Long-term evaluation of patient satisfaction and quality of life in pectus excavatum repair

Abstract Background: The aim of our study was to evaluate long-term patient satisfaction and quality-of-life improvement in grown-up patients treated for pectus excavatum with the Nuss procedure in the pediatric age, searching for correlation between preoperative characteristics and long-term outcomes. Methods: At first, we performed a retrospective analysis of pediatric patients undergoing the Nuss procedure in a 5-year period. We administered, at least 5 years after bar removal, a single-step questionnaire to focus on the assessment of patient satisfaction with operative results. Results: Most patients stated general health and exercise tolerance were improved after the operation. High levels of overall satisfaction were reported after Nuss repair, with 95.6% of patients being either satisfied or very satisfied. Overall, 87.0% of patients stated they would have the operation again. The high overall satisfaction after surgery was not correlated with the deformity severity and the presence of physical symptoms before correction. Conclusions: Patients expressed high levels of satisfaction in terms of self-image and quality of life. Improvement in cosmetic appearance and health in general translated in most patients in an improvement of social life. The degree of postoperative pain after the Nuss procedure is the overriding factor in the patient’s perception of the quality of the postoperative course

Fish Skin Graft: Narrative Review and First Application for Abdominal Wall Dehiscence in Children

Summary: Acellular fish skin grafts (FSGs) are tissue-based products created by minimally processing the skin of the Atlantic cod (Gadus morhua). The FSG is rich in omega-3 and facilitates tissue regeneration by supporting revascularization and ingrowth in the proliferation and remodeling phases of wound healing. FSG is structurally more similar to human skin than antiviral-processed skin substitutes such as amniotic membrane, and there are no known prion, bacterial, or viral diseases that can be transmitted from North-Atlantic cod to humans. The FSG is processed using a proprietary method that preserves the structure and lipid composition of the skin. FSG is CE marked, and US Food and Drug Administration cleared for multiple clinical applications in partial and full-thickness wounds. FSG is currently the only acellular dermal matrix product that does not originate from mammalian tissues. For this narrative review, Medline and UpToDate were used to include a total of 21 articles published from 2015 to 2022 about fish skin graft use. We also reported a case of a 7-year-old boy who underwent treatment with FSG for abdominal wall dehiscence at our department of pediatric surgery, IRCCS Sant’Orsola- Malpighi, Alma Mater Studiorum, University of Bologna, University Hospital of Bologna. FSG provides a valuable and sustainable treatment that improves wound healing in both adult and pediatric populations. We described the first application of an FSG for wound dehiscence of the abdominal wall in a pediatric patient, reporting how FSG was completely reabsorbed and improved the skin’s repai

A case of massive subcutaneous emphysema and transient ischemic attack due to argon plasma coagulation following endoscopic pilonidal sinus treatment

Pilonidalsinusisasmallholeaffectingtheskinandsubcutaneoustissue,whichusuallycontainshairandskindebris,resultinginthecreationoftheso-calledpilonidalcyst.Theendoscopicpilonidalsinustreatment(EPSiT)isaminimallyinvasiveprocedureconsistingoftheremovalofhairsandcauterizationofthecavityunderdirectendoscopicvision.Inourinstitution,weusedtoendthisprocedurewithargonplasmacoagulation(APC).Here,wediscussacaseof22-year-oldmanaffectedbypilonidaldisease,whodevelopedamassivesubcutaneousemphysemaandsuspectedtransientischemicattacksecondarytogasreabsorptionafteranEPSiTinwhichAPCwassedforthecoagulation

Pelvic Health Assessment in Adult Females Following Pediatric Appendicitis: A Monocentric Retrospective Case—Control Study

open10noAbstract: Background: The anatomical location of the appendix in females determines its close contact with the internal genitalia, involving the latter in case of acute appendicitis (AA). The aim of this study was to evaluate the incidence of pelvic health impairment in adult women who underwent appendicectomy during childhood. Materials and Methods: A retrospective observational study was conducted including all female patients who underwent appendicectomy for acute appendicitis at our Center between January 1985 and December 1995. The patients were divided into two groups, i.e., complicated AA (Group A) and not complicated AA (Group B), and were asked to respond to a questionnaire investigating their general health status, fertility impairment, ectopic pregnancies, miscarriages, endometriosis, and chronic pelvic pain. The same questionnaire was administered to female volunteers with past medical history (PMH) negative for AA. The data were compared using chi-square test and Fisher exact test (a p value < 0.05 was considered for statistical significance). Results: In total, 75 patients operated for AA during childhood (22 in Group A and 53 in group B) and 44 female volunteers with PMH negative for AA (group C) were enrolled in the study. Seventeen patients (77.3%) in group A, 40 (75.4%) in group B, and 29 (65.9%) in group C (p > 0.05) had pregnancies. The number of miscarriages among women who became pregnant in their life was 5 in group A, 13 in group B, and 12 in group C (p > 0.05). Chronic pelvic pain was reported by 7 out of 22 (31.8%) patients in group A, 7 out of 53 (13.2%) in group B, and 5 out of 44 (11.4%) in group C (A vs. C: p = 0.04, OR = 3.64; A vs. B: p = 0.06 and B vs. C: p = 0.52). Conclusions: In our series, AA, complicated or not, neither determined repercussions on fertility, risk of miscarriages, and ectopic pregnancies nor increased the risk of developing endometriosis. However, women who experienced complicated AA showed a higher prevalence of chronic pelvic pain onset in adulthood compared to healthy women.openParente, Giovanni; Di Mitri, Marco; D’Antonio, Simone; Cravano, Sara; Thomas, Eduje; Vastano, Marzia; Lunca, Robert; Gargano, Tommaso; Libri, Michele; Lima, MarioParente, Giovanni; Di Mitri, Marco; D’Antonio, Simone; Cravano, Sara; Thomas, Eduje; Vastano, Marzia; Lunca, Robert; Gargano, Tommaso; Libri, Michele; Lima, Mari

An Activatable Cancer-Targeted Hydrogen Peroxide Probe for Photoacoustic and Fluorescence Imaging.

Reactive oxygen species play an important role in cancer, however, their promiscuous reactivity, low abundance, and short-lived nature limit our ability to study them in real time in living subjects with conventional noninvasive imaging methods. Photoacoustic imaging is an emerging modality for in vivo visualization of molecular processes with deep tissue penetration and high spatiotemporal resolution. Here, we describe the design and synthesis of a targeted, activatable probe for photoacoustic imaging, which is responsive to one of the major and abundant reactive oxygen species, hydrogen peroxide (H2O2). This bifunctional probe, which is also detectable with fluorescence imaging, is composed of a heptamethine carbocyanine dye scaffold for signal generation, a 2-deoxyglucose cancer localization moiety, and a boronic ester functionality that specifically detects and reacts to H2O2. The optical properties of the probe were characterized using absorption, fluorescence, and photoacoustic measurements; upon addition of pathophysiologic H2O2 concentrations, a clear increase in fluorescence and red-shift of the absorption and photoacoustic spectra were observed. Studies performed in vitro showed no significant toxicity and specific uptake of the probe into the cytosol in breast cancer cell lines. Importantly, intravenous injection of the probe led to targeted uptake and accumulation in solid tumors, which enabled noninvasive photoacoustic and fluorescence imaging of H2O2. In conclusion, the reported probe shows promise for the in vivo visualization of hydrogen peroxide. SIGNIFICANCE: This study presents the first activatable and cancer-targeted hydrogen peroxide probe for photoacoustic molecular imaging, paving the way for visualization of hydrogen peroxide at high spatiotemporal resolution in living subjects.Graphical Abstract: http://cancerres.aacrjournals.org/content/canres/79/20/5407/F1.large.jpg

Ask Doctor Smartphone! An App to Help Physicians Manage Foreign Body Ingestions in Children

Abstract: Background: Foreign body ingestion (FBI) represents the most common cause of emergent gastrointestinal endoscopy in children. FBI’s management can be quite challenging for physicians because of the variability of the clinical presentation, and the decision tree becomes even more intricate because of patient-specific variables that must be considered in the pediatric age range (e.g., age of patients and neuropsychiatric disorders) in addition to the mere characteristics of the foreign body. We present an application for smartphones designed for pediatricians and pediatric surgeons based on the latest guidelines from the official pediatric societies. The app aims to help physicians manage FBI quickly and properly in children. Materials and methods: The latest pediatric FBI management guidelines were reviewed and summarized. The flow chart we obtained guided the development of a smartphone application. A questionnaire was administered to all pediatric surgeon trainees at our institute to test the feasibility and helpfulness of the application. Results: An app for smartphones was obtained and shared for free on the Google Play Store and Apple Store. The app guides the physician step by step in the diagnostic process, analyzing all patient- and foreign body-specific characteristics. The app consultation ends with a suggestion of the most proper decision to make in terms of further radiological investigations and the indication and timing of endoscopy. A questionnaire administered to trainees proved the app to be useful and easy to use. Conclusion: We developed an app able to help pediatricians and pediatric surgeons manage FBI in children, providing standardized and updated recommendations in a smart and easily available way

Characterization of the transient response of diamond sensors to collimated, sub-ps, 1 GeV electron bunches

Diamond sensors (DS) are widely used as solid-state particle detectors, beam loss monitors, and dosimeters in high-radiation environments, e.g., particle colliders. We have calibrated our DS with steady β - and X-radiation, spanning a dose rate in the range 0.1-100 mGy/s. Here, we report the first systematic characterization of transient responses of DS to collimated, sub-picosecond, 1 GeV electron bunches. These bunches, possessing a charge ranging from tens to hundreds of pC and a size from tens of microns to millimeters, are suitably provided by the FERMI electron linac in Trieste, Italy. The high density of charge carriers generated by ionization in the diamond bulk causes a transient modification of electrical properties of DS (e.g., resistance), which in turn affects the signal shape. We have modeled a two-step numerical approach, simulating the effects on the signal of both the evolution of charge carrier density in the diamond bulk and the changes in the circuit parameters. This approach interprets features observed in our experimental results to a great extent

Implementation of Radio-Frequency Deflecting Devices for Comprehensive High-Energy Electron Beam Diagnosis

In next-generation light sources, high-brightness electron beams are used in a free-electron laser configuration to produce light for use by scientists and engineers in numerous fields of research. High-brightness beams are described for such light sources as having low transverse and longitudinal emittances, high peak currents, and low slice emittance and energy spread. The optimal generation and preservation of such high-brightness electron beams during the acceleration process and propagation to and through the photon-producing element is imperative to the quality and performance of the light source. To understand the electron beam's phase space in the accelerating section of a next-generation light source machine, we employed radio-frequency cavities operating in a deflecting mode in conjunction with a magnetic spectrometer and imaging system for both low (250 MeV) and high (1.2 GeV) electron energies. This high-resolution, high-energy system is an essential diagnostic for the optimization and control of the electron beam in the FERMI light source generating fully transversely and longitudinally coherent light in the VUV to soft x-ray wavelength regimes. This device is located at the end of the linear accelerator in order to provide the longitudinal phase space nearest to the entrance of the photon-producing beam-lines. Here, we describe the design, fabrication, characterization, commissioning, and operational implementation of this transverse deflecting cavity structure diagnostic system for the high-energy (1.2 GeV) regime

Emphysematous Pyelonephritis Following Ureterovesical Reimplantation for Congenital Obstructive Megaureter. Pediatric Case Report and Review of the Literature

Introduction: Emphysematous pyelonephritis (EPN) is a rare, life-threatening necrotizing infection of the kidney. To date, very few cases of EPN have been described in the pediatric age. The first case of EPN in a toddler occurring after ureterovesical reimplantation for congenital obstructive megaureter is reported with a literature review.Case Report: A 23-month-old male, with a prenatal diagnosis of obstructive megaureter and incomplete duplication of the left urinary tract, was admitted to our Unit where he underwent surgery to treat increased dilatation of the renal pelvis and appearance of an obstructive curve. The latter was revealed at renal scintigraphy, the exam highlighted the radiographic aspect of the cortical renal parenchymal sufferance. At admission preoperative exams were normal, and no recurrent urinary tract infections were documented. Surgical removal of the left stenotic ureteral common tract of the incomplete duplex collecting system was accomplished; ureterovesical reimplantation was performed without ureteral recalibration. No intraoperative complications were recorded. In the immediate postoperative period, urosepsis and the patient's lethargic condition led to life-threatening conditions requiring urgent admission to the intensive care unit. Biochemical analysis showed leukocytosis, anemia, increased C-reactive protein, prolonged prothrombin time, pancytopenia, hyponatremia. Abdominal sonographic evaluation revealed the presence of gas in the left kidney. Unilateral EPN (Class 2) was confirmed by CT- scan. Escherichia coli was cultured from peripheral blood and antimicrobial therapy was started. No additional interventions were required. The child was discharged 14 days postoperatively with normal renal function.Conclusion: EPN is a serious condition that can occur after surgical treatment for urinary tract obstruction. Early detection of air in the kidney should be considered a sign of complicated urinary tract infection. Immediate aggressive resuscitation and antimicrobial therapy are effective and curative with a positive outcome

Radar Evidence of Subglacial Liquid Water on Mars

Strong radar echoes from the bottom of the martian southern polar deposits are interpreted as being due to the presence of liquid water under 1.5 km of ice