Pediatric laparoscopic appendectomy, risk factors, and costs associated with nationwide readmissions.

BACKGROUND: Previous studies of readmission after pediatric laparoscopic appendectomy have been limited to individual hospitals or noncompeting public pediatric hospitals. The purpose of this study was to evaluate the risk factors and costs associated with nonelective, 30-d readmissions in pediatric patients nationwide across public and private hospitals. MATERIALS AND METHODS: The Nationwide Readmission Database for 2013 was queried for all patients under the age of 18 y with a diagnosis of acute appendicitis undergoing laparoscopic appendectomy. Using multivariate logistic regression with 26 different variables, the odds ratios (ORs) for nonelective readmissions within 30 d were determined. The costs of readmission were calculated as well as the most common diagnoses on readmission. RESULTS: In 2013, there were 12,730 patients under the age of 18 y undergoing laparoscopic appendectomy, and 3.4% were readmitted within 30 d. The overall mean age was 11.6 ± 3.8 y, and the mean age of the readmitted patients was 10.7 ± 4.0 whereas the mean age of patients not readmitted was 11.6 ± 3.8 (P < 0.01, 95% CI: 0.54-1.26). The total cost of readmissions was $3,645,502 with a weighted nationwide estimated cost of $10,351,690. The mean readmission cost was $8304 ± 7864. The most common diagnosis group on readmission was postoperative, posttraumatic, other device infections (36.0%), whereas the most common principal diagnosis was other postoperative infection (38.5%) and the most common secondary diagnosis was peritoneal abscess (11.9%). CONCLUSIONS: Readmission within 30 d after laparoscopic appendectomy in pediatric patients represents a significant resource burden. This study elucidates the patient characteristics that predispose these patients to readmission. Efforts to reduce these readmissions should be focused around preventing infections in patients with these predisposing risk factors.

Novel Causative Variants in DYRK1A, KARS, and KAT6A Associated with Intellectual Disability and Additional Phenotypic Features.

Patients with unclear patterns of developmental and cognitive delay may go years without a definitive diagnosis despite extensive testing due to overlapping phenotypes of many genetic disorders. In this study, we identified causative variants in DYRK1A, KARS, or KAT6A in four individuals with global developmental delay and various findings including microcephaly and sensorineural hearing loss using whole exome sequencing. We present the cognitive, neurologic, and physical findings of four individuals to expand the clinical knowledge of possible features of the phenotypes of three rare genetic disorders. Through this process, we provide support for the use of whole exome sequencing in the setting of severe, intellectual disability or in those in whom a genetic disorder is suspected despite initial negative testing.

Imaging through the pupal case of Drosophila melanogaster.

The longstanding use of Drosophila as a model for cell and developmental biology has yielded an array of tools. Together, these techniques have enabled analysis of cell and developmental biology from a variety of methodological angles. Live imaging is an emerging method for observing dynamic cell processes, such as cell division or cell motility. Having isolated mutations in uncharacterized putative cell cycle proteins it became essential to observe mitosis in situ using live imaging. Most live imaging studies in Drosophila have focused on the embryonic stages that are accessible to manipulation and observation because of their small size and optical clarity. However, in these stages the cell cycle is unusual in that it lacks one or both of the gap phases. By contrast, cells of the pupal wing of Drosophila have a typical cell cycle and undergo a period of rapid mitosis spanning about 20 hr of pupal development. It is easy to identify and isolate pupae of the appropriate stage to catch mitosis in situ. Mounting intact pupae provided the best combination of tractability and durability during imaging, allowing experiments to run for several hours with minimal impact on cell and animal viability. The method allows observation of features as small as, or smaller than, fly chromosomes. Adjustment of microscope settings and the details of mounting, allowed extension of the preparation to visualize membrane dynamics of adjacent cells and fluorescently labeled proteins such as tubulin. This method works for all tested fluorescent proteins and can capture submicron scale features over a variety of time scales. While limited to the outer 20 µm of the pupa with a conventional confocal microscope, this approach to observing protein and cellular dynamics in pupal tissues in vivo may be generally useful in the study of cell and developmental biology in these tissues.