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8-times more likely to die than MVC patients (OR 7.83, 95% CI 3.68-16.66, p<0.0001), adjusted for age, sex, and injury severity. Statewide,there were10,790 pediatric GSWs with 1586 deaths (CFR14.7%) vs. 710 deaths in 261,363 children in MVCs (CFR0.3%, p<0.0001). The GSW CFRrose (13.4% to 16.5%, p=0.05) while the MVC CFR decreased (0.5% to 0.2%, p<0.0001) in 2015vs. 2006.

Firearm violence in pediatric patients is significantly more lethal than MVCs and is resource intensive. The case fatality rate for pediatric firearm violence is rising. Resources must be directed at preventing pediatric firearm injuries.

Prognosis study, Level II.

Prognosis study, Level II.

Fetal myelomeningocele (MMC) repair improves lower extremity motor function. We have previously demonstrated that augmentation of fetal MMC repair with placental mesenchymal stromal cells (PMSCs) seeded on extracellular matrix (PMSC-ECM) further improves motor function in the ovine model. However, little progress has been made in improving bowel and bladder function, with many patients suffering from neurogenic bowel and bladder. We hypothesized that fetal MMC repair with PMSC-ECM would also improve bowel and bladder function.

MMC defects were surgically created in twelve ovine fetuses at median gestational age (GA) 73 days, followed by defect repair at GA101 with PMSC-ECM. Fetuses were delivered at GA141. Primary bladder function outcomes were voiding posture and void volumes. Primary bowel function outcome was anorectal manometry findings including resting anal pressure and presence of rectoanal inhibitory reflex (RAIR). Secondary outcomes were anorectal and bladder detrusor muscle thickness. PMSC-ECM lambs were compared to normal lambs (n=3).

Eighty percent of PMSC-ECM lambs displayed normal voiding posture compared to 100% of normal lambs (p=1). Void volumes were similar (PMSC-ECM 6.1ml/kg vs. normal 8.8ml/kg, p=0.4). Resting mean anal pressures were similar between cohorts (27.0mmHg PMSC-ECM vs. normal 23.5mmHg, p=0.57). RAIR was present in 3/5 PMSC-ECM lambs that underwent anorectal manometry and all normal lambs (p=0.46). Thicknesses of anal sphincter complex, rectal wall muscles, and bladder detrusor muscles were similar between cohorts.

Ovine fetal MMC repair augmented with PMSC-ECM results in near-normal bowel and bladder function. Further work is needed to evaluate these outcomes in human patients.

Ovine fetal MMC repair augmented with PMSC-ECM results in near-normal bowel and bladder function. Further work is needed to evaluate these outcomes in human patients.

In recent history, healthcare payment reform and legislative initiatives have drastically altered the practice environment for many physicians. Individual providers have migrated from self-managed smaller practices toward employed positions with larger entities, in which provider productivity is tracked. In academic institutions, surgical departments are tasked with meeting clinical productivity metrics while maintaining research and education missions.The objective was to review the current literature regarding the status of physician compensation.

A narrative review of the literature with a defined search strategy using Pubmed and MEDLINE was performed. Using keywords of physician reimbursement, physician compensation, performance-based incentives, relative value unit, RVU, searches were completed and subsequently reviewed by the authors for inclusion. Subsequently, all review articles had their included studies hand searched by the research team and any relevant articles were included in our review.

ducation activities with institutional goals.

Appendicitis is the most common surgical emergency in children. This study aims to examine how the COVID-19 pandemic affected pediatric patients with acute appendicitis with regards to presentation and complications.

After obtaining ethics approval, we performed a chart review of pediatric patients admitted with a diagnosis of appendicitis from March 1, 2019 to June 30, 2019 and March 1, 2020 to June 30, 2020. Data collection included a post-operative period of 30 days. The primary outcome of interest was complication rates post-appendectomy. Secondary outcomes included time to presentation, symptoms, time to surgery, and rate of perforation.

Overall, 205 patients were included with 115 in the pre-pandemic group and 90 in the pandemic group. There was no significant difference in complication rates (16% pre-pandemic vs. 13.3% pandemic). In the pandemic group, time from symptom onset to presentation was significantly longer (1.87 days vs. 2.42 days, p=0.01), more patients presented with emesis (70% vs. 55%, p<0.05), more patients had perforated appendicitis (47% vs. 32%, p<0.05), more patients were likely to be tachycardic (46% vs. 32%, p=0.05) and waited less time for surgery (5.75h vs. 4.15h, p=0.05) which both approached significance.

Significant delays in pediatric appendicitis presentation, and higher rates of tachycardia and perforation were seen during the pandemic. This did not result in increased complication rates but could suggest pandemic patients were more ill than their pre-pandemic counterparts.

Significant delays in pediatric appendicitis presentation, and higher rates of tachycardia and perforation were seen during the pandemic. This did not result in increased complication rates but could suggest pandemic patients were more ill than their pre-pandemic counterparts.Bone tissue can be involved by primitive or metastatic tumors and requires a specific processing both at the department of pathology and during multidisciplinary meetings. The development of fine-needle percutaneous biopsies and of molecular techniques in bone tumor pathology requires a specific management. Moreover, decalcification of samples is crucial but can be deleterious if not controlled or not appropriate. The aim of this review is to provide recommendations for management and decalcification of bone tumor samples.

Waste is endemic in the U.S. health care system. Operating rooms are a source of significant solid waste. Surgeons are integral to many decisions in the operating room.

Online survey of surgeons at 2 major academic centers in the United States assessing perspectives on intraoperative waste and willingness to work to actively reduce intraoperative waste.

We received responses from 219 surgeons 90% agreed or strongly agreed that waste of sterile surgical items is an issue, and 95% agreed or strongly agreed to a willingness to change the operating room workflow to reduce waste. Surgeons estimated 26% of single-use, sterile supplies opened for surgery were unused at the end of the case. The barriers to waste reduction cited most frequently were (1) lack of awareness of waste, (2) lack of concern for waste, and (3) lack of time to address the waste.

Surgeons understand there is significant waste in the operating room and are willing to change their workflow to reduce waste. Changes in operating room practihe precise sources of perioperative waste and what initiatives can be implemented to reduce this burden while maintaining high-value patient care.

The objective of this study was to investigate the morphological changes of the upper airway and the position of the hyoid bone in hyperdivergent adults with different mandibular lengths after premolar extraction.

The data of57 hyperdivergent adults, aged 20-35 years, who had 4 premolar extractions were included for the study. Mandibular length (CoGn) was used for grouping (A long CoGn, B short CoGn). Pretreatment and posttreatment lateral cephalograms and cone-beam computed tomography images were used to assess the position of mandible, hyoid bone, and upper airway using paired t test. An independent sample ttest was used to detect changes of the airway and hyoid position between groups A and B. Pearson correlation analysis was applied to estimate the correlation between pharyngeal spaces and dentoskeletal morphology at P<0.05.

In all subjects, we observed retraction of the upper incisors, mesial movement of the lower molars, and reduction of the mandibular planes. In group A, differences were found in anterior and posterior movements of the hyoid bone, increase of airway volume, minimum cross-sectional area (MCA) and anteroposterior linear distance (APL) (P<0.05). There were notable differences in the change of hyoid position, airway volume, MCA, and APL between group A and group B. Glossopharyngeal and hypopharyngeal volumes, MCA, and APL were correlated with articular angle, mandibular plane, and hyoid bone position (P<0.05).

With a comprehensive diagnosis and treatment, premolar extraction in hyperdivergent adults with favorable CoGn can facilitate improvement of esthetics, hyoid bone position, and the increase in glossopharyngeal and hypopharyngeal volumes and MCA.

With a comprehensive diagnosis and treatment, premolar extraction in hyperdivergent adults with favorable CoGn can facilitate improvement of esthetics, hyoid bone position, and the increase in glossopharyngeal and hypopharyngeal volumes and MCA.

The objective was to evaluate health care providers' (HCP) adherence to and efficacy of varicella post-exposure prophylaxis (PEP) recommendations. CPI-203 chemical structure It was an observational, prospective, multicenter study set in Ile-de-France, France.

All children under 18 with a cancer diagnosis, currently or within 3months of receiving cancer treatment, regardless of varicella zoster virus (VZV) serostatus or previous personal history of varicella, were eligible. Study participants with significant exposure were reviewed prospectively for PEP indications. Main outcome measures werethe percentage of exposure situations for which HCP were guideline-compliant, the proportion of available VZV serostatuses and the incidence of breakthrough varicella after different PEP approaches.

A total of 51 patients from 15 centers were enrolled after 52 exposure episodes. Median age at exposure was 5 years (range, 1-15). Exposure within the household led to 38% of episodes. Prophylactic treatment consisted in specific anti-VZV immunoglobulins (V-ZIG) (n=19) or in oral aciclovir (n=15). No prophylactic treatment was given for 18 patients (in compliance, n=16). In compliance with guidelines, 17 patients received V-ZIG, 11 did not develop varicella (65%, [95% CI, 39-90%]); 15 received aciclovir, 13 did not develop varicella (87%, [95% CI, 67-100%]). Breakthrough varicella occurred in 11 patients, with simple clinical course in all cases; in 8/47 (17%) episodes when PEP was guideline-compliant versus 3/5 (60%) when not.

Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.

Recommendations have been respected and are efficient. PEP needs to be standardized and a study carried out to define the optimal approach. Anti-VZV immunization of seronegative family members should be encouraged.

Adductor spasmodic dysphonia (AdSD) is caused by hyperadduction of the vocal folds during phonation, resulting in a strained voice. Animal models are not yet used to elucidate this intractable disease because AdSD has a difficult pathology without a definitive origin. For the first step, we established an animal model with vocal fold hyperadduction and evaluated its validity by assessing laryngeal function.

In this experimental animal study, three adult Japanese 20-week-old rabbits were used. The models were created using a combination of cricothyroid approximation, forced airflow, and electrical stimulation of the recurrent laryngeal nerves (RLNs). Cricothyroid approximation was added to produce a glottal slit. Thereafter, both RLNs were electrically stimulated to induce vocal fold hyperadduction. Finally, the left RLN was transected to relieve hyperadduction. The sound, endoscopic images, and subglottal pressure were recorded, and acoustic analysis was performed.

Subglottal pressure increased significantly, and the strained sound was produced after the electrical stimulation of the RLNs.