Multivariate Interaction Analysis of Zea mays L. Genotypes Growth Productivity in Different Environmental Conditions.

Evaluating maize genotypes under different conditions is important for identifying which genotypes combine stability with high yield potential. The aim of this study was to assess stability and the effect of the genotype-environment interaction (GEI) on the grain yield traits of four maize genotypes grown in field trials; one control trial without nitrogen, and three applying different levels of nitrogen (0, 70, 140, and 210 kg ha-1, respectively). Across two growing seasons, both the phenotypic variability and GEI for yield traits over four maize genotypes (P0725, P9889, P9757 and P9074) grown in four different fertilization treatments were studied. The additive main effects and multiplicative interaction (AMMI) models were used to estimate the GEI. The results revealed that genotype and environmental effects, such as the GEI effect, significantly influenced yield, as well as revealing that maize genotypes responded differently to different conditions and fertilization measures. An analysis of the GEI using the IPCA (interaction principal components) analysis method showed the statistical significance of the first source of variation, IPCA1. As the main component, IPCA1 explained 74.6% of GEI variation in maize yield. Genotype G3, with a mean grain yield of 10.6 t ha-1, was found to be the most stable and adaptable to all environments in both seasons, while genotype G1 was found to be unstable, following its specific adaptation to the environments.

Multifocal Infantile Hemangioma - Presentation of 4 Cases and Review of the Selected Literature.

BACKGROUND: Multifocal infantile hemangiomas (IHs) are focal cutaneous lesions affecting more than 1 anatomic site. The multifocal distribution pattern is the rarest form of IH manifestation, accounting for only 3-4% of all affected infants. This type of cutaneous IHs may be a marker for extracutaneous disease, with the liver being the most frequently affected organ. METHODS: We investigated the clinical and epidemiological characteristics of a small case series of infants with multifocal IHs presenting with different clinical patterns, all diagnosed and treated in a regional tertiary-care pediatric clinic. RESULTS: Four infants with multifocal IHs were included in the analysis. There were 3 girls and 1 boy. Three out of 4 infants were prematurely born (2 of them very preterm), while only 1 was full-term. Clinical patterns in all cases were quite different, but more than 20 cutaneous IHs were present in each of the patients. Two infants had multifocal liver hemangioma, but without complications. In 3 out of 4 patients, systemic propranolol therapy was introduced, with excellent response in two cases (both with liver involvement). CONCLUSION: With the increase in the number of cutaneous IHs, the probability of internal organ involvement, most often the liver, also increases. Evaluation for extracutaneous lesions is indicated in infants with 5 or more cutaneous IHs. Treatment of infants with multifocal IHs should be individualized and consider all relevant risk factors, including prematurity.

Thyroid Surgery in Children: A 5-Year Retrospective Study at a Single Paediatric Surgical Center and Systematic Review.

The aim of this study was to analyse and evaluate our 5-year experience in paediatric thyroid surgery, as well as the specificities of this kind of surgery in the literature. This retrospective study was based on 19 operations in 17 patients aged from 5 to 17 years who were operated on due to thyroid pathology from 2017 until 2022. We presented data on surgical procedures and complications following surgery. Most of the patients were adolescent girls. The most common clinical presentations included enlarged thyroid gland, followed by thyroid nodules and hyperthyroidism. Eight total thyroidectomies, five left lobectomies, five right lobectomies, and three central neck dissections were performed. The most common histopathological diagnosis was hyperplastic diffuse colloid goitre, followed by papillary carcinoma, cystic nodule, follicular adenoma, Hashimoto thyroiditis and toxic adenoma. Postoperative course was uneventful, with four mild complications (one wound infection, one manifest hypocalcaemia, and two transitory recurrent laryngeal nerve paralysis). In our literature review, eighteen full-text articles were included and analysed. This study demonstrated that thyroid surgery in paediatric population is a safe and efficient procedure. Thyroid pathology in children significantly differs from that in the adults, and paediatric surgeons should be included into the team managing such cases.

Comparison of the Standard vs. Thoracoscopic Extrapleural Modification of the Nuss Procedure-Two Centers' Experiences.

Pectus excavatum is the most common congenital anterior chest wall deformity, with an incidence of 1:400 to 1:1000. Surgical strategy has evolved with the revolutionary idea of Donald Nuss, who was a pioneer in the operative correction of this deformity using minimally invasive surgery. The aim of this paper is to compare the preliminary results of pectus excavatum repair in two University Centers with a moderate number of patients using the standard Nuss procedure and its modification, the extrapleural thoracoscopic approach. The statistical analysis showed no significant difference for the patient's age (14.52 ± 3.70 vs. 14.57 ± 1.86; p = 0.95) and the CT Haller index (4.17 ± 1.58 vs. 3.78 ± 0.95; p = 0.32). A statistically significant difference was noted for the duration of a pectus bar implant (2.16 ± 0.24 vs. 2.48 ± 0.68; p = 0.03) between the Maribor and Novi Sad Center. We report 14 complications (28%), including dislocation of the pectus bar (10%), pleural effusion (8%), wound inflammation (6%), pericarditis (2%) and an allergic reaction to the pectus bar (2%). Standard and thoracoscopic extrapleural Nuss procedures are both safe and effective procedures used to correct a pectus excavatum deformity. The choice of surgical procedure should be made according to a surgeon's reliability in performing a particular procedure. Our study found no advantages of one procedure over the other.

Predictive Value of Red Blood Cell Distribution Width, Mean Platelet Volume and Platelet Distribution Width in Children with Acute Appendicitis.

BACKGROUND AND OBJECTIVES: Acute appendicitis in pediatric patients is one of the most common surgical emergencies, but the early diagnosis still remains challenging. The aim of this study was to determine the predictive value of Red blood cell distribution width (RDW), Mean platelet volume (MPV) and Platelet distribution width (PDW) in children with acute appendicitis. MATERIALS AND METHODS: This study was a retrospective assessment of laboratory findings (RDW, MPV, PDW) of patients who underwent surgical treatment for acute appendicitis from January 2019 to December 2020. RESULT: During this period, 223 appendectomies were performed at our Institute. In 107 (43%) cases appendicitis was uncomplicated, while in 116 (46.6%) it was complicated. WBC and RDW/MPV ratio were significant parameters for the diagnosis of acute appendicitis with cut-off values of 12.86 (susceptibility: 66.3%; specificity: 73.2%) and 1.64 (susceptibility: 59.8%; specificity: 71.9%), respectively. WBC and RDW/RBC ratio were independent variables for the diagnosis of complicated appendicitis. The cut-off values were 15.05 for WBC (sensitivity: 60.5%; specificity: 70.7%) and 2.5 for RDW/RBC ratio (sensitivity: 72%; specificity: 52.8%). CONCLUSIONS: WBC is an important predictor of appendicitis and complicated appendicitis. RDW, MPV and PDW alone have no diagnostic value in pediatric acute appendicitis or predicting the degree of appendix inflammation. However, the RDW/MPV ratio can be an important predictor of appendix inflammation, with higher values in patients with more severe appendix inflammation. RDW/RBC ratio may be an important predictor of complicated appendicitis.

Laparoscopic-Endoscopic "Rendezvous" Procedure in Pediatric Gastrointestinal Surgery-Case Series.

Laparoscopic-endoscopic "rendezvous" procedures were introduced in surgery for common bile duct stone treatment but are now widely used in other fields of abdominal surgery. An endoscopist navigates a surgeon during the same operative procedure and, thus, enables a better visualization of the location, resection margins, bleeding control, less thermal damage, etc. Here, we present case series of 11 patients that were treated using a "rendezvous" procedure for gastrointestinal lesions on different parts of the gastrointestinal tract such as juvenile polyps on the colon (transversum, ascendens, cecum, sigma), leiomyomatosis of the stomach, Peutz-Jeghers intestinal polyposis, hyperplastic gastric polyp, ectopic pancreatic tissue in the stomach, gastric trichobezoar, and gastric schwannoma. "Rendezvous" procedures are suitable for intestinal lesions that could not be resected endoscopically due to their size, morphology and/or location. In our experience this procedure should be used for endoscopically unresectable lesions as it decreases the time of surgery, possibility of iatrogenic injury, bleeding and technical inability. Furthermore, this procedure has been shown to better navigate the surgeon during laparoscopic surgery, especially in treating polyps in particularly difficult locations such as the duodenum or cecum, and it decreases conversion rates. However, conversion is sometimes necessary, in order to assure all oncological principals are respected, and the best option in some cases.

Single stage surgical treatment of amniotic band syndrome ­ Case report.

Introduction: Amniotic band syndrome is a rare congenital disorder with clinical presentation of constricting bands in different parts of extremities or whole extremities. Conservative or surgical treatment is provided depending on the type and severity of the anomaly. Case Outline: The paper presents the case of a neonate patient with constriction bands localized on the left leg. During the second week of life, a surgery was indicated, and a single-stage multiple Z-plasty was performed to correct the anomalies on the left lower leg. Postoperative edema in the distal part of the lower leg was easily managed by incisions and drainage. Two months later, the correction of the stricture of the left thigh was managed using the same procedure. The postoperative course was uneventful and the outcome was satisfactory after a two-year follow-up. Conclusion: Evaluation of a patient with amniotic band syndrome, as well as diagnosis, monitoring, treatment and postoperative care, should always be multidisciplinary. A single-stage correction approach provided satisfactory both functional and aesthetic results. Given many morphological variations of the syndrome, a decision on the strategy of treatment should be made individually for each patient.

[Minimal invasive surgical correction of pectus excavatum deformities in adolescents: our institutional experience].

INTRODUCTION: Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five-year (2006-2011) institutional experience of 21 patients. OBJECTIVE: The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. METHODS: Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so-called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made.The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. RESULTS: In the period 2006-2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting) of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. CONCLUSION: Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

Burns treatment in ancient times.

Discovery of fire at the dawn of prehistoric time brought not only the benefits to human beings offering the light and heat, but also misfortune due to burns; and that was the beginning of burns treatment. Egyptian doctors made medicines from plants, animal products and minerals, which they combined with magic and religious procedures. The earliest records described burns dressings with milk from mothers of male babies. Goddess Isis was called upon to help. Some remedies and procedures proved so successful that their application continued for centuries. The Edwin Smith papyrus (1500 BC) mentioned the treatment of burns with honey and grease. Ebers Papyrus (1500 BC) contains descriptions of application of mud, excrement, oil and plant extracts. They also used honey, Aloe and tannic acid to heal burns. Ancient Egyptians did not know about microorganisms but they knew that honey, moldy bread and copper salts could prevent infections from dirt in burns healing. Thyme, opium and belladona were used for pain relief. In the 4th century BC, Hippocrates recorded that Greek and Roman doctors used rendered pig fat, resin and bitumen to treat burns. Mixture of honey and bran, or lotion of wine and myrrh were used by Celsus. Honey was also known in Ayurveda (Indian medicine) time. Ayurvedic records Characa and Sushruta included honey in their dressing aids to purify sores and promote the healing. Burn treatment in Chinese medicine was traditional. It was a compilation of philosophy, knowledge and herbal medicine. The successful treatment of burns started in recent time and it has been made possible by better knowledge of the pathophysiology of thermal injuries and their consequences, medical technology advances and improved surgical techniques.

Towards a database for genotype-phenotype association research: mining data from encyclopaedia.

To associate phenotypic characteristics of an organism to molecules encoded by its genome, there is a need for well-structured genotype and phenotype data. We use a novel method for extracting data on phenotype and genotype characteristics of microorganisms from text. As a resource, we use an encyclopedia of microorganisms, which holds phenotypic and genotypic data and create a structured, flexible data resource, which can be exported to a range of database formats, containing genotype and phenotype data for 2412 species and 873 genera of microbes. This data source has great potential as a resource for future biological research on genotype-phenotype associations. In this paper, we focus on describing the structure and content of the resulting database and on evaluating the method used for extracting the data. We conclude that the resulting database can be used as a reliable complementary resource for research into genotype-phenotype association.

[Historical review of congenital foot deformity treatment].

INTRODUCTION: There is still no good solution for the treatment of all the forms of clubfoot. HISTORY OF THE TREATMENT IN THE WORLD: The first written description of the treatment of this deformity was given by Hippocrates. In the Middle Ages, Galenus, Celsus and Averroe only reviewed the lessons of Hippocrates's principles. The first description of orthopedic prosthetic for the treatment of clubfoot was published in "Opera Chirurgica" by Amboise Peréa in 1575. In 1796, Bruckner wrote the first monography about clubfoot. The biggest contribution to the modern way of treating clubfoot was given by Abel Mix Phelebs, who described the medial "release" in 1890. Since 1980 an advantage has been given to early non-operative treatment. The progressive operative approach (use of "release procedures") was introduced. THE HISTORY OF TREATMENT IN OUR COUNTRY: The first procedures were performed by D. Jovcic and S. Stojanovic in Belgrade in 1937. In the period from 1960 to 1970, more and more orthopedic and pediatric surgeons became interested in clubfoot treatment. In 1970 one of the main topics of the 5th Congress of Orthopedics and Traumatology in Belgrade was "Foot Surgery". Many specialists from Belgrade were engaged in clubfoot treatment: D. Rakic, S. Rajic, S. Popovic, L. Stojanovic among pediatricians, and B. Radulovic, P. Klisic among orthopedic surgeons, as well as R. Brdar, Z. Vukasinovic and G. Cobeljic with their assistants. In Novi Sad, in 1967, D. Pajic began diagnosis and treatment of clubfoot. Very soon D. Pajic became a symbol of clubfoot treatment followed by hardworking assistants L. Petkovic and V. Tomasevic. CONCLUSION: The treatment of clubfoot is still controversial and continues to be one of the most interesting fields in pediatric orthopedics.

[Neonatal hip dysplasia--differential diagnosis].

INTRODUCTION: Hip dysplasia is the elementary form of the developmental dysplasia of the hip (DDH). The diagnosis may be made by the ultrasound examination (types II a-, II b). OBJECTIVE: The aim of the authors was to define the congenital structural neonatal hip dysplasia, and to differentiate hip hypoplasia, hip dysplasia and teratogenic anomalies. METHODS: In all the cases, the uniform clinical and ultrasound tests were performed. All the patients were examined in the neonatal period of life (the first six weeks). The following clinical tests were used: Le Damany-Ortolany, Coleman-Barlow-Palmen and Weissman-Strinovic. For the ultrasound examination, the Graph's method was used. RESULTS: The investigation was performed in the period 2007-2008. 2,878 neonates were included. The distribution of the sonotypes, according to Graph, was as follows: Ia in 16.17%. Ib in 65.08%; IIa+ in 18.17%, IIc in 0.28%, IId in 0.19%; IIIa in 0.009%, IIIb in 0.02%; and IV in 0.01%. It was found that DDH was 8 times more frequent in girls; located more frequently at the left side than bilaterally. CONCLUSION: Hip sonoscreening has to be performed in all newborns in the first 72 hours. The suggested follow-up period is six weeks: for the diagnosis--the first three weeks, and for the prevention and treatment--all six weeks.

[Systematic struggle to eradicate developmental displacement of the hip in newborns in the regions of Kula and Vrbas].

INTRODUCTION: Successful treatment of developmental displacement of the hip (DDH) depends on early diagnosis. Clinical screening of all newborns is a useful tool and should be encouraged in everyday practice, because DDH has a high prevalence and significant morbidity. Clinical exam is an important part of early diagnosis, but insufficient. Ultrasound exam is more sensitive in early diagnosis of DDH. OBJECTIVE: Systematic struggle against DDH by means of early detection and treatment begins in neonatology units, and continues in primary healthcare centres. METHODS: Methodology consists of personal history, clinical exam, ultrasonography and radiography. After these procedures, treatment is advised if necessary. Basically, DDH treatment is atraumatic involving abduction pillow, Von Rosen abduction device, Pavlik harnesses. RESULTS: During 2007 and 2008, screening examination was performed in 769 boys (51.47%) and 725 girls (58.52%), born at the Medical Center "Veljko Vlahovic" in Vrbas. A total of 1,494 neonates or 2,988 hips were examined. Ultrasonographically, a normal type Ia was found in 406 hips (13.60%), intermediate type Ib in 2,014 hips (67.40%), immature type IIa+ in 374 hips (12.50%), unstable type IIg in 39 hips (1.30%), decentering IId in 52 hips (1.70%), and eccentric types III and IV in 35 hips (1.20%). Of 2988 examined hips, normal finding was detected in 2794 (93.50%) and pathological finding (DDH) was found in 194 (6.50%). Ultrasonographical findings were determined according to Graph classification. CONCLUSION: The frequency of DDH in the regions of Vrbas and Kula above 5% (6.50%) presents a social and medical problem in children of these locations. Eradication, early detection and treatment involve systematic examinations (clinical, sonographical and radiographical) in the first year of life. Treatment has to be initiated in a neonatal unit by atraumatic means. The team work including a gynaecologist, neonatologist and paediatric orthopaedic surgeon is crucial.

[Diagnostic and prognostic values of standard and dynamic ultrasound in early detection and treatment of developmental hip deformity].

INTRODUCTION: A clinical examination of a newborn infant is indispensable, but certainly insufficient for a diagnosis of developmental deformity of the hip (DDH) to be made. The use of the ultrasound in the diagnostics of DDH, beside the visualization and making the respective clinical findings objective, made possible verification (still without a distinction of the tissues) of the two basic categories of the primary condition of a newborn baby hips. OBJECTIVE: The purpose of this study was to find out the optimal methodological procedure for the early detection of DDH in newborn infants and sucklings. METHOD: During 2002 and 2003, at the Neonatal Department of the Clinic for Gynaecology and Obstetrics, Novi Sad, as well as at the Institute for Orthopaedic Surgery "Banjica" Belgrade, there were 4016 newborn infants examined, i.e. 8032 hips clinically and by ultrasound. The standard Graf's methodological procedure was applied completely, supplemented by the dynamic examination by pushing back and streching femora along, that is by the techniques of Couture and Harcke. RESULTS: In order to categorize the condition of the hip of a newborn infant, the sonographic classification of R. Graaf, Th. Harcke and D. Pajidcwas used. The ultrasound analysis demonstrated a frequency of the sonotype lI in 552 (13.08%) of the newborn infants, the sonotype lI in 2934 (73.00%), the sonotype iII+ in 481 (11.97%) and the pathological cases with sonotypes IlIg+42 (1.04%), lIl 17 (0.42%), IlII 15 (0.37%) and IV5 (0.12%). The total number of unstable critical, discentering and discentered cases of DDH was 79 (1.95%). The incidence of DDH was three times more frequent in girls, mostly bilateral; when unilateral, it was more frequent in the left one.T he results of the early treatment were uniformly excellent, but in two cases there was established osteochondritis of the first degree (Pavlik's harness 1, Von Rosen's splint 1). CONCLUSION: iIt as been proven that the clinical examination was inevitable, but insufficient for diagnosis of DDH.T he standard sonographic examination should be supplemented by provocative dynamic diagnostic procedures in all immature, at risk and discentering hips. By doing so, it is possible to differentiate prognostically the hips evolving to a spontaneous normalization from those striving to a progredient decentralization. For a sonographic diagnosis, the first three weeks are essential, but for therapy, the crucial is the sixth week.

[Primary abductor hip contracture as diagnostic, prognostic and therapeutic problem in child hip pathology].

Coxa obliqua represents a special functional entity in the pathology of the child hip. Authors have confirmed the results of S.L. Weissman and B. Strinovic which claimed that the abductor contracture of the hip was a primary congenital condition that developed as a result of intrauterine malposition, leading later to the contralateral adductor contracture. Critical period for the development of complications was between 6 and 8 month after birth, adductor contracture might keep persisting together with the development of acetabular dysplasia, and later on with ipsilateral subluxation. This malformation has usually been diagnosed within 3 and 6 months of age. It could be connected with some other signs of malposition, such as plagiocephaly, torticollis or infantile thoracic C scoliosis. For the diagnosis of coxa obliqua, the examination of hips in the prone position was very important and the ultrasonic and radiological examinations were crucial. The applied treatment used to be exclusively physical rehabilitation. Wide diapering has been contraindicated. In this study, we included 2,500 newborns, 1,300 boys and 1,200 girls (5,000 hips). In 22 cases of coxa obliqua (10 per thousand), the excellent results were obtained in 96% of cases. In two unsuccessfully treated cases, a contralateral dysplasia developed, and in one untreated, subluxation. The authors are advocating a systematic and early detection and treatment of the primary coxa obliqua.

[Septic arthritis in neonates and infants]. / Septicni artritis novorodenceta i odojceta.

INTRODUCTION: Septic arthritis represents an intra-articular infection caused by pyogenic bacteria. During the earliest childhood it is considered to be a systemic septic condition and demands early diagnosis and prompt surgical treatment. MATERIAL AND METHODS: This is a retrospective analysis of patients with septic arthritis treated at the Department of Orthopedics of the Pediatric Surgery Clinic in Novi Sad, over a 10-year period. We are also presenting a case of a 12-day-old newborn baby, with clear radiological signs of osteoarthritis of the right knee. RESULTS: A retrospective study included the period 1991-2000, and showed that 15 patients, aged 10 days--12 months were treated for osteoarthritis. The most common localization was the hip, in 60% of cases. In 11 patients the causative agent was Staphylococcus aureus, while in the 4 remaining patients the bacteriologic finding was negative. One patient died of generalized sepsis. DISCUSSION: In neonates and infants septic arthritis is characterized by atypical clinical picture, often causing delayed diagnosis. In the initial phases of the disease ultrasonographic findings were of greater use compared to radiological imaging, due to relatively late appearance of radiological signs of disease. CONCLUSIONS: Due to possible development of serious and irreversible damage, even lethal outcome, septic arthritis requires early diagnosis, prompt administration of antibiotics and early surgical treatment. It is a quite unique area in Pediatric Orthopedics where missed or delayed diagnosis may have serious consequences.