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Purpose: Dehydration is a paediatric medical emergency but there is no single standard parameter to evaluate it at the emergency department. Our aim was to evaluate the reliability and validity of capillary refilling time as a triage parameter to assess dehydration in children. Methods: This was a prospective pilot cohort study of children who presented to two paediatric emergency departments in Italy, with symptoms of dehydration. Reliability was assessed by comparing the triage nurse's measurements with those obtained by the physician. Validity was demonstrated by using 6 parameters suggestive of dehydration. Comparison between refilling time (RT) and a validated Clinical Dehydration Score (CDS) was also considered. The scale's discriminative ability was evaluated for the outcome of starting intravenous rehydration therapy by using a receiver operating characteristic (ROC) curve. Results: Participants were 242 children. All nurses found easy to elicit the RT after being trained. Interobserver reliability was fair, with a Cohen's kappa of 0.56 (95% confidence interval [CI], 0.41 to 0.70). There was a significant correlation between RT and weight loss percentage (r-squared=-0.27; 95% CI, -0.47 to -0.04). The scale's discriminative ability yielded an area under the ROC curve (AUC) of 0.65 (95% CI, 0.57 to 0.73). We found a similarity between RT AUC and CDS-scale AUC matching the two ROC curves. Conclusion: The study showed that RT represents a fast and handy tool to recognize dehydrated children who need a prompt rehydration and may be introduced in the triage line-up. [ABSTRACT FROM AUTHOR]

Objective: To test the prognostic role of treatment delay in patients affected by prostate cancer (PCa).Materials and Methods: The study included 2,653 patients treated with radical prostatectomy (RP) at a single institution between 2006 and 2011. The evaluated outcomes were biochemical recurrence (BCR) and clinical recurrence (CR). Multivariable Cox regression analysis was used to test the association between time from diagnosis to RP and oncological outcomes. Nonparametric curve fitting methods were used to graphically explore the relationship between time from diagnosis to RP and oncological outcomes. Sensitivity analyses were repeated in the subgroups of low-, intermediate-, and high-risk patients.Results: At median follow-up of 56 months (interquartile range: 26, 92), 283 patients experienced BCR, and 84 patients developed CR. Median time from PCa diagnosis to surgery was 2.8 months (interquartile range: 1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (hazard ratio = 1.02, P = 0.0005) and CR (hazard ratio = 1.03, P = 0.0002). Using Nonparametric curve fitting methods, a significant increased risk of BCR and CR after approximately 18 months was observed. However, when sensitivity analyses were repeated according to risk groups, this effect was maintained in high-risk patients only, and such time interval was reduced to 12 months.Conclusions: Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark. [ABSTRACT FROM AUTHOR]

It is currently debated whether specific psychiatric disorders or Internalizing versus Externalizing psychopathological dimensions are associated to Internet Addiction Disorder (IAD). We explored this issue in youth with and without IAD referred to a third-level Department of Adolescent Psychiatry during a 12-month period. All the 101 consecutively referred adolescents were assessed using categorical (Schedule for Affective Disorders and Schizophrenia for School- Age Children-K-SADS) and dimensional (Child Behavior Checklist-CBCL) measures of psychopathology, and two measures for addictive behaviors, Internet Addiction Test (IAT) (used as screening for detecting IAD patients) and Use, Abuse, Dependence on the Internet (UADI) inventory. According to an IAT cutoff score of 50, 39 patients (38.6%) presented IAD. The IAD and the no IAD groups did not differ according to age and gender. Most of the IAD patients (92.3%) endorsed multiple addictions. The IAD group had higher scores in all the UADI dimensions, except for Impact of Life. All the IAD patients endorsed psychiatric diagnoses, but only Autism Spectrum Disorders were more represented in the IAD group. According to the CBCL, patients with IAD had more social problems and anxiety symptoms. However, clusters analysis with the t-scores of the CBCL scales of Internalizing and Externalizing domains showed no differences in IAT and UADI scores among clusters. The small sample size and a selection bias (referrals for severe symptomatology) limit the generalization of the findings. Comorbidity should be systematically assessed in IAD adolescents, with categorical and dimensional measures, as it may guide personalized treatments. [ABSTRACT FROM AUTHOR]