Abstract Background We aimed to define characteristics and needs of Facebook users in relation to congenital anomalies. Methods Cross-sectional analysis of Facebook related to four congenital ...anomalies: Anorectal Malformation(ARM), Congenital Diaphragmatic Hernia(CDH), Congenital Heart Disease(CHD) and Hypospadias/Epispadias(HS/ES). A keyword search was performed to identify relevant Groups/Pages. An anonymous survey was posted to obtain quantitative/qualitative data on users and their healthcare needs. Results 54 Groups and 24 Pages were identified (ARM:10 Groups; CDH:9 Groups, 7 Pages; CHD:32 Groups, 17 Pages; HS/ES: 3 Groups), with 16,191 Group members and 48,766 Page likes. 868/1103 (79%) of respondents were parents. Male:female ratio 1:10.9. 65% of users were 26-40 years old. Common reasons for joining these Groups/Pages included: seeking support, education, making friends, providing support to others. 932/1103 (84%) would like healthcare professionals (HCPs) actively participating in their Group. 31% of the respondents felt they did not receive enough support from their healthcare system. 97% of the respondents would like to join a Group linked to their primary hospital. Conclusions Facebook Groups/Pages related to congenital anomalies are highly populated and active. There is a need for HCPs and policy makers to better understand and participate in social media to support families and improve patient care.
An infant presented repeatedly with features of transient bowel obstruction 72 hours after unwitnessed ingestion of water beads. At the third presentation 5 days later, he underwent laparotomy and ...jejunal enterotomy for retrieval of obstructing water bead in the duodenum. Four other water beads were retrieved. Due to persistent obstructive symptoms, he had a relaparotomy on fourth postoperative day. A further obstructing bead at the duodenojejunal flexure was retrieved. Antegrade upper gastrointestinal endoscopy and retrograde endoscopy through the enterotomy were performed to ensure no further retained water beads. The patient progressed well postoperatively and was discharged home 5 days later. This case highlights the challenges involved in the diagnosis and management of water bead ingestion in children. Children under 2 years are at a higher risk of complications and most require intervention. Palpation alone can miss residual water beads at surgery. Endoscopy including intraoperative enteroscopy could be a useful adjunct.
Develop a score summarising how successfully a child with any surgical condition has been treated, and test the clinical validity of the score.
Discrete choice experiment (DCE), and secondary ...analysis of data from six UK-wide prospective cohort studies.
253 people with lived experience of childhood surgical conditions, 114 health professionals caring for children with surgical conditions and 753 members of the general population completed the DCE. Data from 1383 children with surgical conditions were used in the secondary analysis.
Normalised importance value of attribute (NIVA) for number/type of operations, hospital-treated infections, quality of life and duration of survival (reference attribute).
Quality of life and duration of survival were the most important attributes in deciding whether a child had been successfully treated. Parents, carers and previously treated adults placed equal weight on both attributes (NIVA=0.996; 0.798 to 1.194). Healthcare professionals placed more weight on quality of life (NIVA=1.469; 0.950 to 1.987). The general population placed more weight on survival (NIVA=0.823; 95% CI 0.708 to 0.938). The resulting score (the Children's Surgery Outcome Reporting (CSOR) Treatment Success Score (TSS)) has the best possible value of 1, a value of 0 describes palliation and values less than 0 describe outcomes worse than palliation. CSOR TSSs varied clinically appropriately for infants whose data were included in the UK-wide cohort studies.
The CSOR TSS summarises how successfully children with surgical conditions have been treated, and can therefore be used to compare hospitals' observed and expected outcomes.
•Fetal MRI provides additional information to support or modify clinical management in more than half of fetuses with a known body anomaly.•Incidental findings of body anomalies on fetal MRI require ...careful consideration when recruiting healthy controls.•We recommend that all fetuses with US identified anomalies undergo fetal MRI.
We sought to assess variability and concordance between fetal MRI and ultrasound (USS) in the evaluation of fetal body abnormalities.
All fetal body anomalies reported on F-MRI within the iFIND database (http://www.ifindproject.com) were included. Differences in findings regarding anomalies on contemporaneous USS were explored. Three clinical specialists evaluated each case independently, and the anomaly severity was graded: as “insignificant” to “lethal”. The value of MRI in alteration of either antenatal or postnatal care was established.
Fifty-four cases were identified consisting of 5 healthy controls, 37 with USS-identified body anomalies, and 12 with known CNS or cardiac anomalies. In fetuses with a known body anomaly, information on the MRI was relevant to change the clinical course in 59% of cases. There was also an incidental detection rate of 7% in fetuses with known cardiac or CNS anomalies, or 1.5% of normal control, although these were rarely clinically relevant.
Importantly, fetuses undergoing MRI for cardiac concerns did have major anomalies that were missed (one case of oesophageal atresia and two cases of ARM).
In cases where fetal anomalies are suspected, F-MRI is a valuable means of further characterizing anomalies and may detect additional anomalies in fetuses with recognized cardiac or CNS anomalies. In fetuses with a recognized body anomaly, more than half of those scanned by MRI had information available which changed clinical management. Importantly there were also incidental findings in healthy control fetuses, so the management of these needs to be recognized in fetal MRI research.
II, Prospective cohort study.
•11 UK centres report using oesophageal lengthening by traction in 22 patients.•Oesophageal anastomosis was achieved in around 3/4 of cases.•There was pre- or peri-operative oesophageal leak or ...disruption in all patients where anastomosis was abandoned. All went on to have a cervical oesophagostomy and gastric pull-up.•No predictors of successful anastomosis were identified (including patient gestation, birthweight, type of atresia, length of gap or co-morbidities).
Preliminary reports suggest a promising role for oesophageal lengthening by traction (OLBT) in long gap oesophageal atresia (LGOA). Nevertheless, these encouraging results originate from specialist centres, and real-world experience is unquantified. We report the first multicentre, nationwide study of OLBT.
Cumulative experience of OLBT was recorded through a questionnaire sent to all UK paediatric surgery centres. OLBT was defined as “any attempt to increase oesophageal length using tension sutures”. Contributors submitted all cases of attempted OLBT, regardless of outcome. Demographics, surgical detail, and outcomes were analysed with summary statistics.
The response rate was 23/26 centres. Eleven centres reported using OLBT in 22 patients (2003-2020) with 117 LGOA treated by other means. One patient died from complications of cardiac surgery and was excluded. OLBT enabled oesophageal anastomosis in 16 (76%), of which 2 died of complications of surgery, and another died of unrelated disease. Of the survivors, 7 required oesophageal dilatation 2-14 times. Oesophageal anastomosis was not achieved in 5 (24%) patients. All had pouch leak or disruption pre- or peri-operatively and underwent cervical oesophagostomy with subsequent gastric pull-up. One patient required dilatation of the oesophagogastric anastomosis.
OLBT is being carried out in the UK in a limited number of centres in a minority of patients. These data suggest OLBT enables oesophageal anastomosis in 76% of infants with LGOA. Oesophageal pouch leak or disruption was common to all instances of failure to anastomose. Our findings will inform discussions between surgeons and families of babies born with LGOA.
ObjectivesAcute appendicitis is the most common surgical condition in children. In the UK, appendicectomy is the most common treatment with non-operative management unusual. Due to concerns about the ...risk of SARS-CoV-2 transmission during surgical procedures, surgeons were advised to consider non-operative treatment and avoid laparoscopy where possible. This study aims to report management and outcomes, to date, of children with appendicitis in the UK and Ireland during the COVID-19 pandemic.DesignSurvey of consultant surgeons who treat children with appendicitis that informed a prospective multicentre observational cohort study.SettingData were collected from centres in the UK and Ireland for cases admitted between 1 April and 31 May 2020 (first 2 months of the COVID-19 pandemic) at both general surgical and specialist paediatric surgical centres.ParticipantsThe study cohort includes 838 children with a clinical and/or radiological diagnosis of acute appendicitis of which 527 (63%) were male.Main outcomes measuredPrimary outcome was treatment strategy used for acute appendicitis. Other outcomes reported include change in treatment strategy over time, use of diagnostic imaging and important patient outcomes to 30 days following hospital admission.ResultsFrom very early in the pandemic surgeons experienced a change in their management of children with appendicitis and almost all surgeons who responded to the survey anticipated further changes during the pandemic. Overall, 326/838 (39%) were initially treated non-operatively of whom 81/326 (25%) proceeded to appendicectomy within the initial hospital admission. Of cases treated initially surgically 243/512 (48%) were performed laparoscopically. Diagnostic imaging was used in 445/838 (53%) children. Cases treated non-operatively had a shorter hospital stay than those treated surgically but hospital readmissions within 30 days were similar between groups. In cases treated surgically the negative appendicectomy rate was 4.5%. There was a trend towards increased use of surgical treatment and from open to laparoscopic appendicectomy as the pandemic progressed.ConclusionNon-operative treatment of appendicitis has been widely used for the first time in children in the UK and Ireland and is safe and effective in selected patients. Overall patient outcomes do not appear to have been adversely impacted by change in management during the pandemic thus far.
Abstract
Background
A major shift in treatment of appendicitis occurred early in the SARS-CoV-2 pandemic with non-operative management used commonly outside research protocols and in units with ...limited previous experience. This study aims to compare real-world outcomes of surgery versus non-operative management of uncomplicated appendicitis in children with 1-year follow-up.
Method
A prospective multicentre observational study of children treated for uncomplicated appendicitis at 74 hospitals in the UK and Ireland from 1 April to 31 July 2020 was performed. Propensity-score matched analysis was conducted using age, sex, C-reactive protein at diagnosis and duration of symptoms as covariates. Primary outcomes were success of non-operative management defined as achieving 1-year follow-up without undergoing appendicectomy due to recurrent appendicitis or ongoing symptoms, and occurrence of any predefined complication (intra-abdominal collection, wound infection, bowel obstruction or reintervention).
Results
Of 1464 children with presumed uncomplicated appendicitis, 1027 (70.2 per cent) underwent surgery and 437 (29.9 per cent) underwent non-operative management. Ninety-four children (21.5 per cent) treated by initial non-operative management required appendicectomy during the index hospital admission while recurrent appendicitis after discharge occurred in 25 (10.4 per cent) children within 1 year. The overall success rate of non-operative management at 1 year was 63.1 per cent (95 per cent c.i. 58.0 to 68.3 per cent). For propensity-score matched analyses, 688 children undergoing surgery and 307 undergoing non-operative management were included. Any predefined complication occurred in 50 (7.3 per cent) children undergoing surgery and in four (1.3 per cent) children undergoing non-operative management (OR 5.9 (95 per cent c.i. 2.1 to 16.6)) in the propensity-score matched cohort. There was no mortality or stoma formation.
Conclusion
Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.
This is a prospective multicentre observational study of children treated for uncomplicated appendicitis in the UK and Ireland comparing operative to non-operative management. In 1464 children with presumed uncomplicated appendicitis, operative treatment was associated with greater odds of any complication, intra-abdominal collection and wound infection but lower odds of unplanned general anaesthetic and readmission compared with non-operative management. Non-operative management is a safe and valid alternative to appendicectomy in children with uncomplicated appendicitis.
Glioblastoma multiforme (GBM) is an aggressive brain tumor for which current immunotherapy approaches have been unsuccessful. Here, we explore the mechanisms underlying immune evasion in GBM. By ...serially transplanting GBM stem cells (GSCs) into immunocompetent hosts, we uncover an acquired capability of GSCs to escape immune clearance by establishing an enhanced immunosuppressive tumor microenvironment. Mechanistically, this is not elicited via genetic selection of tumor subclones, but through an epigenetic immunoediting process wherein stable transcriptional and epigenetic changes in GSCs are enforced following immune attack. These changes launch a myeloid-affiliated transcriptional program, which leads to increased recruitment of tumor-associated macrophages. Furthermore, we identify similar epigenetic and transcriptional signatures in human mesenchymal subtype GSCs. We conclude that epigenetic immunoediting may drive an acquired immune evasion program in the most aggressive mesenchymal GBM subtype by reshaping the tumor immune microenvironment.
Display omitted
•Disease-relevant TME is recapitulated in immunocompetent GBM mouse models•Stable reconfiguration of the transcriptome occurs in GSCs following immune attack•Immune evasive GSCs deploy “myeloid mimicry” to establish a myeloid-enriched TME•Acquired transcriptional changes consistent with a process of epigenetic immunoediting
Glioblastoma stem cells deploy a myeloid mimicry program through epigenetic immunoediting, rather than subclonal selection, to drive a myeloid-enriched tumor microenvironment, thereby enabling immune evasion and tumor progression.
PDF
