Physio-Biochemical, Anatomical, and Molecular Analysis of Resistant and Susceptible Wheat Cultivars Infected with TTKSK, TTKST, and TTTSK Novel Puccinia graminis Races.

Stem rust, caused by Puccinia graminis f.sp. tritici, is one of the most dangerous rust diseases on wheat. Through physiological, biochemical, and molecular analysis, the relationship between the change in resistance of 15 wheat cultivars to stem rust disease and the response of 41 stem rust resistance genes (Sr,s) as well as TTKSK, TTKST, and TTTSK races was explained. Some cultivars and Sr genes, such as Gemmeiza-9, Gemmeiza-11, Sids-13, Sakha-94, Misr-1, Misr-2, Sr31, and Sr38, became susceptible to infection. Other new cultivars include Mir-3 and Sakha-95, and Sr genes 13, 37, 40, GT, and FR*2/SRTT3-SRTT3-SR10 remain resistant. Some resistance genes have been identified in these resistant cultivars: Sr2, Sr13, Sr24, Sr36, and Sr40. Sr31 was not detected in any cultivars. Reactive oxygen species such as hydrogen peroxide and superoxide, enzymes activities (catalase, peroxidase, and polyphenoloxidase), and electrolyte leakage were increased in the highly susceptible cultivars, while they decreased in the resistant ones. Anatomical characteristics such as the thickness of the epidermis, ground tissue, phloem tissue and vascular bundle diameter in the midrib were decreased in susceptible cultivars compared with resistant cultivars. Our results indicated that some races (TTKSK, TTKST, and TTTSK) appeared for the first time in Egypt and many other countries, which broke the resistant cultivars. The wheat rust breeding program must rely on land races and pyramiding genes in order to develop new resistance genes that will survive for a very long time.

Assessing the toxicity of pesticides exposure on hepatic miRNA-target gene alterations in rat liver tissues via molecular and integrated network bioinformatics analysis.

The prevalent use of pesticides, including pirimiphos-methyl (PPM) and bifenthrin (BF), poses a serious health risk, particularly to workers who encounter these chemicals daily. Despite the recognized hepatotoxic effects, the specific molecular mechanisms, especially those involving miRNAs in liver damage caused by PPM and BF, are not fully elucidated. Prior studies have not exhaustively analyzed the hepatic miRNA-target gene dynamics following exposure to these pesticides; thus, this research aims to fill that gap through an extensive miRNA analysis to discern their regulation in PPM or BF-induced hepatic toxicity. In this study, male Sprague-Dawley rats were exposed to BF or PPM for 28 days through oral gavage, simulating the chronic exposure faced by humans. We conducted a thorough assessment of the hepatotoxicity induced by PPM and BF, employing multiple evaluation levels, including histological analysis, liver enzyme measurements, and real-time PCR to detect changes in hepatic miRNA-target gene expressions. Additionally, we utilized DIANA-miRPath prediction tools to delineate the functional implications of these hepatic miRNA target genes. Our findings reveal a significant modulation in the expression of rno-miR-155-5p and rno-miR-122-5p, along with their target genes, following PPM and BF treatment. In contrast, rno-miR-21-5p levels remained unaltered. These observations suggest potential utility of these specific hepatic miRNAs as biomarkers for liver injury resulting from pesticide exposure. Subsequent GO enrichment analysis linked target genes to functions like molecular activity, protein binding, and cellular processes. Additionally, KEGG pathway analysis showed these genes, influenced by varied miRNA expressions, play significant roles in metabolic and signaling pathways In conclusion, this study enhances our comprehension of the biological roles of miRNAs in hepatic toxicity induced by PPM and BF. The insights gained here not only shed light on molecular mechanisms but also open avenues for considering these miRNAs as potential diagnostic biomarkers in conditions of pesticide-induced hepatotoxicity, thereby guiding future therapeutic strategies.

Exogenous application of nano-silicon, potassium sulfate, or proline enhances physiological parameters, antioxidant enzyme activities, and agronomic traits of diverse rice genotypes under water deficit conditions.

Water deficit is a critical obstacle that devastatingly impacts rice production, particularly in arid regions under current climatic fluctuations. Accordingly, it is decisive to reinforce the drought tolerance of rice by employing sustainable approaches to enhance global food security. The present study aimed at exploring the effect of exogenous application using different biostimulants on physiological, morphological, and yield attributes of diverse rice genotypes under water deficit and well-watered conditions in 2-year field trial. Three diverse rice genotypes (IRAT-112, Giza-178, and IR-64) were evaluated under well-watered (14400 m3/ha in total for the entire season) and water deficit (9170 m3/ha) conditions and were exogenously sprayed by nano-silicon, potassium sulfate, or proline. The results showed that drought stress substantially decreased all studied photosynthetic pigments, growth traits, and yield attributes compared to well-watered conditions. In contrast, antioxidant enzyme activities and osmoprotectants were considerably increased compared with those under well-watered conditions. However, the foliar application of nano-silicon, potassium sulfate, and proline substantially mitigated the deleterious effects of drought stress and markedly enhanced photosynthetic pigments, antioxidant enzyme activities, growth parameters, and yield contributing traits compared to untreated stressed control. Among the assessed treatments, foliar spray with nano-silicon or proline was more effective in promoting drought tolerance. The exogenous application of proline improved chlorophyll a, chlorophyll b, and carotenoids by 21.4, 19.6 and 21.0% followed by nano-silicon treatment, which enhanced chlorophyll a, chlorophyll b, and carotenoids by 21.1, 17.6 and 9.5% compared to untreated control. Besides, the application of proline demonstrated a superior improvement in the content of proline by 52.5% compared with the untreated control. Moreover, nano-silicon exhibited the maximum enhancement of catalase and peroxidase activity compared to the other treatments. The positive impacts of applied exogenously nano-silicon or proline significantly increased panicle length, number of panicles/plant, number of grains/panicle, fertility percentage, 1000-grain weight, panicle weight, and grain yield, compared to untreated plants under water deficit conditions. In addition, the physiological and agronomic performance of evaluated rice genotypes significantly contrasted under drought conditions. The genotype Giza-178 displayed the best performance under water deficit conditions compared with the other genotypes. Consequently, the integration of applied exogenously nano-silicon or proline with tolerant rice genotype as Giza-178 is an efficient approach to ameliorating drought tolerance and achieving agricultural sustainability under water-scarce conditions in arid environments.

Prelacrimal Recess Approach in Unilateral Maxillary Sinus Lesions: What Is the Impact and Efficacy?

Background and Objectives: Chronic sinusitis is a commonly encountered diagnosis for otorhinolaryngologists. The profound negative effect of rhinosinusitis on patients' quality of life is frequently overlooked, and surgical lines of treatment are numerous. The aim of the study was to assess the comparative efficacy of endoscopic middle meatal antrostomy with the endoscopic prelacrimal recess approach, combined with middle meatal antrostomy in the treatment of unilateral chronic maxillary sinus lesion. Materials and Methods: Thirty patients with unilateral chronic maxillary sinus lesions enrolled in the study at Alahsa hospital. Patients were divided into two groups: 15 treated through a middle meatal antrostomy and 15 treated via a combined middle meatal antrostomy and prelacrimal recess approach. Demographic and clinical information of the patients, including the medical history, CT scan findings, diagnosis, recurrence, and complications, were gathered and analyzed. Pre- and postoperative clinical findings were graded utilizing the Lund-Kennedy Endoscopic Scoring System. Results: The enrolled patients varied in age from 18 to 56, with 60% being male and 40% being female. Antrochoanal polyp, maxillary sinus mucocele, and unilateral allergic fungal sinusitis were among the pathological diagnoses. The follow-up period averaged 14.3 months. Following surgery, two patients in Group II encountered nasal discomfort, which included synechia and epiphora. The success rate for preserving a patient's disease-free condition was 86.7%. A statistically significant difference in disease-free incidence was observed among the patients in group II. In group I, recurrence was identified in 26.7% of the patients. The postoperative symptoms diminished considerably, and the VAS score was reduced substantially. In Group II patients, however, there was no significant difference in scarring. Clinically significant differences were observed in the mean total Lund-Kennedy Endoscopic scores when compared to their preoperative values. Conclusions: Achieving endoscopic access to the sinus's anterior, lateral, inferior, and inferomedial regions is facilitated by operating via the prelacrimal recess, which is the most advantageous approach. This approach facilitates rapid mucosal healing by maintaining the integrity of the nasolacrimal duct and mucosal covering. The specific pathology, surgical objectives, surgeon expertise, and equipment accessibility influence the choice of endoscopic surgical technique.

How to Differentiate between Resistant and Susceptible Wheat Cultivars for Leaf Rust Fungi Using Antioxidant Enzymes and Histological and Molecular Studies?

Eight wheat cultivars, Sakha-94, Giza-171, Sids-1, Sids-12, Sids-13, Shandweel-1, Misr-1, and Misr-2, were evaluated for leaf rust at the seedling and adult stages in the 2021 and 2022 seasons. Biochemical, histological, and genetic analyses were performed to determine the link between cultivars that were either sensitive or resistant to the disease. Misr-2 and Giza-171 cultivars had the highest levels of resistance to leaf rust races in 2021 (LTCGT, STSJT, and TTTST) and 2022 (MBGJT, TTTKS, and TTTTT) at the seedling stage. However, at the adult stage, Sakha-94, Giza-171, Misr-1, and Misr-2 cultivars had the highest levels of resistance; consequently, they had the lowest final disease severity and the lowest values of AUDPC. The correlation between the seedling reaction and adult reaction was non-significant, with values of 0.4401 and 0.4793 in the 2021 and 2022 seasons, respectively. Throughout the biochemical, histological, and genetic analyses, it was observed that catalase, peroxidase, and polyphenol oxidase activities significantly increased in the resistant cultivars. The discoloration of superoxide (O2-) and hydrogen peroxide (H2O2) significantly decreased in resistant and moderately resistant wheat cultivars (Sakha-94, Giza-171, Misr-1, and Misr-2); higher hydrogen peroxide (H2O2) and superoxide (O2-) levels were recorded for the susceptible cultivars compared to the resistant cultivars. Molecular markers proved that the Lr50 gene was detected in the resistant cultivars. Puccinia triticina infections negatively affected most histological characteristics of flag leaves, especially in susceptible cultivars. The thickness of the blade (µ), the thickness of the upper and lower epidermis (UE and LE), the thickness of mesophyll tissue (MT), and bundle length and width in the midrib were decreased in susceptible cultivars such as Sids-1, Sids-13, and Shandwel-1 compared with resistant cultivars.

Alterations in Inflammatory Markers and Cognitive Ability after Treatment of Pediatric Obstructive Sleep Apnea.

Background and Objectives: Determination of the impact of obstructive sleep apnea (OSA) on the cognitive function (CF), and serum tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and 1ß levels and the effect of OSA management on these variables in children. Materials and Methods: A total of 224 patients were evaluated using the Pediatric Sleep Questionnaire, the NEPSY score for CF, and polysomnography (PSG) to grade OSA severity according to the apnea/hypopnea index (AHI). Adentonsillectomy (AT) was performed for patients with adenotonsillar hypertrophy grade > 2. Patients with overweight or obesity with mild or moderate OSAS underwent a 6-month protocol of lifestyle intervention (LSI). Blood samples were obtained for an enzyme-linked immunosorbent assay (ELISA) estimation of cytokine levels. All variables were re-evaluated at the end of the 6-month follow-up period. Results: A total of 181 patients had surgical interference and 43 patients underwent a LSI trial; 15 patients failed to respond and underwent surgery. At the end of the follow-up, 33 patients had residual OSAS with a significantly higher incidence among patients with severe OSAS, the mean score of the pediatric sleep questionnaire was significantly decreased in all patients, 181 patients showed an improved NESPY score, and cytokine levels were decreased. The baseline NESPY score, AHI index and sleep questionnaire score were negatively correlated. The percentage of change in the NESPY score and serum cytokine levels showed a positive correlation. Conclusions: OSAS is associated with cognitive dysfunction that significantly improves after adenotonsillectomy. LSI as a therapeutic line is satisfactory for children with mild OSAS and minimal cognitive dysfunction and is of value preoperatively to improve the surgical outcomes of AT.

Variations in Polysomnographic Indices of Obstructive Sleep Apnea following Lingual Tonsil Hypertrophy Excision: Is the Difference Significant?

Background and Objectives: Obstructive sleep apnea (OSA) is a sleep-related respiratory disorder that affects between 5% and 20% of the population. In obstructive sleep apnea, lingual tonsillar hypertrophy (LTH) has been suggested as a contributing factor to airway blockage. Objectives: The aim of this work is to demonstrate the polysomnographic indices and their values in OSA patients with LTH before and after the surgical intervention. Materials and Methods: The study was conducted on eighteen patients endoscopically diagnosed as having LTH, with the main complaints being snoring, sleep apnea, and/or sleep disturbance. Clinical examination, grading of LTH, body mass index (BMI), endoscopic assessment using Muller's maneuver, and sleep endoscopy were recorded for all patients. The Epworth Sleepiness Scale (ESS) and overnight sleep polysomnography (PSG) were conducted before and after the surgical removal of LTH. All data were submitted for statistical analysis. Results: The mean ± SD of the AHI decreased from 33.89 ± 26.8 to 20.9 ± 19.14 postoperatively, and this decrease was of insignificant statistical value. The average SpO2 (%) mean ± SD was 91.14 ± 5.96, while the mean ± SD of the desaturation index was 34.64 ± 34.2. Following surgery, these indices changed to 96.5 ± 1.47 and 9.36 ± 7.58, respectively. The mean ± SD of the ESS was changed after the surgery, from 17.27 ± 6.48 to 7.16 ± 3.56. The mean ± SD of sleep efficacy was 71.2 ± 16.8 and the snoring index mean ± SD was 277.6 ± 192.37, and both improved postoperatively, to become 88.17 ± 9.1 and 62.167 ± 40.01, respectively. Conclusions: The AHI after lingual tonsillectomy showed no statistically significant change. The changes in the average SpO2 (%), desaturation index, sleep efficiency, snoring index, and Epworth Sleepiness Scale following the surgery were statistically significant.

Bacillus thuringiensis and Silicon Modulate Antioxidant Metabolism and Improve the Physiological Traits to Confer Salt Tolerance in Lettuce.

We investigated the impact of Bacillus thuringiensis as seed treatment and application with silicon on lettuce plants exposed to salinity levels (4 dS m-1 and 8 dS m-1). Results revealed that leaves number, head weight, total yield, relative water content (RWC), and chlorophyll a and b declined considerably due to two salinity levels. Oxidative stress markers, i.e., hydrogen peroxide (H2O2), superoxide (O2-), and lipid peroxidation (MDA) dramatically augmented in stressed plants. On the other hand, leaves number, total yield, RWC, and chlorophyll a, b in stressed lettuce plants were considerably enhanced because of the application of Si or B. thuringiensis. In contrast, EL%, MDA, and H2O2 were considerably reduced in treated lettuce plants with Si and B. thuringiensis. In addition, the treatment with Si and B. thuringiensis increased head weight (g) and total yield (ton hectare-1), and caused up-regulation of proline and catalase, superoxide dismutase, peroxidase, and polyphenol oxidase activity in lettuce leaves under salinity conditions.

Efficacy of Mushroom Metabolites (Pleurotus ostreatus) as A Natural Product for the Suppression of Broomrape Growth (Orobanche crenata Forsk) in Faba Bean Plants.

Broomrape parasitism on faba bean (Vicia faba L.) is the most destructive factor for this crop in Egypt. Pot experiments were conducted during the two successive seasons 2017/2018 and 2018/2019 to study the mitigation of broomrape stress on faba bean using a ten-fold dilution of 10% (w/v) spent mushroom substrate extract (SMSE) of Pleurotus ostreatus and the same dilution of culture filtrate of mushroom (MCF) grown in potato dextrose broth (PDB) at a rate of 48 l hectare-1 compared with the commercial herbicide Roundup (Glyphosate 48% emulsifiable concentrate) at a rate of 144 cm3 ha-1 on the two varieties (Misr3 and Sakha3) cultivated in broomrape-infested soil. The treatments include the use of mushroom products as foliar spray and/or soil amendment in addition to Roundup spraying as a recommended treatment. Using Gas Chromatography-Mass Spectrometry (GC-MS) spectroscopy, our results indicate that the major components of the two mushroom products were bioactive compounds such as polyphenol and high molecular weight aliphatic and aromatic hydrocarbons that may interfere with parasite and host metabolism. These results indicated that SMSE of P. ostreatus and MCF of the same mushroom grown in potato dextrose broth (PDB) gave the best control of broomrape, and increased plant height, root length, leaf area, chlorophyll concentration, relative water content and seed yield (g plant-1), as well as anatomical characters of leaves in the two faba bean varieties (Misr3 and Sakha3), such as upper and lower epidermis, palisade tissue, spongy tissue and vascular bundles. Additionally, electrolyte leakage was decreased in the treated plants compared to control plants and the plants treated with Roundup (glyphosate) because of the important role of SMSE and MCF in the improvement of faba bean water status.

Biochemical and molecular characterization of non-host resistance keys in food crops.

Generally, under normal conditions plants are resistant to many of the incompatible pathogens (viral, fungal and bacterial), and this is named "non-host resistance phenomenon". To understand this phenomenon, different types of food crops (faba bean, squash, barley and wheat) were inoculated with compatible and incompatible pathogens. Strong resistance symptoms were observed in the non-host/incompatible pathogen combinations as compared with host/compatible pathogen combinations, which showed severe infection (susceptibility). Reactive oxygen species (ROS) mostly hydrogen peroxide and superoxide were significantly increased early 24 and 48 h after inoculation (hai) in the non-host plants comparing to the host. Antioxidant enzymes activity (catalase, polyphenol oxidase and peroxidase) were not increased at the same early time 24, 48 hai in the non-host resistant and host resistant plants, however, it increased later at 72 and 168 hai. Electrolyte leakage decreased significantly in non-host resistant and host resistant/pathogen combinations. Catalase and peroxidase genes were significantly expressed in non-host resistant and in host resistant plants as compared to the host susceptible one, which did not show expression using RT-PCR technique. Furthermore, Yr5, Yr18 and Yr26 resistant genes were identified positively using PCR in all treatments either host susceptible or non-host resistant plants in which prove that no clear role of these resistant genes in resistance. Early accumulation of ROS could have a dual roles, first role is preventing the growth or killing the pathogens early in the non-host, second, stimulating the gene appearance of related genes in addition the activition of antioxidant enzymes later on which thereby, neutralize the harmful effect of ROS and consequently suppressing disease symptoms. The new finding from this study supporting the plant breeders with new source of resistance to develop new resistant cultivars and/or stop the breakdown of resistance in resistant cultivars.

Poor Outcome of Surgical Management of Acute Malfunctioning Mechanical Mitral Valve During Pregnancy. Should Centers with Limited Resources Find Different Options?

BACKGROUND: Rheumatic heart disease (RHD) is the most common cardiac disease in pregnancy in developing countries with the mitral valve being the most affected. In this study, the results of surgical intervention in pregnant women presented with acute malfunctioning mechanical mitral valve were discussed. METHODS: All patients underwent emergency redo mitral valve replacement due to acute malfunctioning mechanical mitral valve during pregnancy in a single center between January 2005 and December 2017. These patients were retrospectively analyzed. Additionally, anticoagulation strategy before the event and outcomes for the mother and the fetus were outlined. RESULTS: Between 2005 and 2017, 16 pregnant women arrived in a single tertiary center with acute malfunctioning mechanical mitral valves. The mean gestational age at the time of presentation was 13.19 ± 2.6 weeks. Fifteen out of the 16 patients changed their anticoagulation regimen either with or without medical advice. After replacing the valve, cardiopulmonary bypass successfully was weaned in 12 patients, who were transferred to the ICU sedated and ventilated with variable doses of chemical Inotropes. The remaining 4 patients died on the table after failure of weaning from bypass. In one case, the patient developed immediate postoperative stroke with the Glasgow Coma Scale (GCS) of 7, CT brain revealed massive infarction, her fetus was not viable, she remained sedated and ventilated, and she passed away on post-operative Day 12, due to pneumonia and sepsis. Another patient, with a viable fetus, passed away on post-operative Day 1, due to low cardiac output. CONCLUSION: Acute malfunctioning MHV during pregnancy represents a real dilemma to patients and caregivers. It carries high fetal and maternal morbidity and mortality, especially in centers with limited resources. We believe that an alternative plane must be formulated for such patients to avoid devastating complications, including maternal and fetal deaths.

Effect of some osmoregulators on photosynthesis, lipid peroxidation, antioxidative capacity, and productivity of barley (Hordeum vulgare L.) under water deficit stress.

Water deficit stress is an abiotic stress that causes reductions in growth and yield of many field crops around the world. The present research was aimed to elucidate the mitigating efficiency of exogenous application of select osmoregulators and biostimulants, i.e., potassium dihydrogen phosphate, actosol® (humic acid), Amino more (amino acids), and Compound fertilizer, applied as a spray that reached both foliage and the soil, on growth characteristics, antioxidant capacity, and productivity of barley (Hordeum vulgare L. Giza123) under water deficit stress during two successive growing seasons of field experiments in Egypt. Water deficit resulted in stress as estimated by stress indicators and decreased growth and poor health and development as reflected in statistically significant decreases in chlorophyll a and b and major nutrient (NPK) levels in tissues, stem length, number of leaves, and fresh and dry mass as well as yield components such as spike length, grains per spike, biological yield, grain yield, and 1000-grain weight. As a response to water deficit stress, reactive oxygen species (ROS, i.e., superoxide and hydrogen peroxide) levels increased significantly resulting in lipid peroxidation and decreased membrane integrity and significant increases in antioxidant enzymes such as catalase (CAT), polyphenol oxidase (PPO), and peroxidase (POX). All four treatments alleviated the detrimental impacts of water deficit stress as evidenced by statistically significantly increased photosynthetic pigment concentration, tissue NPK levels, growth, and yield parameters compared to the water deficit-stressed control, while the stress responses were significantly reduced. The osmoregulators used either partially restored the growth and yield of osmotic-stressed barley plants or certain treatments enhanced them. All osmoregulators tested mitigated the adverse impacts of water deficit stress on barley plants, but the highest induction was found when plants were treated with actosol®. The beneficial effects of the osmoregulators tested were the strongest overall in the order actosol® ˃ potassium dihydrogen phosphate ˃ Amino more ˃ Compound fertilizer.

Variables associated with loss of ileoanal pouches constructed in childhood.

AIMS: To quantify the incidence of loss of an ileoanal pouch in children and to identify variables associated this event. METHODS: Logistic regression of possible explanatory variables: age, sex, indication for procto-colectomy, pre-operative continence status, use of immunosuppressive drugs, open or laparoscopic surgery, number of stages, anastomotic leak, operative complication excluding anastomotic leak, performance of revisional surgery, albumin concentration and platelet count at time of surgery, rank order in series. Univariate logistic regression was used to identify significant variables which were then assessed in a multivariate model and construction of Kaplan-Meier graphs. RESULTS: 103 children, 56 girls, underwent ileoanal pouch at median age 14years (SD 3.7). Indications and mean age were: ulcerative colitis (n=71, 14years), polyposis syndromes (n=13, 15years), chronic idiopathic constipation (n=9, 11years), Hirschsprung's disease (n=4, 1year), Crohn's disease (n=2, 16years), and fibrosing colonopathy (n=2, 11years). 13 patients had their pouch excised or permanently diverted. Three patients had successful revisional pouch surgery. Only pre-operative fecal incontinence and anastomotic leak were significantly associated with pouch excision/diversion, however on multivariate analysis, only fecal incontinence remained significant, odds ratio 21 (95%CI 1.8-235, p=0.01). Pouch survival was significantly worse where there was fecal incontinence pre-operatively, p<0.0001 or an anastomotic leak, p<0.001. CONCLUSIONS: 13% of children subjected to restorative procto-colectomy ultimately receive a permanent ileostomy. Fecal incontinence prior to surgery is a relative contra-indication. Anastomotic leak increases the probability of later pouch excision. LEVEL OF EVIDENCE: IV.

Colonic disease site and perioperative complications predict need for later intestinal interventions following intestinal resection in pediatric Crohn's disease.

INTRODUCTION: We studied variables associated with outcomes following intestinal resection for Crohn's disease. METHODS: A retrospective review of a prospectively maintained single surgeon database was performed. Outcomes evaluated included disease recurrence, need for further resection/dilatation, and complications. Explanatory variables included: anatomical region of resection, open or laparoscopic approach, surgical procedure, technique of anastomosis, number of anastomoses, use of biological therapy, resection margin disease, age at resection, and period (quartile) in series. RESULTS: 81 children had 100 resections at a median age 14.5years with a median follow-up of 7.7years. Overall complication rate was 22%. Of the 77 children with no prior resection, 40 (52%) had disease recurrence, and 24 (31%) underwent further resection or dilatation. None of the explanatory variables predicted complications. Disease recurrence was significantly associated with younger age at first resection but not duration of follow-up. The probability of further intestinal intervention was strongly associated with disease site and complications. Odds ratio for further surgery for colonic disease site compared to ileocecal disease site was 7 (95% CI 1.8-26; P=0.004). Odds ratio for further intestinal resection following surgery where a complication had occurred compared to no complication was 3.4 (95% CI 1.1-10.3; P=0.02. Both disease site and complication status also significantly affected the interval to further surgery. CONCLUSIONS: The probability of requiring a second intestinal intervention for pediatric Crohn's disease is related to the disease site and the complication status.

A surgical approach to Wilms' tumour with retrohepatic vena caval extension.

PURPOSE: Wilms' tumours (WT) with retrohepatic vascular extension traditionally requires cardiac bypass for complete excision. We share our experience of these complex cases. METHODS: A retrospective review was performed of children with WT with retrohepatic vascular extension presenting to two UK children's hospitals. Tumour stage, chemotherapy, level of vascular extension, operative details and complication data were analysed. RESULTS: Ten children were identified. Mean age 6.6 years (range 3.3-8.2 years); tumour side 6 right, 2 left, 2 bilateral. Level of tumour extension was to the right atrium in two, diaphragm in two, hepatic vein (HV) level in four and retrohepatic inferior vena cava (IVC) in one patient. Following chemotherapy it reduced to hepatic veins (5) or below (4). Surgery involved radical nephrectomy and complete mobilisation of the liver off the IVC, which was then clamped, opened and the thrombus excised. There were no intraoperative complications. Mean hospital stay was 9.77 days (7-20 days). Histology showed viable tumour thrombus in six patients. One patient died after 1 year from metastatic disease. CONCLUSION: Retrohepatic extension of WT can be managed without bypass using pre-operative chemotherapy and by complete liver mobilisation. The tumour was always adherent to IVC and required sharp dissection.