The effect of biofeedback on nonneurological dysfunctional voiding in children: A meta-analysis and systematic review.

OBJECTIVE: This study was conducted to investigate the effect of biofeedback (BF) on the rehabilitation of children with nonneurological dysfunctional voiding (NDV). METHODS: RCTs were retrieved from various databases (published from inception to February 29, 2024). The effects of the BF and non-BF treatments were compared. A random-effects model was used to evaluate the combined data. RESULTS: Meta-analysis revealed that BF increased the maximum urinary flow rate (SMD = 3.78, 95% CI 1.33∼6.22), improved urination time (SMD = 5.88, 95% CI 3.75∼8.01), and reduced the postvoid residual (SMD = -19.18, 95% CI -27.03∼-11.33) and urinary tract infection incidence (RR = 0.43, 95% CI 0.21∼0.87). Electromyogram activity (RR = 0.46, 95% CI 0.25∼0.84) and abnormal urination patterns (RR = 0.51, 95% CI 0.35∼0.74) improved, with effects persisting for more than 1 year. However, the effect of BF on the mean urinary flow rate in children with NDV was significant only after 1 year of follow-up (SMD = 1.90, 95% CI 0.87∼2.92). CONCLUSION: Existing evidence indicates that BF can enhance urinary parameters and patterns in children with NDV. However, its effectiveness in addressing constipation, daytime urinary incontinence, and nocturnal urinary incontinence is not substantial. High-quality randomized controlled trials can offer additional insights.

Paravertebral Block Under Direct Vision Versus Local Anesthetic Infiltration for Pediatric Thoracoscopic Surgery.

Background: For children with congenital lung malformations (CLMs), there is insufficient evidence of the efficacy of direct visual paravertebral block (PVB). We aimed to evaluate its effectiveness and safety by comparing it with local anesthetic infiltration (LAI). Materials and Methods: This was a nonrandomized control study of CLMs in children younger than 3 years of age who underwent thoracoscopic surgery in our hospital from January to December 2020. The children were divided into group A (PVB analgesia group) and group B (LAI group). The primary outcome was the incidence of rebound pain within 72 hours. Secondary outcomes included the Face, Legs, Activity, Crying, Consolability (FLACC) pain scores at 0, 6, 12, 24, 36, 48, and 72 hours, side effects, adverse events, the number of rebound pains, and the postoperative family observation scores. Results: The incidence of rebound pain was 10% in group A and 60.5% in group B within 72 hours (P < .001). The PVB was associated with decreased FLACC pain scores at 12, 24, 36, 48, and 72 hours, family observation scores, and the number of rebound pains (P < .001, P = .01, P = .028, P = .005, P = .006, P = .026, and P < .001, respectively). Group B was also associated with a higher rate of side effects and adverse events. There was no difference in the length of hospital stay. Conclusion: The PVB under direct vision analgesia technique is effective and safe for postoperative pain control in pediatric patients with CLMs. It may be an attractive alternative to LAI for pediatric thoracoscopic surgical procedures.

Analysis of Resilience, Coping Style, Anxiety, and Depression Among Rescue Nurses on EMTs During the Disaster Preparedness Stage in Sichuan, China: A Descriptive Cross-Sectional Survey.

OBJECTIVE: The purpose of this study was to investigate the current situation and influencing factors of resilience, coping style, anxiety, and depression among rescue nurses on Emergency Medical Teams (EMTs) during the disaster preparedness stage, and to explore the relationship between resilience, coping style, anxiety, and depression. METHODS: A descriptive cross-sectional survey was used. The convenience sampling method was used to select rescue nurses from 4 national EMTs in Sichuan Province, China. CD-RISC, SCSQ, Zung SAS, and SDS were used as research tools. RESULTS: A total of 197 valid questionnaires were returned, with a 98.5% response rate. The results of multiple regression analysis showed that average monthly income, depression level, and coping style were the main factors affecting nurses' resilience. Resilience was significantly and positively correlated with coping style and negatively correlated with anxiety and depression. There were significant differences in SCSQ, Zung SAS, and SDS scores among Clusters. CONCLUSION: In the disaster preparedness stage, rescue nurses on EMTs have a medium level of resilience and good coping styles, but their levels of anxiety and depression are high. It is suggested that more attention should be devoted to the target population to formulate effective intervention plans, reduce psychological pressures, and improve their capacity for coping with disasters.

Nocturnal enuresis in children: Parents' perspectives.

AIM: Parents of children with nocturnal enuresis (NE) may have uncertainty and anxiety. This study aimed to investigate the level of uncertainty and anxiety in the parents of children with NE and analyse its influencing factors. DESIGN: We conducted a descriptive cross-sectional study among the parents of children with NE in China. METHODS: A general information questionnaire, the Parent Perception of Uncertainty Scale (PPUS), and the Self-Rating Anxiety Scale (SAS) were used. Multiple linear regression analysis was used to identify factors influencing the parental uncertainty level independently. RESULTS: A total of 247 valid questionnaires were collected. The PPUS score of children with NE was 81.18 ± 10.82, and the anxiety self-rating scale score was 41.86 ± 9.20. Parents' working status, the family's per capita monthly income, and the children's treatment time were the main influencing factors of parental illness uncertainty.

Factors influencing the quality of life in children after biliary atresia treatment.

BACKGROUND: Despite surgical treatment, children with biliary atresia (BA) may face many problems which seriously affect their quality of life. However, there is a paucity of studies in China examining the quality of life of these children after BA treatment. This study investigated the current status of the quality of life of children after BA treatment and analyzed the influencing factors so as to provide a scientific basis for the development of targeted interventional measures. METHODS: From May 1 to May 31, 2021, the STAR questionnaire method was used to conduct cross-sectional surveys in children following BA surgery in the West China Hospital of Sichuan University, China. The basic information questionnaire was used to investigate the general characteristics of the children. The children were also given quality of life questionnaires during follow-up sessions after surgical treatment for BA. In addition, a 12-point health survey was used to assess the physical and mental health of the children's caregivers. Age- and gender-matched healthy children were recruited as controls. Correlation analysis and multiple linear regression equations were established to explore the influencing factors of the quality of life of children after surgery for BA. RESULTS: After surgery, children with BA experienced significantly lower physical health, emotional function, social function, cognitive function, and quality of life compared to healthy children (P<0.050). Co-existing diseases had a statistically significant impact on the quality of life of children with BA (b=-12.566; t=-2.343; P=0.021), and the caregiver's understanding level of liver transplantation also had a statistically significant impact on the quality of life of these children (b=6.481; t=2.376; P=0.021). CONCLUSIONS: The quality of life of children after BA surgery was significantly lower than that of age-matched healthy children. Co-existing diseases and the caregiver's understanding level of liver transplantation were the main factors affecting the quality of life of these children.

Preoperative anxiety in children aged 2-7 years old: a cross-sectional analysis of the associated risk factors.

BACKGROUND: Preoperative anxiety in children is harmful. Despite this, there is a scarcity of studies examining the incidence of preoperative anxiety and its related effects in China. This study investigated preoperative anxiety in children aged 2 to 7 in the pediatric surgery department of a tertiary hospital in China. The factors influencing preoperative anxiety in these children were identified. METHODS: The researchers used the Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS) and the Short Form of CmYPAS (CmYPAS-SF) to assess the preoperative anxiety state of children aged 2 to 7 who underwent elective surgery in the pediatric department of a tertiary hospital in China from July 1, 2020 to September 30, 2020 were enrolled in this study. The generalized estimating equation model was used to analyze the factors influencing preoperative anxiety in children. RESULTS: The preoperative anxiety rate of 220 children in the tertiary hospital was 67.6%. Multivariate analysis revealed that children who attended elementary school had a lower risk of preoperative anxiety compared to children who did not attend school [odd ratio (OR) =0.39, 95% confidence interval (CI), 0.19 to 0.79, P=0.010]. Children whose caregivers felt very worried experienced an increased risk of preoperative anxiety compared to children whose caregivers were not worried about the surgery at all (OR =3.40, 95% CI, 1.35 to 8.56, P=0.009). Children who were very resistant, cried violently, twisted their bodies during puncturing the needle were 5.8 times more likely to experience preoperative anxiety compared to children who were very cooperative. The risk of preoperative anxiety in children who cooperated with a staff member was about 1.5 times higher than that of children who were very cooperative. CONCLUSIONS: The incidence of preoperative anxiety in children aged 2 to 7 in the tertiary hospital in China was similar to the children in other countries. The caregivers' degree of concern priored to the operation and the degree of cooperation from the children during puncturing the indwelling needle were the main factors influencing the occurrence of preoperative anxiety.

Roles of Rho guanine nucleotide triphosphatases in hippocampal mossy fiber sprouting in the pentylenetetrazole kindling model.

BACKGROUND: One unique feature of chronic human and experimental epilepsy is hippocampal dentate granule cell axon (mossy fiber) sprouting which creates an aberrant positive-feedback circuit that may be epileptogenic. However, the mechanism underlying this process remains unclear. Rho guanine nucleotide triphosphatases (RhoGTP ases) Rac1 and RhoA are important regulators of axon growth and synaptic plasticity and can be blocked by treatment with fasudil. We hypothesized that Rac1 and RhoA are involved in aberrant mossy fiber sprouting (MFS). METHODS: A temporal lobe epilepsy model was established by intraperitoneal pentylenetetrazole (PTZ) injection for animals in PTZ group, and fasudil was injected 30 minutes prior to PTZ injection for animals in PTZ + Fas group. The expression of Rac1 and RhoA in the rat hippocampus was tested at different time points by immunohistochemistry, Western blot and quantitative real-time PCR. Mossy fiber sprouting in the hippocampus was evaluated by Timm staining. RESULTS: Rac1 and RhoA were significantly up-regulated in the PTZ group, and as predicted, the degree of aberrant MFS was correspondingly increased. However, the expression of Rac1 and RhoA was not inhibited in the PTZ + Fas group, and the epileptiform activity, EEG and aberrant MFS were not suppressed following PTZ + Fas treatment. CONCLUSIONS: RhoGTPases play a role in MFS but fasudil is not sufficient to inhibit RhoGTPases and MFS in the PTZ kindling model.

Expression of SOCSs and TLRs in the hippocampus of pentylenetetrazole kindling model.

BACKGROUND: Epilepsy is one of the most common neurological disorders, and approximately one-third of patients with epilepsy are resistant to anti-epileptic drugs (AEDs). Recent emerging evidence has demonstrated the roles of innate immunity and the associated inflammatory processes in epilepsy. Toll-like receptors (TLRs) are a type of pattern-recognition receptor that promote innate immune defense. The SOCS proteins as negative-feedback regulators in cytokine signaling are involved in the regulation of TLR-mediated immune responses. However, few studies investigating the role of TLRs and SOCSs in epilepsy have been reported. METHODS: To explore the role of innate immunity in the mechanism of epilepsy, the pentylenetetrazole (PTZ) kindling rat model was established using intraperitoneal injection of PTZ. The expression levels of TLR2, TLR4, and STAT molecules in rat hippocampi were analyzed using qRT-PCR and western blotting techniques. The expression levels of SOCS-1 and SOCS-3 in rat hippocampi were analyzed using qRT-PCR. RESULTS: Our data demonstrated that both the mRNA and protein expression of TLR2 and TLR4 were significantly upregulated in the rat hippocampus with PTZ injection, which was accompanied by an inhibition of SOCS-1 and SOCS-3 and an upregulation of STAT3. CONCLUSIONS: Our study suggested that SOCSs and TLRs contribute to the development of epilepsy which may lead to therapeutic interventions that limit epileptogenesis.

GSK-3ß may be involved in hippocampal mossy fiber sprouting in the pentylenetetrazole-kindling model.

Mossy fiber sprouting (MFS) is a pathological phenomenon that is commonly observed in temporal lobe epilepsy (TLE). However, the molecular mechanisms underlying MFS remain unclear. It has been demonstrated that the tau protein is important in the progression of MFS by the regulation of microtubule dynamics and axonal transport, with all of these functions of tau modulated by its site-specific phosphorylation. Glycogen synthase kinase-3ß (GSK-3ß) is an active kinase that regulates the phosphorylation of tau protein. Therefore, it was hypothesized that GSK-3ß contributes to MFS by phosphorylating tau protein. The aim of the present study was to determine the expression and activity of GSK-3ß at different regions in the rat hippocampus during the pentylenetetrazole (PTZ)-kindling process in order to demonstrate the possible correlation with MFS, and to investigate the involvement of GSK-3ß in epileptogenesis. Male Sprague-Dawley rats (n=180) were randomly divided into the control and PTZ-treated groups. The chronic epileptic model was established by intraperitoneal injection of PTZ and the hippocampus was observed for the presence of MFS using Timm staining. GSK-3ß mRNA, protein and activity were analyzed in various regions of the hippocampus using in situ hybridization, immunohistochemistry and immunoprecipitation followed by a kinase assay and liquid scintillation counting, respectively. MFS was observed prior to kindling and an increased distribution of Timm granules were observed in the CA3 region of the PTZ-treated rats; however, this was not demonstrated in the supragranular layer of the dentate gyrus. The expression of GSK-3ß mRNA and protein, as well as the GSK-3ß activity, increased significantly from 3 days to 4 weeks in the PTZ group, and this was correlated with the progression of MFS in the CA3 area. In addition, it was demonstrated that MFS did not result from TLE. GSK-3ß may therefore be involved in the progression of MFS and is important in epileptogenesis. An understanding of the molecular mechanisms underlying MFS may lead to the identification of a novel therapeutic target to limit epileptogenesis.

Potential roles of Cdk5/p35 and tau protein in hippocampal mossy fiber sprouting in the PTZ kindling model.

BACKGROUND: The most well-documented synaptic reorganization associated with temporal lobe epilepsy is mossy fiber sprouting (MFS), which is believed to play a critical role in epileptogenesis. However, the molecular mechanisms underlying this phenomenon remain unclear. Cyclin-dependent kinase 5 (Cdk5) is a proline-directed serine/threonine kinase which is found to be crucial in axon growth and synaptic plasticity. We hypothesized that Cdk5 contributed to MFS via phosphorylating its substrate tau protein, which was known to facilitate microtubule stabilization and axonal elongation. METHODS: 240 male SD rats were randomly divided into the control group and PTZ group. The epileptic models were established by intraperitoneal PTZ injection, while the control rats were injected with an equal dose of saline. At different time points, Cdk5/p35 mRNA and protein, total tau protein and its phosphorylation at Ser202 (p-tau) and Cdk5 activity were analyzed in different regions of hippocampus by in situ hybridization, immunohistochemistry, Western blot, immuno-precipitation and liquid scintillation counter. Hippocampus was also evaluated for MFS with Timm stain. RESULTS: Prominent MFS was observed in area CA3 rather than the inner molecular layer in PTZ treated rats and the degree of MFS progressed with the development of behavioral kindled seizures. The expression of Cdk5/p35 mRNA and protein, tau protein and its phosphorylation at Ser202 significantly increased from 3 days to 4 weeks in the PTZ group, which was in accordance with the progression of MFS in area CA3. CONCLUSIONS: Cdk5/p35 and its substrate tau protein may be involved in MFS. Understanding the molecular mechanisms underlying MFS may lead to therapeutic interventions that limit epileptogenesis.

Mossy fiber sprouting, hippocampal damage and spontaneous recurrent seizures in pentylenetetrazole kindling rat model.

AIM: The aim of this study was to determine the correlations among hippocampal damage, spontaneous recurrent seizures (SRS), and mossy fiber sprouting (MFS) using pentylenetetrazole (PTZ) kindling model. METHODS: Chronic epileptic model was established by administration of PTZ. Behaviour and EEG seizure activity were recorded. Rats' hippocampus were analyzed with haematoxylin and eosin (H&E) stain for histological lesions and evaluated for MFS with Timm stain. RESULTS: Prominent MFS was observed in area CA3 rather than the inner molecular layer in PTZ treated rats and the degree of MFS progressed with the development of behavioral kindled seizures. MFS preceded the occurrence of spontaneous seizures. No obvious neuronal necrosis and loss were observed in different regions of the hippocampus during kindling progression. CONCLUSION: MFS is not the outcome of SRS. Severe hippocampal damage is not required in the development of MFS and SRS.