Rebecca A. Stark

Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients ☆

BACKGROUND Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. METHODS A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications. RESULTS Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications. CONCLUSION Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice. LEVEL OF EVIDENCE Retrospective study - level III.

Incidence of Gastroschisis in California

pants as patient information is more likely derived from the presentation when the electronic medical record becomes less accessible. The increased ability to hear patient presentations was likely because of the concurrent reduction in simultaneous conversations, as well as a noticeable change with the arrangement of the rounding group becoming more compact. The association of these changes with efficiency or clinical outcomes was not monitored. Limitations include the potential for a Hawthorne effect4 and a change in the residents during the study period. Alternative technologies should be identified that optimize human-computer interactions and facilitate effective communication.

Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012

BACKGROUND Although the incidence of gastroschisis is increasing, risk factors are not clearly identified. METHODS Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995–2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. RESULTS The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p=0.609), narcotics (p=0.072), hallucinogenics (p=0.239), or cocaine (p=0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p=0.040; OR 2.02, p=0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08–16.21, p<0.001) and pre-term birth (OR 3.26–10.0, p<0.001). Multivariable analysis showed lower risk in black (OR 0.44, p<0.001), Asian/Pacific Islander (OR 0.76, p=0.003), and Hispanic patients (OR 0.72, p<0.001) compared to white patients. Risk was higher in rural areas (OR 1.24–1.76, p=0.001). Compared to women age<20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p<0.001). Patients with gastroschisis had increased total charges (

Isolation of myogenic progenitor cell population from human placenta: A pilot study

336,270 vs.

Association of Procedures and Patient Factors With 30-Day Readmission Rates After Pediatric Surgery

9,012, p<0.001) and length of stay (38.1 vs. 2.9 days, p<0.001). Mortality was 4.6%. CONCLUSIONS This is the largest population-based study summarizing current epidemiology of gastroschisis in California.

Outcomes of bedside sutureless umbilical closure without endotracheal intubation for gastroschisis repair in surgical infants

PURPOSE The purpose of this study was to demonstrate a method of isolating myogenic progenitor cells from human placenta chorionic villi and to confirm the myogenic characteristics of the isolated cells. METHODS Cells were isolated from chorionic villi of a second trimester male placenta via a combined enzymatic digestion and explant culture. A morphologically distinct subpopulation of elongated and multinucleated cells was identified. This subpopulation was manually passaged from the explant culture, expanded, and analyzed by fluorescence in situ hybridization (FISH) assay, immunocytochemistry, and flow cytometry. Myogenic characteristics including alignment and fusion were tested by growing these cells on aligned polylactic acid microfibrous scaffold in a fusion media composed of 2% horse serum in Dulbeccos modified Eagle medium/high glucose. RESULTS The expanded subpopulation was uniformly positive for integrin α-7. Presence of Y-chromosome by FISH analysis confirmed chorionic villus origin rather than maternal cell contamination. Isolated cells grew, aligned, and fused on the microfibrous scaffold, and they expressed myogenin, desmin, and MHC confirming their myogenic identity. CONCLUSION Myogenic progenitor cells can be isolated from human chorionic villi. This opens the possibility for translational and clinical applications using autologous myogenic cells for possible engraftment in treatment of chest and abdominal wall defects.

Midgut volvulus and complex meconium peritonitis in a fetus with undiagnosed cystic fibrosis

Association of Procedures and Patient Factors With 30-Day Readmission Rates After Pediatric Surgery Efforts to create verified pediatric surgical centers require rigorous standards to ensure quality across surgical specialties. However, risk factors for readmission after pediatric surgery are poorly understood. This study aims to identify surgical procedures and patient factors associated with increased rates of readmission from the American College of Surgeons Pediatric National Surgical Quality Improvement Program (NSQIP-P) database.