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Choledochal cysts (CCs), a congenital anomaly resulting in the abnormal dilation of the biliary ductal system, are most often identified in patients younger than 10 years of age. Regardless of clinical presentation, the cornerstone of therapy for CCs is complete surgical excision with reconstruction with either hepaticoduodenostomy or hepaticojejunostomy. Although both procedures are used by surgeons for the correction of CCs, evidence on clinical outcomes following both approaches is inconclusive as to which may offer superior reconstruction. This narrative review aims to compare the current literature regarding both approaches by evaluating their anatomic and operative considerations, as well as their perioperative, postoperative, and long-term outcomes. Future studies should closely focus on long-term, comparative outcomes, including the risk of biliary malignancy, and refine techniques to minimize complications, such as biliary reflux and bowel obstruction, in order to improve care for pediatric patients undergoing treatment for CCs. [ABSTRACT FROM AUTHOR]

Background Gluteal augmentation with autologous fat transfer is one of the fastest growing aesthetic surgical procedures worldwide over the past decade. However, this procedure can be associated with high mortality from fatal pulmonary fat embolism events caused by intramuscular injection of fat. Ultrasound-guided fat grafting allows visualization of the transfer in the subcutaneous space, avoiding intramuscular injection. Objectives The aim of this study was to assess the safety and efficacy of gluteal fat grafting performed with ultrasound-guided cannulation. Methods A retrospective chart review of all patients undergoing ultrasound-guided gluteal fat grafting at the authors' center between 2019 and 2022 was performed. All cases were performed by board-certified and board-eligible plastic surgeons under general anesthesia in ASA Class I or II patients. Fat was only transferred to the subcutaneous plane when over the gluteal muscle. Patients underwent postoperative follow-up from a minimum of 3 months up to 2 years. Results were analyzed with standard statistical tests. Results The study encompassed 1815 female patients with a median age of 34 years. Controlled medical comorbidities were present in 14%, with the most frequent being hypothyroidism (0.7%), polycystic ovarian syndrome (0.7%), anxiety (0.6%), and asthma (0.6%). Postoperative complications occurred in 4% of the total cohort, with the most common being seroma (1.2%), local skin ischemia (1.2%), and surgical site infection (0.8%). There were no macroscopic fat emboli complications or mortalities. Conclusions These data suggest that direct visualization of anatomic plane injection through ultrasound guidance is associated with a low rate of complications. Ultrasound guidance is an efficacious adjunct to gluteal fat grafting and is associated with an improved safety profile that should be considered by every surgeon performing this procedure. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3% of children in the world. Objective: In this work, we seek to compare the different brain activations of pediatric patients with and without ADHD. Methods: A functional resonance examination with BOLD contrast was applied using the MOXO-CPT test (Continuous Performance test with single and double visual-auditory distractors). Results: Differences in BOLD activation were observed indicating that control children regularly presented negative BOLD activations that were not found in children with ADHD. Inhibitory activity in audiovisual association zones in control patients was greater than in patients with ADHD. The inhibition in the frontal and motor regions in the controls contrasted with the overactivation of the motor areas in patients with ADHD, this, together with the detection of cerebellar activation which attempted to modulate the responses of the different areas that lead to executive failure in patients with ADHD. Conclusions: In view of these results, it can be argued that the lack of inhibition of ADHD patients in their executive functions led to a disorganization of the different brain systems. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to describe the clinical, immunological, and genetic features of patients with DOCK8 deficiency (DOCK8‐Def) in a tertiary care center for children. Methods: Retrospective chart review of patients' clinical, immunological, and genetic characteristics with DOCK8‐Def. Genetic analysis was performed with targeted‐ or whole‐exome sequencing; we also assessed DOCK8 protein expression and a lymphoproliferation assay and analyzed survival by the Kaplan–Meier method. Results: We described 11 patients from 8 unrelated kindreds. The median age at symptoms' onset was 10 months (range 1–54 months). The median follow‐up time was 53.4 months (4.8–118.8). All patients presented eczema and recurrent sinopulmonary and cutaneous infections. Besides those symptoms, the most frequent manifestations were bronchiectases (8/11), food allergies (6/11), and severe infections (6/11). Infrequent characteristics were detection of CMV in bronchial lavage, C. parvum‐driven sclerosing cholangitis, Takayasu vasculitis, neurological syndromes, pulmonary tuberculosis, and lymphomatoid granulomatosis. Conclusion: DOCK8‐Def has a broad spectrum of manifestations, including allergy, autoimmunity, inflammation, infection, and cancer. The hallmark of this inborn error of immunity is IEI‐associated eczema with eosinophilia and increased IgE. Here, we report six new mutations causing human DOCK8 deficiency and symptoms previously unrecognized to occur in DOCK8‐Def. Therefore, an early diagnosis of DOCK8‐Def is essential to facilitate an adequate treatment such as HSCT. [ABSTRACT FROM AUTHOR]

Background: At some point in their lives, many people will require major heart surgery (MHS). Patients are generally older adults with various risk factors for infection. However, the incidence of infection after MHS is poorly known, as reported infection data are frequently biased due to different factors like the surgical procedure, postoperative timing, and infectious syndromes or etiologic agents, among others. In addition, most patient data are retrospectively obtained. Purpose and methods: Data were prospectively collected regarding the incidence of all nosocomial infections produced from the time of surgery to hospital discharge in a cohort of 800 adults consecutively undergoing a MHS procedure. Results: During postoperative hospitalization, 124 of the 800 participants developed one or more infections (15.5%): during their ICU stay in 68 patients (54.8%), during their stay on the general ward post ICU in 50 (40.3%), and during their stay in both wards in 6 (4.8%). The most common infections were pneumonia (related or not to mechanical ventilation), surgical site and bloodstream. As etiological agents, 193 pathogens were isolated: mostly Gram-negative bacilli (54.4%), followed by Gram-positive bacteria (30%), viruses (4.6%) and fungi (1.5%). In our cohort, all-cause mortality was recorded in 33 participants (4.1%) and 9 infection-related deaths (1.1%) were produced. Among subjects who developed infections, overall mortality was 13.7% and in those who did not, this was only 2.3%. Conclusion: Infection following MHS remains frequent and severe. Our data suggest that hospital-acquired infection studies should consider episodes of infection in all populations during their entire hospital stay and not only those related to specific clinical syndromes or acquired while the patient is in intensive care. [ABSTRACT FROM AUTHOR]

Chronic granulomatous disease (CGD) presents with granuloma formation and lethal infections. It is inherited in an autosomal or X-linked recessive pattern. We describe a 10-monthold patient with a fatal secondary HLH as a CGD primary manifestation. We carried out an autopsy and found noncaseating granulomas, an aspergilloma in the lung, and hemophagocytosis. We performed a DHR assay on the patient's mother and grandmother, showing a bimodal pattern conclusive of X-linked CGD. Thus, our definitive diagnosis was CGD complicated by macrophage activation syndrome. CGD is caused by phagocytes' inability to control pathogens, resulting in granulomas. Secondary HLH is a severe complication and could be characterized by the proliferation of macrophages and T lymphocytes and the production of proinflammatory cytokines. The early suspicion of this presentation helps establish a specific treatment, and the study of the carriers helps determine the etiology. [ABSTRACT FROM AUTHOR]

We characterize TiN/Ti/HfO2/TiN memristive devices for neuromorphic computing. We analyze dierent features that allow the devices to mimic biological synapses and present the models to reproduce analytically some of the data measured. In particular, we have measured the spike timing dependent plasticity behavior in our devices and later on we have modeled it. The spike timing dependent plasticity model was implemented as the learning rule of a spiking neural network that was trained to recognize the MNIST dataset. Variability is implemented and its influence on the network recognition accuracy is considered accounting for the number of neurons in the network and the number of training epochs. Finally, stochastic resonance is studied as another synaptic feature. It is shown that this eect is important and greatly depends on the noise statistical characteristics. [ABSTRACT FROM AUTHOR]

Purpose: Elective resection of congenital pulmonary airway malformations (CPAM) has been debated for decades and varies significantly between individual surgeons. However, few studies have compared outcomes and costs associated with thoracoscopic and open thoracotomy approaches on a national level. This study sought to compare nationwide outcomes and resource utilization in infants undergoing elective lung resection for CPAM. Materials and Methods: The Nationwide Readmission Database was queried from 2010 to 2014 for newborns who underwent elective surgical resection of CPAM. Patients were stratified by operative approach (thoracoscopic versus open). Demographics, hospital characteristics, and outcomes were analyzed using standard statistical tests. Results: A total of 1716 newborns with CPAM were identified. Elective readmission for pulmonary resection was performed in 12% (n = 198), with 63% of resections completed at a different hospital than the newborn stay. Most resections were thoracoscopic (75%), compared to only 25% via thoracotomy. Infants treated with thoracoscopic resection were more often male (78% versus 62% open, P = .040) and were older at the time of resection. Patients who had an open thoracotomy experienced a higher rate of serious complications (40% versus 10% thoracoscopic, P < .001), including postoperative hemorrhage, tension pneumothorax, and pulmonary collapse. Readmission costs were higher for infants treated via thoracotomy (P < .001). Conclusion: Thoracoscopic lung resection for CPAM is associated with lower cost and fewer postoperative complications than thoracotomy. Most resections are performed at different hospitals than the place of birth, which may affect long-term outcomes from single institutional studies. These findings may be used to address costs and improve future evaluations of elective CPAM resections. [ABSTRACT FROM AUTHOR]

Obesity is a troubling public health problem as it increases risks of sleep disorders, respiratory complications, systemic arterial hypertension, cardiovascular diseases, type 2 diabetes mellitus, and metabolic syndrome (MetS). As a measure to counteract comorbidities associated with severe obesity, bariatric surgery stands out. This study aimed to investigate the adiponectin/leptin ratio in women with severe obesity with and without MetS who had undergone Roux-en-Y gastric bypass (RYGB) and to characterize the biochemical, glucose, and inflammatory parameters of blood in women with severe obesity before and after RYGB. Were enrolled females with severe obesity undergoing RYGP with MetS (n = 11) and without (n = 39). Anthropometric data and circulating levels of glucose, total cholesterol, high-density lipoprotein (HDL), non-HDL total cholesterol, low-density lipoprotein (LDL), adiponectin, and leptin were assessed before and 6 months after RYGB. Significant reductions in weight, body mass index, and glucose, total cholesterol, LDL, and leptin were observed after surgery, with higher levels of HDL, adiponectin, and adiponectin/leptin ratio being observed after surgery compared to the preoperative values of those. This study demonstrated that weight loss induced by RYGB in patients with severe obesity with or without MetS improved biochemical and systemic inflammatory parameters, particularly the adiponectin/leptin ratio. [ABSTRACT FROM AUTHOR]

Duodenal webs are a rare clinical entity with the presentation of a double duodenal web being exceedingly uncommon. Management of duodenal webs traditionally involves duodenal web excision with duodenoduodenostomy, which is usually performed via a laparoscopic or an open approach. We report the case of a 6-month-old child who presented with progressively worsening bilious emesis with imaging findings concerning for a duodenal web. Endoscopic evaluation was performed that identified 2 webs in the fourth portion of the duodenum. These were managed completely endoscopically with balloon dilation. Although surgery is the mainstay of treatment of duodenal webs, this patient was successfully managed by endoscopic intervention without the need for open or laparoscopic excision, which has not been previously described for double duodenal webs. This work demonstrates the safety and efficacy of endoscopic management for infants with this anomaly. [ABSTRACT FROM AUTHOR]

The reliable and compact modeling of RRAM devices is crucial for supporting the development of novel technologies including them. This includes a wide range of applications, such as in-memory computing or memristive logic. A major advantage of the considered HfO $_{2}$ -based RRAM devices is their CMOS-compatibility, which allows them to already be utilized in present applications. However, one problem is that their fabrication still leads to device variabilities, which makes it challenging to test their functionality in an experimental fashion. This work is dedicated to the compact modeling and efficient emulation of 1T-1R RRAM devices. We aim to provide an enhanced model for multilevel capable RRAM devices, based on the Stanford-PKU model, that can be used on any simulation platform such as SPICE or VERILOG-A. Furthermore, we provide an algorithmic model, based on the wave digital (WD) concept, which allows for emulating the considered devices in real-time. Using the latter, we show the hysteresis of our enhanced model to exhibit astounding resemblance with real device measurements. Finally, we extend the WD model to describe an array composed of RRAM devices for performing vector-matrix multiplication. [ABSTRACT FROM AUTHOR]

Most pedestrian detection methods focus on bounding boxes based on fusing RGB with lidar. These methods do not relate to how the human eye perceives objects in the real world. Furthermore, lidar and vision can have difficulty detecting pedestrians in scattered environments, and radar can be used to overcome this problem. Therefore, the motivation of this work is to explore, as a preliminary step, the feasibility of fusing lidar, radar, and RGB for pedestrian detection that potentially can be used for autonomous driving that uses a fully connected convolutional neural network architecture for multimodal sensors. The core of the network is based on SegNet, a pixel-wise semantic segmentation network. In this context, lidar and radar were incorporated by transforming them from 3D pointclouds into 2D gray images with 16-bit depths, and RGB images were incorporated with three channels. The proposed architecture uses a single SegNet for each sensor reading, and the outputs are then applied to a fully connected neural network to fuse the three modalities of sensors. Afterwards, an up-sampling network is applied to recover the fused data. Additionally, a custom dataset of 60 images was proposed for training the architecture, with an additional 10 for evaluation and 10 for testing, giving a total of 80 images. The experiment results show a training mean pixel accuracy of 99.7% and a training mean intersection over union of 99.5%. Also, the testing mean of the IoU was 94.4%, and the testing pixel accuracy was 96.2%. These metric results have successfully demonstrated the effectiveness of using semantic segmentation for pedestrian detection under the modalities of three sensors. Despite some overfitting in the model during experimentation, it performed well in detecting people in test mode. Therefore, it is worth emphasizing that the focus of this work is to show that this method is feasible to be used, as it works regardless of the size of the dataset. Also, a bigger dataset would be necessary to achieve a more appropiate training. This method gives the advantage of detecting pedestrians as the human eye does, thereby resulting in less ambiguity. Additionally, this work has also proposed an extrinsic calibration matrix method for sensor alignment between radar and lidar based on singular value decomposition. [ABSTRACT FROM AUTHOR]

Vaccine-associated rubella is a very rare adverse effect after rubella vaccination; we report the characteristics of a young women who, after a vaccination campaign where she received three different vaccines against influenza, tetanus/diphtheria, and measles/rubella, developed a fever and rash consistent with rubella disease that was confirmed by sequencing of the virus. The evolution was favorable. The woman had two close contacts who did not develop the disease. Follow-up of the patient and her contacts was important to detect complications and for epidemiology surveillance. [ABSTRACT FROM AUTHOR]

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of arthritis of autoimmune aetiology. Systemic-onset juvenile idiopathic arthritis (soJIA) presents with fever, transient erythematous rash, hepatomegaly, splenomegaly, lymphadenopathy, and serositis. SoJIA presents multiple complications, and the most severe is the macrophage activation syndrome (MAS); the timely treatment of MAS must be established early and aggressively to avoid a fatal outcome. Therapeutic plasma exchange has anecdotally been used in refractory cases. A 66-month-old male with a 1-year illness characterized by evening-predominant, intermittent fever, adenomegalies, urticarial-like rash, arthralgia, and arthritis. Biochemical analysis revealed anaemia, leukocytosis, neutrophilia, hypertriglyceridemia, hyperferritinemia, and hypofibrinogenemia; bone marrow aspirate showed hemophagocytosis. He was diagnosed with SoJIA complicated with MAS. He received multiple treatments with IV human gammaglobulin, cyclosporine, dexamethasone, and tocilizumab without improvement. Plasma replacement treatment was performed. Afterwards, he presented significant improvement. After 3-year-follow-up, he remains in good general condition. We present a refractory case of soJIA complicated with MAS successfully treated with plasma exchange. [ABSTRACT FROM AUTHOR]

Introduction: Children with cancer have a higher risk of adverse outcomes during critical illness than general pediatric populations. In Low- and middle-income countries, lack of resources can further negatively impact outcomes in critically ill children with cancer. Methods: In this study, we describe the outcomes of a large cohort of children with cancer including mortality and resource utilization. We performed a retrospective review of all patients admitted to our PICU between December 12th, 2013 and December 31st, 2019. Outcomes were defined as recovery or death and resource utilization was described via use of critical care interventions, Length of stay as well as PICU- and Mechanical Ventilation-free days. Results: Overall mortality was 6.9% while mortality in the unplanned admissions was 9.1%. This remained lower than expected mortality based on PIM2 scoring. Type of PICU admission, Neurological Deterioration as a cause of PICU admission, and PIM2 were significant as risk factors in univariate analysis, but only PIM2 remained significant in the multivariate analysis. Discussion: Our Study shows that high survival rates are achievable for children with cancer with critical illness in resource-limited settings with provision of high-quality critical care. Organizational and clinical practice facilitating quality improvement and early identification and management of critical illness may attenuate the impact of known risk factors for mortality in this population. [ABSTRACT FROM AUTHOR]

Accomplishing truly analog conductance modulation in memristive arrays is crucial in order to implement the synaptic plasticity in hardware-based neuromorphic systems. In this paper, such a feature was addressed by exploiting the inherent stochasticity of switching dynamics in amorphous HfO2 technology. A thorough statistical analysis of experimental characteristics measured in 4 kbit arrays by using trains of identical depression/potentiation pulses with different voltage amplitudes and pulse widths provided the key to develop two different updating rules and to define their optimal programming parameters. The first rule is based on applying a specific number of identical pulses until the conductance value achieves the desired level. The second one utilized only one single pulse with a particular amplitude to achieve the targeted conductance level. In addition, all the results provided by the statistical analysis performed may play an important role in understanding better the switching behavior of this particular technology. [ABSTRACT FROM AUTHOR]

Background: The utility of incidental appendectomy, appendectomy during another index surgery in the absence of appendicitis, has not been evaluated in the pediatric population during cholecystectomy. This study sought to compare nationwide outcomes after cholecystectomy with incidental appendectomy in children.Methods: Patients ≤ 18 years old who underwent cholecystectomy from 2010-2014 were identified from the Nationwide Readmissions Database. A propensity score-matched analysis (PSMA) with > 40 covariates including demographics, comorbidities, and hospitalization factors was performed between those receiving cholecystectomy alone versus incidental appendectomy at the time of cholecystectomy.Results: 34,390 patients underwent cholecystectomy (median age 15 [13-17] years). Laparoscopic (92%) approach was utilized most frequently, with 2% requiring conversion to open cholecystectomy. PSMA demonstrated a higher frequency of perforation or laceration of adjacent organs occurring in those receiving cholecystectomy alone during index admission. No significant differences in readmissions within 30 days or the calendar year were detected. Those undergoing cholecystectomy alone had higher overall readmission costs ($11,783 [$4942-$39,836] vs. $6,100 [$2358-$19,719] cholecystectomy with appendectomy; p = 0.010).Conclusion: This nationwide PSMA indicates that incidental appendectomy in pediatric cholecystectomies is not associated with higher postoperative complications, cost, or readmissions. This suggests that incidental appendectomy during cholecystectomy is safe, cost-effective, and worthy of future study.Level Of Evidence: Level III. [ABSTRACT FROM AUTHOR]

The crossbar structure of Resistive-switching random access memory (RRAM) arrays enabled the In-Memory Computing circuits paradigm, since they imply the native acceleration of a crucial operations in this scenario, namely the Matrix-Vector-Multiplication (MVM). However, RRAM arrays are affected by several issues materializing in conductance variations that might cause severe performance degradation. A critical one is related to the drift of the low conductance states appearing immediately at the end of program and verify algorithms that are mandatory for an accurate multi-level conductance operation. In this work, we analyze the benefits of a new programming algorithm that embodies Set and Reset switching operations to achieve better conductance control and lower variability. Data retention analysis performed with different temperatures for 168 hours evidence its superior performance with respect to standard programming approach. Finally, we explored the benefits of using our methodology at a higher abstraction level, through the simulation of an Artificial Neural Network for image recognition task (MNIST dataset). The accuracy achieved shows higher performance stability over temperature and time. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration is a progressive retinal disease that is associated with factors such as oxidative stress and inflammation. In this study, we evaluated the protective effects of SIG-1451, a non-steroidal anti-inflammatory compound developed for treating atopic dermatitis and known to inhibit Toll-like receptor 4, in light-induced photoreceptor degeneration. SIG-1451 was intraperitoneally injected into rats once per day before exposure to 1000 lx light for 24 h; one day later, optical coherence tomography showed a decrease in retinal thickness, and electroretinogram (ERG) amplitude was also found to have decreased 3 d after light exposure. Moreover, SIG-1451 partially protected against this decrease in retinal thickness and increase in ERG amplitude. One day after light exposure, upregulation of inflammatory response-related genes was observed, and SIG-1451 was found to inhibit this upregulation. Iba-1, a microglial marker, was suppressed in SIG-1451-injected rats. To investigate the molecular mechanism underlying these effects, we used lipopolysaccharide (LPS)-stimulated rat immortalised Müller cells. The upregulation of C-C motif chemokine 2 by LPS stimulation was significantly inhibited by SIG-1451 treatment, and Western blot analysis revealed a decrease in phosphorylated I-κB levels. These results indicate that SIG-1451 indirectly protects photoreceptor cells by attenuating light damage progression, by affecting the inflammatory responses. [ABSTRACT FROM AUTHOR]

Introduction: Debate is ongoing regarding the best service model for achieving a prompt recanalization in LVO ischemic stroke with an indication for thrombectomy. We aim to assess differences between two of the existing models within our region.Methods: We work in a cluster of three public hospitals (one hub and two spokes) forming a single functional neurology service in Madrid (Spain). Upon a LVO case out of regular hours, the interventional neuroradiologist drives to the hub hospital following the drive-the-doctor paradigm (DD). For any of the spokes, the patient is transferred to the nearest endovascular-capable hospital (drip-and-ship-DS) following the Madrid Stroke Plan. We compared times to endovascular procedures between cases managed under each model.Results: Thirty-eight patients in the period April 2014-March 2021 meet the inclusion criteria (DD 27; DS 11). While baseline characteristics are comparable between groups, we observed a notable difference in the time delays favoring those managed under the DD model; with differences between median times of 105 min for hospital arrival-groin puncture (DD 140 [110-181]; DS 245 [222-310], p 0.0004); 122 min for CT-groin puncture (DD 100 [85-144]; DS 222 [200-255], p = 0.0001); and 98 min for hospital arrival-recanalization (DD 180 [140-209]; DS 278 [241-360], p = 0.0014). No differences were observed for NIHSS or mRS on discharge.Conclusions: Compared to the drip-and-ship, the drive-the-doctor triage model for patients with LVO ischemic stroke in primary centers seems to guarantee a shorter time to the start of the endovascular procedure and to recanalization in our region. [ABSTRACT FROM AUTHOR]

Purpose: Identifying at-risk children can provide a crucial opportunity for preventative measures to avoid opioid addiction. This study sought to determine at-risk pediatric patients that were previously hospitalized due to other causes prior to their opioid-related admission. Methods: The Nationwide Readmissions Database (2010–2014) was queried for children 1–18 years old with an opioid-related hospitalization. Previous admissions (up to 1 year prior) and associated diagnoses were compared. Results were weighted for national estimates. Results: 51,349 opioid-related hospitalizations were identified with an overall in-hospital mortality of 0.8%. Seventeen percent had a previous admission during the same calendar year of which 44% had > 1 and 11% had ≥ 5 prior admissions. Only 4% of prior admissions occurred at a different hospital. Males and females were equally represented, and 82% were ≥ 13 years old. Only 16% of previously admitted patients underwent a major surgical procedure during a previous hospitalization. The most common concomitant diagnoses for patients with prior hospitalizations were drug abuse (37%), chronic pulmonary disease (18%), and depression (10%). Conclusion: Opioid-related hospitalizations often occur among children with multiple recent admissions, usually to the same hospital. Most patients do not have a history of cancer or recent surgery to account for their opioid use. [ABSTRACT FROM AUTHOR]

Combined immunodeficiency, EBV infection, lymphoproliferative disorder, DOCK8 deficiency, lymphomatoid granulomatosis Keywords: combined immunodeficiency; DOCK8 deficiency; EBV infection; lymphomatoid granulomatosis; lymphoproliferative disorder EN combined immunodeficiency DOCK8 deficiency EBV infection lymphomatoid granulomatosis lymphoproliferative disorder 1 5 5 06/29/22 20220601 NES 220601 To the Editor, Combined immunodeficiency (CID) due to DOCK8 deficiency is an inborn error of immunity (IEI) characterized by defects in T and B lymphocytes, resulting in severe atopic dermatitis, recurrent cutaneous viral infections, susceptibility to the development of neoplasms, and normal/elevated levels of IgE.1 The spectrum of manifestations includes allergy, autoimmunity, neoplasms, and recurrent infections. Furthermore, patients with DOCK8 deficiency are particularly susceptible to viruses belonging to the herpes family.2 Lymphomatoid granulomatosis (LYG) is a lymphoproliferative disorder associated with chronic EBV infection. [Extracted from the article]

The resistive switching properties of HfO2 based 1T-1R memristive devices are electrically modified by adding ultra-thin layers of Al2O3 into the memristive device. Three different types of memristive stacks are fabricated in the 130 nm CMOS technology of IHP. The switching properties of the memristive devices are discussed with respect to forming voltages, low resistance state and high resistance state characteristics and their variabilities. The experimental I–V characteristics of set and reset operations are evaluated by using the quantum point contact model. The properties of the conduction filament in the on and off states of the memristive devices are discussed with respect to the model parameters obtained from the QPC fit. [ABSTRACT FROM AUTHOR]

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Purpose: Child abuse is often unrecognized by healthcare practitioners. This study sought to characterize pediatric abuse injury patterns and associated mortality rates in a nationwide cohort. Methods: The Kids' Inpatient Database (1997–2012) was queried for patients < 18 years old with a diagnosis of child abuse (utilizing ICD-9 codes for abusive head trauma [AHT], neglect, physical, emotional, sexual, and other abuse). Demographic factors, mortality, and injury patterns were compared with demographic factors using standard statistical tests. Results: > 39,000 children were hospitalized for abuse from 1997 to 2012. The majority were Caucasian (36%), male (51%) and < 4 years old (70%). Most sustained physical abuse (53%), followed by AHT (14%), sexual (9%) and emotional abuse (2%). Multiple injuries were sustained by 44% of patients. Mortality was 4% (n = 1476). Burns (2%) and intrathoracic (2%) injuries had the highest mortality compared to other injuries (21% and 19%, respectively; both P < 0.001). Emotional abuse (5%) and neglect (1%) were highest in those ≥ 13 years old (both P = 0.001). Conclusion: Physical injuries are less common in adolescents (13–18 years) hospitalized for abuse. However, they are more likely to report emotional abuse and neglect, which has not been compared in previous studies. Intrathoracic injuries and AHT are associated with significant mortality. [ABSTRACT FROM AUTHOR]

Background: There are few nationwide studies comparing outcomes of open, laparoscopic (LAP), and percutaneous endoscopic (PEG) gastrostomy tube (GT) placement in the pediatric population. Materials and Methods: The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients ≤18 years (excluding newborns) who underwent GT placement. Demographics, hospital characteristics, and outcomes were compared by the GT approach. Results: There were 3278 patients (41% female, age 3 ± 5 years) identified who underwent GT placement (40% open versus 32% PEG versus 28% LAP). Following an open approach, there were higher rates of GT-related complications (10% versus 4% LAP versus 3% PEG) and postoperative gastrointestinal issues (24% versus 12% LAP versus 9% PEG) on index hospitalization, both P < .001. Readmission within 30 days and 1 year were 18% and 43%, respectively. Overall readmission rates were not affected by the GT approach (44% open versus 44% LAP versus 43% PEG, P = .773). However, readmission for GT-related complications was the lowest following the LAP approach (<0.3% versus 2% open versus 2% PEG, P < .001). When those who also underwent fundoplication were excluded, conversion to gastrojejunostomy or jejunostomy (GJ/J) on readmission was higher following open and PEG approaches (4% open versus 2% PEG versus 0% LAP, P = .039). Conclusions: Compared with PEG gastrostomy and open gastrostomy, LAP GT placement appears to have lower index complications and reoperation rates, and at least comparable readmission outcomes. Despite these advantages, LAP GT placement remains underutilized. [ABSTRACT FROM AUTHOR]

Purpose: Fundoplications are a common operation in the pediatric population. This study aims to explore outcomes comparing laparoscopic versus open operative techniques. Methods: From 2010 to 2014 the Nationwide Readmissions Database was used to identify patients aged 0-18 years who underwent a fundoplication. Propensity score matched analysis was performed based on 87 covariates. Demographics, hospital factors, readmissions, and complications were compared by surgical technique (laparoscopic versus open). Results: There were 4411 patients (47% female) who underwent fundoplication via laparoscopic (69%) versus open (31%) technique. Gastrostomy tubes were placed in 75% of patients also undergoing fundoplication. Newborn made up 64% of the cohort, with 47% of newborns having cardiac anomalies and 96% being premature. Open fundoplications were more likely to be performed in newborns (72% versus 61%) and those in the lowest income quartile compared to laparoscopic (41% versus 31% P < .001), both P < .001. The readmission rate was 20% within 30 days and 38% within the year, with 15% admitted to a different hospital. Only 14% of readmissions were elective. Open fundoplication was associated with more unplanned readmissions (94% versus 84%), conversion to gastrojejunostomy tube (11% versus 5%) along with major (5% versus 3%) and minor (8% versus 2%) complications compared to the laparoscopic approach, all P < 0.001. Conclusion: The majority of fundoplications are being performed in newborns and are being done laparoscopically, which are associated with lower complication and postoperative readmission rates compared to open fundoplications. [ABSTRACT FROM AUTHOR]

Introduction/Purpose Obesity increases significantly every year worldwide. Since 1980, the prevalence of individuals with obesity has practically doubled. Obesity plays an important role in the pathophysiology of diseases that arise from a complex interaction of nutritional, genetic, and metabolic factors, characterizing a chronic inflammatory state. This study aimed to verify the systemic inflammatory response through the analysis of IGF-1, IL-23, and resistin levels and the lipid profile in severely obese women undergoing surgery for obesity and weight-related diseases. Materials and Methods This randomized controlled clinical trial includes female patients clinically diagnosed with severe obesity with an indication for bariatric surgery. Results In the initial evaluation, no significant difference was observed between the control (CG) and bariatric surgery (BSG) groups. The weight, BMI, systolic and diastolic blood pressures, total cholesterol, LDL, HDL, total non-HDL cholesterol, and glucose in BSG patients showed a significant change after surgery. Pre- and post-surgery levels of resistin, IGF-1, and IL-23 showed a significant difference in the BSG group, but only IL-23 was changed after 6 months in the CG. Conclusion The results of this study confirmed that weight loss induced by surgery for obesity and weight-related diseases improved the lipid profile and reduced the chronic inflammatory status in women with severe obesity. [ABSTRACT FROM AUTHOR]

In ultrasound nondestructive testing (NDT), a widespread approach is to take synthetic aperture measurements from the surface of a specimen to detect and locate defects within it. Based on these measurements, imaging is usually performed using the synthetic aperture focusing technique (SAFT). However, SAFT is suboptimal in terms of resolution and requires oversampling in the time domain to obtain a fine grid for the delay-and-sum (DAS). On the other hand, parametric reconstruction algorithms give better resolution, but their usage for imaging becomes computationally expensive due to the size of the parameter space and a large amount of measurement data in realistic 3-D scenarios when using oversampling. In the literature, the remedies to this are twofold. First, the amount of measurement data can be reduced using state-of-the-art sub-Nyquist sampling approaches to measure Fourier coefficients instead of time-domain samples. Second, parametric reconstruction algorithms mostly rely on matrix–vector operations that can be implemented efficiently by exploiting the underlying structure of the model. In this article, we propose and compare different strategies to choose the Fourier coefficients to be measured. Their asymptotic performance is compared by numerically evaluating the Cramér–Rao bound (CRB) for the localizability of the defect coordinates. These subsampling strategies are then combined with an $\ell _{{1}}$ -minimization scheme to compute 3-D reconstructions from the low-rate measurements. Compared to conventional DAS, this allows us to formulate a fully physically motivated forward model matrix. To enable this, the projection operations of the forward model matrix are implemented matrix-free by exploiting the underlying two-level Toeplitz structure. Finally, we show that high-resolution reconstructions from as low as a single Fourier coefficient per A-scan are possible based on simulated data and measurements from a steel specimen. [ABSTRACT FROM AUTHOR]

Intracellular amyloid beta oligomer (iAβo) accumulation and neuronal hyperexcitability are two crucial events at early stages of Alzheimer's disease (AD). However, to date, no mechanism linking iAβo with an increase in neuronal excitability has been reported. Here, the effects of human AD brain‐derived (h‐iAβo) and synthetic (iAβo) peptides on synaptic currents and action potential firing were investigated in hippocampal neurons. Starting from 500 pM, iAβo rapidly increased the frequency of synaptic currents and higher concentrations potentiated the AMPA receptor‐mediated current. Both effects were PKC‐dependent. Parallel recordings of synaptic currents and nitric oxide (NO)‐associated fluorescence showed that the increased frequency, related to pre‐synaptic release, was dependent on a NO‐mediated retrograde signaling. Moreover, increased synchronization in NO production was also observed in neurons neighboring those dialyzed with iAβo, indicating that iAβo can increase network excitability at a distance. Current‐clamp recordings suggested that iAβo increased neuronal excitability via AMPA‐driven synaptic activity without altering membrane intrinsic properties. These results strongly indicate that iAβo causes functional spreading of hyperexcitability through a synaptic‐driven mechanism and offers an important neuropathological significance to intracellular species in the initial stages of AD, which include brain hyperexcitability and seizures. [ABSTRACT FROM AUTHOR]

Resistive switching memory (RRAM) is a promising technology for embedded memory and its application in computing. In particular, RRAM arrays can provide a convenient primitive for matrix–vector multiplication (MVM) with strong impact on the acceleration of neural networks for artificial intelligence (AI). At the same time, RRAM is affected by intrinsic conductance variations, which might cause degradation of accuracy in AI inference hardware. This work provides a detailed study of the multilevel-cell (MLC) programming of RRAM for neural network applications. We compare three MLC programming schemes and discuss their variations in terms of the different slopes in the programming characteristics. We test the accuracy of a two-layer fully connected neural network (FC-NN) as a function of the MLC scheme, the number of weight levels, and the weight mapping configuration. We find a tradeoff between the FC-NN accuracy, size, and current consumption. This work highlights the importance of a holistic approach to AI accelerators encompassing the device properties, the overall circuit performance, and the AI application specifications. [ABSTRACT FROM AUTHOR]

Achieving a reliable multilevel programming operation in resistive random access memory (RRAM) arrays is still a challenging task. In this work, we assessed the impact of the voltage step value used by the programming algorithm on the device-to-device (DTD) variability of the current distributions of four conductive levels and on the energy consumption featured by programming 4-kbit HfO2-based RRAM arrays. Two different write-verify algorithms were considered and compared, namely, the incremental gate voltage with verify algorithm (IGVVA) and the incremental step pulse with verify algorithm (ISPVA). By using the IGVVA, a main tradeoff has to be considered since reducing the voltage step leads to a smaller DTD variability at the cost of a strong increase in energy consumption. Although the ISPVA cannot reduce the DTD variability as much as the IGVVA, its voltage step can be decreased in order to reduce the energy consumption with almost no impact on the DTD variability. Therefore, the final decision on which algorithm to employ should be based on the specific application targeted for the RRAM array. [ABSTRACT FROM AUTHOR]

Vici syndrome is also characterized by marked brain and neuromuscular involvement, clinically manifested by hypotonia, seizures, hearing loss, neurodevelopmental delay, and progressive microcephaly [[1]]. In conclusion, this report expands the mutational spectrum of the EPG5 gene and confirms the presence of the Vici syndrome in our population, with concordant features to those previously described. The Vici syndrome protein EPG5 regulates intracellular nucleic acid trafficking linking autophagy to innate and adaptive immunity. [Extracted from the article]

Logic-in-memory (LiM) circuits based on resistive random access memory (RRAM) devices and the material implication logic are promising candidates for the development of low-power computing devices that could fulfill the growing demand of distributed computing systems. However, these circuits are affected by many reliability challenges that arise from device nonidealities (e.g., variability) and the characteristics of the employed circuit architecture. Thus, an accurate investigation of the variability at the array level is needed to evaluate the reliability and performance of such circuit architectures. In this work, we explore the reliability and performance of smart IMPLY (SIMPLY) (i.e., a recently proposed LiM architecture with improved reliability and performance) on two 4-kb RRAM arrays based on different resistive switching oxides integrated in the back end of line (BEOL) of the 0.25-μm BiCMOS process. We analyze the tradeoff between reliability and energy consumption of SIMPLY architecture by exploiting the results of an extensive array-level variability characterization of the two technologies. Finally, we study the worst case performance of a full adder implemented with the SIMPLY architecture and benchmark it on the analogous CMOS implementation. [ABSTRACT FROM AUTHOR]

The present work aimed to isolate plant growth-promoting bacteria from forest soil and to study their effect on the development of Pinus oocarpa. Strain C2 was selected from 35 isolated soil bacteria for its high phosphate solubilization index (2.40) in solid media. Its ability to solubilize different sources of phosphate (calcium, aluminum, or iron) was studied in liquid medium at different pH, 5 and 7. Maximum P released was 118.44 mg/L (tricalcium phosphate). Strain C2 was also able to produce up to 45 mg/L of indoleacetic acid-homologous compounds (IAAs) at different initial pH, glucose, and tryptophan (as IAAs precursor) concentration. Strain C2 was identified as Enterobacter hormaechei subsp. xiangfangensis and was periodically inoculated on P. oocarpa seedlings during 180 days (nursery stage, double-transplanting system). It was observed that the mineral content in P. oocarpa inoculated with E. hormaechei (strain C2) increased, especially nitrogen in roots and phosphorus in stems. The Dickson quality index (DQI) of inoculated plants was higher in comparison with the control ones. [ABSTRACT FROM AUTHOR]

Introduction: Surgery remains an important treatment modality for the management of pediatric Crohn's disease (CD). The objective of this study was to perform a comparative analysis of open right hemicolectomy (ORH) and laparoscopic right hemicolectomy (LRH) for the management of pediatric CD. Materials and Methods: The Kids' Inpatient Database (KID) was queried (2009-2012) for ICD-9 procedure codes for ORH (45.73) and LRH (17.33) in patients with CD (ICD-9 codes: 555.0, 555.1, 555.2, 555.9). Open and laparoscopic procedures were compared using propensity score (PS)-matched analysis (PSMA) of 41 variables. Results: Overall 889 patients were identified and after PS matching, there were 380 ORHs and 380 LRHs. There were zero in-hospital deaths (0/821). ORH patients were more likely to have septicemia, respiratory compromise, pneumonia, perforation and/or laceration, complications, and require blood transfusions (all, P < .05). Although LRH patients were more likely to develop postoperative nausea/vomiting/diarrhea (P < .0001), they had a shorter hospital length of stay (P < .0001) and lower overall hospital charges and cost (P < .001). Conclusion: ORH and LRH in KID have similar low in-hospital mortality in pediatric CD. However, ORH was associated with higher morbidity including an increased risk for respiratory complications, surgical complications, need for blood transfusions, and increased resource utilization than patients who had laparoscopic procedures. In select patients, LRH is safe, feasible, and potentially superior to ORH. [ABSTRACT FROM AUTHOR]

Anthropogenic activities are causing increased noise levels in the marine environment. To date, few studies have been undertaken to investigate the effects of different noise frequencies on the behaviour of juvenile fish. In this study, the behavioural changes of juvenile gilthead seabream (Sparus aurata) are evaluated when exposed to white noise filtered in third-octave bands centred at 63, 125, 500, and 1000 Hz (sound pressure level, 140–150 dB re 1 μΡa) for 7 h. The group dispersion, motility, and swimming height of the fish were analysed before and during the acoustic emission. Dispersion of the fish was found to reduce immediately upon application of low frequency sound (63 and 125 Hz) with a return to control condition after 2 h (indicative of habituation), whereas at 1 kHz, dispersion increased after 2 h without any habituation. The motility decreased significantly at 63 Hz throughout the 7 h of sound exposure. The swimming height decreased significantly for all frequencies other than 125 Hz. The results of this study highlight significant variations in the behavioural responses of juvenile fish that could have consequences on their fitness and survival. [ABSTRACT FROM AUTHOR]

Background: As minimally invasive pediatric surgery becomes standard approach to many surgical solutions, access has become an important point for improvement. Laparoscopic cholecystectomy (LC) is the gold standard for many conditions affecting the gallbladder; however, open cholecystectomy (OC) is offered as the initial approach in a surprisingly high percentage of cases. Materials and Methods: The Kids' Inpatient Database (1997-2012) was searched for International Classification of Disease, 9th revision, Clinical Modification procedure code (51.2x). LC and OC performed in patients <20 years old were identified. Propensity score-matched analyses using 39 variables were performed to isolate the effects of race, income group, location, gender, payer status, and hospital size on the percentage of LCs and OCs offered. Cases were weighted to provide national estimates. Results: A total of 78,578 cases were identified, comprising LC (88.1%) and OC (11.9%). Girls were 1.6 (CI: 1.4, 1.7) times more likely to undergo LC versus boys. Large facilities were 1.4 (1.3, 1.7) times more likely to perform LCs than small facilities. Children in lower income quartiles were 1.2 (1.1, 1.3) times more likely to undergo LC compared with those in higher income quartiles. Rates of LC were not affected by race, hospital location, or payer status. Conclusions: Risk-adjusted analysis of a large population-based data set demonstrated evidence that confirms, but also refutes, traditional disparities to minimally invasive surgery access. Despite laparoscopic gold standard, OC remains the initial approach in a surprisingly high percentage of pediatric cases independent of demographics or socioeconomic status. Additional research is required to identify factors affecting the distribution of LC and OC within the pediatric population. [ABSTRACT FROM AUTHOR]

Purpose: Pancreatic tumors are rare in children and limited data are available regarding incidence, treatment, and outcomes. We aim to describe patient and tumor characteristics and to report on survival of these diseases.Methods: Children with pancreatic tumors were queried from the National Cancer Database (2004-2014). The association between treatment and hazard of death was assessed using Kaplan-Meier method and Cox regression model.Results: We identified 109 children with pancreatic tumors; 52% were male and median age at diagnosis was 14 years. Tumors were distributed as follows: pseudopapillary neoplasm (30%), endocrine tumors (27%), pancreatoblastoma (16%), pancreatic adenocarcinoma (16%), sarcoma (6%) and neuroblastoma (5%). Seventy-nine patients underwent surgery, of which 76% achieved R0 resection. Most patients (85%) had lymph nodes examined, of which 22% had positive nodes. Five-year overall survival by tumor histology was 95% (pseudopapillary neoplasm), 75% (neuroblastoma), 70% (pancreatoblastoma), 51% (endocrine tumors), 43% (sarcoma), and 34% (adenocarcinoma). On multivariable analysis, surgical resection was the strongest predictor of survival (HR 0.26, 95% CI 0.10-0.68, p < 0.01).Conclusion: Overall survival of children with pancreatic tumors is grim, with varying survival rates among different tumors. Surgical resection is associated with improved long-term survival. [ABSTRACT FROM AUTHOR]

In this work, the influence of specific switching algorithms on device-to-device (D2D) variability of the forming process, in an integrated Al-doped HfO2 1T-1R 4 kbit resistive random access memory array, is investigated. The resistive devices are programed by using two different algorithms: the incremental step pulse and verify algorithm (ISPVA) at different temperatures and the constant amplitude pulse and verify algorithm (CAPVA) at different voltage amplitudes. The stabilized forming currents of both algorithms are compared in terms of their distributions, yields, and dispersions. The D2D distributions of the forming voltages of ISPVA and the forming times of CAPVA are fitted by Weibull distributions. The obtained Weibull parameters provide a link with the statistics governing the process. Finally, the authors discuss the importance of the ISPVA, CAPVA, temperature, and voltage amplitudes to improve the reliability of the forming process. [ABSTRACT FROM AUTHOR]