Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n\uc2 =\uc2 36) and robotic (n\uc2 =\uc2 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center\ue2\u80\u99s protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2\uc2 \uc2\ub1\uc2 71.9\uc2 cc for the laparoscopic and 47.2\uc2 \uc2\ub1\uc2 32.3\uc2 cc for the robotic, respectively (p\uc2 =\uc2 0.004). Mean days of hospitalization were 5.9\uc2 \uc2\ub1\uc2 2.4 for the laparoscopic group and 7.6\uc2 \uc2\ub1\uc2 3.4 for the robotic group (p\uc2 =\uc2 0.006). No differences were found in terms of operative time and post-operative complications. After a median follow-up of 27\uc2 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p\uc2 =\uc2 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence

Cyclic Vomiting Syndrome in Children

Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CV

Inter-society consensus for the use of inhaled corticosteroids in infants, children and adolescents with airway diseases

Background: In 2019, a multidisciplinary panel of experts from eight Italian scientific paediatric societies developed a consensus document for the use of inhaled corticosteroids in the management and prevention of the most common paediatric airways disorders. The aim is to provide healthcare providers with a multidisciplinary document including indications useful in the clinical practice. The consensus document was intended to be addressed to paediatricians who work in the Paediatric Divisions, the Primary Care Services and the Emergency Departments, as well as to Residents or PhD students, paediatric nurses and specialists or consultants in paediatric pulmonology, allergy, infectious diseases, and ear, nose, and throat medicine. Methods: Clinical questions identifying Population, Intervention(s), Comparison and Outcome(s) were addressed by methodologists and a general agreement on the topics and the strength of the recommendations (according to the GRADE system) was obtained following the Delphi method. The literature selection included secondary sources such as evidence-based guidelines and systematic reviews and was integrated with primary studies subsequently published. Results: The expert panel provided a number of recommendations on the use of inhaled corticosteroids in preschool wheezing, bronchial asthma, allergic and non-allergic rhinitis, acute and chronic rhinosinusitis, adenoid hypertrophy, laryngitis and laryngospasm. Conclusions: We provided a multidisciplinary update on the current recommendations for the management and prevention of the most common paediatric airways disorders requiring inhaled corticosteroids, in order to share useful indications, identify gaps in knowledge and drive future research

Patterns in ash-covered melting snow

The formation of regular patterns in snow covered by a layer of dark material is investigated as an instability phenomenon. A detailed analysis of the energy balance of the system highlights the prevalent role of solar radiation in such phenomena, and puts the base for further investigations

Stability of the Plane Bingham–Poiseuille Flow in an Inclined Channel

We study the stability of laminar Bingham–Poiseuille flows in a sheet of fluid (open channel) down an incline with constant slope angle β∈(0,π/2). This problem has geophysical applications to the evolution of landslides. In this article, we apply to this problem recent results of Falsaperla et al. for laminar Couette and Poiseuille flows of Newtonian fluids in inclined channels. The stability of the basic motion of the generalised Navier–Stokes system for a Bingham fluid in a horizontal channel against linear perturbations has been studied. In this article, we study the flows of a Bingham fluid when the channel is oblique and we prove a stabilizing effect of the Bingham parameter B. We also study the stability of the linear system with an energy method (Lyapunov functions) and prove that the streamwise perturbations are always stable, while the spanwise perturbations are energy-stable if the Reynolds number Re is less than the critical Reynolds number Rc obtained solving a generalised Orr equation of a maximum variational problem

Marginal regions for the solute Be\u301nard problem with many types of boundary conditions

A large number of variants of the Be\u301nard problem (with a solute, rotating, subject to mag- netic field, etc.) have been extensively studied. Despite this, new interesting results can be obtained imposing very general yet physically relevant boundary conditions. In this frame- work, we develop a technique to analytically compute the marginal region in parameter space. We investigate the thermal stability of a fluid layer salted from below, subject to finite slip on velocity and Robin conditions on temperature and solute concentration. We write analytical conditions for the onset of stationary convection, obtain simplified formulas for particularly symmetric cases, and draw the associated (convective) marginal regions in some significant cases. Moreover, we describe the analytical conditions for the onset of overstability, and use such equations to numerically draw the associated (overstable) marginal region. We finally perform an asymptotic analysis for small wave numbers

Some results in the nonlinear stability for rotating Bénard problem with rigid boundary condition

The scope of this article is to expose the stabilizing properties of rotation and solute gradient for the Bénard problem with (at least one-sided) rigid boundary conditions. We perform a linear investigation of the critical threshold for the rotating Bénard problem with a binary fluid, and we also make an investigation with a Lyapunov function for the particular problem of a rotating single fluid. In all the these cases an increase of the Taylor number has stabilizing effects

Does Symmetry of the Operator of a Dynamical System Help Stability?

In this article, we address the question of relating the stability properties of an operator with the stability properties of its associate symmetric operator. The linear-algebra results of Bendixson and Hirsch indicate that the symmetric part of a matrix is always less stable than the matrix itself. We show that in a variety of cases, including infinite dimen- sional cases associated to systems of PDEs, the same result is valid. We also discuss the applicability to non-autonomous systems, and we show that, in general, this result is not valid. We also review some of the literature that in these years has appeared on the subject

Laminar hydromagnetic flows in an inclined heated layer

In this paper we investigate, analytically, stationary laminar flow solutions of an inclined layer filled with a hydromagnetic fluid heated from below and subject to the gravity field. In particular we describe in a systematic way the many basic solutions associated to the system. This extensive work is the basis to linear instability and nonlinear stability analysis of such motions