Roux-en-Y hepaticojejunostomy or hepaticoduodenostomy for biliary reconstruction after resection of congenital biliary dilatation: a systematic review and meta-analysis.

The ideal surgical management for reconstruction after excision of congenital biliary dilatation remains controversial. This updated meta-analysis compared the clinical outcomes of hepaticoduodenostomy (HD) and hepaticojejunostomy (HJ) after resection of congenital biliary dilatation. PubMed, Web of Science, Embase, Ovid, and the Cochrane Library were searched for studies published from November 1981 through July 2020. The primary outcomes were the operative time, enteral feeding time, hospital stay, and postoperative complications. The quality and risk of bias were assessed with the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Thirteen total studies included 518 (55.76%) HD cases and 411 (44.24%) HJ cases. Five studies were published post-2013; one was a randomized clinical trial. Patients undergoing HD had a shorter hospital stay (MD, 0.40; p = 0.02) and operative time (MD, 59.54; p < 0.00001) and a lower incidence of adhesive intestinal obstruction (OR, 0.20; p = 0.02) than HJ. HD was comparable to conventional HJ with regard to most postoperative outcomes; however, it was associated with a higher incidence of postoperative bilious gastritis (OR, 6.24; p = 0.002). HD is as safe and feasible as HJ with better outcomes in the short run, although reports with long-term follow-up are relatively few. Long-term follow-up will be necessary to monitor possible associated malignancies in the future.

Case Report: Pancreatic and hepatic kaposiform hemangioendothelioma presenting as consumptive coagulopathy and right hepatic atrophy.

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor that causes progressive angiogenesis and lymphangiogenesis, which often occurs in the skin or soft tissue, with an acute onset and rapid progression. A 4-year-old girl was admitted to our hospital with a 2-year history of thrombocytopenia, combined with right hepatic atrophy and pancreatic lesion for 3 months. At the age of two, she developed purpura and thrombocytopenia was detected, after treatment with gamma globulin and corticosteroids, the platelet count normalized, but it dropped immediately at lower doses. One year after the cessation of corticosteroids therapy, the patient presented with abdominal pain and abnormal liver function and the magnetic resonance imaging (MRI) revealed right hepatic atrophy and pancreatic occupancy, but the first liver biopsy did not reveal any positive pathological results. By analyzing the clinical manifestations in conjunction with MRI and abnormal coagulation, we considered that the patient might be diagnosed as KHE with Kasabach-Merritt phenomenon, however, sirolimus treatment was ineffective and pancreatic biopsy only showed a tendency for tumors of vascular origin. Finally, we performed a Whipple operation after the right hepatic artery embolization, histological and immunohistochemical examination suggested KHE. Three months postoperatively, the patient's liver function, pancreatic enzymes and blood clotting function gradually returned to normal. KHEs may result in significant blood loss with worsening of the coagulopathy and functional impairment, timely surgical intervention for KHE is necessary when non-invasive or minimally invasive treatment is ineffective, or the symptoms of tumor compression are obvious.

LncRNA-mRNA coexpression analysis reveals distinct pathogenic mechanisms for subtypes of congenital biliary dilatation.

BACKGROUND/PURPOSE: Congenital biliary dilatation (CBD) is a bile duct malformation often associated with pancreaticobiliary maljunction. Different subtypes of CBD have been noted for clinical differences, but their pathogenic mechanisms are unclear. METHODS: To elucidate the genetic basis of CBD, we performed lncRNA and mRNA sequencing and bioinformatic analysis on 18 cystic and 18 fusiform CBD samples. RESULTS: We identified differentially expressed mRNAs and lncRNAs between the two types of CBD, and constructed coexpression modules that correlated with clinical characteristics of CBD using weighted gene coexpression network analysis. We found that the brown module was the highest positive correlation with fusiform CBD (R = 0.67, p = 7.9e-6) and contained the most genes. We then built a lncRNA-mRNA coexpression network to identify potential target genes of lncRNAs in CBD, and a protein-protein interaction network to investigate the hub genes from the target genes and the brown module. Finally, we performed enrichment analyses and found differences between cystic and fusiform CBD in hepatobiliary system development, liver and pancreas development involving hub genes ONECUT1 and HNF1B that could be regulated by corresponding lncRNAs. CONCLUSION: Our study suggests that lncRNAs may modulate pancreaticobiliary duct development differently in cystic and fusiform CBD, providing new insights for etiology studies and clinical treatment.

Corrigendum: Molecular characteristics of choledochal cysts in children: transcriptome sequencing.

[This corrects the article DOI: 10.3389/fgene.2021.709340.].

Crash proximity and equivalent property damage calculation techniques: An investigation using a novel horizontal curve dataset.

Despite the numerous breakthroughs in crash analytics, there remains a lack of consensus among safety practitioners as to the optimal method for locating high crash locations. Two critical components in the traffic safety analysis process not agreed upon are 1) how the crash distance to a target location is included in the analysis and 2) how crashes are weighted based on crash-related characteristics. For example, the commonly used buffering technique to determine which crashes are associated with a specific target road segment does not associate crashes that are closer to a target road segment with any additional weight, even though it is likely to be more greatly associated with the characteristics of the target location. Additionally, the commonly used equivalent property damage only (EPDO) crash weight method has been found to weigh fatal crashes significantly more than serious injury crashes, even if the difference between the two outcomes was a single factor. This study proposes more robust crash weighting techniques for use in high-risk location identification using an application of a novel horizontal curve dataset. Specifically, a heteroscedastic censored regression approach was used to investigate the impact of different crash proximity weighting techniques and crash severity weighting methods on model outcomes. The results demonstrate that the use of a linear distance weighting factor used in conjunction with the buffering technique as well as a less precise EPDO weighting factor method results in more robust safety analysis outcomes. The improved results have the potential to improve hot spot identification and resource allocation at both the federal and regional levels by employing models that more accurately link specific crash segments with contributing crash characteristics.

Investigating the effectiveness of safety countermeasures at highway-rail at-grade crossings using a competing risk model.

INTRODUCTION: Highway-rail at-grade crossings (HRGCs) are critical locations where a railway and a roadway intersect with one another. Crashes at those locations often result in fatalities and economic and social damages due to the impacts on both road and rail users. The main purpose of countermeasures at HRGCs is to permit safe and efficient rail and highway operations. METHOD: Countermeasures at highway-rail grade crossings (HRGCs) considered in this study include all traffic control devices and other warning and barrier devices at or on approaches to crossings. In general, active devices are commonly accepted as more effective countermeasures than passive devices. However, many of the previous effectiveness studies are either at the project level or were conducted without considering the before-improvement condition. This study focuses on the network-level marginal effectiveness of countermeasures on crash rate and severity levels during the 29-year study period from 1990 to 2018 by fully considering before-improvement control levels. A competing risk model (CRM) is able to accommodate the competing nature of crash severities as multiple outcomes from the same event of interest, which is crash occurrence in this study. Subsequently, CRM is used in this study as an integrated one-step estimation approach that investigates both crash frequency and severity likelihood over time. RESULTS: The study findings indicate that adding audible devices to crossings already equipped with gates will result in a considerable annual decline in crash occurrence likelihood (0.25%). The same device installed at crossings already controlled by gates and flashing lights results in less reduction in crash occurrence likelihood of 0.14%. Moreover, adding a stop sign to the active crossing controls of gates, standard flashing lights, and audible devices will lead to a decrease in the probability of crash occurrence and severe crashes (injury and fatal). However, adding stop signs to crossings equipped only with crossbucks will increase the crash occurrence.

Preliminary Experiences With Robot-Assisted Choledochal Cyst Excision Using the Da Vinci Surgical System in Children Below the Age of One.

The purpose of this study is to introduce our preliminary experiences with using the da Vinci surgical system to treat choledochal cysts in children under 1 year old and discuss the application of this robot-assisted surgery. We retrospectively analyzed all available clinical data of children below the age of 1 who underwent surgery for choledochal cysts using the da Vinci robotic surgical system between January 2015 and December 2020. Data collection mainly included demographic information, imaging data, perioperative details, and postoperative outcomes. Ten patients were included in this study. The average patient age was 8.5 months, and the average weight was 9.11 kg. Half of these patients suffered from abdominal pain, while 30% exhibited vomiting and 10% jaundice. Eight of them were type Ia, and two were Ic. The average operation time among the patients was 219.5 min. None of the 10 patients had to receive a blood transfusion or conversion. The average time of the patients' subsequent fluid diet was 3.28 days, and the solid diet was 3.76 days. Meanwhile, the average length of hospital stay was 7.6 days. All 10 patients recovered and were eventually discharged. We believe that the da Vinci surgical system is a safe and feasible form of treatment for choledochal cysts in children <1 year old.

Molecular Characteristics of Choledochal Cysts in Children: Transcriptome Sequencing.

A choledochal cyst (CC) is a common congenital biliary disease in children, yet the underlying molecular bases for the cystic and fusiform clinical subtypes are unknown. RNA sequencing (RNA-seq) has been performed on 22 high-quality CC samples, including 12 cystic CC and 10 fusiform CC samples, to search for molecular features. Weighted gene co-expression network analysis (WGCNA) was performed to identify key modules associated with clinical subtypes. Bioinformatic analyses were conducted to elucidate potential mechanisms. Then, we constructed protein-protein interaction (PPI) networks to identify candidate hub genes related to CC. Finally, we used the support vector machine (SVM) to eliminate redundant features and screen out the hub genes. The selected gene expression was determined in CC patients through quantitative real-time polymerase chain reaction (PCR). A total of 6,463 genes were found to be aberrantly expressed between cystic CC and fusiform CC. Twelve co-expression modules that correlated with clinical subtypes of CC were identified and assigned representative colors. Among the 12 modules, the blue module was considered the key module. Two functionally distinct sets of dysregulated genes have been identified in two major subtypes, metabolism-related genes in cystic CC and immune-related genes in fusiform CC. A total of 20 candidate hub genes that were correlated with clinical subtypes were found in the blue module. In addition, we found ERBB2 and WNT11 that have not been studied in CC and verified their differential expression in CC through quantitative real-time PCR experiments. For the first time, we have described the transcriptome characteristics of CC. These results suggest that cystic CC and fusiform CC have different molecular mechanisms. The bi-omics-identified novel candidate genes and pathways might be helpful for personalized treatment and are of great clinical significance for CC.