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For developing novel photosensitizers with therapeutic potential in non-malignant and malignant cutaneous disorders, the unsymmetrical porphyrin, 5-(2-hydroxy-3-methoxyphenyl)-10, 15, 20-tris-(4-carboxymethylphenyl) porphyrin, was evaluated in silico and in vitro. The cellular uptake of the investigated porphyrin and its ability to perform photodynamic therapy were investigated in terms of the viability, proliferation, and necrosis of human HaCaT keratinocytes and human Hs27 skin fibroblasts, in correlation with the predictions regarding diffusion through cell membranes, ADMET profile (absorption, distribution, metabolism, elimination, toxicity), and potential pharmacological mechanism. Molecular docking and 250 ns molecular dynamics simulations revealed that P5.2 has the potential to form a relatively stable complex with the carbonic anhydrase IX catalytic site, the lowest predicted free energy of binding (MM/PBSA) being −39.097 kcal/mol. The results of the in vitro study showed that P5.2 is incorporated within 24 h in the investigated cells, especially in HaCaT keratinocytes, indicating its photosensitizing ability. Nevertheless, P5.2 does not exert significant cytotoxicity in “dark” conditions. In turn, PDT induced a decrease in the number of metabolically active HaCaT keratinocytes within 24 h, accompanied by a 4-fold increase in lactate dehydrogenase release, indicating its ability to perform PDT in human skin cells. The experimental results suggest that the asymmetrical porphyrin is a promising candidate theranostics agent for skin disorders.

This study aimed to evaluate the biostimulant effects of three protein-based gels, GHC 1-B (20% gelatin (GPU-B) obtained by thermal hydrolysis from residual untanned leather and 80% collagen hydrolysates (HCE-B) obtained by alkaline–enzymatic hydrolysis from residual bovine-tanned leather), GHC 2-B (40% keratin hydrolysate (HKU-B) obtained by alkaline–enzymatic hydrolysis from sheep wool + 40% HCE-B + 20% GPU-B), and GHC 3-B (20% GPU-B + 80% hydrolyzed collagen (HPU-B) obtained by thermal and enzymatic hydrolysis from residual untanned leather). A germination study was carried out on pepper and tomato seeds at concentrations of 1%, 3%, and 10%. As a result of the study, it was found that all three protein-based gels showed a stimulatory effect on the tomato seeds at a 1% concentration, where the Gi (germination index) was ˂100%. The GHC 2-B variant had the highest stimulatory effect (Gi-190.23%). Pepper seeds have proven to be more sensitive to the gel’s composition. The concentration at which it proved to be non-inhibitory (Gi–88.29%) was 1% in the case of GHC 2-B. It was found that the presence of hydrolyzed keratin in the composition can be a plus compared to the other two protein gels tested due to its composition, which is richer in phytonutrient compounds (e.g., sulfur molecules).

In order to select for further development novel photosensitizers for photodynamic therapy in cutaneous disorders, three unsymmetrical porphyrins, namely 5-(4-hydroxy-3-methoxyphenyl)-10,15,20-tris-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.2), 5-(2-hydroxy-5-methoxyphenyl)-10,15,20-tris-(4-carboxymethylphenyl) porphyrin (P3.2), and 5-(2,4-dihydroxyphenyl)-10,15,20-tris-(4-acetoxy-3-methoxyphenyl) porphyrin (P4.2), along with their fully symmetrical counterparts 5,10,15,20-tetrakis-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.1) and 5,10,15,20-tetrakis-(4-carboxymethylphenyl) porphyrin (P3.1) were comparatively evaluated. The absorption and fluorescence properties, as well as atomic force microscopy measurements were performed to evaluate the photophysical characteristics as well as morphological and textural properties of the mentioned porphyrins. The cellular uptake of compounds and the effect of photodynamic therapy on the viability, proliferation, and necrosis of human HaCaT keratinocytes, human Hs27 skin fibroblasts, human skin SCL II squamous cell carcinoma, and B16F10 melanoma cells were assessed in vitro, in correlation with the structural and photophysical properties of the investigated porphyrins, and with the predictions regarding diffusion through cell membranes and ADMET properties. All samples were found to be isotropic and self-similar, with slightly different degrees of aggregability, had a relatively low predicted toxicity (class V), and a predicted long half-life after systemic administration. The in vitro study performed on non-malignant and malignant skin-relevant cells highlighted that the asymmetric P2.2 porphyrin qualified among the five investigated porphyrins to be a promising photosensitizer candidate for PDT in skin disorders. P2.2 was shown to accumulate well within cells, and induced by PDT a massive decrease in the number of metabolically active skin cells, partly due to cell death by necrosis. P2.2 had in this respect a better behavior than the symmetric P.2.1 compound and the related asymmetric compound P4.2. The strong action of P2.2-mediated PDT on normal skin cells might be an important drawback for further development of this compound. Meanwhile, the P3.1 and P3.2 compounds were not able to accumulate well in skin cells, and did not elicit significant PDT in vitro. Taken together, our experiments suggest that P2.2 can be a promising candidate for the development of novel photosensitizers for PDT in skin disorders.

Essential oils are valuable alternatives to synthetic antibiotics that have the potential to avoid the pathogen resistance side effects generated by leather. Helichrysum italicum and Lavandula latifolia essential oils combined with fish scale gelatin were electrospun using a coaxial technique to design new bioactive materials for skin wound dressings fabrication. Fish scale gelatins were extracted from carp fish scales using two variants of the same method, with and without ethylenediaminetetraacetic acid (EDTA). Both variants showed very good electrospinning properties when dissolved in acetic acid solvent. Fish scale gelatin nanofibers with Helichrysum italicum and Lavandula latifolia essential oil emulsions ensured low microbial load (under 100 CFU/g of total number of aerobic microorganisms and total number of yeasts and filamentous fungi) and the absence of Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 10536, and Candida albicans ATCC 1023 as compared to fish scale gelatin without essential oils, which recommends them for pharmaceutical or topical applications. A scratch-test performed on human dermal fibroblasts proved that the biomaterials contributing to the wound healing process included fish scale gelatin nanofibers without EDTA (0.5% and 1%), fish scale gelatin nanofibers without EDTA and Lavandula latifolia essential oil emulsion (1%), fish scale gelatin nanofibers with EDTA (0.6%), and fish scale gelatin nanofibers with EDTA with Helichrysum italicum essential oil emulsion (1% and 2%).

VIPomas are a type of neuroendocrine tumor that independently produces vasoactive intestinal peptide (VIP). VIPomas causing watery diarrhea, hypokalemia, and achlorhydria (WDHA) syndrome are not frequently observed in adult patients without pancreatic ailments. However, in children, the occurrence of a VIPoma originating in the pancreas is exceedingly uncommon. Instead, WDHA syndrome is more commonly associated with neurogenic tumors that secrete VIP, often located in the retroperitoneum or mediastinum. Among infants, chronic diarrhea is a prevalent issue that often necessitates the attention of pediatric gastroenterologists. The underlying causes are diverse, and delays in arriving at a definitive diagnosis can give rise to complications affecting the overall well-being of the child. The authors present the case of an infant with chronic watery diarrhea, subocclusion manifestations, mild hypokalemia, and metabolic hyperchloremic acidosis secondary to a VIPoma in the retroperitoneum that was diagnosed via abdominal ultrasound and tomography. The laboratory results revealed lowered potassium levels and an excessive secretion of VIP. Following the surgical removal of the tumor, the diarrhea resolved, and both electrolyte levels and the imbalanced hormone levels returned to normal. Immunohistochemical examination confirmed the diagnosis of ganglioneuroblastoma, with N-MYC negative on molecular biology tests. We present the clinical and histo-genetic aspects of this rare clinical entity, with a literature review.

Currently, the treatment of wounds is still a challenge for healthcare professionals due to high complication incidences and social impacts, and the development of biocompatible and efficient medicines remains a goal. In this regard, mesoporous materials loaded with bioactive compounds from natural extracts have a high potential for wound treatment due to their nontoxicity, high loading capacity and slow drug release. MCM-41-type mesoporous material was synthesized by using sodium trisilicate as a silica source at room temperature and normal pressure. The synthesized mesoporous silica was characterized by using Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), N2 absorption–desorption (BET), Dynamic Light Scattering (DLS) and Fourier transform infrared spectroscopy (FT-IR), revealing a high surface area (BET, 1244 m2/g); pore diameter of approx. 2 nm; and a homogenous, ordered and hexagonal geometry (TEM images). Qualitative monitoring of the desorption degree of the Salvia officinalis (SO) extract, rich in ursolic acid and oleanolic acid, and Calendula officinalis (CO) extract, rich in polyphenols and flavones, was performed via the continuous recording of the UV-VIS spectra at predetermined intervals. The active ingredients in the new composite MCM-41/sage and marigold (MCM-41/SO&CO) were quantified by using HPLC-DAD and LC-MS-MS techniques. The evaluation of the biological composites’ activity on the wound site was performed on two cell lines, HS27 and HaCaT, naturally involved in tissue-regeneration processes. The experimental results revealed the ability to stimulate collagen biosynthesis, the enzymatic activity of the main metalloproteinases (MMP-2 and MMP-9) involved in tissue remodeling processes and the migration rate in the wound site, thus providing insights into the re-epithelializing properties of mesoporous composites.

Hepatitis E virus (HEV) infection is a polymorphic condition, present throughout the world and involving children and adults. Multiple studies over the last decade have contributed to a better understanding of the natural evolution of this infection in various population groups, several reservoirs and transmission routes being identified. To date, acute or chronic HEV-induced hepatitis has in some cases remained underdiagnosed due to the lower accuracy of serological tests and due to the evolutionary possibility with extrahepatic manifestations. Implementation of diagnostic tests based on nucleic acid analysis has increased the detection rate of this disease. The epidemiological and clinical features of HEV hepatitis differ depending on the geographical areas studied. HEV infection is usually a self-limiting condition in immunocompetent patients, but in certain categories of vulnerable patients it can induce a sudden evolution toward acute liver failure (pregnant women) or chronicity (immunosuppressed patients, post-transplant, hematological, or malignant diseases). In acute HEV infections in most cases supportive treatment is sufficient. In patients who develop chronic hepatitis with HEV, dose reduction of immunosuppressive medication should be the first therapeutic step, especially in patients with transplant. In case of unfavorable response, the initiation of antiviral therapy is recommended. In this review, the authors summarized the essential published data related to the epidemiological, clinical, paraclinical, and therapeutic aspects of HEV infection in adult and pediatric patients.

Osteoarthritis (OA) as a multi-factorial disease that features interrelated mechanisms (senescence/ apoptosis, proliferation, decreased synthesis of matrix proteins, activation of degrading enzymes, inflammation) and a diversity of cells involved in bone and cartilage metabolism: chondrocytes, osteoblasts, osteoclasts etc. A complete pharmaceutical solution remains an unsolved question in this interdisciplinary field of research. We focused our approach on osteoarthritic primary chondrocytes HC-OA (Cell Application), exploring on this primary cell line the small sea fish extract’s potential to improve the proliferation rate and to stop the cytokines pro-inflammatory signaling. Previous research results have shown an important therapeutic potential of the small sea fish extract, restoring the intrinsic functionality of the cartilage through its correlative effects: antioxidant and anti-inflammatory action, stimulatory activity of cell proliferation and matriceal proteins homeostasis. In the context of pro-inflammatory and degradative stimulation with IL1β, the small sea fish extract prove a counteracting “in vitro” effect, restoring the proliferative capacity of HCOA cells and inhibiting the IL8 release, with implication in several cartilage degradation pathways: MMP13 activation, neutrophils’ accumulation, synovium leucocytes activation, as well as the hypertrophic and differentiation processes of chondrocytes.

The inflammatory, degenerative and rheumatic diseases are triggered and evolving at osteoarticular level due to the disruption of functionality of constitutive cells and extracellular microenvironment correlated with systemic responses as synthesis of progressively degradative cytokines. Objectives. The in vitro bioactive efficacy of standardized small sea fish extract has therapeutic relevance on the strength of optimal physiological and structural biologic system rendered by primary cells isolated from human cartilage (HCH, PromoCell) unlike standardized cell lines that may have genetic and functional changes and beside the primary cells directly isolated from animal tissue that do not reproduce an authentic biological response because of metabolic stress adaptation to growing conditions in vitro. The main therapeutic targets in osteoarticular disorders are regeneration of affected cartilage and attenuation of local inflammatory processes. Materials and methods. The in vitro articular matrix reconstruction action was evaluated by molecular tests with relative quantification of gene expression (qPCR) for aggrecan, the predominant component of human cartilage, and for the enzyme responsible for degradation of aggrecan, aggrecanase (ADAMTS4) whose activities were phenotypically measured by ELISA (enzyme-linked immunosorbent assay) test. The anti-inflammatory profile was proved by techniques of quantitative evaluation of mRNA level and detection of extracellular soluble proteins by flow-cytometry (BD™ Cytometric Bead Array) for pro-inflammatory cytokines IL-6, IL-8 and gene expression for nuclear factor NF-κB. Results and discussion. The results prove the matrix regenerator effect of standardized small fish extract by stimulation at gene expression level of aggrecan synthesis in early stages of chondrocytes differentiation, directing cells to a mature functional status, as well as by inhibition of aggrecan degradation by action on gene expression and extracellular activity of ADAMTS4. The standardized small sea fish extract has an anti-inflammatory effect proven by extracellular and transcriptional inhibition of pro-inflammatory cytokines, IL-6, IL-8 and the nuclear factor NF-κB gene. Conclusions. The in vitro anti-inflammatory and regenerative action of standardized small fish extract reflects a significant therapeutic potential for osteoarticular disease sustained both through the effects at gene and phenotypic expression levels and through the reproducible characteristics of dynamics of in vivo chondrocytes evolution evidenced by primary cell lines.

Introducere. Apneea în somn (SA) la copil este subdiagnosticată. Compromiterea dezvoltării somatice şi alterarea calităţii vieţii sunt frecvent prezente. Apneea centrală în somn (CSA) poate reprezenta cauza epi soadelor convulsive morfeice sau poate fi consecinţa acestora. Polisomnografi a reprezintă gold-standardul evaluării obiective a SA. Material şi metodă. Prezentăm un băiat în vârstă de 7 ani internat în septembrie 2013 pentru episoade de sufocare survenite în timpul somnului. Evaluarea s-a realizat prin anamneză, examen clinic, investigaţii paraclinice (funcţionale, imagistice, biologice) şi consulturi interdisciplinare. Rezultate. Repetate infecţii de căi respiratorii şi istoric de aproximativ 20 de zile al episoadelor de sufocare s-au stabilit anamnestic. Au fost diagnosticate următoarele: hipotrofi e ponderală; rinită cronică; hipertrofi e amigdaliană; disfuncţie ventilatorie obstructivă; apnee în somn formă mixtă predominant centrală; status atopic; sindrom convulsiv. Explorările imagistice au relevat aspecte normale. Tratamentul complex igieno-dietetic şi medica mentos a condus la dispariţia tulburărilor respiratorii în somn, cu normalizarea parametrilor spirometrici şi a statusului nutriţional. Concluzii. Studiul poligrafi c al somnului a identifi cat apneea în somn, precizând predominanţa componentei centrale şi facilitând diagnosticul etiologic. Managementul interdisciplinar a condus la evoluţia favorabilă a cazului.

Introducere. Ischemia intestinală neonatală este o patologie frecventă, dar din păcate, de multe ori subdiagnosticată. Tehnica actuală permite investigarea non-invazivă a circulaţiei la nivel splahnic, putând decela precoce modifi cările de perfuzie-oxigenare care apar la acest nivel. Obiective. Scopul acestui studiu a fost de a determina valoarea clinică a spectroscopiei în infraroşu (NIRS) în detectarea precoce a modifi cărilor ischemice intestinale la nou-născuţii din secţia de Terapie Intensivă Neonatală. Material şi metodă. Am efectuat un studiu prospectiv observaţional pe o perioadă de 18 luni, pe un lot de 15 nou-născuţi cu vârsta de gestaţie între 25-38 săptămâni. Toţi nou-născuţii luaţi în studiu au prezentat unul sau mai multe semne clinice de patologie digestivă. Începerea monitorizării non-invazive continue prin NIRS cerebrală şi abdominală s-a efectuat în momentul apariţiei primelor modifi cări digestive, între ziua 3-21 de viaţă. A fost măsurată saturaţia oxigenului la nivel cerebral şi abdominal (rSO2 -C şi rSO2 -A) şi s-a efectuat raportul oxigenării cerebro-splahnice (ROCS). În paralel nou-născuţii au fost monitorizaţi complex prin metode biologice şi paraclinice. Perioada de monitorizare a fost variabilă, fi ind cuprinsă între 1-5 zile, perioadă necesară în stabilirea diagnosticului cauzal, şi apoi mai departe pentru urmărirea în dinamică a modifi cărilor perfuziei intestinale sub tratamentul instituit. Semnifi caţia statistică a fost determinată folosind testul statistict, calculând „p“ pentru un interval de încredere de 95% (semnifi caţie statistică p < 0,05). De asemenea, a fost evaluată curba ROC pentru a determina capacitatea acestei tehnici de a fi un instrument de diagnostic. Rezultate. Lotul de copii luaţi în studiu a inclus: 3 nou-născuţi cu malformaţie cardiacă congenitală (MCC) cu scăderea importantă a fl uxului sanguin în aortă, 4 nou-născuţi cu enterocolită ulcero-necrotică (EUN) stadiul II, 3 pacienţi cu retard de creştere intrauterină (RCIU) formă severă, 1 nou-născut cu atrezie intestinală şi peritonită secundară, 1 nou-născut cu anemie prin incompatibilitate Rh cu anasarcă feto-placentară şi 3 pacienţi cu sepsis şi patologie digestivă asociată dar fără criterii de EUN. La toţi pacienţii valorile măsurătorilor NİRS au fost semnifi cativ scăzute faţă de valoarea normală, cu valori diferite în funcţie de severitatea afecţiunii. Valoarea medie a rSO2 -A a fost de 41,85 (interval de variaţie 15-85) faţă de o valoare medie considerată normală. De asemenea, valoarea medie a raportului ROCS a fost sem nifi cativ scăzută faţă de valoarea normală. Cele mai mici valori ale rSO2 -A la începutul simptomatologiei le-a avut grupul de pacienţi cu MCC urmaţi de cei cu EUN. Aria de sub curba ROC a fost 0,95 (95% CI 0,88-1,02) pentru raportul ROCS. Considerând o valoare limită a ROCS pentru predicţia ischemiei intestinale de < 0,75, acest raport se dovedeşte a fi un indicator excelent al modifi cărilor circulaţiei intestinale. Concluzii. Metoda NIRS are potenţialul de a detecta apariţia alterărilor în oxigenarea şi perfuzia intestinală, permiţând detectarea precoce a ischemiei intestinale, chiar înainte de modifi carea altor parametri hemodinamici. NIRS este o metodă bună, non-invazivă, de urmărire în dinamică a modifi cărilor perfuziei tisulare sub tratamentul instituit, fi ind de asemenea capabilă să ghideze tratamentul, având un real folos în practica clinică.

Introduction. Sleep apnea (SA) in children is underdiagnosed. Compromising somatic development and alterated quality of life are frequently present. Central sleep apnea (CSA) may be the cause of convulsive episodes in sleep or could be their result. Polysomnography is the gold-standard of SA objective assessment. Material and methods. We present a 7-year-old boy hospitalized in September 2013 for choking episodes occurred during sleep. The assessment was made by history, clinical examination, laboratory investigations (functional, imaging, biological) and interdisciplinary checkups. Results. Repeated respiratory tract infection and a history of about 20 days of episodes of choking were established by anamnesis. Were diagnosed: underweight status; chronic rhinitis; tonsillar hypertrophy; obstructive ventilatory dysfunction; mixed sleep apnea with predominant central component; atopic status; convulsions. Imaging explorations revealed normal aspects. Complex hygienic-dietary and medical treatment has led to the disappearance of respiratory disorders during sleep, with normalization of spirometric parameters and nutritional status. Conclusions. Polygraphic sleep study identifi ed sleep apnea, indicating the predominance of the central component and facilitating etiologic diagnosis. Interdisciplinary management led to favorable evolution of the case.

Introduction. Neonatal intestinal ischemia is a frequent pathology, but unfortunately, often underdiagnosed. Current technique allows non-invasive investigation of splanchnic circulation, being capable of detecting early perfusion changes that occur at this level. Objectives. The aim of this study was to determine the clinical value of infrared spectroscopy (NIRS) in early detection of ischemic bowel modifi cations in newborns from neonatal intensive care unit. Material and methods. We performed a prospective observational study over a period of 18 months, on a group of 15 newborns with gestational age between 25-38 weeks. All infants included in the study had one or more clinical signs of digestive pathology. Starting non-invasive continuous monitoring by cerebral and abdominal NIRS was performed according to the appearance of the fi rst digestive changes between day 3 and 21 of life. Oxygen saturation was measured in the cerebral and abdominal regions (rSO2-C and rSO2-A) and cerebro-splanchnic oxygenation ratio (CSOR) was carried out. Meanwhile infants were monitored by biological and hemodinamyc methods.The monitoring period was variable, being between 1-5 days, the period required for establish the causal diagnosis. Statistical signifi cance was determined using statistical t-test. “p” was calculated for confi dence interval of 95% (statistical signifi cance p < 0.05). Also was evaluated the area under the receiver operating characteristic (ROC) curve to determine the suitability of this technique as a diagnostic tool. Results. The study group included: 3 neonates with congenital heart disease(CHD) with signifi cant decrease in aortic blood fl ow, 4 neonates with necrotizing enterocolitis (NEC) stage II, 3 pacients with intrauterine growth retardation (IUGR) severe form, 1 newborn with intestinal atresia and secondary peritonitis, 1 newborn with Rh incompatibility anemia with placental anasarca and 3 pacients with sepsis and associated gastrointestinal pathology without NEC criteria. In all 15 patients, NIRS measurement values were signifi cantly lower compared to the normal range, with different values depending on the severity of the condition. Mean rSO2-A value was 41.85 (interquartile range15-85) compared to an average value, considered normal. Also the average value of the CSOR ratio was signifi cantly lower compared to the normal. The lowest values of rSO2 -A at the beginning of simptoms has had the group of patients with CHD followed by those with NEC. The area under the ROC curve was 0.95 (95% CI 0.88 to 1.02) for the CSOR ratio. Considering a limit value of ROCS for prediction of intestinal ischemia < 0.75, this ratio proves to be an excellent indicator of changes in bowel circulation. Conclusion. NIRS method has the potential to detect the occurrence of alterations in intestinal oxygenation and perfusion, allowing early detection of bowel ischemia, just before the modifi cation of other hemodynamic parameters. NIRS is a non-invasive, highly accurate method, to follow in evolution the changes in tissue perfusion under the treatment instituted, also being able to guide treatment, proving helpful in clinical practice.

The leather industry byproducts and coarse wool are valuable bioresources, rich in bioactive proteins, but which are not fully exploited and represent a source of environmental pollution. The biomaterials based on native collagen and keratin are made using sophisticated methods of extraction, synthetic polymers, and organic solvents with toxic potential. The paper presents two methods for collagen gelatin extraction from rabbit skin and bovine pelt, and for keratin solubilization and enzymatic refinery, which were proved to be suitable for the fabrication of new collagen nanofibers and porous keratin powders compatible with wound healing formulations in dressing, creams or gel forms. The neutral and chemical-enzymatic-based technologies for bioactive protein extraction and refinery are presented as alternatives to more expensive and sophisticated methods for native collagen and keratin hydrogels used in making wound healing biomaterials. Bioactive collagen nanofibers and keratin powders for new wound-healing formulations and dressings were successfully obtained. The collagen extracts were found to have good properties for nanofiber fabrication, rabbit collagen showing exceptional characteristics and a high Bloom value. The use of collagen extracts, soluble in ecological solvents with spinnable properties from leather industry byproducts, as well as the preparation of keratin hydrolysate powders from wool waste represents an efficient approach for the capitalization of biomass and the development of new biomaterials with low toxic potential. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction: the majority of studies of acute gastrointestinal bleeding in children are retrospective, focusing on therapeutic endoscopy. Previous studies performed in adult patients have demonstrated that both scheduled second look endoscopy and high dose continuous omeprazole infusion are effective in the prevention of peptic ulcer rebleeding. The aim of this study was to compare the efficacy of these two strategies using esomeprazole for the prevention of rebleeding following primary endoscopic hemostasis in children with peptic ulcers. The main outcome was to assess the rebleeding rate within 30 days after the initial hemostasis. Methods: consecutive pediatric cases who underwent endoscopic treatment for bleeding peptic ulcers were randomized into two treatment groups following hemostasis. The first group received esomeprazole as an intravenous bolus every 12 hours for 72 hours and a routine second look endoscopy within 12-24 hours with endotherapy retreatment in the case of a persistent stigmata of bleeding. The second group received a continuous high dose esomeprazole infusion for 72 hours without endoscopic reassessment unless required due to rebleeding. Results: a total of 63 children were randomized to the second look endoscopy group and 64 to the esomeprazole infusion group. Rebleeding occurred within 30 days in four patients (6.3%) in the first group and in three patients (4.6%) in the second group (p = 0.7). Conclusions: a pharmaceutical approach using a high dose continuous esomeprazole infusion in children after an initial endoscopic hemostasis has a similar efficacy compared to second look endoscopy and bolus esomeprazole administration for the prevention of peptic ulcer rebleeding. Thus, the discomfort of a second endoscopy in children can be avoided and is only recommended for selected high risk cases.

A 7 year old patient known from his medical history with visual impairment from the age 2 years and 6 months, which have progressed once the child began school. Careful examination revealed the presence of a tumor formation with selar location, which proved to be craniopharyngioma. Postoperative evolution was relatively good, but a redoubtable complication appeared, namely diencephalic obesity. [ABSTRACT FROM AUTHOR]

Objectives: We present the clinical and imaging exploration of four patients that have duplicated collecting system emphasizing the diagnostic and therapeutic features. Methods: The cases of: Lacramioara, 10 years old- both sides duplication of renal pelvis and calyces, Alexandra 7 years old - duplicity of renal pelvis and calyces on left side, Denis 1 month old and Bianca 1 year old - complete unilateral duplicated collecting system. Results: Presenting reasons: recurrent urinary tract infections, urinary incontinence, bronchopneumonia and sepsis in the neonate. Using the ultrasound investigation, urinary tract abnormalities are being seen and then confirmed by MRI. Therapeutic attitudes differ depending on the severity of the malformation. For the 7 years old girl, the urinary incontinence is due to aberrant implantation of the megaureter in the urethra. In the case of the newborn patient, surgical correction has been performed later on, at the age of 2 years and a half, due to the parent's noncompliance to treatment. Conclusions: Higher ureteral dilatation along with large ureter pole is the most specific ultrasound sign for complete double urinary collecting system. Corrective surgery in these cases is necessary. [ABSTRACT FROM AUTHOR]