A position paper on predicting the onset of nocturnal enuresis using advanced machine learning

Bed-wetting during normal sleep in children and young people has a significant impact on the child and their parents. The condition is known as nocturnal enuresis and its underlying cause has been subject to different explanatory factors that include, neurological, urological, sleep, genetic and psychosocial influences. Several clinical and technological interventions for managing nocturnal enuresis exist that include the clinician’s opinions, pharmacology interventions, and alarm systems. However, most have failed to produce any convincing results. Clinical information is often subjective and often inaccurate, the use of desmopressin and tricyclic antidepressants only report between 20 % and 40 % success, and alarms only a 50 % success fate. This position paper posits an alternative research idea concerned with the early detection of impending involuntary bladder release. The proposed framework is a measurement and prediction system that processes moisture and bladder volume data from sensors fitted into undergarments that are used by patients suffering with nocturnal enuresis. The proposed framework represents a level of sophistication in nocturnal enuresis treatment not previously considered

A Smart Framework for Predicting the Onset of Nocturnal Enuresis (PrONE) in Children and Young People

Bed wetting during normal sleep in children and young people has a significant impact on the child and their parents. The condition is known as nocturnal enuresis and its underlying cause has been subject to different explanatory factors that include, neurological, urological, sleep, genetic and psychosocial influences. Several clinical and technological interventions for managing nocturnal enuresis exist that include the clinician’s opinions, pharmacology interventions, and alarm systems. However, most have failed to produce any convincing results; clinical information is often subjective and often inaccurate, the use of desmopression and tricyclic antidepressants only report between 20% and 40% success, and alarms only a 50% success fate. This paper posits an alternative research idea concerned with the early detection of impending involuntary bladder release. The proposed framework is a measurement and prediction system that processes moisture and bladder volume data from sensors fitted into undergarments that are used by patients suffering with nocturnal enuresis. The proposed framework represents a level of sophistication and accuracy in nocturnal enuresis treatment not previously considered

THE USE OF ACTIGRAPHY FOR RISK STRATIFICATION IN PEDIATRIC OBSTRUCTIVE SLEEP APNEA

Objectives. (i) To determine the feasibility of using actigraphy to identify sleep interruption in children with suspected obstructive sleep apnea (OSA); (ii) to assess the utility of actigraphy for prediction of OSA severity. Subjects and Methods. Ten healthy children aged 2 to 15 years with suspicion for OSA underwent polysomnography (PSG) with actigraphy. Statistical learning algorithms were used to (i) identify sleep-related respiratory events (awake, asleep, hypopneas and apneas), and (ii) predict OSA severity (mild, moderate and severe) utilizing actigraphy counts. Results. No adverse events were identified. Actigraphy counts were obtained in all 10 children. Linear discriminant analysis identified 100% of patients with severe OSA. Actigraphy counts reliably identified hypopneas and awakenings but not apneas. Conclusions. Actigraphy counts may provide effective risk stratification for pediatric OSA. Further investigations are necessary to investigate the utility of using actigraphy and pulse oximetry together to identify all respiratory events during sleep

Efficacy of a Mandibular Advancement Appliance on Sleep Disordered Breathing in Children

Background: Sleep-Disordered Breathing (SDB) varies from habitual snoring to partial or complete obstruction of the upper airway, and can be found in up to 10% of children. SDB can significantly affect children’s wellbeing, as it can cause growth disorders, educational and behavioural problems, and even life-threatening conditions, such as cardiorespiratory failure. Adenotonsillectomy represents the primary treatment for paediatric SDB where adeno-tonsillar hypertrophy is indicated. For those with craniofacial anomalies, for whom adenotonsillectomy or other treatment modalities have failed, or surgery is contra-indicated, mandibular advancement splints (MAS) may represent a viable treatment option. Whilst the efficacy of these appliances has been consistently demonstrated in adults, there is little information about their effectiveness in children. Study objective: The aims of this research are first, to define the most accepted appliance from different designs of MAS to be used in the main study and second, to determine the efficacy of mandibular advancement appliances (MAS) for the management of Sleep-Disordered Breathing (SDB) and related health conditions in children. Methods: The first part of this research was a pilot study designed as a randomized controlled study with crossover application of four different MAS designs. Questionnaires filled out by the patient and parent were used to gauge effectiveness of the different MAS designs regarding: the effects on speech, the initial acceptance, and the acceptance after wearing the appliance for a full night. A clinical examination then followed to test the appliance retention. One volunteer (11 year old male with class II dental and skeletal jaw relationships) participated in this pilot study and he was suitable for functional appliance treatment. Appliances tested were: 1) traditional Twin-Block with vertical elastics added to ensure the anteroposterior and vertical predetermined position of the mandible when wearing the appliance during sleep; 2) Twin-Block with a metallic fastener in the anterior area to test the function of mandibular advancement; 3) Clear elastic Twin-block which has the same traditional Twin-Block design with vertical elastics but uses vacuum formed retainers instead of the acrylic material; 4) a sham Twin-Block with upper and lower vacuum formed retainers without any mandibular repositioning. This pilot study showed that traditional Twin-Block was the best design to be used in the main study as it was highly accepted by the patient and showed the highest levels of retention in comparison to the other designs. The main study was designed as a single-blind crossover randomised controlled trial with administration of both an ‘Active MAS’ (Twin-block) and a ‘Sham MAS’ (two Hawley retainers). Eligible participants were children aged 8 to 12 years, whose parents reported them snoring ≥ 3 nights per week. Exclusion criteria included class III incisor and/or skeletal relationship, confirmed by lateral cephalometric radiograph. 18 children participated in the study. Each child was randomly assigned to a treatment sequence, starting with either the Active or the Sham MAS. Participants wore the appliances for three weeks, separated by a two-week washout period. For each participant, home-based polysomnographic (PSG) data was collected four times, once before and once after each treatment period. The Apnoea Hypopnoea Index (AHI) represented the main outcome variable. Secondary outcomes, assessed at the same time with PSG recordings, included serum levels of Insulin-like Growth Factor 1 (IGF-1), obstructive sleep-related breathing symptoms, as assessed by the Paediatric Sleep Questionnaire (PSQ), quality of life, as assessed by the OSA-18 questionnaire, and childhood behaviour, as assessed by the Behavioural Assessment System for Children (BASC-2) Behavioural and Emotional Screening System (BESS), and nocturnal enuresis. In addition, blood samples were collected at the end of each treatment period to assess growth hormone changes by measuring blood levels of insulin-like growth factor-1 (IGF-1). Results: Compared to a Sham MAS, wearing an Active MAS resulted in a significant reduction in AHI of 40% (p=0.002) with a decrease in AHI when using the Active MAS, and a tendency for an increase in AHI when using the Sham MAS. The separate assessment of AHI in supine and non-supine sleeping positions revealed that only the former was significantly influenced by treatment, with a reduction of 4.1 events per hour (95% CI=1.8-6.4; p<0.001). Snoring time was 46.3 minutes shorter with the Twin-Block than with the Sham appliance (95% CI=14.5-78.1; p=0.004). The lowest oxygen saturation showed significant improvement of 3.4% (95% CI=0.9-5.9; p=0.007) with the Twin-block in comparison to the Sham MAS. Compared to a Sham MAS, the Active MAS also reduced SDB symptoms. Subjective assessment by parents showed significant improvement, as represented by PSQ, OSA-18, and BASC-2 scores (p≤0.028). IGF-1 levels, however, did not differ between the two treatment periods (p=0.172). There were no reports of nocturnal enuresis incidents during the study periods. Conclusion: The short-term use of mandibular advancement splints significantly reduced AHI, supine AHI. The decrease in the overall AHI resulted from a combination of a decrease in AHI when using the Active MAS, and a tendency towards an increase in AHI when using the Sham MAS. Snoring time decreased significantly when using MAS in children with SDB, and participants showed improvement in subjectively assessed SDB symptoms and quality of life. In addition, significant improvement was detected in parent-reported child behaviour

Family perspectives on bed wetting in young people

The aim of this study was to explore the nature and experience of bed wetting from the perspective of young people who wet the bed, and that of their parents and siblings. A review of the literature suggested that there was still much to be learned about how families manage a young person's bed wetting in the context of every day family life. A qualitative, inductive approach and grounded theory generating methods were used. Nineteen families and twenty young people aged 4 to 17 years, living in some of the most deprived as well as the most affluent localities in the study area, took part. Analysis of in-depth unstructured conversations was facilitated by NUD#IST Power Version 3.0 computer software. With the aid of memos, logic diagrams and a coding paradigm (axial coding) the relationships between emergent concepts were identified and tested and a grounded theory developed around the core concept of "perceived control", which often manifested as "perceived helplessness". The data help to explain how parents' and young people's attitudes towards bed wetting may be reinforced as they interact from day to day. The study has revealed many insights into family processes and the roles played by individual family members, including fathers and siblings. The social consequences of bed wetting are described. Several conditions have been identified which, it is strongly suggested by the data, may need to be fulfilled for the young person to have the best chance of becoming reliably dry at night, using conventional treatment methods. Families' experiences of methods suggested by health care professionals have important implications for practice. It is argued that the family, rather than the individual or the mother-child dyad, should be the unit of intervention. Ways of enhancing a belief in competence among young people, their parents and health care professionals are described

Stem Cell Oncology

Stem cell research is one of the fascinating areas of contemporary biology, but, as with many expanding fields of scientific inquiry, research on stem cells raises scientific questions as rapidly as it generates discoveries. Research on stem cell treatment continues to advance knowledge about how an organism develops from a single cell and how healthy cells replace damaged cells in adult organisms. The most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies, especially oncology. The Faculty of Medicine, Universitas Sumatera Utara, collaborated with the center of excellence and innovation (Pusat Unggulan Inovasi /PUI). The Stem Cell center of the Universitas Sumatera Utara (USU) organized an International Conference. The International Stem Cell and Oncology Conference (ISCOC) 2017 was an comprehensive academic conference in the field of stem cell and oncology research and also tropical medicine and related scientific topics. We expect this conference will benefit academics and practitioners in the field of health sciences in Indonesia. During the two day conference, researchers presented the most recent discoveries in stem cell and oncology and also general medical topics, and served as well in establishing networking for joint researchers and collaboration among participants. The editors and the scientific committee would like to thank the participants and express their gratitude to Faculty of Medicine of the Universitas Sumatera Utara for their support to ISCOC 2017. Lastly, we are most indebted for the generous support given by Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia

Pediatric and Adolescent Nephrology Facing the Future: Diagnostic Advances and Prognostic Biomarkers in Everyday Practice

The Special Issue entitled “Pediatric and adolescent nephrology facing the future: diagnostic advances and prognostic biomarkers in everyday practice” contains articles written in the era when COVID-19 had not yet been a major clinical problem in children. Now that we know its multifaceted clinical course, complications concerning the kidneys, and childhood-specific post-COVID pediatric inflammatory multisystem syndrome (PIMS), the value of diagnostic and prognostic biomarkers in the pediatric area should be appreciated, and their importance ought to increase

Urology

УЧЕБНО-МЕТОДИЧЕСКИЕ ПОСОБИЯУРОЛОГИЯУРОЛОГИЧЕСКИЕ БОЛЕЗН

Factors affecting daytime function in the sleep apnoea/hypopnoea syndrome

The sleep apnoea/hypopnoea syndrome (SAHS) is characterised by repetitive upper airway obstructions during sleep, which lead to recurrent hypoxaemia and brief arousals from sleep. SAHS patients suffer from excessive daytime sleepiness (EDS), cognitive impairments and decreased psychological well -being. Previous studies have examined relationships between the nocturnal events of SAHS and a limited number of daytime function measures, frequently in small, non -consecutive patient samples. Relationships found have been either weak or non -significant. This thesis examines the relationships between a wide range of nocturnal sleep and breathing variables and daytime function. Additionally, this thesis examines the use of subjective and objective measures of daytime sleepiness, to determine which tests provide the most useful information for SAHS patients.A pilot study found that neither the 103 patients' nor their partners' Epworth rating of sleepiness were strong predictors of SAHS severity. In 150 patients with a wide range of SAHS severity, relationships between nocturnal events and daytime function were examined using newer definitions of arousal and measures of sleep continuity. A broad battery of daytime tests were used including the maintenance of wakefulness test (MWT) and the short form (SF) -36. Unlike previous studies, all correlations were controlled for age and awake oxygen saturation, known to influence the variables measured. The current study also examined these correlations in an unselected patient sample with a range of disease severity. The study found a lack of strong relationships between conventional nocturnal sleep and breathing variables and daytime function. Few baseline variables significantly predicted CPAP use.Daytime function measures were compared within the 150 patients. The multiple sleep latency test (MSLT) and the MWT displayed a moderate, discordant relationship. Measures of cognitive function, psychological well -being and subjective sleepiness ii better related to the MWT than MSLT, suggesting that the MWT may be a more useful tool in assessing functional impairment in sleep apnoea.A randomised cross -over study, on 12 SANS patients, compared daytime sleepiness measured following a night's sleep at home (as performed in this thesis) versus a night in the sleep centre (standard protocol). Preliminary results indicated that daytime sleepiness, as measured by the MSLT and MWT, was not significantly different between the two study limbs. This suggests that the non -standard method of conducting the MSLT and MWT in this thesis does not explain the lack of correlational relationships between nocturnal measures and daytime sleepiness.The studies presented in this thesis demonstrate a lack of identified factors affecting daytime function in a group of unselected SANS patients. This may be due to inter - individual patient variability. Also, more sophisticated nocturnal SANS measures should be examined, as should more `real -life' daytime assessments, such as ambulatory EEG recorded during a patient's normal daily routine