Pediatric open partial nephrectomy: analysis of contemporary outcomes with a supracostal-12 approach

ObjectiveReports in the literature increasingly have demonstrated a shorter length of stay (LOS) with the laparoscopic approach to partial nephrectomy compared to historic open partial nephrectomy. We present data from the largest open series to date, to provide a more contemporary perspective.MethodsA retrospective review was performed on all pediatric patients who underwent upper pole partial nephrectomy from 1999 to 2011. Using univariate and multivariate linear regression, the associations between multiple explanatory covariates and outcomes such as pain and length of stay were analyzed.ResultsTwenty-five surgeries were performed via a supracostal-12 approach. The mean incision length and operative time was 3.7 cm and 137 min, respectively. The average pain score was 1.7/10 and 72% of patients did not require morphine. The mean LOS was 36 h and all patients with postoperative imaging had normal blood flow. Multivariate analysis demonstrated that a later date of surgery was the only covariate significantly associated with decreased operative time and LOS.ConclusionOpen partial nephrectomy can be performed in a minimally invasive manner via a small supracostal-12 incision with minimal pain and LOS. Surgeon experience is associated with decreased operative time and LOS. These contemporary open results should be considered when comparisons are made with laparoscopic surgery.     

Molecular Characterization of Three New Avian Infectious Bronchitis Virus (IBV) Strains Isolated in Quebec

Three unrecognized field isolates of Infectious Bronchitis Virus (IBV) were recovered from commercial broiler chickens vaccinated with live Mass viral strain (H120). These isolates were identified by immunofluorescence using monoclonal antibodies produced against reference serotypes: Mass, Conn, and Ark. RT-PCRs were performed on viral RNAs to amplify S1 gene using a specific set of primers S1OLIGO3 and S1OLIGO5. Restriction polymorphism (RFLP) of PCR products was determined by the use of HaeIII restriction enzyme. As expected, patterns of PCR products were different from common pattern of strains assigned to Mass serotype M41, Beaudette, H120, and Florida. Molecular analysis showed a nucleotide insertion in hypervariable region one (HVR-1) of S1 gene of only Quebec isolates (Qu16, Qu_mv and Q_37zm). However, New Brunswick IBV isolate (NB_cp) did not display these insertions. Major amino acid changes involved insertion of two stretches (aa_118–119: Arg–Ser and aa_141–145: Sys–Ser–Asn–Ala–Ser–Cys) located at N-terminal and C-terminal regions of HVR-2. It is speculated that cysteine residue located upstream and downstream of Cys–Ser–Asn–Ala–Ser–Cys segment might be involved in the formation of loop structure and disulfide bond that could trigger important epitope changes. Insertion of new NXT and NXS (XP) glycosylation motifs scattered along S1 region and insertion of cysteine residues in HVR are contributing to the antigenic shifting of Quebec isolates. Fragment insertions were thought to be induced by inter-serotype recombination between vaccine strain (H120) that belongs to Mass serotype and another strain belonging to Ark serotype. Phylogenetic tree based on amino acid sequences showed that Quebec isolates formed a new phylogenetic cluster.     

Complete Sequences of the Neuraminidase Genes of Swine Influenza Viruses (H1N1) Associated with the Respiratory Disease in Pigs

The complete nucleotide sequences of neuraminidase (NA) of two swine influenza viruses (H1N1) are presented. A/Sw/Quebec/5393/91 (SwQc91) virus, associated with the chronic respiratory disease and A/Sw/Quebec/192/81 (SwQc81) virus, associated with the acute respiratory disease, were used. The deduced amino acid sequences of NA of SwQc91 and SwQc81 viruses showed a high degree (>95%) of similarity. The NA gene of both viruses was a single open reading frame of 1459 nucleotides coding for 469 aa with a 5′ noncoding region of 21 nucleotides and a 3′ noncoding region of 28 nucleotides. The comparison of two sequences showed that there were 23 differences recorded for SwQc91 strain, of which 5, 6, and 12 differences were recorded in the hydrophobic, stalk and head regions, respectively. A potential antigenic determinant changed from Ala to Thr at position 453 and there was a new potential glycosylation site present at position 88 for SwQc91 strain whereas it was absent at position 50 when compared with SwQc81 strain. Estimates of genetic distance and phylogenic tree analysis showed that SwQc91 and SwQc81 viruses were closely related with each other and with the American strain, A/Sw/Wisconsin/4754/94. However, the swine viruses represented a distinct group that was considerably divergent from the group of human viruses. This revised version was published online in July 2006 with corrections to the Cover Date.