Urethral multiplicity in boys: systematic review of case reports and case series from the last 15 years.

Introduction: Urethral multiplicity is a rare congenital anomaly characterized by the presence of two or more urethral channels. It is more common in males and can cause double urinary stream, incontinence, obstruction, and recurrent urinary infections. Diagnosis is difficult due to diverse clinical manifestations. Implementing an evidence-based treatment plan is challenging due to the need for more concise and informative summary publications. Our paper provides a comprehensive review of the management of this pathology and might serve as a valuable resource for pediatric urologists and specialists in the field. Methods: A comprehensive search in four electronic databases, PubMed®, PubMed Central® (PMC), Scopus, and Clarivate Analytics's Web of Science (WoS), was conducted to identify case reports and series published between 2008 and 2023 on urethral multiplicities. The quality of the articles was assessed using qualified instruments. Covidence® tool-guided synthesis was followed by individual patient data extraction. Further classifications and analysis were made using Microsoft Excel®. Results: Out of the 90 papers included in the review, 62 were case presentations, and 28 were case series. We found 250 boys with urethral multiplicity. Based on Effman's classification, there were 38 cases of type I (15.3%), 21 type IIA1 (8.4%), 55 type IIA2 (22.1%), 91 type IIA2Y (36.5%), 4 type IIB (1.6%), and 6 type III (2.4%) urethral duplications. There were 19 cases of prepubic sinuses (7.6%), 9 triplications (3.6%), and 6 unknown forms (2.4%). We have provided data for each type, including clinical presentation, investigations, surgical management, and outcomes. Conclusions: Urethral multiplicities are a rare and varied group of malformations that require high-quality imaging examination for successful management. Treatment is specific to each patient and may depend on the surgeon's preference or skill. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID = CRD42023471685, identifier (CRD42023471685).

Not only perception but also grasping actions can obey Weber's law.

Weber's law, the principle that the uncertainty of perceptual estimates increases proportionally with object size, is regularly violated when considering the uncertainty of the grip aperture during grasping movements. The origins of this perception-action dissociation are debated and are attributed to various reasons, including different coding of visual size information for perception and action, biomechanical factors, the use of positional information to guide grasping, or, sensorimotor calibration. Here, we contrasted these accounts and compared perceptual and grasping uncertainties by asking people to indicate the visually perceived center of differently sized objects (Perception condition) or to grasp and lift the same objects with the requirement to achieve a balanced lift (Action condition). We found that the variability (uncertainty) of contact positions increased as a function of object size in both perception and action. The adherence of the Action condition to Weber's law and the consequent absence of a perception-action dissociation contradict the predictions based on different coding of visual size information and sensorimotor calibration. These findings provide clear evidence that human perceptual and visuomotor systems rely on the same visual information and suggest that the previously reported violations of Weber's law in grasping movements should be attributed to other factors.

Current perspectives in hypospadias research: A scoping review of articles published in 2021 (Review).

Hundreds of papers are written about hypospadias every year referring to all aspects of the pathology, being one of the most common congenital malformations. The present study conducted a scoping review of articles published in 2021 to present the main issues and summarize current perspectives and achievements in the field. It searched for the keyword 'hypospadias' in the three most popular databases (PubMed, Scopus and Web of Science). After the analysis of the publications, they were categorized into different domains. The present review was performed respecting the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA ScR) guidelines. A total of 284 articles were included. These were published in 142 different journals. The most accessed was the Journal of Paediatric Urology with 54 articles. The main identified domains were related to surgical techniques, postoperative care, complications, anesthesia, anatomical factors, genetics, environmental factors, endocrinology, associated malformations, questionnaires and recommendations, management, biological materials, animal models, retrospective studies of centers, social media, bibliometrics, small gestational age, neoplasm, or fertility. Promising modifications of existing surgical techniques were presented with improved outcomes for both the proximal and distal types of hypospadias. Relevant anatomical and etiological, and also genetic factors were clarified. Aspects of the peri- and postoperative management referring to the antibiotherapy, analgesia, dressing techniques, and the future use of novel bioengineering agents to prevent, reduce or treat the occurring complications were discussed.

EEG response in humans for frequency-tagged anticorrelated random-dot stereograms: Increased coherency and alpha oscillations.

In humans, the presence of a neural mechanism triggered by anticorrelated random-dot stereograms have been theorized based on animal models from invasive studies, but have not been experimentally verified with the use of electroencephalography. In this study, we employed a phase-consistent, temporally modulated alternating depth stereogram stimulus, where we created anticorrelation by inverting the contrast between the eyes. We recorded the electrical response of the resulting brain oscillations of our four participants using EEG in both the correlated and anticorrelated conditions and whether they perceived depth movement. Our analysis found that the correlated stereograms elicited a strong coherency at the even harmonics of the depth alternation, and the anticorrelated stimulus created lower coherency peaks at the first harmonic of the depth alternation, even when participants did not report the depth movement to be visible. While both conditions created a diminishment of spectral power in the beta band, we found that the anticorrelated condition created increased spectral power in the alpha band. We experimentally verified the presence of a neural mechanism triggered by anticorrelated random-dot stereograms in the human brain with our coherency analysis and that it would not have been detected with the conventional spectral analysis due to the weakness of the response. We hypothesize that the decreased beta oscillations are related to either visual discomfort and visual attention to our stimulus, and that the increased alpha oscillations in the anticorrelated condition is a response to the incorrect depth information created by the stereogram.

Rapunzel Syndrome-An Extremely Rare Cause of Digestive Symptoms in Children: A Case Report and a Review of the Literature.

Rapunzel syndrome is an extremely rare condition seen in adolescents or young females with psychiatric disorders consisting of a gastric trichobezoar with an extension within the small bowel. The delays in diagnosis are common since in its early stages, it is usually asymptomatic. We report the case of a 13-year-old girl admitted in our clinic for abdominal pain, anorexia, and weight loss. The clinical exam pointed out diffuse alopecia, a palpable mass in the epigastric area, and abdominal tenderness at palpation, the patient weighing 32 kg. The laboratory tests showed anemia. The abdominal ultrasound showed a gastric intraluminal mass with a superior hyperechoic arc. The upper digestive endoscopy revealed a mass formed by hair, mucus, and food occupying the gastric cavity with the extension into the duodenum confirming the diagnosis of Rapunzel syndrome. The giant trichobezoar of 511 g, measuring 17 × 7 × 6.5 cm with a tail of approximately 3 cm, was successfully removed through laparotomy. Although rare, Rapunzel syndrome must never be forgotten as a differential diagnosis for digestive symptoms since its early detection hinders the occurrence of further complications.

Optimal Approach for Signal Detection in Steady-State Visual Evoked Potentials in Humans Using Single-Channel EEG and Stereoscopic Stimuli.

In EEG studies, one of the most common ways to detect a weak periodic signal in the steady-state visual evoked potential (SSVEP) is spectral evaluation, a process that detects peaks of power present at notable temporal frequencies. However, the presence of noise decreases the signal-to-noise ratio (SNR), which in turn lowers the probability of successful detection of these spectral peaks. In this paper, using a single EEG channel, we compare the detection performance of four different metrics to analyse the SSVEP: two metrics that use spectral power density, and two other metrics that use phase coherency. We employ these metrics find weak signals with a known temporal frequency hidden in the SSVEP, using both simulation and real data from a stereoscopic apparent depth movement perception task. We demonstrate that out of these metrics, the phase coherency analysis is the most sensitive way to find weak signals in the SSVEP, provided that the phase information of the stimulus eliciting the SSVEP is preserved.

Upper Extremity Fractures in Children-Comparison between Worldwide, Romanian and Western Romanian Region Incidence.

(1) Background: Fractures represent a significant part of all pediatric injuries, with distal forearm fracture being the most common fracture type in children. (2) Methods: In this comparative, epidemiological study we collected fracture incidence data from the scientific literature and compared it to real-world data extracted from the Romanian national and regional hospital database. In order to collect information on the epidemiology of upper extremity fractures in children, we conducted a systematic literature review on Medline, via PubMed. Extracted incidence data were stratified by fracture location, age or age interval and gender. Nationwide and Western Region incidence values were calculated for different fracture locations of the upper extremity using data extracted from a centralized hospital database. Incidence values were calculated using the mid-2018 census data. The search was restricted to the pediatric population. (3) Results: Incidence values for upper arm fractures nationwide and for Western Region were 54.83/100,000 person-years and 64.79/100,000 person-years, respectively. Forearm fractures had an incidence of 139.77/100,000 person-years and 139.56/100,000 person-years, respectively. The overall incidence of upper extremity fractures nationwide and for the Romanian Western Region were 206.02/100,000 person-years and 220.14/100,000 person-years, respectively. (4) Conclusions: Incidence of upper extremity fractures in the pediatric population varies according to the analyzed data. The calculated incidence depends on the site of fractures, assessed population (worldwide, Romanian population or regional-Western part of Romania) or patients' age.

MOTOM toolbox: MOtion Tracking via Optotrak and Matlab.

We present a Matlab toolbox that allows the user to control and collect data using Northern Digital's Optotrak system. The Optotrak is a modular motion capture system, which tracks the positions of infrared markers. It also supports grouping markers together as a single body. The body's position, orientation as well as all the marker position data can be obtained simultaneously. The installation, set-up and alignment procedures are highly automated, and thus require minimal human interaction. We provide additional scripts, functions, documentation and examples to help experimenters integrate the Optotrak system into experiments using recent 64-bit computers and existing Matlab toolboxes.

Finite-element-based 3D computer modeling for personalized treatment planning in clubfoot deformity: Case report with technique description.

RATIONALE: In clubfoot deformity, planning of corrective treatment requires a complex understanding of the foot anatomy, as well as of the geometry and distribution of altered mechanical forces acting at the level of the deformed foot. At the same time, treatment success depends largely on the selection of the most appropriate shape and angles of the customized orthesis developed for foot correction. Therefore, a complex assessment of the intensity and distribution of the mechanical forces at this site is mandatory prior to initiation of any corrective therapy. PATIENT CONCERNS: We present here the case of a 3-year-old male child with clubfoot deformity, weighting 20 kg, with no other congenital malformations, in whom finite element modeling (FEM) technology associated with a newly developed technique of three-dimensional (3D) computational simulation was applied for personalized treatment planning. INTERVENTIONS: The FEM-based computational 3D simulation technique allowed selection of the corrective treatment associated with the most physiologic pattern of force distribution at the level of the foot. OUTCOMES: The proposed technique led to selection of the most appropriate therapy that successfully corrected the foot deformity. After 3D computer simulations, the elongations recorded were 2.71 cm for Achilles tendon, 1.69 cm for anterior tibialis tendon, 1.35 cm for the long flexor of the toes, and 1.69 cm for the long flexor of the hallux. The Von Mises equivalent stress distribution was σ = 4.26 MPa, not exceeding the elastic capacity of the bones, therefore the residual deformations were minimal. The customized treatment selected in this way was highly appropriate for the child, and led to complete recovery of the deformity in three months. LESSONS: This case is the first one in which FEM-based computational 3D modeling was applied for selection of treatment strategy in a child with clubfoot. The case reported here illustrates the role of advanced medical computer technology, based on complex image processing, FEM and 3D simulations, in providing an effective clinical decision support tool for personalized treatment selection in children with clubfoot deformity.

Kite versus Ponseti Method in the Treatment of 235 Feet With Idiopathic Clubfoot: Results of a Single Romanian Medical Center.

Congenital idiopathic clubfoot (CC) represents the fifth common most congenital malformation which may be treated conservatively or by surgery. In this article, we present the results obtained in our clinic after conservative therapy performed with 2 methods.A total of 235 consecutive feet (161 patients) were conservatively treated using Kite (n = 129) and Ponseti method (n = 106). The Dimeglio score was determined before and at 6 months after treatment to compare the 2 methods. All of the patients were treated in their first week of life.CC was more frequently diagnosed in males (n = 93; 57.76%), bilaterality being seen in 45.96% of the patients (n = 74). Although before therapy the Dimeglio score was similar in both groups (P = 0.85), it was significantly improved in patients treated by Ponseti method (P = 0.005). Duration of therapy was also longer in patients from Kite versus Ponseti group (20 vs 11 weeks). Failure of orthopedic treatment was more frequent in Kite group (30.32% vs 8.49% of the patients) and the relapses rate at 6 months was also higher (35.65% vs 11.32%).The conservative method used to treat the CC should be adapted on the patient's age and Ponseti method seems to be the most effective type of treatment used for patients treated in their first week of life. Dimeglio score can be successfully used for evaluation of these children. This is the eighth published study that compare the efficacy of Kite versus Ponseti method.

Arteriovenous synovial hemangioma of the popliteal fossa diagnosed in an adolescent with history of unilateral congenital clubfoot: case report and a single-institution retrospective review.

Synovial hemangioma (SH) is a very rare soft tissue tumor; in our department, SH represented 0.07% from all soft tissue tumors (one case from 1311 soft tissue tumors), and 0.78% from all excised hemangiomas (one case from 128 hemangiomas) diagnosed over a five-year period. The aim of this paper was to present the clinicopathologic characteristics of hemangiomas and particularities of one SH of the popliteal fossa diagnosed in an athletic adolescent with previously corrected congenital clubfoot. To our knowledge, this is the 275 case of reported SH. A 13-year-old trick cyclist presented with two-year history of slowly growing mass of the left posterior fossa. The magnetic resonance imaging of the left knee showed a juxta-articular mass with intramuscular component. Open excision of the tumor and partial removal of the synovial membrane was the therapy of choice. Histopathological examination revealed clusters of large arteries and veins embedded in a fibrotic tissue, the tumor mass being lined by synovial membrane. Intramuscular growing was also confirmed. Without any other postoperative therapies, no recurrence or functional disorders were noted after 21 months of follow-up. SH of the knee should be excised as soon as possible to avoid complications such as muscle invasion and risk of recurrence.

Surgical reconstruction of the genitalia in a 3-year-old infant with a 46XX karyotype: case report.

UNLABELLED: A 3-year-old patient was hospitalized with ambiguous genitalia (clitoromegaly, labioscrotal fusion, absence of vaginal introitus), classified as stage III/IV according to Prader's virilization scale. Our patient, with a 46XX karyotype, was previously diagnosed with congenital adrenal hyperplasia caused by a deficiency of the adrenal enzyme 21-hydroxylase; corticosteroids and salt replacement therapy have been used. At the present admission, the surgical treatment consisted on clitoroplasty (with the removal of erectile tissue), reconstruction of the labia minor, creation of a neovulva and vaginoplasty. It was a single-step operation to restore the anatomical female structures. She had an uneventful postoperative period and the wound healed well with good cosmetic results. We present the details about the surgical procedure and a short review of data from literature. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Morphological aspects and distribution of interstitial cells of Cajal in the human upper urinary tract.

OBJECTIVE: The mechanism by which the ureter propels urine towards the bladder has a myogenic origin, through peristaltic contractions. This pyeloureteral autorhythmicity is generated by specialized, electrically active cells, the interstitial cells of Cajal, located in the proximal regions of the upper urinary tract. The aim of this study was to describe the exact location and the distribution of interstitial Cajal cells in the human upper urinary tract and to analyze their normal number and morphology. This is a preliminary study, which will allow the study of these cells in different urinary tract pathologies. MATERIAL AND METHOD: Urinary tract fragments were sampled at different levels, from 13 autopsy cases. Cases with clinical evidence of renal disease, and with histological changes in the kidney or in the urinary tract tissue samples, visible in hematoxylin-eosin staining, were excluded. The interstitial Cajal cells were highlighted with anti-CD117 antibody, immunohistochemically. RESULTS: Cajal cells were indirectly highlighted by the presence of a finely granulated cytoplasm indicating immunoreactivity. These cells were spindle-shaped or stellate, with cytoplasmic extensions at one or both poles of the cell and large oval nucleus. We found that interstitial Cajal cells were located at all upper urinary tract levels, with a higher predominance in the calyces and pyelon. Interstitial Cajal cells were observed mostly between the two layers of the muscularis, but also between the muscle bundles. Most often, these cells were parallel to the muscle fibers. CONCLUSION: Our study describes the method of detection of interstitial Cajal cells in normal human urinary tract. These results can be used to analyze the number, morphology and the location of these cells in different congenital pathologies, such as vesicoureteral reflux, pyeloureteral junction obstruction or primary obstructive megaureter.

Congenital clubfoot in children after walking age: management and evaluation of 41 feet with the dimeglio score.

INTRODUCTION: Congenital Clubfoot (CC) is one of the most frequent orthopedic lesions in patients younger than 10-15 years. The surgical correction is more difficult in children over 1.5 years, compared to newborns, due to advanced osteoarticular development and higher rigidity of the foot. The aim of this study was to report the results of our experience regarding the combined orthopedic-surgical treatment of CC and the follow-up prognostic value of Dimeglio score in children aged between 1.5 to 12 years. MATERIAL AND METHODS: From June 2009 and May 2012, 31 consecutive patients with CC, aged between 1.5 to 12 years, underwent surgical treatment. To assess the results, pre-operative and post-operative Dimeglio scores, at 6 months after surgery, were compared in each of the cases. An adapted Ponseti-Mitchelle orthosis-bar was used for aftercare. RESULTS: The mean age of patients enrolled in this study was 4.32±2.04 years old. From the 31 patients, 10 had bilateral deformity; surgical intervention was performed for a total of 41 feet. Independently by the age of patients, between pre-operative and post-operative evaluation, the Dimeglio score regressed from a mean of 11.70±7.43 (ranged between 4 and 18) to 3.80±0.96 (ranged between 0 and 12). Unfavorable outcome was observed in 5 feet; the success correction rate was 85.37%. CONCLUSION: This study reveals that CC can also be treated in older children by using a proper orthopedic, surgical and post-operative management. The Dimeglio score is useful, easy to use and relevant also in children over 1.5 years.