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• Doses of aficamten were assessed for nonobstructive hypertrophic cardiomyopathy. • Treatment with aficamten was well tolerated. • Improvements in symptoms and angina were observed. • Changes in clinical status paralleled improvements in cardiac biomarkers. • Our findings support a larger pivotal phase 3 trial (ACACIA-HCM, NCT06081894). This open-label phase 2 trial evaluated the safety and efficacy of aficamten in patients with nonobstructive hypertrophic cardiomyopathy (nHCM). Patients with symptomatic nHCM (left ventricular outflow tract obstruction gradient ≤ 30 mmHg, left ventricular ejection fraction [LVEF] ≥ 60%, N-terminal pro-B-type natriuretic peptide [NT-proBNP] > 300 pg/mL) received aficamten 5–15 mg once daily (doses adjusted according to echocardiographic LVEF) for 10 weeks. We enrolled 41 patients (mean ± SD age 56 ± 16 years; 59% female). At Week 10, 22 (55%) patients experienced an improvement of ≥ 1 New York Heart Association class; 11 (29%) became asymptomatic. Clinically relevant improvements in Kansas City Cardiomyopathy Questionnaire Clinical Summary Scores occurred in 22 (55%) patients. Symptom relief was paralleled by reductions in NT-proBNP levels (56%; P < 0.001) and high-sensitivity cardiac troponin I (22%; P < 0.005). Modest reductions in LVEF (mean ± SD) of −5.4% ± 10 to 64.6% ± 9.1 were observed. Three (8%) patients had asymptomatic reduction in LVEF < 50% (range: 41%–48%), all returning to normal after 2 weeks of washout. One patient with prior history of aborted sudden cardiac death experienced a fatal arrhythmia during the study. Aficamten administration for symptomatic nHCM was generally safe and was associated with improvements in heart failure symptoms and cardiac biomarkers. ClinicalTrials.gov Identifier: NCT04219826 Summary of results from REDWOOD-HCM Cohort 4: Data in panel C are presented as mean and 95% CI; data in panel D are presented as mean and SD. Horizontal dotted lines represent the thresholds at which IP was down-titrated to the previous dosage (yellow) or was discontinued (red). CI, confidence interval; HCM, hypertrophic cardiomyopathy; hs-cTnI, high-sensitivity cardiac troponin T and I; KCCQ-CSS, Kansas City Cardiomyopathy Questionnaire clinical summary score; LVEF, left ventricular ejection fraction; LVOT, left ventricular outflow gradient; NT-proBNP, N-terminal pro B-type natriuretic peptide; NYHA, New York Heart Association; SD, standard deviation. [Display omitted] [ABSTRACT FROM AUTHOR]

Antibody-drug conjugates (ADCs) are an emerging class of anticancer agents that combine targeting antibodies with potent cytotoxic agents. Their molecular configuration allows for increased therapeutic efficacy and reduced adverse-effect profiles compared to monoclonal antibodies or cytotoxic chemotherapy alone. ADCs cause off-target toxicities through several mechanisms, including premature deconjugation of the cytotoxic agent in the serum and the presence of the targeted antigen on normal tissues. Given cutaneous adverse events comprise 31.3% of all-grade adverse events in clinical trials involving ADCs, dermatologists are increasingly called upon to manage the cutaneous toxicities caused by these drugs. In this review, we summarize known cutaneous toxicities of the ADCs that have been approved for use by the US Food and Drug Administration to date. Dermatologists can play a key role in recognizing cutaneous reactions associated with ADCs, contributing to guidelines for their management, and aiding during clinical trials to generate detailed morphologic and histopathologic descriptions of cutaneous toxicities caused by ADCs. [ABSTRACT FROM AUTHOR]

The foot placement is a determinant of the base of support and influences standing balance. The reliability of postural stability tests with different foot placement angles is unclear. To determine and compare the intra- and inter-day reliability of the center of pressure-based postural stability while standing with different foot placement angles. Twenty-five healthy adults (16 females and 9 males; age: 29 ± 6 years) completed 70 s trials of eyes open and eyes closed stability tests with 0°, 15°, 30°, and 45° angles between the feet while standing on a forceplate in three sessions: two sessions were in the same day, and the third session was one-week apart. The repeatability of measurements was tested using analysis of variance, interclass correlation, and standard error of measurements. Throughout the three study sessions, there was no difference in postural stability while participants stood with different foot placement angles. The interclass correlation scores ranged from 0.71 to 0.96, the standard error of measurements ranged from 2.1% to 12.9%, and no significant systematic changes (p < 0.05) occurred between the testing sessions for any foot placements. Standing with a 45° angle between the feet with closed eyes showed higher reliability values than other conditions. The intra-day reliability scores were greater than inter-day reliability. The relative reliability of postural stability could be impacted by foot placement angles, which might alter ankle mobility and base of support dimensions. The advantages of larger foot placement angles on improving the relative reliability of postural stability could be better demonstrated in healthy people under challenging conditions such as standing with closed eyes. Standing with foot placement angles between 0° and 45° are reliable and a quantitative assessment of the center of pressure could be used to monitor the changes in postural stability between sessions. • Between-sessions reliability of postural stability varies based on between foot angle. • Mean velocity of CoP has moderate to excellent ICC. • 45° between foot angle has higher reliability values than 0°, 15°, and 30°. • The intra-day reliability values are greater than inter-day reliability. [ABSTRACT FROM AUTHOR]

Ataxia telangiectasia (AT) is an autosomal recessive multisystem disorder. Most patients have progressive cerebellar ataxia, oculocutaneous telangiectasia, frequent pulmonary infection, and an increased risk of malignancies. Although N-acetyl- dl -leucine (ADLL) has shown some efficacy in patients with AT, its more pharmacologically active enantiomer, N-acetyl- l -leucine (NALL), has just recently been investigated in ataxic individuals. The current study assessed the efficacy of NALL in patients with AT. This 2 × 2 crossover, double-blind, randomized clinical trial was conducted on 20 patients with AT. After excluding four patients, 16 subjects (eight females, eight males; mean age 9.8 ± 3.5 years) with a definitive genetic diagnosis of AT were randomly assigned to one of two study groups, with one group receiving 1–4 g/day NALL or a placebo for six weeks. Subjects then had a 4-week washout before crossing over to the other treatment for an additional six weeks. The Spinocerebellar Ataxia Functional Index (SCAFI) and the Scale for Assessment and Rating of Ataxia (SARA) score assessed patients' motor function. Quality of life (QOL) was evaluated by a specialist using the PedsQL questionnaire. Fasting blood samples were taken from all subjects before and after each intervention to determine potential side effects. Although patients' nausea and constipation were improved, the results failed to reveal any significant benefits of NALL treatment on ataxia symptoms. NALL treatment had no significant effects on SARA, SCAFI-9HPT (9-hole peg test) nondominant, SCAFI-9HPT dominant, or SCAFI-8WMT (8 m walking time) (p > 0.05). Our patient's Physical Health score in Child self-report and Parent proxy-report did not significantly change in the treatment group compared to the placebo (p > 0.05). Furthermore, there were no significant changes in energy and macronutrient intake after NALL treatment. None of the volunteers reported serious or moderate side effects. To the best of our knowledge, this was the first placebo-controlled, randomized clinical trial exploring NALL's potential effects for treating AT. Despite improvements in some symptomss, NALL intervention failed to improve motor function significantly. However, patients' nausea and constipation were improved by NALL, which can be a relevant benefit clinically. • This was the first placebo-controlled trial studying NALL's effects on AT. • NALL improved nausea and constipation in AT patients, providing a clinical benefit. • NALL did not significantly improve motor function in AT patients. • No serious or moderate side effects were reported with NALL treatment. [ABSTRACT FROM AUTHOR]

Motor vehicle collisions (MVC) are the second leading cause of death in children and adolescents, but appropriate restraint use remains inadequate. Our previous work shows that about half of pediatric MVC victims presenting to our trauma center were unrestrained. This study evaluates restraint use among children and adolescents who did not survive after MVC. We hypothesize that restraint use is even lower in this population than in pediatric MVC patients who reached our trauma center. We reviewed the local Medical Examiner's public records for fatal MVCs involving decedents <19 years old from 2010 to 2021. When restraint use was not documented, local Fire Rescue public records were cross-referenced. Patients were excluded if restraint use was still unknown. Age, demographics, and restraint use were compared using standard statistical methods. Of 199 reviewed cases, 92 met selection criteria. Improper restraint use was documented in 72 patients (78%). Most decedents were White (72% versus 28% Black) and male (74%), with a median age of 17 years [15–18]. Improper restraint use was more common among Black (92% vs 73% White, p = 0.040) and male occupants (85% vs 58% female, p = 0.006). Improper restraint use was lower in the Hispanic population (73%) compared to non-Hispanic individuals (89%), but this difference was not statistically significant (p = 0.090). Most pediatric patients who die from MVCs in our county are improperly restrained. While male and Black patients are especially high-risk, the overall dismal rates of restraint use in our pediatric population present an opportunity to improve injury prevention measures. Retrospective Comparative Study. Level III. [ABSTRACT FROM AUTHOR]

Previous studies have shown improved survival for severely injured adult patients treated at American College of Surgeons verified level I/II trauma centers compared to level III and undesignated centers. However, this relationship has not been well established in pediatric trauma centers (PTCs). We hypothesize that severely injured children will have lower mortality at verified level I/II PTCs compared to centers without PTC verification. All patients 1–15 years of age with ISS >15 in the 2017–2019 American College of Surgeons Trauma Quality Programs (ACS TQP) dataset were reviewed. Patients with pre-hospital cardiac arrest, burns, and those transferred out for ongoing inpatient care were excluded. Logistic regression models were used to assess the effects of pediatric trauma center verification on mortality. 16,301 patients were identified (64 % male, median ISS 21 [17–27]), and 60 % were admitted to verified PTCs. Overall mortality was 6.0 %. Mortality at centers with PTC verification was 5.1 % versus 7.3 % at centers without PTC verification (p < 0.001). After controlling for injury mechanism, sex, age, pediatric-adjusted shock index (SIPA), ISS, arrival via interhospital transfer, and adult trauma center verification, pediatric level I/II trauma center designation was independently associated with decreased mortality (OR 0.72, 95 % CI 0.61–0.85). Treatment at ACS-verified pediatric trauma centers is associated with improved survival in critically injured children. These findings highlight the importance of PTC verification in optimizing outcomes for severely injured pediatric patients and should influence trauma center apportionment and prehospital triage. Level IV – Retrospective review of national database. [ABSTRACT FROM AUTHOR]

Cryptorchidism is commonly treated with orchiopexy at 6–12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT. The Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates. We analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration. In newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6–12 months of age to reassess for surgery. Level III Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Erythropoietic protoporphyria and X-linked protoporphyria are rare genetic photodermatoses. Limited expertise with these disorders among physicians leads to diagnostic delays. Here, we present evidence-based consensus guidelines for the diagnosis, monitoring, and management of erythropoietic protoporphyria and X-linked protoporphyria. A systematic literature review was conducted, and reviewed among subcommittees of experts, divided by topic. Consensus on guidelines was reached within each subcommittee and then among all members of the committee. The appropriate biochemical and genetic testing to establish the diagnosis is reviewed in addition to the interpretation of results. Prevention of symptoms, management of acute phototoxicity, and pharmacologic and nonpharmacologic treatment options are discussed. The importance of ongoing monitoring for liver disease, iron deficiency, and vitamin D deficiency is discussed with management guidance. Finally, management of pregnancy and surgery and the safety of other therapies are summarized. We emphasize that these are multisystemic disorders that require longitudinal monitoring. These guidelines provide a structure for evidence-based diagnosis and management for practicing physicians. Early diagnosis and management of these disorders are essential, particularly given the availability of new and emerging therapies. [ABSTRACT FROM AUTHOR]

Pediatric pedestrian injuries (PPI) are a major public health concern. This study utilized geospatial analysis to characterize the risk and injury severity of PPI. A retrospective chart review of PPI patients (age < 18) from a level 1 trauma center was performed (2013–2020). A geographic information system geocoded injury location to home and other public landmarks. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association statistic tested for spatial clustering of injury rates per 10,000 children. Predictors for increased injury severity were assessed by logistic regression. PPI encompassed 6% (n = 188) of pediatric traumas. Most patients were black (54%), male (58%), >13 years (56%), and with Medicaid insurance (68%). Nine zip codes comprised a statistically significant cluster of PPI. Nearly half (40%) occurred within a quarter mile of home; 7% occurred at home. Most (65%) PPI occurred within 1 mile of a school, and 45% occurred within a quarter mile of a park. Nearly all (99%) PPI occurred within a quarter mile of a major intersection and/or roadway. Using admission to ICU as a marker for injury severity, farther distance from home (OR 1.060, 95% CI 1.001–1.121, p = 0.045) and age <13 years (3.662, 95% CI 1.854–7.231, p < 0.001) were independent predictors of injury severity. There are significant sociodemographic disparities in PPI. Most injuries occur near patients' homes and other public landmarks. Multidisciplinary injury prevention collaboration can help inform policymakers, direct local safety programs, and provide a model for PPI prevention at the national level. Level IV. [Display omitted] [ABSTRACT FROM AUTHOR]

Pathogenic variants in the MYBPC3 gene are the leading genetic cause of hypertrophic cardiomyopathy (HCM) resulting in reduced functional myosin-binding protein C (MyBP-C) levels. Studies have shown that adult patients with pathogenic sarcomere variant-HCM exhibit higher incidence of major clinical events than genotype-negative HCM patients. With the emergence of gene replacement therapies, characterizing the natural history of MYBPC3 + HCM is essential to inform future development of this class of targeted therapies. We conducted an analysis of all adult MYBPC3 + HCM patients enrolled in SHaRe (Sarcomeric Human Cardiomyopathy Registry) based on their primary diagnosis at the age of 18-39, 40-59, and ≥60 years. As of September 2023, 1493 adult HCM patients with a pathogenic or likely pathogenic variant in MYBPC3 had enrolled in SHaRe, a multicenter registry involving 12 cardiac centers in the US, EU, and Australia. This analysis included 635 patients (42.5%) diagnosed at 18–39 years, 659 (44.1%) at 40–59 years, and 199 (13.3%) at ≥60 years. Duration of follow-up in the three cohorts was 8.4, 6.6, and 4.5 years, respectively. Demographics, genotype, first echocardiographic metrics, and time to major clinical events were compared across the three groups. Most patients diagnosed at 18–39 and 40–59 years were males (67.0% and 56.3% respectively), while those diagnosed at ≥60 years were primarily female (59.5%). Family history of HCM and proband status were comparable across cohorts (range of 56.3 – 65.7% and 88.0 – 91.5%, respectively). Patients in the youngest cohort presented with the greatest left ventricular maximal wall thickness (median of 19 mm, 18 mm, and 17 mm for the 18 – 39, 40 – 59, and ≥60 years cohorts, respectively). Symptom burden was comparable across cohorts, as the proportion of patients with NYHA III/IV was 13.1%, 10.5%, and 11.4%, respectively. The prevalence of patients having SRT, syncope and need for transplant or left ventricular assist device (LVAD) were highest in the youngest cohort (see Table). Across all three cohorts, patients experienced atrial fibrillation (AF) at 13.7%, the ventricular arrhythmia (VA) composite at 5.3%, and the heart failure (HF) composite at 9.1%. Adult MYBPC3 + HCM patients of all ages are at risk for serious clinical manifestations including heart failure, arrhythmias, and sudden cardiac death (SCD). These findings underscore the importance of genetic diagnosis and development of targeted therapies to restore MyBP-C levels, which could potentially modify the natural history of the disease. [ABSTRACT FROM AUTHOR]

Malrotation with midgut volvulus is a surgical emergency commonly encountered in pediatric surgical practice. Outcomes are excellent with timely diagnosis and treatment, but the development of bowel ischemia is associated with many negative consequences. The Nationwide Readmissions Database was used to identify patients 0–18 years (excluding newborns) with malrotation and midgut volvulus from 2010 to 2014. Demographics, procedures, and outcomes were compared by income group (highest quartile vs. lowest quartile) using standard statistical tests. Results were weighted for national estimates. Emergency surgery for midgut volvulus was performed in 572 patients. The majority (86%) underwent Ladd's procedure, while 14% required bowel resection and/or ostomy. Patients in the lowest income quartile were more likely to require bowel resection (18% vs. 8%, p = 0.03) or ostomy (9% vs. 2%, p = 0.015) compared to those in the highest income quartile. Low-income patients were more likely to experience prolonged hospital stay (8 [5-13] days vs. 6 [4-8] days, p <0.001) and experience complications including infections (19% vs. 5%, p = 0.002), endotracheal intubation (18% vs. 4%, p <0.001), and blood transfusions (13% vs. 3%, p = 0.003). Income disparity represents a major factor in surgical outcomes in children with midgut volvulus. A broad spectrum of clinical outcomes following surgery for midgut volvulus exists. Patients from lower-income communities are at significantly higher risk for numerous complications, negative outcomes, and higher resource utilization. These findings support additional investigations of practices to mitigate risk for low-income patients. Level III: Retrospective comparative study [ABSTRACT FROM AUTHOR]

Intestinal malrotation may be asymptomatic in patients with heterotaxy syndrome (HS), and whether these newborns benefit from prophylactic Ladd procedures is unknown. This study sought to uncover nationwide outcomes of newborns with HS receiving Ladd procedures. Newborns with malrotation were identified from the Nationwide Readmission Database (2010-2014) and stratified into those with and without HS utilizing ICD-9CM codes for situs inversus (759.3), asplenia or polysplenia (759.0), and/or dextrocardia (746.87). Outcomes were analyzed using standard statistical tests. 4797 newborns with malrotation were identified, of which 16% had HS. Ladd procedures were performed in 70% overall and more common in those without heterotaxy (73% vs. 56% HS). Ladd procedures in newborns with heterotaxy were associated with higher complications compared to those without HS including surgical site reopening (8% vs. 1%), sepsis (9% vs. 2%), infections (19% vs. 11%), venous thrombosis (9% vs. 1%), and prolonged mechanical ventilation (39% vs. 22%), all p < 0.001. HS newborns were less frequently readmitted with bowel obstructions (0% vs. 4% without HS, p < 0.001) with no readmissions for volvulus in either group. Ladd procedures in newborns with heterotaxy were associated with increased complications and cost without differences in rates of volvulus and bowel obstruction on readmission. Retrospective Comparative. III. [ABSTRACT FROM AUTHOR]

Debate exists on whether patients with Hirschsprung Disease (HD) should undergo immediate resection during their newborn hospitalization or undergo a staged procedure. This study sought to compare postoperative outcomes among newborns receiving immediate versus staged surgery for rectosigmoid HD. The Nationwide Readmission Database was queried (2016–2018) for newborns with HD who underwent surgical resection during their newborn hospitalization (immediate) versus planned readmission (staged). Those who did not receive rectal biopsy or had long-segment or total colonic HD were excluded. A propensity score-matched analysis (PSMA) of patients receiving either surgery was constructed utilizing >70 comorbidities. Outcomes were analyzed using standard statistical tests. 1,048 newborns with HD were identified (56% immediate vs. 44% staged). Staged resection was associated with higher total hospitalization cost ($56,642 vs. $50,166 immediate), p = 0.014. After PSMA, the staged cohort was more likely to require home healthcare at discharge and experience unplanned readmission (40% vs. 23%). These patients experienced more gastrointestinal complications (40% vs. 22%) on readmission, especially Hirschsprung-associated enterocolitis (35% vs. 20%). Newborns receiving staged procedures for HD experience higher rates of unplanned readmission complications and incur higher hospitalization costs. This information should be utilized to defray healthcare utilization costs for newborns with HD. Retrospective Comparative. III. [ABSTRACT FROM AUTHOR]

Oophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovarian operations in the pediatric population. Females less than 21 years old who underwent ovarian operations (oophorectomy, detorsion, and/or drainage) from 2016 to 2017 were identified from the Nationwide Readmissions Database. Patients were stratified by surgical approach (laparoscopic or open). Hospital characteristics and outcomes were compared using standard statistical tests. There were 13,202 females (age 17 [14–20] years) who underwent open (59%) or laparoscopic (41%) ovarian operations. The most common indications for surgery were ovarian mass (48%), cyst (36%), and/or torsion (19%) for which oophorectomy (88%), detorsion (26%), and drainage (13%) were performed most frequently. The open approach was utilized more frequently for oophorectomy (95% vs. 77% laparoscopic) and detorsion (33% vs. 16% laparoscopic), both p < 0.001. A greater proportion of laparoscopic procedures were performed at large (67% vs. 61% open), teaching (82% vs. 76% open) hospitals in patients with private insurance (47% vs. 42% open), all p < 0.001. Patients undergoing open procedures had significantly higher index length of stay (LOS) and rates of wound infections. Thirty-day and overall readmission rates, as well as overall readmission costs, were higher in patients who received open surgeries. Despite fewer overall complications, decreased cost, fewer readmissions, and shorter LOS, laparoscopic approaches are underutilized for pediatric ovarian procedures. Retrospective Comparative. Level III. • Oophorectomy and ovarian detorsion are common operations performed in the female pediatric population. • Few studies have directly compared outcomes after laparoscopic and open ovarian operations in the pediatric population. • Despite fewer complications, readmissions, and shorter LOS, laparoscopy is underutilized for pediatric ovarian procedures. [ABSTRACT FROM AUTHOR]

Management of complicated pleural effusions and empyema using tube thoracostomy with intrapleural fibrinolysis versus surgical drainage has been debated for decades. However, there remains considerable variation in management with these approaches in the pediatric population. This study aims to compare the nationwide outcomes of pediatric patients with complicated pleural effusions. Patients <18 years old with a diagnosis of pleural effusion or empyema associated with pneumonia were identified from the Nationwide Readmissions Database (2016–2018). Demographics, hospital characteristics, and complications were compared among patients undergoing isolated percutaneous drainage (PD), percutaneous drainage with intrapleural fibrinolysis (PDF), or operative drainage (OD) using standard statistical tests. 5424 patients (age 4 [IQR 1–11] years) were identified with a pleural effusion or empyema who underwent percutaneous or surgical intervention. PD (22%) and OD (24%) were utilized more frequently than PDF (3%). Index complications, including bleeding and postprocedural air leak, were similar between groups. Those receiving PDF had lower index length of stay (LOS) and admission costs. Thirty-day and overall readmission rates were highest in patients receiving PD (15% and 24%) and OD (12% and 23%) versus PDF, all p < 0.001. Those receiving OD had fewer readmission complications including recurrent effusion or empyema, pneumonia, and bleeding. Overall readmission cost was highest in those receiving PD (p = 0.005). In this nationwide cohort, PDF was associated with lower index admission cost, shorter LOS and lower rates of readmissions compared to OD. This knowledge should be used to improve selection of these treatments in this patient population. Retrospective Comparative III [ABSTRACT FROM AUTHOR]

Hirschsprung Disease (HD) is a common congenital intestinal disorder. While aganglionosis most commonly affects the rectosigmoid colon (rectosigmoid HD), outcomes for patients in which aganglionosis extends to more proximal segments (long-segment HD) remain understudied. This study sought to compare postoperative outcomes among newborns with rectosigmoid and long-segment HD. The Nationwide Readmission Database was queried from 2016 to 2018 for newborns with HD. Newborns were stratified into those with rectosigmoid or long-segment HD. Those who received no rectal biopsy or pull-through procedure during their newborn hospitalization were excluded. A propensity score-matched analysis (PSMA) of newborns with either type of HD was constructed utilizing 17 covariates including demographics, comorbidities, and congenital-perinatal conditions. There were 1280 newborns identified with HD (82% rectosigmoid HD, 18% long-segment HD). Patients with rectosigmoid HD had higher rates of laparoscopic resections (35% vs. 12%) and less frequently received a concomitant ostomy (14% vs. 84%), both p < 0.001. Patients with long-segment HD were more likely to have a delayed diagnosis (12% vs. 5%) and require multiple bowel operations (19% vs. 4%), both p < 0.001. They experienced higher rates of complications, including small bowel obstructions (10% vs. 1%), infections (45% vs. 20%), and Hirschsprung-associated enterocolitis (11% vs. 5%), all p < 0.001. After PSMA, newborns with long-segment HD were found to have a longer length of stay and higher hospitalization costs. Newborns with long-segment HD experience significant delays in diagnosis, surgery, and complications compared to those with rectosigmoid HD. This information should be utilized to improve healthcare delivery for this patient population. Retrospective comparative study. III. • Aganglionosis in Hirschsprung Disease (HD) most commonly affects the rectosigmoid colon. Outcomes for patients with long-segment HD remain understudied. • Newborns with long-segment HD (LSDH) experience delays in diagnosis and surgery compared to those with rectosigmoid HD. • Newborns with LSHD experience higher complications and utilize more healthcare resources than those with rectosigmoid HD. [ABSTRACT FROM AUTHOR]

Untreated pediatric choledochal cyst (CC) is associated with complications including cholangitis, pancreatitis, and risk of malignancy. Therefore, CC is typically treated by surgical excision with biliary reconstruction. Both open and laparoscopic (lap) surgical approaches are regularly used, but outcomes have not been compared on a national level. The Nationwide Readmissions Database was used to identify pediatric patients (age 0–21 years, excluding newborns) with choledochal cyst from 2016 to 2018 based on ICD-10 codes. Patients were stratified by operative approach (open vs. lap). Demographics, operative management, and complications were compared using standard statistical tests. Results were weighted for national estimates. Choledochal cyst excision was performed in 577 children (75% female) via lap (28%) and open (72%) surgical approaches. Patients undergoing an open resection experienced longer index hospital length of stay (LOS), higher total cost, and more complications. Anastomotic technique differed by approach, with Roux-en-Y hepaticojejunostomy (RYHJ) more often utilized with open cases (86% vs. 29%) and hepaticoduodenostomy (HD) more common with laparoscopic procedures (71% vs. 15%), both p < 0.001. There was no significant difference in post-operative cholangitis or mortality. Although utilized less frequently than an open approach, laparoscopic choledochal cyst resection is safe in pediatric patients and is associated with shorter LOS, lower costs, and fewer complications. HD anastomosis is more commonly performed during laparoscopic procedures, whereas RYHJ more commonly used with the open approach. While HD is associated with more short-term gastrointestinal dysfunction than RYHJ, the latter is more commonly associated with sepsis, wound infection, and respiratory dysfunction. Level III: Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Although conservative management followed by readmission for interval appendectomy is commonly used to manage perforated appendicitis, many studies are limited to individual or noncompeting pediatric hospitals. This study sought to compare national outcomes following interval or same-admission appendectomy in children with perforated appendicitis. The Nationwide Readmission Database was queried (2010–2014) for patients <18 years old with perforated appendicitis who underwent appendectomy using ICD9-CM Diagnosis codes. A propensity score-matched analysis (PSMA) utilizing 33 covariates between those with (Interval Appendectomy) and without a prior admission (Same-Admission Appendectomy) was performed to examine postoperative outcomes. There were 63,627 pediatric patients with perforated appendicitis. 1014 (1%) had a prior admission for perforated appendicitis within one calendar year undergoing interval appendectomy compared to 62,613 (99%) Same-Admission appendectomy patients. The Interval Appendectomy group was more likely to receive a laparoscopic (87% vs. 78% same-admission) than open (13% vs. 22% same-admission; p < 0.001) operation. Patients receiving interval appendectomy were more likely to have their laparoscopic procedure converted to open (5% vs. 3%) and receive more concomitant procedures. PSMA demonstrated a higher rate of small bowel obstruction in those receiving Same-Admission appendectomy while all other complications were similar. Although those receiving Interval Appendectomy had a shorter index length of stay (LOS) and lower admission costs, they incurred an additional $8044 [$5341-$13,190] from their prior admission. Patients treated with interval appendectomy experienced more concomitant procedures and incurred higher combined hospitalization costs while still having a similar postoperative complication profile compared to those receiving same-admission appendectomy for perforated appendicitis. III. Retrospective Comparative Study. • National cohort of patients undergoing same-admission versus interval appendectomy (IA) for perforated appendicitis. • Patients treated with IA experienced more concomitant procedures and incurred higher combined hospitalization costs. • Those treated with IA experienced similar postoperative complications to those receiving same-admission appendectomy. [ABSTRACT FROM AUTHOR]

Electricity generation using airborne wind energy system (AWES) tends to be more efficient than that of conventional wind turbines due to their ability at extracting higher speeds from wind at higher altitudes by the tethered kite generator system (TKGS). The speed regulation of a permanent synchronous machine (PMSM) attached to a kite to maximize harvested power from wind is the topic of the present research. To track the optimal speed produced by TKGS, a finite-control-set model predictive control (FCS-MPC) with a new cost function is directly employed to generate appropriate gate signals for a 3-level neutral point clamped (3-L NPC) inverter that drives a PMSM. A novel adaptive algorithm is also provided for adjusting the weight coefficients of the cost function to improve the system's performance across a wider range of change in the operating conditions. Moreover, a terminal sliding mode disturbance observer (TSMDO) is designed to estimate the load torque. A terminal sliding mode speed controller (TSMSC) is also used to produce the current reference for the optimizing algorithm in FCS-MPC. The proposed control scheme eliminates the need for a cascade structure while significantly reduces current deformation and torque oscillations. Additionally, the controller operates as fast as a traditional direct speed controller without the use of a cascade structure and is more robust against parameter uncertainties. To illustrate the success of the suggested controller, the results of simulations are presented in MATLAB/SIMULINK® software. The performance of the proposed technique is evaluated in three situations which simulates a grid-connected PMSM fed by a back to back 3-L NPC. In the first scenario, it is demonstrated that the suggested technique performs well when the system's operational conditions vary. The performance of the adaptive tuning mechanism of the cost function weight factors is investigated in the second scenario, which takes into account model parameter uncertainty. The impacts of the disturbance observer (DO) on the system performance are explored in the final scenario, and it is discovered that the disturbance observer may increase the speed response and DC link voltage tracking performance. All of the simulation results show that the new technique outperformed the traditional FSC-MPC. • A novel FCS-MPC method is utilized to control the speed of PMSG in AWES directly. • A TSMSC is designed to produce the current reference for optimization algorithm. • To estimate the unknown load torque, a TSMDO is also designed. • By considering the system dynamics and constraints, a new cost function is introduced. • An adaptive mechanism is proposed to tune the weights factors of the cost function. [ABSTRACT FROM AUTHOR]

In historically frequent-fire forests of the western US there has been an increase in stand-replacing wildfire that is well outside of the historical range of variability (HRV), leading to forest loss at unprecedented scales. As a result, forest managers are increasingly applying forest management treatments designed to reduce the probability of stand-replacing wildfire, by reducing the tree densities and woody debris that have accumulated after more than a century of fire exclusion. Although these treatments have generally been shown to be effective, increasingly warm and dry conditions may challenge the efficacy of these treatments. We compared fire severity (% basal area mortality) in areas that had mechanical thinning with a follow up fire treatment (broadcast burning or pile burning), mechanical thinning without a follow up fire treatment, and untreated areas in California's largest wildfire to date, the 2021 Dixie Fire. We found that the probability of stand-replacing wildfire (defined here as 100 % basal area mortality) was highest on large fire growth days, and lowest in areas that were treated with mechanical thinning and fire; mechanical thinning treatments with no follow up fire treatment did not differ from untreated areas. Where stand-replacing wildfire did not occur, percent basal area mortality was reduced in both the mechanical plus fire treatment and the mechanical-only treatment, both of which were characterized by larger trees and lower densities. This suggests that the addition of the fire treatment is critical for reducing fire severity under more extreme burning conditions, but that the mechanical-only treatments can still be effective under milder burning conditions. We also found that the majority (93 %) of our treated plots were within the HRV for tree density prefire. Postfire, 79 % of the plots with a mechanical thinning plus fire treatment remained within HRV target conditions. In contrast, 48 % of the mechanical thinning only plots, and 58 % of untreated plots, had no live trees. This work contributes to a growing body of evidence that forest treatments to reduce both tree densities and surface fuels are critical for reducing fire severity and forest loss. • Mechanical thinning with prescribed fire or pile burning reduced stand replacing wildfire. • Stand-replacing wildfire was also predicted by large growth days and steep slopes. • Outside of stand replacement, mechanical only treatments also reduced fire severity. [ABSTRACT FROM AUTHOR]

Slow wound healing and wound infections are significant challenges for burn patients. Biosynthesis of nanoparticles (NPs) using plant extracts offers a rapid, facile, and safe method for producing biocompatible NPs. In this study, Anethum graveolens seed (AGS) extract served as a masking and reducing agent for the synthesis of silver nanoparticles (AGS@AgNPs). Initially, the parameters influencing AGS@AgNPs synthesis, including silver nitrate concentration, reaction time, temperature, and pH, were optimized. Subsequently, AGS@AgNPs structural and biological characteristics were evaluated. Observation of the surface plasmon resonance (SPR) of the AGS@AgNPs at approximately 420 nm, accompanied by a color change of the suspension to dark brown, confirmed AGS@AgNPs synthesis. Analysis via X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR), dynamic light scattering (DLS), zeta potential, and transmission electron microscopy (TEM) confirmed the production of pure, homogeneous, spherical, and stable silver NPs with sizes ranging from 20 to 40 nm using Anethum graveolens extract. Antibacterial assays revealed significant activity against both Gram-positive and Gram-negative bacterial strains. Antioxidant assessments demonstrated that AGS@AgNPs at a concentration of 250 μg/ml exhibited 92% inhibition of DPPH free radicals and in FRAP test, A. graveolens seed extract and AGS@AgNPs reduced Fe3+ ions to Fe2+ by 48.7% and 73.1%, respectively. Investigation of anticancer properties against the lung cancer cell line (A-549) revealed an IC 50 value of 242 μg/ml. The results of the flow cytometry test and lactate dehydrogenase (LDH) assay demonstrated the death of cancer cells. Moreover, wound healing assays demonstrated a significant acceleration in burn wound closure rates in rats on days 3, 7, and 14 following treatments with AGS@AgNPs. Overall, these findings highlight the favorable biological activities of AGS@AgNPs, suggesting their potential utility in nanomedicine applications. • Green synthesis of silver nanoparticles using Anethum graveolens seed extracts (AGS@AgNPs). • The influence of silver nitrate concentration, reaction time, temperature, and pH, were optimized during AGS@AgNPs synthesis. • AGS@AgNPs revealed significant activity against both Gram-positive and Gram-negative bacterial strains. • AGS@AgNPs showed high anticancer and antioxidant activity. • AGS@AgNPs increased wound closure speed. [ABSTRACT FROM AUTHOR]

Heterozygous MYBPC3 variants are the leading genetic cause of hypertrophic cardiomyopathy (HCM). Pathogenic and likely pathogenic (P/LP) MYBPC3 variants (MYBPC3 +) are predominantly truncating variants and result in reduced functional protein (MyBP-C) levels. Despite a common genetic basis, there is wide variability in disease severity and onset. Prior work demonstrates pediatric-onset HCM associated with sarcomeric mutations has worse outcomes, but limited studies have examined this by genotype. To better understand the natural history of pediatric-onset MYBPC3+ HCM, we analyzed data of all MYBPC3 + HCM patients enrolled in SHaRe (Sarcomeric Human Cardiomyopathy Registry). As of December 2023, 1,713 HCM patients with ≥1 P/LP MYBPC3 variants had been enrolled in SHaRe, a multicenter registry spanning 12 cardiac centers in the US, EU, and Australia. Pediatric-onset (218/1713 patients) and adult-onset MYBPC3 + HCM (1495/1713) were defined as <18 and ≥18 years of age, respectively. Both cohorts were followed for a similar median duration of 7 years. Analysis of demographics, genotype, first echocardiographic metrics, and time to major clinical events was performed and compared across pediatric and adult groups. Compound heterozygosity for MYBPC3 P/LP variants was more common in pediatric disease onset (8.3%) compared to adult-onset (3.7%) (p=0.002). Pediatric-onset MYBPC3 + HCM had more prominent hypertrophy with median left ventricular wall thickness (LVMWT) Z score 11.5 vs 8.9 in adult-onset disease (p=0.006). While the prevalence of overall composite events (i.e. death, transplant, heart failure, or ventricular arrhythmia events) was similar in pediatric- and adult-onset MYBPC3 + HCM patients (16.1% and 20.2%, respectively), events occurred 27 years earlier in the pediatric-onset cohort (median age at event 30.5 vs 57.5 years, p<0.001). Heart failure (HF) composite outcomes and septal reduction therapy (SRT) demonstrated a pattern of similar prevalence between pediatric- and adult-onset disease (HF: 11.5% pediatric and 9.1% adult; SRT: 11.5% pediatric and 13.2% adult) but with earlier onset (HF: median 23 years earlier; SRT: median 23 years earlier, p<0.001). Pediatric-onset MYBPC3+ HCM patients had more severe hypertrophy and showed an earlier age of disease morbidity than adult-onset MYBPC3+ HCM. These results underscore the critical importance of early clinical diagnosis with genetic confirmation to understand prognostic implications and guide treatment. [ABSTRACT FROM AUTHOR]

In the present study, the integration of electrochemically mediated amine regeneration (EMAR) with amine thermal swing process is investigated as a novel method for CO 2 capture, utilizing experimental practical data. The aim is to increase the absorption-desorption temperature difference in order to improve the energy efficiency of the capture process and hamper the amine degradation issue at high desorption temperatures. A comprehensive experimental procedure is presented, and an experimental process setup is designed and constructed. As the main novelty of the study a special heating-cooling subsystem is incorporated with the base EMAR process in order to devise a combined electrochemical-thermal system. The performance of the system is evaluated at sequential incremental desorption temperatures while the absorption temperature is kept constant. Relevant data, including the desorbed CO 2 flow, absorbed CO 2 flow, stream points temperature, and cell voltage are collected. Based on the data collected, two performance parameters are calculated, including normalized carbon separation work, and CO 2 desorption density. Based on these performance parameters the system's capability is assessed, and the optimal desorption temperature is ultimately selected. The presented electrochemical-thermal CO 2 separation system, operating with a chloride salt system, demonstrates its best energetics performance at a desorption temperature of 44 °C, resulting in a normalized capture work of 95.2 kJ/molCO 2. Under these optimal conditions, the cell's average voltage is measured to be 0.37 V, and the CO 2 desorption density is determined to be 0.71 l.min−1.m−2. • Novel integration of EMAR and thermal swing for energy-efficient CO 2 capture is proposed. • Unique heating-cooling subsystem enhances the electrochemical-thermal system. • Performance evaluated by calculating capture work and CO 2 desorption density. • Optimal desorption at 44°C, achieving work of 95.2 kJ/molCO 2 with 0.37 V voltage. [ABSTRACT FROM AUTHOR]

Intimate partner violence is a lead cause of ill health and premature death among Australian women. Abused women are likely to present to Emergency Departments. Routine screening provides opportunities to identify and respond to intimate partner violence. A six-month screening feasibility study was conducted in two rural and one urban NSW Emergency Departments. Surveys with participating nurses, medical officers and social workers, as well as focus groups with nurses and social workers were conducted at each site to understand their experience. Survey respondents (n = 198) agreed it was appropriate (87%) and acceptable (91%) to screen for intimate partner violence in Emergency Departments. Overall 62% of respondents suggested screening had positive impacts on womens' care. Focus group discussions with 39 nurses and social workers identified enablers of screening as: ease of use of the screening tool; availability of social work response within one hour (as per the study protocol); and executive support. Barriers were: high patient volume; lack of integration with existing processes; lack of privacy and brevity of training. Screening in Emergency Departments was strongly supported by health practitioners who responded to the survey. Work is needed to address competing demands, integration of screening processes, and staff training. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (as measured by peak oxygen consumption [VO2peak]) is an independent predictor of cardiovascular disease and all-cause mortality. Limited data exist on VO2peak following repair for an acute type A aortic dissection (ATAAD) or proximal thoracic aortic aneurysm (pTAA). This study prospectively evaluated VO2peak, functional capacity, and health-related quality of life (HR-QOL) following open repair. Participants with a history of an ATAAD (n = 21) or pTAA (n = 43) performed cardiopulmonary exercise testing (CPX), 6-minute walk testing, and HR-QOL at 3 (early) and 15 (late) months following open repair. The median age at time of surgery was 55-years-old and 60-years-old in the ATAAD and pTAA groups, respectively. Body mass index significantly increased between early and late timepoints for both ATAAD (p = 0.0245, 56% obese) and pTAA groups (p = 0.0045, 54% obese). VO2peak modestly increased by 0.8 mLO2·kg-1·min-1 within the ATAAD group (p = 0.2312) while VO2peak significantly increased by 2.2 mLO2·kg-1·min-1 within the pTAA group (p = 0.0003). Anxiety significantly decreased in the ATAAD group whereas functional capacity and HR-QOL metrics (social roles and activities, physical function) significantly improved in the pTAA group (p values < 0.05). There were no serious adverse events during CPX. Cardiorespiratory fitness among the ATAAD group remained 36% below predicted normative values >1 year after repair. CPX should be considered post-operatively to evaluate exercise tolerance and blood pressure response to determine whether mild-to-moderate aerobic exercise should be recommended to reduce future risk of morbidity and mortality. [ABSTRACT FROM AUTHOR]

• Diverse surface modification techniques for Mg and its alloys are introduced. • Mechanical, tribological and corrosion behavior of thermal sprayed coatings are presented. • Benefits and restrictions of the cold spray (CS) process are introduced. • The latest development of cold spray (CS) process for industrial applications is presented. • Bonding mechanism at the Mg alloy/cold sprayed layer interface is introduced. Potential engineering applications of magnesium (Mg) and Mg-based alloys, as the lightest structural metal, have made them a popular subject of study. However, the inferior corrosion and wear characteristics significantly limit their application range. It is widely recognized that surface treatment is the most commonly utilized technique for remarkably improving a substrate's surface characteristics. Numerous methods have been introduced for the surface treatment of Mg and Mg-based alloys to improve their corrosion behavior and tribological performance. Among these, thermal spray (TS) technology provides several methods for deposition of various functional metallic, ceramic, cermet, or other coatings tailored to particular conditions. Recent researches have shown the tremendous potential for thermal spray coated Mg alloys for biomedical and industrial applications. In this context, the cold spray (CS) method, as a comparatively new TS coating technique, can generate the coating layer using kinetic energy rather than combined thermal and kinetic energies, like the high-velocity oxy-fuel (HVOF) spray method. Moreover, the CS process, as a revolutionary method, is able to repair and refurbish with a faster turnaround time; it also provides solutions that do not require dealing with the thermal stresses that are part of the other repair processes, such as welding or other TS processes using a high-temperature flame. In this review paper, the recently designed coatings that are specifically applied to Mg alloys (primarily for industrial applications) employing various coating processes are reviewed. Because of the increased utilization of CS technology for both 3D printed (additively manufactured) coatings and repair of structurally critical components, the most recent CS methods for the surface treatment, repair, and refurbishment of Mg alloys as well as their benefits and restrictions are then discussed and reviewed in detail. Lastly, the prospects of this field of study are briefly discussed, along with a summary of the presented work. [ABSTRACT FROM AUTHOR]

[Display omitted] • Isolating and sequencing the genome of F. oxysporum from potato tubers with dry rot symptoms. • SA efficiently arrests hyphal growth, sporular production and pathogenicity of F. oxysporum. • SA inhibits the activity of FoTORC1 via activating FoSNF1 in F. oxysporum. • Transgenic potato plants with interference of FoTOR1 and FoSAH1 genes prevent the occurrence of Fusarium wilt. • Providing insights SA into controlling various fungal diseases by targeting the SNF1-TORC1 pathway of pathogens. Biofungicides with low toxicity and high efficiency are a global priority for sustainable agricultural development. Phytohormone salicylic acid (SA) is an ancient medicine against various diseases in humans and activates the immune system in plants, but little is known of its function as a biofungicide. Here, Fusarium oxysporum , the causal agent of devastating Fusarium wilt and immunodepressed patients, was used as a model system to explore whether SA can enter the pathogen cells and suppress key targets of the pathogen. Oxford Nanopore MinION sequencing and high-throughput chromosome conformation capture (Hi-C) sequencing were used to analyzed the genome of F. oxysporum. In addition, RNA-seq, qRT-PCR, and western blotting were conducted to detect gene and protein expression levels. We isolated and sequenced the genome of F. oxysporum from potato dry rot, and the F. oxysporum included 12 chromosomes and 52.3 Mb genomic length. Pharmacological assays showed that exogenous application of SA can efficiently arrest hyphal growth, spore production, and pathogenicity of F. oxysporum , whereas endogenous salicylate hydroxylases significantly detoxify SA. The synergistic growth inhibition of F. oxysporum was observed when SA was combined with rapamycin. Kinase assays showed that SA inhibits FoTOR complex 1 (FoTORC1) by activating FoSNF1 in vivo. Transgenic potato plants with the interference of FoTOR1 and FoSAH1 genes inhibited the invasive growth of hyphae and significantly prevented the occurrence of Fusarium wilt. This study revealed the underlying mechanisms of SA against F. oxysporum and provided insights into SA in controlling various fungal diseases by targeting the SNF1-TORC1 pathway of pathogens. [ABSTRACT FROM AUTHOR]

• National cohort of pediatric patients with Hirschsprung disease used to compare those with and without Down syndrome. • Patients with Down syndrome have delays in diagnosis and poorer outcomes than those with Hirschsprung disease alone. • Earlier suspicion of Hirschsprung disease in patients with Down syndrome may improve outcomes. Down syndrome (DS) is the most common abnormality associated with Hirschsprung disease (HD). It has been suggested patients with HD and DS have worse outcomes, however the literature is controversial. The Kids' Inpatient Database (KID) from 2003 to 2012 was used to identify newborns with HD. Demographics, hospital characteristics, and outcomes were compared among patients with and without DS using standard statistical tests. There were 481 patients identified with HD, of which 45 (9%) had DS. Patients with DS were older at the time of first rectal biopsy (6 [3–11] days vs. 4 [3–6] days, p = 0.012). There were no differences in operative versus non-operative management in patients with and without DS (p = 0.706). Hospital length of stay was longer in the DS cohort (22 [13–33] days vs. 15 [10–24] days, p = 0.019), and patients with DS were more likely to have a concomitant diagnosis of wound infection (<12% vs. 3%, p = 0.002) and necrotizing enterocolitis (<14% vs. 5%, p = 0.018). The mortality rate for patients with DS was four times higher than those without DS (< 5% vs. < 0.8%, p = 0.018). In this nationwide cohort of patients with Hirschsprung disease, those with Down syndrome experienced delays in diagnosis and worse outcomes. Level III. Treatment study, retrospective comparative study. [ABSTRACT FROM AUTHOR]

• Colectomy is a common surgical operation for pediatric Crohn's patients, and the use of laparoscopy is considered safe when compared to open colectomy. • Using a national database, this study showed that laparoscopy has improved outcomes compared to open colectomy. Additionally, disparities in treatment were shown between low- and high-income families. Pediatric patients with Crohn's disease often require colectomies. The laparoscopic approach is considered safe, but there is little national data on outcomes and readmissions in this population. The Nationwide Readmissions Database was queried from 2010 to 2014 for patients ≤ 18 years who underwent colectomy for Crohn's disease during index admission. Patients were stratified by operative approach: laparoscopic versus open. Outcomes were compared with standard statistical methods. There were 2833 patients (47% female) who underwent a colectomy via laparoscopic (58%) vs. open (42%) approach. Index admissions were elective 55% of the time. Most operations were right hemicolectomy (86%), followed by total colectomy (8%). Of the study population, 489 (17%) were diverted with an ostomy. Readmission rates at 30 days and 1 year were 9% and 18%, respectively. The most common diagnoses at readmission were intra-abdominal infection (16%), small bowel obstruction (16%), and surgical site infection (9%). Laparoscopy was more commonly performed during elective admissions (63% vs. 44%), for patient with private insurance (72% vs. 39%), and for patients in the highest income quartile (66% vs. 48% in the lowest income quartile), all p <0.001. Length of stay was longer on index admission for open colectomy (8[5–12] days vs. 6[4–11] days, p <0.001), while cost was similar ($17,754[$12,375-$30,625] vs. $17,017[$11,219-$27,336], p = 0.104). There were no differences in readmission rate, intraabdominal infection or small bowel obstruction. In pediatric patients, laparoscopic colectomy for Crohn's disease is safe and is associated with shorter hospitalization and equivalent hospital costs compared to the open procedure. Socioeconomic disparities in laparoscopic utilization exist and warrant future investigation. Level of Evidence: Level III [Display omitted] [ABSTRACT FROM AUTHOR]

• In surgically managed pediatric patients with ulcerative colitis, laparoscopy has been suggested as a safe alternative to an open approach. • This study utilized a nationally representative cohort of pediatric patients with ulcerative colitis to compare laparoscopic to open colectomy or proctocolectomy and found an improved outcome profile following laparoscopic approach. This study aims to compare the morbidity of open versus laparoscopic colectomy or proctocolectomy for pediatric patients with ulcerative colitis (UC) using national readmission outcomes. The 2010–2014 Nationwide Readmissions Database was used to identify patients < 18 years (excluding newborns) who underwent colectomy or proctocolectomy for UC. Patients with planned readmissions for staged procedures were excluded from readmission analysis. Demographics, hospital factors, and outcomes were compared by operative approach (open vs. laparoscopic) using standard statistical analysis. Results were weighted for national estimates. There were 1922 patients (51% female, age 13 ± 3 years) with UC who underwent colectomy or proctocolectomy during index admission. Most cases were performed open (54%) and as elective admissions (64%). Compared to open approach, laparoscopy was associated with shorter index hospital length of stay (8 [5-17] days vs. 9 [6-18] days, p = 0.015), fewer surgical site infections (< 2% vs. 2%, p = 0.022), and less post-operative gastrointestinal dysfunction (5% vs. 8%, p = 0.008). After stratifying to control for elective and unplanned index admissions, laparoscopic approach was associated with fewer small bowel obstructions during index hospitalizations in both elective (9% vs. 15%, p = 0.003) and unplanned (5% vs. 16%, p <0.001) settings. Readmission for surgical site infection was also less common following laparoscopic approach in both elective (0% vs. 7%, p = 0.008) and unplanned (0% vs. < 7%, p = 0.017) settings. In pediatric patients with ulcerative colitis, laparoscopic colectomy or proctocolectomy is associated with shorter hospital length of stay, less post-operative complications, and improved readmission outcomes. [ABSTRACT FROM AUTHOR]

Genetic markers for acne are being studied to create personalized treatments based on an individual's genes, and the field is benefiting from the application of artificial intelligence (AI) techniques. One such AI tool, the Q-learning algorithm, is increasingly being utilized by medical researchers to delve into the genetics of acne. In contrast to previous methods, our research introduces a Q-learning model that is adaptable to diverse sample groups. This innovative approach involves preprocessing data by identifying differentially expressed genes and constructing gene-gene connectivity networks. The key advantage of using the Q-learning model lies in its ability to transform acne gene data into Markovian domains, which are essential for selecting relevant genetic markers. Performance evaluations of our Q-learning model have shown high accuracy and specificity, although there may be some sensitivity variations. Notably, this research has identified specific genes, such as CD86, AGPAT3, TMPRSS11D, DSG3, TNFRSF1B, PI3, C5AR1, and KRT16, as being acne-related through biological verification and text data mining. These findings underscore the potential of AI-driven Q-learning models to revolutionize the study of acne genetics. In conclusion, our Q-learning model offers a promising approach for the selection of acne-related genetic markers, despite minor sensitivity fluctuations. This research highlights the transformative potential of Q-learning in advancing our understanding of the genetics underlying acne, paving the way for more personalized and effective treatments in the future. [ABSTRACT FROM AUTHOR]

Pyloromyotomy for hypertrophic pyloric stenosis (HPS) is one of the most common non-elective operations performed in the neonatal period. This project aims to explore outcomes of pyloromyotomy and compare differences between laparoscopic versus open pyloromyotomies in newborns diagnosed with HPS. The Nationwide Readmissions Database (NRD) from 2010 to 2014 was queried to identify patients diagnosed with HPS that underwent repair. In total, 30,915 children (18% female) underwent pyloromyotomy for HPS. Median length of stay for index admission was 2 days. A total of 212 (0.7%) patients required a redo pyloromyotomy. 127 (60%) were performed during index admission. Readmission rate at 30 days was 3% and 5% at one year, and 22% presented to a different hospital. The most common indications for readmission were feeding intolerance (24%), dehydration (10%), and malnutrition (10%). Patients from low-income households were more likely to present with malnutrition and weight loss (9% vs 4%, p <0.001) and had higher readmission rates (8% vs 4%, p <0.001). Laparoscopic pyloromyotomies accounted for 10% (n = 2951) of cases. Those undergoing laparoscopy were less likely to have electrolyte disturbances (41% vs 54%, p <0.001) or weight loss (2% vs 11%, p <0.001) on admission. The rate of open conversion was 1%. Intraoperative perforation was not more common in laparoscopic than open cases. Open pyloromyotomies had higher 30-day readmission rates and more surgical site infections. Complications from pyloromyotomies are rare. Although infrequent, the incidence of incomplete pyloromyotomy is higher than previously reported and more common with open approaches. Newborns from low-income households are more likely to present with advanced symptoms and have disproportionately higher rates of readmission. Level III Treatment Study, retrospective [ABSTRACT FROM AUTHOR]

• DBS of the internal capsule/NAc may be effective for treatment-refractory OCD. • DBS of the internal capsule/NAc may be effective for treatment of severity and anxiety. • Improvement in anxiety and cognitive performance are consistent with OCD improvement. • No significant cognitive declines were seen after DBS. Deep brain stimulation (DBS) is considered a promising intervention for treatment-resistant obsessive–compulsive disorder (OCD). The present study describes the outcomes of the first DBS procedures for OCD in Iran. Four women patients (age range, 25–35 years) with severe OCD meeting stringent criteria for refractoriness to treatment were selected by Psychosurgery Review Board. DBS electrodes were bilaterally implanted in the internal capsule and nucleus accumbens (NAc). Clinical and neuropsychological assessments were undertaken before and after implantation. The outcomes included Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Anxiety Rating Scale (HAM-A), neuropsychological assessments including the Wisconsin Card Sorting Test, Wechsler Memory Scale, and adverse events. The baseline mean score of the Y-BOCS and HAM-A was 32 ± 6 and 23 ± 14 respectively and decreased to 26 ± 8 and 17 ± 9 after one-year implantation, showing a 19% improvement. Two patients were responders and showed a notable improvement. One patient's score declined 28%, who was not satisfied with DBS results, and one patient worsened under-stimulation. Improvements in the severity of anxiety and cognitive performance were consistent with OCD improvement, and the successfully treated patients showed improvement in anxiety and cognitive performance. No significant cognitive declines were seen. Two patients' suicidal ideation appeared after DBS as an important adverse event. Bilateral DBS of the internal capsule/NAc may be an effective and safe treatment for treatment-refractory OCD. However, there is a need to consider accessibility, high cost, cost-effectiveness, and standardized methodology in future research. [ABSTRACT FROM AUTHOR]

The recently proposed Blockchain-based healthcare system proposes an interesting vision for the level of data integrity and security. This research aims to propose a conceptual model of a break-glass conceptual for Blockchain-based healthcare systems. In case of emergency, it provides access to the whole patient's medical records for healthcare professionals as quickly as possible regarding patients' privacy and data security. The proposed conceptual model was designed based on blockchain technology, IPFS (InterPlanetary File System), and ABAC (Attribute-Based Access control) as a novel design in this domain. In current healthcare systems, regulatory and non-integrated offline data sources make it near impossible for timely access to patients' EHRs and EMRs, even in case of emergencies for healthcare professionals. Our conceptual model could be a satisfactory alternative not only for patients but also for governing organizations to handle this situation clearly by regarding patients' privacy. Additionally, it can work in an untrusted environment, and it doesn't require bypassing the access control system to make the patients' data available. In case of emergencies, healthcare professionals receive medical records access near just in time with regard to all the rights of security and privacy based on the attribute which were set by the patients in the past. This novel conceptual model has been designed by coupling Blockchain technology with IPFS, and the attribute base control system (ABAC). [ABSTRACT FROM AUTHOR]

• Hospital readmission is common after Ladd's procedure • Laparoscopic Ladd's procedure results in fewer index complications and lower readmission rates than the open approach • The rate of redo Ladd's procedure is lower than previously reported Laparoscopic Ladd's procedure has been proven safe and effective for the treatment of malrotation. However, the nationwide utilization and outcomes of elective Ladd's procedure are largely unknown. The Nationwide Readmissions Database from 2010 to 2014 was used to identify patients 0–18 years (excluding newborns) with malrotation who underwent elective Ladd's procedure. Demographics, hospital factors, and outcomes were compared by approach (laparoscopic vs. open) using standard statistical tests and propensity score (PS) matched analysis. Results were weighted for national estimates. 1343 patients (44% male) underwent elective Ladd's procedure via laparoscopic (22%) or open (78%) approach. Laparoscopic approach was more common in large hospitals (26% vs. 16%), patients >13 years (30% vs. 20%), and those with higher income (29% vs. 16%), all p < 0.001. Following PS matching, compared to the laparoscopic approach, open Ladd's was associated with index hospital length of stay > 7 days (20% vs. 8%), more post-operative gastrointestinal dysfunction (12% vs. < 1%), and more nausea, vomiting, and/or diarrhea (16% vs. 6%), all p < 0.001. The overall readmission rates within 30 days and the year of index operation were 8% and 15%, respectively. In the matched cohort, those undergoing laparoscopic Ladd's were less likely to be readmitted than those with the open approach (7% vs. 16%, p < 0.001) and experienced less gastrointestinal issues on readmission (5% vs. 15%, p = 0.002). There were similar rates of post-operative small bowel obstruction (< 3% vs. < 3%, p = 0.840) and volvulus (0% vs. < 1%, p = 0.136). Redo Ladd's procedure was performed in less than 4% of readmissions and all occurred within 5 days of initial hospital discharge. The majority of Ladd's procedures in the U.S. are being performed open, despite comparable outcomes following a laparoscopic approach. Readmission rates are similar with either approach, and the rate of redo Ladd's procedure is lower than previously reported. Level III. [ABSTRACT FROM AUTHOR]

Oysters are widespread throughout the intertidal regions, and accurate identification and monitoring of their ecological status are still difficult due to their high level of plasticity. Anthropogenic activities facilitate oyster dispersal to new habitats through the shipping and elimination of existing barriers. In this study, a combination of morphological and molecular techniques was used to clarify the identity of an oyster species occurring along the Iranian coast of the Persian Gulf. Specimens were collected from the jetties of the ports and the rocky shores along the northern Persian Gulf. Oyster identification was carried out to the lowest possible taxonomic level based on shell morphology. The phylogenetic analysis was done using the cytochrome c oxidase subunit 1 (COI) fragments. Morphological results confirmed that studied samples belong to the genus Crassostrea and showed close to the Vietnamese (Crassostrea markushuberi) species. Molecular analysis reveals that species are a sister species to a clade containing Crassostrea zhanjiangensis and Crassostrea talonata. According to the relatively high genetic distances and lack of similarity in shell characteristics, the species is considered as distant sister species of C. zhanjiangensis and C. talonata. The results showed a non-native small size of oyster in the northern Persian Gulf, which might be a new species. The relative abundance of this species in the introduced location (Imam Khomeini port) may be linked to the high adaptation capability to the new environment. [ABSTRACT FROM AUTHOR]

Objective: The objective was to assess the effects of object position, field of view (FOV) size, peak kilovoltage (kVp), and a metal artifact reduction (MAR) algorithm on metal artifacts in cone beam computed tomography (CBCT) as measured with an auto-edge counting method.Study Design: A titanium implant and a stainless steel intracanal post in a root were inserted in bovine rib blocks. CBCT scans were acquired with changes in object position (incisor, canine, and premolar-molar areas), FOV, kVp, and MAR (on or off) mode. Images were quantitatively analyzed in MATLAB by using the Canny edge detection algorithm. Four-way analysis of variance and Tukey tests were applied for data analysis.Results: The implant produced no significant differences in number of artifacts among the object positions through changing the kVp and MAR mode for all FOV sizes (P > .05). The intracanal post scanned with the medium-sized FOV, high kVp, and MAR off mode generated significant differences among object positions (P = .033). Among the variables assessed, FOV size and MAR mode had a significant influence on the number of artifacts (P ≤ .039).Conclusion: Reduction of FOV size and application of the MAR tool significantly decreased the number of streak artifacts. The Canny edge detection algorithm could be an efficient method of metal artifact quantification. [ABSTRACT FROM AUTHOR]

• Increased serum levels of HGF and s-cMet is associated with meningioma. • Increased concentration of HGF and s-cMet is associated with advanced grades of meningioma. • HGF/s-cMet might be involved in the physiopathology and progression of meningioma. Meningiomas are the most common primary intracranial tumor. Hepatocyte growth factor (HGF) and its receptor, cMet, were shown to be involved in meningioma. This study was aimed to determine the concentration of HGF and soluble cMet (s-cMet) in the serum of patients with different grades of meningioma. Ninety serum samples from different grades of meningioma patients (42 cases of grade I, 28 grade II, 20 grade III) and 51 controls were included in this study. The serum total protein concentration (TPC) was measured by a Bio-Rad protein assay and serum concentration of HGF and s-cMet by enzyme linked immunosorbent assay (ELISA). No significant change in the serum TPC of patients was seen as compared to controls. We also showed that serum HGF and s-cMet concentration in meningioma patients was higher than in controls. The results showed that starting from grades I to III meningioma, a significant increase in HGF and s-cMet serum concentration was observed (HGF; 380 ± 57.69, 430.27 ± 48.72, 596.36 ± 104.49 pg/ml, respectively, as compared to controls which was 327.72 ± 49.68 pg/ml and for s-cMet was 274.45 ± 45.05, 314.81 ± 38.71, 433.54 ± 51.81 ng/ml, respectively, as compared to controls which was 213.72 ± 29.13 ng/ml). The results showed that a high concentration of HGF and s-cMet is associated with advanced grades of meningioma. It is concluded that HGF and s-cMet serum levels increased in meningioma patients and their concentration was significantly higher in more advanced grades of the disease. It is also suggested that HGF/s-cMet might be involved in the progression of meningioma. [ABSTRACT FROM AUTHOR]

The etiologies of primary aortoenteric fistula include aneurysm (most common), foreign body, tumor, radiation therapy, and infection (e.g., tuberculosis, syphilis). Brucellosis is a rare cause of primary aortoenteric fistula. In this study, we reported the case ofa 55-years-old male with an aortoenteric fistula and a positive brucellosis test. In regions where brucellosis is endemic, the coexistence of aortitis and aneurysm should prompt consideration of brucella infection as a relatively uncommon cause of aortoenteric fistula. While aortitis due to brucellosis is rare, it can lead to life-threatening manifestations such as aortoduodenal fistula. Therefore, we recommend the use of Wright, Coombs Wright, and 2ME tests in similar cases. • Aortoenteric fistulas are a rare but hazardous pathological connection between the alimentary tract and abdominal aortic aneurysms. • Aortitis due to brucellosis can have a life-threatening manifestation such as aortoduodenal fistula. • In similar cases, performing Wright, Coombs Wright, and 2ME testes is necessary. [ABSTRACT FROM AUTHOR]

Bicycle accidents are potentially preventable, and helmets can mitigate the severity of injuries. The purpose of the study it to investigate geo-demographic areas to establish prevention policies and targeted programs. From October 2013 to March 2020 all bicycle injuries at a Level 1 trauma center were collected for ages ≤18 years. Demographics, injuries, and outcomes were analyzed. Incidents were aggregated to zip codes and the Local Indicators of Spatial Association (LISA) statistic was used to test for spatial clustering of injury rates per 10,000 children. Over the 8-year time period, 77 cases were identified with an average age of 13±4 years, 83% male and 48% non-Hispanic white. The majority of patients (98%) were not wearing a helmet. Loss of consciousness was reported in 44% and 21% sustained a traumatic brain injury. Twenty-eight percent required ICU care and 36% required operative interventions. There was only 1 mortality in the cohort (<1%).Injuries were more common in lower household income zip codes (Figure 1). Six zip codes encompassing several interstate exits and the connected heavy-traffic roadways comprise a statistically significant cluster of pediatric bicycle accidents (Figure 1). Low-income neighborhoods and those near major roadways held the highest risk for pediatric bicycle accidents. Use of helmets was extremely low in the patient population, with high rates of traumatic brain injury. With this information, targeted programs to address high-risk intersections, helmet access, and safety education can be implemented locally. [ABSTRACT FROM AUTHOR]

Objective: Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP.Methods: We conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences.Results: We launched the study in October 2018 and interviewed pharmacists (n = 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n = 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n = 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions.Conclusion: This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists. [ABSTRACT FROM AUTHOR]

In this study, Bacillus thuringiensis var. tenebrionis -BN1 (Btt - BN1) was used as an effective bio-pesticide against elm leaf beetles. Statistical experimental design was applied for optimization of the culture media in order to achieve high level of colony forming unit (CFU) response from Btt - BN1. The response surface methodology (RSM) was used to optimize the parameters of the culture medium. Carbon source value, nitrogen source value, and carbon source type parameters were evaluated at five levels regarding CFU response. The results at operating condition of pH = 7 and temperature of 30° C after 72 h indicated that the maximum CFU of 4.85 × 107 spores.ml−1 (for sugar cane molasses) was achieved at the minimum nitrogen source (less than 2%v), at the maximum carbon source (above 11%v), and the optimal C/N ratio of 5.0. Moreover, the results of model validation indicated the CFU response for sugar cane molasses of 6.34 × 107 spores.ml−1. The results of Btt-BN1 bioassay on elm leaf beetle showed that two concentrations of five and 10 per thousand cause 66.7% and 80.0% mortality, respectively. [ABSTRACT FROM AUTHOR]

This paper studies semi-global state synchronization of discrete-time homogeneous networks with diffusive full-state coupling or partial-state coupling subject to actuator saturation and unknown nonuniform input delay. We assume that agents are at most critical unstable, that is the agents have all its eigenvalues in the closed unit disc. The communication network is associated with an undirected and weighted graph, which is represented by a row stochastic matrix. In this paper, we derive an upper bound for the input delay tolerance, which explicitly depends only on the agent dynamics. Moreover, for any unknown delay less than the upper bound, we propose a linear static protocol for MAS with full-state coupling and a linear dynamic protocol for MAS with partial-state coupling based on a low-gain methodology such that state synchronization is achieved among agents for any initial conditions in a priori given compact set. [ABSTRACT FROM AUTHOR]