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Pediatric Varicocele, Micropenis, Buried and Webbed Penis, Penile Torsion, Diphallia, Penoscrotal Transposition, and Aphallia 203 8. The complete type of transposition is rare and is usually part of complex congenital malformations. Treatment is always secondary to correction of the other anomalies, and should only be done in centres with expertise. The proposed classification is related to prognosis and has not been in use subsequently. The authors postulate that the relative relationship of the urethral meatus to the anal sphincter will determine the prognosis, with the post-sphincteric patients having highest survival and lowest incidence of other abnormalities. Eight articles included a variety of other causes for a small penis as well as feminizing genitoplasty, and were descriptive papers of surgical techniques used for phalloplasty. Twenty-four papers are case reports, the majority with single cases, four with 3 cases, one with 4 cases, and one with 5 cases. The studies were assessed according to the level of evidence and grade of recommendation. If the child presents earlier, other associated malformations will decide and impact the timing of genital reconstruction (this is based on common sense and not on any evidence). Physicians should consider donor site morbidity, complexity of surgery, and recovery time when planning for surgery. Surgical treatment is staged and should be carried out in a centre with relevant expertise. Pediatric Varicocele, Micropenis, Buried and Webbed Penis, Penile Torsion, Diphallia, Penoscrotal Transposition, and Aphallia 205 8. A Doppler-based study on the prevalence of varicocele in German children and adolescents. The prevalence of varicocele and varicocele-related testicular atrophy in Turkish children and adolescents. Testicular volume and semen parameters in patients aged 12 to 17 years with idiopathic varicocele. Assessment of sapheno-femoral junction continence in patients with primary adolescent varicocoele. Is the comparison of a left varicocele testis to its contralateral normal testis sufficient in determining its well-being Adolescent varicocele: influence of Tanner stage at presentation on the presence, development, worsening and/ or improvement of testicular hypotrophy without surgical intervention. Nationwide survey to evaluate the prevalence of varicoceles in South Koreanmiddle school boys: a population based study. Evaluation of inguinoscrotal pathologies among adolescents with special emphasis on association between varicocele and body mass index. Pediatric Varicocele, Micropenis, Buried and Webbed Penis, Penile Torsion, Diphallia, Penoscrotal Transposition, and Aphallia 207 25. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature. Hydrodynamic relationship between color Doppler ultrasonography findings and the number of internal spermatic veins in varicoceles. The role of Doppler ultrasonography in determining the proper surgical approach to the management of varicocele in children and adolescents. Cost-benefit analysis of scrotal ultrasound in treatment of adolescents with varicocele. Comparative assessment of pediatric testicular volume: orchidometer versus ultrasound. Color Doppler ultrasound imaging in varicoceles: is the venous diameter sufficient for predicting clinical and subclinical varicocele

Ramirez2 1 Hospital la Fe, Intensive Care Unit, Valencia, Spain; 2Hospital la Fe, Valencia, Spain Correspondence: E. Endotoxaemia is associated with infections caused by Gram-negative bacteria, but can occurs in absence of it. In sepsis, some of the protective mechanisms of gut barrier are disrupted and subsequently, bacterial products, like endotoxin, may cross the gut mucosa and spread to the mesenteric lymph nodes or more distant organs. A859 the relationship between the neutrophil/lymphocyte ratio and mortality in the severe sepsis patients Y. Prognostic importance of neutrophillymphocyte ratio in critically ill patients: short- and long-term outcomes. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. A860 Evaluating initiatives advocating appropriate fluid therapy in severe sepsis/septic shock according to the surviving sepsis campaign H. Handler Saint Barnabas Medical Center, Department of Medicine, Livingston, United States Correspondence: H. Data was collected to determine whether the educational intervention would affect patients receiving adequate treatment using Chi-square testing and if there was an effect on mean length of stay using student-t testing. Methods: Controlled, randomized semi cross-over, single blind trial conducted at Bordeaux Universitary Hospital. We excluded patients with parenchyma damage, respiratory and/or hemodynamic instability, and high infectious risk. Despite being included in guidelines for the prevention of ventilator-associated pneumonia, it is accomplished less than recommended. Descriptive, bivariate and multivariate analyses were performed according to the source of data. Here we describe an observational analysis of airway (A), breathing (B), and circulation (C) pathophysiology and supportive care in these three locations to test whether there are differences in practice. To compare patient pathophysiology, in the first 24 hours of hospital admission, in A,B and C. Methods: Institutional/patient & public approval was gained to collect staff opinions and anonymised patient data. This included physiological observations and supportive care standards around A, B and C. Finally, in respect to patient pathophysiology, all groups were under ventilated and over oxygenated. However, changes in pathophysiology were related to interventions (fluid boluses, analgesia, surgical interventions, inotropes, pressors) rather than location. Despite the divergent views regarding the relative value of flow monitoring, observed fluid boluses were predominantly triggered by pressure changes in all three locations. Conclusions: Differences in staff attitudes; application of standards and patient pathophysiology were identified between care locations. The influence of variation in resources and professional composition of teams (nurses:doctors) on these results requires further work. It remains uncertain whether more uniform approaches would improve patient outcomes. Exclusion criteria were Age < 18 years, pregnant, amputees, cardiac pacemakers, pre-existing lung diseases and ascites. Ultrasound assessment for extravascular lung water in patients undergoing hemodialysis. Johns Medical College Hospital, Critical Care Medicine, Bangalore, India Intensive Care Medicine Experimental 2016, 4(Suppl 1):A864 Table 15 (abstract A864). In total 1062 (66 %) were surgical patients, 331 (21 %) medical, and 201 (13 %) were neurological patients. No differences in sleep scores were found between surgical, medical and neurological patients.

However, the risk assessment of patients undergoing cardiac surgery remains an unanswered question. Methods: Prospective single center study was developed according with the previous protocol. All patients from elective cardiac surgery were eligible from May to December 2015. Comorbidities were hypertension (59 %), diabetes mellitus (26 %) and atrial fibrillation (18. On-pump surgery was performed in the 88 % and the coronary bypass was the most frequent (31 %). Conclusions: We detected a rise in Pro-Adrenomedullin levels after cardiac surgery. More data are necessary to confirm the role in the prediction of relevant outcomes. Postoperative Pro-Adrenomedullin Levels Predict Mortality in Thoracic Surgery Patients. Zhou Sir Run Run Shaw Hospital, Intensive Care Medicine, Hanghzou, China Intensive Care Medicine Experimental 2016, 4(Suppl 1):A1136 Introduction: Acute aortic disease is a common but challenging entity in clinical practice. Titration the blood pressure and heart rate to a target level is of paramount importance in the acute phase regardless of whether the patient will undergo a surgery or not eventually. In addition to the initially intravenous -blockers, parenteral infusion of nicardipine and urapidil are the most common used antihypertensive therapy currently in mainland China. Objectives: To evaluate the difference of the abovementioned two antihypertensive strategies on the outcome of patients with aortic disease. Methods: All patients with new diagnosed aortic diseases presented to our hospitals from January 1, 2013 to June 30, 2014 were retrospectively reviewed. Results: A total of 120 patients with new diagnosed aortic disease were included in the study. Of them, 47 patients received urapidil while 73 patients received nicardipine antihypertensive therapy. Patients with nicardipine were more quickly to reach the target blood pressure level than those treated with urapidil (median 18 vs 35 mins, P = 0. Canadian Cardiovascular Society position statement on the management of thoracic aortic disease. Importance of blood pressure control after repair of acute type a aortic dissection. Liu2 1 Fooyin University, Department of Physical Therapy, Kaohsiung City, Taiwan, Province of China; 2Kaohsiung Veterans General Hospital, Cardiovascular Division, Kaohsiung City, Taiwan, Province of China; 3 Kaohsiung Veterans General Hospital, Critical Care Division, Kaohsiung City, Taiwan, Province of China Correspondence: C. In this study, we investigated to provide quality care for patients with pulmonary arterial hypertension via multidisciplinary care model. Yoon2 1 Pusan National University Yangsan Hospital, Anesthesia and Pain Medicine, Yangsan-si, Republic of Korea; 2Korea University Anam Hospital, Anaesthesiology and Pain Medicine, Seoul, Republic of Korea Correspondence: Y. These demographic and clinical characteristics, perioperative laboratory findings, and postoperative complications were assessed using computerized databases from our institution. Grant acknolwedgment this study was supported by a Korea University Research Grant. We pair a group of 1528 patients with statins with other similar group that do not take, based on an propensity score. Conclusions: Preoperative statin use was associated with a lower risk of atrial fibrillation after cardiac surgery, observed in valve surgery (significant differences) and bypass (although significant differences by possible under sample number). A1139 Predictors of mortality after cardiac surgery in elderly patients in the intensive care unit in a referral hospital S. Guergue Irazabal Complejo Hospitalario de Navarra, Intensive Care Medicine, Pamplona, Spain Correspondence: S. Objectives: Knowing the prognostic factors associated with mortality in over 75 years undergoing cardiac surgery.

Key Elements for, and Indicators of, a Successful Transition: An International Delphi Study. Functional independence among young adults with Spina Bifida, in relation to hydrocephalus and level of lesion. The National Spina Bifida Program Transition Initiative: the People, the Plan, and the Process. Perspectives of school-work transitions among youth with Spina Bifida, their parents and health care providers. Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review. Adult outcomes and lifespan issues for people with childhood-onset physical disability. Access to Care for Youth with Special Health Care Needs in the Transition to Adulthood. Transitioning adolescents and young adults with a chronic health condition to adult healthcare - an exemplar program. Crossing the transition chasm: Experiences and recommendations for improving transitional care of young adults, parents and providers. Transition of care to an adult Spina Bifida clinic: patient perspectives and medical outcomes. Risk of bladder cancer in patients with Spina Bifida: case reports and review of the literature. Transition to adult health care for adolescents with Spina Bifida: Research issues. Youth with Spina Bifida and transitions: health and social participation in a nationally represented sample. Exploration of internet use: profile and preferences of transition-aged adolescents with Spina Bifida. Families of children with Spina Bifida show few differences in marital function compared to families of typically-developing children. Findings suggest both positive and negative effects of having a sibling with Spina Bifida. This is an example of cumulative risk, which is an important construct relevant to both family functioning and Spina Bifida care. Maximize family resilience and adaptation to multiple Spina Bifida-related and normative stressors as appropriate for developmental level. Maximize parental adaptation, expectations, and responsiveness to the changing developmental level of the child by identifying and reinforcing effective parenting techniques. Maximize independence of the child within the family context, given developmental level and condition-related constraints. Minimize parental and marital stress and maladaptation when raising a child with a serious chronic health condition. Maximize family engagement in social activities, including parental self-care activities. Refer families who have received a prenatal diagnosis of Spina Bifida for prenatal counseling and consultation with members of a Spina Bifida multidisciplinary clinical team. Provide information about Spina Bifida, parenting, treatments, support groups, and the Spina Bifida Association. Coordinate services during the transition from the hospital stay to subsequent clinic follow-up, stressing the need for ongoing multi-specialty care. Teach necessary home care procedures such as post- surgical care, skin care, and clean intermittent catheterization, as needed. Refer the parents or caregivers to infant intervention and appropriate state programs. Provide anticipatory guidance for parents regarding strengths and possible cognitive and behavioral challenges in children with Spina Bifida and their siblings. Teach parents to advocate for themselves and their child when working with medical, educational, and agency staff. Provide anticipatory guidance for parents regarding possible behavioral challenges and autonomy needs in children with Spina Bifida and their siblings.

For example, approximately 19 % of the catchments in North Carolina lost Brook Trout since the 2005 assessment (Hudy et al. In other cases, previously unoccupied catchments were recolonized or restored (less than 2%). The majority of Brook Trout populations throughout the southern range co-occur with nonnative trout (Rainbow Trout and/or Brown Trout (watersheds: 7. While the establishment of nonnative trout in Brook Trout watersheds has been previously addressed in a number of studies (Kelly et al. The data suggest that even catchments that currently contain only native Brook Trout are vulnerable to invasion from nonnative trout established within their sub-watersheds. These invaded populations may be at increased risk, as some studies have found negative impacts of nonnative trout on wild Brook Trout (Kelly et al. Monitoring efforts need to focus on rates of nonnative establishment at the catchment scale and the fate and status of Brook Trout populations currently in sympatry, particularly as compared to the few remaining allopatric populations. If negative impacts are detected, this would place particular emphasis on keeping those few sub-watersheds that currently contain only Brook Trout free of nonnative species. Model results were sensitive to both scale and the number of classification categories with respect to classification accuracy, variable selection, and variable threshold values (Table 3). For all three cases, classification accuracy was lowest at the catchment scale, potentially reflecting stochastic population processes and barriers to movement, which would complicate predication based on landscape variables. A total of 39 of the original 85 metrics were used at least once in the 9 different models (Table 3). The metric of soil permeability was the most important variable for watershed and sub-watershed models but was not important at the catchment scale (Table 3). These models are therefore useful in targeting actions (increasing canopy cover, decommissioning roads, liming watersheds) that would increase Brook Trout population resilience. Most of the data used here were provided by state and federal agencies and had not been published or peer reviewed. Despite the criteria developed for status classification, there remains some element of subjectivity in the assessment of status and occupancy. It was impossible to generate a comprehensive review without such data (Reiman et al. We attempted to limit errors, reduce subjectivity, and provide consistency in data by using consistency rules and data standards (quality and age); developing broad classification categories; and employing standard, validated procedures in consulting experts (Hudy et al. Moving forward, continued improvement and standardization of decision rules and data collection protocols, along with increasing understanding of the factors limiting Brook Trout population and incorporation of these factors into new models, will further increase our ability to assess status, predict trends, and target management actions. Each metric summarized by the relevant scale of analysis (watershed; sub-watershed; catchment). An Index of Cumulative Disturbance to River Fish Habitats of the Conterminus United States from Landscape Anthropogenic Activities. Distribution, status, and perturbations to brook trout within the eastern United States. Encroachment of exotic rainbow trout into stream populations of native brook trout in the southern Appalachian Mountains. Development of an index of biotic integrity for the mid-Atlantic Highlands region. Assessment and predictive model for brook trout (Salvelinus fontinalis) population status in the eastern United States. Distribution and status of seven native salmonids in the interior Columbia River basin and portions of the Klamath River and Great basins. Landscape-Scale Evaluation of Asymmetric Interactions between Brown Trout and Brook Trout Using Two-Species Occupancy Models. Monitoring both short- and long-term trends on individual Brook Trout populations and the resource as a whole are important needs of managers. Currently, standard population estimates using mark-recapture and depletion removal estimates are not viable for large scale monitoring because of expense, inability to detect trend. However, extensive fine-scale occupancy data (at the catchment level) exist for many states.