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Purpose: Laparoscopic appendectomy for pediatric acute appendicitis is commonly performed by pediatric surgeons. A single incision approach has been investigated, but the lack of technical uniformity has resulted in conflicting data. We hypothesized that an initial single incision laparoscopic-assisted extracorporeal appendectomy (SILEA) approach is associated with similar complication rates as compared to the standard three-incision laparoscopic appendectomy (TILA). Methods: Approximately 1300 laparoscopic appendectomies were retrospectively reviewed for acute appendicitis over a 5 year period. Patients were split into TILA or SILEA cohorts. Propensity score matching identified 102 matched cases in both cohorts. Case and control cohort comparisons were then analyzed. Results: Successful SILEA was associated with no difference in post-operative complication rate. SILEA was associated with decreased postoperative narcotic dosage and shorter operative time than TILA. Conclusions: An initial SILEA approach is safe and associated with similar complication rates as TILA. Based on this data, the authors advocate adoption of the an initial SILEA approach for uncomplicated, freely mobile, acute appendicitis with seamless conversion to TILA if the appendix is not amendable to SILEA. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Constraint Optimization Problems (COPs) ask for an assignment of values to variables in order to optimize an objective subject to constraints that restrict the value combinations in the assignment. They are usually solved by the classical Branch and Bound (B&B) search algorithm. Dominance breaking is an important technique in B&B to prune assignments that are subordinate to others concerning the objective value and/or the satisfiability of constraints. In practice, the addition of constraints for dominance breaking can drastically speed up the B&B search for solving many COPs. However, identification of suboptimal assignments in COPs and derivation of useful constraints for dominance breaking are usually problem-specific and require sophisticated human insights on the problem structure. This paper proposes the first theoretical and practical framework for automatic generation of dominance breaking constraints for a class of COPs consisting of efficiently checkable objectives and constraints. In particular, the framework focuses on generating nogood constraints representing incompatible value assignments and formulates nogood generation as solving auxiliary constraint satisfaction problems. The proposed method can generate nogoods of varying strengths for dominance breaking by controlling the number of involved variables. Experimentation on various benchmarks demonstrates the effectiveness of the proposal in both efficiency and ease of use. The superior performance is also supported by a theoretical analysis to compare the relative strength of automatically generated nogoods with manually derived dominance breaking constraints in the literature. [ABSTRACT FROM AUTHOR]

Purpose: Pilonidal disease (PD) is marked by chronic inflammation and frequent recurrence which can decrease quality of life. However, debate remains regarding the optimal treatment for PD in the pediatric population. This study compares two recommended treatment approaches—excision with off-midline flap reconstruction (OMF: Bascom cleft lift flap, modified Limberg flap) and minimally invasive endoscopic pilonidal sinus treatment (EPSiT). Methods: Single-center retrospective evaluation of patients 1–21 years of age with PD who underwent either excision with OMF reconstruction or EPSiT between 10/1/2011 and 10/31/2021. Outcomes included were disease recurrence, reoperation, and wound complication rates. Comparisons were performed using Chi-square and Mann–Whitney U tests. Results: 18 patients underwent excision/OMF reconstruction and 45 patients underwent EPSiT. The excision/OMF reconstruction cohort was predominantly male (44.4% vs 17.8% p = 0.028), with history of prior pilonidal infection (33.3% vs 6.7%; p = 0.006), and longer median operative time (60 min vs 17 min; p < 0.001). The excision/OMF reconstruction cohort had a higher rate of wound complications (22.2% vs 0%; p = 0.001), but lower rates of disease recurrence (5.6% vs 33.3%; p = 0.022) and reoperation (5.6% vs 31.1%; p = 0.031). Conclusion: In pediatric patients with PD, excision with OMF reconstruction may decrease recurrence and reoperation rates with increased operative times and wound complication rates, compared to EPSiT. [ABSTRACT FROM AUTHOR]

1. Utilizing resident needs-based assessments, the participants will self-report the ability to survey residents in order to identify and fill resident-reported training deficiencies. 2. Utilizing a multimodal approach, the participants will self-report the ability to design, integrate, implement, and tailor a surgical palliative care curriculum. Formal integration of palliative care education is a recognized deficiency of general surgery education. A needs assessment of general surgery residents identified a desire to implement a resident-driven surgical palliative care curriculum. A novel, resident-driven surgical palliative care curriculum was created and implemented with close interprofessional collaboration. Palliative care is essential for optimal surgical care. Currently, there is a lack of palliative care education within general surgery training. A palliative care needs/knowledge assessment was performed with general surgery residents of a tertiary care center academic program. The survey identified clinical subject matter of emphasis. A curriculum was then created, validated, and implemented, in collaboration with the palliative care department, to target these resident-driven initiatives. A post-curriculum survey will be conducted to assess resident comfort and effectiveness in providing palliative care, including usage of a surgical palliative care note template. The assessment was answered by 38/77 (49.4%) residents. Majority of respondents (60.5%) lacked formal palliative care education/training. Most respondents (74.3%) have participated in palliative care conferences with 42.1% of respondents being the primary surgical liaison. There was no correlation between PGY level and palliative care conference participation. Eighty-seven percent of respondents were interested in a palliative care curriculum. Seventy-six percent of respondents were unaware of the surgical palliative care note template and only 3.9% of respondents used the template within the past 6 months. Residents identified several palliative care topics for curriculum emphasis including DNR/DNI discussions (77%), goals of care/conducting family conference (69%), delivering serious news (63%), palliative surgery (63%), and palliative care and hospice referrals (60%). Despite their need to practice surgical palliative care, the majority of general surgery residents were not comfortable with essential surgical palliative care subjects and skills and desired formal training. To address this educational gap, a novel surgical palliative care curriculum was developed and is currently being implemented with interprofessional collaboration between the surgical and palliative care departments. A post-curriculum survey will be conducted to assess resident understanding and application of the curriculum. Surgical Palliative Care/Interdisciplinary Teamwork / Professionalism [ABSTRACT FROM AUTHOR]

Adult Drosophila melanogaster has long been a popular model for learning and memory studies. Now the larval stage of the fruit fly is also being used in an increasing number of classical conditioning studies. In this study, we employed heat shock as a novel negative reinforcement for larvae and obtained high learning scores following just one training trial. We demonstrated heat-shock conditioning in both reciprocal and non-reciprocal paradigms and observed that the time window of association for the odor and heat shock reinforcement is on the order of a few minutes. This is slightly wider than the time window for electroshock conditioning reported in previous studies, possibly due to lingering effects of the high temperature. To test the utility of this simplified assay for the identification of new mutations that disrupt learning, we examined flies carrying mutations in the dnc gene. While the sensitivity to heat shock, as tested by writhing, was similar for wild type and dnc homozygotes, dnc mutations strongly diminished learning. We confirmed that the learning defect in dnc flies was indeed due to mutation in the dnc gene using non-complementation analysis. Given that heat shock has not been employed as a reinforcement for larvae in the past, we explored learning as a function of heat shock intensity and found that optimal learning occurred around 41°C, with higher and lower temperatures both resulting in lower learning scores. In summary, we have developed a very simple, robust paradigm of learning in fruit fly larvae using heat shock reinforcement. [ABSTRACT FROM AUTHOR]