The APpendicitis PEdiatric (APPE) score: a new diagnostic tool in suspected pediatric acute appendicitis

Our aim was to develop an APpendictis-PEdiatric score (APPE score) in quantifying risk of acute appendicitis based on combination of clinical and laboratory markers. 1025 patients were classified in: acute appendicitis (AA) and non-appendicitis. Demographic/clinical features, and laboratory were collected. They were compared for quantitative-variables and categorical-variables. Significant predictors (P=<0,05) were included in logistic regression model. Based on regression-coefficients, a diagnostic score was tested by calculating the area under the ROC curve. Two cut-offs were established to define classes of risk of AA. 9 variables were identified as potentially predictors for AA. Those underwent logistic regression and a score was assigned, for maximum 21-points. The score showed an area under the curve: 0.831 and a linear proportion with the state of appendicular inflammation (R20.85). Patients with a score ≤8 were at low risk of AA (sensitivity 94%); those with a score ≥15 were at high risk for AA (specificity 93%). Those between 8 and 15 were defined at intermediate risk class. APPE-score guides clinicians in classifying patients with suspected-AA according to clinical and laboratory findings in order to improve their management

Amor constante : Quevedo más allá de la muerte

La col·lecció Studia Aurea Monográfica, coeditada por la Universitat Autònoma de Barcelona y la Universitat de Girona, es una colección auspiciada por Studia Aurea. Revista de Literatura Española y Teoría Literaria del Renacimiento y Siglo de Oro.Els capítols d'aquest llibre els trobareu també al Dipòsit digital de documents de la UAB en text complet.El estudio de la recepción de la obra de Quevedo como 'clásico contemporáneo' se enriquece hoy con la publicación de una serie de ensayos que, por su propia naturaleza específica y variedad del conjunto, proporcionan y confirman un dato incontrovertible: Quevedo no solo es un modelo literario, sino un arquetipo, de la cultura y del pensamiento; su obra no solo vale como antecedente o hipotexto, sino que funciona como verdadero sistema comunicativo, disponible al uso de las distintas formas de la expresión humana

Tree species that 'live slow, die older' enhance tropical peat swamp restoration : Evidence from a systematic review

Degraded tropical peatlands lack tree cover and are often subject to seasonal flooding and repeated burning. These harsh environments for tree seedlings to survive and grow are therefore challenging to revegetate. Knowledge on species performance from previous plantings represents an important evidence base to help guide future tropical peat swamp forest (TPSF) restoration efforts. We conducted a systematic review of the survival and growth of tree species planted in degraded peatlands across Southeast Asia to examine (1) species differences, (2) the impact of seedling and site treatments on survival and growth and (3) the potential use of plant functional traits to predict seedling survival and growth rates. Planted seedling monitoring data were compiled through a systematic review of journal articles, conference proceedings, reports, theses and unpublished datasets. In total, 94 study-sites were included, spanning three decades from 1988 to 2019, and including 141 indigenous peatland tree and palm species. Accounting for variable planting numbers and monitoring durations, we analysed three measures of survival and growth: (1) final survival weighted by the number of seedlings planted, (2) half-life, that is, duration until 50% mortality and (3) relative growth rates (RGR) corrected for initial planting height of seedlings. Average final survival was 62% and half-life was 33 months across all species, sites and treatments. Species differed significantly in survival and half-life. Seedling and site treatments had small effects with the strongest being higher survival of mycorrhizal fungi inoculated seedlings; lower survival, half-life and RGR when shading seedlings; and lower RGR and higher survival when fertilising seedlings. Leaf nutrient and wood density traits predicted TPSF species survival, but not half-life and RGR. RGR and half-life were negatively correlated, meaning that slower growing species survived for longer. Synthesis and applications. To advance tropical peat swamp reforestation requires expanding the number and replication of species planted and testing treatments by adopting control vs. treatment experimental designs. Species selection should involve slower growing species (e.g. Lophopetalum rigidum, Alstonia spatulata, Madhuca motleyana) that survive for longer and explore screening species based on functional traits associated with nutrient acquisition, flooding tolerance and recovery from fire.Peer reviewe

Tree species that 'live slow, die older' enhance tropical peat swamp restoration : Evidence from a systematic review

Degraded tropical peatlands lack tree cover and are often subject to seasonal flooding and repeated burning. These harsh environments for tree seedlings to survive and grow are therefore challenging to revegetate. Knowledge on species performance from previous plantings represents an important evidence base to help guide future tropical peat swamp forest (TPSF) restoration efforts. We conducted a systematic review of the survival and growth of tree species planted in degraded peatlands across Southeast Asia to examine (1) species differences, (2) the impact of seedling and site treatments on survival and growth and (3) the potential use of plant functional traits to predict seedling survival and growth rates. Planted seedling monitoring data were compiled through a systematic review of journal articles, conference proceedings, reports, theses and unpublished datasets. In total, 94 study-sites were included, spanning three decades from 1988 to 2019, and including 141 indigenous peatland tree and palm species. Accounting for variable planting numbers and monitoring durations, we analysed three measures of survival and growth: (1) final survival weighted by the number of seedlings planted, (2) half-life, that is, duration until 50% mortality and (3) relative growth rates (RGR) corrected for initial planting height of seedlings. Average final survival was 62% and half-life was 33 months across all species, sites and treatments. Species differed significantly in survival and half-life. Seedling and site treatments had small effects with the strongest being higher survival of mycorrhizal fungi inoculated seedlings; lower survival, half-life and RGR when shading seedlings; and lower RGR and higher survival when fertilising seedlings. Leaf nutrient and wood density traits predicted TPSF species survival, but not half-life and RGR. RGR and half-life were negatively correlated, meaning that slower growing species survived for longer. Synthesis and applications. To advance tropical peat swamp reforestation requires expanding the number and replication of species planted and testing treatments by adopting control vs. treatment experimental designs. Species selection should involve slower growing species (e.g. Lophopetalum rigidum, Alstonia spatulata, Madhuca motleyana) that survive for longer and explore screening species based on functional traits associated with nutrient acquisition, flooding tolerance and recovery from fire.Peer reviewe

Chirurgia Pediatrica

Chirurgia pediatrica; M Lima; G Ruggeri; B Randi; bullettino scienze mediche- 2010 fasc. 2; pagg 91-11

Laparoscopic-assisted anorectal pull-through for high imperforate anus: 14 years experience in a single center

none4noPurpose: To report our 14 years experience with the laparoscopic-assisted anorectal pull-through (LAARP) for the treatment of male neonates with high imperforate anus. Materials and Methods: We reviewed all medical charts of patients who underwent LAARP from January 2001 to January 2015 collecting information regarding demographic data, associated anomalies, type of fistula, pelvic floor muscles tropism, surgery (operative time, conversion to open technique, and complications), and follow-up. Follow-up data were obtained through the use of validated questionnaires that aim to assess the intestinal function in terms of constipation and continence. Results: At the Department of Pediatric Surgery of the University of Bologna, 13 male patients were operated in the study period (our protocol consisted of colostomy at birth followed by delayed LAARP). Mean age at operation was 4.75 months (range 1-14). There was one conversion to open technique due to a strong tension from the colostomy (this patient was excluded). Functional results were acceptable at a minimum 2-year-long follow-up. Conclusions: LAARP is a good choice for the correction of the high imperforate anus. Short-term outcomes are similar to those after posterior sagittal anorectoplasty (PSARP). Long-term outcomes should be better assessed.openRuggeri, Giovanni; Destro, Francesca; Randi, Beatrice; Lima, MarioRuggeri, Giovanni; Destro, Francesca; Randi, Beatrice; Lima, Mari

A New Robotic Platform for Endoscopic Skill Training

none5Background: Applications of Minimally Invasive Surgery (MIS) techniques are quickly extending. Therefore, also surgical education is changing rapidly, although several factors, including budget constraints and medico-legal concerns, still limit opportunities for pediatric trainees. New training devices, such as low fidelity bench trainers and virtual reality simulators, offer new ways for surgical training. Moreover, there is considerable interest in the development of haptic simulators for MIS even though the importance of force feedback remains poorly understood. Methods: In this report, we present the LapLab (Laparoscopic Laboratory) device, an innovative laparoscopic training solution developed at the University of Bologna. Results: LapLab is a haptic simulator for MIS designed to improve and test the skill of surgeons. Moreover, it also allows to test in safe conditions (i.e. by means of realistic simulations) new kinds of MIS instruments. Conclusions: Actually the LapLab simulation system has matured from a technological point of view, but still it represents just a starting point for a new generation of simulation systems able to give a real contribute to the education and training of the surgeons of tomorrow.openMogiatti, Mirella; Ruggeri, Giovanni; Gargano, Tommaso; Randi, Beatrice; Lima, MarioMogiatti, Mirella; Ruggeri, Giovanni; Gargano, Tommaso; Randi, Beatrice; Lima, Mari

Neuroblastoma in Neonates

In neonatal period, tumours, although very rare, represent an important cause of morbidity and mortality. The prevalence of neoplasms, within the first month after birth, occurs once in every 12,500\u201327,500 live births, and malignant tumours develop in approximately 40\u201350% of them. Diagnosis often occur during prenatal screening or during follow-up for a known cancer predispo- sition syndrome; in fact the presence of congeni- tal anomalies, multifocal or bilateral diseases and cancer in close relatives is suggestive for an underlying cancer predisposition syndrome, and genetic counselling and testing should be consid- ered to investigate these possibilities

Technical Modification of the Georgeson Procedure for Hirschsprung\u2019s Disease: a 12 Years Experience with the Laparoscopic-Assisted Mesocolon Dissection

Introduction: Actually the primary laparoscopic endorectal colon pull-through, reported by Georgeson, is the gold standard in the treatment of Hirschsprung\u2019s disease. In this procedure the dissection of the aganglionic colon is performed laparoscopically. We describe a technical modification of the Georgeson procedure: the laparoscopic-assisted mesocolon dissection. Methods: A retrospective analysis was performed on all patients undergoing laparoscopic pull-through for Hirschsprung\u2019s disease, in our department, from September 2000 to March 2012. A pneumatic anchorage Hasson type 10 mm port is used for the camera (umbilical) to allow the video-assisted procedure. The two or three operative access are small abdominal port (3-5 mm). The distal ganglionic zone is initially identified by seromuscular biopsies, obtained exteriorizing the colon through the umbilical wound. A colon pedicle, preserving the marginal artery, is fashioned through a laparoscopic-assisted stage: the mesocolon dissection was performed not endoscopically, but exteriorizing the colon through the umbilical wound progressively. Then the rectal mobilization is performed transanally, using an endorectal sleeve technique. The anastomosis is performed transanally, 5 mm above the dentate line. Results: 27 patients underwent laparoscopic colon pull-through sec. Georgeson for Hirschsprung\u2019s disease with a laparoscopic-assisted mesocolon dissection. Also patients affected by Hirschsprung\u2019s disease long segment were treated with this video-assisted technique. Patients treated with this technique were aged between 1 month and 1 year. Intraoperatively no complications occurred and the video-assisted dissection stage was easy to perform in all patients. The post-operative course was uneventful. Conclusions: Laparoscopic-assisted colon pull-through, described by Georgeson, represents actually the gold standard in the treatment of Hirschsprung\u2019s disease, but the totally endoscopic mesocolon dissection is encumbered by technical complexity and a significant learning-curve for the surgeon. The laparoscopic-assisted mesocolon dissection allows to simplify this stage, decreasing the rate of intra-operative complications. Moreover, this technique is also feasible in patients affected by Hirschsprung\u2019s disease long segmen