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The 2 most common congenital abdominal wall defects are gastroschisis and omphalocele. Both are usually diagnosed prenatally with fetal ultrasonography, and affected patients are treated at a center with access to high-risk obstetric services, neonatology, and pediatric surgery. The main distinguishing features between the 2 are that gastroschisis has no sac and the defect is to the right of the umbilicus, whereas an omphalocele typically has a sac and the defect is at the umbilicus. In addition, patients with an omphalocele have a high prevalence of associated anomalies, whereas those with gastroschisis have a higher likelihood of abnormalities related to the gastrointestinal tract, with the most common being intestinal atresia. As such, the prognosis in patients with omphalocele is primarily affected by the severity and number of other anomalies and the prognosis for gastroschisis is correlated with the amount and function of the bowel. Because of these distinctions, these defects have different management strategies and outcomes. The goal of surgical treatment for both conditions consists of reduction of the abdominal viscera and closure of the abdominal wall defect; primary closure or a variety of staged approaches can be used without injury to the intra-abdominal contents through direct injury or increased intra-abdominal pressure, or abdominal compartment syndrome. Overall, the long-term outcome is generally good. The ability to stratify patients, particularly those with gastroschisis, based on risk factors for higher morbidity would potentially improve counseling and outcomes.

On initial examination, a male newborn has the finding shown in Fig 1. Figure 1. Initial presentation. ### Prenatal and Birth Histories ### Presentation (Day 1) The infant was placed nil per OS (NPO) and a large-bore nasogastric tube was placed to low-intermittent suction to decompress the stomach. Total parenteral nutrition was initiated for nutritional support. His glucose levels were monitored and found to be normal. The pediatric surgical team was consulted. Vital signs were as follows: ### Physical Examination (Day 1)

Management of complex esophageal problems in children is challenging. We report our experience with the use of esophageal stents in three children with esophageal strictures, leaks, or airway-esophageal fistulae refractory to conventional treatment. The stent played a key role in allowing extubation of a child with a large tracheo-esophageal-pleural fistula and in the resolution of pulmonary infection in a child with esophago-bronchial fistula, both followed by surgery. In the third child, with stricture, stents were complicated with migration, esophageal erosion, and esophago-bronchial fistula. In our experience, esophageal stents were useful mainly as a bridge to definitive surgical repair.

Embolization is a well-established method of treatment of arteriovenous malformations. Most procedures are performed under general anesthesia due to the painful nature of some sclerosing agents, procedure duration, and need for immobilization to allow precise injection. Familiarity with the possible side effects of these agents is important for the anesthesiologist to facilitate timely and successful management of intra- and postprocedural complications. This case report describes an unusual presentation of systemic migration of glue-lipiodol mixture during embolization of a calf arteriovenous malformation in an adolescent that resulted in accelerated idioventricular rhythm and its successful management leading to complete resolution.

DenverRetrospective chart review of a 6-year-old girl with generalized lymphatic anomaly, who presented with refractory lymphorrhea from the labium majus, was performed. This was managed with innovative placement of the Denver shunt between a large abdominal wall cyst and the peritoneal cavity.There was progressive reduction in lymphorrhea with complete cessation at 11 months post shunt placement. At 33-month follow-up, the shunt remains patent with no further lymphorrhea.Denver shunts can be utilized for the creation of internal drainage pathways besides its traditional uses for draining peritoneal and pleural fluids.

Introduction: Pediatric chronic pancreatitis is not commonly diagnosed. Most patients with chronic pancreatitis have at least one gene mutation, often CFTR, PRSS1, or SPINK1.1 Other risk f...

Introduction: Metabolic syndrome is a well-known disease of multiple risk factors that has at its core, insulin resistance accompanying abnormal adipose deposition and function. Multiple studies demonstrate a potential relationship between Visceral Fat Thickness (VFT) and metabolic syndrome. Ultrasound provides a radiation free low-cost alternative, which is high reproducible in the quantification of visceral fat and can act as an effective screening modality. The simplicity of the method combined with its objectiveness makes it advantageous for accurate measurement of VFT. Aim: To correlate of sonographic measurement of VFT with existing metabolic syndrome. Materials and Methods: This cross-sectional study was conducted on all patients that underwent ultrasound at the study center between August 2016 to August 2019 and were clinically suspected of suffering from metabolic syndrome at the Endocrinology Outpatient Department (OPD). Collation of data into three categories based on VFT (10 cm) was done. The patients in each category underwent further testing and metabolic syndrome was either ruled out or diagnosed. Results: The study cohort comprised of 2022 patients. The VFT ranged between 4 and 16 with a mean value of 10.8 and standard deviation of 2.8. The percentage of patients with metabolic syndrome increased in proportion to the increased VFT. VFT >10 cm was found to have specificity and Positive Predictive Value (PPV) 92.52% and 92.53% respectively while VFT

Background Global transcriptional profiling of individual cells represents a powerful approach to systematically survey contributions from cell-specific molecular phenotypes to human disease states but requires tissue-specific protocols. Here we sought to comprehensively evaluate protocols for single cell isolation and transcriptional profiling from heart tissue, focusing particularly on frozen tissue which is necessary for study of human hearts at scale. Methods and results Using flow cytometry and high-content screening, we found that enzymatic dissociation of fresh murine heart tissue resulted in a sufficient yield of intact cells while for frozen murine or human heart resulted in low-quality cell suspensions across a range of protocols. These findings were consistent across enzymatic digestion protocols and whether samples were snap-frozen or treated with RNA-stabilizing agents before freezing. In contrast, we show that isolation of cardiac nuclei from frozen hearts results in a high yield of intact nuclei, and leverage expression arrays to show that nuclear transcriptomes reliably represent the cytoplasmic and whole-cell transcriptomes of the major cardiac cell types. Furthermore, coupling of nuclear isolation to PCM1-gated flow cytometry facilitated specific cardiomyocyte depletion, expanding resolution of the cardiac transcriptome beyond bulk tissue transcriptomes which were most strongly correlated with PCM1+ transcriptomes (r = 0.8). We applied these methods to generate a transcriptional catalogue of human cardiac cells by droplet-based RNA-sequencing of 8,460 nuclei from which cellular identities were inferred. Reproducibility of identified clusters was confirmed in an independent biopsy (4,760 additional PCM1- nuclei) from the same human heart. Conclusion Our results confirm the validity of single-nucleus but not single-cell isolation for transcriptional profiling of individual cells from frozen heart tissue, and establishes PCM1-gating as an efficient tool for cardiomyocyte depletion. In addition, our results provide a perspective of cell types inferred from single-nucleus transcriptomes that are present in an adult human heart., Human; Heart; Single cell; Transcriptomics; Methods; Protocol; Transcriptome; Health sciences; Cardiology; Cardiovascular System