Requirements for Supporting Diagnostic Equipment of Respiration Process in Humans.

There is abundant worldwide research conducted on the subject of the methods of human respiration process examination. However, many of these studies describe methods and present the results while often lacking insight into the hardware and software aspects of the devices used during the research. This paper's goal is to present new equipment for assessing the parameters of human respiration, which can be easily adopted for daily diagnosis. This work deals with the issue of developing the correct method of obtaining measurement data. The requirements of the acquisition parameters are clearly pointed out and examples of the medical applications of the described device are shown. Statistical analysis of acquired signals proving its usability is also presented. In the examples of selected diseases of the Upper Respiratory Tract (URT), the advantages of the developed apparatus for supporting the diagnosis of URT patency have been proven.

Laparoscopic histological mapping for the determination of the length of aganglionic segment in children with Hirschsprung disease.

BACKGROUND: Modern approach to the surgical treatment of Hirschsprung's disease (HD) consists in the earliest possible repair and reduction of the number of surgical interventions. Primary one-stage transanal endorectal pull-through (TEPT) technique requires preoperative determination of the length of aganglionic segment. The efficacy of the standard method - contrast enema - is questionable in patients with a poorly defined transitional zone. OBJECTIVES: To present the proposed laparoscopic method for the management pathway in patients with HD, in whom the determination of the length of aganglionic segment with contrast enema was not possible. MATERIAL AND METHODS: A retrospective analysis of the diagnostic and therapeutic management employed in 14 patients, from 2 weeks to 55 months of age, with diagnosed HD, treated between January 2013 and May 2020. Laparoscopic histological mapping was performed with the use of 3 laparoscopic ports of 3-5 mm diameter. RESULTS: In all patients, laparoscopic mapping allowed for the determination of the length of aganglionic segment and the mode of surgical treatment. Four children with determined short-segment disease underwent TEPT, while 2 underwent temporary colostomy formation using the Duhamel-Martin-Ikeda method. Five patients with long-segment HD underwent laparoscopic-assisted TEPT. One patient with long-segment disease was treated with a temporary double-barrel colostomy and definitive surgery was performed 3 months later using the Duhamel-Martin-Ikeda method. In 2 patients with an initial diagnosis of HD established using current diagnostic pathway, HD pathology was later excluded based on the results of laparoscopic mapping and repeat rectal suction biopsy. No complications related to the laparoscopic procedure were identified. CONCLUSIONS: The method of laparoscopic mapping is effective in the determination of the length of aganglionic segment in children with diagnosed HD. In doubtful cases, it can be the preferred option in establishing the final mode of surgical treatment.

Biodegradable airway stents: Novel treatment of airway obstruction in children.

BACKGROUND: Tracheobronchomalacia is the most common cause of congenital airway obstruction in infants. An alternative for surgical approach (aortopexy) can be metallic airway stents. Usually, they are not considered as a first choice because of the relatively high risk of complications. Recent years have brought encouraging reports of biodegradable stents applied in children. OBJECTIVES: The aim of this study was to report our experience in the treatment of airway malacia using biodegradable stents. MATERIAL AND METHODS: Six polydioxanone (PDS), self-expanding custom-made stents (ELLA-CS) were implanted in 2 children: 3 in the patient with left main bronchus occlusion due to postpnemonectomy syndrome and 3 stents in the baby with tracheomalacia. RESULTS: Airway collapse was always relieved after stent expansion. Both patients needed repeated stenting because of limited stent lifespan. All the stents were implanted without complications through a rigid bronchoscope. The baby with stented main bronchus died because of irreversible lung lesion. CONCLUSIONS: This small study shows that biodegradable airway stents seem to be an attractive option in the treatment of tracheobronchomalacia in children. We consider this method to be safe, effective, repeatable, and reversible in small children with growing airways. As a time-buying procedure they can be especially useful in the treatment of tracheobronchomalacia.

Faecal Occult Blood Point-of-Care Tests.

BACKGROUND: Early detection of colorectal cancer decreases the risk of mortality. Faecal occult blood tests (FOBT) are recognised as a useful tool for colorectal cancer screening. These non-invasive, rapid, and easy-to-carry assays are very often used as a point-of-care test and for self-testing. On the market, there are various types of FOB tests available, including chemical and immunochromatographic tests, which are based on different detection methods and differ in their sensitivity and specificity. CONCLUSIONS: Clinicians should be aware of the causes of false-negative and false-positive test results, which can vary depending on the test. Additionally, stool sampling bias may be a source of error and must be considered by the clinician. The current FOBT methods are subject to various interfering factors; items such as proper preparation of the patient prior to testing or the clinician's knowledge of testing limitations are key in correct interpreting results. Novel technologies such as FOBT DNA tests, micro RNA tests, and biochips equipped with bacteria can indicate bleeding from the gastrointestinal tract and improve diagnostics process.

Prognostic value of assessment of stool and serum IL-1ß, IL-1ra and IL-6 concentrations in children with active and inactive ulcerative colitis.

INTRODUCTION: Interleukin-1ß (IL-1ß), interleukin-1 receptor antagonist (IL-1ra) and interleukin-6 (IL-6) contribute to the pathogenesis of ulcerative colitis (UC). The aim of our study was to evaluate the serum and stool IL-1ß, IL-1ra and IL-6 concentrations as potential prognostic factors in children with UC. MATERIAL AND METHODS: Thirty-eight children with UC (20 active, 18 inactive) and 14 healthy controls were prospectively included in the study. IL-1ß, IL-1ra and IL-6 concentrations were measured in serum and stool supernatants at inclusion to the study using ELISA immunoassays. The children were followed up over 5 years, and at each follow-up clinical disease activity, quantity and severity of relapses, nutritional status, endoscopic and histopathologic activity, disease complications and the treatment regimen were evaluated. RESULTS: In children with active and inactive UC who had relapsed during a 5-year follow-up period compared to the non-relapse groups we found significantly increased serum IL-1ß (1.34 vs. 0.98 pg/ml, p < 0.05, and 1.02 vs. 0.68 pg/ml, p < 0.01, respectively,) and IL-1ra (718.0 vs. 453.2 pg/ml, p < 0.05, and 567.4 vs. 365.1 pg/ml, p < 0.01, respectively). Additionally, in children who had experienced complications during a 5-year follow-up period we observed significantly increased serum and stool IL-1ß (p < 0.05) and serum IL-1ra (p < 0.01) compared to the group without complications. CONCLUSIONS: We concluded that serum IL-1ß and IL-1ra and to a lesser extend stool IL-1ß concentrations may be useful prognostic factors in children with active and inactive UC over a short-term follow-up period, which may help to identify children that require more aggressive therapy due to an increased risk of relapse or complications resulting from UC.

UriSed - Preliminary reference intervals and optimal method for urine sediment analysis in newborns and infants.

OBJECTIVES: The aim of this study was to establish reference intervals for urine sediment in newborns and infants in the second month of life for the UriSed automated analyser and for bright field microscopy. We also aimed to provide an optimal protocol for UriSed analysis, which best corresponds to the results of manual microscopy. DESIGN AND METHODS: Urine sediment analyses of 75 healthy newborns and infants in the second month of life were performed by manual microscopy and UriSed automated analyser (two modes: 15 and 20 images per sample). Images were then reviewed and manually corrected by an operator when needed. RESULTS: We observed statistically significant differences between bright-field microscopy and UriSed (when manual correction was not performed) for squamous epithelial cells and red blood cells counts (P<0.0001). There were no differences based on the number of images per sample (P>0.05). Upper reference values for bright-field microscopy and UriSed analyser taking 15 images per sample with manual correction (method we recommend) were as follows: squamous epithelial cells: microscope 8.7×10(6)/l, UriSed 6.4×10(6)/l, non-squamous epithelial cells: microscope 4.3×10(6)/l, UriSed 3.9×10(6)/l; erythrocytes: microscope 5.9×10(6)/l, UriSed: 4.6×10(6)/l; leukocytes: microscope 8.6×10(6)/l, UriSed 9.9×10(6)/l; hyaline casts: microscope 0×10(6)/l, UriSed (no correction) 0.7×10(6)/l. CONCLUSIONS: We established preliminary reference intervals for urine sediment analysis in newborns and infants for UriSed and bright-field microscopy. We concluded that for routine laboratory examination of non-pathological urine it is enough to use the faster mode, with 15 images per sample, followed by a manual correction.

Advances in nutritional therapy in inflammatory bowel diseases: Review.

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.

Cosmetic Outcomes of Sutureless Closure in Gastroschisis.

Purpose A sutureless gastroschisis repair allows for spontaneous closure of abdominal wall defect. We report our experience focusing on final esthetic outcome. Methods Retrospective data were collected from medical reports of all neonates with gastroschisis operated from January 2009 to December 2013. Variables recorded included patients descriptors, management modality, and cosmetic outcome. Results From the overall group of 38 patients with gastroschisis, 20 infants treated with sutureless closure were included in this study. In the analyzed cohort, 17 (85%) children were operated under general anesthesia and 3 (15%) without intubation. Primary reduction was possible in 15 (75%) cases, and in 5 (25%) we used silo. There were two (10%) deaths in late postoperative course due to septic complications. Three (15%) infants needed laparotomy because of adhesions and bowel obstruction. There were no infectious complications of the wound. Only 55% (10/18) of children presented umbilical hernia prior to discharge. Only two (11%) children with umbilical hernia were operated until now. Almost all patients (16/18; 89%) present excellent final cosmetic result without scar formation. Conclusion Sutureless closure of uncomplicated gastroschisis is a safe technique that reduces need of intubation and provides excellent cosmetic results.

Laparoscopic and Laparoscopy-Assisted Resection of Enteric Duplication Cysts in Children.

INTRODUCTION: Enteric duplication (ED) cysts are rare. The commonness of ultrasonographic investigation contributes to an earlier diagnosis of such a pathology before the onset of the first clinical symptoms. A planned mini-invasive surgical treatment during the infancy is proposed. This study presents the possibility and safety of elective laparoscopic or laparoscopy-assisted mini-invasive resection of ileal (IL) and ileocecal (IC) duplications, thus avoiding bowel resection. MATERIALS AND METHODS: A retrospective review was conducted of medical records of 6 patients at the age from 3 to 22 months with the diagnosis of ED, treated in the Department of Pediatric Surgery, Jagiellonian University Medical College, Krakow, Poland, within the period from January 2012 to September 2014. RESULTS: Excision of cysts without bowel resection was performed in five children with IC and IL duplications. Laparoscopic excision was performed in two children with IC duplication; in the other three children (1 IC and 2 IL duplication), laparoscopy confirmed the diagnosis with consecutive cyst excision without bowel resection after external evacuation of the cyst. The external resection of the cecum and Bauhin's valve was necessary in 1 patient with large IC duplication and malrotation. The postoperative course was satisfactory in all the cases. CONCLUSIONS: The laparoscopic approach allows for confirming the diagnosis and accurately defining the exact site of duplication, as well as for effective and safe mini-invasive treatment. Laparoscopic or laparoscopy-assisted excision of ED without bowel resection is a safe option in a significant number of IL and IC duplications.

Effect of LLLT on endothelial cells culture.

Growth factors as vascular endothelial growth factor (VEGF), produced by the endothelial cells, take an essential part in pathological and physiological angiogenesis. The possibility of angiogenesis modulation by application of laser radiation may contribute to the improvement of its use in this process. Thus, the aim of the study was to investigate the influence of low-level laser therapy (LLLT) on the proliferation of endothelial cells, secretion of VEGF-A and presence of soluble VEGF receptors (sVEGFR-1 and sVEGFR-2) in the medium after in vitro culture. Isolated human umbilical vein endothelial cells (HUVECs) were irradiated using a diode laser at a wavelength of 635 nm and power density of 1,875 mW/cm(2). Depending on radiation energy density, the experiment was conducted in four groups: I 0 J/cm(2) (control group), II 2 J/cm(2), III 4 J/cm(2), and IV 8 J/cm(2). The use of laser radiation wavelength of 635 nm, was associated with a statistically significant increase in proliferation of endothelial cells (p = 0.0041). Moreover, at 635-nm wavelength, all doses of radiation significantly reduced the concentration of sVEGFR-1 (p = 0.0197).

Peptides from adipose tissue in mental disorders.

Adipose tissue is a dynamic endocrine organ that is essential to regulation of metabolism in humans. A new approach to mental disorders led to research on involvement of adipokines in the etiology of mental disorders and mood states and their impact on the health status of psychiatric patients, as well as the effects of treatment for mental health disorders on plasma levels of adipokines. There is evidence that disturbances in adipokine secretion are important in the pathogenesis, clinical presentation and outcome of mental disorders. Admittedly leptin and adiponectin are involved in pathophysiology of depression. A lot of disturbances in secretion and plasma levels of adipokines are observed in eating disorders with a significant impact on the symptoms and course of a disease. It is still a question whether observed dysregulation of adipokines secretion are primary or secondary. Moreover findings in this area are somewhat inconsistent, owing to differences in patient age, sex, socioeconomic status, smoking habits, level of physical activity, eating pathology, general health or medication. This was the rationale for our detailed investigation into the role of the endocrine functions of adipose tissue in mental disorders. It seems that we are continually at the beginning of understanding of the relation between adipose tissue and mental disorders.

Gastric lipase secretion in children with gastritis.

Gastric lipase is one of the prepancreatic lipases found in some mammalian species and in humans. Our knowledge of the hormonal regulation of gastric lipase secretion in children and adolescents is still very limited. The aim of this study was to compare the activity of human gastric lipase (HGL) in gastric juice in healthy adolescents and in patients with gastritis. The adolescents were allocated to three groups: the first including patients with Helicobacter pylori gastritis (HPG; n = 10), the second including patients with superficial gastritis caused by pathogens other than H. pylori (non-HPG; n = 14) and the control group including healthy adolescents (n = 14). Activity of HGL was measured in gastric juice collected during endoscopy. Plasma concentrations of cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) were measured in all adolescents. Activity of HGL in the non-HPG group was significantly lower than in the HPG group (p < 0.005) and the control group (p < 0.005). Mean plasma GIP levels in the control group were lower than in the non-HPG group (p < 0.003) and the HPG group (p < 0.01). We conclude that the regulation of HGL secretion by GLP-1 and CCK is altered in patients with gastritis. Moreover, GIP is a potent controller of HGL activity, both in healthy subjects and in patients with gastritis.

Simulation of reflected and scattered laser radiation for designing laser shields.

This paper presents a computer simulation of reflected and scattered laser radiation for calculating the angle of laser shields performed with the Laser Shield Solver computer program. The authors describe a method of calculating the shield angle for laser shields which protect workers against reflected and scattered laser radiation and which are made from different materials. The main assumptions of the program, which calculates and simulates reflected laser radiation from any material and which can be used for designing shield angles, are presented. Calculations are compared with measurements of reflected laser radiation. The results for one type of laser and different materials which interacted with a laser beam showed that the Laser Shield Solver was an appropriate tool for designing laser shields and its simulations of reflected laser radiation distribution have practical use.

Cardiorespiratory response to exercise in children after modified fontan operation.

OBJECTIVE: Examination of exercise function of Fontan patients and comparison with healthy control subjects. DESIGN: Fourteen patients (6 males, 8 females; age: 5.7-17 years, mean 8.1 years) after Fontan repair in New York Heart Association (NYHA) class I with rest O(2)sat > 85% requiring no cardiovascular medications performed graded exercises on a treadmill 0.5-3.2 years postoperatively (mean 1.8 years). During the tests the heart and respiratory rate, blood pressure, oxygen uptake, carbon dioxide production, minute ventilation, tidal volume and O(2)sat were recorded. Spirometry was performed before and during exercise. RESULTS: The peak VO(2)max in Fontan patients was significantly reduced compared with controls (p = 0.0002). Other parameters: anaerobic threshold (p = 0.0001); pulsO(2) (p = 0.00005); peak minute ventilation (p = 0.0014); physiological dead space to tidal volume ratio at peak exercise (p = 0.0004); maximal work rate (p = 0.00008); exercise time (p = 0.00003) were significantly reduced in univentricular patients. The heart rate at peak exercise was lower in the patients (p = 0.0003) and O(2)sat dropped significantly (p = 0.003). CONCLUSION: The aerobic capacity, work and ventilatory parameters in Fontan patients are markedly reduced compared with controls. The anaerobic threshold was significantly lower. The decreased O(2)sat at peak exercise may suggest intrapulmonary shunting.