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Objectives: To provide perspectives from the HEAT-SHIELD project (www.heat-shield.eu): a multi-national, inter-sectoral, and cross-disciplinary initiative, incorporating twenty European research institutions, as well as occupational health and industrial partners, on solutions to combat negative health and productivity effects caused by working on a warmer world.Methods: In this invited review, we focus on the theoretical and methodological advancements developed to combat occupational heat stress during the last five years of operation.Results: We outline how we created climate forecast models to incorporate humidity, wind and solar radiation to the traditional temperature-based climate projections, providing the basis for timely, policy-relevant, industry-specific and individualized information. Further, we summarise the industry-specific guidelines we developed regarding technical and biophysical cooling solutions considering effectiveness, cost, sustainability, and the practical implementation potential in outdoor and indoor settings, in addition to field-testing of selected solutions with time-motion analyses and biophysical evaluations. All recommendations were adjusted following feedback from workshops with employers, employees, safety officers, and adjacent stakeholders such as local or national health policy makers. The cross-scientific approach was also used for providing policy-relevant information based on socioeconomic analyses and identification of vulnerable regions considered to be more relevant for political actions than average continental recommendations and interventions.Discussion: From the HEAT-SHIELD experiences developed within European settings, we discuss how this inter-sectoral approach may be adopted or translated into actionable knowledge across continents where workers and societies are affected by escalating environmental temperatures. [ABSTRACT FROM AUTHOR]

Congenital short bowel syndrome (CSBS) is a rare gastrointestinal disorder caused by intrauterine reduction of small bowel length whose etiology is still unknown. Chronic diarrhea, vomiting, and failure to thrive are the most important complications, arising from less absorptive intestinal surface. This review examines clinical features and outcomes of CSBS patients. A PubMed and EMBASE research on CSBS was performed. Inclusion criterion was congenital short bowel diagnosis in a range of ages between 33 weeks of gestational age and 15 years old (IQR 38 days). Exclusion criteria were history of atresia of any part of the gastrointestinal tract and extensive surgical bowel resections. Qualitative and quantitative variables were collected and analyzed. Data were expressed in mean and IQR. Sixty-one patients were identified (38 males, 23 females) from 1969 to date. Mean bowel length was 58.24 cm (IQR 37.5). Malrotation of the midgut was seen in 98.4% of cases. Our data showed an interesting trend in improving the survival rate of these patients (from 28.5% before 2008 to 75% in the period after 2008). Sepsis was the most frequent cause of death reported (57.9%). Interestingly, 18 patients were genetically analyzed, finding mutations either in FLNA gene (38.8%) or in CLMP gene (61.1%). CSBS is a condition that seems to be related to an autosomal recessive (CLMP) or an X linked (FLNA) type of inheritance. Advance in medical management seems to have improved survival of these children in recent years. Further genetic studies can better understand the causes of this disease aiming to create personalized treatment. Systematic review. Level IV. [ABSTRACT FROM AUTHOR]

Total esophagogastric dissociation (TEGD) has been performed in our institution since 1994, predating its published description by Bianchi in 1997. Originally it was considered a rescue procedure when conventional antireflux surgery failed. Recently TEGD has been considered a viable primary option for the treatment of gastroesophageal reflux disease (GERD) in severely neurological impaired (NI) patients. We describe our institution's experience of TEGD in this selected cohort of patients. An institutional retrospective review was performed detailing our total experience of open TEGD between 1994 and 2015 in severely neurologically impaired (NI) patients. Demographic, complications, and outcome were analyzed. Sixty-six NI patients underwent TEGD between 1994 and 2015 (39 female). Primary TEGD was performed in forty-nine patients (74.2%), while the remainder were rescue procedures following the failure of previous antireflux surgery. In 98% of cases no recurrence of clinically significant reflux was reported. The mean hospital length of stay was 10.2 days. There were sixteen reported complications in twelve patients representing 18.2% of the cohort. One death was attributable to the procedure (1.5%). Median follow-up was 31.6 months (range, 1.3–137.9 months). TEGD appears to be a valid surgical option to treat severe GERD in severely neurologically impaired children, both as a primary procedure and as a rescue procedure following failure of anti-reflux surgery. Further studies comparing TEGD versus laparoscopic fundoplication are desirable to understand which of these procedures can be the most effective in this compromised group of patients. Type of study : Retrospective study Level of evidence : IV [ABSTRACT FROM AUTHOR]

Surface thermal hot-spot areas, and especially industrial and commercial areas, mainly characterized by high artificial surfaces and low vegetation coverages, consistently affect the livability in urban areas. In this study, one of the warmest areas of Florence (Italy), the main agri-food market was selected to perform three tree design mitigation scenarios: a) mitigation intervention by using 5-m high trees (T 5), b) intervention with 10-m high trees (T 10) and c) intervention alternating 5- and 10-m high trees (T 5-10). The methodology was based on the microclimate monitoring and simulation by urban characterization, involving open GIS data from different data sources by using spatial software tools (QGIS and the ENVI-met software). Thermal patterns (air Temperature, AT; Mean Radiant Temperature, MRT; Surface Temperature, ST; Universal Thermal Climate Index, UTCI) were simulated at 9 a.m. and 3 p.m. by the three scenarios and were then compared through a non-parametric statistical test with the ex-ante thermal situation. The results revealed that a 10% increase in the tree canopy on road surfaces had a significant impact on the thermal environment, showing the greatest effect at the surface level. The greatest cooling impact was observed during the afternoon (3 p.m.) considering the T 10 three design scenario: MRT, ST and UTCI decreased by 6.0 °C, 4.1 °C and 1.7 °C respectively when compare to the ex-ante situation. These findings provide very useful information for urban planners and landscape architects to plan targeted interventions aimed at mitigating urban thermal anomalies in industrial areas. [Display omitted] • Industrial urban sites represent significant thermal hot-spot areas. • Tree shading can contribute to mitigating surface thermal hot-spot areas. • Greening simulations is necessary to develop target urban mitigation strategies. • The best cooling effect is obtained using 10-m height and canopy diameter trees. • An increase of 10% in tree canopy surface averagely decreases LST of about 4 °C. [ABSTRACT FROM AUTHOR]

Abstract Thraustochytrids are marine protists highly ecologically relevant in mangrove environments. The family Thraustochytriaceae underwent profound taxonomical rearrangements in the last decade, with the description and emendation of several genera. Here, we identified two new thraustochytrid strains (CCAP 4062/1 and CCAP 4062/3) collected from the same mangrove environment in Mayotte Island (Indian Ocean) and representative of two sister clades in the phylogenetic Aurantiochytrium super clade. Phylogenomic (on 2389 genes) and phylogenetic analyses on 18S rDNA sequences led us to propose the description of a new genus, Hondaea gen. nov. (CCAP 4062/3), closely related and pseudo-cryptic to Aurantiochytrium (CCAP 4062/1). Compared to Aurantiochytrium , Hondaea did not produce amoeboid cells and its zoospores were smaller. Chemotaxonomical traits, such as fatty acid, sterol, and carotenoid profiles measured along the growth curves, validated the new genus description. Genome sequencing and manual annotation of lipid metabolism genes revealed similar pathways in both strains. However, such pathways showed different dynamics during the growth phases. Aurantiochytrium accumulated carotenoids (canthaxanthin) and large amounts of triacylglycerols enriched in ω3-docosahexaenoic acid in the stationary phase, while squalene and free cholesterol increased during the early exponential phase. In contrast, Hondaea accumulated low amounts of triacylglycerols enriched in odd and saturated fatty acids during the early exponential phase, whereas free-sterol and carotenoid contents were little affected. These results suggest that these genera evolved independently, although phylogenetically and ecologically closely related. This comparative study also showed that the biotechnological potential of thraustochytrids cannot be deduced solely from phylogenetic and genomic analyses. Highlights • A new thraustochytrid genus Hondaea gen. nov. is described; its genome was sequenced. • The Hondaea genus and its closely related Aurantiochytrium genus were compared. • Genes for lipid syntheses were annotated and the pathways were reconstituted. • Lipid analyses in the two genera showed different lipid regulations and dynamics. • The two genera have different biotechnological potentials. [ABSTRACT FROM AUTHOR]

Abstract In February 2017 a case of Hemolytic-Uremic Syndrome (HUS) was reported to the National Registry of HUS in an adult living in Northern Italy. Stool specimens from the patient and his family contacts were collected and the analyses led to the isolation of a Locus of Enterocyte Effacement (LEE)-negative Shiga toxin 2 (Stx2)-producing Escherichia coli. The epidemiological investigations performed brought to collect fecal samples from the animals reared in a farm held by the case's family and a mixture of bovine and swine feces proved positive for Shiga toxin-producing E. coli (STEC) and yielded the isolation of a LEE-negative stx2 -positive E. coli strain. Further characterization by whole genome sequencing led to identify the isolates as two identical O2:H27 hybrid Enterotoxigenic Shiga toxin-producing E. coli (ETEC-STEC). Sequencing of a high molecular weight plasmid present in the human isolate disclosed a peculiar plasmid harboring virulence genes characteristic for both pathotypes, including the enterohemolysin-coding gene and sta1 , encoding the heat stable enterotoxin. Moreover, a complete fae locus encoding the ETEC F4 fimbriae could be identified, including a novel variant of faeG gene responsible for the production of the main structural subunit of the fimbriae. This novel faeG showed great diversity in the nucleotidic sequence when compared with the reference genes encoding the swine F4 allelic variants, whereas at the amino acid sequence level the predicted protein sequence showed some similarity with FaeG from E. coli strains of bovine origin. Further investigation on the plasmid region harboring the newly identified faeG allelic variant allowed to identify similar plasmids in NCBI sequence database, as part of the genome of other previously uncharacterized ETEC-STEC strains of bovine origin, suggesting that the novel F4-like fimbriae may play a role in bovine host specificity. [ABSTRACT FROM AUTHOR]

Background Short bowel syndrome (SBS) is the most common cause of intestinal failure in children. Many factors have been investigated in an attempt to define which parameters influence most survival and ability to wean off parenteral nutrition (PN). The aim of this study was to investigate if aetiology of SBS affects the outcomes in paediatric patients treated with autologous gastrointestinal reconstructive surgery. Methods All children with SBS who underwent autologous gastrointestinal reconstructive surgery between 2002 and 2012 were retrospectively reviewed and outcome measures were recorded. Results Forty-three patients were divided into 4 groups according to aetiology (gastroschisis, volvulus, necrotizing enterocolitis (NEC), intestinal atresia). No significant differences were found among groups regarding survival and median age at surgery. The volvulus group had a lower pre-operative bowel length in comparison with gastroschisis and intestinal atresia and the lowest percentage of patients off PN (30%). Gastroschisis had the lowest rate of preserved ileocaecal valve (10%), while intestinal atresia had the highest (66%). For children who weaned off PN, intestinal atresia had also the longest time to achieve enteral autonomy (14.5 months), while NEC had the shortest (3.5 months), followed by gastroschisis (8.5 months). None of the patients needed transplant. Conclusions In our experience it does not appear that diagnosis is significantly related to outcome and this is consistent with the conclusions of other reviews. However, it should be noted that in our series patients with volvulus had the worse outcome in terms of weaning off PN when compared with intestinal atresia. Type of Study Retrospective Study. Level of Evidence II [ABSTRACT FROM AUTHOR]

In order to study the role of sediment re-suspension and deposition versus the role of organic complexation, we investigated the speciation of cadmium (Cd), copper (Cu) and lead (Pb) in samples collected in the Venice Lagoon during several campaigns from 1992 to 2006. The increment in Cd and Pb concentration in the dissolved phases, observed in the central and northern basins, can be linked to important alterations inside the lagoon caused by industrial and urban factors. The study focuses on metal partition between dissolved and particulate phases. The analyses carried out in different sites illustrate the complex role of organic matter in the sedimentation process. While Cd concentration in sediments can be correlated with organic matter, no such correlation can be established in the case of Pb, whose particulate concentration is related only to the dissolved concentration. In the case of Cu, the role of organic complexation remains unclear. [ABSTRACT FROM AUTHOR]

The high penetration rate of new technologies in all the activities of everyday life is fostering the belief that for any new societal challenge there is always an ICT solution able to successfully deal with it. Recently, the solution that is proposed almost anytime is the “ Internet of Things ” (IoT). This apparent panacea of the ICT world takes different aspects on and, actually, is identified with different (often very different) technological solutions. As a result, many think that IoT is just RFIDs, others think that it is sensor networks, and yet others that it is machine-to-machine communications. In the meanwhile, industrial players are taking advantage of the popularity of IoT to use it as a very trendy brand for technology solutions oriented to the consumer market. The scientific literature sometimes does not help much in clarifying, as it is rich in definitions of IoT often discordant between them. Objective of this paper is to present the evolutionary stages, i.e., generations , that have characterized the development of IoT, along with the motivations of their triggering. Besides, it analyzes the role that IoT can play in addressing the main societal challenges and the set of features expected from the relevant solutions. The final objective is to give a modern definition of the phenomenon, which de facto shows a strong pervasive nature, and, if not well understood in its theories, technologies, methodologies, and real potentials, then runs the risk of being regarded with suspicion and, thus, rejected by users. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Pediatric Surgery is the property of W B Saunders and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Heavily calcified lesions may limit optimal stent deployment resulting in stent underexpansion, thus increasing the risk of restenosis and thrombosis. We describe the case of overlapping stents underexpansion treated with a shockwave intravasuclar lithoplasty system (Shockwave Medical Inc., Santa Clara, CA, USA). A 65-year-old man with angina, underwent coronary angiography and intravascular ultrasound showing restenosis, in a site of overlapping stents, due to calcified tissue. Shockwave lithoplasty balloon was able to break calcified tissue in a site of overlapping stents, allowing subsequent vessel dilation and repeat stent implantation with optimal final stent expansion. < Learning objective > Heavily calcified lesions may limit optimal stent deployment resulting in stent underexpansion. Treating stent underexpansion or restenosis due to calcified tissue is a great challenge. Shockwave lithoplasty is effective in breaking calcified tissue also in a site of overlapping stents. The improved plaque compliance allows to repeat stent implantation with optimal final stent expansion. [ABSTRACT FROM AUTHOR]

Abstract Kounis syndrome refers to an acute coronary syndrome, consequent to an allergic reaction. It results from mast cell degranulation with subsequent release of numerous inflammatory mediators, leading to coronary vasospasm, atheromatous plaque rupture, or stent thrombosis. Here, we describe the case of a 47-year-old Caucasian man with acute stent thrombosis, as a consequence of allergic reaction to contrast media. < Learning objective: Kounis syndrome is an acute coronary syndrome, consequent to an allergic reaction. Cytokine release might precipitate coronary spasm, plaque rupture, or stent thrombosis. Stent thrombosis is a dramatic complication of coronary stenting, presenting as sudden death or acute myocardial infarction. Our case serves as an example for clinicians to consider the possibility of Kounis syndrome in patients with acute coronary syndrome and anaphylaxis in order to ensure appropriate treatment.> [ABSTRACT FROM AUTHOR]

Purpose To predict patients who would benefit from adaptive radiotherapy (ART) and re-planning intervention based on machine learning from anatomical and dosimetric variations in a retrospective dataset. Materials and methods 90 patients (pts) treated for head-neck cancer (H&N) formed a multicenter data-set. 41 H&N pts (45.6%) were considered for learning; 49 pts (54.4%) were used to test the tool. A homemade machine-learning classifier was developed to analyze volume and dose variations of parotid glands (PG). Using deformable image registration (DIR) and GPU, patients’ conditions were analyzed automatically. Support Vector Machines (SVM) was used for time-series evaluation. “Inadequate” class identified patients that might benefit from replanning. Double-blind evaluation by two radiation oncologists (ROs) was carried out to validate day/week selected for re-planning by the classifier. Results The cohort was affected by PG mean reduction of 23.7 ± 8.8%. During the first 3 weeks, 86.7% cases show PG deformation aligned with predefined tolerance, thus not requiring re-planning. From 4th week, an increased number of pts would potentially benefit from re-planning: a mean of 58% of cases, with an inter-center variability of 8.3%, showed “inadequate” conditions. 11% of cases showed “bias” due to DIR and script failure; 6% showed “warning” output due to potential positioning issues. Comparing re-planning suggested by tool with recommended by ROs, the 4th week seems the most favorable time in 70% cases. Conclusions SVM and decision-making tool was applied to overcome ART challenges. Pts would benefit from ART and ideal time for re-planning intervention was identified in this retrospective analysis. [ABSTRACT FROM AUTHOR]

Summary Background & aims Abnormalities of blood glucose (BG) concentration (hyper- and hypoglycemia), now referred to with the cumulative term of dysglycemia, are frequently observed in critically ill patients, and significantly affect their clinical outcome. Acute kidney injury (AKI) may further complicate glycemic control in the same clinical setting. This narrative review was aimed at describing the pathogenesis of hyper- and hypoglycemia in the intensive care unit (ICU), with special regard to patients with AKI. Moreover, the complex relationship between AKI, glycemic control, hypoglycemic risk, and outcomes was analyzed. Methods An extensive literature search was performed, in order to identify the relevant studies describing the epidemiology, pathogenesis, treatment and outcome of hypo- and hyperglycemia in critically ill patients with AKI. Results and conclusion Patients with AKI are at increased risk of both hyper-and hypoglycemia. The available evidence does not support a protective effect on the kidney by glycemic control protocols employing Intensive Insulin Treatment (IIT), i.e. those aimed at maintaining normal BG concentrations (80–110 mg/dl). Recent guidelines taking into account the high risk for hypoglycemia associated with IIT protocols in critically ill patients, now suggest higher BG concentration targets (<180 mg/dl or 140–180 mg/dl) than those previously recommended (80–110 mg/dl). Notwithstanding the limited evidence available, it seems reasonable to extend these indications also to ICU patients with AKI. [ABSTRACT FROM AUTHOR]

The purpose of the present retrospective study was to evaluate the outcomes (ie, ulcer recurrence, major amputation, death) in diabetic patients undergoing Chopart amputation because of deep infection or gangrene extending to the midfoot. From 2009 to 2011, 83 patients, aged 71.4 ± 9.3 years, underwent a midtarsal amputation and were followed up until December 31, 2012 (mean follow-up 2.8 ± 0.8 years). Of the 83 patients, 26 were female, 61 required insulin, 47 had renal insufficiency, 19 underwent hemodialysis, 65 had hypertension, 34 had a history of cardiac disease, and 4 had a history of stroke. Chopart amputation was performed in 38 patients (45.8%) with gangrene, 31 (37.4%) with abscess, and 14 (16.9%) with osteomyelitis. Urgent surgery was performed in 56 patients (67.5%). Effective revascularization was performed in 64 patients (77.1%) patients. Of the 83 patients, 47 had healed at a mean period of 164.7 (range 11 to 698) days. Ulcer recurrence developed in 15 patients (31.9%). A major amputation was necessary in 23 patients (27.7%), with an annual incidence of 13.0%. None of the included variables on logistic regression analysis was significantly associated with proximal amputation. Of the 83 patients, 38 (45.8%) died, with an annual incidence of 25.8%. On logistic regression analysis, age (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.01 to 1.16), history of stroke (OR 9.94, 95% CI 3.16 to 31.24), and urgent surgery (OR 2.60, 95% CI 1.14 to 5.93) were associated with mortality. Chopart amputation represents the last chance to avoid major amputation for diabetic patients with serious foot complications. Our success rate was great enough to consider Chopart amputation a viable option for limb salvage in this high-risk population. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus causes significant morbidity and mortality in both developed and developing countries, and a vaccine that adequately protects from severe disease remains an important unmet need. RSV disease has an inordinate impact on the very young, and the physical and immunological immaturity of early life complicates vaccine design. Defining and targeting the functional capacities of early life immune responses and controlling responses during primary antigen exposure with selected vaccine delivery approaches will be important for protecting infants by active immunization. Alternatively, vaccination of older children and pregnant mothers may ameliorate disease burden indirectly until infants reach about six months of age, when they can generate more effective anti-RSV immune responses. [ABSTRACT FROM AUTHOR]

Remotely sensed Land Surface Temperature (LST) is widely used to characterize Surface Urban Heat Island (SUHI) intensity and spatial variability. SUHI may differ significantly from the Urban Heat Island (UHI), which is related to air temperature and is more representative of human wellbeing. The lack of information and results on UHI development is due to the difficulty in having measurements with high spatial density within the city and the uncertainties in finding relationships between air and surface temperatures. Characterizing UHI is fundamental when dealing with human thermal wellbeing especially when extreme events occur. A new index, named Urban Heatwave Thermal Index (UHTI), was presented here to quantify daytime air temperature variability patterns in an urban environment during a meteorological heatwave. UHTI integrates a) air temperature recorded by local sensors; b) structural microclimatic Envi-met fluidodynamic modeling simulations; and c) remotely sensed environmental indicators. UHTI is a reliable representation of thermal criticalities in the city for its inhabitants. A case study on Bologna (Italy) municipality is presented. Moreover, UHTI was calculated and compared with the Urban Thermal Field Variance Index (UTFVI), commonly used for urban climate characterization. Results showed a high degree of correlation (R2 = 0.795) between the two indexes; residual mapping and hot-spot detection indicated that their biggest differences are next to dense urban fabric areas like historical centers and water body areas. • A new index, named Urban Heatwave Thermal Index (UHTI), is presented here. • UHTI depicts daytime air temperature patterns in urban areas during a heatwave. • UHTI integrates: a) ground data, b) satellite data and c) Envi-met modeling output. • A case study on Bologna (Italy) municipality is presented. [ABSTRACT FROM AUTHOR]

Aim Fundoplication has high failure rates in neurodisability: esophagogastric dissociation (TOGD) has been proposed as an alternative. This study aimed to compare the long-term and ‘patient-reported’ outcomes of TOGD and laparoscopic fundoplication (LapFundo). Methods Matched cohort comparison comprises (i) retrospective analysis from a prospective database and (ii) carer questionnaire survey of symptoms and quality of life (CP-QoL-Child). Children were included if they had severe neurodisability (Gross Motor Function Classification System five) and spasticity. Results Groups were similar in terms of previous surgery and comorbidities. The TOGD group was younger (22 vs. 31.5 months, p = 0.038) with more females (18/23 vs. 11/24, p = 0.036). TOGD was more likely to require intensive care: operative time, length of stay and time to full feeds were all longer ( p < 0.0001). Median follow-up was 6.3 and 5.8 years. Rates of complications were comparable. Symptom recurrence (5/24 vs. 1/23, p = 0.34) and use of acid-reducing medication (13/24 vs. 4/23, p = 0.035) were higher for LapFundo. Carer-reported symptoms and QoL were similar. Conclusions TOGD had similar efficacy to LapFundo (with suggestion of lower failure), with comparable morbidity and carer-reported outcomes. However, TOGD was more ‘invasive,’ requiring longer periods of rehabilitation. Families should be offered both procedures as part of comprehensive preoperative counseling. [ABSTRACT FROM AUTHOR]

In this paper a scheme is proposed that exploits the timing channel, i.e., the logical communication channel in which information is encoded in the timing of transmissions, in nanocommunications. The above scheme is called Timing Channel for Nanonetworks (TCN) and supports low rate communications in an energy efficient and reliable manner. Performance of TCN are analytically evaluated and compared, through numerical examples, to those achieved by traditional communication schemes. Performance results show that TCN outperforms traditional schemes in a wide range of system settings. [ABSTRACT FROM AUTHOR]

Wilms tumor (WT) occurs infrequently in adults. Even rarer is adult WT with extension by direct intravascular spread into the right side of the heart. The present report describes a WT with intracaval and intracardiac extension in a 38-year-young man. In addition, thrombus extension above the infrahepatic IVC represents a major technical topic for surgeons because of the possible occurrence of uncontrollable hemorrhages and tumor fragmentation. We report the results of a surgical approach to caval thrombosis including the isolation of the IVC from the liver as routinely performed during liver harvesting. The morphologic and immune-histochemical findings confirmed the diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Our purpose was to examine the validity of 140 mg/dL cutoff value in oral glucose challenge test screening for gestational diabetes mellitus when including in the group to be identified women fulfilling more inclusive Carpenter and Coustan criteria for 100-g oral glucose tolerance testing interpretation and gravid women with borderline glucose intolerance.Study Design: We reanalyzed data of a multicenter study performed on 704 pregnant women screened at the twenty-fourth to twenty-eighth week with a 50-g oral glucose challenge test followed by a universal 100-g oral glucose tolerance test. We used receiver-operator characteristic curve analysis, assembling positive and negative groups according to the different criteria adopted in oral glucose tolerance test interpretation (National Diabetes Data Group or Carpenter-Coustan) and in assignment of women with borderline glucose intolerance. Besides the statistical cutoff value, defined by the Youden index (Sensitivity + Specificity - 1), we also selected a "high-sensitivity" cutoff value, identified by the maximal sensitivity associated with >70% specificity.Results: With use of National Diabetes Data Group criteria, the statistical and high-sensitivity cutoff values were set at 142 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance. With use of Carpenter-Coustan criteria, the statistical cutoff value was set at 141 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 140 mg/dL when it also included subjects with borderline glucose intolerance; the high-sensitivity cutoff value was set at 140 mg/dL when the positive group included only women with positive oral glucose tolerance test results and at 136 mg/dL when it also included subjects with borderline glucose intolerance.Conclusions: We suggest maintaining the 140 mg/dL oral glucose challenge test threshold if the diagnostic target is to recognize only women with positive results of the oral glucose tolerance test. To prevent perinatal risks in pregnancies complicated by borderline glucose intolerance, with Carpenter-Coustan criteria a lower cutoff value (136 mg/dL) could be hypothesized to improve test sensitivity, allowing more extensive diagnosis of "borderline" subjects; however, the higher economic costs resulting from the increased false-positive rate and the limited improvement obtainable in sensitivity currently do not justify its generalized use. [ABSTRACT FROM AUTHOR]

Craniofacial duplication is a very rare malformation. The phenotype comprises a wide spectrum, ranging from partial duplication of few facial structures to complete dicephalus. We report the case of a newborn with an accessory oral cavity associated to duplication of the tongue and the mandible diagnosed by multi-row detector Computed Tomography, few days after her birth. Our case of partial craniofacial duplication can be considered as Type II of Gorlin classification or as an intermediate form between Type I and Type II of Sun classification. Our experience demonstrates that CT scan, using appropriate reconstruction algorithms, permits a detailed evaluation of the different structures in an anatomical region. Multi-row CT scan is also the more accurate diagnostic procedure for the pre-surgical evaluation of craniofacial malformations. [ABSTRACT FROM AUTHOR]

The main cause of intestinal failure in children is due to short bowel syndrome (SBS) resulting from congenital or acquired intestinal lesions. From the first lengthening procedure introduced by Bianchi, the last three decades have seen lengthening procedures established as fundamental components of multidisciplinary intestinal rehabilitation programs. Debate on indications and timing of the procedures is still open leaving SBS surgical treatment a great challenge. However, enteral autonomy is possible only with an individualized approach remembering that each SBS patient is unique. Current literature on autologous gastrointestinal reconstruction technique was reviewed aiming to assess a comprehensive pathway in SBS non-transplant management. [ABSTRACT FROM AUTHOR]

Verocytotoxin-producing Escherichia coli (VTEC) are food borne pathogens causing severe human infections. The virulence genes asset of VTEC is complex and has not been completely defined yet. Nonetheless, all the virulence genes described so far have been described as conveyed by mobile genetic elements. A gene, termed toxB, has been identified in a large virulence plasmid of VTEC O157, later described in similar plasmids carried by VTEC O26 and O145. In this study we identified for the first time an intact copy of toxB gene in a plasmid present in a VTEC O111 strain and observed the existence of two allelic variants of the gene, that we termed toxB1 and toxB2. We investigated the distribution of the two alleles in a panel of VTEC strains belonging to different serogroups and demonstrated that this gene is present only in VTEC serogroups associated with the most severe forms of the infections such as those belonging to the five serogroups O157, O26, O111, O103 and O145 and that the two alleles segregate with the serogroup of the hosting strains. In particular the toxB1 variant was only present in VTEC O157 while the toxB2 allele was present in the remaining four VTEC serogroups. [ABSTRACT FROM AUTHOR]

Marine macroalgal biomass provides polysaccharides that could result in the valuable transformation of waste into an economic resource. Crude extracts, or polysaccharides, from Chaetomorpha aerea (Chlorophyta) and Agardhiella subulata and Hypnea cornuta (Rhodophyta), collected from the coastal brackish Lake Ganzirri (Italy), were evaluated for their effects on the adhesion and biofilm formation of Pseudomonas aeruginosa ATCC 27853 and Staphylococcus aureus ATCC 29213, as model organisms. Without exerting any antibacterial activity, each crude extract showed dose-dependent inhibitory effect on biofilm formation, differing each other and also on the strain tested. The highest concentration (400 μg mL−1) of C. aerea extract, a sulfated polysaccharide mainly composed by glucuronic acid, strongly acted on the initial attachment of P. aeruginosa (54% of biofilm reduction), whereas H. cornuta extract greatly acted on that of S. aureus (59%). The addition of A. subulata and C. aerea extracts reduced the biofilm growth of S. aureus , but did not its mature biofilm. Conversely, A. subulata extract, a κ-carrageenan was also able to reduce the developed biofilm of P. aeruginosa. As resulted by surface-coating and the bacterial affinity to hydrocarbons assays, extracts from C. aerea and H. cornuta were able to inhibit the adhesion to polystyrene of P. aeruginosa and S. aureus, and modify their cell-surface properties and hydrophobicity. Furthermore, all the extracts formed stable emulsions. No in vitro cytotoxicity effects were observed for H. cornuta extract, while they were moderate for C. aerea and high for A. subulata. However, all the extracts did not show any potential toxicity in vivo fish-embryo Danio rerio assay. These extracts could be used to prevent or remove the bacterial biofilms in several medical and non-medical applications. • Seaweed biomass provides polysaccharides able to hinder bacterial biofilm formation. • C. aerea and H. cornuta extracts strongly acted on the initial bacterial attachment. • A. subulata extract was able to reduce the developed biofilm of P. aeruginosa. • No in vivo toxicity effects of crude polysaccharides were observed in D. rerio assay. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we consider the Hydrodynamic Controlled microfluidic Network (HCN) paradigm which is based on purely hydrodynamic microfluidic switching and medium access control. The HCN paradigm can be applied to build programmable microfluidic devices, i.e., Lab-on-a-Chips (LoCs), that by exploiting hydrodynamic effects only, route chemical or biological samples in a microfluidic network, in a controlled way. These microfluidic devices will be highly flexible and inexpensive, and thus are expected to become extremely competitive as compared to the alternative solutions for chemical and biological analysis and synthesis or cheap sensing. This paper provides the design guidelines for the microfluidic circuits implementing the switching function and the medium access control and illustrates through simulations the feasibility of the proposed idea. [Copyright &y& Elsevier]

Abstract: Background: Bariatric surgery leads to resolution of arterial hypertension and diabetes mellitus; isolated reports indicate that response to bariatric surgery is lower in aged patients. The aim of this study was to evaluate the role of age and of duration of obesity on the frequency of co-morbidities in morbid obesity, as well as on improvement of co-morbidities. Methods: A total of 837 consecutive patients with known duration of obesity, undergoing gastric banding, were considered for this study; they were divided into quartiles of age and of duration of obesity. Presence of co-morbidities (diabetes mellitus, arterial hypertension, metabolic syndrome), metabolic variables (cholesterol and HDL-C, triglycerides, blood glucose), anthropometric variables, and loss of weight during 24 months were considered. Results: Older patients had a higher frequency of co-morbidities; duration of obesity only affected frequency of co-morbidities, but not response to surgery. At logistic regression, duration of obesity had a moderate independent effect on the frequency of diabetes. Older patients lost less weight than younger patients, but diabetes mellitus and arterial hypertension improved to the same extent in patients of different ages, and metabolic syndrome disappeared more in older patients, associated with a greater decrease of blood glucose. Frequency of removal of gastric banding and loss to follow-up were not different in different quartiles of age or in different quartiles of duration of obesity. Conclusion: Older patients, despite lower weight loss, have a response to bariatric surgery that is similar to that of younger patients; age and duration of obesity should not be considered as limits to indications to bariatric surgery. [Copyright &y& Elsevier]

Abstract: Background: Ki-67 expression has gained attention as a breast cancer prognostic factor, however its significance in the remaining malignant cells after neoadjuvant chemotherapy (NAC) has been rarely examined. This investigation, extension and analysis of a previously reported cohort of patients, evaluates the significance of Ki-67 and estrogen receptor (ER) expression after NAC in LABC (locally advanced breast cancer). Patients and methods: clinical stage, tumor size, clinical and pathological lymph node involvement, Ki-67, ER, progesterone receptor (PgR), HER2 expression, grading and clinical response were evaluated before and after NAC in 110 patients with LABC. Ki-67 expression was assessed both in pre and post-therapy histological samples, using >15% positive cells as cut-off value to distinguish high from low Ki-67 expressing tumors. Results: six patients (5.45%) attained pCR after NAC. A significant relationship between elevated post-CT Ki-67 and ER expression was showed at Cox multivariate analysis of disease free survival (DFS). On univariate analysis high post-chemotherapy Ki-67 and ER status were associated with worse survival; at multivariate model included these results were confirmed. Based on these two parameters, a prognostic model identified two different groups: low risk (low postchemotherapy Ki-67 and ER positive, or either high post-chemotherapy Ki-67 or ER negative), and high risk (high post-chemotherapy Ki-67 and ER negative). The low risk group showed a good prognosis (median OS still not reached), while the high risk group had a worse OS (median 41 months). Conclusions: Ki-67 value after NAC and ER status could predict a worse prognosis among LABC patients treated with NAC. [Copyright &y& Elsevier]

Abstract: Introduction: Spiral Intestinal Lengthening and Tailoring (SILT) offers a new opportunity for the surgical treatment of short bowel syndrome. SILT requires less manipulation on the mesentery than the Bianchi procedure and does not alter the orientation of the muscle fibers like serial transverse enteroplasty (STEP). This study reports the first SILT results in a surviving animal model. Material and Methods: Vietnamese minipigs (n=6) underwent interposition of a reversed intestinal segment to produce proximal small bowel dilation. Five weeks later the reversed segment was resected, and the wall of the dilated intestine was cut spirally at 45°–60° to its longitudinal axis. The bowel was lengthened longitudinally, and the spiral shaped intestinal wound was sutured. Five weeks later, the animals were explored, and the lengthened segments were measured. Haematoxylin and eosin, picrosirius, neuron specific enolase, S-100, C-kit, and immunohistochemistry were performed. Results: Mean lengthening was 74.8%±29.5% and mean tailoring (lumen reduction) was 56.25%±18.8%. No instances of necrosis, perforation, suture break down, or peritonitis were observed in 6/6 animals. Four of six animals recovered uneventfully with viable lengthened segments. Statistical analysis showed no significant difference in length (p=0,078) and width (p=0,182) after 5weeks. Two animals developed bowel obstruction due to narrowed lumen, adhesion, and strangulation after 14 and 24days of surgery. In both animals the lumen was tailored by more than 70% to less than 1.5cm diameter. The mucosa and the muscle layers in the operated segment had become hypertrophic, but the orientation of the circular and longitudinal muscle fibres remained normal after the SILT procedure. There were no signs of chronic ischemia or collagen accumulation after the SILT. The myenteric and submucosal plexuses and the Cajal cell network appeared normal. Conclusion: The bowel remained viable macroscopically and microscopically after SILT, such that SILT may be an alternative or an addition to the present technical repertoire of intestinal lengthening. However the limitations of tailoring should be kept in mind. [Copyright &y& Elsevier]

Abstract: The current classification of pulmonary neuroendocrine tumours includes four subtypes: low-grade typical carcinoid tumour (TC), intermediate-grade atypical carcinoid tumour (AC), and two high-grade malignancies: large cell neuroendocrine carcinoma and small cell lung cancer (SCLC). Unfortunately, with the exclusion of SCLC, no large phase II and III trials for pulmonary neuroendocrine tumours have been published. Thus, several treatment approaches are available for their treatment but none of them has been validated in appropriately designed and adequately sized clinical trials. The main problem of the published studies is that they include neuroendocrine tumours from various sites of origin with different clinical behaviour. It is important that future studies consider these tumours separately. In this regard, increased awareness and referral of these patients to tertiary centres, in which a multidisciplinary management is available, may be of value. The aim of this review is to evaluate the state of the art and discuss future developments in the management of pulmonary neuroendocrine tumours excluding SCLC which we consider should be addressed in a different issue. [Copyright &y& Elsevier]

Abstract: Background/Purpose: Total esophagogastric dissociation has been described as both a primary and a rescue procedure for patients with severe gastroesophageal reflux. Although most commonly used in the neurologically impaired, it has also been used in those with no neurological impairment. The main objective of this study was to determine morbidity and mortality for this procedure. Methods: All published cases of esophagogastric dissociation in children were identified. Series were updated where possible by personal communication with the author. Patient characteristics, indications, morbidity, and mortality were analyzed. Results: One hundred eighty-one cases were identified. One hundred seventeen were primary operations and 64 were rescue procedures. There were 29 (16.0%) early complications and 28 (15.5%) late complications with 6 (3.3%) deaths related to the procedure of a total of 35 deaths. Twenty-one patients (11.6%) required re-operation in the study periods. Conclusions: Esophagogastric dissociation has an acceptable morbidity and mortality. It is useful as both a primary and a rescue procedure. [Copyright &y& Elsevier]

Abstract: Introduction: Extracorporeal stool transport (recycling of chyme discharged from the proximal stoma end to the distal end of a high jejunostomy or ileostomy) is thought to be beneficial in preventing malabsoprtion, sodium loss, cholestasis and atrophy of the distal intestine until restoration of the intestinal continuity becomes possible. However little is known about its adverse effects. Our aim was to investigate the microbiological safety of recycling. Material and Method: Native samples were taken from the proximal stoma in 5 premature neonates who underwent an ileostomy or a jejunostomy due to necrotising enterocolitis, for qualitative culture. The first sample was drawn immediately after the change of the stoma bag, further samples were sent from the stoma bag at 30, 60, 90, 120, 150, and 180min later. The samples were inoculated by calibrated (10μl) loops onto blood agar (5% sheep blood), eosin–methylene blue agar and anaerobic blood agar, respectively (Oxoid). The aerobic plates were incubated for 18–20h at 5% CO2, whereas the anaerobic plates were incubated for 24–48h in an anaerobic chamber (Concept 400). The bacterial strains were identified to species level by specific biochemical reactions, RapID-ANA II system (Oxoid) and ID32E, Rapid ID 32 Strep ATB automatic system cards (bioMérieux). Results: The number of colony forming unit (CFU) of Gram-negative bacteria (mainly E. coli) exponentially increased after 30min and reached 105/ml after 120min. Gram-positive strains (primarily E. faecalis) were detected after 60min and CFU increased to 105/ml after 120min. The number of anaerobic (principally Bacteroides fragilis) CFU started to increase after 120min. In two cases coagulase negative Staphylococcus strains were isolated the earliest in the chyme. The average of total CFU approached 105/ml after 90min and exceeded 105/ml after 120min. Conclusion: The chyme in the stoma bag is colonized by commensal facultative pathogenic enteral/colonic as well as skin flora species after 120min. Recycling of stoma bag content may be dangerous after 90min. [Copyright &y& Elsevier]

Purpose: Within the evidence-based medicine paradigm, randomized controlled trials represent the "gold standard" to produce reliable evidence. Indeed, planning and implementing randomized controlled trials in critical care medicine presents limitations because of intrinsic and structural problems. As a consequence, observational studies still occur frequently. In these cases, propensity score (PS) (probability of receiving a treatment conditional on observed covariates) is an increasingly used technique to adjust the results. Few studies addressed the specific issue of a PS correction of repeated-measures designs. Materials and Methods: Three techniques for correcting the analysis of nonrandomized designs (matching, stratification, regression adjustment) are presented in a tutorial form and applied to a real case study: the comparison between intravenous and enteral sedative therapy in the intensive care unit setting. Results: After showing the results before and after the use of PS, we suggest that such a tool allows to partially overcoming the bias associated with the observational nature of the study. It permits to correct the estimates for any observed covariate, while unobserved confounders cannot be controlled for. Conclusions: Propensity score represents a useful additional tool to estimate the effects of treatments in nonrandomized studies. In the case study, an enteral sedation approach was equally effective to an intravenous regime, allowing for a lower level of sedation and spare of resources. [ABSTRACT FROM AUTHOR]

Abstract: Microfluidics is a science and a technology which deals with manipulation and control of small volumes of fluids flowing in channels of micro-scale size. It is currently used for Labs-On-a-Chip (LoCs) applications mainly. In this context, recently fluids have been used in the discrete form of droplets or bubbles dispersed into another immiscible fluid. In this case, droplets or bubbles can be exploited as a means to transport digital information between microfluidic components, with sequences of particles (i.e. droplets or bubbles) representing sequences of binary values. LoCs are today realized through monolithic devices in which samples are processed by passing them through a predetermined sequence of elements connected by fixed and preconfigured microfluidic channels. To increase the reusability of LoCs, effectiveness and flexibility, networking functionalities can be introduced so that the sequence of elements involved in the processing can be dynamically selected. Accordingly, in this paper we introduce the Networked LoC (NLoC) paradigm that brings networking concepts and solutions into microfluidic systems such as LoCs. More specifically, in this paper the need for the introduction of the NLoC paradigm is motivated, its required functions are identified, a system architecture is proposed, and the related physical level design aspects, such as channel characterization, information representation and information capacity are investigated. [Copyright &y& Elsevier]

Abstract: Background: Proximal large bowel volvulus is considered as an extremely rare surgical emergency in children. Approximately 40 cases have been reported, and because of its rarity, the diagnosis is often missed or delayed. The purpose of this study was to review the presentation, treatment, and clinical outcome of proximal large bowel volvulus. Methods: A systematic review and analysis of the data relating to 6 patients from the author''s practice and cases published in the English literature from 1965 to 2010 was performed. Detailed information regarding demographics, clinical presentation and methods of diagnosis, surgical procedure, complications, and outcome were recorded. Results: Thirty-six cases of proximal large bowel volvulus were retrieved from the English literature, and 6 cases, from the author''s practice. The male-female ratio was 1:1, with a median age of 10 years. There were 29 (69%) cases with neurodevelopmental delay. Clinical presentation included 29 (69%) cases with constipation, 41 (98%) with colicky abdominal pain, 42 (100%) with abdominal distension, and 35 (83%) with vomiting. Plain radiography was specific in 64% (27/42) of cases, barium enema in 100% (15/15), and computed tomography in 100% (2/2). All patients underwent surgery, with resection and primary anastomosis in 24 (57%) cases, stoma formation in 11 (26%), and detorsion of volvulus without resection in 7 (17%) cases. Six patients (14%) died postoperatively. Conclusion: A child with neurodevelopmental delay and a history of constipation presenting with an acute onset of colicky abdominal pain and progressive abdominal distension with vomiting should be suspected of having a cecal and proximal large bowel volvulus. [Copyright &y& Elsevier]

Abstract: Objective: Fatigue has multiple causes but the pathogenesis is not completely understood. Fatigue is one of the worst threats to the functional independence of older individuals. The aim of this study is to establish an association between fatigue, anemia and functional dependence in older cancer patients receiving chemotherapy. Materials and methods: Patients aged 70years or older with a diagnosis of metastatic malignancy were enrolled. All patients were evaluated at the beginning and after 3months of treatment. A comprehensive geriatric assessment and Fatigue Symptom Inventory (FSI) were used at the beginning and at the end of the study. Results: The final sample involved 129 patients. Almost all fatigue scores had a significant increase from the beginning to the end of treatment. IADLs and PS decreased significantly between the baseline and the final evaluations. The worsening in severity of fatigue, anemia, the increase in interference with daily living as well as the hours of fatigue during the day were associated with disabilities in IADLs. The decline in creatinine value was the only parameter associated with PS. Conclusions: Fatigue is almost universal in older cancer patients at the end of chemotherapy treatment and is associated with functional dependence, especially IADLs. We also established an independent correlation of anemia and functional dependence in older individuals. [Copyright &y& Elsevier]

Abstract: The Yan''an Formation of the Ordos Basin is a sequence of four members, consisting of siliciclastic sediments deposited in alluvial, lacustrine and mire settings during the Middle Jurassic. Samples collected from Members Two and Four contain abundant blackened plant material identified through standard analytical techniques as fusain (fossil charcoal). The occurrence of fusain in fluvial sandstones at multiple horizons in the outcrops, combined with the previously reported high concentration of inertinite in the coals of Member One, indicates that paleowildfire was a common occurrence in the Ordos Basin during Yan''an deposition. Sedimentary evidence from Yan''an outcrops suggests that the paleoclimate was seasonal during deposition of Members Two through Four, which may have contributed to the wildfire frequency. The presence of fusain in the Yan''an Formation indicates that atmospheric oxygen levels were clearly above the minimum required for sustained combustion during the Middle Jurassic. This conclusion contradicts previous geochemical models for paleoatmospheric composition, but supports more recent studies. [Copyright &y& Elsevier]

Abstract: Purpose: Although gastroschisis infants usually have a good outcome, there remains a cohort of babies who fare poorly. We inquired whether the presence of bowel dilatation in utero is predictive of postnatal course in infants with gastroschisis. Methods: We compared the clinical course of infants who had bowel dilatation with those who did not. Bowel dilatation was defined as more than 20 mm in cross-sectional diameter on ultrasound at any gestational age. Outcome measures used were length of time of parenteral nutrition, death, and surgery for intestinal failure. Results: A review of 170 infants with gastroschisis identified 74 who had dilatation of more than 20 mm (43.5%). There was no significant difference in the incidence of intestinal atresia in those with bowel dilatation and those without (P = .07). Those with bowel dilatation spent a longer period on parenteral nutrition. There were significantly more deaths in the group with bowel dilatation (P = .01). There was no significant difference in the number of infants requiring surgery for intestinal failure between the 2 groups (P = .47). Conclusions: We found that sonographically detected bowel dilatation more than 20 mm in utero in fetuses with gastroschisis may have value in predicting clinically significant adverse postnatal outcomes. [Copyright &y& Elsevier]

Abstract: Shiga toxin-producing Escherichia coli (STEC) strains belonging to serogroup O26 have been associated with sporadic cases and outbreaks of hemorrhagic colitis and hemolytic uremic syndrome. In addition to chromosomal virulence genes, STEC strains usually harbor a large plasmid that carries genes associated with pathogenicity. The complete nucleotide sequence and genetic organization of 6 plasmids carried by STEC O26:H11 strain H30 were determined. The large virulence plasmid (pO26-Vir) was approximately 168kb in size and contained 196 open reading frames (ORFs). pO26-Vir possesses a mosaic structure and shows similarity to the virulence plasmids in locus of enterocyte effacement (LEE)-negative STEC O113:H21 EH41 (pO113), in E. coli clinical strain C1096 (pSERB1), and in E. coli O157:H7 RIMD 0509952 (pO157). Plasmid pO26-Vir shares several highly conserved regions with pO157 and carries important virulence genes, including toxB, katP, espP, and the hly gene cluster. In addition, pO26-Vir possesses genes encoding for type IV pili (pilL-V). The second largest plasmid, pO26-L (73kb) contains 101 ORFs. pO26-L carries the tetracycline resistance gene and has regions that show similarity to the E. coli conjugative resistance plasmid NR1. The third largest plasmid, pO26-S4 (5.8kb), is homologous to the ColE2 colicinogenic plasmid that encodes for colicin E2. The remaining 3 plasmids, pO26-S1 (1.5kb), pO26-S2 (3.1kb), and pO26-S3 (4.2kb), carry very little genetic information except for putative proteins involved in plasmid replication and DNA maintenance. The data presented underscore the diversity among the STEC virulence plasmids and provide insights into the evolution of these plasmids in STEC strains that cause serious human illness. [Copyright &y& Elsevier]

Abstract: Background: The role of the transcrotal approach to the undescended testis remains controversial despite its increasing popularity. The authors update their previous published series and review the literature on this subject, aiming to delineate the value of this technique. Methods: The authors performed a retrospective review of the transcrotal primary orchidopexy carried out to treat palpable undescended testis at Royal Manchester Children''s Hospital between 1993 and 2005. A structured review of literature published since the proposal of this technique was also performed. Results: 122 procedures were included. The transcrotal approach was successfully completed in 119 (97.5%). Additional groin incision was needed in three (2.5%) to further mobilize the spermatic cord. No immediate complications were recorded and 8.4% required a reoperative procedure. On review of the literature, a total of 16 articles were discovered spanning 1695 transcrotal procedures, including the previously published authors'' experience. On combining the data, the transcrotal approach required an additional groin incision in 4.4% of cases, 1.6% experienced immediate and/or early complications, and the overall recurrence rate was 2.0%. Conclusions: Transcrotal orchidopexy for the treatment of palpable undescended testes is a safe procedure with a long-term success rate comparable to the two-incision approach. [Copyright &y& Elsevier]

Abstract: Background: Transanal anorectoplasty was developed through the 1980s by the senior author (AB) as an alternative approach to posterior sagittal anorectoplasty for the management of imperforate anus. This study evaluates this surgical approach and its longer-term results. Methods: Case notes of all patients treated from 1984 to 2005 were reviewed. Operative procedures, colostomy requirement, complications, and long-term outcome were recorded. Patients were grouped according to the status of the pelvic floor, the location of the rectal fistula, and the sacral ratio. Results: A total of 245 patients (175 male, 70 female) underwent transanal anorectoplasty. The perineum was well formed in 208 patients (85%), moderately formed in 15 (6%), and poorly formed in 22 (9%) patients. Two hundred three patients (82.8%) had a visible perineal or vulval fistula, 24 (9.8%) had a prostatic urethral fistula, whereas 18 (7.4%) had a bulbourethral fistula. Overall, 6 patients (2.5%) had wound infection or breakdown. As continence is age related, 32 patients were excluded from the study. Of the remaining 212 patients, 182 are continent with no soiling or only minimal staining. Thirty patients born with a poor perineum are incontinent. Conclusion: Transanal anorectoplasty is a safe procedure with limited morbidity. It is sphincter sparing and permits accurate placement of the rectum with its internal sphincter within the anal canal. The anus lies accurately placed at the center of the external anal sphincter muscle complex. Given a well-performed surgical intervention, eventual continence relates to the original anatomy and neurology of the pelvic floor. Transanal anorectoplasty should be regarded as an alternative rather than as a substitute to posterior sagittal anorectoplasty for reconstruction of most forms of imperforate anus. [ABSTRACT FROM AUTHOR]