proteins adsorbed from bovine serum to the SAMs showed less protein adsorption to PEG and OH than to CH3, NH2 and COOH. Immunoblotting revealed that a key component of adsorbed proteins is vitronectin while fibronectin was not detectable. The interaction of human fibroblasts with CH3, PEG and OH terminated SAMs was similarly weak while strong attachment, spreading, fibronectin matrix formation and growth were observed on COOH and NH2. The strong interaction of fibroblasts with the latter SAMs was linked to an enhanced activity of integrins as observed after antibody-tagging of living cells. [Copyright &y& Elsevier]