Incorporation of nanostructured hydroxyapatite and poly(N-isopropylacrylamide) in demineralized bone matrix enhances osteoblast and human mesenchymal stem cell activity.

Demineralized bone matrix (DBM) is currently used in many clinical applications for bone augmentation and repair. DBM is normally characterized by the presence of bone morphogenetic proteins. In this study, the authors have optimized methods to obtain DBM under good manufacturing practice, resulting in enhanced bioactivity. The processed DBM can be used alone, together with nanostructured hydroxyapatite (nanoHA), or dispersed in a physiological carrier or hydrogel. In this study, osteoblasts (MG-63) and human bone marrow derived mesenchymal stem cells (hMSCs) were cultured on DBM pastes made in phosphate buffered saline solution or poly(N-isopropylacrylamide) (PNIPAAM) hydrogels with or without nanoHA. The authors observed that the presence of PNIPAAM reduced osteoblast adhesion, while the addition of nanoHA increased osteoblast adhesion, proliferation, interleukin-6 (IL-6) production, and reduced lactate dehydrogenase (LDH) production. Increasing concentrations of PNIPAAM in combination with nanoHA further increased osteoblast proliferation, and decreased IL-6 and LDH production. Incorporation of PNIPAAM in DBM enhanced hMSCs proliferation and collagen type-I production. Furthermore, a combination of PNIPAAM and nanoHA further increased alkaline phosphatase and osteocalcin production in hMSCs, independently from the concentration of PNIPAAM. This study shows that combinations of DBM with nanoHA and PNIPAAM seem to offer a promising route to enhance cell activity and induce osteogenic differentiation.

Toll-free telephone medical information on nocturnal enuresis: the first Italian experience over a two-year period.

PURPOSE: The aim of the study is to promote, through this toll-free number (TFN) service, a health communication program providing information on nocturnal enuresis (NE) and related problems by a subspecialty-trained physician and to collect the callers' characteristics too. All phone calls were scheduled to data collections. METHODS: The telephone service operated as follows: the TFN was available from March 1 to May 31, 2000, and from April 1 to June 30, 2001. People called the free telephone line and received information needs. RESULTS: A total of 12,806 calls were received by the help line during the two study periods (7,046 in 2000 and 5,760 in 2001). Of the calls, 61% came from subjects with NE without pharmacological or non-pharmacological treatment, 16% (2000) and 13% (2001) came from subjects >12 years old. CONCLUSIONS: A TFN for NE can be both accessible and effective in order to provide information on NE and related problems. Finally, such a service should be included in a national program to improve health and well-being.

Health care of children living with their mother in prison compared with the general population.

BACKGROUND: Italian law allows female prisoners in specific "nest areas" to keep their babies with them until the child reaches the age of 3 years. We describe health care of children living in the nest areas and we compare this condition with the general population. METHODS: Our study was conducted in the female detention centre of Rome Rebibbia, Italy. Clinical diaries of all babies have been screened. The pediatrics ambulatory of A. Gemelli Hospital of Rome provided all data for comparison. RESULTS: We describe 391 children (150 in the prison group, G1; 150 children with Italian parents, G2, and 91 children with foreign parents, G3) with similar characteristics. There were statistical differences between-groups in respect of the auxological data, gestational age (lower in G1 vs G2, p < 0.0004, and lower in G1 vs G3, p < 0.03), time of weaning age earlier in G1 vs G2, (p < 0.035), number of respiratory infective disease (G1>G2, p < 0.0001, and G1>G3, p < 0.003). We also found inadequate immunisation status in children at their admission to prison. According to our observations children received good sanitary assistance inside the prison and the adjustment of their immunisation status when they stayed in prison for a long enough period. CONCLUSIONS: The significant information shown by our data suggest that children living in prison with their mothers represent a vulnerable group with particular healthcare needs.

Polythelia: still a marker of urinary tract anomalies in children?

OBJECTIVE: Supernumerary nipples (SNN), or polythelia, are the most common form of the accessory mammary tissue malformation. The frequency of this condition ranges from 0.2% to 5.6% depending on various factors. This condition is associated with several anomalies, although this association is often controversial. The aim of this study was to evaluate the association between SNN and kidney/urinary tract (K/UT) anomalies, where anomalies is taken to mean functional disorders, malformations and diseases. MATERIAL AND METHODS: A case-control study was performed. The study evaluated 166 children (case group) referred to the Pediatric Nephrology Unit of the Department of Pediatrics of the Catholic University of Rome and 182 children (control group) admitted to the Department of Pediatrics because of pathologies not involving the urinary tract. RESULTS: There were 11 children with SNN in the case group, and only two patients in the control group (6.62% vs 1.09%, p<0.05). CONCLUSION: The results show a high incidence of K/UT anomalies in children with SNN, and therefore K/UT should be investigated in this specific population.

Should a renal biopsy be performed at the first relapse of 'clinical nephrotic syndrome'?

Immunoglobulin A (IgA) nephropathy is considered to be the commonest primary glomerulonephritis worldwide. The commonest clinical presentation of the disease is macroscopic hematuria, and nephrotic syndrome (NS) at the time of onset of symptoms is a predictor of poor outcome in both adults and children. In this report we describe a case of IgA nephropathy in a 15-year-old girl with a diagnosis of NS who was admitted to our hospital following 15 days of remarkable weight gain, and eyelid and pretibial oedema. NS was diagnosed when she was 3 years old. During the period between diagnosis and our observation the patient presented with three episodes of relapse. After the third episode a renal biopsy was performed and, together with clinical data, this enabled us to make the diagnosis of IgA nephropathy. NS is now recognized as a possible clinical manifestation of an IgA nephropathy, even at onset. Based on this case report, we suggest that a more vigilant management of children with NS may be necessary, even if they do not have atypical characteristics at onset. We suggest that it may be better to perform a renal biopsy at the time of first relapse.

Homotoxicological remedies versus desmopressin versus placebo in the treatment of enuresis: a randomised, double-blind, controlled trial.

The aim of this trial was to compare the safety and efficacy of homotoxicological remedies versus placebo and versus desmopressin (dDAVP) in the treatment of monosymptomatic nocturnal enuresis (MNE). We conducted a randomised, double-blind, double-dummy, controlled trial in which 151 children with MNE were randomly assigned to receive oral homotoxicological remedies (n = 50), dDAVP (n = 50) or placebo (n = 51). The primary outcomes were: the reduction of wet nights per week after 3 months of therapy; the evaluation of the numbers and percentages of non-responders and responders; the number of children relapsing after initial response and the number of children attaining 14 consecutive dry nights during the treatment. The secondary outcome was the detection of adverse effects. Baseline clinical characteristics were similar in the three groups of patients. After the 3 months of therapy there was a significant difference between the three groups (P < 0.001) in the mean number of wet nights per week. The daily dose of dDAVP produced a statistically significant decrease (62.9%) in wet nights compared to placebo (2.4%) (P < 0.001) and compared to homotoxicological remedies (30.0%) (P < 0.001). There was a significant decrease in wet nights among the group treated with homotoxicological medications if compared with placebo (P < 0.001). The full response achieved with homotoxicological remedies (20%) was superior if compared with placebo (0%) (P < 0.001). Homotoxicology was superior to placebo (P < 0.001) with regard to the number of children attaining 14 consecutive dry nights during treatment. Our study demonstrates that homotoxicology is safe and effective when compared with placebo, even if it is significantly less effective than dDAVP in this clinical condition.

Penile involvement in Henoch-Schönlein purpura with good prognosis.

Henoch-Schönlein purpura (HSP), the commonest vasculitis in children, occurs most frequently between the ages of 4 and 6 years. We report the case of a 3-year-old boy with an otomastoiditis who was treated with cephalosporin and corticosteroids following a typical purpuric skin rash diagnosed as HSP. The patient also developed an acute occurrence of impairment of the glans, prepuce and penis 4 days after recovery that completely disappeared after a further 2 days, with the cutaneous rash subsiding on discharge from hospital.

Increased excretion of glycosaminoglycans in children with urinary incontinence compared to those with monosymptomatic nocturnal enuresis.

OBJECTIVE: To analyse the urinary excretion of glycosaminoglycans (GAGs) in patients with either urinary incontinence or nocturnal enuresis. MATERIAL AND METHODS: The study population comprised 65 patients with either nocturnal enuresis (n=34) or urinary incontinence (n=31) and 67 controls. Excretion of urinary GAGs was assessed using the sodium tetraborate-carbazole method. RESULTS: GAG excretion in patients with urinary incontinence was significantly higher than that in controls (p<0.000129) and in children with nocturnal enuresis (p<0.016). There were no age or sex differences in GAG excretion in the three groups studied. CONCLUSION: Increased GAG excretion in patients with urinary incontinence suggests an association with urothelial/detrusor pathology.