Sodium fraction excretion rate in nocturnal enuresis correlates with nocturnal polyuria and osmolality

Abstract: Purpose: We verify the sodium fraction excretion rate (FE Na) and potassium fraction excretion WE K) rates in monosymptomatic nocturnal enuresis. We also correlate FE Na and FE K to urinary osmolality, nocturnal polyuria and vasopressin in the same population. Materials and Methods: A total of 438 children 6 to 15 years old (mean age 9.7) presenting with monosymptomatic nocturnal enuresis were recruited from different centers. Inclusion criteria were 3 or greater wet nights a week, no daytime incontinence and no treatment in the previous 2 months. Exclusion criteria were cardiopathy, endocrinopathy, psychiatric problems and urinary tract abnormalities. Micturition chart, diurnal (8 am to 8 pm) and nocturnal (8 pm to 8 am) urine collection, including separate diuresis volumes, (Na, K and Ca) electrolytes and osmolality were evaluated, as well as serum electrolytes, creatinine and nocturnal (4 am) vasopressin. Diurnal and nocturnal FE K and FE Na were calculated. ANOVA test, chi-square test, Student's t test and Pearson correlation test were used for statistical analysis. Results: Nocturnal polyuria (diurnal to nocturnal diuresis ratio less than 1) was found in 273 children (62.3%, group I and nocturnal urine volumes were normal in 165 with enuresis (37.7%, group 2). Nocturnal FE Na was abnormal in 179 children (40.8%), including 118 in group 1 (43.2%) and 61 in group 2 (36.9%) (chi-square not significant). FE Na was also increased in nocturnal versus daytime diuresis (Student's t test p < 0.001). In group 1 nocturnal FE Na correlated with nocturnal diuresis (Pearson correlation p = 0.003, r = +0.175), while daytime FE Na and nocturnal FE Na correlated with diurnal diuresis (Pearson correlation p = 0.001, r = +0.225 and Pearson correlation p = 0.001, r = +0.209, respectively). In group 2 nocturnal FE Na did not correlate with diuresis (Pearson correlation p = 0.103, r = +0.128) but correlated with vasopressin values (Pearson correlation p = 0.042, r = -0.205). Urine osmolality was reduced in 140 children (31.9%) and correlated with nocturnal diuresis (Pearson correlation p = 0.003, r = -0.321). Vasopressin was decreased in 332 children (75.8%, 62.6% in group 1 and 13.2% in group 2). No significant difference was found between sexes and age of enuretic subgroups. Conclusions: Nocturnal FE Na correlates with nocturnal diuresis, whereas daytime FE Na does not. FE K in daytime and nighttime diuresis does not statistically differ in nocturnal polyuric and nonpolyuric enuretic groups. Osmolality correlates with nocturnal diuresis, and vasopressin at 4 am was lower in the nocturnal polyuric group. The hypothesis of a subset of enuretic patients presenting with nocturnal polyuria associated with high nocturnal natriuria and low vasopressin values has been confirmed

Antibiotic susceptibility of isolates of Bacillus anthracis, a bacterial pathogen with the potential to be used in biowarfare

Bacillus anthracis is a bacterial species that could be used in a bioterrorist attack. We tested a collection of isolates with a range of relevant antimicrobial compounds. All isolates tested were susceptible to ciprofloxacin and doxycycline. Penicillin and amoxicillin, with or without clavulanate, showed in vitro activity against all B. anthracis isolates. Ceftriaxone demonstrated lower-level in vitro activity compared to penicillin-related compounds against B. anthracis. In vitro data from this study are in keeping with available guidelines

Laparoscopic vs. open mesorectal excision for rectal cancer: Are these approaches still comparable? A systematic review and metaanalysis

Background To analyze pathologic and perioperative outcomes of laparoscopic vs. open resections for rectal cancer performed over the last 10 years. Methods A systematic literature search of the following databases was conducted: Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), EMBASE, and Scopus. Only articles published in English from January 1, 2008 to December 31, 2018 (i.e. the last 10 years), which met inclusion criteria were considered. The review only included articles which compared Laparoscopic rectal resection (LRR) and Open Rectal Resection (ORR) for rectal cancer and reported at least one of the outcomes of interest. The analyses followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement checklist. Only prospective randomized studies were considered. The body of evidence emerging from this study was evaluated using the Grading of Recommendations Assessment Development and Evaluation (GRADE) system. Outcome measures (mean and median values, standard deviations, and interquartile ranges) were extracted for each surgical treatment. Pooled estimates of the mean differences were calculated using random effects models to consider potential inter-study heterogeneity and to adopt a more conservative approach. The pooled effect was considered significant if p &lt;0.05. Results Five clinical trials were found eligible for the analyses. A positive involvement of CRM was found in 49 LRRs (8.5%) out of 574 patients and in 30 ORRs out of 557 patients (5.4%) RR was 1.55 (95% CI, 0.99–2.41; p = 0.05) with no heterogeneity (I2 = 0%). Incorrect mesorectal excision was observed in 56 out of 507 (11%) patients who underwent LRR and in 41 (8.4%) out of 484 patients who underwent ORR; RR was 1.30 (95% CI, 0.89–1.91; p = 0.18) with no heterogeneity (I2 = 0%). Regarding other pathologic outcomes, no significant difference between LRR and ORR was observed in the number of lymph nodes harvested or concerning the distance to the distal margin. As expected, a significant difference was found in the operating time for ORR with a mean difference of 41.99 (95% CI, 24.18, 59.81; p &lt;0.00001; heterogeneity: I2 = 25%). However, no difference was found for blood loss. Additionally, no significant differences were found in postoperative outcomes such as postoperative hospital stay and postoperative complications. The overall quality of the evidence was rated as high. Conclusion Despite the spread of laparoscopy with dedicated surgeons and the development of even more precise surgical tools and technologies, the pathological results of laparoscopic surgery are still comparable to those of open ones. Additionally, concerning the pathological data (and particularly CRM), open surgery guarantees better results as compared to laparoscopic surgery. These results must be a starting point for future evaluations which consider the association between ‘‘successful resection” and long-term oncologic outcomes. The introduction of other minimally invasive techniques for rectal cancer surgery, such as robotic resection or transanal TME (taTME), has revealed new scenarios and made open and even laparoscopic surgery obsolete

Systematic review of irreversible electroporation role in management of locally advanced pancreatic cancer

Background: Ablative techniques provide in patients with locally advanced pancreatic cancer (LAPC) symptomatic relief, survival benefit and potential downsizing. Irreversible Electroporation (IRE) represents potentially an ideal solution as no thermal tissue damage occurs. The purpose of this review is to present an overview on safety, feasibility, oncological results, survival and quality of life improvement obtained by IRE. Methods: A systematic search was performed in PubMed, regarding the use of IRE on PC in humans for studies published in English up to March 2019. Results: 15 original studies embodying 691 patients with unresectable LAPC who underwent IRE were included. As emerged, IRE works better on tumour sizes between 3–4 cm. Oncological results are promising: median OS from diagnosis or treatment up to 27 months. Two groups investigated borderline resectable tumours treated with IRE before resection with margin attenuation, whereas IRE has proved to be effective in pain control. Conclusions: Electroporation is bringing new hopes in LAPC management. The first aim of IRE is to offer a palliative treatment. Further efforts are needed for patient selection, as well as the use of IRE for ‘margin accentuation’ during surgical resection. Even if promising, IRE needs to be validated in large, randomized, prospective series

Compton Thick AGN in the XMM-COSMOS survey

Heavily obscured, Compton Thick (CT, NH>10^24 cm^-2) AGN may represent an important phase in AGN/galaxy co-evolution and are expected to provide a significant contribution to the cosmic X-ray background (CXB). Through direct X-ray spectra analysis, we selected 39 heavily obscured AGN (NH>3x10^23 cm^-2) in the 2 deg^2 XMM-COSMOS survey. After selecting CT AGN based on the fit of a simple absorbed two power law model to the XMM data, the presence of CT AGN was confirmed in 80% of the sources using deeper Chandra data and more complex models. The final sample of CT AGN comprises 10 sources spanning a large range of redshift and luminosity. We collected the multi-wavelength information available for all these sources, in order to study the distribution of SMBH and host properties, such as BH mass (M_BH), Eddington ratio (\lambda_Edd), stellar mass (M*), specific star formation rate (sSFR) in comparison with a sample of unobscured AGN. We find that highly obscured sources tend to have significantly smaller M_BH and higher \lambda_edd with respect to unobscured ones, while a weaker evolution in M* is observed. The sSFR of highly obscured sources is consistent with the one observed in the main sequence of star forming galaxies, at all redshift. We also present optical spectra, spectral energy distribution (SED) and morphology for the sample of 10 CT AGN: all the available optical spectra are dominated by the stellar component of the host galaxy, and a highly obscured torus component is needed in the SED of the CT sources. Exploiting the high resolution Hubble-ACS images available, we conclude that these highly obscured sources have a significantly larger merger fraction with respect to other X-ray selected samples of AGN. Finally we discuss implications in the context of AGN/galaxy co-evolutionary models, and compare our results with the predictions of CXB synthesis models.Comment: Revised version after referee comments. Accepted for publication in Astronomy & Astrophysics on 25 November 2014. 23 pages, 2 tables, 16 figure

The evolving AGN duty cycle in galaxies since z ∼ 3 as encoded in the X-ray luminosity function

We present a new modeling of the X-ray luminosity function (XLF) of active galactic nuclei (AGNs) out to z ~ 3, dissecting the contributions of main-sequence (MS) and starburst (SB) galaxies. For each galaxy population, we convolved the observed galaxy stellar mass (M sstarf) function with a grid of M sstarf-independent Eddington ratio (λ EDD) distributions, normalized via empirical black hole accretion rate (BHAR) to star formation rate (SFR) relations. Our simple approach yields an excellent agreement with the observed XLF since z ~ 3. We find that the redshift evolution of the observed XLF can only be reproduced through an intrinsic flattening of the λ EDD distribution and with a positive shift of the break λ*, consistent with an antihierarchical behavior. The AGN accretion history is predominantly made by massive (1010 44.36 + 1.28 × (1 + z). We infer that the probability of finding highly accreting (λ EDD > 10%) AGNs significantly increases with redshift, from 0.4% (3.0%) at z = 0.5%–6.5% (15.3%) at z = 3 for MS (SB) galaxies, implying a longer AGN duty cycle in the early universe. Our results strongly favor a M sstarf-dependent ratio between BHAR and SFR, as BHAR/SFR ∝ ${M}_{\star }^{0.73[+0.22,-0.29]}$, supporting a nonlinear BH buildup relative to the host. Finally, this framework opens potential questions on super-Eddington BH accretion and different λ EDD prescriptions for understanding the cosmic BH mass assembly

Evidence for Cold-stream to Hot-accretion Transition as Traced by Ly alpha Emission from Groups and Clusters at 2 < z < 3.3

We present Keck Cosmic Web Imager observations of giant Ly alpha halos surrounding nine galaxy groups and clusters at 2 < z < 3.3, including five new detections and one upper limit. We find observational evidence for the cold-stream to hot-accretion transition predicted by theory by measuring a decrease in the ratio between the spatially extended Ly alpha luminosity and the expected baryonic accretion rate (BAR), with increasing elongation above the transition mass (M-stream). This implies a modulation of the share of BAR that remains cold, diminishing quasi-linearly (logarithmic slope of 0.97 +/- 0.19, 5 sigma significance) with the halo to M-stream mass ratio. The integrated star formation rates (SFRs) and active galactic nucleus (AGN) bolometric luminosities display a potentially consistent decrease, albeit significant only at 2.6 sigma and 1.3 sigma, respectively. The higher scatter in these tracers suggests the Ly alpha emission might be mostly a direct product of cold accretion in these structures rather than indirect, mediated by outflows and photoionization from SFR and AGNs; this is also supported by energetics considerations. Below M-stream (cold-stream regime), we measure L (Ly alpha) /BAR = 10(40.51 +/- 0.16) erg s(-1) M-circle dot(-1) yr, consistent with predictions, and SFR/BAR = 10(-0.54 +/- 0.23): on average, 30(-10)(+20) M-stream (hot-accretion regime), L-Ly alpha is set by M-stream (within 0.2 dex scatter in our sample), independent of the halo mass but rising 10-fold from z = 2 to 3.Peer reviewe

Multimodal Brain Changes in First-Episode Mania: A Voxel-Based Morphometry, Functional Magnetic Resonance Imaging, and Connectivity Study

Background: Brain structural and functional changes in bipolar disorder (BD) are well-established findings, but it is uncertain whether these changes are already present in first episode mania (FEM). Methods: We compared 31 FEM subjects, with 31 healthy individuals matched for age, sex, and premorbid IQ. Whole-brain voxel-wise morphometry, functional magnetic resonance imaging during the n-back task, and a functional connectivity analysis were performed. Results: There were no volumetric differences between the 2 groups. During the 2-back task, FEM patients did not perform differently from controls and activated similar regions, but they showed less deactivation in the ventromedial prefrontal cortex (vmPFC), the anterior hub of the default mode network (DMN). They showed preserved functional connectivity between the vmPFC and other regions of the DMN, but increased connectivity with the superior frontal gyrus. Conclusions: The absence of volumetric changes in FEM patients suggests that these changes could be related to progression of the illness. On the other hand, the failure of deactivation of the anterior hub of the DMN is present from the onset of the illness and may represent a core pathophysiological feature of BD