Reliability and validity of body weight and body image perception in children and adolescents from the South American Youth/Child Cardiovascular and Environmental (SAYCARE) Study

Objective: To assess the reliability and validity of body weight (BW) and body image (BI) perception reported by parents (in children) and by adolescents in a South American population. Design: Cross-sectional study. BW perception was evaluated by the question, "Do you think you/your child are/is: severely wasted, wasted, normal weight, overweight, obese?" BI perception was evaluated using the Gardner scale. To evaluate reliability, BW and BI perceptions were reported twice, two weeks apart. To evaluate validity, the BW and BI perceptions were compared with WHO BMI Z-scores. Kappa and Kendall's tau-c coefficients were obtained. Setting: Public and private schools and high schools from six countries of South America (Argentina, Peru, Colombia, Uruguay, Chile, Brazil). Participants: Children aged 3-10 years (n 635) and adolescents aged 11-17 years (n 400). Results: Reliability of BW perception was fair in children's parents (k=0·337) and substantial in adolescents (k=0·709). Validity of BW perception was slight in children's parents (k=0·176) and fair in adolescents (k=0·268). When evaluating BI, most children were perceived by parents as having lower weight. Reliability of BI perception was slight in children's parents (k=0·124) and moderate in adolescents (k=0·599). Validity of BI perception was poor in children's parents (k=-0·018) and slight in adolescents (k=0·023). Conclusions: Reliability of BW and BI perceptions was higher in adolescents than in children's parents. Validity of BW perception was good among the parents of the children and adolescents with underweight and normal weight

Reliability and validity of a sedentary behavior questionnaire for South American pediatric population: SAYCARE study

Background Multicenter studies from Europe and the United States have developed specifically standardized questionnaires for assessing and comparing sedentary behavior, but they cannot be directly applied for South American countries. The aim of this study was to assess the reliability and validity of the South American Youth Cardiovascular and Environmental (SAYCARE) sedentary behavior questionnaire. Methods Children and adolescents from seven South American cities were involved in the test-retest reliability (children: n = 55; adolescents: n = 106) and concurrent validity (children: n = 93; adolescents: n = 94) studies. The SAYCARE sedentary behavior questionnaire was administered twice with two-week interval and the behaviors were parent-reported for children and self-reported for adolescents. Questions included time spent watching television, using a computer, playing console games, passive playing (only in children) and studying (only in adolescents) over the past week. Accelerometer was used for at least 3 days, including at least one weekend day. We compared values of sedentary time, using accelerometers, by quartiles of reported sedentary behavior time and their sum. Results The reliability of sedentary behavior time was moderate for children (rho ≥0.45 and k ≥ 0.40) and adolescents (rho ≥0.30). Comparisons between the questionnaire and accelerometer showed a low overall agreement, with the questionnaire systematically underreporting sedentary time in children (at least, − 332.6 ± 138.5 min/day) and adolescents (at least, − 399.7 ± 105.0 min/day). Conclusion The SAYCARE sedentary behavior questionnaire has acceptable reliability in children and adolescents. However, the findings of current study indicate that SAYCARE questionnaire is not surrogate of total sedentary time

Airway bleeding during pulmonary endarterectomy: the "bubbles" technique.

Pulmonary endarterectomy (PEA) is a technically demanding operation, currently performed in few centers worldwide. 1 A bloodless surgical field is mandatory to identify the correct arterial dissection plane, which has to be extended toward subsegmental branches with limited visibility. Vessel perforation is a rare but potentially fatal complication, leading to uncontrollable airway bleeding. A general algorithm for the approach to pulmonary hemorrhage has been proposed by the group from the University of California at San Diego,2 whereas alternative managements are only briefly mentioned in the literature.3 Extracorporeal life support unloads pulmonary circulation but invariably requires anticoagulation, which is detrimental in pulmonary hemorrhage. We describe a novel technique for the treatment of intraoperative airway bleeding during PEA

Sistema vascolare epatico

none6Il fegato è un organo con una vascolarizzazione peculiare, essendo da un lato interposto tra due sistemi venosi, dall’altro possedendo una irrorazione arteriosa afferente ad un sistema venoso, quello dei sinusoidi, condiviso con l’afferenza venosa. Il sistema venoso afferente è quello costituito dal sistema portale che comprende l’efflusso splenico, quello pancreatico e quello gastroenterico. Dal punto di vista funzionale l’affluenza epatica del sangue refluo dal pancreas ha importanza dal punto di vista endocrino-metabolico mentre l’affluenza del sangue refluo dalla milza è importante per l’emocateresi. Il flusso portale è il risultato dell’efflusso splenico e mesenterico ed è quindi regolato solo dall’afflusso splenico e mesenterico. Il fegato a tal riguardo svolge solo il ruolo di modificare le resistenze per mantenere un regime pressorio constante. Il sitema prevede invece una regolazione dell’afflusso arterioso controllata prevalentemente dal flusso portale, con un sistema buffer di vasocostrizione arteriosa epatica in seguito all’aumento del flusso portale che si verifica fasicamente ad esempio in occasione dei pasti. Vi possono essere delle variazioni di resistenze al flusso portale In condizioni patolologiche, quale la cirrosi, l’ostruzione portale o delle vene sovraepatiche, le resistenze al flusso portale aumentano determinando conseguenze a monte con aumento della pressione (ipertensione portale), formazione di circoli collaterali che rappresentano degli shunts porto-sistemici. Le conseguenze sono quindi di tipo emodinamico e metabolico. Lo studio della vascolarizzazione epatica è effettuabile in maniera completa e dinamica mediante l’eco-color-Doppler. Tale metodica consente di ottenere informazioni sulla morfologia dei vasi e sul flusso ematico, valutandone la presenza o assenza, le velocità nelle diverse fasi del ciclo cardiaco, e numerosi indici di resistenza o compliance sia a livello arterioso che venoso. La fattibilità di un esame eco-color-Doppler completo è circa del 70%. Il mezzo di contrasto può consentire una migliore visualizzazione dei vasi epatici in condizioni di scarsa visualizzazione (1) ed in particolare nel trapianto di fegato in cui il monitoraggio della pervietà venosa ed arteriosa è di fondamentale importanza (2-4). Vi sono dati in letteratura che dimostrano il miglioramento della capacità diagnostica dell’eco-Doppler con l’uso del mezzo di contrasto ed anche una riduzione dei tempi di esecuzione degli esami, in particolare dopo trapianto di fegato (1). A tal riguardo è consigliabile, anche per motivi economici, riservare l’uso del mezzo di contrasto ai soli casi dubbi. Da un punto di vista pratico è molto importante conoscere la cinetica dei mezzi di contrasto ecografici a livello epatico, al fine di poter usare in modo razionale l’ecografia con mezzo di contrasto a scopo diagnostico, non solo vascolare ma anche per lo studio delle lesioni focali epatiche. Se noi somministriamo del Levovist in bolo attraverso una vena periferica otterremo la visualizzazione sequenziale dell’arteria epatica, dei rami portali epatici e successivamente delle vene sovraepatiche. Come illustrato nella fig. 1, dopo circa 15 secondi il mezzo di contrasto consentirà la visualizzazione dei rami arteriosi epatici, dopo 20 secondi quella dei rami portali, dopo 40 secondi quella delle vene sovraepatiche. Mentre il ritardo di opacizzazione dei rami portali è di facile interpretazione, dovendo il mezzo di contrasto attraversare il letto arterioso, capillare e venoso gastroenterico e splenico, di più difficile interpretazione è il ritardo di opacizzazione delle vene sovraepatiche. Esso è verosimilmente dovuto al tempo di transito sinusoidale. Il mezzo di contrasto permette quindi di ottenenere un’ottima visualizzazione dei rami principali arteriosi e venosi portali e sovraepatici. Disponendo dell’idonea tecnologia è poi possibile costruire le curve di transito del mezzo di contrasto nei diversi distretti vascolari. Tali curve, ottenute con il Levovist usando la seconda armonica, la pulse-inversion e un indice meccanico piuttosto basso (MI=1,0) ed un frame rate di 1/battito cardiaco (circa 1/sec), sono illustrate nella figura 2. Delle curve si possono valutare molteplici parametri. I più usati sono: il tempo di comparsa del contrasto, il tempo di picco massimo, il livello del picco massimo, l’inclinazione della retta.noneCascina ; Azzaretti A; Sacerdoti D; Quaretti P; Garbagnati F; Rossi SCascina, ; Azzaretti, A; Sacerdoti, David; Quaretti, P; Garbagnati, F; Rossi, S

Immunological evaluation in children with juvenile chronic arthritis treated with Auranofin.

An immunological evaluation was performed before therapy and every four months during the first year of treatment with auranofin in 6 children with juvenile chronic arthritis. The immunological tests included: IgG, IgA, IgM, IgE and "natural" antibody serum levels, CH50 of the classical and alternative complement pathways, PWM-induced IgM production in vitro, and polymorphonuclear neutrophil functions. A reduction of the in vitro IgM synthesis and in the CH50 of the classical pathway of complement, and a normalization of impaired chemotaxis, occurred in patients who presented a clinically significant improvement during auranofin treatment

Contrast-enhanced versus conventional and color doppler sonography for the detection of thrombosis of the portal and hepatic venous systems

We conducted a prospective study to compare sonography, color Doppler sonography, and contrast-enhanced sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancies. SUBJECTS AND METHODS: Three hundred sixteen patients with biopsy-proved hepatic tumors were studied at baseline and 3 months later with sonography, color Doppler sonography, and contrast-enhanced sonography. Thrombosis was defined as the presence of intraluminal echogenic material at sonography, absence of intraluminal color signals at color Doppler sonography, and presence of nonenhancing intraluminal area at contrast-enhanced sonography. Thrombi were considered malignant if they displayed continuity with tumor tissue at sonography, intrathrombus color signals at color Doppler sonography, and enhancing signals at contrast-enhanced sonography, both having arterial waveforms at Doppler spectral examination. Definitive diagnoses were obtained by sonographically guided biopsy except for thrombi displaying at conventional sonography unequivocal continuity with tumor tissue. RESULTS: Thrombosis was detected in 79 (25.0%) of 316 patients at baseline and in 83 (26.3%) of 316 patients after 3 months. Eighty-one (97.6%) of the 83 thrombi were malignant. Definitive diagnosis was performed by imaging in 60 (72.3%) of the 83 cases and by biopsy in 23 cases (27.7%). For thrombus detection, contrast-enhanced sonography displayed significantly higher sensitivity than color Doppler sonography (p = 0.004) and borderline superiority over sonography (p = 0.058). For thrombus characterization, contrast-enhanced sonography was significantly more sensitive than color Doppler sonography (p < 0.0005) and conventional sonography (p = 0.02). CONCLUSION: Contrast-enhanced sonography is superior to sonography and color Doppler sonography for the detection and characterization of portal and hepatic vein thrombosis complicating hepatic malignancie