Sex determination in ratite and non ratite birds by molecular method

In spite of number of methods for sex determination in birds, it is very difficult to distinguish sex especially in ratite birds due to lack of sexual dimorphism. Chromodomain helicase DNA binding 1 gene (CHD 1) is the choice of gene for gender differentiation using PCR based molecular method. In present study, non ratite CHD gene specific primers viz. 1237L/1272H, 2550F/2718R, P2/P8, P2/P3 and ratite bird specific primers viz.W5/ W7 and W1/ K7 were used for gender differentiation in ratite birds. The ratite bird specific primer W5/W7 was the only primer, which determined the sex in emu as well as ostrich successfully, while 1237L/1272H, 2550F/2718R, P2/ P8, P2/P3 primers were unable to discriminate sex in emu and ostrich but ratite and non ratite primers can be used to discriminate the sex in non-ratite bird, primarily in chicken. In an alternative approach of PCR-RFLP, the high resolution melting curve (HRM) analysis showed conflicting pattern in both sexes of ratite birds but in chicken HRM analysis showed clear cut differential melting temperature in both sexes, hence HRM can be used for gender differentiation successfully

Inverse treatment planning for radiofrequency ablation

Radiofrequency ablation (RFA) offers localized and minimally invasive thermal ablation of small-to-medium sized inoperable superficial tumors. In RFA, needles are inserted into the target with image guidance and current is passed through the needles, resulting in high temperatures and consequently target ablation. However, RFA has a high local recurrence rate caused by incomplete ablation. We therefore develop a novel two-stage mathematical framework for pre-operative inverse treatment planning where first, we identify needle positions and orientations using convex and integer programming techniques, referred to as needle orientation optimization (NOO), and then we determine the optimal thermal dose delivery for full target coverage by computing simultaneous thermal and electrostatic partial differential equations, referred to as thermal dose optimization (TDO). In NOO, different methodologies using geometric approximations for needle placement with and without trajectory considerations for single, multiple, and clustered RFA applicators are presented. Using outputs from NOO, in TDO, we perform thermal dose analysis, using several thermal damage models, for targets and organs-at-risk (OARs). Finally, we present scenario-based thermal damage analysis to understand the effect of translational and rotational needle deflection on target and OAR coverage. We test our framework on three clinical cases with four different margins, for a total of 12 targets. Our methodologies provide fast treatment plans that meet clinical guidelines, and our deflection analysis indicates that, depending on thermal damage model used, uncertain needle placement may significantly impede target coverage, and therefore, clinical study into causes of deflection are recommended.Ph.D

Sigmoid volvulus: A pediatric case report and review of management

Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus (SV) is extremely rare. Herein we report a case of SV, review the literature and provide a suggested algorithm for diagnosis and management

Inflammatory myofibroblastic tumor masquerading as perforated appendicitis

Inflammatory myofibroblastic tumor (IMT) is a rare and histologically benign tumor that most commonly presents in pediatric patients. Abdominal IMTs often present with non-specific symptoms, and therefore they can masquerade as other more common abdominal conditions. This report describes two cases of IMT presenting as perforated appendicitis. Both cases are of young children who presented with over 48 hours of abdominal pain and who had peritonitis on examination. Pre-operative ultrasounds for both patients revealed complex free fluid. Laparoscopic evaluation demonstrated hemoperitoneum, and further exploration revealed mesenteric avulsion with abnormally thickened mesentery. Pathology confirmed IMT arising from the small bowel mesentery in both cases. Both children underwent limited bowel resection and were discharged in stable condition on a course of non-steroidal anti-inflammatory drugs (NSAIDs). Given the association of avulsed bowel to trauma, non-accidental trauma was suspected in both cases and demonstrated in one. Both patients showed complete resolution of tumor on follow-up MRI. The diagnosis of IMT must always be considered when an intra-abdominal mass is encountered as its treatment differs greatly from other neoplasms

Solid pseudopapillary neoplasm of the pancreas

Solid pseudopapillary neoplasm of the pancreas (SPN) is a very rare tumor with a low malignant potential. Although most commonly presenting in females in the second to fourth decade of life, it has been reported in the pediatric population with an incidence of 8–16.6%. SPN was first described by Virginia Kneeland Frantz in 1959 as a papillary cystic tumor of the pancreas in a 2 year old male patient. Herein we report 2 cases of SPN and review the pathophysiology, diagnosis, and management. Keywords: Solid pseudopapillary neoplasm, Frantz tumor, Pancreatic tumo

Unintentional Window Falls in Children and Adolescents.

OBJECTIVE: Unintentional window falls represent a preventable source of injury and death in children. Despite major campaigns in some larger cities, there continue to be unintentional falls from windows throughout the United States. We aimed to identify risk factors and trends in unintentional window falls in the pediatric population in a national and regional sample. METHODS: A retrospective analysis of annual ED visits from the National Electronic Injury Surveillance System (NEISS) using product codes specific to windows, as well as patient encounters for unintentional window falls from January 2007 - August 2017 using site-specific trauma registries from 10 tertiary care children\u27s hospitals in New England. National and state-specific census population estimates were used to compute rates per 100,000 population. RESULTS: There were 38,840 ED visits and 496 regional patients who unintentionally fell from a window across the study period between 0-17 years old. The majority of falls occurred in children under the age of 6, and were related to falls from a second story or below. A decreased trend in national ED visits was seen, but no change in rates over time for regional trauma center encounters. A high number of falls were found to occur in smaller cities surrounding metropolitan areas and from single family residences. CONCLUSIONS: Falls from windows represent a low proportion of overall types of unintentional sources of injury in children, but are a high-risk for severe disability. These results provide updated epidemiologic data for targeted intervention programs, as well as raise awareness for continued education and advocacy

Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries based on a multicenter analysis: A pediatric trauma society collaborative

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. BACKGROUND Guidelines for nonoperative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers to develop a consensus-based standard clinical pathway. METHODS A multicenter, retrospective review was conducted of children with high-grade (American Association of Surgeons for Trauma grade III-V) pancreatic injuries treated with NOM between 2010 and 2015. Data were collected on demographics, clinical management, and outcomes. RESULTS Eighty-six patients were treated at 20 pediatric trauma centers. Median age was 9 years (range, 1-18 years). The majority (73%) of injuries were American Association of Surgeons for Trauma grade III, 24% were grade IV, and 3% were grade V. Median time from injury to presentation was 12 hours and median ISS was 16 (range, 4-66). All patients had computed tomography scan and serum pancreatic enzyme levels at presentation, but serial enzyme level monitoring was variable. Pancreatic enzyme levels did not correlate with injury grade or pseudocyst development. Parenteral nutrition was used in 68% and jejunal feeds in 31%. 3Endoscopic retrograde cholangiopancreatogram was obtained in 25%. An organized peripancreatic fluid collection present for at least 7 days after injury was identified in 59% (42 of 71). Initial management of these included: observation 64%, percutaneous drain 24%, and endoscopic drainage 10% and needle aspiration 2%. Clear liquids were started at a median of 6 days (IQR, 3-13 days) and regular diet at a median of 8 days (IQR 4-20 days). Median hospitalization length was 13 days (IQR, 7-24 days). Injury grade did not account for prolonged time to initiating oral diet or hospital length; indicating that the variability in these outcomes was largely due to different surgeon preferences. CONCLUSION High-grade pancreatic injuries in children are rare and significant variability exists in NOM strategies, which may affect outcomes and effective resource utilization. A standard clinical pathway is proposed. LEVEL OF EVIDENCE Therapeutic/care management, level V (case series)

Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries based on a multicenter analysis: A pediatric trauma society collaborative

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. BACKGROUND Guidelines for nonoperative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers to develop a consensus-based standard clinical pathway. METHODS A multicenter, retrospective review was conducted of children with high-grade (American Association of Surgeons for Trauma grade III-V) pancreatic injuries treated with NOM between 2010 and 2015. Data were collected on demographics, clinical management, and outcomes. RESULTS Eighty-six patients were treated at 20 pediatric trauma centers. Median age was 9 years (range, 1-18 years). The majority (73%) of injuries were American Association of Surgeons for Trauma grade III, 24% were grade IV, and 3% were grade V. Median time from injury to presentation was 12 hours and median ISS was 16 (range, 4-66). All patients had computed tomography scan and serum pancreatic enzyme levels at presentation, but serial enzyme level monitoring was variable. Pancreatic enzyme levels did not correlate with injury grade or pseudocyst development. Parenteral nutrition was used in 68% and jejunal feeds in 31%. 3Endoscopic retrograde cholangiopancreatogram was obtained in 25%. An organized peripancreatic fluid collection present for at least 7 days after injury was identified in 59% (42 of 71). Initial management of these included: observation 64%, percutaneous drain 24%, and endoscopic drainage 10% and needle aspiration 2%. Clear liquids were started at a median of 6 days (IQR, 3-13 days) and regular diet at a median of 8 days (IQR 4-20 days). Median hospitalization length was 13 days (IQR, 7-24 days). Injury grade did not account for prolonged time to initiating oral diet or hospital length; indicating that the variability in these outcomes was largely due to different surgeon preferences. CONCLUSION High-grade pancreatic injuries in children are rare and significant variability exists in NOM strategies, which may affect outcomes and effective resource utilization. A standard clinical pathway is proposed. LEVEL OF EVIDENCE Therapeutic/care management, level V (case series)