Gastroschisis: Impact of Bedside Closure on Ventilator-Associated Outcomes

Aim In our practice, preformed silos are routine rather than reserved for difficult cases. We aimed to identify whether silo and bedside closure can minimize: general anesthetic (GA) exposure, need for intubation and ventilation, or days intubated for neonates with simple gastroschisis (SG). Methods After approval, patients were identified via the neonatal discharge log (April 2010 to April 2019). Data were collected by case-note review and analyzed with respect to GA, ventilation, and core outcomes. Results Of 104 patients (50 female, mean birth weight 2.43 kg, mean gestational age 36 + 2 weeks), 85 were SG and 19 complex. Silo application was initial management in 70 SG, 57 completed successful bedside closure (by day 4 of life—median). Fifteen SG had initial operative closure.Of the 70 SG managed with silo, 46 (66%) had no GA as neonates. Twelve required GA for line insertion. Thirteen patients with initial silo had closure in theater (7 opportunistic at time of GA for line). Nine required intubation and ventilation out-with the operating theater during neonatal management. Seven had already been intubated at delivery; 3 because of meconium aspiration.One-hundred percent of those treated with operative closure had GA, 1 patient subsequently required surgery for subglottic stenosis. Time to full feeds did not differ between groups. Conclusion Silo and bedside closure allow the majority of SG neonates to avoid GA or intubation in the neonatal period, without increased risk of complication. However, it is important that the nursing expertise required to manage these patients safely is not underestimated.

Implicit Estimation of Paragraph Relevance From Eye Movements

Eye movements were shown to be an effective source of implicit relevance feedback in constrained search and decision-making tasks. Recent research suggests that gaze-based features, extracted from scanpaths over short news articles (g-REL), can reveal the perceived relevance of read text with respect to a previously shown trigger question. In this work, we aim to confirm this finding and we investigate whether it generalizes to multi-paragraph documents from Wikipedia (Google Natural Questions) that require readers to scroll down to read the whole text. We conduct a user study (n = 24) in which participants read single- and multi-paragraph articles and rate their relevance at the paragraph level with respect to a trigger question. We model the perceived document relevance using machine learning and features from the literature as input. Our results confirm that eye movements can be used to effectively model the relevance of short news articles, in particular if we exclude difficult cases: documents which are on topic of the trigger questions but irrelevant. However, our results do not clearly show that the modeling approach generalizes to multi-paragraph document settings. We publish our dataset and our code for feature extraction under an open source license to enable future research in the field of gaze-based implicit relevance feedback.

Transseptal Access: A Review of Contemporary Tools

Transseptal left atrial catheterization is routinely used for many common catheter-based interventions. Tools for transseptal catheterization have advanced over the recent years. Such tools include imaging advances with intracardiac echocardiology as well as an array of needles, wires, and dilators to achieve transseptal access with greater ease and safety. This review will discuss the contemporary tools for transseptal catheterization and guidance for difficult cases.

IS A BIG OMENTUM THE SURGEON'S BEST FRIEND OR WORST ENEMY? REVIEW

The interest of surgeons in the greater omentum is associated with a unique combination of such functions as plasticity, immune defense, barrier, hormonal, angiogenesis and regeneration for adjacent tissues, reabsorption, hemostatic, thermoregulation. The purpose of this review was to track the historically changing position of operations with the use of the greater omentum in abdominal, thoracic surgery, reconstructive plastic surgery, analyze the aspects of the use and controversial issues of omentization of the anastomoses line and omentoplasty in modern conditions, as well as highlight promising directions for the use of the greater omentum in medicine. in the sources of domestic and foreign databases until July 2021. Information about the negative consequences of omentectomy is given – a decrease in local and general immunoresistance, the development of adhesive disease, an increase in the number of postoperative purulent-inflammatory complications. It is useful for the surgeon to use a large omentum in non-standard and technically difficult cases. Situations are described in which a radical attitude to the greater omentum is justified – torsion of the omentum strand, metastasis, adhesions, omentitis, entrapment in hernias, complications from the pedicle flap. Analysis of the literature revealed ambiguous results of omentization and omentoplasty, which indicates the need for randomized studies in this area, the development of clinical recommendations for these operations with a description of clear indications and methods of carrying out.

Comparative Evaluation of Difficult Intubation Predictors in Children Under Two Years of Ages

Background: Tracheal intubation is the most reliable way of securing an airway. Pediatric airway management is one of the significant challenges, especially for non-pediatric anesthesiologists. Early airway evaluation for detecting difficult intubation and preventing catastrophic events is necessary before anesthesia, especially in children. Objectives: Therefore, this study was done to compare some valuable adult predictors in children under two years of age. Methods: This prospective descriptive-analytical study was performed on 405 children under two years of age that were referred for elective surgery under general anesthesia with endotracheal intubation in Imam Hossein Hospital, Isfahan. Under sedation in a supine position, we measured items, including age, weight, height, stern omental distance (SMD), mouth opening (MO), neck circumference (NC), acromio-axillo-suprasternal notch index (AASI), and intubation difficulty scale score (IDS). An expert anesthesiologist did laryngoscopy and intubation, and difficult cases were recorded. Results: Our study showed that the frequency of difficult intubation with IDS > 4 was %16, and with IDS > 5 was %3. The variables, including age, weight, height, and SMD, significantly predicted difficult intubation. The cut-off points for age < 6 months, weight < 5/9 kg, height < 61 cm, and SMD < 5/3 cm were obtained, respectively. Other variables, such as MO, AASI, NC, and sex, were unreliable predictors for difficult intubation. Conclusions: We found that IDS > 4, age< 6-month, weight < 5/9 kg, and SMD < 5/3 cm are predictors for difficult intubation. It is helpful for the anesthesiologist to measure these predictions before anesthesia is started to find who has difficult intubation.

Pigmented Epithelioid Melanocytomas and Their Mimics; Focus on Their Novel Molecular Findings

Pigmented epithelioid melanocytoma (PEM) is a unique tumor with significantly pigmented appearance and indolent behavior; however, it can demonstrate cytological atypia and metastasize to local lymph nodes. Clinical and histomorphological overlap between PEM and its lower or higher-grade mimics can make it difficult to distinguish in certain cases. Genomic, transcriptomic and epigenetic data indicate that PEMs are molecularly distinct entities from other melanocytic neoplasms and melanomas. In addition, methylation studies are emerging as a tool that can be useful in difficult cases. In this review, we focus on the clinical, histopathologic and recent insights in the molecular features of pigmented epithelioid melanocytic melanocytomas and their mimics. We also present a challenging case that was resolved using methylation analysis providing a proof of concept for using epigenetic studies for similar challenging cases.

Endometrial Stromal Expression of ER, PR, and B-Catenin Toward Differentiating Hyperplasia Diagnoses

Background. The interpretation of histopathological changes of endometrial hyperplasia with or without atypia can be challenging. We aim to investigate the role of specific immunohistochemical markers in the endometrial stroma to classify endometrial hyperplasia in difficult cases. Methods and Results. We retrospectively reviewed and reclassified (WHO 2014): 47 specimens with endometrial hyperplasia without atypia, 33 with atypical hyperplasia (AH), and 13 endometrioid adenocarcinomas. We performed IHC for B-catenin, E-cadherin, p16, estrogen receptors and progesterone receptors, and B-cell lymphoma 2 (BCL2). Percentage of positive stromal cells was calculated. B-catenin was equally expressed in the stroma of both hyperplasia and AH (mean 60%, 50%; P = .17) and was absent from adenocarcinoma (0%, hyperplasia vs adenocarcinoma; P < .0001, AH vs adenocarcinoma; P < .0001). E-cadherin was not expressed in the stroma of any lesion, while p16 expression levels were not statistically different (hyperplasia vs AH; P = .46, hyperplasia vs adenocarcinoma; P = .22, AH vs adenocarcinoma; P = .48). Estrogen and progesterone were highly identified in stromal cells of hyperplasia (80%) and diminished in AH (respectively, at 30% and 60%, hyperplasia vs AH; P < .0001), and in adenocarcinoma (0% and 40%, respectively). Finally, BCL2 was not differentially expressed (hyperplasia vs AH; P = .33, hyperplasia vs adenocarcinoma; P = .17, AH vs adenocarcinoma; P = .36). Conclusion. Estrogen and progesterone were strongly expressed in stroma exclusively of hyperplasia, while B-catenin was particularly expressed in hyperplasia and AH. Use of these markers can be useful in the differential diagnosis of hyperplasia from AH, and AH from adenocarcinoma in challenging cases.

Clinical case of Fournier’s gangrene in a patient with adenocarcinoma

The article describes a clinical case of Fournier’s gangrene in a 65-year-old man with rectal mucinous adenocarcinoma. Given the presence of a malignant neoplasm, elderly age and the general severity of the patient’s condition, the widest empirical antibiotic therapy was prescribed, the spectrum of which overlapped the most probable pathogens. The patient was discharged from the hospital on the 32nd day. The article discusses the rational tactics of antimicrobial therapy in such difficult cases for treatment.