Search

Background: Radical removal of the ureter is not routinary performed during nephrectomy/hemineprectomy, distal ureteral stump syndrome may follow. Case summary: A 17-year-old male with urinary malformation history came to the emergency department for abdominal pain and tenesmus. Imaging revealed a huge abdominal mass, compatible with a massively dilated residual ureteral stump resulting from heminephrectomy operation performed 7 years before for a complete right duplex system with hypoplasia of the upper right system. A robotic procedure was planned and the stump, which was ectopic and drained into the seminal vesicles, was successfully removed. The patient was discharged after recovery; he was followed up for one year after surgery without any complications. Conclusion: Ureteral stumps rarely require reoperation, but our case suggests a need for long-term follow-up. Robotic-assisted excision showed to be a safe and effective technique for surgical management of a massively dilated ectopic stump in the pediatric population.

In the context of the ESA Climate Change Initiative project, we are engaged in a regional reprocessing of high-resolution (20 Hz) altimetry data of the classical missions in a number of the world's coastal zones. It is done using the ALES (Adaptive Leading Edge Subwaveform) retracker combined with the X-TRACK system dedicated to improve geophysical corrections at the coast. Using the Jason-1 and Jason-2 satellite data, high-resolution, along-track sea level time series have been generated, and coastal sea level trends have been computed over a 14-year time span (from July 2002 to June 2016). In this paper, we focus on a particular coastal site where the Jason track crosses land, Senetosa, located south of Corsica in the Mediterranean Sea, for two reasons: (1) the rate of sea level rise estimated in this project increases significantly in the last 4–5 km to the coast compared to what is observed further offshore, and (2) Senetosa is the calibration site for the TOPEX/Poseidon and Jason altimetry missions, which are equipped for that purpose with in situ instrumentation, in particular tide gauges and a Global Navigation Satellite System (GNSS) antenna. A careful examination of all the potential errors that could explain the increased rate of sea level rise close to the coast (e.g., spurious trends in the geophysical corrections, imperfect inter-mission bias estimate, decrease of valid data close to the coast and errors in waveform retracking) has been carried out, but none of these effects appear able to explain the trend increase. We further explored the possibility that it results from real physical processes. Change in wave conditions was investigated, but wave setup was excluded as a potential contributor because the magnitude was too low and too localized in the immediate vicinity of the shoreline. A preliminary model-based investigation about the contribution of coastal currents indicates that it could be a plausible explanation of the observed change in sea level trend close to the coast.

Echinococcosis is a parasitic zoonosis in which humans are involved as an intermediate host. It is a very common pathology in the areas of Eastern Europe and Asia, where the main activity is represented by pastoralism and animal breeding. In humans, the most frequently affected sites are the liver (60–70%) and lungs (20–30%), manifesting themselves with symptoms such as abdominal pain, coughing, dyspnea, hemoptysis, up to cases of anaphylactic shock. In Italy it is not a common disease with an incidence of 2:100.000 inhabitants, and it's extremely rare in pediatric population. In this work we presented a case of a 11-years male patient came for a persistent cough, to whom was found a giant cystic mass in the thorax. Serological tests confirmed the diagnosis of echinococcosis. Patient underwent to thoracotomy to remove the cyst and he begun the antiparasitic therapy. Post-operative outcome was good and the patient is, until now, free of problems. Echinococcosis is a challenging problem for a pediatric surgeon, especially in non-endemic area, not only because it is not a common disease in pediatric population, but also for the surgical management that can presents some difficulties and complications in the post-operative course.

Technological advances in the recent satellite altimeter missions of Jason-2, SARAL/AltiKa and CryoSat-2 have improved their signal-to-noise ratio, allowing us to observe finer-scale ocean processes with along-track data. Here, we analyse the noise levels and observable ocean scales in the northwestern Mediterranean Sea, using spectral analyses of along-track sea surface height from the three missions. Jason-2 has a higher mean noise level with strong seasonal variations, with higher noise in winter due to the rougher sea state. SARAL/AltiKa has the lowest noise, again with strong seasonal variations. CryoSat-2 is in synthetic aperture radar (SAR) mode in the Mediterranean Sea but with lower-resolution ocean corrections; its statistical noise level is moderate with little seasonal variation. These noise levels impact on the ocean scales we can observe. In winter, when the mixed layers are deepest and the submesoscale is energetic, all of the altimeter missions can observe wavelengths down to 40–50 km (individual feature diameters of 20–25 km). In summer when the submesoscales are weaker, SARAL can detect ocean scales down to 35 km wavelength, whereas the higher noise from Jason-2 and CryoSat-2 blocks the observation of scales less than 50–55 km wavelength. This statistical analysis is completed by individual case studies, where filtered along-track altimeter data are compared with co-located glider and high-frequency (HF) radar data. The glider comparisons work well for larger ocean structures, but observations of the smaller, rapidly moving dynamics are difficult to co-locate in space and time (gliders cover 200 km in a few days, altimetry in 30 s). HF radar surface currents at Toulon measure the meandering Northern Current, and their good temporal sampling shows promising results in comparison to co-located SARAL altimetric currents. Techniques to separate the geostrophic component from the wind-driven ageostrophic flow need further development in this coastal band.

This paper investigates links between rainfall variability in the Ogooué River Basin (ORB) and El Niño Southern Oscillation (ENSO) in the Pacific Ocean. Recent hydroclimatology studies of the ORB and surrounding areas resulting in contrasting conclusions about links between rainfall variability and ENSO. Thus, to make the issue clearer, this study investigates the links between ENSO and rainfall in the ORB over the period 1940–1999. The principal component analysis of monthly rainfall in the ORB was done. The temporal mode of the first component corresponds to the interannual variations of rainfall on the ORB. Also, the pattern of the spatial mode of the first component shows that the ORB is a homogeneous hydroclimatic zone. However, no leading mode is significantly correlated to the ENSO index. A cross-wavelet analysis of the time series of basin-scale rainfall and the ENSO index was therefore carried out. The result is a set of periodogram structures corresponding to some ENSO episodes recorded over the study period. And wavelet coherence analysis of both time series confirms that there are significant links between ENSO and rainfall in the ORB.

The 2015–2016 El-Niño and related ocean warming has generated significant coral bleaching and mortality worldwide. In Indonesia, the first signs of bleaching were reported in April 2016. However, this El Niño has impacted Indonesian coral reefs since 2015 through a different process than temperature-induced bleaching. In September 2015, altimetry data show that sea level was at its lowest in the past 12 years, affecting corals living in the bathymetric range exposed to unusual emersion. In March 2016, Bunaken Island (North Sulawesi) displayed up to 85 % mortality on reef flats dominated by Porites, Heliopora and Goniastrea corals with differential mortality rates by coral genus. Almost all reef flats showed evidence of mortality, representing 30 % of Bunaken reefs. For reef flat communities which were living at a depth close to the pre-El Niño mean low sea level, the fall induced substantial mortality likely by higher daily aerial exposure, at least during low tide periods. Altimetry data were used to map sea level fall throughout Indonesia, suggesting that similar mortality could be widespread for shallow reef flat communities, which accounts for a vast percent of the total extent of coral reefs in Indonesia. The altimetry historical records also suggest that such an event was not unique in the past two decades, therefore rapid sea level fall could be more important in the dynamics and resilience of Indonesian reef flat communities than previously thought. The clear link between mortality and sea level fall also calls for a refinement of the hierarchy of El Niño impacts and their consequences on coral reefs.

Argo observations from 2005 to 2013 are used to characterize spatial scales of temperature and salinity variations from the surface down to 1300 m. Simulations are first performed to analyze the sensitivity of results to Argo sampling; they show that several years of Argo observations are required to estimate spatial scales of ocean variability over 20° × 20° boxes. Spatial scales are then computed over several large-scale areas. Zonal and meridional spatial scales (Lx and Ly which are zero crossing of covariance functions) vary as expected with latitudes. Scales are of about 100 km at high latitudes and more of 700 km in the Indian and Pacific equatorial–tropical regions. Zonal and meridional scales are similar except in tropical–equatorial regions where zonal scales are much larger (by a factor of 2 to 3) than meridional scales. Spatial scales are the largest close to the surface and have a general tendency for temperature to increase in deeper layers. There are significant differences between temperature and salinity scales, in particular, in the deep ocean. Results are consistent with previous studies based on sparse in situ observations or satellite altimetry. They provide, however, for the first time a global description of temperature and salinity scales of variability and a characterization of their variations according to depths.

Single-molecule localization microscopy (SMLM) is a powerful tool for studying intracellular structure and macromolecular organization at the nanoscale. The increasingly massive pointillistic data sets generated by SMLM require the development of new and highly efficient quantification tools. Here we present FOCAL3D, an accurate, flexible and exceedingly fast (scaling linearly with the number of localizations) density-based algorithm for quantifying spatial clustering in large 3D SMLM data sets. Unlike DBSCAN, which is perhaps the most commonly employed density-based clustering algorithm, an optimum set of parameters for FOCAL3D may be objectively determined. We initially validate the performance of FOCAL3D on simulated datasets at varying noise levels and for a range of cluster sizes. These simulated datasets are used to illustrate the parametric insensitivity of the algorithm, in contrast to DBSCAN, and clustering metrics such as the F1 and Silhouette score indicate that FOCAL3D is highly accurate, even in the presence of significant background noise and mixed populations of variable sized clusters, once optimized. We then apply FOCAL3D to 3D astigmatic dSTORM images of the nuclear pore complex (NPC) in human osteosaracoma cells, illustrating both the validity of the parameter optimization and the ability of the algorithm to accurately cluster complex, heterogeneous 3D clusters in a biological dataset. FOCAL3D is provided as an open source software package written in Python.

Human–robot interaction requires the robot to recognize and convey emotions. Emotions also enhance adaptation by influencing deliberative actions. However, scientists traditionally relegate the emulation of emotions to high levels in multi-level architectures, where those emulated emotions collaborate with reasoning to come up with the best action. In contrast, in this research, we propose the use of emulated emotions at the lowest level of a cognitive architecture, for instance, robot motion control. Thus, the traditional definition of error used by a controller changes in order to include anticipation. The discrepancy between an anticipated ideal state and an anticipated robot state elicits an emotion. This simple emotion-inspired definition of the error improves the controller by more than 11% according to the definition of performance in this article, which argues that robot control architectures should use emulated emotions from their lowest levels.

Even if vesicoureteral reflux is a common condition in children, there are no guidelines about the best therapeutic approach. This study aims to compare the results of endoscopic injection and ureteral reimplantation in children with grade III, IV and V VUR. A multicenter retrospective study included children with grade III, IV and V VUR treated from 2003 to 2018 at three Departments of Pediatric Surgery. Patients were divided into Group A (endoscopic injections) and Group B (anti-reflux surgery), B1 (open, OUR), B2 (laparoscopic, LUR) and B3 (robot-assisted laparoscopic RALUR). Follow-up was at least 5 years. 400 patients were included, 232 (58%) in group A and 168 (42%) in group B. Mean age at surgery was 38.6 months [3.1-218.7]. Mean follow-up was 177.8 months [60-240]. Group A had shorter operative time than group B (P < 0.01); lower analgesic requirement (p < 0.05), shorter hospital stay (P < 0.05) and lower overall costs (p < 0.05), but higher postoperative PNPs (p < 0.01), lower success rate (p < 0.01) and higher redo-surgery percentage (p < 0.01). No differences in terms of postoperative complications, success rate and mean radiation exposure between the two groups. Endoscopy is associated with shorter operative time, shorter hospitalization and lower cost, also in case of multiple injections. Recurrence rate after surgery is lower meaning lower rate of re-hospitalization and radiation exposure for children., (© 2024. The Author(s).)

Laparoscopic Appendectomy (LPSA) is the first choice for appendectomy in pediatric surgery. Trans-Umbilical Laparoscopic Assisted Appendicectomy (TULAA) is another used technique. We compared both these procedures used for the treatment of acute appendicitis. The study was conducted between January 2019 to December 2020. Patients were divided into two groups: LPSA and TULAA groups. The collected data were: operative time, number of conversions, time of canalization and hospital stay. A total of 181 patients were included: 73 were kept in the LPSA and 108 in the TULAA group. Mean operative time was 70.9 minutes (range 45-130 min) for LPS and 56.4 (30-145 min) for TULAA group (p <0.0001). Complications rate showed no statistically significant difference between both the two groups. However, conversions showed a statistically significant difference (p=0.04). Both techniques showed similar results. TULAA technique takes a significantly shorter operating time. The selection between LPSA and TULAA techniques depends on the experience of the surgeon's work and the personal laparoscopic learning curve. In our experience LPSA was a useful technique to improve the laparoscopic skill of the pediatric surgery residents.

Introduction: Robotic surgery has shown explicit benefits and advantages in adults, but it is not yet strongly established in the pediatric population, even though its popularity is increasing, especially in the urologic field. Materials and methods: In this article we present our experience with the Da Vinci System (SI first and XI nowadays) at our pediatric institution in order to analyze our progress over the years. We considered all patients from the start of the robotic surgery program in 2016 until the end of 2021, dividing them into general abdominal surgery and genitourinary surgery. Analyzed data were the patient's demographic, details of surgery, and intra and post-operative complications. Results: The total number of patients (pts) included in this study was 76, of whom 40 (52%) were male and 36 (48%) were female. The mean age at surgery was 90.9 months (range 10-207 months), and the mean weight at surgery was 29.3 kg (range 9.5-68 kg). There were 18 general abdominal robotic surgeries and 58 genitourinary robotic surgeries performed. The most performed surgeries in these two categories were fundoplication for gastro-oesophageal reflux disease (11%) and Anderson-Hynes pyeloureteroplasty. The mean operative time was 224.2 min (range 72-530 min): the mean times in the two groups (general abdominal surgery and genitourinary surgery) were 165 min (range 84-204 min) and 194 min (range 95-360 min), respectively. A total of four (5%) minor complications were reported. The total conversions were two (2.6%) and the mortality rate was 0%. Conclusions: Pediatric robotic surgery is a field of considerable interest and it is rapidly expanding. In our experience, it is evident how the learning curve has increased gradually, but steadily, allowing us to advance from standardized surgery, such as fundoplication and pieloplasty, towards a more technically complex one, achieving the same good results. We believe that robotic surgery is very respectful of tissues and feasible, especially for reconstructive surgery. For these reasons, it could become of common use also in the pediatric population, overcoming impediments such as excessive cost and the lack of pediatric instruments, in order to be able to treat children with a progressively lower age and weight.

Background: Dog bites are a major cause of traumatic injury in children. The aim of this study was to determine the experience, management, and outcome of dog bite injuries in our department., Methods: We retrospectively reviewed the clinical records for 127 patients (mean age 7.15 ± 4.24 years, range 1 to 17 years; 68 males) affected by dog-related injuries, from 2012 to 2018. Characteristics of patients and dogs, type and severity of injuries, circumstances of the accidents, treatment and outcome were analyzed., Results: Of 141 wounds, 73 (51.8%) affected the head and neck, 62 (44%) the limbs, and six (4.2%) affected the trunk. According to the Mcheik classification, 107 lesions (75.9%) were stage 1, 26 (18.4%) stage 2, and eight (5.7%) stage 3. Seventy-eight percent of the cases involved known dogs. The breed of the dog was recorded in 62/127 cases (48.8%) and the most common were mongrels (23/62, 37.1%). Seventy-five percent of the attacks occurred during spring and summer. All patients underwent antibiotic prophylaxis and immediate surgical repair. Wound infection was observed in two patients. Three unsightly scars required rectification, with good cosmetic results in all cases., Conclusions: Our results are consistent with previous data showing that the typical dog-related injury occurs from a known dog, during spring and summer, and in younger boys, who are frequently exposed to head and neck wounds. Our experience showed the feasibility and safety of primary repair and antibiotic prophylaxis in all patients, with very low incidence of infection and good cosmetic results., (© 2020 Japan Pediatric Society.)

Objective: The authors present their experience in the management of pediatric patients with Herlyn-Werner-Wunderlich syndrome (HWWS) considering clinical classification and anatomical characteristics of the malformation., Methods: All the data of the patient presented at our Pediatric Surgery Unit from February 2010 to August 2015 were collected. According to the type of malformations, patients were divided in 3 groups: A (completely obstructed hemivagina), B (incompletely obstructed hemivagina), and C (communication between the duplicated cervices)., Results: Six patients were treated in the study period. The mean age was 9 years (2 months-15 years). According to the characteristics of the HWWS, we had 5 patients in group A, 1 in group B, and none in group C. One-stage surgical treatment was performed in all cases of complete obstruction, but in one case a second look was necessary for a better resection of the septum. At a mean follow-up of 18 months all patients were symptoms free., Conclusions: Prognosis of this malformation is good in case of early diagnosis and treatment. We suggest that when a renal agenesia is diagnosed, the patient needs an ultrasonographic follow-up of the contralateral kidney but also of the genital tract to find each minimal abnormalities, furthermore, a MRI scanning before the onset of menstruation can be necessary.

Introduction: The aim of this study was to evaluate the efficacy of the retroperitoneoscopic one -trocar -assisted pyeloplasty (OTAP) in children of different ages., Materials and Methods: Clinical data of all children who underwent OTAP for ureteropelvic junction (UPJ) obstruction at our Institution, between 2006 and 2014, were reviewed by focusing on demographics, surgical management, and outcomes. Data were analyzed by dividing patients into three groups according to age at operation: patients younger than 2 years (group 1), between 2 and 6 years (group 2), and older than 6 years (group 3)., Results: During the study period, 70 children (50 males) underwent OTAP (45 left and 25 right). A 10-mm ballooned trocar was inserted under the 11-12th rib and pneumoretroperitoneum was induced (12 mmHg pressure). Through an operative scope, the UPJ was carefully mobilized and exteriorized to the skin level to perform conventional Anderson-Hynes dismembered pyeloplasty. Mean age was 48 months (range, 1 month-14 years). Thirty-six patients (mean age 8.8 months) were in G1, 18 patients (mean age 4.2 years) in G2, and 16 patients (mean age 10.2 years) in G3. There were no intraoperative complications. Mean operative time was 137 minutes: 128 minutes (range, 85-213) in G1, 118 minutes (range, 90-215) in G2 (P > .05 versus G1), and 154 minutes (range, 95-215) in G3 (P < .05 versus G1; P < .05 versus G2). Conversion (an extension of the subcostal incision) rate was 27.1%: 16.6% in G1, 22.2% in G2 (P > .05 versus G1), and 56.25% in G3 (P < .05 versus G1; P < .05 versus G2). At a mean follow-up of 29 months (range, 12 months-5 years), recurrence was observed in 3 patients (2 G1, 1 G3)., Conclusions: Our results show that OTAP is a good alternative in children younger than 6 years. OTAP is more challenging in older children because of the thickness of the abdominal wall and the higher incidence of aberrant crossing vessels.

Vesicoureteral reflux (VUR) is the retrograde passage of urine from the bladder to the upper urinary tract. It is the most common congenital urological anomaly affecting 1-2% of children and 30-40% of patients with urinary tract infections. VUR is a major risk factor for pyelonephritic scarring and chronic renal failure in children. It is the result of a shortened intravesical ureter with an enlarged or malpositioned ureteric orifice. An ectopic embryonal ureteric budding development is implicated in the pathogenesis of VUR, which is a complex genetic developmental disorder. Many genes are involved in the ureteric budding formation and subsequently in the urinary tract and kidney development. Previous studies demonstrate an heterogeneous genetic pattern of VUR. In fact no single major locus or gene for primary VUR has been identified. It is likely that different forms of VUR with different genetic determinantes are present. Moreover genetic studies of syndromes with associated VUR have revealed several possible candidate genes involved in the pathogenesis of VUR and related urinary tract malformations. Mutations in genes essential for urinary tract morphogenesis are linked to numerous congenital syndromes, and in most of those VUR is a feature. The Authors provide an overview of the developmental processes leading to the VUR. The different genes and signaling pathways controlling the embryonal urinary tract development are analyzed. A better understanding of VUR genetic bases could improve the management of this condition in children.