Association of Sociodemographic Factors with Surgical Management of Hepatoblastoma and Hepatocellular Carcinoma in Children.

OBJECTIVE: To evaluate for disparities in surgical care among US children with hepatoblastoma (HB) and hepatocellular carcinoma (HCC). STUDY DESIGN: In this retrospective National Cancer Database study (2004-2015), children aged <18 years with HB or HCC were included. Multivariable mixed-effects logistic regression was used to evaluate the association of sociodemographic factors (age, sex, race and ethnicity, insurance status, income, proximity to treating hospital) with the odds of undergoing surgical treatment after adjusting for disease-related factors (tumor size, metastasis, comorbidities) and hospital-level effects. Subgroup analyses by tumor histology were performed. RESULTS: A total of 811 children were included (HB: 80.9%; HCC: 19.1%), of which 610 (75.2%) underwent surgical treatment. Following adjustment, decreased odds of undergoing surgical treatment were associated with Black race (OR: 0.46 vs White, 95% CI [95% CI]: 0.26-0.80, P = .01), and having Medicaid (OR: 0.58 vs private, 95% CI: 0.38-0.88, P = .01) or no insurance (OR: 0.33 vs private, 95% CI: 0.13-0.80, P = .02). In children with HB, Black race was associated with decreased odds of undergoing surgical treatment (OR: 0.47 vs White, 95% CI: 0.25-0.89, P = .02). In children with HCC, Medicaid (OR: 0.10 vs private, 95% CI: 0.03-0.35, P < .001), or no insurance status (OR: 0.10 vs private, 95% CI: 0.01-0.83, P = .03) were associated with decreased odds of undergoing surgical treatment. Other than metastatic disease, no additional factors were associated with likelihood of surgical treatment in any group. CONCLUSIONS: Black race and having Medicaid or no insurance are independently associated with decreased odds of surgical treatment in children with HB and HCC, respectively. These children may be less likely to undergo curative surgery for their liver cancer.

Multi-institutional assessment of the prevalence of neuroendocrine tumors in children undergoing laparoscopic appendectomy for acute appendicitis in the United States.

As non-operative management of acute appendicitis in children has become more common, missed incidental appendiceal pathology can be an unintended consequence. We assessed the prevalence of neuroendocrine tumors in appendectomy specimens from eight US children's hospitals from 2012 to 2021. The prevalence of neuroendocrine tumors (NET) was found to be 1:271, with a median age of 14 years and 62% female. Most tumors were small (median 6 mm; interquartile range [IQR]: 3-10), and no recurrence was noted during the follow-up period (median 22.5 months; IQR: 3-53). The possibility of delayed diagnosis of these tumors should be part of the discussion for non-operative management of pediatric acute appendicitis.

STEP improves long-term survival for pediatric short bowel syndrome patients: A Markov decision analysis.

INTRODUCTION: Increasingly, for pediatric patients with short bowel syndrome (SBS), intestinal lengthening procedures such as serial transverse enteroplasty (STEP) are being offered with the hope of improving patients' chances for achieving enteral autonomy. However, it remains unclear to what extent STEP reduces the long-term need for intestinal transplant or improves survival. METHODS: Based on existing literature, a decision analytic Markov state transition model was created to simulate the life of 1,000 pediatric SBS patients. Two simulations were modeled: 1) No STEP: patients were listed for transplant once medical management failed and 2) STEP: patients underwent STEP therapy and subsequent transplant listing if enteral autonomy was not achieved. Sensitivity analysis of small bowel length and anatomy was completed. Base case patients were defined as neonates with a small bowel length of 30cm. RESULTS: For base case patients with an ostomy and a NEC SBS etiology, STEP was associated with increased rates of enteral autonomy after 10 years for patients with an ICV (53.9% [STEP] vs. 51.1% [No STEP]) and without an ICV (43.4% [STEP] vs. 36.3% [No STEP]). Transplantation rates were also reduced following STEP therapy for both ICV (17.5% [STEP] vs. 18.2% [No STEP]) and non-ICV patients (20.2% [STEP] vs. 22.1% [No STEP]). 10-year survival was the highest in the (+) STEP and (+) ICV group (85.4%) and lowest in the (-) STEP and (-) ICV group (83.3%). CONCLUSIONS: For SBS patients, according to our model, STEP increases rates of enteral autonomy, reduces need for intestinal transplantation, and improves long-term survival. TYPE OF STUDY: Economic/Decision Analysis or Modeling Studies LEVEL OF EVIDENCE: Level III.

Filling the gap: Objective data to guide pediatric surgery applicants who do not match on the first attempt.

PURPOSE: Acquiring a pediatric surgery fellowship is an arduous process, with less than half of applicants matching each year. For those who fail to match initially but remain steadfast in their goal to become a pediatric surgeon, choosing a valuable postresidency path can be challenging. Furthermore, objective data to evaluate the utility of pediatric surgical subspecialty fellowships (PSSF) are lacking. METHODS: PSSF training programs were identified on the APSA website. Names and contact information of PSSF graduates between 2014 and 2018 were obtained from individual training programs. Each graduated fellow was then contacted to participate in a voluntary 14-question survey. RESULTS: Names of 47 graduated fellows were obtained from programs listed on the APSA website. Among them, 30 (64%) ultimately matriculated into a pediatric surgery fellowship, 11 (37%) of whom matched at the same institution they completed their PSSF. The type of PSSF was not predictive of matriculation into a pediatric surgical fellowship (p = 0.43). Thirty-two (68%) of the 47 study participants completed a satisfaction survey. While all but two graduates found their fellowships to be at least satisfactory, those who matched were more likely to recommend their PSSF compared to those who did not (100% vs 67%, respectively, p = 0.02). Within the cohort of fellows who did not ultimately match into pediatric surgery (n = 17) and completed a survey (n = 9), all who completed a critical care fellowship (4/4) currently use/or plan to use the skills obtained during their PSSF while only two of five (40%) completing other PSSFs use them. CONCLUSION: The matriculation rate from a PSSF into a pediatric surgery fellowship was 64% with no significant difference among subspecialties. Of fellows who did not match, those completing a critical care PSSF were more likely to use their fellowship training than those completing a different PSSF. TYPE OF STUDY: Clinical research paper. LEVEL OF EVIDENCE: III.

Development of a targeted adductomic method for the determination of polycyclic aromatic hydrocarbon DNA adducts using online column-switching liquid chromatography/tandem mass spectrometry.

Human exposure to polycyclic aromatic hydrocarbons (PAHs) from sources such as industrial or urban air pollution, tobacco smoke and cooked food is not confined to a single compound, but instead to mixtures of different PAHs. The interaction of different PAHs may lead to additive, synergistic or antagonistic effects in terms of DNA adduct formation and carcinogenic activity resulting from changes in metabolic activation to reactive intermediates and DNA repair. The development of a targeted DNA adductomic approach using liquid chromatography/tandem mass spectrometry (LC/MS/MS) incorporating software-based peak picking and integration for the assessment of exposure to mixtures of PAHs is described. For method development PAH-modified DNA samples were obtained by reaction of the anti-dihydrodiol epoxide metabolites of benzo[a]pyrene, benzo[b]fluoranthene, dibenzo[a,l]pyrene (DB[a,l]P) and dibenz[a,h]anthracene with calf thymus DNA in vitro and enzymatically hydrolysed to 2'-deoxynucleosides. Positive LC/electrospray ionisation (ESI)-MS/MS collision-induced dissociation product ion spectra data showed that the majority of adducts displayed a common fragmentation for the neutral loss of 116 u (2'-deoxyribose) resulting in a major product ion derived from the adducted base. The exception was the DB[a,l]P dihydrodiol epoxide adduct of 2'-deoxyadenosine which resulted in major product ions derived from the PAH moiety being detected. Specific detection of mixtures of PAH-adducted 2'-deoxynucleosides was achieved using online column-switching LC/MS/MS in conjunction with selected reaction monitoring (SRM) of the [M+H](+) to [M+H-116](+) transition plus product ions derived from the PAH moiety for improved sensitivity of detection and a comparison was made to detection by constant neutral loss scanning. In conclusion, different PAH DNA adducts were detected by employing SRM [M+H-116](+) transitions or constant neutral loss scanning. However, for improved sensitivity of detection optimised SRM transitions relating to the PAH moiety product ions are required for certain PAH DNA adducts for the development of targeted DNA adductomic methods.

Assessment of knowledge and practice of high risk sexual behavior at a private Midwestern University.

In the United States, an estimated 15.3 million new cases of sexually transmitted infections (STIs) occur each year. Approximately two-thirds of people who acquire STIs in the U.S. are younger than 25 years of age. In addition, approximately 57% (3.1 million) of all pregnancies in the United States are classified as unintended. It is only logical that the consequences of high-risk sexual behavior (unintended pregnancy and contraction of an STI) would most affect those who exhibit high-risk sexual behavior. Thus, one would expect to find high-risk sexual behavior in the same populations that have high rates of STIs and unintended pregnancy. The purpose of this study was to survey freshman students living in the residence halls at a local college to assess their knowledge and the prevalence of high-risk sexual behavior, and give feedback to the participating institution about these results. The survey was designed to answer two questions: (1) What is the current level of high-risk sexual behavior at a small private Midwestern College? (2) What is the current level of knowledge about high-risk sexual behaviors of those surveyed? A total of 38 men and 131 women participated in the survey. Forty-seven percent of men and 41% of women respondents reported having sexual intercourse at least once in their lifetimes. Of those respondents who were sexually active, 67% of men and 54% of women reported that they "always use a condom" with sexual activity. Fifty-six percent of men and 51% of women that were sexually active reported that they were "not at all concerned" about contracting an STI. Twenty-two percent of men and 17% of women answered that they were "not at all concerned" about pregnancy. Three true/false questions about STIs were answered correctly over 95% of the time by those surveyed. Seventy-nine percent of respondents reported never having attended educational opportunities about STIs and safe sexual practices at the college.