Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012.

BackgroundAlthough the incidence of gastroschisis is increasing, risk factors are not clearly identified.MethodsUsing the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis.ResultsThe prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs.$9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%.ConclusionsThis is the largest population-based study summarizing current epidemiology of gastroschisis in California.Type of studyRetrospective comparative cohort study.Level of evidenceIII

Thoracoamniotic shunt placement for a right-sided congenital diaphragmatic hernia complicated by hydrops

AbstractMortality associated with congenital diaphragmatic hernia (CDH) is high, and the role of prenatal management continues to evolve. We report a case of a right-sided CDH complicated by fetal hydrops successfully managed with thoracoamniotic shunt placement. Subsequent ultrasounds indicated resolution of hydrops. Despite preterm premature rupture of membrane and preterm delivery at 32 3/7 weeks gestation, the infant survived to hospital discharge at 2.5 months of life. This is the first case of a hydropic right-sided CDH successfully treated with a thoracoamniotic shunt

AsiaPEX:Challenges and Prospects in Asian Precipitation Research

The Asian Precipitation Experiment (AsiaPEX) was initiated in 2019 to understand terrestrial precipitation over diverse hydroclimatological conditions for improved predictions, disaster reduction, and sustainable development across Asia under the framework of the Global Hydroclimatology Panel (GHP)/Global Energy and Water Exchanges (GEWEX). AsiaPEX is the successor to GEWEX Asian Monsoon Experiment (GAME; 1995-2005) and Monsoon Asian Hydro-Atmosphere Scientific Research and Prediction Initiative (MAHASRI; 2006-16). While retaining the key objectives of the aforementioned projects, the scientific targets of AsiaPEX focus on land-atmosphere coupling and improvements to the predictability of the Asian hydroclimatological system. AsiaPEX was designed for both fine-scale hydroclimatological processes occurring at the land surface and the integrated Asian hydroclimatological system characterized by multiscale interactions. We adopt six approaches including observation, process studies, scale interactions, high-resolution hydrological modeling, field campaigns, and climate projection, which bridge gaps in research activities conducted in different regions. Collaboration with mesoscale and global modeling researchers is one of the core methods in AsiaPEX. We review these strategies based on the literature and our initial outcomes. These include the estimation and validation of highresolution satellite precipitation, investigations of extreme rainfall mechanisms, field campaigns over the Maritime Continent and Tibetan Plateau, areas of significant impact on the entire AsiaPEX region, process studies on diurnal- to interdecadal-scale interactions, and evaluation of the predictabilities of climate models for long-term variabilities. We will conduct integrated observational and modeling initiative, the Asian Monsoon Year (AMY)-II around 2025-28, whose strategies are the subregional observation platforms and integrated global analysis.</p

Necrotizing enterocolitis following diazoxide therapy for persistent neonatal hypoglycemia.

Recalcitrant neonatal hypoglycemia poses a treatment challenge for clinicians. When a patient's hypoglycemia does not respond to dextrose infusion, several medication options are available, including diazoxide(1,2). Several side effects of diazoxide are described in the literature, including fluid retention with the risk of development of congestive heart failure(3,4). We describe a case of necrotizing enterocolitis in a patient with Beckwith-Wiedemann Syndrome with persistent neonatal hypoglycemia who was treated with increasing doses of diazoxide

Resection of a thoracoabdominal ganglioneuroma via a retroperitoneal minimally invasive approach.

A 10-year-old girl presented to her pediatrician with a history of cough and fever. A chest radiograph revealed a paraspinal mass. On cross-sectional imaging, the mass traversed the diaphragm, extending from T9 to L1 spinal levels with involvement of the T10-12 neural foramen. Vanillylmandelic and homovanillic acid levels were normal. On review of historical radiographs, the mass had increased in size. Thus, surgical resection was recommended for diagnosis and treatment. The patient was placed in left lateral decubitus position. The retroperitoneal space was accessed inferior to the twelfth rib. One 12 mm and two 5 mm ports were used. Development of the retroperitoneal space was achieved with both blunt dissection and a vessel-sealing device. The diaphragm was incised to resect the thoracic component of the mass. The tumor was adherent at the neural foramen and was resected flush with the spine. The diaphragm repaired primarily. She was discharged home on post-operative day four without complication. Pathology demonstrated a ganglioneuroma. The patient was well at her follow-up, and imaging one year postoperatively was without recurrence. No additional treatment was required. A laparoscopic retroperitoneal approach allows for a safe, minimally invasive resection of a thoracoabdominal mass without violation of the abdominal cavity

Resection of a thoracoabdominal ganglioneuroma via a retroperitoneal minimally invasive approach

A 10-year-old girl presented to her pediatrician with a history of cough and fever. A chest radiograph revealed a paraspinal mass. On cross-sectional imaging, the mass traversed the diaphragm, extending from T9 to L1 spinal levels with involvement of the T10-12 neural foramen. Vanillylmandelic and homovanillic acid levels were normal. On review of historical radiographs, the mass had increased in size. Thus, surgical resection was recommended for diagnosis and treatment.The patient was placed in left lateral decubitus position. The retroperitoneal space was accessed inferior to the twelfth rib. One 12 mm and two 5 mm ports were used. Development of the retroperitoneal space was achieved with both blunt dissection and a vessel-sealing device. The diaphragm was incised to resect the thoracic component of the mass. The tumor was adherent at the neural foramen and was resected flush with the spine. The diaphragm repaired primarily. She was discharged home on post-operative day four without complication. Pathology demonstrated a ganglioneuroma. The patient was well at her follow-up, and imaging one year post-operatively was without recurrence. No additional treatment was required.A laparoscopic retroperitoneal approach allows for a safe, minimally invasive resection of a thoracoabdominal mass without violation of the abdominal cavity. Keywords: Pediatric laparoscopic, Retroperitoneoscopic, Ganglioneuroma, Ganglioneuroblastoma, Neuroblastoma, Thoracoabdominal resectio

Midgut volvulus and complex meconium peritonitis in a fetus with undiagnosed cystic fibrosis

In utero small bowel volvulus with meconium peritonitis is a rare complication of cystic fibrosis.We report the case of fetal small bowel volvulus with necrosis, perforation and meconium peritonitis in a fetus with undiagnosed cystic fibrosis. The mother presented with four days of decreased fetal movement and ultrasound findings of fetal small bowel dilation with wall thinning and ascites. The fetus' status declined three days thereafter, prompting an emergent delivery. The infant was born with peritonitis and underwent an exploratory laparotomy with a small bowel resection and interval anastomosis. Following restoration of continuity, the patient was able to tolerate oral and enteral nutrition with appropriate growth. This report provides an example of the signs, symptoms and sonographic findings associated with this rare fetal complication and explores the intricacies of prenatal genetic testing. Keywords: Cystic fibrosis, Fetal cystic fibrosis complication, Fetal small bowel volvulus, Fetal small bowel perforation, Complicated meconium peritoniti

A periodic split attractor reconstruction method facilitates cardiovascular signal diagnoses and obstructive sleep apnea syndrome monitoring

Electrocardiogram (ECG) is a powerful tool to detect cardiovascular diseases (CVDs) and health conditions. We proposed a new method for evaluating ECG for efficient medical diagnosis in daily life. By splitting the signal according to the cardiac activity cycle, the periodic split attractor reconstruction (PSAR) method is proposed with time embedding, including three types of splitting methods to show its chaotic domain characteristics. We merged the CVDs dataset and the obstructive sleep apnea syndrome (OSAS) first-lead ECG signal dataset to validate the performance of PSAR for diagnosis and health monitoring using PSAR density maps as SE-ResNet input features. PSAR under 3 split methods showed different sensitivities for different CVDs. While in OSAS monitoring, PSAR showed good ability to recognize sleep abnormalities

Novel Use of a Bronchial Blocker in a Challenging Case of Congenital Diaphragmatic Hernia-A Case Report.

The diagnosis of congenital diaphragmatic hernia (CDH) is associated with significant morbidity and mortality. Survival of neonates with CDH has improved recently, although the clinical course is complicated by sequelae of hypoplastic pulmonary parenchyma and vasculature, pulmonary hypertension, ventilation/perfusion (V/Q) mismatch, reduced pulmonary function and poor somatic growth. In this case report, we describe an infant with an antenatal diagnosis of CDH with a poor prognosis who underwent initial surgery followed by a tracheostomy but had a worsening clinical course due to a large area of ventilated but poorly perfused lung based on a V/Q nuclear scintigraphy scan. The emphysematous left lung was causing mediastinal shift and compression of the right lung, further compromising gas exchange. The infant had clinical improvement following bronchial blockade of the under-perfused left lung. This paved the way for further management with resection of the under-perfused lung lobe and continued clinical improvement. We present the novel use of selective bronchial blockade in a challenging case of CDH to determine if surgical lung resection may benefit the infant. We also review the physiology of gas exchange during the use of a bronchial occluder and the relevant literature