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Background: Aortic valve neocuspidization using the Ozaki technique has shown promising results both in adults and children.Methods: A systematic search of the PubMed and Cochrane databases was performed up to November 13, 2021. Individual patient data were reconstructed and analyzed from the Kaplan-Meier curves of all eligible studies for time-to-event outcomes.Results: We included a total of 22 studies reporting on 1,891 patients that underwent Ozaki reconstruction. Mean age at the time of surgery was 43.2 ± 24.5 years (65 ± 12.3 years for adult patients and 12.3 ± 3.8 years for pediatric patients). The most common indication was aortic stenosis (46.4%, 95% CI 34.1-58.6). Mean cross-clamp and cardiopulmonary bypass duration were 106.8 ± 24.8 minutes and 135.2 ± 35.1 minutes, respectively. Permanent pacemaker was implanted in 0.7% (95% CI 0.4-1.2) of the patients. At discharge, mean effective orifice area was 2.1 ± 0.5 cm2/m2. At latest follow-up, peak gradient was 15.7 ± 7.4 mm Hg and only 0.25% (95% CI 0-2.3) had moderate aortic insufficiency. In-hospital mortality was 0.7% (95% CI 0.1-1.7). Late mortality was 1.9% during a mean follow-up of 38.1 ± 23.8 months. One-year, 3-year, and 5-year freedom from reoperation rates were 98.0 %, 97.0 % and 96.5%, respectively. More than half of the reoperations were due to infective endocarditis (51.5%, 95% CI 18.3-84.0). In our cohort, the risk of endocarditis per patient per year was 0.5%.Conclusions: The midterm outcomes of the Ozaki procedure are excellent in terms of hemodynamics, survival, and freedom from reoperation. Acquiring long-term follow-up will help solidify this technique in the cardiac surgery armamentarium. [ABSTRACT FROM AUTHOR]

Cervical spine injuries (CSI) are a major concern in young pediatric trauma patients. The consequences of missed injuries and difficulties in injury clearance for non-verbal patients have led to a tendency to image young children. Imaging, particularly computed tomography (CT) scans, presents risks including radiation-induced carcinogenesis. In this study we leverage machine learning methods to develop highly accurate clinical decision rules to predict pediatric CSI. The PEDSPINE I registry was used to investigate CSI in blunt trauma patients under the age of three. Predictive models were built using Optimal Classification Trees, a novel machine learning approach offering high accuracy and interpretability, as well as other widely used machine learning methods. The final Optimal Classification Trees model predicts injury based on overall Glasgow Coma Score (GCS) and patient age. This model has a sensitivity of 93.3% and specificity of 82.3% on the full dataset. It has comparable or superior performance to other machine learning methods as well as existing clinical decision rules. This study developed a decision rule that achieves high injury identification while reducing unnecessary imaging. It demonstrates the value of machine learning in improving clinical decision protocols for pediatric trauma. Retrospective Prognosis Study. II [ABSTRACT FROM AUTHOR]

Carmi syndrome is a rare genetic disorder characterized by junctional epidermolysis bullosa (JEB) and pyloric atresia (PA). We reviewed the clinicopathologic and molecular features of patients with Carmi syndrome to identify predictors of clinical outcome and guide surgical PA repair. A PRISMA-compliant systematic literature review of PubMed, CINAHL, and the Cochrane Library was performed. 63 original studies including a total of 100 patients were included. PA type 1 and 2 were equally prevalent (47.2%, 95% CI: 34.4–60.3). Heineke–Mikulicz pyloroplasty (96%, 95% CI: 78.8–99) and gastroduodenostomy (72%, 95% CI: 52.2–85.9) were the most common type 1 and 2 PA repairs, respectively. Seventy lethal cases were identified (74.5%, 95% CI: 64.8–83.5). Of the 73 patients that received an operation, 49 died (67.1%, 95% CI: 55.7–76.8) and 24 survived (32.9%, 95% CI: 23.2–44.3). Integrin α6β4 expression was absent or markedly reduced in lethal cases. Integrin α6, plectin-1, cephalic integrin β4 (exon 3 to intron 11), and premature termination codon mutations were also associated with poor prognosis. Although Carmi syndrome typically has poor prognosis, 1 in 4 patients exhibits nonlethal phenotypes. Immunofluorescence mapping and genetic consultation can guide surgical intervention and provide valuable family planning information. Prognosis study, Level IV. [ABSTRACT FROM AUTHOR]

Repeat cardiac operations are common among patients with complex congenital heart disease. Inadvertent cardiotomy during redo sternotomy can increase intraoperative time and mortality. Establishing extracorporeal circulation before resternotomy may render redo congenital cardiac surgery cases safer and more expeditious. In the present report, we describe the technique of preemptive cannulation of the abdominal aorta (or right common iliac artery) and inferior vena cava. This approach may be a useful when femoral vessels are occluded owing to many catheterizations or prior cannulations. In our practice, no reentry injuries or other complications related to abdominal vessel cannulation have occurred. [ABSTRACT FROM AUTHOR]

Background A better understanding of the analgesia needs of patients who undergo common operative procedures is necessary as we address the growing opioid public health crisis in the United States. The aim of this study was to evaluate patient experience with our opioid prescribing practice after elective inguinal hernia repairs. Methods A prospective, observational study was conducted between October 1, 2015, and September 30, 2016, in a single-surgeon, high-volume, practice of inguinal hernia operation. Adult patients undergoing elective inguinal herniorrhaphy under local anesthesia with intravenous sedation were invited to participate. All patients were prescribed 10 opioid analgesic tablets postoperatively and were counseled to reserve opioids for pain not controlled by nonopioid analgesics. Their experience was captured by completing a questionnaire 2 to 3 weeks postoperatively during their postoperative visit. Results A total of 185 patients were surveyed. The majority of the participants were males (177, 95.7%) and ≥60 years old (96, 51.9%). Of the 185 patients, 159 (85.9%) reported using ≤4 opioid tablets; 110 patients (59.5%) reported that they used no opioid analgesics postoperatively. None of the patients was taking opioids within 7 days of their postoperative appointment. Of the 147 patients who were employed, 111 (75.5%) reported missing ≤3 work days, 57 of whom (51.4%) missed no work at all. Patients who were employed were more likely to take opioid analgesics postoperatively ( P = .049). Patients who took no opioid analgesics experienced less maximum ( P < .001) and persistent groin pain ( P = .037). Pain interfered less with daily activities ( P = .012) and leisure activities ( P = .018) for patients who did not use opioids. Conclusion The majority of our patients reported that they did not require any opioid analgesics, and nearly all of those who thought that they did need opioids used <5 tablets. Our data suggest that for elective inguinal hernia repair under a local anesthetic with intravenous sedation, a policy of low opioid analgesic prescribing is achievable; these findings call for further investigation of how to best prescribe opioid medications to patients after an inguinal herniorrhaphy. [ABSTRACT FROM AUTHOR]

We report a case of nonfatal junctional epidermolysis bullosa and pyloric atresia in a newborn. We identified a substitution (c.914C>T) for the integrin β4 gene that has been associated with favorable outcome. A novel mutation (c.2011T>G) of unknown significance was also found in this patient who is now thriving. [ABSTRACT FROM AUTHOR]

Objectives: To examine patient and clinicopathological features of malignant urachal neoplasms (MUN) in a population-based cohort, to investigate survival outcomes, and to review the current evidence that exists in the literature.Material and Methods: The Surveillance, Epidemiology, and End Results database was used to identify microscopically confirmed MUN cases diagnosed between 1988 and 2012. Kaplan-Meier analysis was used to determine median and 5-year overall survival (OS) as well as cancer-specific survival (CSS) rates. Cox proportional hazards model was employed to identify variables independently associated with cancer-specific mortality. A systematic literature review was conducted in line with the PRISMA statement.Results: A total of 420 patients with MUNs were identified. The majority were white (77.6%) and male patients (59%) who presented with low-grade (62.1%), mucinous, noncystic adenocarcinomas (42.9%). From the cohort, 19%, 15.2%, 29.5%, and 30.5% of the patients presented with American Joint Committee on Cancer Stage I to IV disease, respectively. Cancer-directed surgery was performed in 86.5% of the patients. The most common procedure performed was partial cystectomy (52.4%) followed by local tumor excision (20.7%). Median OS was 57 months (95% CI: 41.6-72.4), and median CSS was 105 months (95% CI: 61.5-148.5). Five-year OS and CSS rates were 51% and 57%, respectively. Grade and stage were independently associated with cancer-specific mortality. Mortality rates did not differ between patients who underwent partial cystectomy and radical cystectomy/exenteration (P = 0.165), even after controlling for tumor stage. A total of 16 studies reporting on 585 patients were systematically reviewed, and relevant outcomes were summarized in the Supplemental material.Conclusions: MUNs are usually low-grade, mucinous, noncystic adenocarcinomas diagnosed at advanced stages. Overall, the prognosis is poor, and high-grade and disease stage are independently associated with cancer-specific mortality. [ABSTRACT FROM AUTHOR]