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991.
992.
Maadrika M.N.P. Kanglie Nanko de Graaf Femke Beije Elise M.J. Brouwers Sabine D.M. Theuns-Valks Frits H. Jansen Diederick B.W. de Roy van Zuidewijn Bas Verhoeven Rick R. van Rijn Roel Bakx 《Journal of pediatric surgery》2019,54(3):500-506
Background
There is a lack of studies addressing the occurrence of negative intraoperative findings (that is the absence of intussusception) after an unsuccessful hydrostatic reduction of an ileocolic intussusception. The aim of this study is to determine the incidence of negative intraoperative findings after unsuccessful hydrostatic reduction of ileocolic intussusception.Methods
We conducted a multicentre retrospective study of all children aged 0–18?years treated for ileocolic intussusception from January 1, 2010 to December 31, 2015 in 9 Dutch hospitals. Primary outcome measure was the percentage of children without an intussusception during surgical exploration after unsuccessful hydrostatic reduction.Results
In the study period 436 patients were diagnosed with an ileocolic intussusception. Of these, 408 patients underwent hydrostatic reduction of an ileocolic intussusception. 112 patients (27.5%) underwent surgery after an unsuccessful hydrostatic reduction. In 13 (11.6%) patients no intraoperative evidence of intussusception was found. Patients who underwent surgical intervention after unsuccessful hydrostatic reduction were significantly younger than patients who had a successful hydrostatic reduction; there was no gender difference.Conclusion
A substantial number of children (11.6%) underwent a laparotomy after unsuccessful hydrostatic reduction in whom no intussusception was found intraoperatively. We suggest initiating laparoscopy instead of laparotomy when surgery is necessary.Level of evidence
Level II. 相似文献993.
Dave R. Lal Samir K. Gadepalli Cynthia D. Downard Peter C. Minneci Michelle Knezevich Thomas H. Chelius Cooper T. Rapp Deborah Billmire Steven Bruch R. Carland Burns Katherine J. Deans Mary E. Fallat Jason D. Fraser Julia Grabowski Ferdynand Hebel Michael A. Helmrath Ronald B. Hirschl Rashmi Kabre Thomas T. Sato 《Journal of pediatric surgery》2019,54(4):688-692
Purpose
Right sided aortic arch (RAA) is a rare anatomic finding in infants with esophageal atresia with or without tracheoesophageal fistula (EA/TEF). In the presence of RAA, significant controversy exists regarding optimal side for thoracotomy in repair of the EA/TEF. The purpose of this study was to characterize the incidence, demographics, surgical approach, and outcomes of patients with RAA and EA/TEF.Methods
A multi-institutional, IRB approved, retrospective cohort study of infants with EA/TEF treated at 11 children's hospitals in the United States over a 5-year period (2009 to 2014) was performed. All patients had a minimum of one-year follow-up.Results
In a cohort of 396 infants with esophageal atresia, 20 (5%) had RAA, with 18 having EA with a distal TEF and 2 with pure EA. Compared to infants with left sided arch (LAA), RAA infants had a lower median birth weight, (1.96?kg (IQR 1.54–2.65) vs. 2.57?kg (2.00–3.03), p?=?0.01), earlier gestational age (34.5?weeks (IQR 32–37) vs. 37?weeks (35–39), p?=?0.01), and a higher incidence of congenital heart disease (90% vs. 32%, p?<?0.0001). The most common cardiac lesions in the RAA group were ventricular septal defect (7), tetralogy of Fallot (7) and vascular ring (5). Seventeen infants with RAA underwent successful EA repair, 12 (71%) via right thoracotomy and 5 (29%) through left thoracotomy. Anastomotic strictures trended toward a difference in RAA patients undergoing right thoracotomy for primary repair of their EA/TEF compared to left thoracotomy (50% vs. 0%, p?=?0.1). Side of thoracotomy in RAA patients undergoing EA/TEF repair was not significantly associated with mortality, anastomotic leak, recurrent laryngeal nerve injury, recurrent fistula, or esophageal dehiscence (all p?>?0.29).Conclusion
RAA in infants with EA/TEF is rare with an incidence of 5%. Compared to infants with EA/TEF and LAA, infants with EA/TEF and RAA are more severely ill with lower birth weight and higher rates of prematurity and complex congenital heart disease. In neonates with RAA, surgical repair of the EA/TEF is technically feasible via thoracotomy from either chest. A higher incidence of anastomotic strictures may occur with a right-sided approach.Level of evidence
Level III. 相似文献994.
Mahwash Kassi Venkateshwar Polsani Robert C. Schutt Solomon Wong Faisal Nabi Michael J. Reardon Dipan J. Shah 《The Journal of thoracic and cardiovascular surgery》2019,157(5):1912-1922.e2
Background
The purpose of this analysis is to describe the differences in cardiac magnetic resonance characteristics between benign and malignant tumors, which would be helpful for surgical planning.Methods
This was a prospective cohort study of 130 patients who underwent cardiac magnetic resonance imaging for evaluation of a suspected cardiac mass. After excluding thrombi and tumors without definitive diagnosis, 66 tumors were evaluated for morphologic features and tissue composition.Results
Of the 66 patients, 39 (59.0%) had malignant tumors and 27 (41.0%) had benign tumors. Patients with malignant tumors were younger when compared with those with benign tumors (age 51 years [42.8-60.0] vs 65 years [60.0-71.0] median). Malignant tumors more often demonstrated tumor invasion (69% vs 0% P < .001) and were more often associated with pericardial effusion (41% vs 7.4% P = .004). Presence of first-pass perfusion (100% vs 33% P < .001) and late gadolinium enhancement (100% vs 59.2%, P < .001) were significantly higher in malignant tumors. In logistic regression modeling, tumor invasion (P < .001) and first-pass perfusion (P < .001) were independently associated with malignancy. Furthermore, using classification and regression tree analysis, we developed a decision tree algorithm to help differentiate benign from malignant tumors (diagnostic accuracy ~90%). The algorithm-weighted cost of misclassifying a malignant tumor as benign was twice that of classifying a benign tumor as malignant.Conclusions
Our study demonstrates that cardiac magnetic resonance imaging is a useful noninvasive method for differentiating malignant from benign cardiac tumors. Tumor size, invasion, and first-pass perfusion were useful imaging characteristics in differentiating benign from malignant tumors. 相似文献995.
John P. Sundberg Kathleen A. Silva Victoria E. Kennedy John J. Wilson Nicholas E. Gott Beth A. Sundberg Derry C. Roopenian 《Experimental dermatology》2019,28(9):1091-1093
2‐deoxy D‐glucose (2DG) was tested for efficacy in treating alopecia areata using the C3H/HeJ skin graft model. 2DG has proven to be efficacious in treatment of various mouse models of autoimmunity with minimal serious side effects noted. This agent has been shown to normalize abnormally activated T‐cell populations while also preventing cell surface expression of NKG2D; key factors defining alopecia areata disease progression. Daily oral ingestion of 2DG via drinking water to mice with patchy or diffuse alopecia areata for 16 weeks failed to prevent expansion of alopecia or cause regrowth of hair in treated mice. Histologically, there were no differences between treated and control groups. These results indicate that, while 2DG is effective for some autoimmune diseases, it was not efficacious for the cell‐mediated autoimmune mouse disease, alopecia areata. 相似文献
996.
997.
W. P. T. James R. J. Johnson J. R. Speakman D. C. Wallace G. Frühbeck P. O. Iversen P. J. Stover 《Journal of internal medicine》2019,285(5):533-549
Our understanding of human evolution has improved rapidly over recent decades, facilitated by large‐scale cataloguing of genomic variability amongst both modern and archaic humans. It seems clear that the evolution of the ancestors of chimpanzees and hominins separated 7–9 million years ago with some migration out of Africa by the earlier hominins; Homo sapiens slowly emerged as climate change resulted in drier, less forested African conditions. The African populations expanded and evolved in many different conditions with slow mutation and selection rates in the human genome, but with much more rapid mutation occurring in mitochondrial DNA. We now have evidence stretching back 300 000 years of humans in their current form, but there are clearly four very different large African language groups that correlate with population DNA differences. Then, about 50 000–100 000 years ago a small subset of modern humans also migrated out of Africa resulting in a persistent signature of more limited genetic diversity amongst non‐African populations. Hybridization with archaic hominins occurred around this time such that all non‐African modern humans possess some Neanderthal ancestry and Melanesian populations additionally possess some Denisovan ancestry. Human populations both within and outside Africa also adapted to diverse aspects of their local environment including altitude, climate, UV exposure, diet and pathogens, in some cases leaving clear signatures of patterns of genetic variation. Notable examples include haemoglobin changes conferring resistance to malaria, other immune changes and the skin adaptations favouring the synthesis of vitamin D. As humans migrated across Eurasia, further major mitochondrial changes occurred with some interbreeding with ancient hominins and the development of alcohol intolerance. More recently, an ability to retain lactase persistence into adulthood has evolved rapidly under the environmental stimulus of pastoralism with the ability to husband lactating ruminants. Increased amylase copy numbers seem to relate to the availability of starchy foods, whereas the capacity to desaturase and elongate monounsaturated fatty acids in different societies seems to be influenced by whether there is a lack of supply of readily available dietary sources of long‐chain polyunsaturated fatty acids. The process of human evolution includes genetic drift and adaptation to local environments, in part through changes in mitochondrial and nuclear DNA. These genetic changes may underlie susceptibilities to some modern human pathologies including folate‐responsive neural tube defects, diabetes, other age‐related pathologies and mental health disorders. 相似文献
998.
999.
Murat Yücel Erin Oldenhof Serge H. Ahmed David Belin Joel Billieux Henrietta Bowden‐Jones Adrian Carter Samuel R. Chamberlain Luke Clark Jason Connor Mark Daglish Geert Dom Pinhas Dannon Theodora Duka Maria Jose Fernandez‐Serrano Matt Field Ingmar Franken Rita Z. Goldstein Raul Gonzalez Anna E. Goudriaan Jon E. Grant Matthew J. Gullo Robert Hester David C. Hodgins Bernard Le Foll Rico S. C. Lee Anne Lingford‐Hughes Valentina Lorenzetti Scott J. Moeller Marcus R. Munaf Brian Odlaug Marc N. Potenza Rebecca Segrave Zsuzsika Sjoerds Nadia Solowij Wim van den Brink Ruth J. van Holst Valerie Voon Reinout Wiers Leonardo F. Fontenelle Antonio Verdejo‐Garcia 《Addiction (Abingdon, England)》2019,114(6):1095-1109