Anorectal manometry in children with defecation disorders BSPGHAN Motility Working Group consensus statement

Defecatory disorders in children, including chronic constipation (CC) and fecal incontinence (FI), are common conditions worldwide and have a significant impact on children, their families, and the healthcare system. Anorectal manometry (ARM) and high‐resolution anorectal manometry (HRAM) are relatively novel tools for the assessment of anal sphincter function and rectal sensation and have contributed significantly to improving the understanding of the anorectum as a functional unit. ARM has been recognized as the investigation of choice for adults with symptoms of defecation disorders, including fecal incontinence (FI), evacuation difficulties, and constipation. Although it is the gold standard tool in adults, it has yet to be formally accepted as a standardized diagnostic tool in the pediatric age, with limited knowledge regarding indications, protocol, and normal values. ARM/HRAM is slowly becoming recognized among pediatricians, but given that there are currently no agreed guidelines there is a risk that will lead to diversity in practice. The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN)—Motility Working Group (MWG) therefore has taken the opportunity to provide guidance on the use of ARM/HRAM in children with CC and/or FI

Women's views on autologous cell-based therapy for post-obstetric incontinence

Aim: Fecal and urinary incontinence are devastating consequences of obstetric-related perineal injury. The aim of the present study is to determine acceptability to parous women of autologous cell-based therapy for fecal and urinary incontinence that arises due to pelvic diaphragm tearing during vaginal childbirth. Materials & methods: A multiple choice questionnaire survey was offered to 76 parous women at the Maternity Unit, University College Hospital, London, UK. Seventy completed questionnaires – response rate: 92%. Results: In total, 84% of women indicated a willingness to accept autologous cell-based therapy for obstetric injury-induced incontinence rather than surgery. Conclusion: These observational data provide an indication of likely acceptance of autologous cell-based therapies for birth injury incontinence and will help with designing new therapeutic approaches.The project was supported by grants from the UK Medical Research Council (MR/L002752/1), The Sir Halley Stewart Trust, The Henry Smith Charity, and the UCL Grand Challenge Studentship Scheme. The research was undertaken at UCL/UCLH which receives funding from the Department of Health's NIHR as a Comprehensive Biomedical Research Centre.Published versio

Doença de Hirschsprung: experiência com uma série de 55 casos Hirschsprung's disease: experiment with a serie of 55 cases

OBJETIVOS: analisar aspectos clínicos de pacientes com Doença de Hirschprung (DH). MÉTODOS: realizou-se estudo de caso institucional, retrospectivo, via revisão de prontuários de pacientes com DH atendidos no Instituto Fernandes Figueira entre 1993 e 2003. RESULTADOS: Em um total de 55 pacientes, 98% apresentaram sintomas neonatais, sendo 47,2% diagnosticados nesse período; em 88,9% o enema baritado foi conclusivo; 69% tinham DH de segmento curto; 16,3% síndrome de Down; 15,2% outras anomalias congênitas; 40% foram rastreados para mutações RET associadas a neoplasias endócrinas múltiplas (MEN2A), não sendo detectada nenhuma; 63,6% fizeram abaixamento estagiado do colon/íleo; 12,72% abaixamento endoretal transanal primário; as principais complicações cirúrgicas foram sepse, enterocolite e obstrução intestinal; distúrbios da defecação foram detectados anos pós-cirurgia; a taxa de letalidade foi 9,25%; os óbitos relacionaram-se a enterocolite e sepse pós-operatórias. CONCLUSÃO: embora apresentasse sintomas neonatais, a maioria dos pacientes foi diagnosticada tardiamente. Enterocolite foi a principal causa de morbimortalidade. Distúrbios da defecação ocorrem com frequência, demandando follow-up prolongado. Embora rara, a associação com MEN2A precisa ser investigada devido à agressividade da doença. A heterogeneidade clínica e genética da DH exige atuação de equipe multidisciplinar.<br>OBJECTIVES: to analyze clinical features of patients with Hirschprung's Disease (HD). METHODS: a retrospective institutional case study was carried out using the medical records of patients with HD attending the Fernandes Figueira Institute between 1993 and 2003. RESULTS: out of a total of 55 patients, 98% presented symptoms on birth, 47.2% of whom were diagnosed during the neonatal period; in 88.9% of cases the barium enema was conclusive; 69% had short segment HD; 16.3% Down's Syndrome; 15.2% other congenital anomalies; 40% were screened for RET mutations associated with multiple endocrine neoplasias (MEN2A), although none were detected; 63.6% had staged pull-through surgery on the colon or ileum; 12.72% primary transanal endorectal pull-through surgery; the main complications arising from surgery were sepsis, enterocolitis and obstruction of the intestines; abnormal bowel movements were detected years after the surgery; the mortality rate was 9.25%, the causes of death being post-operal enterocolitis and sepsis. CONCLUSION: although patients presented symptoms on birth, most were diagnosed at a later stage. Enterocolitis was the main cause of death. Abnormal bowel movements frequently occurred, requiring prolonged follow-up. Although rare, the association with MEN2A needs to be investigated owing to the highly aggressive nature of the disease. The clinical and genetic heterogeneity of HD necessitates the involvement of a multidisciplinary team

A Muon Collider Facility for Physics Discovery

International audienceMuon colliders provide a unique route to deliver high energy collisions that enable discovery searches and precision measurements to extend our understanding of the fundamental laws of physics. The muon collider design aims to deliver physics reach at the highest energies with costs, power consumption and on a time scale that may prove favorable relative to other proposed facilities. In this context, a new international collaboration has formed to further extend the design concepts and performance studies of such a machine. This effort is focused on delivering the elements of a $\sim$10 TeV center of mass (CM) energy design to explore the physics energy frontier. The path to such a machine may pass through lower energy options. Currently a 3 TeV CM stage is considered. Other energy stages could also be explored, e.g. an s-channel Higgs Factory operating at 125 GeV CM. We describe the status of the R&D and design effort towards such a machine and lay out a plan to bring these concepts to maturity as a tool for the high energy physics community

A Muon Collider Facility for Physics Discovery

Muon colliders provide a unique route to deliver high energy collisions that enable discovery searches and precision measurements to extend our understanding of the fundamental laws of physics. The muon collider design aims to deliver physics reach at the highest energies with costs, power consumption and on a time scale that may prove favorable relative to other proposed facilities. In this context, a new international collaboration has formed to further extend the design concepts and performance studies of such a machine. This effort is focused on delivering the elements of a $\sim$10 TeV center of mass (CM) energy design to explore the physics energy frontier. The path to such a machine may pass through lower energy options. Currently a 3 TeV CM stage is considered. Other energy stages could also be explored, e.g. an s-channel Higgs Factory operating at 125 GeV CM. We describe the status of the R&D and design effort towards such a machine and lay out a plan to bring these concepts to maturity as a tool for the high energy physics community

A Muon Collider Facility for Physics Discovery

Muon colliders provide a unique route to deliver high energy collisions that enable discovery searches and precision measurements to extend our understanding of the fundamental laws of physics. The muon collider design aims to deliver physics reach at the highest energies with costs, power consumption and on a time scale that may prove favorable relative to other proposed facilities. In this context, a new international collaboration has formed to further extend the design concepts and performance studies of such a machine. This effort is focused on delivering the elements of a $\sim$10 TeV center of mass (CM) energy design to explore the physics energy frontier. The path to such a machine may pass through lower energy options. Currently a 3 TeV CM stage is considered. Other energy stages could also be explored, e.g. an s-channel Higgs Factory operating at 125 GeV CM. We describe the status of the R&D and design effort towards such a machine and lay out a plan to bring these concepts to maturity as a tool for the high energy physics community

Muon Collider Forum Report

A multi-TeV muon collider offers a spectacular opportunity in the direct exploration of the energy frontier. Offering a combination of unprecedented energy collisions in a comparatively clean leptonic environment, a high energy muon collider has the unique potential to provide both precision measurements and the highest energy reach in one machine that cannot be paralleled by any currently available technology. The topic generated a lot of excitement in Snowmass meetings and continues to attract a large number of supporters, including many from the early career community. In light of this very strong interest within the US particle physics community, Snowmass Energy, Theory and Accelerator Frontiers created a cross-frontier Muon Collider Forum in November of 2020. The Forum has been meeting on a monthly basis and organized several topical workshops dedicated to physics, accelerator technology, and detector R&D. Findings of the Forum are summarized in this report