Journal of pediatric surgery最新文献

{"title":"Development and Internal-external Validation of a Post-operative Mortality Risk Calculator for Pediatric Surgical Patients in Low- and Middle- Income Countries Using Machine Learning.","authors":"Lauren Eyler Dang, Greg Klazura, Ava Yap, Doruk Ozgediz, Emma Bryce, Maija Cheung, Maíra Fedatto, Emmanuel A Ameh","doi":"10.1016/j.jpedsurg.2024.161883","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161883","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to develop and validate a mortality risk algorithm for pediatric surgery patients treated at KidsOR sites in 14 low- and middle-income countries.</p><p><strong>Methods: </strong>A SuperLearner machine learning algorithm was trained to predict post-operative mortality by hospital discharge using the retrospectively and prospectively collected KidsOR database including patients treated at 20 KidsOR sites from June 2018 to June 2023. Algorithm performance was evaluated by internal-external cross-validated AUC and calibration.</p><p><strong>Findings: </strong>Of 23,905 eligible patients, 21,703 with discharge status recorded were included in the analysis, representing a post-operative mortality rate of 3.1% (671 mortality events). The candidate algorithm with the best cross-validated performance was an extreme gradient boosting model. The cross-validated AUC was 0.945 (95% CI 0.936 to 0.954) and cross-validated calibration slope and intercept were 1.01 (95% CI 0.96 to 1.06) and 0.05 (95% CI -0.10 to 0.21). For Super Learner models trained on all but one site and evaluated in the holdout site for sites with at least 25 mortality events, overall external validation AUC was 0.864 (95% CI 0.846 to 0.882) with calibration slope and intercept of 1.03 (95% CI 0.97 to 1.09) and 1.18 (95% CI 0.98 to 1.39).</p><p><strong>Interpretation: </strong>The KidsOR post-operative mortality risk algorithm had outstanding cross-validated discrimination and strong cross-validated calibration. Across all external validation sites, discrimination of Super Learner models trained on the remaining sites was excellent, though re-calibration may be necessary prior to use at new sites. This model has the potential to inform clinical practice and guide resource allocation at KidsOR sites world-wide.</p><p><strong>Type of study and level of evidence: </strong>Observational Study, Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine Urology Consultation and Follow-up After Pediatric Blunt Renal Trauma is Likely Unnecessary.","authors":"Christopher Clinker, Jack Scaife, Chance Basinger, Kacey L Barnes, Christopher Roach, Glen A Lau, Sidney Norton, Robert A Swendiman, Katie W Russell","doi":"10.1016/j.jpedsurg.2024.161886","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161886","url":null,"abstract":"<p><strong>Introduction: </strong>This study examines the outcomes of high-grade renal trauma in pediatric patients and evaluates the intervention rate. In our hospital, we routinely consult urology on all high-grade injuries. We anticipated minimal intervention, casting doubt on the need for routine urology consultation and follow-up.</p><p><strong>Methods: </strong>We conducted a retrospective review at a single pediatric trauma center from January 2018 to June 2023, focusing on patients with severe (grade III-V) renal injuries. Data collected included demographics, trauma-related variables, hospital course, interventions, and follow-up. When the grade was not readily available in the electronic medical record, we had a board-certified pediatric radiologist review the imaging and provide the grade. Follow-up was included only if it was with a pediatric urologist.</p><p><strong>Results: </strong>There were 92 patients that met our inclusion criteria. Of these, 47 were grade III, 32 were grade IV, and 13 were grade V. Six (6.5%) patients required inpatient renal stent procedures. Follow-up occurred in 55/92 (60%) patients with a pediatric urologist. Follow-up by grade is as follows: 22/47 (47%) grade III, 22/32 (69%) grade IV, and 11/13 (85%) grade V. Overall 5.8% of patients required antihypertensive medications and this was more likely as injury grade increased. All stents were removed outpatient and there were 3 (3.3%) additional outpatient interventions, all in patients that were symptomatic.</p><p><strong>Conclusion: </strong>Given the low prevalence of interventions after discharge, routine consultation and follow-up with urology is likely unnecessary in the absence of an inpatient urologic procedure during the index hospitalization. Patients with high-grade injuries should instead follow up with a trauma clinic or general provider with urology follow-up based on symptoms.</p><p><strong>Type of study: </strong>Retrospective Review.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Tracheomalacia Severity With Esophageal Gap Length as Assessed by Ultrashort Echo-time MRI.","authors":"Douglas C von Allmen, Erik B Hysinger, Alister J Bates, Nara S Higano, Aaron Garrison, Ashley Walther, Alessandro de Alarcon, Jason Woods, Paul Kingma","doi":"10.1016/j.jpedsurg.2024.161880","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161880","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheomalacia severity is difficult to quantify, however, ultrashort echo-time MRI objectively quantifies tracheomalacia in infants without sedation, radiation, or intubation. Patients with tracheoesophageal fistula and esophageal atresia (TEF/EA) commonly have tracheomalacia, however, the relationship between tracheomalacia severity and esophageal atresia has not been well defined. The primary objective of this study was to establish the relationship between EA and tracheomalacia severity and identify possible predictors of tracheomalacia severity.</p><p><strong>Methods: </strong>A retrospective review of neonates with TEF/EA who had previously undergone UTE MRI was performed. The trachea was divided into thirds. Maximal eccentricity in each third was calculated by measuring the anterior posterior dimension (MinD) and dividing it by the maximum width of the trachea (MaxD). Frequency of respiratory related admissions, number of upper respiratory infections, and number of steroids courses were quantified in addition to eccentricity in short and long gap esophageal atresia patients.</p><p><strong>Results: </strong>A total of 16 TEF/EA patients were included. Patients with long gap esophageal atresia had more severe tracheomalacia than short gap as measured by eccentricity in the upper (0.60 vs 0.72, p = 0.03), middle (0.48 vs 0.61, p = 0.02), and lower (0.5 vs 0.65, p = 0.01) trachea. Long gap esophageal atresia patients had more frequent respiratory readmissions (1.87 admissions/year vs 0.54 admissions/year) (p = 0.03). Following TEF/EA repair the trachea was less eccentric in the upper third (0.64 pre, 0.79 post, p < 0.01) and more eccentric in the lower third (0.69 pre, 0.56 post, p < 0.01).</p><p><strong>Conclusion: </strong>Differences in esophageal gap and repair status correlate with airway eccentricity and tracheomalacia symptoms.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anorectal Malformation Patients in Australia and Europe: Different Location, Same Problem? A Retrospective Comparative Registry-based Study.","authors":"Isabel C Hageman, Misel Trajanovska, Sebastian K King, Hendrik Jj van der Steeg, Anna Morandi, Eva E Amerstorfer, Ivo de Blaauw, Iris Alm van Rooij","doi":"10.1016/j.jpedsurg.2024.161879","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161879","url":null,"abstract":"<p><p>Anorectal malformations (ARM) encompass a spectrum of rare congenital defects of the rectum and anus, requiring specialized reconstructive surgery. To improve epidemiological and clinical research in rare diseases such as ARM, collaborative efforts and patient registries are key. This retrospective study pools clinical data over a 30-year period from two ARM patient registries (The Royal Children's Hospital (RCH) in Melbourne, Australia, and the ARM-Network Consortium in Europe). It aims to draw comparisons on demographics, management, and outcomes between ARM patients in Australia and Europe. A total of 2947 ARM patients were included in the analyses. The RCH cohort had more complex ARM types (including rectal atresia and recto-vaginal fistula) and more associated anomalies, specifically skeletal, cardiac, and/or trachea-esophageal, than ARM-Net patients. Other patient characteristics were similar. Treatments clearly differed between the groups. European surgeons favoured the PSARP approach for both less complex and more complex ARM types, where Australian surgeons opted more often for cutback surgery in less complex, and laparoscopic assistance in more complex types. Complications were differently distributed, with less complications after LAARP and more after PSARP at RCH, compared to ARM-Net. While RCH patients more often required a redo, ARM-Net patients more commonly underwent anal dilatations. Anorectal malformation patients in Australia and Europe had minor differences in disease characteristics, and both operative and medical approaches differed. Joint efforts such as the present study emphasize the importance of collaboration to elucidate areas of improvement where surgeons may learn from each other across the world, ultimately improving patient outcomes. TYPE OF STUDY: Original Research. LEVEL OF EVIDENCE: III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Report on the 33rd Annual Meeting of the International Pediatric Endosurgery Group (IPEG)","authors":"Pablo Laje","doi":"10.1016/j.jpedsurg.2024.161884","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161884","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features Associated with Delayed Diagnosis of Appendicitis in Children: A Retrospective Analysis of 1411 Cases","authors":"Mohamed Zouari, Manel Belhajmansour, Oumaima Jarboui, Najoua Ben Kraiem, Riadh Mhiri","doi":"10.1016/j.jpedsurg.2024.161878","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161878","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Surgery for Duodenal Obstructions, 10 Years of Experience in a Single Center.","authors":"Joel Cazares, Jorge Colín-Garnica, Jorge Alberto Cantú-Reyes, Marbella Sepulveda-Valenzuela, Miguel Torres-Salas, Eduardo de la Rosa-Bustamante, Arturo Guillen-Cárdenas","doi":"10.1016/j.jpedsurg.2024.161700","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161700","url":null,"abstract":"<p><strong>Purpose: </strong>Duodenal obstructions are one of the most common causes of upper intestinal obstruction during the neonatal period. Minimally invasive surgical treatment is considered highly complex. We report our experience with 43 patients treated using this method.</p><p><strong>Methods: </strong>We conducted a retrospective study at our institution from January 2013 to May 2023, including patients classified as having upper intestinal obstructions. All patients received preoperative diagnoses based on clinical findings, radiography, and abdominal ultrasound. Laparoscopic surgery was performed on all patients.</p><p><strong>Results: </strong>We included 43 patients diagnosed with duodenal obstruction (DO) in our study after reviewing the medical records at our hospital for cases meeting this diagnosis. The laparoscopic Kimura procedure was performed on 31 patients (72%), while duodenotomy and anastomosis following the Heineke-Mikulicz principle were performed on 9 patients (21%). In the remaining 3 patients (7%), a side-to-side duodeno-duodeno anastomosis was conducted. Annular pancreas was the most common cause of duodenal obstruction in our series, affecting 21 patients (49%). Type I duodenal atresia was observed in 17 patients (40%), while type III atresia was present in 3 patients (7%), and type II atresia in 2 patients (4%). One case required conversion to open surgery due to concomitant jejunoileal atresia. The only reported complication was partial anastomotic dehiscence, which occurred in two patients (4%).</p><p><strong>Conclusions: </strong>Minimally invasive surgery (MIS) for managing duodenal obstruction (DO) has proven to be both feasible and safe, yielding comparable outcomes to the traditional open approach; its effectiveness can be significantly enhanced through appropriate training. Furthermore, the growing availability of duodenal atresia simulators offers valuable opportunities to refine laparoscopic skills and apply them effectively. Better outcomes and fewer complications are expected with further experience and an increased number of cases.</p><p><strong>Level of evidence: </strong>IV, Case series with no comparison group.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morio Kasai Corrects the Uncorrectable: Hepatic Portoenterostomy for Biliary Atresia","authors":"Don K. Nakayama","doi":"10.1016/j.jpedsurg.2024.161765","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161765","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human Liver Organoids to Predict the Outcome of Kasai Portoenterostomy","authors":"Amy Wing Yi Wai, Vincent Chi Hang Lui, Clara Sze Man Tang, Bin Wang, Paul Kwong Hang Tam, Kenneth Kak Yuen Wong, Patrick Ho Yu Chung","doi":"10.1016/j.jpedsurg.2024.161686","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161686","url":null,"abstract":"Kasai portoenterostomy (KPE) remains the primary intervention for biliary atresia (BA), but its outcomes are highly variable. Reliable prognostic biomarkers remain elusive, complicating the management and prediction of postoperative progression. Liver biopsies from BA patients taken at and after KPE (post-KPE) were used to generate organoids for RNA-sequencing analysis. Control organoids were derived from non-BA livers. Differential gene expression and enrichment analyses were performed to assess post-KPE transcriptomic changes between native liver survivors (NLS) and patients who eventually became liver transplant recipients (LTR). Organoid datasets: 70 from liver biopsies at KPE (10 patients), 112 from post-KPE livers (13 livers; 12 patients), and 47 from control livers (9 patients). At KPE, BA organoids displayed mainly hepatocyte expression, a trait notably reduced in control organoids. Similarly, post-KPE organoids from NLS revealed a significant decrease in hepatocyte expression features and an overall increase in cholangiocyte expression features. A similar hepatocyte-to-cholangiocyte expression transition was evidenced in paired liver organoids (at- and post-KPE) generated from an NLS. In contrast, post-KPE organoids from LTR maintained a high level of hepatocyte expression features. Our study demonstrated that an elevated expression of hepatocyte features in KPE organoids may indicate aberrant cholangiocyte development in BA livers. In contrast, a post-KPE hepatocyte-to-cholangiocyte expression transition in NLS may imply effective biliary recovery. The lack of this transition in LTR organoids indicates ongoing disease progression, highlighting the potential for organoid-based transcriptomic profiling to inform KPE success and guide BA management. Level III.","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CAMK2G Promotes Neuronal Differentiation and Inhibits Migration in Neuroblastoma","authors":"Yujie Ma, Cong He, Weihong Lin, Jing Wang, Chaoliang Xu, Deshen Pan, Zuopeng Wang, Wei Yao, Rui Dong, Deshui Jia, Kai Li","doi":"10.1016/j.jpedsurg.2024.08.019","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.08.019","url":null,"abstract":"Neuroblastoma (NB) originates from differentiation arrest of sympathoadrenal progenitors in the neural crest. It is necessary to reveal the differentiation mechanism of NB. Previously, we reported that Purkinje cell protein 4 (PCP4) is a well-differentiated marker of NB tissues. Herein, we explored the underlying mechanism of PCP4 induced differentiation in order to find better treatment options for patients. We screened the interacting proteins of PCP4 by co-immunoprecipitation (Co-IP) and liquid chromatography-mass spectrometry (LC-MS/MS). Then we investigated the relevance between expression of calmodulin-dependent protein kinase II gamma (CAMK2G) and clinical features using R2 platform. We also explored the function of CAMK2G in NB cells by knockdown and RNA sequencing. Here, we verified the binding of PCP4 and calmodulin (CaM) by Co-IP and identified a target kinase of CaM, CAMK2G, by LC-MS/MS. PCP4 overexpression activates the autophosphorylation of CAMK2G. Patients with high CAMK2G expression had better survival while low CAMK2G was associated with unfavorable clinical features including -amplification, unfavorable histology, progression and high INSS stage. CAMK2G knockdown inhibited neurite outgrowth and down-regulated neuronal differentiation markers (NF–H, MAP2), yet promoted migration, invasion and proliferation. Gene Ontology (GO) analysis showed that knockdown of CAMK2G downregulated the expression of neuronal differentiation-related genes. Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that knockdown of CAMK2G upregulated the expression of migration-related genes. These findings indicate that CAMK2G activated by PCP4/CaM complex promotes differentiation and inhibits migration in NB cells. Not applicable.","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}