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Introduction: Tubularized incised plate urethroplasty (TIPU) surgery is among the most successful techniques for distal hypospadias. Our objective was the investigation of complication rates and their predictors., Methods: Between 2010 and 2021, 150 patients with distal hypospadias were operated on consecutively by a single surgeon using the TIPU technique. The primary outcome was the complication rates including fistula, meatal stenosis, and glans dehiscence. Secondary outcomes were predictor factors of complications., Results: The average glans diameter was 13.9 ± 0.10 mm and 57.0% of the patients had a glans diameter greater than 14 mm. Single-layer and double-layer urethroplasty were used in 55.3% (n = 83) and 44.7% (n = 67) of patients, respectively. Overall complication rate was 23.3% (n = 35), which included fistula (3.3%, n = 5), glans dehiscence (12.7%, n = 19), and meatal stenosis (8.6%, n = 13). Glandular meatus localization (OR = 58.8, p = 0.001) and smaller glans diameter (OR = 0.39, p = 0.001) were significant predictors in the multivariate analysis of overall complications. For fistula complications, only short operation time (OR = 0.83, p = 0.03) was found as a significant predictor. Glans width (<14 mm) was the only significant predictor of both glans dehiscence (OR = 3.4, p = 0.03) and stenosis (OR = 5.67, p = 0.013) complication., Conclusion: TIPU technique for distal hypospadias has notable success and acceptable complication rates. Dartos augmented single-layer urethral closure seems adequate for complication prevention. Preoperative assessment of the glans width and meatus site is advised to predict complication rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Akova et al.)

Background: There is no consensus whether circumcision performed in the first months of life has negative effects on feeding, sleep, and maternal attachment in babies. This prospective study aimed to investigate this relation in the first months of life. This study is the first to investigate the effects of circumcision on feeding, sleep, and maternal attachment simultaneously., Methods: The study group consisted of 75 families with their babies aged 0-4 months. Surgical circumcision procedure under regional anesthesia was applied to all patients. The questionnaires were used to evaluate the babies' feeding and sleeping habits, and the Maternal Attachment Inventory (MAI) was used to assess mother-baby attachment level. All assessments were performed before and one month after the circumcision., Results: The mean age of the patients when circumcision was performed was 75 (74.52 ± 37.03) (3-120) days. The mean ages of mothers were 32 (32.51 ± 4.05) years. There was no statistically significant change in the sleep habits and feeding status of babies before and after circumcision. The mean maternal attachment value before circumcision was 101 (98.89 ± 6.77) points, while it was 103 (101.36 ± 4.21) points after circumcision. This result indicates that the maternal attachment score increased significantly after circumcision (p < 0.001)., Conclusions: The circumcision performed under regional anesthesia between 0 and 4 months did not have any negative effect on sleep, feeding, and maternal attachment in babies., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Inc.)

Introduction: Child abuse combines emotional, physical, sexual, and neglect aspects of violence, thus diversifying the trauma for a child. Publications about child abuse had been discussed in academia for long years and evaluated by bibliometric analysis, frequently. This study aims to evaluate the most discussed/disseminated scientific publications about child abuse in electronic media such as social media accounts, blogs, podcasts, and media news sites using a new analysis method called altmetric analysis., Methods: The data were obtained from the Altmetric Explorer database using the phrase "child abuse," in 2021. After being ranked by altmetric attention score (AAS), descriptive statistics for all publications as well as detailed analyses for the first-100 publications were performed. Variables evaluated were AAS, dimensions-badge value, distribution of web sources, demographic/geographic-breakdown type distributions, main subject categories, and mesh terms. Kruskal Wallis test was used for AAS and dimensions-badge value comparisons while Spearman correlations and regression analysis were also performed. Analyses were performed by SPSS 23.0 (IBM SPSS, Inc., Chicago, IL, USA) and p<0.05 was considered statistically significant., Results: Publications about child abuse were shared extensively on social media, mostly on Twitter. In terms of the main subject, sexual abuse was the trending topic, followed by physical abuse and maltreatment. Psychology, studies in human society, health sciences, and law/legal issues were the four main science categories about the subject. The United States was the major disseminator of publications while Child Abuse and Neglect was the most productive journal. There was a weak but significant (p<0.05) positive correlation between AAS and dimensions-badge values., Conclusion: Child abuse is a multidimensional subject in social media. As the number of publications increases, the possibility of articles to be shared on different social media platforms also increases. The majority of the top-100 publications are the ones emphasizing the importance of child abuse in terms of the prevalence, individual/social burden, and negative consequences., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Akova et al.)

Objective: Since the first definition of anal canal little has been discovered about the etiology of this rare condition. We present four asymptomatic cases of anal canal duplication with diverse clinical and surgical findings., Methods: A retrospective chart review was performed on four infants presenting with asymptomatic anal canal duplication, born between 2014 and 2016. Clinical characteristics and pathologic findings of patients either by radiological imaging or pathology were evaluated. The primary outcome measure was the complications., Results: All patients were followed-up with physical examination and ultrasound for a mean of 3.5±1.0 years, lastly seen at the beginning of 2018. The female to male ratio was 3:1. Duplicate anal canal length varied between 12-20mm, and two of the four patients had a presacral cystic mass confirmed as a tail gut cyst following surgery. At follow-up, none of the patients had developed symptoms related to anal canal duplication, regardless of whether they had surgical intervention., Conclusion: Though surgical management is the preferred treatment for anal canal duplication, it seems that patients who do not undergo surgery might remain free of symptoms, suggesting that surgical intervention may be unnecessary., Competing Interests: Conflict of Interests: The authors declare that they have no conflict of interests., (Copyright: © Pakistan Journal of Medical Sciences.)

Introduction: There is a tendency toward nonoperative management of appendicitis resulting in an increasing need for preoperative diagnosis and classification. For medical purposes, simple conceptual decision-making models that can learn are widely used. Decision trees are reliable and effective techniques which provide high classification accuracy. We tested if we could detect appendicitis and differentiate uncomplicated from complicated cases using machine learning algorithms., Materials and Methods: We analyzed all cases admitted between 2010 and 2016 that fell into the following categories: healthy controls (Group 1); sham controls (Group 2); sham disease (Group 3), and acute abdomen (Group 4). The latter group was further divided into four groups: false laparotomy; uncomplicated appendicitis; complicated appendicitis without abscess, and complicated appendicitis with abscess. Patients with comorbidities and whose complete blood count and/or pathology results were lacking were excluded. Data were collected for demographics, preoperative blood analysis, and postoperative diagnosis. Various machine learning algorithms were applied to detect appendicitis patients., Results: There were 7244 patients with a mean age of 6.84 ± 5.31 years, of whom 82.3% (5960/7244) were male. Most algorithms tested, especially linear methods, provided similar performance measures. We preferred the decision tree model due to its easier interpretability. With this algorithm, we detected appendicitis patients with 93.97% area under the curve (AUC), 94.69% accuracy, 93.55% sensitivity, and 96.55% specificity, and uncomplicated appendicitis with 79.47% AUC, 70.83% accuracy, 66.81% sensitivity, and 81.88% specificity., Conclusions: Machine learning is a novel approach to prevent unnecessary operations and decrease the burden of appendicitis both for patients and health systems., Levels of Evidence: III.

The tendency of non-operative management of appendicitis let us explore the natural history of appendiceal carcinoids, compare them with appendicitis patients, and determine the possibility of deciding the extent of the surgery and post-operative follow-up on behalf of the intraoperative findings. A retrospective review was performed of patients with appendicitis between 2009 and 2017. Of 2781 patients, 10 (0.36%) were diagnosed with appendiceal carcinoids. Sixty percent were female with an average age of 13.10 ± 1.73. The mean tumor size was 0.97 ± 0.34 cm with 70% located at the tip. Majority had an insular pattern (n = 9), six had subserosal fat tissue invasion, one had extension to mesoappendix, one had vascular invasion, and two had lymphatic invasion. The average mitotic index was 3.20 ± 1.40/50HPF, and Ki 67 activity was 3 ± 1.7%. The mean follow-up period was 66.40 ± 25.92 months. Patients were further evaluated with ultrasonography (n = 10), CT (n = 3), and MRI (n = 10). Serum markers including chromogranin (n = 9), NSE (n = 6), and 5-HIAA (n = 6) were normal. None required further treatment and had any symptoms of carcinoid syndromes or recurrences post-operatively.Conclusion: Other than appendectomy, no additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size, regardless of the lymphoid or vascular invasion. What is Known: • The treatment of patients with a 1-2-cm tumor is not clear in both the pediatric and adult populations, and additional resection is needed. • Patients are monitored post-operatively with radiological and/or biochemical testing. What is New: • Appendectomy is curative for tumors less than 2 cm. • No additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size regardless of the lymphoid or vascular invasion.

Background: Flow cytometry (FC)-based computer-aided diagnostics is an emerging technique utilizing modern multiparametric cytometry systems.The major difficulty in using machine-learning approaches for classification of FC data arises from limited access to a wide variety of anomalous samples for training. In consequence, any learning with an abundance of normal cases and a limited set of specific anomalous cases is biased towards the types of anomalies represented in the training set. Such models do not accurately identify anomalies, whether previously known or unknown, that may exist in future samples tested. Although one-class classifiers trained using only normal cases would avoid such a bias, robust sample characterization is critical for a generalizable model. Owing to sample heterogeneity and instrumental variability, arbitrary characterization of samples usually introduces feature noise that may lead to poor predictive performance. Herein, we present a non-parametric Bayesian algorithm called ASPIRE (anomalous sample phenotype identification with random effects) that identifies phenotypic differences across a batch of samples in the presence of random effects. Our approach involves simultaneous clustering of cellular measurements in individual samples and matching of discovered clusters across all samples in order to recover global clusters using probabilistic sampling techniques in a systematic way., Results: We demonstrate the performance of the proposed method in identifying anomalous samples in two different FC data sets, one of which represents a set of samples including acute myeloid leukemia (AML) cases, and the other a generic 5-parameter peripheral-blood immunophenotyping. Results are evaluated in terms of the area under the receiver operating characteristics curve (AUC). ASPIRE achieved AUCs of 0.99 and 1.0 on the AML and generic blood immunophenotyping data sets, respectively., Conclusions: These results demonstrate that anomalous samples can be identified by ASPIRE with almost perfect accuracy without a priori access to samples of anomalous subtypes in the training set. The ASPIRE approach is unique in its ability to form generalizations regarding normal and anomalous states given only very weak assumptions regarding sample characteristics and origin. Thus, ASPIRE could become highly instrumental in providing unique insights about observed biological phenomena in the absence of full information about the investigated samples.

A recently introduced technique for pathogen recognition called BARDOT (BActeria Rapid Detection using Optical scattering Technology) belongs to the broad class of optical sensors and relies on forward-scatter phenotyping (FSP). The specificity of FSP derives from the morphological information that bacterial material encodes on a coherent optical wavefront passing through the colony. The system collects elastically scattered light patterns that, given a constant environment, are unique to each bacterial species and serovar. The notable similarity between FSP technology and spectroscopies is their reliance on statistical machine learning to perform recognition. Currently used methods utilize traditional supervised techniques which assume completeness of training libraries. However, this restrictive assumption is known to be false for most experimental conditions, resulting in unsatisfactory levels of accuracy, poor specificity, and consequently limited overall performance for biodetection and classification tasks. The presented work demonstrates application of the BARDOT system to classify bacteria belonging to the Salmonella class in a nonexhaustive framework, that is, without full knowledge about all the possible classes that can be encountered. Our study uses a Bayesian approach to learning with a nonexhaustive training dataset to allow for the automated detection of unknown bacterial classes., (© 2010 International Society for Advancement of Cytometry.)

Technologies for rapid detection of bacterial pathogens are crucial for securing the food supply. A light-scattering sensor recently developed for real-time identification of multiple colonies has shown great promise for distinguishing bacteria cultures. The classification approach currently used with this system relies on supervised learning. For accurate classification of bacterial pathogens, the training library should be exhaustive, i.e., should consist of samples of all possible pathogens. Yet, the sheer number of existing bacterial serovars and more importantly the effect of their high mutation rate would not allow for a practical and manageable training. In this study, we propose a Bayesian approach to learning with a nonexhaustive training dataset for automated detection of unmatched bacterial serovars, i.e., serovars for which no samples exist in the training library. The main contribution of our work is the Wishart conjugate priors defined over class distributions. This allows us to employ the prior information obtained from known classes to make inferences about unknown classes as well. By this means, we identify new classes of informational value and dynamically update the training dataset with these classes to make it increasingly more representative of the sample population. This results in a classifier with improved predictive performance for future samples. We evaluated our approach on a 28-class bacteria dataset and also on the benchmark 26-class letter recognition dataset for further validation. The proposed approach is compared against state-of-the-art involving density-based approaches and support vector domain description, as well as a recently introduced Bayesian approach based on simulated classes.

Purpose: We review our experience of treating intestinal rotation anomalies in infants and children in the 22-year period between 1978 and 2000., Methods: The type of operation performed, postoperative complications, and mortality were compared in three age groups. Group 1 consisted of neonates <1 month old, Group 2 consisted of infants aged <1 year old, and Group 3 consisted of children aged >1 year old., Results: There were 101 infants and children, with a female : male ratio of 2 : 1. Of the 101 patients, 72 (71%) were neonates, with a mean age of 11.8 days (range 1-28 days); 20 (19.8%) were under the age of 1 year, with a mean age of 6.7 months (range 1-12 months); and 9 (8.9%) were >1 year of age, with a mean age of 6 years (range 1-9 years). Eighty-five (84%) patients underwent emergency procedures. Ladd's operation was performed in all patients, with various additional procedures. The most frequent postoperative complications were adhesive intestinal obstruction, stoma necrosis, evisceration, and short bowel syndrome. The mortality rate was 36% in Group 1, 20% in Group 2, and 0% in Group 3., Conclusions: In this series surgery was usually performed as an emergency procedure, with higher morbidity and mortality in newborns than in older infants and children.