Explore the vast range of titles available.

Splenic angioembolization (SAE) is increasingly used in the management of splenic injuries in adults, although its value in pediatric trauma is unclear. We sought to assess outcomes related to splenectomy vs SAE. The National Trauma Data Bank was queried for patients 0 to 15 years of age from 2007 to 2011. Subgroup analysis of splenectomy vs SAE was performed for high-grade injuries using propensity analysis and inverse probability weighting. Of 11,694 children presenting with splenic trauma, over 90% were treated nonoperatively. Adjusted analysis of high-grade injuries included 265 children who underwent splenectomy and 199 who underwent SAE. The Injury Severity Score, number of transfusions, and complications rates were not significantly different between the 2 groups. Overall adjusted mortality for children with high-grade injuries was 13.4% following splenectomy and 10.0% following SAE (P = .31) Patients undergoing SAE for high-grade splenic trauma have comparable morbidity and mortality with splenectomy. •Splenectomy was compared with splenic angioembolization for management of splenic trauma in children.•Less than 10% of the children require intervention for splenic injury.•There was no difference in transfusion rates or postprocedural complications.•Mortality rates between the 2 groups were not statistically different.

Background Previous studies have demonstrated the challenges of parenthood in surgical training and careers. However, certain aspects of childrearing for surgeons remain understudied. We aim to leftacterize the complexity and costs of childcare amongst surgical trainees and faculty. Methods An anonymous, self-administered survey was conducted within the Department of Surgery at a large academic medical center. Both male and female trainees and faculty were included in the analysis. Chi-square or Fisher’s Exact test was performed. Results Forty-six respondents provided information about childcare costs, with 37% of respondents being residents or fellows. Trainees worked longer workhours ( p  = 0.003) than their faculty counterparts. Despite trainees having fewer ( p  = 0.001) and younger ( p  = 0.001) children, there was no statistically significant difference in the annual childcare costs ( p  = 0.6). Over half of trainees and faculty report spending more than $20,000 annually. Childcare costs seem to place a greater burden on trainees, with 89% of trainees and 46% of faculty reporting that they are worried about the cost of childcare ( p  = 0.04). In addition to the expense, coordinating childcare is also challenging, with most respondents reporting multiple sources of childcare. Conclusion Concerted efforts are needed to support surgeon-parents at all career stages. The cost of childcare places an increased burden on surgical trainees compared to their faculty counterparts. Management of multiple sources of childcare is also a source of stress for both faculty and trainees.

Complications after a pullthrough for Hirschsprung disease can occur either early or late in the postoperative period. A small number of these patients may require reoperation, with rates varying from 3% to 28% at a large volume colorectal center.1 2 Indications for reoperation include stricture, leak, fistula, transition zone pullthrough or retained aganglionosis, retained Soave cuff, or a Duhamel spur. Some of these may manifest as obstructive symptoms or constipation, which can be seen in 11% to 42% of patients.3 Other patients may develop soiling and fecal incontinence, which can be caused by sphincter injury during surgery or by loss of the dentate line.4 In a review of 46 redo pullthroughs, 71% occurred because of aganglionosis or a transition zone pullthrough, 19% from stricture or obstruction by the Duhamel pouch, and 8% from a tight Soave cuff.2 The choice of pullthrough, whether a Swenson, Yancey-Soave, or Duhamel, does not influence the rate of complication but rather each has its own unique pitfalls to avoid.5 The timing of surgery, whether performed as a neonate or delayed into infancy, continues to be debated, with a large study from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) showing no difference in anastomotic or cuff stricture, Duhamel spur, or transition zone pullthrough, and several others showing higher rates of stricture and leak when repairs are done in the neonatal period.6 7 In this review, we discuss avoidable pitfalls during the pullthrough procedure and provide guidance for identification and prevention.

Purpose Sclerotherapy is the mainstay of treatment of macrocystic lymphatic malformation (LM), but the response using traditional sclerosants is much less beneficial in microcystic lesions. Intralesional bleomycin has been reported to be effective in microcystic LM; however, its use is limited by concerns about pulmonary fibrosis. The purpose of this study was to evaluate the safety and efficacy of bleomycin sclerotherapy in microcystic LM. Methods The medical records and imaging studies of all patients with microcystic or combined LM who underwent percutaneous image-guided sclerotherapy using bleomycin were retrospectively reviewed. Only patients with pre- and postprocedure imaging were included. Thirty-one patients with a mean age of 13.4 years (range 3 months–31 years) were treated. Response was graded as complete (>90 % size reduction), partial (25–90 %), or minimal/no response (<25 %). Pulmonary function tests (PFT) and chest X-rays were performed before the procedure. PFT were repeated at 6 months and 1 year postprocedure. Annual postprocedure chest X-rays were also performed. Results The malformations were located in the head and neck ( n  = 27) and trunk ( n  = 4). The number of procedures ranged from 1 to 4 (mean 1.7). Up to 1 U/kg of bleomycin was injected per session, with a maximum of 15 U. The mean follow-up period was 3.2 years (range 1.5–5 years). There was complete response in 38 % ( n  = 12), partial response in 58 % ( n  = 18), and no response in 3 % ( n  = 1). No complications were identified. Conclusions Preliminary indicate that sclerotherapy of microcystic LMs using bleomycin is effective and safe.

Fluorescence has been observed directly across the band gap of semiconducting carbon nanotubes. We obtained individual nanotubes, each encased in a cylindrical micelle, by ultrasonically agitating an aqueous dispersion of raw single-walled carbon nanotubes in sodium dodecyl sulfate and then centrifuging to remove tube bundles, ropes, and residual catalyst. Aggregation of nanotubes into bundles otherwise quenches the fluorescence through interactions with metallic tubes and substantially broadens the absorption spectra. At pH less than 5, the absorption and emission spectra of individual nanotubes show evidence of band gap-selective protonation of the side walls of the tube. This protonation is readily reversed by treatment with base or ultraviolet light.

Ultrasonography (US) is the diagnostic modality of choice during work-up for ovarian torsion, although computed tomography (CT) may be used. We examined the utilization of CT in girls with ovarian torsion, and determined which patients are most likely to undergo this study. The Nationwide Emergency Department Sample dataset was searched for patients <18 years who presented with ovarian torsion from 2006 to 2012. Hospitals were categorized by the volume of pediatric patients seen. A total of 1279 patients were identified. Seven hundred twelve (56%) were seen at adult hospitals, 154 (12%) at pediatric privileged, and 413 (32%) at pediatric hospitals. Patients cared for in a pediatric or pediatric privileged hospital had more US alone performed to diagnose ovarian torsion (p < 0.01). Girls seen at pediatric hospitals are more likely to undergo US for work-up of ovarian torsion.

Most cases of pancreatic cancer are not diagnosed until they are no longer curable with surgery. Therefore, it is critical to develop a sensitive, preferably noninvasive, method for detecting the disease at an earlier stage. In order to identify biomarkers for pancreatic cancer, we devised an in vitro positive/negative selection strategy to identify RNA ligands (aptamers) that could detect structural differences between the secretomes of pancreatic cancer and non-cancerous cells. Using this molecular recognition approach, we identified an aptamer (M9-5) that differentially bound conditioned media from cancerous and non-cancerous human pancreatic cell lines. This aptamer further discriminated between the sera of pancreatic cancer patients and healthy volunteers with high sensitivity and specificity. We utilized biochemical purification methods and mass-spectrometric analysis to identify the M9-5 target as cyclophilin B (CypB). This molecular recognition-based strategy simultaneously identified CypB as a serum biomarker and generated a new reagent to recognize it in body fluids. Moreover, this approach should be generalizable to other diseases and complementary to traditional approaches that focus on differences in expression level between samples. Finally, we suggest that the aptamer we identified has the potential to serve as a tool for the early detection of pancreatic cancer.

Purpose: The proportions of select stem cells in term amniotic fluid have been shown to correlate with the type and size of experimental neural tube defects (NTDs). We sought to determine the impact of gestational age upon this form of targeted amniotic cell profiling. Methods: Sprague-Dawley fetuses with retinoic acid-induced NTDs (n = 110) underwent amniotic fluid procurement at four time points in gestation. Samples were analyzed by flow cytometry for the presence of cells concomitantly expressing Nestin and Sox-2 (neural stem cells, aNSCs) and cells concomitantly expressing CD29 and CD44 (mesenchymal stem cells, aMSCs). Statistical analysis was by nonparametric Kruskal-Wallis ANOVA (p < 0.05). Results: There was a statistically significant impact of gestational age on the proportions of both aMSCs (p = 0.01) and aNSCs (p < 0.01) in fetuses with isolated spina bifida. No such impact was noted in normal fetuses (p > 0.10 for both cells), in isolated exencephaly (p > 0.10 for both cells), or in combination defects (p > 0.10 for both cells). Gestational age had no effect on aNSC/aMSC ratios. Conclusions: Targeted quantitative amniotic cell profiling varies with gestational age in experimental isolated spina bifida. This finding should be considered prior to the eventual translation of this diagnostic adjunct into the prenatal evaluation of these anomalies.

BackgroundThe authors sought better outcomes for uncomplicated gastroschisis through development of clinical practice guidelines.MethodsThe authors and the American Pediatric Surgical Association Outcomes and Evidenced-based Practice Committee used an iterative process and chose two questions to develop clinical practice guidelines regarding (1) standardized nutrition protocols and (2) postnatal management strategies. An English language search of PubMed, MEDLINE, OVID, SCOPUS, and the Cochrane Library Database identified literature published between January 1, 1970, and December 31, 2019, with snowballing to 2022. The Appraisal of Guideline, Research and Evaluation reporting checklist was followed.ResultsThirty-three studies were included with a Level of Evidence that ranged from 2 to 5 and recommendation Grades B–D. Nine evaluated standardized nutrition protocols and 24 examined postnatal management strategies. The adherence to gastroschisis-specific nutrition protocols promotes intestinal feeding and reduces TPN administration. The implementation of a standardized postnatal clinical management protocol is often significantly associated with shorter hospital stays, less mechanical ventilation use, and fewer infections.ConclusionsThere is a lack of comparative studies to guide practice changes that improve uncomplicated gastroschisis outcomes. The implementation of gastroschisis-specific feeding and clinical care protocols is recommended. Feeding protocols often significantly reduce TPN administration, although the length of hospital stay may not consistently decrease.