Primary Closure without Diversion in Management of Operative Blunt Duodenal Trauma in Children

Background. Operative blunt duodenal trauma is rare in pediatric patients. Management is controversial with some recommending pyloric exclusion for complex cases. We hypothesized that primary closure without diversion may be safe even in complex (Grade II-III) injuries. Methods. A retrospective review of the American College of Surgeons\u27 Trauma Center database for the years 2003-2011 was performed to identify operative blunt duodenal trauma at our Level 1 Pediatric Trauma Center. Inclusion criteria included ages \u3c 14 years and duodenal injury requiring operative intervention. Duodenal hematomas not requiring intervention and other small bowel injuries were excluded. Results. A total of 3,283 hospital records were reviewed. Forty patients with operative hollow viscous injuries and seven with operative duodenal injuries were identified. The mean Injury Severity Score was 10.4, with injuries ranging from Grades I-IV and involving all duodenal segments. All injuries were closed primarily with drain placement and assessed for leakage via fluoroscopy between postoperative days 4 and 6. The average length of stay was 11 days; average time to full feeds was 7 days. No complications were encountered. Conclusion. Blunt abdominal trauma is an uncommon mechanism of pediatric duodenal injuries. Primary repair with drain placement is safe even in more complex injuries

Interleukin-8 levels and activity in delayed-healing human thermal wounds

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72020/1/j.1524-475x.2000.00216.x.pd

tRNA structural and functional changes induced by oxidative stress

Oxidatively damaged biomolecules impair cellular functions and contribute to the pathology of a variety of diseases. RNA is also attacked by reactive oxygen species, and oxidized RNA is increasingly recognized as an important contributor to neurodegenerative complications in humans. Recently, evidence has accumulated supporting the notion that tRNA is involved in cellular responses to various stress conditions. This review focuses on the intriguing consequences of oxidative modification of tRNA at the structural and functional level

Congenital Diaphragmatic hernia – a review

Congenital Diaphragmatic hernia (CDH) is a condition characterized by a defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity interfering with normal development of the lungs. The defect may range from a small aperture in the posterior muscle rim to complete absence of diaphragm. The pathophysiology of CDH is a combination of lung hypoplasia and immaturity associated with persistent pulmonary hypertension of newborn (PPHN) and cardiac dysfunction. Prenatal assessment of lung to head ratio (LHR) and position of the liver by ultrasound are used to diagnose and predict outcomes. Delivery of infants with CDH is recommended close to term gestation. Immediate management at birth includes bowel decompression, avoidance of mask ventilation and endotracheal tube placement if required. The main focus of management includes gentle ventilation, hemodynamic monitoring and treatment of pulmonary hypertension followed by surgery. Although inhaled nitric oxide is not approved by FDA for the treatment of PPHN induced by CDH, it is commonly used. Extracorporeal membrane oxygenation (ECMO) is typically considered after failure of conventional medical management for infants ≥ 34 weeks’ gestation or with weight >2 kg with CDH and no associated major lethal anomalies. Multiple factors such as prematurity, associated abnormalities, severity of PPHN, type of repair and need for ECMO can affect the survival of an infant with CDH. With advances in the management of CDH, the overall survival has improved and has been reported to be 70-90% in non-ECMO infants and up to 50% in infants who undergo ECMO

“That’s the Hate They’re Giving Us, Baby, A System Designed Against Us.” The Restorative Justice Solution to the School-to-Prison Pipeline

The school-to-prison pipeline is one of the nation’s biggest challenges as students of color, LGBTQIA+ students, and students with disabilities are being funneled into prisons. Thousands of articles have been written on the existence of the school-to prison pipeline and potential solutions. Federal and state policies have shifted to combat the pipeline, but there is still a large proportion of our nation’s students being criminalized on account of their looks and behaviors. This Note argues that the school-to-prison pipeline is a systemic practice of the American education system, and the education system is functioning exactly as designed. The continued use of zero tolerance policies and school resource officers are proof that this system exists and continues to evolve. To address the real structural inequities of the school system, it must be met with equally radical practices, such as restorative justice, that address the systemic harm. Restorative justice, when done correctly and with the right resources, can be the solution to the school-to-prison pipeline

Effectiveness of an ECMO simulation program in a smaller volume center

Poster presentation at ELSO 25th Anniversary Conference Ann Arbor, M