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We consider the 3D simplified Bardina turbulence model with horizontal filtering, fractional dissipation, and the presence of a memory term incorporating hereditary effects. We analyze the regularity properties and the dissipative nature of the considered system and, in our main result, we show the existence of a global exponential attractor in a suitable phase space.

In this paper we deal with the 3D tropical climate model with damping terms in the equation of the barotropic mode $u$ and in the equation of the first baroclinic mode $v$ of the velocity, and we establish a regularity criterion for this system thanks to which the local smooth solution $(u, v, \theta)$ can actually be extended globally in time., Comment: 16 pages. Amended version of the article, which has been accepted by J. Math. Anal. Appl

Ileocolic intussusception is a common cause of bowel obstruction. When spontaneous reduction does not occur, non-operative management through enema reduction is necessary. Despite the evidence indicating that sedatives favor success in the reduction, their use is still not a common practice. To determine if midazolam (MDZ) before enema improves the rate of procedure success, we retrospectively reviewed charts of patients admitted to two Italian pediatric emergency departments. Outcome measures were the success rate of the enema, recurrence, and need for surgery. Patients were grouped according to the use of MDZ or not, before hydrostatic reduction attempt. We included 69 and 37 patients in the MDZ and non-MDZ groups, respectively. The two groups did not differ in demographics, clinical characteristics, and ultrasound findings. Intussusception reduction after the first enema attempt occurred in 75% (MDZ group) and 32.4% (non-MDZ group) of patients (P .001); 27.9% (MDZ group) and 77.8% (non-MDZ group) of patients underwent surgery (P .001). Among them, spontaneous reduction of intussusception during the induction of general anesthesia occurred in 31.6% and 42.9% of patients, respectively (P .43). Multivariate logistic regression analysis showed that only MDZ had a positive effect on the result of the enema (OR 7.602, 95%CI 2.669-21.652, P .001).Procedural sedation with MDZ for enema reduction of intussusception can increase the success rate and lead to a better management of patients.• Despite the evidence of the usefulness of sedatives in the reduction of intussusception, their use is still not a common practice.• Midazolam during enema reduction of intussusception can increase the success rate and consequently lead to better management of patients.

Introduction: Surgical management of jejuno-ileal atresia/stenosis (JIA) is shifting to a minimally invasive approach. Our purpose is to evaluate the safety and feasibility of laparoscopy-assisted surgery (LAS) in JIA by comparing outcomes with a control group of open surgery (OS). Methods: A retrospective review of JIA cases was performed. Demographic, surgical, and outcomes data were extracted. LAS cases were compared with OS. Fisher's exact-test for qualitative and Mann-Whitney-test for quantitative values were used. p values

Introduction The uretero-pelvic junction (UPJ) is the most common site of obstruction in the pediatric upper urinary tract, causing hydronephrosis. In our institution, the gold standard approach for hydronephrosis in infants is the One-Trocar- Assisted Pyeloplasty (OTAP). The aim of this study is to evaluate the feasibility of OTAP in terms of efficacy and safety in the first 90 days of life. Methods We retrospectively reviewed all charts and long-term follow-up of 138 infants treated with OTAP; we selected and examined the ones with a defined diagnosis of severe UJPO and, thus, treated in the first 90 days of life: 28 patients. Indica- tions for early surgery were: antero-posterior pelvic diameter (APD) > 20 mm and an obstructive pattern on renography; impaired echotexture and/or relative renal function < 40% had to be associated. Results Out of 23 patients, we witnessed one conversion to open surgery (4.35%) and one recurrence (4.35%) of UPJO. The mean pre-surgery APD was 35.2 mm, while the mean post-surgery APD was 17.32 mm. The mean operative time was 133 min. The mean hospitalization time was 7.71 days. The mean average of follow-up was 46.41 months (minimum 1 year). Conclusions Our experience suggests that OTAP is a valid and feasible technique in terms of safety and efficacy for the early treatment of very young infants affected by UPJO.

Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called &ldquo, anal-lipofilling&rdquo, ) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck&rsquo, s scale (KS) was administered to the patients to evaluate the clinical outcome. Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 &plusmn, 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment). Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs.

Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=

We consider the Euler–Voigt equations in a smooth bounded domain as an approximation for the 3D Euler equations. We show that the solutions of the Voigt equations are global, do not smooth out the data, and converge to the solutions of the Euler equations. For these reasons they represent a good model, also for computations of turbulent flows.

Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients ’demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated.

Introduction The aim of the study was to investigate perinatal outcome of fetuses with hyperechogenic bowel (HB) in relation to gestational age at diagnosis. Materials and Methods This is a retrospective observational study of fetal HB cases from 2002 to 2012. Patients were divided into three groups according to trimester at diagnosis. For each group, data from fetal ultrasound examination, fetal medicine investigations, intrapartum cares, and neonatal outcome were obtained. Results A diagnosis of HB was made in 279 fetuses among them 17 (6%) during the first trimester, 186 (67%) during the second trimester, and 75 (27%) during the third trimester. A significant prevalence of maternal comorbidities was noticed in group 1 (12%: p = 0.02). A chromosomal defect was identified in 13% of the fetuses without difference among the three groups. HB was associated with prenatal infection in 11.5% (n = 32) of the cases, with an equal distribution between groups 2 and 3. Intrauterine growth retardation was noticed in 23% (n = 64) of the cases with a slightly high prevalence in groups 1 (35%). HB was the only ultrasonographic intestinal soft marker in 80% (n = 223) of the fetuses, two-third of them were detected during the first and the second trimesters (p = 0.001). However, HB was associated with bowel dilation in 33% of the cases diagnosed during the third trimester (p = 001). Ultrasonographic extraintestinal anomalies were identified in 30% of the fetuses with a higher prevalence in group 1 (59%). HB resolved spontaneously in 55 (19.7%) cases—without difference among the three groups. In group 1 we recorded a significant prevalence of intrauterine demise (23.5%, p = 0.004). Two hundred twenty-seven (81.3%) pregnancies resulted in live-born neonates; among them gastrointestinal anomalies were noticed in 12.5% with a significant prevalence in group 3 (36%) compared with 6 and 5.4% in groups 1 and 2, respectively (p = 0.001). Extraintestinal anomalies were confirmed in 27% of the cases, whereas postnatal mortality rate was of 7% without differences between the three groups. Conclusion Detection of HB during the first trimester is associated with an increased risk for maternal comorbidities, intrauterine growth retardation, and adverse pregnancy outcome. Moreover, if HB is detected during the second trimester, it is associated with a favorable prognosis. Otherwise, HB detected during the third trimester is associated with a significant risk of gastrointestinal anomaly.

Purpose Lung-sparing strategies such as segmentectomy or atypical resection have been advocated for small congenital pulmonary airway malformation (CPAM), even by thoracoscopy. The aims of our study were to evaluate surgical and clinical outcome of patients undergoing lung-sparing surgery and to determine whether thoracoscopy is superior to thoracotomy. Methods We conducted a retrospective review of patients who underwent lung-sparing resection for CPAM from 2004 to 2018. Demographic data, presenting symptoms, size and location of the CPAM, operative and post-operative data were collected and analyzed according to surgical technique (thoracoscopy—TS, vs thoracotomy—TO). Data were compared using Fisher’s exact test for qualitative values and Mann–Whitney test for quantitative values. P values less than 0.05 were considered as statistically significant. Results 167 lung-sparing surgery procedures were performed (segmentectomy n = 21 or atypical resection n = 146). 67 procedures were completed in TS. All histological examination revealed negative margins for residual CPAM. Patients in the TS group were older and presented a higher weight compared to the TO group. TS was associated with shorter duration of pleural drainage and shorter hospital stay. Rate of conversion was 35% (n = 29). Location of CPAM in the lower lobe and CPAM size greater than 5 cm were predictor factors of conversion from TS to TO. Conclusion Lung-sparing surgery for CPAM is a safe and feasible technique in pediatric patients. TS results in reduced post- operative morbidity compared to TO and should be proposed as first surgical approach for selected patients.

Omental infarction (OI) is a rare cause of acute abdomen in children. It is found in 0.1–0.5% of pediatric patients undergoing abdominal exploration for the suspect of acute appendicitis. OI is considered a self-limited entity, and conservative management should be considered. This approach implicates computer tomography scan radiation exposure, prolonged hospitalization, and prolonged analgesic and anti-inflammatory therapy. In contrast, surgery allows immediate pain resolution with low complication rate. We present our experience with two cases of pediatric acute abdomen due to OI, misdiagnosed as acute appendicitis, which were successfully treated surgically.Keywords: acute abdomen, acute appendicitis, omental infarction, pediatric

We consider a Large Eddy Simulation model for a homogeneous incompressible Newtonian fluid in a box space domain with periodic boundary conditions on the lateral boundaries and homogeneous Dirichlet conditions on the top and bottom boundaries, thus simulating a horizontal channel. The model is obtained through the application of an anisotropic horizontal filter, which is known to be less memory consuming from a numerical point of view, but provides less regularity with respect to the standard isotropic one defined as the inverse of the Helmholtz operator. &nbsp It is known that there exists a unique regular weak solution to this model that depends weakly continuously on the initial datum. We show the existence of the global attractor for the semiflow given by the time-shift in the space of paths. We prove the continuity of the horizontal components of the flow under periodicity in all directions and discuss the possibility to introduce a solution semiflow.

We propose a new Large Eddy Simulation (LES) model for the Boussinesq equations. We consider the motion in a three-dimensional domain with solid walls, and in a particular geometrical situation we look for solutions which are periodic in the vertical direction and satisfy homogeneous Dirichlet conditions on the lateral boundary. We are thus modeling a vertical pipe and one main difficulty is that of considering regularizations of the equation which are well behaved also in presence of a boundary. The LES model we consider is then obtained by introducing a vertical filter, which is the natural one for the setting that we are considering. The related interior closure problem is treated in a standard way with a simplified-Bardina deconvolution model. The most technical analytical point is related to the fact that anisotropic filters provide less regularity than the isotropic ones and, in principle, the density term appearing in the Boussinesq equations may behave very differently from the velocity. We are able to define an appropriate notion of regular weak solution, for which we prove existence, uniqueness, and we also show that the energy associated to the model is exactly preserved.

We show the existence of an inertial manifold (i.e. a globally invariant, exponentially attracting, finite-dimensional manifold) for the approximate deconvolution model of the 2D mean Boussinesq equations. This model is obtained by means of the Van Cittern approximate deconvolution operators, which is applied to the 2D filtered Boussinesq equations.

We consider a large eddy simulation model for the 3D Navier–Stokes equations obtained through fractional deconvolution of generic order. The global well-posedness of such a problem is already known. We prove the existence of the global attractor for the solution operator and find estimates for its Hausdorff and fractal dimensions both in terms of the Grashoff number and in terms of the mean dissipation length, with particular attention to the dependence on the fractional and deconvolution parameters. These results can be interpreted as bounds for the number of degrees of freedom of long-time dynamics, thus providing further information on the validity of the model for the simulation of turbulent 3D flows.

We consider the 2D simplified Bardina turbulence model, with horizontal filtering, in an unbounded strip-like domain. We prove global existence and uniqueness of weak solutions in a suitable class of anisotropic weighted Sobolev spaces.

Summary Introduction Megacystis is a condition of abnormal enlarged fetal bladder for gestational age, which is usually associated with urological malformations that may constitute a life-threatening condition for the baby. Objective The purpose of this study was to assess the prognostic and etiological criteria of fetal megacystis and to describe the neonatal outcome in a large series collected in a single tertiary center. Study design A retrospective observational study was conducted between 2008 and 2012. We reviewed all consecutive cases of fetal megacystis diagnosed during routine ultrasound (US) screening. The following data were collected and analyzed: maternal age, gestational age at diagnosis, prenatal ultrasonographic details of the urinary system, extra-urinary ultrasonographic anomalies, fetal karyotype, pregnancy outcome, postnatal diagnosis, and medical/surgical follow-up. Results Of the 25 fetuses included in this study, 76% were males. The mean gestational age (GA) at diagnosis was 23.1 ± 7.5 weeks (range 12–34), among them only four (16%) were diagnosed during the first trimester. Associated urological malformations were detected in 92% (n = 23) of the cases, while other malformations were detected in 36% (n = 9). Oligohydramnios or anyhydramnios were observed in 52% (n = 13) of the cases. Twelve (48%) fetuses were considered as having poor prognosis for renal function. Vesicocentesis with or without vesico-amniotic infusion were performed in 28% (n = 7) of the cases. Pregnancy outcome was surprisingly good, with only one case of prenatal death and survival rate of 96% (n = 24) of liveborn babies. Posterior urethral valve (PUV) (n = 9, 36%) was the most common etiology of the fetal megacystis, followed by persistent urogenital sinus (n = 2, 8%), Prune belly syndrome (n = 2, 8%) and bilateral vescico-ureteral reflux (VUR) (n = 2, 8%). Surgical or endoscopic procedures were performed in 75% (n = 18) of the cases. Six (24%) newborns presented with moderate/severe respiratory distress that requested invasive assisted ventilation. Three cases (n = 3, 12%) of perinatal death were observed due to severe impaired renal function. After a median follow-up of 29 months renal function was good in 79% (n = 19) of the cases. Conclusions Fetal megacystis may underline a wide range of associated pathologies with the highest prevalence of urinary malformation. Optimal counseling of the involved parents requires a multidisciplinary approach to allow the best management during the pregnancy and the perinatal period. Despite the high risk of renal failure, lung hypoplasia, and severe associated anomalies, the outcome of fetuses with megacystis could be improved thanks to an appropriate perinatal diagnosis and neonatal management.

We consider the free boundary problem for the two-dimensional plasma-vacuum interface in ideal compressible magnetohydrodynamics (MHD). In the plasma region, the flow is governed by the usual compressible MHD equations, while in the vacuum region we consider the Maxwell system for the electric and the magnetic fields. At the free interface, driven by the plasma velocity, the total pressure is continuous and the magnetic field on both sides is tangent to the boundary. We study the linear stability of rectilinear plasma-vacuum interfaces by computing the Kreiss-Lopatinskii determinant of an associated linearized boundary value problem. Apart from possible resonances, we obtain that the piecewise constant plasma-vacuum interfaces are always weakly linearly stable, independently of the size of tangential velocity, magnetic and electric fields on both sides of the characteristic discontinuity. We also prove that solutions to the linearized problem obey an energy estimate with a loss of regularity with respect to the source terms, both in the interior domain and on the boundary, due to the failure of the uniform Kreiss-Lopatinskii condition, as the Kreiss-Lopatinskii determinant associated with this linearized boundary value problem has roots on the boundary of the frequency space. In the proof of the a priori estimates, a crucial part is played by the construction of symmetrizers for a reduced differential system, which has poles at which the Kreiss-Lopatinskii condition may fail simultaneously., 38 pages

We consider two magnetohydrodynamic-α (MHDα) models with kinematic viscosity and magnetic diffusivity for an incompressible fluid in a three-dimensional periodic box (torus). More precisely, we consider the Navier–Stokes-α-MHD and the Modified Leray-α-MHD models. Similar models are useful to study the turbulent behavior of fluids in presence of a magnetic field because of the current impossibility to handle non-regularized systems neither analytically nor via numerical simulations. In both cases, the global existence of the solution and of a global attractor can be shown. We provide an upper bound for the Hausdorff and the fractal dimension of the attractor. This bound can be interpreted in terms of degrees of freedom of the long-time dynamics of the involved system and gives information about the numerical stability of the model. We get the same bound that holds for the Simplified Bardina-MHD model, considered in a previous paper (this result provides, in some sense, an intermediate bound between the number of degrees of freedom for the Simplified Bardina model and the Navier–Stokes-α equation in the nonmagnetic case). However, the Navier–Stokes-α-MHD system is preferable since, in the ideal case, it conserves more quadratic invariants derived from the standard MHD model.

We report the case of 22-month-old boy who sustained spontaneous gastric rupture. The patient had an episode of nausea and vomiting after a large meal the day before admission to our emergency ward. Abdominal ultrasonography revealed free and corpuscolate fluid in the abdomen. Abdominal X-ray showed free air in the abdominal cavity, leading to diagnosis of gastrointestinal perforation. Blood examination revealed metabolic acidosis. An emergency laparotomy detected a wide perforation of gastric wall involving fundus and greater curvature. A sleeve gastrectomy was performed with two layers closure of abdominal wall. Idiopathic gastric rupture, beyond neonatal period, is extremely rare in childhood. Early diagnosis and surgery are mandatory to avoid fatal complications.

We prove local and global existence results for the Cauchy problem of a regularized magnetohydrodynamic-α model with viscous velocity field and no magnetic diffusivity for an incompressible fluid. Such a model is introduced in analogy with the Navier–Stokes equation to study the turbulent behavior of fluids in presence of a magnetic field. We consider the case of two space dimension.

The aim of this study is to compare the outcomes and the complications between the 2 most adopted procedures for gastrostomy placement: percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) in children. We present our study on 69 patients (male: 46/female: 23): group 1 (37 patients, 54%) undergoing PEG, group 2 (32 patients, 46%) undergoing LG. A total of 5 major complications were observed all in the PEG group (13.5%), no major complication was observed in the LG group (P-value

The present study aims to identify clinical and pathological factors that can predict the risk of spinal cord anomalies (SCA) in patients with anorectal malformations (ARM), the need for neurosurgery, and to define the impact of SCA on the outcome of patients with ARM. A 16-year retrospective analysis of all patients treated at a single tertiary children’s Hospital with diagnosis of ARM. Data were collected to assess the impact of defined clinical characteristics on prevalence of SCA (detected at MRI). Children surgically treated or not for SCA were compared for age, clinical symptoms and type of anomalies at surgery or at last follow-up, respectively. Moreover, patients with intermediate/high ARMs, with or without SCA were compared for neurogenic bladder (NB), constipation, soiling and need for bowel management (BM). Two hundred and seventy-five children were treated for ARM in the study period, 142 had spinal MRI that showed SCA in 85. Patients with SCA had significantly higher prevalence of preterm birth (p

The finding of a fetal intra-abdominal cyst is relatively common and it can be due to a wide variety of clinical conditions. The aims of this study were to determine the accuracy of the prenatal ultrasound (US) in identifying the etiology of fetal intra-abdominal cysts and to describe the neonatal outcomes.All cases of fetal intra-abdominal cystic lesion referred to our center between 2004 and 2012 were reviewed. Cysts of urinary system origin were excluded. Prenatal and postnatal data were collected. Our cohort was divided into subgroups according to the prenatal suspected origin of the lesion (ovarian, mesenteric, gastro-intestinal and other locations). For each subgroup, sensitivity, specificity, positive predictive value, false-positive rate and accuracy of fetal US were calculated.In total 47 fetuses (10/37 M/F) were identified. The mean gestational age at the time of diagnosis was 33 ± 4.9 weeks. Our cohort comprised of 25 ovarian cysts (10 simplex and 15 complex), 3 GI duplication, 6 mesenteric lesions, 4 meconium pseudocyst and 9 lesions of other origin. Surgery was performed in 38 cases (81%) at birth. The prenatally established diagnosis was exactly concordant with post-natal findings in 34 cases (72.3%). Sensitivity, specificity, positive predictive value and false-positive rate of US were 88.1%, 95.5%, 71% and 5.4%, respectively. Long-term outcome was good in almost 90% of the cases.The etiology of fetal intra-abdominal cysts can be prenatally diagnosed in about 70% cases. Despite the high risk of surgery at birth, the long-term outcome was good in most of the cases.