Publications by authors named "Mario Lima"

118 Publications

Consequences of COVID-19 Lockdown on Children and Their Pets: Dangerous Increase of Dog Bites among the Paediatric Population.

Children (Basel) 2021 Jul 22;8(8). Epub 2021 Jul 22.

Paediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.

Background: The SARS-CoV-2 pandemic has not only put our national health systems to the test, but it also notably hit the economy, the society and the psychology of the people. Our pets have been subjected to the pandemic related stress too. The aim of the study was to evaluate whether the stress induced on domestic dogs resulted in an increase of dog bites in the paediatric population.

Methods: A retrospective study was conducted on all patients admitted to our paediatric emergency department for dog bite from January 2014 and December 2020. We compared the total mean dog bites of the years 2014-2019 and the mean number per single month with the respective 2020 data. The bites were divided between bites from family dogs and bites from stranger dogs. Continuous data were analysed using single sample test while categorical values with chi-squared test, considering statistically significant a value < 0.05.

Results: From January 2014 to December 2019, we recorded a mean of 41 ± 5.9 dog bites (range: 30-46) of which a mean 13 ± 2.6 (range: 10-17) were due to family dogs (32%) and a mean of 28 ± 2.4 (range: 25-31) were due to stranger dogs (68%); the male-to-female ratio was 3:2 and 43% of the injuries concerned the head and face, 26% the lower limbs, 25% the upper limbs, 3% the genitalia and 3% the torso. From January 2020 to December 2020, 30 children were admitted for dog bites: 22 were from family dogs (73%) and 8 from stranger dogs (27%); the male-to-female ratio was 14:11 and 72% of the injuries concerned the head and face, 16% the upper limbs, 8% the lower limbs and 4% the torso. The 2020 data's higher number of family dog bites compared with the mean of those in the 2014-2019 period was statistically significant ( < 0.01) such as the 2020 data's lower number of stranger dog bites when compared with the mean number of stranger dog bites in the 2014-2019 period ( < 0.01). Between 2014 and 2019, a mean of 9 ± 2 (range: 6-12) of the wounds needed to be sutured (22%), while 32 ± 3 (range: 28-35) wounds were discharged after application of Steri Strips (78%). On the other hand, in 2020, 21 wounds needed to be sutured (70%), and 9 received just Steri Strips application (41%). The frequency distribution of the treatments required (stitches vs. Steri Strips) between the 2014 to 2019 period and the 2020 period was statistically significant ( < 0.0001).

Conclusions: The number of family dog bites in children increased in 2020, especially during the lockdown period. Paediatricians should pay a lot of attention now more than ever to educate parents on the importance of always supervising children who are playing with dogs.
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http://dx.doi.org/10.3390/children8080620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8392619PMC
July 2021

ArtiSential Articulated Wrist-Like Instruments and Their First Application in Pediatric Minimally Invasive Surgery: Case Reports and Literature Review of the Most Commonly Available Robot-Inspired Devices.

Children (Basel) 2021 Jul 17;8(7). Epub 2021 Jul 17.

Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.

Background: Robotic surgery is currently a reality in surgical practice, and many endeavors have been made to extend its application also in pediatric surgery. In the absence of easy access to a robotic surgical system, new devices have been developed to offer a valid alternative such as wristed instruments. These differ from conventional laparoscopic instruments owing to a wrist-like mechanism at the tip, which faithfully reproduces the movements of the surgeon's hands, regaining more movement's degrees; Methods: We present two case reports in which the patients were subjected to minimally invasive procedures with aid of wristed instruments, followed by a review of the literature regarding the devices commonly marketed; Results: Articulated or wristed instruments render the same features seen in robotic surgery, such as major dexterity in smaller spaces, restitution of more natural movements and the ability to get over obstacles in a direct visual line. Our center recently equipped with ArtiSential articulated instruments and so far, they have proven to be of great value; Conclusions: wristed instruments could represent a standpoint for surgeons wanting to benefit from the advantages of robotic surgery with a cost-sensitive perspective.
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http://dx.doi.org/10.3390/children8070603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8306555PMC
July 2021

Surgical Practice in Girls with Congenital Adrenal Hyperplasia: An International Registry Study.

Sex Dev 2021 Jul 21;15(4):229-235. Epub 2021 Jul 21.

Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom.

In this article international trends in surgical practice in girls with congenital adrenal hyperplasia (CAH) are evaluated. All cases that had been classified in the I-CAH/I-DSD registry as 46,XX CAH and who were born prior to 2017 were identified. Centers were approached to obtain information on surgical decision making. Of the 330 included participants, 208 (63.0%) presented within the first month of life, and 326 (98.8%) cases were assigned female. Genital surgery had been performed in 250 (75.8%). A total of 64.3, 89.2, and 96.8% of cases residing in Europe, South America and Asia, respectively, had at least one surgery. In a logistic regression model for the probability of surgery before the second birthday (early surgery) over time an increase of probability for early vaginal surgery could be identified, but not for clitoral surgery or both surgeries combined. Genitoplasty in girls with CAH remains controversial. This large international study provides a snapshot of current practice and reveals geographical and temporal differences. Fewer surgeries were reported for Europe, and there seems to be a significant trend towards aiming for vaginal surgery within the first 2 years of life.
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http://dx.doi.org/10.1159/000517055DOI Listing
July 2021

Is It Better to Operate Congenital Lung Malformations when Patients are Still Asymptomatic?

J Indian Assoc Pediatr Surg 2021 May-Jun;26(3):170-176. Epub 2021 May 17.

Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, Italy.

Context: Congenital lung malformation (CLM) is a rare developmental anomaly of the lower respiratory tract. The purposes are to define if the presence of respiratory symptoms, in CLM may affect surgical outcomes and to define optimal timing for surgery in asymptomatic patients.

Settings And Design: Retrospective review of patients with CLM from 2004 to 2018. Asymptomatic and symptomatic patients were compared. Moreover, asymptomatic patients were stratified according to age at surgery (< or >6 months).

Subjects And Methods: Demographic data, prenatal diagnosis, symptoms, CLM's characteristics, operative and postoperative data were collected. Patients were divided into two groups based on the presence or none of respiratory symptoms.

Statistical Analysis: Data were compared using the Fisher's exact test for qualitative values and Mann-Whitney test for quantitative values < 0.05 was statistically significant.

Results: One hundred and eighty-six patients were treated. Asymptomatic were 137 (74%), while symptomatic were 49 (26%). The most common presenting symptoms were respiratory distress ( = 30, 61%) followed by pneumonia ( = 18, 38%). Prenatal diagnosis of CLM was performed in 98% of asymptomatic patients compared to 30% of symptomatic ( = 0.001). Surgical excision was performed in all cases, and in 50% by thoracoscopy, without difference between the two groups. In 97% of all cases, a lung sparing surgery was performed without difference between the groups. Symptoms are significantly associated with older age, location in the upper lobe, and lobar emphysema. Length of stay in intensive care, postoperative complications, and reintervention rate were higher in the symptomatic group. Eighty-one asymptomatic patients underwent surgery <6 months of life; they had a lower rate of surgical complications (2%) compared with those >6 months (7%).

Conclusions: The present study describes a comprehensive picture of CLM. In addition, we emphasize the role of early postnatal management and thoracoscopic surgery, also before 6 months of life, to prevent the onset of symptoms that are associated with worse outcomes.
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http://dx.doi.org/10.4103/jiaps.JIAPS_70_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286031PMC
May 2021

Laparoscopic versus open orchiopexy for palpable undescended testes: Systematic review and meta-analysis.

J Pediatr Surg 2021 Jul 6. Epub 2021 Jul 6.

Department of Pediatric Surgery, Aghia Sophia Children's Hospital, Athens, Greece.

Background/purpose: Laparoscopic orchiopexy (LO) was recently described as superior to open orchiopexy (OO) for palpable undescended testes (UDT). We aimed to investigate the outcomes of LO of palpable UDT in relation to high retroperitoneal dissection, Prentiss maneuver and intrascrotal testis fixation; also, to identify evidence for the safety, efficacy and cost of LO compared with OO in palpable UDT.

Methods: Systematic search was performed for all studies on LO for palpable UDT, and for all comparative studies between LO and OO in palpable UDT. Fisher's test was used to assess associations between success/complications rates and different LO approaches and meta-analysis to compare LO and OO.

Results: In LO, success rates were not affected by regular high dissection (p = 1.0), Prentiss maneuver (p = 1.0) or intrascrotal fixation (p = 1.0); in fact, higher complications rates were noticed with regular high dissection (p = 0.002) and Prentiss maneuver (p = 0.01). Meta-analysis showed no significant differences between LO and OO in success (p = 0.17) and complications (p = 0.14) rates, while LO cost was higher in all comparative studies.

Conclusions: Evidence shows higher benefit-cost ratio for OO and, therefore, the latter should remain the procedure of choice. LO can be alternatively used, as it shows comparable safety/efficacy, but it should not include high dissection, Prentiss maneuver and testis fixation, when unnecessary.

Type Of Study: Systematic review and meta-analysis LEVEL OF EVIDENCE: III.
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http://dx.doi.org/10.1016/j.jpedsurg.2021.07.003DOI Listing
July 2021

The influence of photobiomodulation on the temperature of the brachial biceps during muscle fatigue protocol.

Lasers Med Sci 2021 Oct 13;36(8):1741-1749. Epub 2021 Jul 13.

Institute of Research and Development, Universidade do Vale do Paraíba (Univap), Av. Shishima Hifumi, 2911 - Urbanova, São José dos Campos, São Paulo, 12244-390, Brazil.

Physical activity raises body temperature. However, the literature does not contain studies about whether the employment of hotobiomodulation (PMB) could significantly influence body temperature during a muscle fatigue (MF) protocol. Thus, the aim of this study was to evaluate the effects of PMB on the temperature of the biceps brachii muscle during the performance of a muscle fatigue protocol. The study consisted of 14 volunteers who were divided into two groups (placebo group and laser group) and all individuals rotated into all groups (crossover study). To induce muscle fatigue, three maximum voluntary isometric contractions (MVIC) were performed for 50 s with a 50-s interval. During the MVIC, the muscle strength was assessed using surface electromyography and infrared temperature at 0, 5, 10, and 15 min after the tests. The laser group presented a less accentuated decrease in muscle strength, evidencing a lower rate of muscle fatigue (p > 0.05) in relation to the other groups. In the temperature analysis, the control group exhibited the highest average temperature, with a significant difference only for the placebo. The results indicate that the control displayed the greatest physical degeneration and the PMB group had a positive effect on MF attenuation and body thermoregulation.
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http://dx.doi.org/10.1007/s10103-021-03360-8DOI Listing
October 2021

Early vagus nerve stimulator implantation as a main predictor of positive outcome in pediatric patients with epileptic encephalopathy.

Epileptic Disord 2021 Aug;23(4):563-571

Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, Nicklaus Children's Hospital, Miami, Florida, USA, Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA.

We describe a multicenter experience with VNS implantation in pediatric patients with epileptic encephalopathy. Our goal was to assess VNS efficacy and identify potential predictors of favorable outcome. This was a retrospective study. Inclusion criteria were: ≤18 years at the time of VNS implantation and at least one year of follow-up. All patients were non-candidates for excisional procedures. Favorable clinical outcome and effective VNS therapy were defined as seizure reduction >50%. Outcome data were reviewed at one, two, three and five years after VNS implantation. Fisher's exact test, Kaplan-Meier and multiple logistic regression analysis were employed. Twenty-seven patients met inclusion criteria. Responder rate (seizure frequency reduction ≥ 50%) at one-year follow-up was 25.9%, and 15.3% at last follow-up visit. The only variable significantly predicting favorable outcome was time to VNS implantation, with the best outcome achieved when VNS implantation was performed within five years of seizure onset (overall response rate of 83.3% at one year of follow-up and 100% at five years). In total, 63% of patients evidenced improved QOL at last follow-up visit. Only one patient exited the study due to an adverse event at two years from implantation. Early VNS implantation within five years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients with epileptic encephalopathy. Improved QOL and a very low incidence of adverse events were observed.
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http://dx.doi.org/10.1684/epd.2021.1299DOI Listing
August 2021

Training minimally invasive surgery's basic skills: is expensive always better?

Pediatr Surg Int 2021 Sep 10;37(9):1287-1293. Epub 2021 Jun 10.

Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 9, 40138, Bologna, Italy.

Introduction: Not all hospitals have a MIS training facility because often training is not a main corporate objective and could require lots of money. We tried to build a laparoscopic simulator that was effective and that would allow to carry out an adequate laparoscopic training similar to that obtained with the models normally used in MIS training programs. To construct a box trainer that would achieve the equivalent results than those usually used. A validation study was carried out by evaluating the content validity and construct validity of our simulator in addition a comparison study of our homemade trainer vs Karl Storz box trainer was performed.

Material And Methods: The HM laparoscopic trainer was assembled using a wood frame. Two LED lights were positioned on the inside roof of the trainer and a webcam was positioned through a special support as operative optic. The webcam was then connected to a PC and the latter was used as a monitor for the operator. Participants were 20 students and a group of 6 surgeons. Students were prospectively randomized to perform 4 of the 5 tasks of the fundamental laparoscopic surgery (FLS) program on both the HM trainer and the KS trainer (pegboard transfer, pattern cut, placement of ligating loop and intracorporeal knot suture). Simple paired t test was performed to compare times between the trainers. Then students performed two more sets of exercises on the HM. The group of surgeons performed three sets of the same exercises performed by the students on the HM. The time taken by surgeons and students to complete the exercises was compared using t test. At the end, all the participants carried out a questionnaire to evaluate their experience with the HM box trainer. For the questionnaire it was chosen to use a Linkert 1-5 scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree).

Results: HM vs KS BT: Comparing time to complete the 4 tasks performed by students on both the BT, for the first task the p value was 0.30, for the second task 0.48, for the third task 0.80, for the fourth task 0.93, and for the total time 0.86. The comparison between the mean time of the first set of tasks of the participants who started with the HM BT and one of the participants who started on the KS p value was 1 p = 0.09; task 2 p = 0.32; task 3 p = 0.62; task 4 p = 0.32; total time p = 0.81. The comparison between the meantime of the second set of tasks of the participants who switched to the HM BT with the one of those who switched to the KS BT showed a p value of: p = 0.20 tasks 1 p = 0.53 task 2; p = 0.39 task 3; p = 0.30 task 4; p = 0.56 total time. Construct validity: The mean experts and students time of every single task and the total one showed a p value of: p < 0.01 for task 1; p < 0.01 task 2; p < 0.01 task 3; p < 0.01 task 4; p < 0.01 total time. Content validity: Both experts and students indicated the HM BT as a useful training tool and appreciated its easy use. Both groups would use it at home if it were available.

Conclusion: Valid MIS trainer can be easily built at home with few low-cost materials. Our study shows how training programs can be structured even with few resources in a creative and innovative way.
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http://dx.doi.org/10.1007/s00383-021-04937-8DOI Listing
September 2021

Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study.

Children (Basel) 2021 May 23;8(6). Epub 2021 May 23.

Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi University Hospital, via Massarenti 11, 40138 Bologna, Italy.

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life-3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were (97%), (2%), and spp. (1%). The only Gram-positive bacteria isolated was an . As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life-11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1-5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were (44%), (27%), and spp. (12%), while spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found ( = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.
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http://dx.doi.org/10.3390/children8060436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8224700PMC
May 2021

Uretero-Pelvic Junction Stenosis: Considerations on the Appropriate Timing of Correction Based on an Infant Population Treated with a Minimally-Invasive Technique.

Children (Basel) 2021 Feb 4;8(2). Epub 2021 Feb 4.

Pediatric Surgery Unit, IRCCS Sant'Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy.

There is no univocal consensus about timing of intervention and best surgical approach for infants with asymptomatic uretero-pelvic junction obstruction (UPJO). We conducted a retrospective analysis of patients undergoing one-trocar-assisted pyeloplasty (OTAP) in a 13 year range period by creating two homogenous groups (indications for surgery were the same for all patients): patients operated on in the first 90 days of life (34 patients; Group 1) and patients operated on between 3 and 12 months of life (34 patients; Group 2). We observed no statistically significant differences between groups in regard to mean operative time, conversion rate to open surgery, mean hospital stay, early complications (urinary leakage) rate and mean antero-posterior diameter (APD) reduction rate. Moreover, no statistical improvement was seen between groups in regard to separate renal function (SRF) at 1-year-follow-up renogram. Thanks to the HSS calculated before and 1 year after surgery, we registered an important improvement in Group I patients ( = 0.023). In our study, there was no significant evidence, in terms of intraoperative data and early postoperative outcomes, between patients who underwent an early pyeloplasty and those who underwent a delayed correction. Nevertheless, we registered a significant improvement in those patients with an impaired SRF that underwent an early surgical correction, especially in terms of urinary flow. Even though this study cannot definitely establish the superiority of early timing of correction, it is evident that further research is needed to clarify this aspect.
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http://dx.doi.org/10.3390/children8020107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913959PMC
February 2021

Discovering Genotype Variants in an Infant with VACTERL through Clinical Exome Sequencing: A Support for Personalized Risk Assessment and Disease Prevention.

Pediatr Rep 2021 Jan 5;13(1):45-56. Epub 2021 Jan 5.

Department of Pediatrics, Ospedale dei Bambini "Vittore Buzzi", 20154 Milano, Italy.

Congenital anomalies may have an increased risk of noncommunicable diseases (NCDs) We performed a clinical exome analysis in an infant affected by "Vertebral, Anorectal, Cardiac, Tracheoesophageal, Genitourinary, and Limb" (VACTERL) malformation association to identify potential biomarkers that may be helpful for preventing malignancy risk or other chronic processes. Among the variants, six variants that may be linked with VACTERL were identified in the exome analysis. The variants c.501G>C on and c.-8C>G on were previously associated with myocardial infarction. The variants c.1936A>G on and c.575A>G on are linked to defects in cardiac conduction and artery disease, respectively. Alterations in metabolism were also suggested by the variants c.860G>A on and c.214C>A on . In addition, three variants associated with colon cancer were discovered. Specifically, the reported variants were c.723G>A on and c.91T>A on proto-oncogenes as well as c.827A>C in the tumor suppressor . A further inspection identified 15 rare variants carried by cancer genes. Specifically, these mutations are located on five tumor suppressors (, , , , ) and eight proto-oncogenes (, , , , , , , ) and have an allele frequency lower than 0.01 in the Genome Aggregation Database (GnomAD). We observed that the cardiac and metabolic phenotypic traits are linked with the genotype of the patient. In addition, the risk of developing neoplasia cannot be excluded a priori. Long-term surgical issues of patients with VATER syndrome could benefit from the clinical exome sequencing of a personalized risk assessment for the appearance of further disease in pubertal timing and adult age.
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http://dx.doi.org/10.3390/pediatric13010006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838983PMC
January 2021

Early Implantation as a Main Predictor of Response to Vagus Nerve Stimulation in Childhood-Onset Refractory Epilepsy.

J Child Neurol 2021 04 25;36(5):365-370. Epub 2020 Nov 25.

Department of Neurology and Comprehensive Epilepsy Program, Brain Institute, 5447Nicklaus Children's Hospital, Miami, FL, USA.

Objective: We describe a multicenter experience with vagus nerve stimulator implantation in pediatric patients with drug-resistant epilepsy. Our goal was to assess vagus nerve stimulation efficacy and identify potential predictors of favorable outcome.

Methods: This is a retrospective study. Inclusion criteria: ≤18 years at time of vagus nerve stimulator implantation, at least 1 year of follow-up. All patients were previously found to be unsuitable for an excisional procedure. Favorable clinical outcome and effective vagus nerve stimulation therapy were defined as seizure reduction >50%. Outcome data were reviewed at 1, 2, 3, and 5 years after vagus nerve stimulator implantation. Fisher exact test and multiple logistic regression analysis were employed.

Results: Eighty-nine patients met inclusion criteria. Responder rate (seizure frequency reduction >50%) at 1-year follow-up was 25.8% (4.5% seizure-free). At last follow-up, 31.5% had a favorable outcome and 5.2% were seizure free. The only factor significantly predicting favorable outcome was time to vagus nerve stimulator implantation, with the best outcome achieved when vagus nerve stimulator implantation was performed within 3 years of seizure onset. Implantation between 3 and 5 years after epilepsy onset correlated with better long-term seizure freedom (13.3% at T5). Overall, 65.2% of patients evidenced improved quality of life at last follow-up. However, 12.4% had adverse events, but most were mild and disappeared after 3-4 months.

Conclusions: Early vagus nerve stimulator implantation within 5 years of seizure onset was the only predictor of favorable clinical outcome in pediatric patients. Improved quality of life and a low incidence of significant adverse events were observed.
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http://dx.doi.org/10.1177/0883073820974855DOI Listing
April 2021

Effects of the association between spirituality, religiosity and physical activity on health/mental health: a systematic review.

Rev Esc Enferm USP 2020 6;54:e03631. Epub 2020 Nov 6.

Universidade do Vale do Paraíba, Instituto de Pesquisa e Desenvolvimento, Laboratório de Engenharia de Reabilitação Sensório Motora, São José dos Campos, SP, Brasil.

Objective: To identify evidence in the literature about the effects of the association between spirituality, religiosity and physical activity on physical and mental health.

Method: A systematic review conducted in January 2019 in the MEDLINE/PubMed, SCOPUS, Web Of Science, CINAHL, PsycINFO, LILACS and SciELO databases with the descriptors: "spirituality", "religion", "physical activity" and "physical exercise ". Primary studies carried out with adults published until 2018 in Portuguese, English or Spanish were included.

Results: Nine international studies were selected which had been published between 2011 and 2017, with cross-sectional design (55%) and an evidence level of four (78%). Eight studies addressed effects on physical health and one addressed effects on mental health.

Conclusion: The association between spirituality, religiosity and physical activity promotes effects on physical and mental health, however the available evidence is not sufficient for this association to be applied in clinical practice.
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http://dx.doi.org/10.1590/S1980-220X2019012903631DOI Listing
July 2021

Resection of primary tumor in stage 4S neuroblastoma: a second study by the Italian Neuroblastoma Group.

Pediatr Surg Int 2021 Jan 29;37(1):37-47. Epub 2020 Oct 29.

Oncology Unit, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy.

Purpose: To clarify the role of primary tumor resection in stage 4S neuroblastoma.

Methods: We investigated a cohort of 172 infants diagnosed with stage 4S neuroblastoma between 1994 and 2013. Of 160 evaluable patients, 62 underwent upfront resection of the primary tumor and 98 did not.

Results: Five-year progression-free and overall survival were significantly better in those who had undergone upfront surgery (83.6% vs 64.2% and 96.8% vs 85.7%, respectively). One post-operative death and four non-fatal complications occurred in the resection group. Three patients who had not undergone resection died of chemotherapy-related toxicity. Thirteen patients underwent late surgery to remove a residual tumor, without complications: all but one alive. Outcomes were better in patients diagnosed from 2000 onwards.

Conclusion: Infants diagnosed with stage 4S neuroblastoma who underwent upfront tumor resection had a better outcome. However, this result cannot be definitely attributed to surgery, since these patients were selected on the basis of their favorable presenting features. Although the question of whether to operate or not at disease onset is still unsolved, this study confirms the importance of obtaining enough adequate tumor tissue to enable histological and biological studies to properly address treatment, to achieve the best possible outcome.
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http://dx.doi.org/10.1007/s00383-020-04766-1DOI Listing
January 2021

Peritoneal dialysis catheters in pediatric patients: 10 years of experience in a single centre.

Pediatr Med Chir 2020 Oct 8;42(1). Epub 2020 Oct 8.

Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.

Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients 'demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated.
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http://dx.doi.org/10.4081/pmc.2020.221DOI Listing
October 2020

Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations.

Children (Basel) 2020 Oct 13;7(10). Epub 2020 Oct 13.

Pediatric Surgery Department, Sant'Orsola-Malpighi University Hospital, 40138 Bologna, Italy.

Aim Of The Study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called "anal-lipofilling") in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs).

Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck's scale (KS) was administered to the patients to evaluate the clinical outcome.

Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 ± 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment).

Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs.
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http://dx.doi.org/10.3390/children7100181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656299PMC
October 2020

Point of view of the Italians pediatric scientific societies about the pediatric care during the COVID-19 lockdown: what has changed and future prospects for restarting.

Ital J Pediatr 2020 Oct 2;46(1):142. Epub 2020 Oct 2.

Federazione Italiana delle Associazioni e Società Scientifiche dell'Area Pediatrica e Società Italiana di Emergenza Urgenza Pediatrica, Rome, Italy.

Background: The coronavirus disease 2019 (COVID-19) is currently rare in children and they seem to have a milder disease course and better prognosis than adults. However, SARS-Cov-2 pandemic has indirectly caused problems in pediatric medical assistance. In view of this we wanted to draw a picture of what happened during health emergency and analyze future prospects for restarting.

Methods: We involved the Italian pediatric scientific societies institutionally collected in the Italian Federation of Associations and Scientific Societies of the Pediatric Area (FIARPED); We sent a questionnaire to all scientific societies about the pediatric care activity during the COVID-19 emergency and future perspectives for the phase of post-containment.

Results: The analysis of the questionnaires showed significant decrease of:admission, outpatient visits and specialist consultancy activities during the COVID-19 emergency, primarily linked to the fear of infection. Instead it was increased the serious degree of diseases admitted. Most of scientific societies maintained the relationship with chronic patients through some form of telemedicine, reporting a strong positive opinion about this modality. Finally showed the need to give life a new approach for hospitalizations and outpatient visits through a greater use of telemedicine, educational programs on families and a more decisive role of family pediatricians.

Conclusions: Our study highlighted many aspects that can be improved in pediatric care. We think that It will be necessary a new shared strategy to improve the management and continuity of care for pediatric patients, primarily developing a network of collaboration between families, family pediatrician and hospitals and by enhancing the use of new methods of telecommunications.
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http://dx.doi.org/10.1186/s13052-020-00907-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531060PMC
October 2020

Bedside surgery in the newborn infants: survey of the Italian society of pediatric surgery.

Ital J Pediatr 2020 Sep 16;46(1):134. Epub 2020 Sep 16.

Department of Neonatal and Emergency Surgery, Meyer Children's Hospital, Florence, Italy.

Introduction: This is the report of the first official survey from the Italian Society of Pediatric Surgery (ISPS) to appraise the distribution and organization of bedside surgery in the neonatal intensive care units (NICU) in Italy.

Methods: A questionnaire requesting general data, staff data and workload data of the centers was developed and sent by means of an online cloud-based software instrument to all Italian pediatric surgery Units.

Results: The survey was answered by 34 (65%) out of 52 centers. NICU bedside surgery is reported in 81.8% of the pediatric surgery centers. A lower prevalence of bedside surgical practice in the NICU was reported for Southern Italy and the islands than for Northern Italy and Central Italy (Southern
Conclusion: Bedside surgery is performed in the majority of the Italian pediatric surgery centers included in this census. The introduction of a national set of surgery guidelines would be widely welcomed.
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http://dx.doi.org/10.1186/s13052-020-00889-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7493058PMC
September 2020

Anastomotic Stricture Definition After Esophageal Atresia Repair: Role of Endoscopic Stricture Index.

J Surg Res 2021 01 11;257:572-578. Epub 2020 Sep 11.

Department of Pediatric Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy.

Background: To evaluate the feasibility and efficacy of endoscopic stricture index (SI) to define anastomotic strictures (ASs) and to predict the need of dilatations.

Materials And Methods: A retrospective longitudinal study was conducted on patients who underwent esophageal atresia repair from 1998-2020 (ethical committee approval CHPED-05-20-AS). SI was calculated on the first endoscopy performed as follows: (D - d)/D, where D is the maximum diameter of lumen of the upper esophagus close to the AS and d is the diameter of lumen of the stricture. Nonparametric variables were examined using Wilcoxon-Mann-Whitney test, and continuous variables were analyzed using Spearman's test and regression analysis. A P value <0.05 was considered statistically significant. The sensitivity, specificity, and positive and negative predictive values of SI were also calculated, and a receiver operating characteristic curve was designed.

Results: A total of 46 patients were included in the study. A statistically significant correlation was found between SI and number of dilations (Spearman's correlation rate, 0.7; P < 0.0005). A SI threshold value ≥0.6 showed sensitivity of 100%, specificity of 80%, positive predictive value of 54%, negative predictive value of 100%, and the area under the curve of 84%.

Conclusions: SI seems to be a good AS definer and prognostic tool; our study suggests that an AS could be defined by a SI ≥0.6.
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http://dx.doi.org/10.1016/j.jss.2020.08.035DOI Listing
January 2021

Ocular Sporotrichosis.

Am J Ophthalmol Case Rep 2020 Sep 6;19:100865. Epub 2020 Aug 6.

Department of Ophthalmology, Complexo Hospitalar Padre Bento de Guarulhos, 1819 Emilio Ribas Avenue, Gopouva, 07051-000, Guarulhos, São Paulo, Brazil.

Purpose: To present 10 cases of Parinaud oculoglandular syndrome caused by sporotrichosis.

Observations: We report 10 cases of Parinaud oculoglandular syndrome after contact with domestic cats diagnosed with sporotrichosis. They all showed ocular hyperemia associated with unilateral tarsal conjunctival granulomas. After histopathological study and culture of the scrapings and conjunctival secretions, six patients were positive for and four had a presumed diagnosis of Parinaud oculoglandular syndrome due to sporotrichosis. Treatment with 200 mg/day of oral itraconazole was started, and all patients had a favorable therapeutic response.

Conclusion And Importance: These case reports are essential for characterizing a rare etiology of Parinaud oculoglandular syndrome.
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http://dx.doi.org/10.1016/j.ajoc.2020.100865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453100PMC
September 2020

Minimally Invasive Approaches in Pediatric Urolithiasis. The Experience of Two Italian Centers of Pediatric Surgery.

Front Pediatr 2020 24;8:377. Epub 2020 Jul 24.

Pediatric Surgery Unit, V. Buzzi Children's Hospital, Milan, Italy.

Over the last 30 years, the incidence of pediatric urolithiasis (PU) has been increasing and the surgical management has evolved toward a minimally invasive approach (MIA). We reported the experience of two Centers of Pediatric Surgery in the management of PU, focusing on MIA as first choice in treatment. Data were retrospectively analyzed from October 2009 to October 2019 in children with urolithiasis who were admitted to two referral Italian Centers of Pediatric Surgery. Demographic and clinical data of the patients, features of the urolithiasis, type of surgery were considered. Seventy patients (7.3 ± 5.0 years) with normal renal function were treated for calculi in the pyelocaliceal system (45.7%), ureter (34.3%), bladder (4.3%), urethra (1.4%), and multiple locations (14.3%). Size of calculi was >10 mm in 55.7% of cases (kidney>bladder/urethra>multiple>ureter, = 0.01). Symptoms were present in 75.7% of patients. Family history was positive in 16.9% of cases. MIA was performed in 59 patients (84.3%): 11.8% shockwave lithotripsy (kidney>ureter>multiple); 32.2% ureteral retrograde surgery (ureteral>other localizations); 30.5% retrograde intrarenal surgery (kidney>other localizations); and 25.4% other procedures including percutaneous nephrolithotomy, cystoscopic bladder stone removal or laser cystolithotripsy (kidney>bladder>multiple). Preoperative stenting was necessary in 52.8% of cases. Four MIA procedures (6.9%, kidney>ureter/multiple) were converted to open surgery. Open surgery was required as first approach in 15.7% of patients (kidney>ureter>multiple) who needed urgent surgery or had associated congenital renal anomalies. In 18/70 of children (25.7%), with prevalence of stones in kidney and multiple location ( < 0.01), a second procedure completed the treatment (88.8% MIA). Intraoperative difficulties were recorded in 8.5% of cases, without difference between location and size of calculi. Late complications (5.7%) were related to displacement and infection of the ureteral stent. MIA resulted to be feasible in more than 75% of primary surgery and in more than 85% of cases requiring a second procedure. Preoperative stent was mandatory in more than 50% of children. The technological evolution allowed to overcome many of the technical difficulties related to the approach to the papilla and lower calyxes. Open surgery is reserved for selected cases and endoscopic surgery represents the best choice of treatment for PU.
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http://dx.doi.org/10.3389/fped.2020.00377DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393988PMC
July 2020

Effect of Modified Laser Transcutaneous Irradiation on Pain and Quality of Life in Patients with Diabetic Neuropathy.

Photobiomodul Photomed Laser Surg 2020 Mar;38(3):138-144

Research and Development Institute (IP&D), Vale do Paraíba University-Univap, São José dos Campos, Brazil.

Diabetic neuropathy (DN) is one of the major complications developed by individuals with diabetes mellitus. DN is responsible for a high morbidity and mortality rate and impacts the public health and medical assistance resources. Intradermic laser irradiation on blood (ILIB) consists of the application of light beams on the radial arterial, providing anti-inflammatory and vasodilator effects, antiarrhythmic action, reduction of glucose, and stabilization of the hormonal and immunological systems. These effects help to maintain the physiological dynamics of the body. The goal of this research was to evaluate the effects of ILIB to relieve pain and improve the quality of life in DN patients. The sample comprised 30 diabetic volunteers with DN, randomly distributed into 3 groups: Control-conventional treatment; ILIB-100 mW, 660 ± 10 nm, 30 applications in total, divided into 3 stages of 10 applications, 30 min each, daily, with a 20-day interval between each stage; SILIB-same protocol described for ILIB, with the equipment switched off. Before and after the application of the therapeutic protocols, all volunteers were evaluated by the following instruments: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), visual analog scale, Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and PAIN DETECT scale. Collected data were statistically analyzed with a 95% confidence interval,  < 0.05. The ILIB group presented significantly lower pain levels and a better quality of life compared with the control and SILIB groups. This study demonstrated that ILIB therapy was effective in reducing pain and improving quality of life in patients with DN.
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http://dx.doi.org/10.1089/photob.2019.4714DOI Listing
March 2020

Laparoscopy-Assisted Versus Open Surgery in Treating Intestinal Atresia: Single Center Experience.

J Invest Surg 2021 Aug 8;34(8):842-847. Epub 2020 Jan 8.

Pediatric Surgery Department, S. Orsola Hospital/University of Bologna, Bologna, Italy.

Introduction: Surgical management of jejuno-ileal atresia/stenosis (JIA) is shifting to a minimally invasive approach. Our purpose is to evaluate the safety and feasibility of laparoscopy-assisted surgery (LAS) in JIA by comparing outcomes with a control group of open surgery (OS).

Methods: A retrospective review of JIA cases was performed. Demographic, surgical, and outcomes data were extracted. LAS cases were compared with OS. Fisher's exact-test for qualitative and Mann-Whitney-test for quantitative values were used. values <0.05 were considered significant.

Results: Forty-seven patients (24/23, F/M) were included. In 19 (40%), the LAS technique was successfully performed, while 3 (17%) required conversion to OS. No differences were observed between the LAS and OS ( = 28) groups concerning demographic data (sex, mean gestational age, mean weight, associated anomalies) and type of JIA. Operative time was shorter in LAS (112 ± 46 min) compared to OS (138 ± 40 min),  = 0.04. Time to start enteral feeding and time to full enteral was shorter in LAS compared to OS,  = 0.04. No difference was observed between the two groups concerning duration of parenteral nutrition, length of hospitalization and weight at discharge. Overall rate of postoperative complications was 14% ( = 7), with a slightly prevalence in OS (18%) compared to LAS (10%),  = 0.68.

Conclusions: The LAS technique in the treatment of neonatal JIA is safe and feasible. LAS is associated with shorter operative and restoration of enteral feeding times. The post-operative outcomes in LAS are similar with OS, with a lower rate of postoperative complications.
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http://dx.doi.org/10.1080/08941939.2019.1704316DOI Listing
August 2021

Gluten Deprivation: What Nutritional Changes Are Found During the First Year in Newly Diagnosed Coeliac Children?

Nutrients 2019 Dec 25;12(1). Epub 2019 Dec 25.

Paediatrics, University of Bologna, 40138 Bologna, Italy.

Aim: A gluten-free diet (GFD) can expose children to excessive calories and fat intake. The study is intended to verify whether and how food intake, laboratory parameters, and growth are modified by a year of GFD.

Methods: In 79 CD (coeliac disease) children (mean age 7.9 ± 3.8 years, 52 females, 27 males) diagnosed over 24 months, 24-h food diaries, food-frequency patterns, anthropometric and laboratory parameters (mainly blood sugar, insulin, lipid profile, and homocysteine) were prospectively collected before and during the first year of GFD. Nutrient intakes were compared over time and with recommendations. They were also used as regressors to explain the levels and changes of metabolic and growth variables. -values < 0.05 were considered statistically significant.

Results: Average macronutrient intake did not change during the year. Caloric intake remained below 90% ( ≤ 0.0001) and protein intake above 200% ( ≤ 0.0001) of recommendations. Lipid intake was stable at 34% of overall energy intake. Unsaturated fats increased (less omega-6 and more omega-3 with a ratio improvement from 13.3 ± 5.5 to 8.8 ± 3.1) and so did fibers, while folate decreased. The children who experienced a containment in their caloric intake during the year, presented a slower catch-up growth. Some differences were found across gender and age groups. In particular, adolescents consumed less calories, and females more omega-3. Fiber and simple sugar intakes emerged as implicated in lipid profile shift: fibers negatively with triglycerides (TG) ( = 0.033), simple sugars negatively with high-density lipoprotein (HDL) ( = 0.056) and positively with TG ( = 0.004). Waist-to-height ratio was positively associated with homocysteine ( = 0.018) and Homeostasis Model Assessment ( = 0.001), negatively with fibers ( = 0.004).

Conclusion: In the short run, GFD is nutritionally very similar to any diet with gluten, with some improvements in unsaturated fats and fiber intake. Along with simple sugars containment, this may offer CD patients the opportunity for a fresh start. Caloric intakes may shift and should be monitored, especially in adolescents.
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http://dx.doi.org/10.3390/nu12010060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7020039PMC
December 2019

Long-term analyses of spastic muscle behavior in chronic poststroke patients after near-infrared low-level laser therapy (808 nm): a double-blinded placebo-controlled clinical trial.

Lasers Med Sci 2020 Sep 10;35(7):1459-1467. Epub 2019 Dec 10.

Laboratório de Engenharia de Reabilitação Sensório Motora, Faculdade de Ciências da Saúde, Universidade do Vale do Paraíba, São José dos Campos, SP, Brasil.

Stroke results in impairment of basic motor functions, such as muscle weakness in limbs affected by spasticity, leading to peripheral fatigue and impaired functionality. The clinical use of photobiomodulation therapy (PBMT) has provided major advances in the treatment of muscular disorders and prevention of muscle fatigue. The aim of this study was to analyze the effects of two distinct therapies in biceps spasticity of chronic hemiparetic patients. We analyzed range of elbow motion, torque, electromyography, and mean spectral frequency after 10 sessions of PBMT (Laser 100 mW, 808 nm, 159.24 J/cm/point, 5 J/point); PBMT active or placebo was associated with exoskeleton-assisted functional treatment. A double-blind placebo-controlled sequential clinical trial was conducted with 12 healthy volunteers and 15 poststroke patients who presented upper-limb spasticity. The healthy volunteers performed only the evaluation protocol, and the poststroke volunteers participated in three consecutive phases (PBMT, PBMT + exoskeleton, placebo + PBMT) with a washout period of 4 weeks between each phase. We could observe significant increases in range of elbow motion after PBMT from 57.7 ± 14 to 84.3 ± 27.6 degrees (p < 0.001). The root mean square (RMS) values also increased after PBMT + exoskeleton from 23.2 ± 15 to 34.9 ± 21 μV (p = 0.0178). Our results suggest that the application of PBMT may contribute to an increased range of elbow motion and muscle fiber recruitment, increases in muscle strength, and, hence, to increase signal conduction on spastic muscle fibers in spastic patients.
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http://dx.doi.org/10.1007/s10103-019-02920-3DOI Listing
September 2020

Analysis of the effects of low-level laser therapy on muscle fatigue of the biceps brachii muscle of healthy individuals and spastic individuals: Study protocol for a single-center, randomized, double-blind, and controlled clinical trial.

Medicine (Baltimore) 2019 Sep;98(39):e17166

Laboratório de Engenharia de Reabilitação Sensório Motora.

Background: Muscular fatigue is caused by biochemical alterations that modify the mechanics of muscle contraction, resulting in negative changes in the performance of the contraction. Several resources are studied to mitigate this situation among which we can cite low-level laser therapy (LLLT). The effects of LLLT are being studied in healthy subjects with fibromyalgia and who are athletes, and currently the studies are being performed in spastic muscles with poststroke individuals. The aim will be to evaluate the effects of LLLT on the fatigue of the biceps brachii muscle of healthy individuals and individuals with spastic hemiparesis.

Methods: A cross-sectional, comparative, randomized, placebo, double-blind clinical trial will be divided into 2 phases: phase I shall consist of 30 healthy subjects and phase II of 30 poststroke individuals. The study will consist of 3 groups (control group, placebo group, and LLLT group), and all individuals will pass through all groups, following the randomization criteria. The protocol consists of the application of LLLT in the biceps brachii muscle on the dominant side in healthy individuals and in the hemiparetic side of poststroke individuals, and, subsequently, 3 maximal isometric voluntary contractions (MIVCs) will be performed for 50 seconds in the dynamometer, with an interval of 50 seconds between them. Pain intensity will be evaluated by means of the visual analog scale, and the myoelectric activity by means of surface electromyography associated with the evaluation of muscular strength by means of the dynamometer. The local temperature will be evaluated by infrared thermography and blood lactate concentration through the lactimeter, which will be measured at 4 different times, before the application of the laser (basal), and 3, 15, and 25 minutes after the MIVC.
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http://dx.doi.org/10.1097/MD.0000000000017166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775413PMC
September 2019

Flexible Optical Amplifier for Visible-Light Communications Based on Organic-Inorganic Hybrids.

ACS Omega 2018 Oct 22;3(10):13772-13781. Epub 2018 Oct 22.

Department of Physics, CICECO-Aveiro Institute of Materials and Department of Electronics, Telecommunications and Informatics, Instituto de Telecomunicações, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal.

Visible-light communications (VLCs) based on white light-emitting diodes (LEDs) are emerging as a low-cost and energy-efficient alternative solution to wireless communications. As white emitting LEDs use a combination of a long-lived yellow emission combined with the faster response of a blue emitting LED (∼460 nm), VLC technology requires amplification of the blue component to improve the signal-to-noise ratio. We report the fabrication and characterization of planar and channel waveguides based on a blue-emitting polyfluorene conjugated polyelectrolyte, namely, poly[9,9-bis(4-sulfonylbutoxyphenyl)fluorene-2,7-diyl--1,4-phenylene] (PBS-PFP) incorporated into diureasil organic-inorganic hybrids for optical amplification in VLC. Taking advantage of the diureasil host as a UV self-patternable material, direct UV laser writing was used to pattern channel waveguides with a larger refractive index (Δ=0.09) compared to the nonexposed region, enabling confinement and guidance of the PBS-PFP emission with a maximum optical gain efficiency value of 1.62 ± 0.02 cm μJ. This value is among the best figures of merit known for polymeric materials with additional advantages added by the diureasil hybrid host, namely, mechanical flexibility, thermal stability, and low insertion losses due to the nearly null refractive index contrast between the optical fiber and the amplification device, establishing the proposed approach as a promising cost-effective solution for optical amplification in VLCs.
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http://dx.doi.org/10.1021/acsomega.8b01726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6644746PMC
October 2018

Sensory-motor and cardiorespiratory sensory rehabilitation associated with transcranial photobiomodulation in patients with central nervous system injury: Trial protocol for a single-center, randomized, double-blind, and controlled clinical trial.

Medicine (Baltimore) 2019 Jun;98(25):e15851

Laboratório de Engenharia de Reabilitação Sensório Motora.

Background: Central nervous system diseases such as stroke, spinal cord injury, traumatic brain injury, and multiple sclerosis can be fatal or cause sequelae, affecting sensorimotor and cardiorespiratory systems and quality of life. These subjects present a low response to aerobic and resistance exercise, due to decreased recruitment of muscle fibers and reduction of metabolic capacity. Aerobic exercises bring benefits in terms of fatigue retardation, gait improvement, regulation of the autonomic nervous system, neuroprotection of the brain, stimulation of the production of endogenous neutrotransmitters related to general well-being, and a favoring of neuroplasticity. Photobiomodulation (PBM Therapy) (previously known as low-level laser therapy), and especially transcranial PBM Therapy, has shown benefits in animals and humans such as cognitive improvement, memory, and behavioral improvement, including attenuation of depression and anxiety, and increased cortical oxygenation. The aims of this trial will be to evaluate the parameters related to the function of the musculoskeletal and cardiorespiratory system and the impact of PBM therapy on these parameters, as part of a rehabilitation and training program for people with reduced mobility.

Methods: This is a randomized, double-blind, placebo-controlled trial with 3 groups: Control, only cardiorespiratory rehabilitation (CCR), CCR with PBM Therapy (CR-PBM), CCR and placebo PBM Therapy (CR-PlaceboPBM). n = 90, 30 per group. PBM Therapy parameters: 810 nm laser, 0.028 cm, 100 mW, 3.5 W/cm, 30 seconds per point, 3 J per point, 107.1 J /cm to 3 electroencephalogram points F7 and F8 and AFz. The trial will be conducted at the University Clinics and the sessions will be 1 hour twice a week for 9 weeks. Baseline, intermediate (4th week), final (9th week), and 2-month follow-up will be performed. Muscular activation, heart rate variability, lung volumes and capacities, fatigability, exercise tolerance, cognition, and quality of life at baseline will be evaluated. Subsequent to baseline evaluations, the PBM Therapy groups will be offered laser therapy (active or inactive); all groups will then receive CCR.

Trial Registration Number: ClinicalTrials.gov ID - NCT03751306 (approval date: November 22, 2018).
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http://dx.doi.org/10.1097/MD.0000000000015851DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636949PMC
June 2019

Congenital multiple median raphe cysts of the penis and scrotum.

J Paediatr Child Health 2019 Nov 10;55(11):1389-1390. Epub 2019 Jun 10.

Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.

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http://dx.doi.org/10.1111/jpc.14534DOI Listing
November 2019

The DATE Association: A Separate Entity or a Further Extension of the VACTERL Association?

J Surg Res 2019 09 22;241:128-134. Epub 2019 Apr 22.

Pediatric Surgery Unit, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy. Electronic address:

Background: The combination of esophageal atresia, congenital duodenal obstruction, and anorectal malformation has seldom been reported. We describe the largest series of patients with such association, which we summed up with the mnemonic acronym DATE [D-duodenal obstruction, A-anorectal malformation (ARM), and TE-tracheoesophageal fistula with esophageal atresia].

Methods: This was a multicenter retrospective review of 13 patients recruited from 8 institutions over a nearly 5-decade period (1968-2017). Information gathered included type of DATE malformations, other associated anomalies, type and timing of surgery, and clinical outcomes.

Results: The DATE association consisted of type C esophageal atresia (13), complete (9) or incomplete (4) congenital duodenal obstruction (CDO), and high or intermediate (8) or low (5) ARM. Eight patients had at least one additional component feature of VACTERL association. A total of 6 patients died. Overall, 9 patients achieved complete restoration of gastrointestinal continuity, 7 of whom are alive at a median follow-up of 4 y (range, 1 to 9). Survivors received a median of 6 major operations (range, 4 to 14) to overcome their anomalies and surgical complications. Two incomplete duodenal obstructions were initially overlooked. All survivors with high or intermediate ARM defects required some form of bowel management to keep them clean.

Conclusions: The DATE association is a low-frequency entity, often occurring among the wider spectrum of VACTERL association. Functional outcomes largely depend on the severity of ARM or other major associated malformations. Awareness of the DATE association may avoid untoward diagnostic delays of subtler component features of the spectrum, such as an incomplete CDO.
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http://dx.doi.org/10.1016/j.jss.2019.03.054DOI Listing
September 2019
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