Non-Reversed Appendicostomy for Antegrade Continence Enema in the Treatment of Encopresis

Background/Purpose: Constipation in children is considered when stool frequency is less than three times per week. Encopresis represents 80-90% of children with fecal incontinence. Operative strategy for management of encopresis ranges from resectional surgery to myotomy. The objective of the study was to evaluate the efficacy of non-reversed appendicostomy without antireflux mechanism for management of encopresis in children. Materials & Methods: The study included 35 patients with severe idiopathic constipation and encopresis with failure of conservative measures. They were subjected to non-reversed appendicostomy without anti-reflux procedures. Results: The incidence of complications was 22.8% and included stomal leak, stricture, retraction and granulation tissue formation. False passage during dilatation occurred in one case. Antegrade continence enema effectively controlled constipation and encopresis. Conclusion: Non-reversed appendicostomy without antireflux mechanism is safe and rapid with minimal incidence of leakage. Constipation and encopresis was effectively controlled with this simple procedure.Index Word: Constipation, encopresis, antegrade continence enema

Modified Koyanagi Technique in Management of Proximal Hypospadias

Background/Purpose: One stage urethroplasty with parameatal foreskin flap (OUPF) applicable to all types of hypospadias was first described by Tomohiko Koyanagi, however high complication rates were reported.The aim of this study is to analyze the results of a modification of the Koyanagi technique as a one-stage repair of proximal hypospadias. Patients and Methods: During the period of from March 2008 to March 2009, 30 patients underwent treatment of proximal hypospadias using the modified Koyanagi technique. Patient age at the time of surgery ranged from 6 to 24 months. In all cases, the urethral opening was at or just proximal to the penoscrotal junction. Follow up ranged from 3 months to 1 year. Results: Primary success occurred in 27 cases (90%) with accepted cosmetic appearance. Complications occurred in 3 cases (10%). Urethrocutaneous fistula occurred in 2 cases (6.7%). Meatal recession occurred in 1 case (3.3%). There was no incidence of meatal stenosis, urethral stricture, residual chordee or complete flap necrosis. Conclusion: The modified technique permits one-stage repair of proximal hypospadias with low complication rates. Keywords: Hypospadias, Koyanagi, One stage urethroplasty

Near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (nesidioblastosis): Mansoura experience

Background/purpose Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is the most common cause of persistent hypoglycemia in infancy with consequences such as seizures and brain damage. Treatment that prevents the occurrence of these sequele is essential. When medical therapy fails or complications are anticipated, early pancreatectomy is recommended to maintain euglycemia. The aim of this study was short-term evaluation of near-total pancreatectomy for PHHI after failure of medical treatment in patients in Mansoura, Egypt.Patients and methods During May 2002 to May 2010, 33 patients suffering from persistent hyperinsulinemic hypoglycemia were admitted to Mansoura university child hospital. Twenty patients responded to medical treatment and 13 patients (eight girls and five boys) were treated by near-total (90–95%) pancreatectomy after failure of medical treatment. Their ages at the time of surgery ranged from 20 days to 27 months. Only patients who were surgically managed were included in this study. All of them suffered from symptoms of PHHI: thermoregulatory problems in five cases, tremors in five cases, seizures in three, irritability in five, respiratory distress in eight, apnea in four, hypotonia in four, lethargy in five, and feeding difficulty in four cases. All cases were diagnosed following strict criteria that included bouts of hypoglycemia without acidosis coinciding with increased insulin level. Follow-up ranged from 3 months to 8 years.Results Primary success occurred in two cases (15%); four more cases (31%) developed temporary diabetes mellitus, and one case (8%) had a temporary pancreatic fistula. Eventually, total cure occurred in seven cases (54%); six cases (46%) developed a variety of complications; and persistent hypoglycemia was seen in two. Persistent diabetes mellitus was observed in three patients, developmental delay in one, and persistent neurological deficit in two patients; there was one case of mortality.Conclusion Near-total (90–95%) pancreatectomy is a suitable procedure for treatment of nesidioblastosis not responding to medical treatment and should be performed as early as possible. Keywords: Mansoura, near-total pancreatectomy, persistent hyperinsulinemic hypoglycemi

Comparison of Best Management Practice Adoption Between Virginia\u27s Chesapeake Bay Basin and Southern Rivers Watersheds

Producers in two regions of Virginia (Chesapeake Bay basin and Southern Rivers region) were surveyed to compare farming practices and agricultural best management practice (BMP) adoption. Objectives were to assess farming operations and determine the extent of cost-share and non-cost-share BMP implementation and gain insight into the impact of selected socioeconomic factors on the BMP adoption. Although farming characteristics and producer attitudes toward pollution and water quality were similar, BMP implementation differed between the two regions. Differences in BMP implementation may be due to a more focused, longer-term NPS pollution control educational effort in the Bay basin

How to Authenticate a Device? Formal Authentication Models for M2M Communications Defending against Ghost Compromising Attack

In Machine-to-Machine (M2M) communications, authentication of a device is of upmost importance for applications of Internet of Things. As traditional authentication schemes always assume the presence of a person, most authentication technologies cannot be applied in machine-centric M2M context. In this paper, we make the first attempt to formally model the authentication in M2M. We first model four attacking adversaries that can formulate all possible attacks in M2M, which are channel eavesdropping attack, credential compromise attack, function compromise attack, and ghost compromise attack. Next, we propose four models to tackle those corresponding adversaries, namely, credential-based model, machine-metrics-based model, reference-based model, and witness-based model. We also illustrate several concrete attacking methods and authentication approaches. We proof the authentication security for all proposed models and compare them for clarity. Our models present soundness and completeness in terms of authentication security, which can guide the design and analysis of concrete authentication protocols. Particularly, we construct a uniform authentication framework for M2M context and point out all possible authentication mechanisms in M2M

Prior exposure to an attenuated Listeria vaccine does not reduce immunogenicity: pre-clinical assessment of the efficacy of a Listeria vaccine in the induction of immune responses against HIV

Abstract Background We have evaluated an attenuated Listeria monocytogenes (Lm) candidate vaccine vector in nonhuman primates using a delivery regimen relying solely on oral vaccination. We sought to determine the impact of prior Lm vector exposure on the development of new immune responses against HIV antigens. Findings Two groups of rhesus macaques one Lm naive, the other having documented prior Lm vector exposures, were evaluated in response to oral inoculations of the same vector expressing recombinant HIV-1 Gag protein. The efficacy of the Lm vector was determined by ELISA to assess the generation of anti-Listerial antibodies; cellular responses were measured by HIV-Gag specific ELISpot assay. Our results show that prior Lm exposures did not diminish the generation of de novo cellular responses against HIV, as compared to Listeria-naïve monkeys. Moreover, empty vector exposures did not elicit potent antibody responses, consistent with the intracellular nature of Lm. Conclusions The present study demonstrates in a pre-clinical vaccine model, that prior oral immunization with an empty Lm vector does not diminish immunogenicity to Lm-expressed HIV genes. This work underscores the need for the continued development of attenuated Lm as an orally deliverable vaccine

Deuteron-Proton Elastic Scattering at Intermediate Energies

The deuteron-proton elastic scattering has been studied in the multiple scattering expansion formalism. The essential attention has been given to such relativistic problem as a deuteron wave function in a moving frame and transformation of spin states due to Wigner rotation. Parameterization of the nucleon-nucleon $t$-matrix has been used to take the off-energy shell effects into account. The vector, $A_y,$ and tensor, $A_{yy}$, analyzing powers of the deuteron have been calculated at two deuteron kinetic energies: 395 MeV and 1200 MeV. The obtained results are compared with the experimental data