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Zhong S, Lin X, Wang M, Mao Y, Shen J, Du X, Zhang L, Ma J. Periaqueductal gray subregions connectivity and its association with micturition desire-awakening function. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02574-9. [PMID: 39235463 DOI: 10.1007/s00787-024-02574-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/26/2024] [Indexed: 09/06/2024]
Abstract
Existing literature strongly supports the idea that children with primary nocturnal enuresis (PNE) have brainstem abnormalities. However, the connection between pre-micturition arousal responses and brain functional connectivities is still not clearly defined. Our study investigated the correlation between the gradations of micturition desire-awakening (MDA) functionality and the functional connectivity of the midbrain periaqueductal gray (PAG), a pivotal brainstem hub implicated in the neural regulation of micturition in humans. Neuroimaging and behavioral data from 133 patients with PNE and 40 healthy children were acquired from functional magnetic resonance imaging (fMRI) and precise clinical observations, respectively. The whole-brain correlation analyses were undertaken to elucidate the complex connectivity patterns between the subregions of PAG and the cerebral cortex, with a focus on their correlation to the spectrum of MDA functionality. A positive correlation was identified between MDA dysfunction and the resting-state functional connectivity (RSFC) between the left ventrolateral periaqueductal gray (vlPAG) and the right temporal pole of the superior temporal gyrus. Conversely, a negative correlation was observed between MDA dysfunction and the RSFC of the right vlPAG with the right superior parietal lobule. Additionally, MDA dysfunction exhibited a negative association with the RSFC between the dorsomedial PAG (dmPAG) and the right inferior parietal lobule. These findings may indicate that the specific signal from a distended bladder is blocked in the PAG and its functional connectivity with the executive function, attention, and default mode networks, ultimately leading to impaired arousal and bladder control. This revelation underscores potential neural targets for future therapeutic interventions.
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Affiliation(s)
- Shaogen Zhong
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Rd. Pudong District, Shanghai, 200127, China
| | - Xindi Lin
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Rd. Pudong District, Shanghai, 200127, China
| | - Mengxing Wang
- College of Medical Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Yi Mao
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Rd. Pudong District, Shanghai, 200127, China
| | - Jiayao Shen
- Department of Nephrology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoxia Du
- Department of Psychology, Center for Exercise and Brain Science, Shanghai University of Sport, Shanghai, China
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Rd. Pudong District, Shanghai, 200127, China.
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Chen X, Sun WJ, Wang JR, Cai YY, Yu XD. A systematic review and meta-analysis assessing the efficacy of Tuina for nocturnal enuresis in children. Front Pharmacol 2024; 15:1421130. [PMID: 38962315 PMCID: PMC11220183 DOI: 10.3389/fphar.2024.1421130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/27/2024] [Indexed: 07/05/2024] Open
Abstract
Background: Desmopressin acetate (DDAVP) and behavioral interventions (BI) are cornerstone treatments for nocturnal enuresis (NE), a common pediatric urinary disorder. Despite the growing body of clinical studies on massage therapy for NE, comprehensive evaluations comparing the effectiveness of Tuina with DDAVP or BI are scarce. This study aims to explore the efficacy of Tuina in the management of NE. Methods: A systematic search of international databases was conducted using keywords pertinent to Tuina and NE. The inclusion criteria were limited to randomized controlled trials (RCTs) that evaluated NE treatments utilizing Tuina against DDAVP or BI. This meta-analysis included nine RCTs, comprising a total of 685 children, to assess both complete and partial response rates. Results: Tuina, used as a combination therapy, showed enhanced clinical efficacy and improved long-term outcomes relative to the control group. The therapeutic efficacy of Tuina was not directly associated with the number of acupoints used. Instead, employing between 11 and 20 acupoints appeared to have the most significant effect. Conclusion: The findings of this meta-analysis support the potential of Tuina as an adjunct therapy to enhance the sustained clinical efficacy of traditional treatments for NE. However, Tuina cannot completely replace DDAVP or BI in the management of NE. While this study illuminates some aspects of the effective acupoint combinations, further research is crucial to fully understand how Tuina acupoints contribute to the treatment of NE in children. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=442644, identifier CRD42023442644.
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Affiliation(s)
- Xin Chen
- Department of Developmental and Behavioral Pediatrics, Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Wei-jie Sun
- The First Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing-rong Wang
- Department of Developmental and Behavioral Pediatrics, Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Ying-ying Cai
- Department of Developmental and Behavioral Pediatrics, Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
| | - Xiao-dan Yu
- Department of Developmental and Behavioral Pediatrics, Fujian Children’s Hospital(Fujian Branch of Shanghai Children’s Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Assimamaw NT, Kebede AK, Bazezew Genetu K. Effects of sex, toilet training, stress, and caffeine on nocturnal enuresis among school children in Gondar Town, the metropolitan city of Ethiopia: a community-based study in 2023. Front Pediatr 2024; 12:1366430. [PMID: 38915871 PMCID: PMC11194331 DOI: 10.3389/fped.2024.1366430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/29/2024] [Indexed: 06/26/2024] Open
Abstract
Background Nocturnal enuresis is associated with severe social and psychological problems that affect one's self-esteem, later in life, harmed adolescent and adult life, emotional stress on the family, and poor school performance. Moreover, enuresis children may cause panic attacks, mood disorders, and depression. This study aims to assess the prevalence and associated factors of nocturnal enuresis among children aged 5-14 years in Gondar city, Northwest Ethiopia, 2023. Methods A community-based, cross-sectional study was conducted from April 1, 2023, to May 30, 2023. A stratified multistage sampling technique was used to select study subject from kebeles in Gondar city. The data were collected by using a structured, interviewer-administer Questionnaire. The data were entered using EPI DATA version 4.6.02 software, and processed,and analyzed using the statistical package for the social sciences (SPSS) version 25. All variables with P ≤ 0.25 in the bivariate analysis were included in the final model of multivariate analysis. The multivariate binary logistic regression was used to assess the association between the independent and outcome variable. The direction and strength of statistical association were measured with an adjusted odds ratio along with 95% CI and a P-value <0.05 was considered statistically significant. Result The overall prevalence of nocturnal enuresis among children aged 5-14 years was 162 (22.2%). The findings showed that being boys [AOR = 0.54; 95% CI (0.31, 0.93)], child and no toilet training practices [AOR = 2.50; 95% CI (1.02, 6.15)], Having no caffeine [AOR = 0.16; 95% CI (0.09, 0.29)], and exposure to stressful events [AOR = 20; 95% CI (11.12, 33.34)] had a significant association with nocturnal enuresis, p-value <0.05. Conclusion In this study, the prevalence of nocturnal enuresis children age 5-14 years was higher than that in previous studies. Sex of child, toilet training practices, caffeine c before bed, and presences of stressful event were a significant predictor of nocturnal enuresis.
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Affiliation(s)
- Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- University of Gondar Comprehensive Specialized Hospital Gondar, Gondar, Ethiopia
| | | | - Kalkidan Bazezew Genetu
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Almaghlouth AK, Alquraini MA, Alsaleh NA, Almulhim MA, Alhabdan TK, Alsalman MA, Alburayh AA. Parental Beliefs About the Causes, Treatments, and Medical Assistance for Children With Nocturnal Enuresis in the Eastern Region of the Kingdom of Saudi Arabia. Cureus 2023; 15:e44557. [PMID: 37790064 PMCID: PMC10544793 DOI: 10.7759/cureus.44557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVE To assess parental beliefs about the causes, treatment, and necessity for medical assistance for children with nocturnal enuresis (NE). METHOD A self-administered survey questioned parents' beliefs about NE, including causes and at-home behavioral therapy. We evaluated the association between demographic characteristics and the tendency to seek medical advice for NE. RESULT The questionnaire received responses from 1232 individuals, 77.1% of whom were female and 82.9% of whom were 30 years of age or older. Psychological issues (53.5%) and laziness to get up (47.6%) were the most often believed causes of NE. Two frequent at-home behavioral therapies chosen by participants were voiding before bedtime and restricting fluid intake at night (73.4% and 70%, respectively). However, only 6.9% of respondents believe that a bedwetting alarm is an effective treatment. The two most frequently reported reasons for not seeking medical attention were parents' belief that their child will eventually outgrow bedwetting (34.1%) and "parents or children's embarrassment" (21.8%). The chi-squared test was used to evaluate the association between demographic characteristics and seeking medical advice. Participants with a single child were more likely than those with more than three children to take their child to the doctor (61.5% vs. 48.6%, respectively). Also, parents who don't have NE-afflicted children were more open to consider seeking medical advice for NE therapy (if their children developed it in the future) compared to parents who already have children with NE. CONCLUSION Parents in the Eastern region of Saudi Arabia hold various misconceptions about the causes and treatment of NE. Only 52.1% of parents would take their child to see a doctor if wetting the bed and only 48.1% of parents were aware of effective treatments for NE. These results emphasize that healthcare practitioners need to provide proper information to raise public awareness of NE.
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Affiliation(s)
| | | | - Noor A Alsaleh
- Pediatrics and Child Health, King Faisal University, Hofuf, SAU
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Sirimongkolchaiyakul O, Sutheparank C, Amornchaicharoensuk Y. The Prevalence of Nocturnal Enuresis in Bangkok, Thailand: A Descriptive and Questionnaire Survey of 5 to 15 Year-Old School Students. Glob Pediatr Health 2023; 10:2333794X231189675. [PMID: 37533961 PMCID: PMC10392157 DOI: 10.1177/2333794x231189675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives. Nocturnal enuresis (NE) is a common problem among school-aged children. Nonetheless, further information on NE prevalence in Thailand is needed. The prevalence of NE and factors associated with it were investigated. Methods. A descriptive study was conducted in schools in Bangkok, Thailand, among children aged 5 to 15 years, using a questionnaire survey between November 2018 and July 2019. Results. The prevalence of primary monosymptomatic, primary nonmonosymptomatic, and secondary NEs was 9.7%, 11.6%, and 8.2%, respectively. Primary NE was associated with a family history of NE (OR = 4.05, P < .001), drinking within 2 hours before bedtime (OR = 1.77, P = .01), and deep sleep (OR = 1.62, P = .001). Conclusion. Primary NE was prevalent in this setting, and the most related factor was a family history of NE. Parents should be aware of NE in their children, especially if a child has a linked factor.
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Affiliation(s)
- Ornatcha Sirimongkolchaiyakul
- Faculty of Medicine, Division of Nephrology, Department of Pediatrics, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chanon Sutheparank
- Faculty of Medicine, Department of Pediatrics, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Yupaporn Amornchaicharoensuk
- Faculty of Medicine, Division of Nephrology, Department of Pediatrics, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Martínez Suárez V, Lostal Gracia MI, Sánchez Vázquez A, Carapau Ferreira C, Quintero Del Álamo J. [Enuresis: Perception and attitude in population of our country]. Semergen 2023; 49:101930. [PMID: 36889224 DOI: 10.1016/j.semerg.2023.101930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE To know the perception and attitude towards enuresis from families and caregivers with the aim of establishing a rational therapeutic plan. MATERIAL AND METHODS A 25-question survey was performed among parents over 18years old with at least a child between 5 and 13years old, maintaining national representativeness in terms of residence, social class and age of the children. Data collection was performed in April 2021. RESULTS Data from 501 out of 626 sent surveys was obtained, mostly from middle-class families from Andalusia, Catalonia and the Community of Madrid. From all the participants, 47.9% knew about the existence of enuresis, although only 23.8% knew which was the medical term. Only 16.6% and 9.6% remembered that the pediatrician or the nurse, respectively, had referred to the condition at any time. Among the respondents with some knowledge about enuresis, their main information source were close cases (36.6%), media outlets (31.1%) and the pediatrician (27.8%). Parents would be very (35.3%) or somewhat (43.1%) worried in the event of an enuresis case. However, the level of knowledge was higher, and the level of concern was lower among parents with a child with enuresis in comparison to those without a case in their family. CONCLUSION Improving parent knowledge about enuresis and changing their perception towards this condition might be of importance to improve their attention and anticipate its resolution.
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Affiliation(s)
- V Martínez Suárez
- Servicio de Salud del Principado, Universidad de Oviedo, Grupo OBGETIBE, Oviedo, España.
| | - M I Lostal Gracia
- Servicio de Pediatría, Centro de Salud Amparo Poch, Zaragoza, España
| | | | - C Carapau Ferreira
- Servicio de Pediatría, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - J Quintero Del Álamo
- Servicio de Psiquiatría, Hospital Universitario Infanta Leonor; Departamento de Psiquiatría Legal y Psiquiatría, Universidad Complutense de Madrid, Madrid, España
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Isfahani M, Yousefichaijan P, Sarmadian R, Salehi B, Habibi D. The association between primary nonmonosymptomatic nocturnal enuresis and the presence of specific phobia: a case–control study. AFRICAN JOURNAL OF UROLOGY 2022. [DOI: 10.1186/s12301-022-00322-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Abstract
Background
Nocturnal enuresis (NE) is a common childhood condition characterized by recurrent bedwetting in children with normal bladder control over 5 years old. The pathogenesis of this condition is unknown, but it is believed to have a complex etiology. NE is primary or secondary, monosymptomatic or nonmonosymptomatic (NMNE). MNE children do not have lower urinary tract (LUT) impairment, and their voided volumes are generally normal. NMNE is linked to malfunction of the LUT, with or without daytime incontinence. Several investigations have discovered significant associations between psychiatric problems, especially anxiety disorders and NMNE. Specific phobia is the most common lifelong anxiety disorder, characterized by extreme anxiety when a stimulus is encountered or expected. This study investigated the association between specific phobia and primary NMNE.
Methods
A total of 204 children were studied, including 102 children with primary NMNE and 102 children in the control group. Girls with an FSS-II score greater than 75 and boys with a score greater than 78 were considered to have specific phobia disorder. The groups were compared using SPSS software version 23 and descriptive statistical methods.
Results
The results of the recent study showed that the mean age of the children in the case and control groups was 7.69 and 7.19 years, respectively (p-value = 0.063). The male to female ratio was 49–53 in the case group and 43–59 in the control group (p-value = 0.399). In the study, the frequency of specific phobia in the case group was 12.7% and in the control group was 9.8% (p-value = 0.507).
Conclusions
Despite the strong impacts of anxiety on children's NMNE, there is likely no significant association between specific phobia and primary NMNE.
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Abstract
Parasomnias, especially disorders of arousal during childhood, are often relatively benign and transitory and do not usually require a pharmacologic therapy. A relevant aspect in both nonrapid eye movement and rapid eye movement parasomnia treatment is to prevent sleep-related injuries by maintaining a safe environment. Physicians should always evaluate the possible presence of favoring and precipitating factors (sleep disorders and drugs). A pharmacologic treatment may be indicated in case of frequent, troublesome, or particularly dangerous events. The aim of this article is to review current available evidence on pharmacologic treatment of different forms of parasomnia.
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Affiliation(s)
- Paola Proserpio
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy.
| | - Michele Terzaghi
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Raffaele Manni
- Sleep Medicine and Epilepsy, IRCCS Mondino Foundation, Via Mondino 2, 27100 Pavia, Italy
| | - Lino Nobili
- Sleep Medicine Center, Department of Neuroscience, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy; Department of Neuroscience (DINOGMI), University of Genoa, Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa 5-16147, Italy
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Huang WJ, Liang YY, Yang Q, Ma X. Nocturnal enuresis in children: Parents' perspectives. Nurs Open 2022; 9:2335-2341. [PMID: 35661439 PMCID: PMC9374395 DOI: 10.1002/nop2.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/21/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023] Open
Abstract
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.
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Affiliation(s)
- Wen-Jiao Huang
- West China School of Nursing/Department of Pediatric Surgery, Sichuan University, Chengdu, China
| | - Yuan-Yuan Liang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qian Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Ma
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China
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Tong C, He Q, Ho M, Zhong Z, Wu Q, Chen M. Tuina for Enuresis in Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Public Health 2022; 10:821781. [PMID: 35493365 PMCID: PMC9039245 DOI: 10.3389/fpubh.2022.821781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/14/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To evaluate the effects of Tuina (massage) vs. non-Tuina traditional Chinese medicine (TCM) treatments on nocturnal enuresis in children. Methods A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reported Items for Systematic Review and Meta-analysis (PRISMA) guidelines. RevMan 5.3 software was used for meta-analysis. Results Twelve RCTs recruiting a total of 1,007 children were included. Meta-analysis results showed that, compared with non-Tuina TCM treatments, Tuina could significantly improve the total effective rate of children's enuresis [RR = 1.29, 95%CI (1.22–1.36), P < 0.00001]. The results of subgroup analyses indicated that the total effective rate of Tuina combined with acupuncture in the treatment of nocturnal enuresis was higher than acupuncture alone [RR = 1.24, 95%CI (1.12–1.37), P < 0.0001]. The total effective rate of Tuina in the treatment of enuresis in children was better than that of herbal medicine alone [RR = 1.45, 95%CI (1.31–1.61), P < 0.00001]. The total effective rate of Tuina combined with herbal medicine in the treatment of enuresis in children was better than that of herbal medicine alone [RR = 1.16, 95%CI (1.06–1.26), P = 0.0007]. No adverse reactions of Tuina were reported in all included studies. Conclusion From the available evidence, Tuina, or Tuina combined with non-Tuina TCM treatments (acupuncture, or herbal medicine) can improve the clinical outcome of children with enuresis, indicating Tuina is a promising treatment choice for children's enuresis. However, because of the intrinsic limitations of the included studies, more high-quality randomized controlled trials with longer follow-up are still needed to further confirm the efficacy and safety of Tuina in the treatment of nocturnal enuresis in children.
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Affiliation(s)
- Chiin Tong
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Qida He
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Manin Ho
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Zhenghong Zhong
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
| | - Qibiao Wu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China.,Zhuhai MUST Science and Technology Research Institute, Zhuhai, China.,Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangzhou, China
| | - Min Chen
- Faculty of Chinese Medicine, Macau University of Science and Technology, Taipa, Macau SAR, China.,State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Taipa, Macau SAR, China
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Bedwetting from the heart: Time for a paradigm shift in the minimal diagnostic evaluation of enuresis. Heart Rhythm 2022; 19:862-865. [DOI: 10.1016/j.hrthm.2022.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 01/08/2023]
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12
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Bladder Training for Individuals with Autism: a Systematic Review Concludes as Empty. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022. [DOI: 10.1007/s40489-022-00315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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13
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Sun M, Li S, Sun X, Deng Z, Xu Y. Association between winter season and desmopressin treatment efficiency in children with monosymptomatic nocturnal enuresis: a pilot study. Int Braz J Urol 2022; 48:275-281. [PMID: 35170888 PMCID: PMC8932042 DOI: 10.1590/s1677-5538.ibju.2021.0236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/22/2021] [Indexed: 01/25/2023] Open
Abstract
Objectives: The purpose of our study was to assess the association between the winter season and desmopressin treatment failure in South Chinese children with monosymptomatic nocturnal enuresis (MNE). Materials and Methods: A retrospective study was conducted to analyze the clinical data of children with monosymptomatic nocturnal enuresis who have visited our urology clinic from January to December 2019. All patients received desmopressin treatment. Final treatment outcomes were categorized as successful (complete response) or failed (absent and partial response). The relationship between winter season and treatment response to desmopressin was evaluated. Additionally, associated risk factors were investigated with both univariate and multivariate regression analysis. Results: In total, 393 patients diagnosed with MNE were included in the present study. There were no statistically significant differences in pretreatment variables at first visit between patients who visited the clinic in winter and those who did so in other seasons. However, the treatment failure rate of MNE in the winter season was higher than that of other seasons (77.50% vs. 52.74%). Multivariate logistic regression analysis demonstrated that the severity of symptoms and an initial clinic visit in the winter season were significantly related to desmopressin treatment failure in MNE patients. Conclusion: Winter season and severity of symptoms are two risk factors associated with desmopressin treatment failure in MNE patients.
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Affiliation(s)
- Mengkui Sun
- Shenzhen Children's Hospital, Department of Urology, Shenzhen, China
| | - Shoulin Li
- Shenzhen Children's Hospital, Department of Urology, Shenzhen, China
| | - Xuerui Sun
- Shenzhen Children's Hospital, Department of Urology, Shenzhen, China
| | - Zhimei Deng
- Shenzhen Children's Hospital, Department of Urology, Shenzhen, China
| | - Yanan Xu
- Shenzhen Children's Hospital, Department of Urology, Shenzhen, China
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Band ME. It’s Not Just for Kids. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Song QX, Li J, Gu Y, Xu L, Abrams P, Xue W. The Clinical Features and Predictive Factors of Nocturnal Enuresis in Adult Women. Front Med (Lausanne) 2022; 8:744214. [PMID: 35111771 PMCID: PMC8801585 DOI: 10.3389/fmed.2021.744214] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
ObjectiveOur current knowledge on nocturnal enuresis (NE) in adults is scarce due to its uncommon nature. The present study was designed to investigate symptom characteristics and risk factors of NE in adult women to improve the current clinical understanding and management of this rare disease.MethodsOver a 3-year period, we enrolled 70 adult women who complained of bedwetting, with a frequency of at least once per week and a symptom duration of 3 months or longer. Patients were excluded if they had known pregnancy, current urinary tract infection, untreated malignancies, anatomical abnormalities, and irregular sleep cycle. The International Consultation on Incontinence Modular Questionnaire—female lower urinary tract symptoms and bladder diary were employed to appraise lower urinary tract symptoms and voiding behavior. Urodynamics was performed to assess the bladder function. A linear regression analysis was applied to determine potential risk factors for NE frequency.ResultsAmong the recruited subjects, comorbidities and lower urinary tract symptoms were frequently reported. On bladder diary, patients commonly presented with nocturnal polyuria (NP), reduced nocturnal voided volumes (RNVVs), or both. Urodynamics revealed multiple dysfunctions, namely, detrusor overactivity (DO), urodynamic stress incontinence (USI), reduced compliance, bladder outlet obstruction, detrusor underactivity (DU), and simultaneous DO and DU. Patients with more frequent NE (≥4/week) demonstrated markedly increased body mass index, more comorbid conditions, worse incontinence symptoms, NP or NP plus RNVVs, reduced compliance, and poorer voiding possibly owing to DU. Whereas, RNVVs alone and worse overactive bladder-related parameters were associated with milder NE. Multivariate analysis indicated that frequency/urgency quality of life, incontinence symptom, NP + RNVVs, poor flow, increased bladder sensation, USI, and simultaneous detrusor overactivity plus DU were independent risk factors for NE severity.ConclusionNE in adult women may have both urological and non-urological pathophysiology. Imbalanced circadian urine production, jeopardized continence mechanisms, overactive bladder, and DU-induced poor voiding are major factors that contribute to the pathogenesis of NE in adult women. Focused treatments on restoring these functions should be individually considered.
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Affiliation(s)
- Qi-Xiang Song
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
- Qi-Xiang Song
| | - Jiayi Li
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiyuan Gu
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Wei Xue
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Non-REM Parasomnias. Respir Med 2022. [DOI: 10.1007/978-3-030-93739-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schloss J, Ryan K, Steel A. A randomised, double-blind, placebo-controlled clinical trial found that a novel herbal formula Urox® (Bedtime Buddy®) assisted children for the treatment of nocturnal enuresis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 93:153783. [PMID: 34628241 DOI: 10.1016/j.phymed.2021.153783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nocturnal enuresis or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. HYPOTHESIS/PURPOSE To determine if a herbal capsule formulation taken once daily can reduce incidence and frequency of nocturnal enuresis in children. STUDY DESIGN This randomised double-blind placebo-controlled trial evaluated the efficacy of an herbal medicine product to reduce the symptoms of nocturnal enuresis. Participants, aged between 6 and 14 years of age, were recruited from the community in Australia. They were randomised via computerised random-number generation at study enrolment to receive one or two oral capsules in the morning of either Urox® (Bedtime Buddy®) or placebo. The Paediatric Quality of life (Pin-Q) was used as a quality-of-life measure and waking wet, fluid intake and urinary urgency per week were monitored. RESULTS Forty-one children completed the trial with an attrition rate of 16%. There were more males (64.6%) compared to females (35.4%) and the mean age was 8.6 years. Forty-one point seven percentages (41.7%) of participants had improvements in bed wetting by two months which was a highly clinically relevant effect (Cohen's D = 0.98). The primary outcome found that there was a statistically significant reduction in NE (p = 0.034; CI 0.086-2.095) and between groups using longitudinal analysis (p = 0.04, Coefficient -1.12, CI 95% -2.20 - -0.04). In the secondary outcomes, urinary urgency reduced statistically significantly for the intervention (p = 0.002; a reduction of 18.3% difference for Bedtime Buddy compared to an increase of 3.7% for the placebo). CONCLUSION Urox® (Bedtime Buddy®) may assist children in reducing nocturnal enuresis compared to placebo. In addition, it may assist in reducing daily incontinence and urinary urgency.
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Affiliation(s)
- Janet Schloss
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, NSW, Australia; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney Australia.
| | - Kimberley Ryan
- The Royal Brisbane Women's Hospital, Herston, Brisbane, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney Australia
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Alqannad EM, Alharbi AS, Almansour RA, Alghamdi MS. Alarm Therapy in the Treatment of Enuresis in Children: Types and Efficacy Review. Cureus 2021; 13:e17358. [PMID: 34567898 PMCID: PMC8453315 DOI: 10.7759/cureus.17358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Enuresis is defined as bedwetting in children aged five years and older when organic reasons have been ruled out. It can result in substantial psychological repercussions and uncomfortable circumstances for both the child and the family. Medical (desmopressin, tricyclic antidepressants [TCAs]) and behavioral treatment are the basis for the treatment of enuresis. Alarm therapy is considered the first treatment modality of choice for enuresis with almost 50% cure rates are in the long term. Cooperation and compliance from parents and children are the cornerstones of the effectiveness of alarm therapy. Multiple factors, such as technical issues, might slow down the therapeutic response time. The objective of this study is to review the role of alarm therapy in the treatment of enuresis, its types, and its efficacy and to explore the factors that may increase or decrease its efficacy.
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Hussong J, Mattheus H, Wachs S, Equit M, von Gontard A. Evaluation of a bladder and bowel training program for therapy-resistant children with incontinence. J Pediatr Urol 2021; 17:302.e1-302.e8. [PMID: 33593624 DOI: 10.1016/j.jpurol.2021.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Daytime urinary incontinence (DUI) and fecal incontinence (FI) are common disorders in children. Although standard treatment is highly effective, subgroups of incontinence (combinations of nocturnal enuresis (NE), DUI and/or FI, or with psychological comorbidity) can relapse or take a chronic course. For these complex, therapy-resistant cases, a manualized outpatient bladder and bowel training program was developed. The aim of the study was to evaluate prospectively treatment effects of this training program, including a follow-up assessment. MATERIAL & METHODS The training program was developed for small groups of 2-6 children (of same age and sex) aged 5-12 years with adaptations for 13-16 year-old adolescents. It consists of 7-9 weekly sessions for group training and 3 weekly sessions for individual training. The training comprises information about anatomy/physiology of the urogenital tract, pathophysiology, hygiene and balanced nutrition. Voiding and drinking diaries, stress management, relaxation and emotion regulation techniques are also included. Data of 32 children (mean age 8.6 years, range 5-13 years; 21 boys), who had received standard treatment (and did not reach complete response) are presented. 14 children received group therapy, 18 (younger children) were treated individually. Children were assessed before and after the treatment, as well as at a follow-up of 6 months later. Treatment effects were measured by incontinence frequency and treatment success according to the ICCS (complete response: 100% reduction of symptoms; partial response: 50-99% reduction of symptoms). Psychological symptoms were measured by the Child Behavior Checklist questionnaire (CBCL). RESULTS Frequencies of DUI were significantly reduced from 5.7 wetting episodes/week (before training) to 4.9 (after training) to 2.0 (6 months after training). Frequencies of FI were reduced from 2.9 soiling episodes/week (before training) to 1.9 (after training), but increased to 2.6 (6 months after training). According to the ICCS classification, 11.1% of children with DUI had a complete response after training and 47.6% at follow-up after 6 months. In children with FI, 33.3% reached a complete response at the end of the training and 25% at follow-up. Additionally, psychological symptoms, especially internalizing, decreased significantly during training. Further, in 14 children with comorbid NE, nighttime wetting reduced from 5.9 before training to 1.5 episodes/week at follow-up. CONCLUSIONS This bladder and bowel training program is an effective and successful treatment option for children with therapy-resistant subtypes of incontinence. Symptoms still improved 6 months after training in DUI. Additionally, the training program is helpful to decrease psychological symptoms.
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Affiliation(s)
- J Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - H Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - S Wachs
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
| | - M Equit
- Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - A von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany.
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Rakowska-Silska M, Jobs K, Paturej A, Kalicki B. Voiding Disorders in Pediatrician's Practice. CLINICAL MEDICINE INSIGHTS-PEDIATRICS 2020; 14:1179556520975035. [PMID: 33293883 PMCID: PMC7705800 DOI: 10.1177/1179556520975035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/22/2020] [Indexed: 01/23/2023]
Abstract
Voiding disorders result usually from functional disturbance. However, relevant
organic diseases must be excluded prior to diagnosis of functional disorders.
Additional tests, such as urinalysis or abdominal ultrasound are required.
Further diagnostics is necessary in the presence of alarm symptoms, such as
secondary nocturnal enuresis, weak or intermittent urine flow, systemic
symptoms, glucosuria, proteinuria, leukocyturia, erythrocyturia, skin lesions in
the lumbar region, altered sensations in the perineum. Functional micturition
disorders were thoroughly described in 2006, and revised in 2015 by ICCS
(International Children’s Continence Society) and are divided into storage
symptoms (increased and decreased voiding frequency, incontinence, urgency,
nocturia), voiding symptoms hesitancy, straining, weak stream, intermittency,
dysuria), and symptoms that cannot be assigned to any of the above groups
(voiding postponement, holding maneuvers, feeling of incomplete emptying,
urinary retention, post micturition dribble, spraying of the urinary stream).
Functional voiding disorders are frequently associated with constipation.
Bladder and bowel dysfunction (BBD) is diagnosed when lower urinary tract
symptoms are accompanied by problems with defecation. Monosymptomatic enuresis
is the most common voiding disorder encountered by pediatricians. It is
diagnosed in children older than 5 years without any other lower urinary tract
symptoms. Other types of voiding disorders such as: non-monosymptomatic
enuresis, overactive and underactive bladder, voiding postponement, bladder
outlet obstruction, stress or giggle incontinence, urethrovaginal reflux usually
require specialized diagnostics and therapy. Treatment of all types of
functional voiding disorders is based on non-pharmacological recommendations
(urotherapy), and such education should be implemented by primary care
pediatricians.
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Affiliation(s)
- Magda Rakowska-Silska
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Jobs
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Aleksandra Paturej
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
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Su MS, Xu L, Gu SG, Huang N, Ren XK, Cai XH, Li CC. Therapeutic effects and modulatory mechanism of Alpiniae oxyphyllae Fructus in chronic intermittent hypoxia induced enuresis in rats. Sleep Breath 2020; 24:329-337. [PMID: 31898190 DOI: 10.1007/s11325-019-01983-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/25/2019] [Accepted: 11/20/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to explore the effect of Alpiniae oxyphyllae Fructus (AOF) on a rat model of chronic intermittent hypoxia (CIH)-induced enuresis. Findings of this study may help identify therapeutic targets in children with nocturnal enuresis (NE). METHODS Female rats were randomly divided into a control group (saline gavage, 4 weeks of normal air), CIH group (saline gavage, 4 weeks of CIH), and AOF group (AOF gavage, 4 weeks of CIH). The variables measured in this study included water intake, urine output, bladder leak point pressure (BLPP), malondialdehyde (MDA) levels, and superoxide dismutase (SOD) activity. The expression levels of the purinergic P2X3 receptor, muscarinic M3 receptor, and ß3-adrenergic receptor (ß3-AR) in the bladder were also measured. The bladder was subjected to haematoxylin and eosin (HE) and Weigert staining, and histological changes were observed under a light microscope to evaluate the morphological changes in the bladder in each group. RESULTS Compared with the control group, urine output was increased, and the BLPP was decreased in the CIH group, but AOF administration decreased urine output and increased BLPP. In addition, the serum MDA level increased and the SOD activity decreased in the CIH group compared with the control group. Administration of AOF decreased the MDA level and increased the SOD activity. Additionally, compared with the control group, HE and Weigert staining in the CIH group showed that the bladder detrusor muscle bundles were disordered and loose, some muscle bundles were broken, the content of collagen fibres in the gap was reduced, and the gap was significantly widened. However, following the administration of AOF, the bladder detrusor muscle bundles were neatly arranged, and the content of collagen fibres in the gap was increased. Furthermore, compared with the control group, the purinergic P2X3 receptor and muscarinic M3 receptor were expressed at higher levels, and ß3-AR was expressed at lower levels in the CIH group, but AOF administration decreased the expression of the purinergic P2X3 receptor and muscarinic M3 receptor and increased the expression of the ß3-AR. CONCLUSIONS AOF improves enuresis by inhibiting oxidative stress and regulating the expression of the purinergic P2X3 receptor, muscarinic M3 receptor, and ß3 adrenergic receptor.
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Affiliation(s)
- Miao-Shang Su
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Li Xu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Shu-Ge Gu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Nan Huang
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Xi-Kai Ren
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Xiao-Hong Cai
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.
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Liu J, Ni J, Miao Q, Wang C, Lin F, Cao Q, Guo W, Yang X, Ji X, Zhai Y, Bi Y, Shen Q, Xu H. Exploration of the Optimal Desmopressin Treatment in Children With Monosymptomatic Nocturnal Enuresis: Evidence From a Chinese Cohort. Front Pediatr 2020; 8:626083. [PMID: 33569362 PMCID: PMC7868531 DOI: 10.3389/fped.2020.626083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/31/2020] [Indexed: 01/15/2023] Open
Abstract
Objectives: Nocturnal enuresis (NE) is a common pediatric condition, and desmopressin (dDAVP) is a first-line therapy for NE. The standard initial dosage of dDAVP is 0. 2 mg/day, and most guidelines recommend that the dose should be increased at 0.2 mg increments until dryness is achieved or to the maximal recommended dose. However, previous evidence has shown that this strategy seems insufficient to further improve efficacy and results in unnecessarily high doses for some patients. Our study aimed to assess the efficacy of our modified dDAVP treatment regimen in children with MNE in China and evaluate predictive factors associated with the dDAVP response. Methods: All MNE patients at the Department of Nephrology at Children's Hospital of Fudan University from January to December 2019 were prospectively and consecutively enrolled. dDAVP treatment comprised a dose titration period and a 3-month maintenance period. The efficacy of dDAVP was assessed according to the latest International Children's Continence Society criteria at the end of the study. Predictive factors were evaluated by logistic regression analysis. Results: Overall, 322 MNE patients were enrolled in our study, and 225 (69.9%) completed the study. The intention to treat analysis showed that the overall dDAVP response rate was 69.9%: among these patients 32.3% were complete responders, and 37.6% were partial responders. At the end of the study, 194/225 (86.2%) patients received a final dose of 0.2 mg, 24/225 (10.7%) patients received a final dose of 0.3 mg, and 7/225 (3.1%) patients received a final dose of 0.4 mg. Multivariate analysis showed that patients requiring lower doses to achieve responses were significantly more likely to experience complete response during the maintenance period [odds ratio (OR)=9.683; 95% confidence interval (CI), 2.770-33.846]. Conclusions: Our results indicate that the dDAVP treatment regimen provides a comparable efficacy to the international conventional treatment regimen with a lower overall dose. Low-dose responders were likely to achieve a complete response without increasing the dose; in these cases, the maximum dose might not be necessary.
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Affiliation(s)
- Jiaojiao Liu
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Jiajia Ni
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Qianfan Miao
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Chunyan Wang
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Fang Lin
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Qi Cao
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Wei Guo
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Xue Yang
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Xiaolu Ji
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Yihui Zhai
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Yunli Bi
- Department of Urology, Children's Hospital of Fudan University, Shanghai, China
| | - Qian Shen
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
| | - Hong Xu
- Department of Nephrology, Children's Hospital of Fudan University, National Pediatric Medical Center of China, Shanghai, China
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Study on neuropathological mechanisms of primary monosymptomatic nocturnal enuresis in children using cerebral resting-state functional magnetic resonance imaging. Sci Rep 2019; 9:19141. [PMID: 31844104 PMCID: PMC6915704 DOI: 10.1038/s41598-019-55541-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/27/2019] [Indexed: 11/08/2022] Open
Abstract
Primary monosymptomatic nocturnal enuresis (PMNE) is a heterogeneous disorder, which remains a difficult condition to manage due to lack of knowledge on the underlying pathophysiological mechanisms. Here we investigated the underlying neuropathological mechanisms of PMNE with functional MRI (fMRI), combining the amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and seed-based functional connectivity (seed-based FC) analyses. Compared to the control group, PMNE group showed decreased ALFF value in the left medial orbital superior frontal gyrus (Frontal_Med_Orb_L), and increased ReHo value in the left superior occipital gyrus (Occipital_Sup_L). With left thalamus as the seed, PMNE group showed significantly decreased functional connectivity to the left medial superior frontal gyrus (Frontal_Sup_Medial_L). We conclude that these abnormal brain activities are probably important neuropathological mechanisms of PMNE in children. Furthermore, this study facilitated the understanding of underlying pathogenesis of PMNE and may provide an objective basis for the effective treatment.
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Su MS, Xu L, Pan WF, Li CC. Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children. World J Pediatr 2019; 15:109-116. [PMID: 30446975 DOI: 10.1007/s12519-018-0199-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children. OSA and NE are thought to be interrelated, but the exact pathophysiological mechanisms are not yet clear. This review aims to explain the possible pathogenesis of NE in children with OSA. DATE SOURCES We have retrieved all relevant original articles from Database that have been published so far, including the prevalence studies of NE and OSA in children, sleep characteristic studies that use polysomnography (PSG) to focus on children with NE, and studies on the relationship between OSA and NE. RESULTS Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers. This increased risk may be associated with sleep disorders, bladder instability, detrusor overactivity, nocturnal polyuria, endocrine and metabolic disorders, and inflammation. CONCLUSIONS Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA, but this remains to be confirmed by animal studies. Other causes such as oxidative stress and inflammatory responses need to be further researched.
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Affiliation(s)
- Miao-Shang Su
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Li Xu
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Wen-Feng Pan
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chang-Chong Li
- Department of Pediatric Respiratory Medicine and Sleep Medicine, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
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Manni R, Toscano G, Terzaghi M. Therapeutic Symptomatic Strategies in the Parasomnias. Curr Treat Options Neurol 2018; 20:26. [DOI: 10.1007/s11940-018-0508-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Wang M, Zhang A, Zhang J, Lu H, Xu S, Qin Z, Ma J, Du X. Morphometric Magnetic Resonance Imaging Study in Children With Primary Monosymptomatic Nocturnal Enuresis. Front Pediatr 2018; 6:103. [PMID: 29707531 PMCID: PMC5908894 DOI: 10.3389/fped.2018.00103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/28/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Primary monosymptomatic nocturnal enuresis (PMNE) refers to bed-wetting in children who have no other lower urinary tract symptoms and are never dry for more than 6 months. Our previous studies demonstrated that children with PMNE exhibited brain functional abnormalities compared with healthy controls; however, researches on the abnormalities in gray matter were limited. This study aimed to investigate brain structural changes in gray matter of children with PMNE using magnetic resonance imaging (MRI). METHODS Gray matter volumes (GMVs) and gyrification indices (GIs) were calculated using voxel-based and surface-based morphometry analyses of structural MRI data acquired from 26 children with PMNE and 28 healthy children. To identify between-group differences in gray matter, two-sample t-tests were conducted on GMV and GI images separately. RESULTS Compared with the controls, children with PMNE showed significantly increased GMVs in the supplementary motor area and medial prefrontal cortex regions (mean GMV in PMNE: 0.54 ± 0.07 l; mean GMV in controls: 0.50 ± 0.06 l) and reduced GIs in the right precuneus (mean GI in PMNE: 25.74° ± 2.34°; mean GI in controls: 27.97° ± 1.79°). CONCLUSION Children with PMNE showed abnormal GMVs in frontal lobe and GIs in precuneus, and these changes might be involved in the pathological mechanism of PMNE.
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Affiliation(s)
- Mengxing Wang
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Anyi Zhang
- Department of Developmental and Behavioral Pediatrics, Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jilei Zhang
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Haifeng Lu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Shuai Xu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Zhaoxia Qin
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
| | - Jun Ma
- Department of Developmental and Behavioral Pediatrics, Shanghai Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China
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