The long-term added value of voiding school for children with refractory non-neurogenic overactive bladder: an inpatient bladder rehabilitation program.

INTRODUCTION & BACKGROUND: Despite adequate management, 20% of children with overactive bladder (OAB) syndrome fail to improve their bladder function. To approach the need for alternative strategies, an inpatient bladder rehabilitation 'voiding school' program was established. OBJECTIVE: The objective of this study was to evaluate the short- and long-term (1-year follow-up) outcome of this voiding school program in children with refractory OAB. In addition, the authors aimed to identify which children achieved the best outcomes with this voiding school program. STUDY DESIGN: The charts of all children (n = 357, mean age: 9.7 ± 2.0 years, 63.6% boys) with refractory OAB who attended voiding school between 2000 and 2010 were reviewed. A linear mixed model with random intercept was used to evaluate the incontinence (expressed by enuresis and daytime incontinence voiding scores) and maximal voiding volume (MVV). RESULTS & DISCUSSION: This study demonstrated an overall beneficial long-term effect of the inpatient program on day- and night-time incontinence, in which 36.6% of children achieved dryness during day- and night-time. In addition, the mean overall decline in the number of wet nights and days declined with 4 extra dry days and/or nights per week, in comparison with the level of continence before attending the voiding school program. In contrast, only a temporary increase in MVV was seen, however, without relapse incontinence. At last, the authors identified the negative impact of decreasing age, male sex, dysfunctional voiding and nocturnal polyuria on the overall outcome of the inpatient program. CONCLUSION: An inpatient rehabilitation 'voiding school' program is a successful and safe treatment modality for children with refractory OAB that results in long-term significant increase of continence, as well as amelioration in degree of severity. The worst outcomes of this voiding school program were detected in children with young age, who were boys, or had associated nocturnal polyuria, dysfunctional voiding, and/or faecal incontinence.

Neuropsychological functioning related to specific characteristics of nocturnal enuresis.

INTRODUCTION/BACKGROUND: There is a high comorbidity demonstrated in the literature between nocturnal enuresis and several neuropsychological dysfunctions, with special emphasis on attention deficit hyperactivity disorder (ADHD). However, the majority of the psychological studies did not include full non-invasive screening and failed to differentiate between monosymptomatic nocturnal enuresis (MNE) and non-MNE patients. OBJECTIVE: The present study primarily aimed to investigate the association between nocturnal enuresis and (neuro)psychological functioning in a selective homogeneous patient group, namely: children with MNE and associated nocturnal polyuria (NP). Secondly, the study investigated the association between specific characteristics of nocturnal enuresis (maximum voided volume, number of wet nights and number of nights with NP) and ADHD-inattentive symptoms, executive functioning and quality of life. STUDY DESIGN: The psychological measurements were multi-informant (parents, children and teachers) and multi-method (questionnaires, clinical interviews and neuropsychological testing). RESULTS: Thirty children aged 6-16 years (mean 10.43 years, SD 3.08) were included. Of them, 80% had at least one psychological, motor or neurological difficulty. The comorbid diagnosis of ADHD, especially the predominantly inattentive presentation, was most common. According to the teachers, a low maximum voided volume (corrected for age) was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. No significant correlations were found between specific characteristics of enuresis and quality of life. Details are demonstrated in Table. DISCUSSION: The children were recruited from a tertiary referral centre, which resulted in selection bias. Moreover, NP was defined as a urine output exceeding 100% of the expected bladder capacity for age (EBC), and not according to the expert-opinion-based International Children's Continence Society norm of 130% of EBC. The definition for NP of a urine output exceeding 100% of the EBC is more in line with the recent findings of the Aarhus group. CONCLUSIONS: For children with MNE and associated NP, a high comorbidity with the predominantly inattentive presentation of ADHD was demonstrated. Children experienced problems with daytime functioning in relation to their wetting problem at night. According to the teachers, a low maximum voided volume was associated with more attention problems, and a high number of nights with NP was associated with more behaviour-regulation problems. Although comorbidity is still the appropriate word to use, the observation favours a more complex pathogenesis of enuresis with a common pathway in the central nervous system, including: neurotransmitters, influencing neuropsychological functioning as well as sleep, circadian rhythm of diuresis and bladder function control.

Data-analytical stability of cluster-wise and peak-wise inference in fMRI data analysis.

BACKGROUND: Carp (2012) demonstrated the large variability that is present in the method sections of fMRI studies. This methodological variability between studies limits reproducible research. NEW METHOD: Evaluation protocols for methods used in fMRI should include data-analytical stability measures quantifying the variability in results following choices in the methods. Data-analytical stability can be seen as a proxy for reproducibility. To illustrate how one can perform such evaluations, we study two competing approaches for topological feature based inference (random field theory and permutation based testing) and two competing methods for smoothing (Gaussian smoothing and adaptive smoothing). We compare these approaches from the perspective of data-analytical stability in real data, and additionally consider validity and reliability in simulations. RESULTS: There is clear evidence that choices in the methods impact the validity, reliability and stability of the results. For the particular comparison studied, we find that permutation based methods render the most valid results. For stability and reliability, the performance of different smoothing and inference types depends on the setting. However, while being more reliable, adaptive smoothing can evoke less stable results when using larger kernel width, especially with cluster size based permutation inference. COMPARISON WITH EXISTING METHODS: While existing evaluation methods focus on validity and reliability, we show that data-analytical stability enables to further distinguish between performance of different methods. CONCLUSION: Data-analytical stability is an important additional criterion that can easily be incorporated in evaluation protocols.

Variation in the degree of D-xylose substitution in water-extractable European durum wheat (Triticum durum desf.) semolina arabinoxylans.

Durum wheat (Triticum durum Desf.) semolina water-extractable arabinoxylan (TWEAX) (yield 0.28%, arabinose-to-xylose ratio (A/X) 0. 62) was fractionated by a stepwise increase in ethanol concentration (up to 65%). The A/X ratios of the resulting fractions varied between 0.42 and 0.80. With increasing ethanol concentrations, increasing A/X ratios went hand in hand with a relative increase of low molecular weight compounds, indicating that high molecular weight compounds with a low A/X ratio are preferentially precipitated from alcohol/water mixtures. (1)H NMR showed that, whereas in TWEAX the levels of unsubstituted xyloses (X(0)), monosubstituted (X(1)), and disubstituted (X(2)) xyloses were 63.1%, 11.8%, and 25.1%, respectively, fractions that precipitated with increasing ethanol concentrations had decreasing levels of X(0). Simultaneously, the level of X(1) decreased equally until it leveled of at ca. 10%. Concomitantly, the level of X(2) increased. The levels of X(0), X(1), and X(2) varied between 69.7% and 53.4%, 18.2% and 10.7%, and 12.2% and 35.9%, respectively.