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Objective: To present our preliminary experiences of robot-assisted laparoscopic radical or partial cystectomy for bladder/prostate rhabdomyosarcoma (B/P RMS) in children. Methods: A retrospective study was conducted with children who underwent robot-assisted laparoscopic surgery for B/P RMS between July 2018 and March 2020 under the approval of IRB of our center. The patient characteristics, tumor position, perioperative information, short time oncologic survival outcomes, and urinary function were recorded and evaluated. Results: We identified eight children who underwent robot-assisted laparoscopic surgery for B/P RMS. Partial cystectomy was performed on all, but one, patients, who underwent radical cystectomy and sigmoid neobladder reconstruction. Preoperative chemotherapy was administered to all eight patients, while preoperative radiotherapy was conducted in three cases, including one patient with a history of pelvic RMS. Unilateral/bilateral ureteral reimplantation was done in four cases in which the patients' ureteral orifices were involved. The mean follow-up time was 13.3 months, and no local recurrence or metastasis was observed. No patient experienced urinary incontinence eventually. Conclusion: Robot-assisted laparoscopic resection for bladder RMS in children is safe and feasible. Preoperative radiotherapy could decrease the tumor volume so that the membranous urethra could be preserved for as long as possible. The oncologic efficacy and the overall survival rate require further investigation and longer follow-up.

BACKGROUND Adrenocortical carcinoma (ACC) is extremely rare in elderly patients. Thus, this study aimed to identify the incidence rate and develop nomogram models for predicting survival in elderly ACC patients. METHODS Data of ACC patients aged >60 years from 1975 to 2016 were obtained from the Surveillance, Epidemiology, and End Results dataset. The national incidence rate was estimated, and survival was subjected to Kaplan-Meier analysis. A multivariate Cox regression model was used to identify predictors of survival. Nomograms were generated to predict survival, calibrated and internally validated. RESULTS We identified 583 cases. Univariate analysis showed that patients with younger age (≤67 years), female sex, lower tumor grade, surgical treatment performed, and earlier European Network for the Study of Adrenal Tumors (ENSAT) stage had a better survival (P

Robotic adrenalectomy for pheochromocytoma is increasingly popular because of the advantage that have been proved by some researchers recently. However, prospective randomized clinical trials comparing robotic assisted laparoscopic adrenalectomy (RA) with traditional laparoscopic adrenalectomy (LA) for pheochromocytoma are rare. The aim of this study is to compare perioperative outcomes of RA versus LA for pheochromocytoma prospectively.From March 2016 to April 2019, all patients with pheochromocytoma suitable for laparoscopic adrenalectomy were assigned randomly to RA or LA. The primary endpoint was the operative (exclude docking time) time. Secondary endpoints were estimated blood loss and postoperative recovery. Demographics and perioperative data were prospectively collected.A total of 140 (RA 70, LA 70) patients were enrolled in this prospective research. The following significant differences were identified in favor of RA: shorter median operative (exclude docking time) time (92.5 vs 122.5 min, P = 0.007), however, RA group has higher total hospitalization cost (8869.9 vs 4721.8 $, P 0.001). Demographics and other perioperative outcomes were similar in both groups. The RA group showed a significant lower blood loss and operative (exclude docking time) time compared with LA group (P 0.05) for patients with high Nor-Metanephrine (NMN).Both RA and LA for pheochromocytoma are safe and effective. Patients with high NMN can benefit from less blood loss and operative time when a robotic surgery system was used, but RA has a significant higher cost.

Background Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics. Methods We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data. Results From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%–100%) and 91.6% (88.8%–94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103–129) and 59 (51–67) ED visits per 10 000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively. Conclusions In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.

Primary Subject area Emergency Medicine - Paediatric Background Many children with acute gastroenteritis (AGE) experience moderate-to-severe pain. To date, the relationship between specific enteropathogens and pain intensity in children with AGE is poorly characterized. Objectives To describe pain severity experienced by children with AGE, by enteropathogen type (i.e., bacteria, virus, co-detection) during the 24 hours prior to emergency department (ED) presentation and while in the ED. We also sought to describe analgesic medication use in AGE. Design/Methods Children 0 to under 18 years with symptoms of AGE (vomiting and/or diarrhea, less than 7 days duration) were prospectively recruited in two pediatric EDs from December 2014 to August 2018. Rectal swabs and stool specimens were analyzed with a commercial enteric panel, an in-house viral panel, and standard enteric bacterial culture. Pain severity was reported by caregivers, with input from the child whenever possible, using a validated 11-point Verbal Numerical Rating Scale from 0 (no pain) to 10 (maximum pain). Results 2686 children with AGE participated in the study. The overall maximal mean pain score was 5.50 (SD 3.00) during the 24 hours preceding the ED visit. Children with bacteria detected in their stool had a significantly higher mean pain score (difference: 1.10 [95% CI: 0.36, 1.84]) prior to ED visit and 1.32 (95% CI: 0.54, 2.10) while in the ED, compared to those with no pathogen identified. They also had significantly higher mean pain scores (difference: 1.10 [95%CI: 0.39, 1.81]) prior to ED visit and 1.44 (95%CI: 0.69, 2.20) while in the ED when compared to AGE caused by a single virus. Using a multivariable regression model, the association between pain severity and enteropathogen type was no longer demonstrated; however, longer illness duration (p=0.01), fever (p < 0.0001), increased number of diarrheal (p < 0.0001) and vomiting (p=0.03) episodes, and respiratory symptoms (p=0.03) were all associated with greater pain at home. Overall, analgesic use was low, with 41.6% (1117/2686) and 20.0% (538/2686) of participants receiving an analgesic at home and in the ED, respectively. Conclusion Enteropathogen type was not predictive of greater pain severity after adjustment for clinical symptoms (i.e., vomiting and diarrhea). The clinical constellation of symptoms accompanying any particular pathogen may differ between pathogens, and this clinical picture may play the greater role in pain experience. Analgesic use was low in children with this painful condition.

Objectives: Sapovirus is increasingly recognized as an important cause of acute gastroenteritis (AGE) worldwide, however studies of prevalence, genetic diversity and strain-specific clinical implications have been scarce. Methods: To fill this knowledge gap, we used reverse transcription real-time PCR and sequencing of the partial major capsid protein VP1 gene to analyze stool specimens and rectal swabs obtained from 3347 children with AGE and 1355 asymptomatic controls (all

Background Infections by previously underdiagnosed viruses astrovirus and sapovirus are poorly characterized compared with norovirus, the most common cause of acute gastroenteritis. Methods Children Results Astrovirus was detected in 56 of 2688 (2.1%) children, sapovirus was detected in 146 of 2688 (5.4%) children, and norovirus was detected in 486 of 2688 (18.1%) children. At illness onset, ~60% of astrovirus cases experienced both diarrhea and vomiting. Among sapovirus and norovirus cases, 35% experienced diarrhea at onset and 80% of 91% (sapovirus/norovirus) vomited; however, diarrhea became more prevalent than vomiting at approximately day 4 of illness. Over the full course of illness, diarrhea was 18% (95% confidence interval [CI], 8%– 29%) more prevalent among children with astrovirus than norovirus infections and had longer duration with greater maximal events; there were a median of 4.0 fewer maximal vomiting events (95% CI, 2.0–5.0). Vomiting continued for a median of 24.8 hours longer (95% CI, 9.6–31.7) among children with sapovirus versus norovirus. Differences between these viruses were otherwise minimal. Conclusions Sapovirus infections attended in the emergency department are more similar to norovirus than previously reported, whereas astrovirus infections have several distinguishable characteristics.

Adrenal pheochromocytoma (PCC) is a very rare tumor that stems from chromaffin cells, which can develop into malignant tumor. During the operation, abundant blood vessels were often observed in PCC than other adrenal tumors, which increases the difficulty and risk of the surgery. Therefore, it is important to investigate the mechanism of PCC angiogenesis. Twelve surgical specimens of PCC from Ruijin Hospital, Shanghai Jiaotong University were grouped into high and low microvessel density (MVD) group. They were also divided into rich blood supply and nonenriched blood supply group, according to computed tomography (CT) manifestation. Comparative proteomic analysis based on liquid chromatography-tandem mass spectrometry (LC-MS/MS) and bioinformatics analysis revealed that 206 proteins differentially regulated in the high MVD group compared with low MVD group (p < 0.05). Besides, 61 proteins were discovered to be significantly changed when the 12 samples were grouped according to CT manifestation. By intersecting the differentially changed protein from MVD and CT grouping, 25 proteins were filtered out, with pathological function. COX4I2 was verified to be increased gradually with angiogenesis with increasing severity, and PLAT was shown to be decreased with angiogenesis in PCC, by quantitative reverse-transcription polymerase chain reaction and immunohistochemistry. The quantitative proteomics result indicated that the tumor angiogenesis in PCC is associated with hypoxia. COX4I2 and PLAT were highly correlated with blood supply in PCC which contribute to angiogenesis in PCC, which could be used as biomarkers to better indicate tumor angiogenesis, or targets to regress tumor angiogenesis as treatment.

Objective Up to 40% of multiple endocrine neoplasia type 1 (MEN1) patients may have adrenal cortical tumors. However, adrenocortical carcinoma (ACC) is rare. The clinical manifestations, prevalence, inheritance and prognosis of ACC associated with MEN1 remain unclear. Here we report the clinical manifestations and prevalence of ACC in patients with MEN1. Design and methods A retrospective analysis of ACC associated with MEN1 patients at a single tertiary care center from December 2001 to June 2017. Genetic analysis of MEN1 and other ACC associated genes, loss of heterozygosity (LOH) of MEN1 locus, immunohistochemistry staining of menin, P53 and β-catenin in ACC tissue were performed. Results Two related patients had ACC associated with MEN1. The father had ENSAT stage IV tumor with excessive production of cortisol; the daughter had nonfunctional ENSAT stage I tumor. Both patients carried novel germline heterozygous mutation (c.400_401insC) of MEN1. The wild-type MEN1 allele was lost in the resected ACC tissue from the daughter with no menin staining. The ACC tissue had nuclear β-catenin staining, with heterozygous CTNNB1 mutation of 357del24 and P53 staining in only 20% cells. Conclusions ACC associated with MEN1 is rare and may occur in familial aggregates.

PURPOSE To investigate the temporal and spatial distribution of tear film breakup time via a noninvasive topographer in normal subjects and patients with dry eye disease (DED). METHODS A total of 77 subjects were separated into normal and DED groups based on their symptoms and tear film instabilities. In noninvasive evaluation with Oculus Keratograph, the precorneal tear film was recorded and reconstructed into a two-dimensional map that evolved with time. Whether or not each sector broke and the breakup time if it did were recorded. The map was further grouped into 4 quadrants to reveal the spatial variation. RESULTS By the end of recording, the inferior quadrant in DED subjects had a higher number of broken sectors than other quadrants (P < 0.01). Over the recording period, the cumulative percentage of sectors that were broken rose much quicker in the inferior quadrants, and the inferior quadrant is the only quadrant that showed a significant difference between the normal and DED groups (P < 0.01). This difference peaked at 12 seconds and declined after 15 seconds. Receiver operating characteristic curve for each index always showed the largest differential value in the inferior quadrant. CONCLUSIONS Tear film breakup is not homogenously distributed, with sectors in the inferior quadrant being more likely to break and to break earlier. Between normal and DED subjects, a significant difference of tear film instability is more likely to be found in the inferior quadrant.

The objective of this study was to characterize the etiological role of human adenovirus (HAdV) serotypes in pediatric gastroenteritis. Using a case-control design, we compared the frequencies of HAdV serotypes between children with ≥3 episodes of vomiting or diarrhea within 24 h and

BACKGROUND The traditional ways indicate using different types of flap to repair the nasal sidewall defect, but the scar in the donor area or bloated flap is a problem that cannot be ignored. This study propose the clinical application of the principle of tissue regeneration priority in small defects (defect diameter

OBJECTIVES: To determine if the clinical characteristics of children with gastroenteritis and influenza identified in their stool differ from those whose stool was influenza-negative. METHODS: Children

Data are lacking regarding the impact of visible pigment on rectal swab diagnostic accuracy. We describe the test characteristics of rectal swabs with and without pigment in children with gastroenteritis. Between December 2014 and September 2017, children (age

Background and objectives To clarify the correlation of variant venous anatomy with adrenal tumor phenotype and surgical outcomes. Patients and methods This retrospective study included 303 consecutive minimally invasive adrenalectomies from 301 patients. All adrenal veins were identified. We compared the preoperative, intraoperative, and postoperative data between patients with and without variant adrenal venous anatomy. We also explored the factors associated with venous variants. Results We found variant venous anatomy in 62 of 303 adrenalectomies (20.5%). Compared with patients with normal anatomy, those with variant anatomy were associated with larger tumor size, larger adrenal veins, more adrenal medullary tumors, longer operation time, more estimated intraoperative blood loss, longer length of hospitalization, and more transfusion. Computed tomography (CT) images may improve the identification of venous anatomy. Tumor size and diagnosis of pheochromocytoma were independently related to variant venous anatomy, whereas sex, tumor size, and venous variant influenced hemorrhage. For pheochromocytoma with variant venous anatomy operated on by a single surgeon, robot-assisted laparoscopic adrenalectomy was associated with shorter postoperative hospitalization. Conclusions Adrenal vein variants are associated with worse outcomes in adrenal tumors and an optimized surgery strategy should be applied to this group of patients.

Background. We sought to develop diagnostic test guidance definitions for pediatric enteric infections to facilitate the interpretation of positive test results in the era of multianalyte molecular diagnostic test platforms.Methods. We employed a systematic, two-phase, modified Delphi consensus process consisting of three web-based surveys and an expert panel face-to-face meeting. In phase 1, we surveyed an advisory panel of North American experts to select pathogens requiring diagnostic test guidance definition development. In phase 2, we convened a 14-member expert panel to develop, refine, and select the final definitions through two web-based questionnaires interspersed with a face-to-face meeting. Both questionnaires asked panelists to rate the degree to which they agreed that if the definition is met the pathogen is likely to be causative of clinical illness.Results. The advisory panel survey identified 19 pathogens requiring definitions. In the expert panel premeeting survey, 13 of the 19 definitions evaluated were rated as being highly likely (“agree” or “strongly agree”) to be responsible for acute gastroenteritis symptoms by ≥67% of respondent panel members. The definitions for the remaining six pathogens (Aeromonas, Clostridium difficile, Edwardsiella,nonenteric adenovirus, astrovirus, andEntamoeba histolytica) were indeterminate. After the expert panel meeting, only two of the modified definitions,C. difficileandE. histolytica/dispar, failed to achieve thea priorispecified threshold of ≥67% agreement.Conclusions.We developed diagnostic test guidance definitions to assist healthcare providers for 17 enteric pathogens. We identified two pathogens that require further research and definition development.

To evaluate the relationship between individual bacterial and viral pathogens and disease severity.Children18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up).Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease.In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.

Enteropathogen detection traditionally relies on diarrhoeal stool samples, but these are inconvenient to collect if they are not immediately available, leading to suboptimum return rates of samples and delayed or missed diagnostic opportunities. We sought to compare the enteropathogen yields of rectal swabs and stool specimens in children with diarrhoea or vomiting, or both.The Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) did a study in three outpatient cohorts in Calgary and Edmonton (AB, Canada)-children enrolled in the Pediatric Emergency Research Canada emergency departments, children receiving routine vaccinations at a Calgary health clinic, and symptomatic children who met criteria for treatment at home. Eligible participants were children younger than 18 years, with at least three episodes of vomiting or diarrhoea in the preceding 24 h and fewer than 7 days of symptoms. After excluding those enrolled within the previous fortnight, unable to follow-up, or having psychiatric illness, neutropenia, or requiring emergent care, we attempted to collect rectal swabs and stool from all participants. Specimens were tested with the multianalyte assay Luminex xTAG Gastrointestinal Pathogen Panel, an in-house five-virus panel and bacterial culture. Primary outcomes were comparative yield (calculated as the proportion of submitted paired specimens only in which at least one pathogen was identified) and overall yield (which calculated the proportion of study participants in whom at least one pathogen was identified in all specimens, where unsubmitted specimens were analysed as negative). We used McNemar's test to do pathogen-specific analyses, and generalised estimating equations (GEE) for the global (ie, any) pathogen analyses, with adjustments made for the presence of diarrhoea, location, and their interactions with specimen type.Between Dec 12, 2014, and Aug 31, 2016, we studied 1519 eligible participants, 1147 (76%) of whom provided stool specimens and 1514 (99%) provided swab specimens. 871 (76%) of 1147 stool specimens and 1024 (68%) of 1514 swabs were positive for any pathogen (p0·0001). Comparative yield adjusted odds ratios (ORs) for stool specimens relative to swabs were 1·24 (95% CI 1·11-1·38) in children with diarrhoea at presentation and 1·76 (1·47-2·11) in children without diarrhoea. GEE analysis identified an interaction between the presence of diarrhoea and specimen type (p=0·0011) and collection location (p=0·0078). In an overall yield analysis, pathogen yield was 57% (871 of 1519 children) for stool specimens and 67% (1024 of 1519 children) for rectal swabs, with an unadjusted OR of 0·65 (95% CI 0·59-0·72) for stool relative to swab.Rectal swabs should be done when enteropathogen identification and rapid detection are needed, appropriate molecular diagnostic technology is available, and a stool specimen is not immediately available. In view of their high yield, we urge that the recommendation against the use of rectal swabs as diagnostic specimens be reconsidered.Alberta Innovates-Health Solutions Team Collaborative Research Innovation Opportunity.

The prognostic value and conflicting results of metastatic lymph node ratio (mLNR) on breast cancer have aroused an increasing concern. We aimed to evaluate the imperative of mLNR classification and prognostic factors in breast cancer with molecular subtypes.This study uses the database of s

Background As diarrheal stool samples are the recommended specimen for testing in acute gastroenteritis (AGE), etiological investigations are rarely performed in children presenting with isolated vomiting. This study identifies enteropathogens in children with AGE presenting with isolated vomiting. Methods Children Results Between Dec 9, 2014 and Apr 14, 2016, 2,184 children were enrolled and tested: 784 (36%) presented with isolated vomiting, 250 (11%) with isolated diarrhea (ID), 1,138 (52%) with both vomiting and diarrhea (V&D), 12 had missing data. The detection of enteropathogens was 56% when presenting with isolated vomiting, 55% with ID and 83% with V&D. Of the 784 children with isolated vomiting, 54% (n = 424) had one or more viruses: the most common was norovirus (NoV) (n = 244, 50%), followed by adenovirus (Adv) (91, 19%), rotavirus (Rota) (57, 12%), sapovirus (84, 17%) and astrovirus (10, 2%). Fifty-eight cases had >1 virus; co-infection with NoV and Adv was the most common (n = 23). Ten of these 424 patients also had enteric bacteria (2 Aeromonas, 2 ETEC, 2 Salmonella, 2 Yersinia, 1 Campylobacter, 1 E coli O157) and 8/9 (89%) of these patients reported development of diarrhea at day 14. In comparison, 212/383 (55%) of patients with virus only reported diarrhea at follow up. Enteric bacteria with no virus was detected in 11 patients (3 Aeromonas, 3 Salmonella, 3 STEC, 1 Campylobacter, 1 E coli O157) and 3/10 of these patients reported diarrhea. Conclusion Over 50% of AGE presented with isolated vomiting had enteric virus identified in stool or rectal swabs, representing a significant pathogen-based disease burden not previously included in healthcare planning (e.g., Rota vaccine). NoV was the predominant agent followed by Adv and Rota. Finding enteric bacteria in these cases is novel and requires further study. Disclosures All authors: No reported disclosures.

Background Little is known about the association between specific enteropathogens and disease severity in outpatient children with acute gastroenteritis. Recent advances in diagnostics enabling the rapid and simultaneous detection of common enteropathogens have become readily available. While such knowledge can be used to optimize therapy it also has the potential to predict disease severity. Such knowledge can aid clinical decision making, can clarify guidance and expectations provided to families, and can guide public health policy. Methods We conducted a prospective cohort study of children with acute gastroenteritis who were brought for emergency department care. The primary outcome measure was the 20-point Modified Vesikari Scale (MVS) score calculated from symptom onset until day14 of follow-up (total MVS score). Stool and/or rectal swab specimens were collected and analyzed for 18 unique pathogens by molecular diagnostic assays (in-house 5 virus panel, Luminex xTAG Gastrointestinal Pathogen Panel) and/or bacterial culture. An enteropathogen was deemed to be present if a candidate pathogen was identified in the rectal swab or stool specimens by any testing method. Binary logistic regression was performed to assess the association between pathogens (including all pathogens as present or not) and disease severity with the dependent variable being the total MVS score categorized as severe (11–20 points) vs.. non-severe (0–10 points). Results The mean total MVS score (SD) was 12.8 (3.2) and 73.0% (807/1102) of participants experienced severe disease. A pathogen was identified in 72.8% (802/1102) of study participants. Rotavirus, norovirus GII and adenovirus were identified in 26.6% (293/1102), 23.0% (253/1102) and 16.0% (176/1102) of participants respectively. After adjusting for other pathogens significant predictors of severe disease were: rotavirus (OR=8.0; 95% CI: 4.8, 13.2), Salmonella (OR=5.4; 95% CI: 1.2, 24.4), adenovirus (OR=2.1; 95% CI: 1.3, 3.3), and norovirus GII (OR=1.8; 95% CI: 1.3, 2.6). Clostridium difficile (OR=1.6; 95% CI: 0.96, 2.6) and Aeromonas (OR=0.97; 95% CI: 0.2, 4.7) were not significantly associated with severe disease. Conclusion In children with acute gastroenteritis, the enteropathogens associated with severe disease included rotavirus, Salmonella, adenovirus and norovirus GII. Disclosures All authors: No reported disclosures.

Background Diarrheal stool samples are currently preferred for enteropathogen detection, but they are inconvenient to collect if they are not immediately available, leading to suboptimal return rates and delayed or missed diagnostic opportunities. We sought to compare the enteropathogen yields of rectal swabs and stool specimens in an outpatient cohort of children with diarrhea and/or vomiting. Methods Eligible children were < 18 years of age, with ≥3 episodes of vomiting or diarrhea in 24 hours and Results Of the 1,519 subjects enrolled, 1,147 (75·5%) and 1,514 (99·7%) provided stool and swab specimens, respectively. The proportions of specimens positive for any pathogen were 75.9% (871/1,147) and 67.6% (1,024/1,514); P Conclusion Rectal swabs should be performed when enteropathogen identification, and/or rapid detection, is needed, molecular diagnostic technology available, and stool not immediately available. Disclosures All authors: No reported disclosures.

Background While nearly 2 million children are brought to emergency department (ED) annually due to vomiting and/or diarrhea from acute gastroenteritis (AGE), it is estimated that 90% of AGE cases do not seek medical care. We sought to determine whether the disease severity and enteropathogen burden of disease of children with AGE brought for ED care is different from those cared for at home. Methods Subjects were prospectively recruited by the APPETITE team in pediatric EDs in 2 urban centers and via HealthLink, a province-wide nurse telephone advice line. Eligibility criteria included: < 18 years old, AGE defined by ≥ 3 episodes of vomiting or diarrhea in the preceding 24 hours, and < 7 days of symptoms. The primary outcome was index encounter disease severity quantified using the modified Vesikari Scale (MVS) score. To eliminate the impact of the index encounter on the score we excluded the index ED visit and intervention from all calculations. Secondary objectives included the enteropathogen burden of disease. Two rectal swabs and stool were collected and tested for enteropathogens by enteric bacterial culture, Luminex xTAG GPP, and a 5-virus in-house RT-qPCR panel. Results Between December 9, 2014 and December 31, 2016, 1,623 participants were enrolled with 81.5% from the EDs. Median age was 20.1 months. Children who went to ED were less likely to have a family physician (62 vs. 82%, P < 0.001), more likely to have clinical dehydration (Clinical Dehydration Scale score 3 vs 1, P < 0.001) and vomiting (91 vs. 85%, P = 0.004), previously received IV fluids (4.1 vs. 0.7%, P = 0.001) or been admitted (5.4 vs. 1.3%, P = 0.002). The MVS score was similar between groups when the contribution of the index visit to the score was excluded (8.1 vs. 7.8, P = 0.15). Participants recruited in the ED were not significantly more likely to have bacterial pathogens (8.0 vs. 3.7%, P = 0.09) but were less likely to have viral pathogens identified (64.1 vs. 80.7, P < 0.001). Conclusion Children presenting for ED care had disease severity scores that were similar to children managed at home when the contribution of the index ED visit was accounted for. Viral pathogens were more common in AGE receiving care at home while those presenting to the ED and potentially have a clinically greater likelihood of having a bacterial enteropathogen. Disclosures All authors: No reported disclosures.

Cardiac hypertrophy is a distinguished feature of several physiological and pathological remodeling (Frey et al., 2004). Pathological hypertrophy is commonly seen in patients with heart injury or stress, such as myocardial infarction, hypertension, and valve disease (Frey et al., 2004). Physiological hypertrophy is typically induced by exercise or pregnancy. Interestingly, physiological hypertrophy is generally accepted as an adaptive beneficial response while pathological hypertrophy can ultimately decompensate to heart failure, a common, costly, disabling, and deadly disease. Thus, dissecting the mechanisms for physiological hypertrophy will help identify novel effective therapies for a large spectrum of cardiovascular diseases (Da Costa Martins and De Windt, 2012). Distinct underlying signaling pathways for physiological and pathological hypertrophy have been identified (Maillet et al., 2013). The classic pathway for physiological hypertrophy is IGF-1/PI3K (p110a)/Akt1 while the key one for pathological hypertrophy is AngII (ET-1)/Gaq/Calcineurin/NFAT (Maillet et al., 2013). MicroRNAs (miRNAs, miRs) are a novel class of non-coding RNAs with 20–24 length of base, which posttranscriptional regulates gene expression via base-pairing with complementary sequences within mRNA (Xiao et al., 2012). It is estimated that over 1000 miRNAs were encoded by the human genome. Individual miRNAs can regulate several target genes while one gene can also be regulated by several miRNAs. Being a center player of gene regulation, miRNAs participate in many essential biological processes, including proliferation, differentiation, apoptosis, necrosis, autophagy, and stress responses (Xiao et al., 2012; Kumarswamy and Thum, 2013). Due to these multiple roles, it is naturally that miRNAs are critical in the development of various heart diseases, such as hypertrophy, heart failure, acute myocardial infarction, and arrhythmia (Xiao et al., 2011; Kumarswamy and Thum, 2013). In addition, circulating miRNAs have also been indicated to be promising biomarkers for cardiovascular diseases (Xu et al., 2012). Among them, pathological hypertrophy is the most widely studied one. Accumulating evidence has indicated that a lot of miRNAs such as miR-1, miR-133, miR-26, miR-9, miR-98, miR-29, miR-199a, miR-199b, miR-208, miR-23a, miR-499, miR-21, and mir-19b contribute to pathological hypertrophy (Da Costa Martins and De Windt, 2012). Some distinguished reviews have summarized it in detail (Da Costa Martins and De Windt, 2012; Ellison et al., 2012). Unlike pathological hypertrophy, only a little studies described how miRNAs response to physiological hypertrophy (Soci et al., 2011; Diniz et al., 2013). It has been reported that miR-1, miR-133, mir-29c, miR-27a, mir-27b, and miR-143 response to physiological hypertrophy (Soci et al., 2011; Da Costa Martins and De Windt, 2012; Ellison et al., 2012). However, these miRNAs are either compensatory or lack of direct evidence for regulating cell size. Thus, these results might only set the beginning of filling the gap in miRNAs and physiological hypertrophy. Although these studies have suggested some potential roles of miRNAs in physiological hypertrophy, more functional studies are highly needed to establish miRNAs as contributors for physiological hypertrophy. Traditionally, the adult mammalian heart is recognized as a post-mitotic organ with no regenerative capacity for cardiomyogenesis (Rosenzweig, 2012). Recently, resident endogenous cardiac stem-progenitor cells (eCSCs) in the adult heart challenged this dogma (Rosenzweig, 2012). Moreover, adult cardiomyocytes have also been reported to proliferate in response to specific stimuli (Rosenzweig, 2012). Two studies regarding physiological hypertrophy are of great importance (Bostrom et al., 2010; Waring et al., 2012). A transcriptional factor named CEBPB has been found to be down-regulated with exercise and reduction of CEBPB induces cardiomyocyte hypertrophy and proliferation (Bostrom et al., 2010). Further studies show that CEBPB promotes cardiomyocyte proliferation via increasing CITED4 (Bostrom et al., 2010). This study indicates that besides the generally accepted idea that physiological hypertrophy is solely due to the hypertrophy of existing cardiomyocytes, physiological hypertrophy also has the phenotype of new cardiomyocytes formation (Bostrom et al., 2010). A more recent study shows that c-Kit positive eCSCs increases their number and activated state in exercise-induced physiological hypertrophy, indicating that c-Kit positive eCSCs might be a source of new cardiomyocyte formation (Waring et al., 2012). Therefore, myocyte-restricted lineage tracing studies are highly needed to definitively unravel this question. Anyway, both studies indicate that it is necessary to check miRNAs roles in promoting new cardiomyocyte formation either in cardiomyocytes or in eCSCs in physiological hypertrophy. With the strategies for checking myocyte hypertrophy and new cardiomyocyte formation, the miRNA basis of physiological hypertrophy will be revealed, which will help develop a miRNA-based therapy for heart failure.