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Objectives The objective was to assess whether testicular torsion is associated with low testicular tissue saturation of oxygen (StO2) as measured by transscrotal near-infrared spectroscopy (NIRS) and to compare the differences in NIRS values between testicles of the same patient, both in patients with testicular torsion and in healthy controls. Methods This was an observational study of healthy controls and patients with surgically confirmed testicular torsion who were recruited from males under 30 years of age presenting to the emergency department (ED). The hypothesis was that the difference in NIRS values for the control's two testicles would be zero, and that the difference between the torsed and healthy testicles on an individual patient would not be zero. Based on animal data, the study was powered to detect an absolute difference of StO2 of 47%. Results The mean StO2 for the left control patients' testicles was 73.6% (95% confidence interval [CI] = 68.0% to 79.1%) and the mean StO2 for the right controls' testicles for controls was 73.6% (95% CI = 66.9% to 80.4%; n = 17). The absolute difference in NIRS StO2 for left minus right for each individual was 3.5% (95% CI = 1.8% to 5.4%), which was significantly different (p = 0.0007), and refuted the hypothesis that there was no significant difference in StO2 between left and right testes in healthy patients. In the testicular torsion group, the torsed side had a mean StO2 of 82.8% (95% CI = 68.7% to 96.9%), and the contralateral nontorsed testes had a mean of 85.8% (95% CI = 72.3% to 99.3%). The mean StO2 difference, nontorsed minus torsed was 3.0% (range = –1% to 9%, 95% CI = –2% to 8%; p = 0.174), refuting the hypothesis that torsed testes would demonstrate significantly lower values for StO2. Conclusions While pilot animal investigations support a potential role for transscrotal NIRS for the detection of testicular torsion, this first clinical translation of animal findings reveals that the investigated, transcutaneous, reflectance geometry NIRS device failed to demonstrate symmetric oxygenation of left and right testes in healthy controls and also failed to demonstrate depressed tissue saturation of oxygen values in patients with confirmed testicular torsion. While limited by a small sample size, other problems such as inability to calibrate depth of measurement of StO2 may have led to falsely elevated readings in patients with torsion. Resumen Valoracion Espectroscopica Infrarroja de la Saturacion de Oxigeno Tisular en los Testiculos Sanos y Torsionados Objetivos Valorar si la torsion testicular (TT) se asocia con la saturacion de oxigeno (SatO2) tisular testicular baja medida con espectroscopia infrarroja (EIR) transescrotal, y comparar las diferencias en los valores de EIR entre los testiculos del mismo paciente, tanto en pacientes con TT como en controles sanos. Metodologia Estudio observacional de controles sanos y pacientes con TT confirmada quirurgicamente en varones menores de 30 anos que acudieron al servicio de urgencias (SU). La hipotesis fue que la diferencia en los valores de EIR para los dos testiculos del control seria cero, y que la diferencia entre los testiculos sanos y torsionados en un mismo paciente no seria cero. Basandose en datos de animales, el estudio tuvo potencia para detectar una diferencia absoluta de SatO2 de un 47%. Resultados La media de SatO2 para los testiculos izquierdos de los pacientes controles fue de un 73,6% (IC 95% = 68,0% a 79,1%) y para los testiculos derechos fue de un 73,6% (IC 95% = 66,9% a 80,4%) (n = 17). La diferencia absoluta en la SatO2 mediante EIR para el izquierdo menos derecho para cada individuo fue de un 3,5% (IC 95% = 1,8% a 5,4%), y esta diferencia fue significativa (p = 0,0007), lo cual rechaza la hipotesis que no habia diferencias significativas en SatO2 entre los testiculos derechos e izquierdos en los pacientes sanos. En el grupo de TT, el lado torsionado demostro una media de SatO2 de un 82,8% (IC 95% = 68,7% a 96,9%), y la de los testiculos contralaterales no torsionados fue de un 85,8% (IC 95% = 72,3% a 99,3%). La diferencia media de SatO2, entre los no torsionados y los torsionados fue de un 3,0% (rango -1% a 9%, IC 95% = -2% a 8%; p= 0,174). De nuevo, se rechazo la hipotesis que los testiculos torsionados demostrarian valores menores de SatO2. Conclusiones Mientras que las investigaciones piloto en animales respaldan un papel potencial de la EIR transescrotal para la deteccion de TT, este primer estudio translacional de los hallazgos en animales releva que el dispositivo de EIR investigado, de reflexion geometrica y transcutaneo, fallo en demostrar la oxigenacion simetrica de los testiculos derechos e izquierdos en los controles sanos y tambien en demostrar la disminucion de los valores de la saturacion tisular de oxigeno en pacientes con TT confirmada. A pesar de la limitacion del pequeno tamano de la muestra, otros problemas, como una incapacidad para calibrar la profundidad de la medicion de la SatO2, pueden haber permitido lecturas falsamente elevadas en los pacientes con torsion.

To determine the ability of children and adolescents with acute asthma exacerbations to adhere to national guidelines for proper metered-dose inhaler (MDI) and peak flow meter (PFM) technique and to define characteristics associated with improper use.A prospective study in which the patients were instructed to use a placebo MDI or a PFM in the emergency department exactly as at home. Technique was graded on the basis of performance of specific steps recommended by national guidelines.Children and adolescents (aged 2-18 years) with acute asthma exacerbations in the emergency department of an urban children's hospital with acute asthma.Thirty-three (45.2%) of 73 patients using an MDI (MDI group) demonstrated multiple steps improperly compared with 60 (44.4%) of 135 using an MDI with a holding chamber (MDI-HC group; P =.92). In the MDI group, young ages of the patients (P.008) and the parents (P.003) were associated with improper use. In the MDI-HC group, factors independently and significantly associated with improper use were no hospitalizations within the past year, parent assistance of the patient with MDI-HC use, and nondaily use of the MDI-HC. Also, 165 (82.9%) of 199 children who, per national guidelines, should be using a PFM at home, did not. Eighty-two (73.9%) of 111 patients demonstrated perfect performance of all PFM steps.Among children with acute asthma, we found high rates of improper MDI use and PFM underuse. A greater emphasis must be placed on teaching methods to optimize drug delivery and to instruct patients about the importance of self-monitoring of disease severity.