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Purpose:Children with attention-deficit/hyperactivity disorder (ADHD) often experience urinary incontinence, yet few studies have examined the effects of ADHD medications on this condition. This study retrospectively evaluated the therapeutic effects of atomoxetine and methylphenidate on urinary incontinence in children with ADHD. Materials and methods:Twelve children (9 boys and 3 girls) aged 6.0 to 11.3 years (median 8.4 years) with ADHD and urinary incontinence were included. All had nocturnal enuresis, while 10 had daytime incontinence. Each child was treated with atomoxetine and/or methylphenidate, and symptoms were assessed using questionnaires, the ADHD-Rating Scale (ADHD-RS), and the Dysfunctional Voiding Symptom Score before and 3 months after treatment. Results:ADHD symptoms improved significantly, with ADHD-RS scores decreasing from 21.9 to 13.5 at home and from 21.4 to 15.4 at school (P < 0.05). Nocturnal enuresis resolved in 5 of 12 children, and daytime incontinence disappeared in 7 of 10. The Dysfunctional Voiding Symptom Score improved from 8.4 to 4.2 (P < 0.05). Conclusion:ADHD medications may improve both ADHD symptoms and urinary incontinence, suggesting a shared underlying neurophysiological mechanism. Screening for ADHD in older children with urinary incontinence and appropriate treatment may enhance their quality of life.
BACKGROUND:Necrotising soft tissue infections (NSTI) are life-threatening conditions caused by diverse bacteria. Treatment strategies have remained largely universal and unchanged, and only modest improvements in patient outcomes have been observed. Emerging insights into NSTI pathogenesis may enable more targeted approaches. Because microbial aetiology is central to guiding appropriate therapy, we aimed to develop and externally validate machine learning models capable of predicting microbial aetiology using only data available at an early stage. In parallel, we explored whether similar models could predict selected clinical endpoints related to surgical management, patient handling, and organ support. METHODS:We used data from the INFECT study, an international multicentre prospective cohort investigating NSTI characteristics and pathogenesis. A total of 409 adults with surgically confirmed NSTI were enrolled between February 2013 and June 2017 from five Scandinavian hospitals. More than 700 clinical variables were collected from hospital admission to intensive care unit entry. Machine learning models were developed to predict the presence of Streptococcus pyogenes (GAS, Group A streptococcus) and five clinical endpoints: risk of amputation, size of skin defect, maximum skin defect size, length of intensive care (ICU) stay, and need for renal replacement therapy. Unsupervised variable selection was implemented, and Shapley Additive explanations were used for model interpretability. External validation employed a retrospective multicentre cohort of 216 NSTI patients treated in 11 Dutch hospitals between January 2013 and December 2017. RESULTS:Eight presurgical variables (age, diabetes, affected area, prior surgical intervention, and blood creatinine and haemoglobin concentrations) were sufficient for predicting GAS aetiology with high discriminatory power. Performance was good in both the development cohort (ROC-AUC 0.828; 95% CI 0.763-0.883) and the external validation cohort (ROC-AUC 0.758; 95% CI 0.696-0.821). Prediction of clinical endpoints related to surgical management, ICU stay, and organ support was unsuccessful. CONCLUSIONS:We developed and externally validated a model predicting GAS aetiology in NSTI using presurgical data alone. Early identification of GAS may improve clinical handling and support tailored decisions on treatment and infection control, including management of close contacts and reduction of hospital transmission risk.
Atherosclerotic abdominal aortic aneurysms (AAAs) are a common vascular pathology with significant morbidity and mortality risks. Timely diagnosis, accurate characterization, and standardized reporting are critical for effective management and monitoring of atherosclerotic AAAs. Imaging modalities, particularly computed tomography angiography (CTA), play a pivotal role in the detection, treatment planning, and identification of both primary and secondary complications, as well as distinguishing AAAs from other etiologies. This narrative review provides a comprehensive exploration of the spectrum of imaging findings in atherosclerotic AAAs on CTA, underscoring the importance of structured reporting. Additionally, it examines therapeutic approaches and complications, and it differentiates AAAs from inflammatory, mycotic, and traumatic variants, serving as a primer for radiologists in AAA evaluation.
PURPOSE:Functional alignment (FA) aims to achieve a symmetric, rectangular extension gap and a rectangular or trapezoidal flexion gap, positioning the components in a manner that reduces the compromises to the soft tissue envelope. Because the FA surgeon can accomplish this goal with a multitude of adjustments to the components' position or soft tissue balance, the purpose of the present study was to analyze the possible paths for achieving FA. METHODS:Ten knees undergoing robotic total knee arthroplasty (TKA) were analyzed. Based on the intraoperatively acquired data, a macro was created to perform a post hoc analysis of the 10 possible paths to align a TKA functionally: (1) starting from mechanical alignment (MA) or kinematic alignment (KA), (2) preserving either the position of the femoral or tibial component and (3) with equal, 1 mm gaps or with increased 90° lateral flexion laxity. RESULTS:Ten different knee phenotypes were analyzed (Var-Neu-Neu 2x; Neu-Neu-Val; Val-Val-Val; Neu-Val-Neu; Var-Neu-Var 3x; Var-Var-Var; Var-Var-Val). On average, 3.5 different paths resulted in FA for each TKA (range: 0-8). Two TKAs (Val-Val-Val; Var-Var-Val) could not be functionally aligned using any of the ten evaluated paths. One TKA could be functionally aligned using eight different paths. CONCLUSION:Functionally aligning a TKA can be achieved through multiple adjustments, resulting in various implant positions and soft tissue balances. To better understand the different combinations behind FA, a more detailed nomenclature is needed, including which initial alignment (MA or KA) was utilized, which component's position (femoral or tibial) was preserved, and whether a rectangular or trapezoidal flexion space was targeted. LEVEL OF EVIDENCE:Level IV, therapeutic study.
Background Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics. Methods A 3-round Delphi consensus process was performed, including 29 experts. The aim of round 1 was to investigate the differing views and opinions of the participants. Round 2 was carried out after the results from the literature on each topic were provided to the participants. During round 3, the participants had the opportunity to finalize their vote. Results Most participants agreed that TCAR can or can probably or possibly be performed within 14 days of a cerebrovascular event, but it is best to avoid it in the first 48 hr. It was felt that TCAR cannot or should not replace TFCAS or CEA, as each procedure has specific indications and contraindications. Symptomatic patients >80 years should probably be treated with TCAR rather than with TFCAS. TCAR can or can probably be used for the treatment of restenosis following CEA or TFCAS. Finally, there is a need for a randomized controlled trial (RCT) to provide better evidence for the unresolved issues. Conclusions This Delphi consensus document attempted to assist the decision-making of physicians or interventionalists or vascular surgeons involved in the management of carotid stenosis patients. Furthermore, areas requiring additional research were identified. Future studies and RCTs should provide more evidence to address the unanswered questions regarding TCAR.
