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Objective: To compare the utility of routine third-trimester ultrasound examination at 36 weeks' gestation with that at 32 weeks in detecting fetal growth restriction (FGR).Methods: This was an open-label parallel randomized trial (ROUTE study) conducted at a single general hospital serving a geographically well-defined catchment area in Barcelona, Spain, between May 2011 and April 2014. Women with no adverse medical or obstetric history and a singleton pregnancy without fetal abnormalities at routine second-trimester scan were assigned randomly to undergo a scan at 32 weeks' gestation (n = 1272) or at 36 weeks' gestation (n = 1314). Primary outcome measures were detection rates of FGR (customized birth weight < 10(th) centile) and severe FGR (customized birth weight < 3(rd) centile).Results: There were no significant differences in perinatal outcome between those who underwent a scan at 32 weeks' gestation and those who underwent a scan at 36 weeks' gestation. Severe FGR at birth was associated significantly with emergency Cesarean delivery for fetal distress (odds ratio (OR), 3.4 (95% CI, 1.8-6.7)), neonatal admission (OR, 2.23 (95% CI, 1.23-4.05)), hypoglycemia (OR, 9.5 (95% CI, 1.8-49.8)) and hyperbilirubinemia (OR, 9.0 (95% CI, 4.6-17.6)). Despite similar false-positive rates (FPRs) (6.4% vs 8.2%), FGR detection rates were superior at 36 vs 32 weeks' gestation (sensitivity, 38.8% vs 22.5%; P = 0.006), with positive and negative likelihood ratios of 6.1 vs 2.7 and 0.65 vs 0.84, respectively. In cases of severe FGR, FPRs for both scans were also similar (8.5% vs 8.7%), but detection rates were superior at 36 vs 32 weeks' gestation (61.4% vs 32.5%; P = 0.008). Positive and negative likelihood ratios were 7.2 vs 3.7 and 0.4 vs 0.74, respectively.Conclusion: In low-risk pregnancies, routine ultrasound examination at 36 weeks' gestation was more effective than that at 32 weeks' gestation in detecting FGR and related adverse perinatal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Many scientific studies have suggested that point-of-use water treatment can improve water quality and reduce the risk of infectious diseases. Despite the ease of use and relatively low cost of such methods, experience shows the potential benefits derived from provision of such systems depend on recipients' acceptance of the technology and its sustained use. To date, few contributions have addressed the problem of user experience in the post-implementation phase. This can diagnose challenges, which undermine system longevity and its sustained use. A qualitative evaluation of two household water treatment systems, solar disinfection (SODIS) and chlorine tablets (Aquatabs), in three villages was conducted by using a diagnostic tool focusing on technology performance and experience. Cross-sectional surveys and in-depth interviews were used to investigate perceptions of involved stakeholders (users, implementers and local government). Results prove that economic and functional factors were significant in using SODIS, whilst perceptions of economic, taste and odour components were important in Aquatabs use. Conclusions relate to closing the gap between factors that technology implementers and users perceive as key to the sustained deployment of point-of-use disinfection technologies. [ABSTRACT FROM AUTHOR]

The current environmental challenges that most middle- and low-income countries have been experiencing has led to new environmentally sustainable and economically viable sanitation solutions, such as waterless systems with source separation of human waste. We conducted a cross-sectional study in eThekwini municipality to explore the post-implementation challenges of urine diversion dehydration toilets (UDDTs) after a decade of installation and the adaptive processes necessary to increase the sustained use of the toilets. A structured questionnaire was administered to 17 499 households in 65 rural and per-urban areas of eThekwini using mobile phone technology. Results report low levels of satisfaction with the facilities as well as an association between perceived smell in the toilets and malfunctioning of the pedestal, and low use of UDDTs when a pit latrine is present in the dwelling perimeter. Conclusions relate to the importance of educational and promotional activities that stress the economic return derived from reusing urine and excreta in agricultural activities. [ABSTRACT FROM AUTHOR]

The idea of implementing ancient water and wastewater technologies in the developing world is a persuasive one, since ancient systems had many features which would constitute sustainable and decentralised water and sanitation (WATSAN) provision in contemporary terminology. Latest figures indicate 2.6 billion people do not use improved sanitation and 1.1 billion practise open defecation, thus there is a huge need for sustainable and cost-effective WATSAN facilities, particularly in cities of the developing world: The objective of this study was to discuss and evaluate the applicability of selected ancient WATSAN systems for the contemporary developing world. Selected WATSAN systems in ancient Mesopotamia, the Indus Valley, Egypt, Greece, Rome and the Yucatan peninsula are briefly introduced and then discussed in the context of the developing world. One relevant aspect is that public latrines and baths were not only a part of daily life in ancient Rome but also a focal point for socialising. As such they would appear to represent a model of how to promote use and acceptance of modern community toilets and ablution blocks. Although public or community toilets are not classified as improved sanitation by WHO/UNICEF, this is a debatable premise since examples such as Durban, South Africa, illustrate how community toilets continue to represent a WATSAN solution for urban areas with high population density. Meanwhile, given the need for dry sanitation technologies, toilets based on the production of enriched Terra Preta soil have potential applications in urban and rural agriculture and warrant further investigation. [ABSTRACT FROM AUTHOR]

Objectives: Retinol Binding Protein-4 (RBP-4), the action of which was initially thought to be only the transport of vitamin A, is a major circulating adipocytokine involved in the inflammation. We evaluated the serum RBP-4 levels in children with inflammatory bowel disease (IBD) and correlated them with transthyretin (TTR), inflammation markers, disease activity, and body mass index (BMI). Design: In 41 children of mean age 11.9 ± 3.6 years (range 5-17.7 y) with IBD (19 with Crohn's disease (CD) and 22 with Ulcerative colitis (UC) serum RBP-4, TTR, Amyloid A (SAA), C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), disease activity and BMI were prospectively determined and compared with those of 42 matched controls. Results: No difference in the RBP-4 and TTR serum levels, between patients and controls as well as between active and remission state of the disease was noticed. A negative correlation of serum RBP-4 with the disease activity, SAA and ESR and a positive correlation with TTR was found, but no significant correlation with CRP or BMI was found. Inflammation markers were significantly increased in patients compared to controls and had a positive correlation with the disease activity. Conclusions: RBP-4 negatively correlated with disease activity of children with IBD probably indicating a protective anti-inflammatory mechanism of action in addition to transport of vitamin A. [ABSTRACT FROM AUTHOR]

Background: Coeliac disease (CD) is common and requires a permanent strict gluten-free diet (GFD). However, data concerning how the situation is experienced by children are limited. The present study aimed to investigate the compliance with a GFD and the impact of CD and GFD on the lifestyle of patients and their families, together with proposed recommendations for improvement of quality of life. Methods: Children with biopsy confirmed CD were recruited consecutively from the outpatient gastroenterology clinic. Participants were evaluated by a special questionnaire for compliance with the GFD, patients’ knowledge about CD, and the well-being and lifestyle of children and their families. Comparisons between discrete variables were performed by a chi-square test. Results: Seventy-three children of median age 9.4 (interquartile range = 5–14.5) years were evaluated. Compliance to diet was reported by 58%. Reasons for noncompliance were: poor palatability (32%), dining outside home (17%), poor availability of products (11%), and asymptomatic disease diagnosed by screening (11%). The acceptance of the GFD was reported as good in 65%, whereas avoidance of travelling and restaurants was stated by 17% and 46% of families, respectively. Most families experienced difficulties detecting gluten from the food label. Proposed factors for improvement of quality of life were: better labelling of gluten-containing ingredients (76%) and more gluten-free (GF) foods in supermarkets (58%) and restaurants (42%). Conclusions: Children with CD have low compliance with the GFD. Better education about the disease, the availability of GF products, and appropriate food labelling could improve compliance and quality of life. [ABSTRACT FROM AUTHOR]

Density functional calculations, using B3LPY/6-31G(d) methods, have been used to investigate the conformations and vibrational (Raman) spectra of a series of long-chain, saturated fatty acid methyl esters (FAMEs) with the formula CnH2nO2 (n=5–21) and two series of unsaturated FAMEs. The calculations showed that the lowest energy conformer within the saturated FAMEs is the simple (all-trans) structure and, in general, it was possible to reproduce experimental data using calculations on only the all-trans conformer. The only exception was C6H12O2, where a second low-lying conformer had to be included in order to correctly simulate the experimental Raman spectrum.The objective of the work was to provide theoretical justification for the methods that are commonly used to determine the properties of the fats and oils, such as chain length and degree of unsaturation, from experimental Raman data. Here it is shown that the calculations reproduce the trends and calibration curves that are found experimentally and also allow the reasons for the failure of what would appear to be rational measurements to be understood. This work shows that although the assumption that each FAME can simply be treated as a collection of functional groups can be justified in some cases, many of the vibrational modes are complex motions of large sections of the molecules and thus would not be expected to show simple linear trends with changes in structure, such as increasing chain length and/or unsaturation. Simple linear trends obtained from experimental data may thus arise from cancellation of opposing effects, rather than reflecting an underlying simplicity. [Copyright &y& Elsevier]

Density functional calculations, using B3LPY/6-31G(d) methods, have been used to investigate the conformations and vibrational (Raman) spectra of three short-chain fatty acid methyl esters (FAMEs) with the formula CnH2nO2 (n=3–5). In all three FAMEs, the lowest energy conformer has a simple ‘all-trans’ structure but there are other conformers, with different torsions about the backbone, which lie reasonably close in energy to the global minimum. One result of this is that the solid samples we studied do not appear to consist entirely of the lowest energy conformer. Indeed, to account for the ‘extra’ bands that were observed in the Raman data but were not predicted for the all-trans conformer, it was necessary to add-in contributions from other conformers before a complete set of vibrational assignments could be made. Provided this was done, the agreement between experimental Raman frequencies and 6-31G(d) values (after scaling) was excellent, RSD=12.6 cm−1. However, the agreement between predicted and observed intensities was much less satisfactory. To confirm the validity of the approach followed by the 6-31G(d) basis set, we used a larger basis set, Sadlej pVTZ, and found that these calculations gave accurate Raman intensities and simulated spectra (summed from two different conformers) that were in quantitative agreement with experiment. In addition, the unscaled Sadlej pVTZ, and the scaled 6-31G(d) calculations gave the same vibrational mode assignments for all bands in the experimental data.This work provides the foundation for calculations on longer-chain FAMEs (which are closer to those found as triglycerides in edible fats and oils) because it shows that scaled 6-31G(d) calculations give equally accurate frequency predictions, and the same vibrational mode assignments, as the much more CPU-expensive Sadlej pVTZ basis set calculations. [Copyright &y& Elsevier]

Background. Work-related musculoskeletal disorders (WRMSDs) are cause of disability and loss of productivity. Part of the workers suffers from WRMSDs while others are exposed to risk factors. Resistance training (RT) can reduce pain symptomatology, counteracting WRMSDs. The aim of this investigation is to evaluate the effectiveness of a RT program in a group of metalworkers on pain perception, disability and physical fitness in context of real work-setting. Methods. Eighteen metalworkers took part to a 12 weeks RT program with a personalized intervention during the sessions. Disability of the arm, shoulder and hand questionnaire (DASH) and the visual analogue scale for the low back (L-VAS) represent the primary outcome regarded. Handgrip strength, shoulder and hamstrings flexibility and cardiorespiratory endurance were tested. Pre-post differences were evaluated through T-test. Results. DASH score improved significantly of 4.28 points (p = 0.03). L-VAS did not change (p = 0.38) while physical fitness outcomes improved significantly except for the shoulder flexibility. Spontaneous attendance reached 83.42%. Conclusions. Pain and disability decreased in upper limb and shoulder but not in the lumbar spine. Moreover, physical fitness of participants improved. Considering the spontaneous attendance to the program of these participants, we exhort RT implementation in occupational primary and secondary prevention programs. [ABSTRACT FROM AUTHOR]

Background: H. pylori infection is common and its acquisition is mainly in young ages. It has been claimed that during early childhood intrafamilial contamination is more possible than from other sources outside home. Aim: The aim of the study was to investigate the H. pylori status within families of children with upper GI symptoms. Methods: 45 symptomatic children without previous eradication therapy aged 4-16 years (median 11yrs) were investigated by [sup 13]C-UBT as well as all their 125 family members (parents and siblings) living in the same house. Socioeconomic status and conditions of living were also investigated. Results: According to H. pylori status the index children were divided into group A: 20 (44%) who were H. pylori infected and group B: 25 (56%) who were negative for H. pylori infection. Forty four out of 57 (77%) relatives of group A were also infected, while H. pylori was found only in 19 out of 68 (28%) relatives of group B, (p=0.000). In group A 79% of fathers, 90% of mothers and 65% of siblings were found H. pylori positive, while in group B 29%, 44% and 5.2% respectively (p=0.001, p=0.01,p=0.001). There was not found any difference concerning living conditions between H. pylori positive and negative children. Conclusions: The significantly higher prevalence H. pylori infection within families of H. pylori positive symptomatic children, compared to the negative ones, supports the hypothesis that transmission of H. pylori in children could be from the infected members of the family or the same source within house. [ABSTRACT FROM AUTHOR]

While there is great demand for effective, affordable radiation detectors in various applications, many commonly used scintillators have major drawbacks. Conventional inorganic scintillators have a fixed emission wavelength and require expensive, high-temperature synthesis; plastic scintillators, while fast, inexpensive, and robust, have low atomic numbers, limiting their X-ray stopping power. Formamidinium lead halide perovskite nanocrystals show promise as scintillators due to their high X-ray attenuation coefficient and bright luminescence. Here, we used a room-temperature, solution-growth method to produce mixed-halide FAPbX 3 (X = Cl, Br) nanocrystals with emission wavelengths that can be varied between 403 and 531 nm via adjustments to the halide ratio. The substitution of bromine for increasing amounts of chlorine resulted in violet emission with faster lifetimes, while larger proportions of bromine resulted in green emission with increased luminescence intensity. By loading FAPbBr 3 nanocrystals into a PVT-based plastic scintillator matrix, we produced 1 mm-thick nanocomposite scintillators, which have brighter luminescence than the PVT-based plastic scintillator alone. While nanocomposites such as these are often opaque due to optical scattering from aggregates of the nanoparticles, we used a surface modification technique to improve transmission through the composites. A composite of FAPbBr 3 nanocrystals encapsulated in inert PMMA produced even stronger luminescence, with intensity 3.8× greater than a comparative FAPbBr 3 /plastic scintillator composite. However, the luminescence decay time of the FAPbBr 3 /PMMA composite was more than 3× slower than that of the FAPbBr 3 /plastic scintillator composite. We also demonstrate the potential of these lead halide perovskite nanocomposite scintillators for low-cost X-ray imaging applications. [ABSTRACT FROM AUTHOR]

Reduced-size polarized (ZmPolX) basis sets are developed for the second-row atoms X = Si, P, S, and Cl. The generation of these basis sets follows from a simple physical model of the polarization effect of the external electric field which leads to highly compact polarization functions to be added to the chosen initial basis set. The performance of the ZmPolX sets has been investigated in calculations of molecular dipole moments and polarizabilities. Only a small deterioration of the quality of the calculated molecular electric properties has been found. Simultaneously the size of the present reduced-size ZmPolX basis sets is about one-third smaller than that of the usual polarized (PolX) sets. This reduction considerably widens the range of applications of the ZmPolX sets in calculations of molecular dipole moments, dipole polarizabilities, and related properties. [ABSTRACT FROM AUTHOR]

Background: Isokinetic dynamometers are becoming very common in assessing muscle strength and pathology, both in research and clinical practice, but for most of those devices reliability studies are still needed to support their extended use. The aim of this study is to assess the test-retest reliability also in health adults. Methods: Thirty adults (13 male and 17 females; mean age 25.4 ± 2.7 years) were recruited among University students. They participated to two testing sessions (7 day apart) in which they performed isokinetic and isometric strength assessment of the knee and ankle flexion and extension. Results: All variable showed an Intra-class correlation coefficient higher than 0.7 (isometric knee extension 0.96; isokinetic knee extension 0.96; isokinetic knee flexion 0.97; isometric ankle right flexion pl and flexion do 0.75-0.96; isometric ankle left flexion pl and flexion do 0.78-0.97; isokinetic ankle right flexion pl and flexion do 0.88-0.73; isokinetic ankle right flexion pl and flexion do 0.88-0.85) and paired-sample t-test showed no significant difference. Moreover, most of the recorded values were included within the upper and lower limits of agreement. Conclusion: Multi-joint evaluation system is a reliable device to assess knee and ankle isokinetic and isometric strength among healthy adults. [ABSTRACT FROM AUTHOR]

Background Functional gastrointestinal disorders (FGIDs) are a common, diverse group of disorders of unknown etiology, resulting in significant socieconomic burden. In this study, we aimed to assess the prevalence of FGIDs in children aged 6-18 years and examine their association with various demographic and socioeconomic parameters. Methods This was a school-based, cross-sectional study approved by the relevant government authorities. Informed consent was obtained by the legal representatives of all children who participated. Diagnoses of FGIDs were based on the Greek official translation of the ROME-III questionnaire. Demographic and socioeconomic information were also collected. Key Results A total of 1588 children (51.8% females, mean age: 12.9±2.8 years) were included. The overall prevalence of any-FGID was 23.1% (95% CI: 21.1-25.2). The most common FGIDs were functional constipation, n=231 (13.9%), abdominal migraine, n=84 (5.6%), aerophagia, n=58 (3.5%), and irritable bowel syndrome, n=48 (3.0%). Multiple logistic regression analysis on the probability of any-FGID identified physical exercise, TV-exposure, victimization, gender, parental educational level, number of children at home and number of adults at home as significant covariates for any-FGID in the final model. Conclusions and Inferences FGIDs affect approximately 1 in 4 school-aged children in Greece. The following characteristics are associated with a higher probability of any-FGID: female gender, living in a non-nuclear household, victimization, lower parental education level, infrequent physical activity, and high television exposure. [ABSTRACT FROM AUTHOR]

Objective: To develop optimal first-trimester algorithms for the prediction of early and late fetal growth restriction (FGR).Methods: This was a prospective cohort study of singleton pregnancies undergoing first-trimester screening. FGR was defined as an ultrasound estimated fetal weight < 10(th) percentile plus Doppler abnormalities or a birth weight < 3(rd) percentile. Logistic regression-based predictive models were developed for predicting early and late FGR (cut-off: delivery at 34 weeks). The model included the a-priori risk (maternal characteristics), mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1).Results: Of the 9150 pregnancies included, 462 (5%) fetuses were growth restricted: 59 (0.6%) early and 403 (4.4%) late. Significant contributions to the prediction of early FGR were provided by black ethnicity, chronic hypertension, previous FGR, MAP, UtA-PI, PlGF and sFlt-1. The model achieved an overall detection rate (DR) of 86.4% for a 10% false-positive rate (area under the receiver-operating characteristics curve (AUC): 0.93 (95% CI, 0.87-0.98)). The DR was 94.7% for FGR with pre-eclampsia (PE) (64% of cases) and 71.4% for FGR without PE (36% of cases). For late FGR, significant contributions were provided by chronic hypertension, autoimmune disease, previous FGR, smoking status, nulliparity, MAP, UtA-PI, PlGF and sFlt-1. The model achieved a DR of 65.8% for a 10% false-positive rate (AUC: 0.76 (95% CI, 0.73-0.80)). The DR was 70.2% for FGR with PE (12% of cases) and 63.5% for FGR without PE (88% of cases).Conclusions: The optimal screening algorithm was different for early vs late FGR, supporting the concept that screening for FGR is better performed separately for the two clinical forms. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Background/Objective:A strict and lifelong commitment to a gluten-free diet (GFD) remains one of the most challenging issues in children with coeliac disease. The present study aimed to record compliance rates and investigate the connection between dietary compliance and demographics, disease-related factors and parental knowledge.Subjects/Methods:Parents of 90 Greek children diagnosed with coeliac disease were recruited from the outpatient gastroenterology clinic of a children's hospital in Athens, Greece. Dietary compliance and a range of demographic and clinical data were obtained from parents through a specially constructed questionnaire. Further data included parental perceived and actual knowledge about coeliac disease and GFD. Compliant and noncompliant groups were compared for measured factors and a multivariate approach was followed to elicit independent effects of compliance determinants.Results:Overall, 44.4% of children with coeliac disease were reported to be compliant to a strict GFD. A 1-year increase in the age of the child was associated with 15% lower odds of adhering to a strict diet after adjusting for other variables (odds ratio (OR)=0.85, 95% CI: 0.75-0.96). Parental perceived knowledge was also independently and significantly associated with dietary compliance (OR=3.3, 95% CI=1.1-9.8). No statistically significant correlation emerged between dietary compliance and other clinical or demographic variables.Discussion:Low compliance rates to GFD were observed in children with coeliac disease. Information based on children's age and perceived parental knowledge can be used to develop risk profiles that health care professionals can utilise to identify children likely to be noncompliant and thus adjust their counselling strategy accordingly. [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the impact of fetoscopic laser coagulation of placental anastomoses in severe twin–twin transfusion syndrome on fetal Doppler indices and umbilical vein blood flow volume as calculated with Doppler and two-dimensional ultrasound. Methods Thirty-two cases of second-trimester severe twin–twin transfusion undergoing laser therapy were examined with serial ultrasound before and 1, 3 and 5 days after therapy. Pulsatility indices in the umbilical artery and ductus venosus were measured. Blood volume flow at the level of the intra-abdominal umbilical vein was calculated by means of Doppler and two-dimensional ultrasound. The development of hydropic signs in donors was recorded. Perinatal outcome in terms of neonatal survival was recorded for all cases. Results In recipients, ductus venosus pulsatility index decreased progressively after therapy and, by day 5, median pulsatility index was significantly lower than that before therapy (0.97 vs. 0.82, P < 0.0001). Umbilical vein blood flow volume in recipient twins showed no significant variations before and after laser. In donors, umbilical artery pulsatility index decreased significantly by the first day following therapy (2.1 vs. 1.6, P < 0.0001). Previously absent or reverse umbilical end-diastolic flow reappeared after therapy in 46% (7/15) of donors. Ductus venosus pulsatility index in donors increased significantly by day 1 after therapy (0.99 vs. 1.35, P < 0.0001) but, over days 3 and 5, it returned towards preoperative values. Umbilical vein flow volume measurements (mL/min/kg) in the donor increased by approximately 50% the day after treatment (151 vs. 232, P < 0.0001) and remained elevated. Umbilical vein flow volume before laser therapy was significantly lower in donors compared to recipients (151 vs. 260, P < 0.0001), but the difference was non-significant after treatment (240 vs. 267). One or more hydropic signs developed in eight (25%) donors during the 5... [ABSTRACT FROM AUTHOR]

Abstract Objective To evaluate the incidence, characteristics, and impact on perinatal outcome of the development of hydropic signs in the donor fetus after laser coagulation for severe twin–twin transfusion syndrome in the second trimester. Methods Forty cases of second-trimester severe twin–twin transfusion underwent fetoscopic laser coagulation of placental anastomoses and were followed up with serial ultrasound up to 14 days after therapy. Ultrasound scans were performed just before, and on days 1, 3, 5 and 14 after therapy, and fetuses were monitored for the presence of hydropic signs (skin edema, pleural effusion, ascites and pericardial effusion). Response to therapy and perinatal outcome in terms of neonatal survival were recorded for all cases. Results Four recipients (10%) and three donors (7.5%) died over the first 72 h after therapy. During the study period, two recipients (5.5%) developed frank hydrops fetalis, and eventually died in utero . Ten donors (27.0%) developed one or more hydropic signs. In nine (90%), signs were mild or moderate and transient (mean, 3.2 days), while in one case hydrops worsened and the fetus eventually died. No donors with transient hydrops died in utero , and two died postnatally due to extreme prematurity. Gestational age at procedure and deepest amniotic fluid vertical pocket were similar between hydropic and non-hydropic donors. Discrepancy in estimated fetal weight at procedure was significantly lower in donors developing hydrops (9.6 (SD, 6.4) vs. 17.8 (14.4)%,P = 0.018). In pregnancies with hydropic donors, gestational age at delivery (33.1 (3.4) vs. 29.7 (3.5) weeks,P = 0.015) and birth weight for recipient (2392 (423) vs. 1631 (576) g, P < 0.001) and donor (1908 (774) vs. 1281 (583) g,P = 0.021) were significantly higher. The development of transient hydrops had no influence on neonatal survival at 28 days nor on the rate of clinical resolution of intertwin transfusion. Conclusions Transient... [ABSTRACT FROM AUTHOR]

Unlabelled: The aim of the study was to investigate retrospectively a cohort of children with peptic ulcer disease during a period that covers the recent changes in diagnosis and management of the disease. Over a period of 9 years, 2550 children underwent upper gastrointestinal endoscopy for various reasons. All children, in whom a diagnosis of primary peptic ulcer was established, were included in the study. Previous and current medical history, family history, endoscopic and histological outcome were evaluated and the children were regularly followed-up on an out-patient basis. Primary peptic ulcer was diagnosed in 52 (10 gastric and 42 duodenal, 2%) out of 2550 children. The median age of children with gastric ulcer was 6.5 years, whereas of those with duodenal ulcer was 10.5 years (P=0.04). With regard to clinical symptoms no significant difference was found between children with and without ulcer. The prevalence of Helicobacter pylori infection was significantly higher in children with duodenal ulcer (62%) compared to those with gastric ulcer (20%; P < 0.001). At first follow-up visit, 1 month after the end of treatment, 19 symptomatic children underwent a repeat endoscopy, which showed ulcer healing in 95% and failure in H. pylori eradication in 27%. During the long-term follow-up (median 3.5 years), six children became symptomatic. Two of them had duodenal ulcer associated with positive H. pylori.Conclusion: Peptic ulcer disease is an uncommon disorder in childhood with non specific clinical features; it seems that efficient treatment and successful Helicobacter pylori eradication result in clinical improvement and cure as well as in long-term healing of ulcers. [ABSTRACT FROM AUTHOR]

Background: Lap Group Roma was established in 1999 to promote and control the development of laparoscopic surgery in the area of Rome and its province. Complications during the creation of pneumoperitoneum were given a high priority of investigation, and a retrospective enquiry was immediately carried out. Methods: A questionnaire about all laparoscopic surgical practice performed from January 1994 to December 1998 was sent to the supervisors of 28 centers of general surgery in the area of Rome and its province participating to the Lap Group Roma, requesting demographics, type of procedure for the creation of pneumoperitoneum, type and timing of operation, and major vascular, visceral, and minor vascular injuries related to the creation of pneumoperitoneum. Results: The questionnaire was returned by 57% of the centers, for a total of 12,919 laparoscopic procedures. The type of procedure used to create the pneumoperitoneum involved a standard closed approach (Veress needle + first trocar) in 82% of the cases, an open (Hasson) approach in 9% of the cases, and the use of an optical trocar in 9% of the cases. There were seven major vascular injuries (0.05%), eight visceral lesions (0.06%), and nine minor vascular lesions (0.07%), for an overall morbility of 0.18%. There was no death related to these complications. The rate of complications differed significantly (p < 0.0001) depending on the type of approach used. It was 0.27% with the optical trocar (3 of 1,009 cases), 0.18% with the closed approach (20 of 10,664 cases), and 0.09% with the open approach (1 of 1,135 cases). Conclusions: There is no foolproof technique for the creation of pneumoperitoneum, and this inquiry confirms the need of a constant search for prevention and early treatment of complications encountered during this obligatory phase of any laparoscopic approach. A well-conducted and prolonged prospective audit of clinical practice could help in identifying the risk factors that can make an alternative approach (open or video controlled) preferable to the widely used closed approach. [ABSTRACT FROM AUTHOR]

We report a case of a seven-year-old girl who suffered from atypical Hemolytic Uremic Syndrome (aHUS) complicated by septicaemia, central nervous system involvement, and cholangiitis. She remained anuric requiring treatment with peritoneal dialysis (PD) for a five-month period. In addition to conventional therapeutic measures including fresh frozen plasma (FFP) and blood cells transfusions she also underwent to plasma exchange (PE) treatment. Following a stormy hospitalization period of 17 weeks, the patient finally regained renal function and three years later she remains well on antihypertensive treatment and free of dialysis. [ABSTRACT FROM AUTHOR]

Aim: The aim of the study was to investigate the presence of H. pylori in the dental plaque of children, who underwent endoscopy for upper GI symptoms and correlate it with the H. priori infection status of their parents. Methods: The study sample consisted of 35 children aged 4 to 14 years old and 49 family members (mother and/or father). Gastric biopsies were collected from all the children for CLO-test, histology and culture. Serology was used to assess the H. pylori status of the parents. Subgingival plaque samples were collected from the parents and children before endoscopy. Only samples positive by two different PCR methods were considered positive for the presence of H. pylori in dental plaque. Results: Fifteen out of 35 (43%) children were considered H. pylori infected by at least two methods (CLO, histology, culture). H. pylori was detected in dental plaques of 6/15 biopsy positive children and in only 1 of the 20 biopsy negative children. The presence of H. pylori in the dental plaque was significantly associated with H. pylori detection in gastric samples from the antrum (Fisher's p=0.027). On the basis of serology, 33.3% of mothers and 45% of fathers were considered positive for H. pylori infection. Children who had H. pylori identified in their plaque belonged to families who also had H. pylori in dental plaque. The presence of H. pylori in mother's dental plaque or positive serology was associated with H. pylori infection in the respective child (p=0.008 and p=0.002 respectively). Although the same trend was also observed for the fathers, the difference was not statistically significant (p=0.11 and p=0.576 respectively). Conclusions: Dental plaque of children and their families may play an important role-acting as a "reservoir" -for H. pylori transmission. The detection of H. pylori in mother's dental plaque seems to be a critical factor for the intrafamilial spread. [ABSTRACT FROM AUTHOR]

But: Évaluer l’incidence et analyser les facteurs de risques des ulcères et des érosions gastroduodénales chez l’enfant. Patients & Méthodes: Étude prospective réalisée simultanément pendant 1 mois dans 20 centres de 14 pays Européens. Les indications, la présence des ulcères et des érosions gastroduodénales avec leurs facteurs de risques ont été rapportés chez tous les enfants bénéficiant d’une endoscopie digestive haute. Résultats: Parmi les 1443 enfants inclus 638 filles, âge médian 8,1 ans, 1 mois – 18 ans, des ulcères ou des érosions ont été observés chez 153 enfants 10,6 % variant de 0–22 % dans les différents centres. Les indications principales ont été ; douleurs épigastriques et abdominales 24 % ou suspicion de reflux gastro-œsophagien 15 %. Les enfants ayant des ulcères ou des érosions sont significativement plus âgés que ceux sans lésions (10,5+5,4 vs 7,9+5,7 ans, p 0.002). La distribution est identique dans les deux groupes pour : sexe, manifestations cliniques, infection à H. pylori, histoire familiale d’ulcère, pays d’origine de l’enfant ou de sa mère, niveau d’éducation du père ou de la mère, prise médicamenteuse, alcool et drogues. Cependant, l’infection à H. pylori, a été fréquemment rencontrée chez les enfants institutionnalisés par rapport à ceux non institutionnalisés : 98,9 % vs 25,4 %, p<0,001. Conclusion: L’incidence des ulcères ou des érosions gastroduodénales dans cette large étude Européenne pilote a été retrouvée chez 10,6 % des enfants, survenant principalement dans la deuxième décade de la vie. Une prévalence élevé d’infection à H. pylori a été retrouvée chez les enfants institutionnalisés contrasté avec une incidence élevé des ulcères/ érosions H. pylori-négatives chez les enfants non institutionnalisés. Il n’a pas été trouvé de corrélation significative entre les ulcère/érosions et les différents facteurs de risques étudiés. [Copyright &y& Elsevier]

Aim: To genotype in terms of cagA and vacA status, H. pylori clinical strains, isolated from children and adults in the Greek population. Materials and Methods: 45 clinical strains from children and 56 from adult patients were isolated from gastric biopsies following gastroscopy. The presence of cagA as well as subtyping of vacA mid-and signal-region was effected by PCR on genomic DNA as described by Atherton et al, 1999 and Yamaoka et al., 1999. Results: 84 (83%) out of 101 strains were detected positive for the presence of cagA (86% in the adult and 80% in the children population). Out of 79 strains analysed, 52 belonged to the vacAs1 and 27 to the vacAs2 subtype (66% and 34% respectively). Out of 74 strains analysed, 23 (31%) were of the vacAm1 and 48 (65%) vacAm2 subtypes while 3 (4%) remained untypeable. The combinations of vacA subtypes observed are summarized in the following table: We did not detect the vacAs2/m1 subtype in the sample population. Conclusion: A high frequency of cagA positive strains was observed in the Greek population. There was no significant difference in the frequency between the vacA mid- and signal-region subtypes. No statistically significant differences among the subtypes were detected between the adult and the children study groups. [ABSTRACT FROM AUTHOR]