Small Bowl Research Articles

8161 A Rare Case of Malignant Melanoma Metastatic to the Thyroid Gland

Abstract Disclosure: J. Ferri-Guerra: None. O. Abdulhussein: None. E. Kasper-Guerra: None. G. Madrigal Loria: None. L. El Hage: None. 69 yo female presented with neck swelling in 2014. TSH was normal. Thyroid ultrasound showed multiple nodules with a right 2.9 x 2.3 x 2.1 cm that was cold on subsequent thyroid uptake scan. FNA of the right nodule in 08/2014 showed malignant cells with spindle cell pattern thought to be medullary thyroid cancer. She was scheduled for total thyroidectomy but presented with small bowl obstruction prior to her surgery and was diagnosed with metastatic melanoma (BRAF +). Initial PET scan showed a 4.1 x 2.8 x 2.8 cm hypermetabolic right thyroid lobe lesion in addition to other multiple hypermetabolic lesions consistent with known melanoma. The thyroid FNA specimen correlated with the small bowel excision specimen and showed similar features diagnosing metastatic melanoma to the thyroid gland.She was started on ipilimumab with subsequent scan in 04/2015 showing increase in right thyroid mass size to 5.4 x 4.2 x 9 cm with mixed results of other metastatic locations. She was switched to pembrolizumab and later dobrafenib/trametinib in 05/2015. Imaging thereafter showing significant improvement including a decrease in the right thyroid nodule size to 1.6 cm x 2.5 cm x 2.4 cm with no hypermetabolic activity on further PET scans. Repeat thyroid ultrasound in 2021 showed multiple nodules with a 2.2 x 1.5 x 1 cm nodule in the right. Repeat FNA of the right nodule was benign. Last imaging in 2023 showed stable nodules. Conclusion: metastasis to thyroid gland from malignant melanoma is a rare finding and should be considered in rapidly growing thyroid nodules. These lesions can be treated with targeted therapy that can spare affected individuals surgery. Presentation: 6/1/2024

An ethnographic study on the traces of Georgian culture in the cuisine of Ordu (Türkiye)

Migration caused by various factors such as war, natural disasters, and famine, significantly influences cultural elements. The tangible and intangible elements acquired from past generations and passed down to subsequent generations can be called cultural heritage. Cuisine is a significant component of the cultural heritage, as earlier migrations have closely influenced culinary culture. Following the wars towards the end of the Ottoman Empire, Georgians who migrated from the Caucasus brought their culinary culture to Türkiye. Ordu was one of the cities where Georgians settled the most during this period. The main objective of this study is to identify and examine traces of Georgian culture in the Ordu cuisine. The research utilized an ethnographic design and a purposive sampling technique. Data were obtained through interviews with eight individuals familiar with Georgian culinary culture and whose families had been in the region for five generations. The obtained data were subjected to content analysis. These findings indicate that prominent elements of Georgian culture in the cuisine of Ordu include the widespread use of spices and sauces, the significant use of walnuts in dishes, limited consumption of oil, frequent preference for medicinal and aromatic plants, changing traditional methods, the preparation of unique dishes on specific occasions, and the resemblance of culturally used materials. Georgian cuisine includes both vary vegetables such as kale, eggplant, corn, leeks, grapes, beans and vary meals such as pepeçura, khachapuri (haçapuri), hinkali, and papa. Common cooking methods include roasting, baking, boiling, and frying. It was also determined that characteristic kitchen utensils such as bileki stone (stone-made bread pan), gobi (wooden dough boat), sanakveli (small wooden bowl for crushing garlic etc.), and laperay (cabbage mashing board) were used in Georgian cuisine. The significant presence of Georgian culture in the cuisine of Ordu is a crucial gastronomic heritage feature that holds considerable value for the region.

Crying over food: An extraordinary response to a multisensory eating experience

Recent years have seen a growing awareness of the extraordinary responses that can sometimes be elicited in diners by food. One such response is crying, and it was this unusual behaviour that chef Federico Rottigni anecdotally observed in response to one of the dishes on his recently-introduced Ayuhuasca menu. In particular, something about Serendipity, the seventh course on a nine-course tasting menu currently served at the restaurant in Milan makes some diners want to cry. This is the first of three dessert courses, and consists of a small bowl of rice pudding covered with white wafers which are broken onto the dish in front of diners at the point of service. But why do a number of the diners spontaneously break into tears during this course? Several factors that may be contributing to this extraordinary emotional response are outlined. Importantly, rice pudding can be considered a nostalgic comfort food associated with childhood for many people. The dessert is accompanied by a complex multi-element soundscape consisting of a school bell, the voice of a female school teacher talking in Italian; Later in the recording, a spatially discrete voice of an old woman reminiscing in English is also heard; At the same time, a simple, almost hypnotic, ascending and descending musical riff is played repetitively, while a music track with sustained low frequency notes appears to help draw people's attention to their own body (bodily sensations). Together, and possibly synergistically (superadditively), these various multisensory elements, both on and off the plate, contribute to delivering what can be classed as an extraordinary multisensory gestalt dining experience for a number of the guests.

Concentration and correlation analysis of hydro-meteorological factors in the northern sub-basin of Lake Issyk-Kul in Central Asia

This paper, based on the non-parametric tests and wavelet analysis, analyzed monthly precipitation and runoff data of the small basin in the northern part of the Lake Issyk-Kull basin over the nearly 62-year period, the concentration and correlation of precipitation and runoff in the small bowl of the north Lake Issyk-Kull basin. The results indicated that (1) the Cholpon-Ata River runoff (runoff 1) and the Chong-Ak-Suu River runoff (runoff 2) in the small watershed in the northern part of Lake Issyk-Kull basin are from June to April, January, and from September to November showed a significant increasing trend. The significant abrupt growth change occurred in 1983, while the precipitation at the Cholpon-Ata station showed a significant increasing trend in February, with a sharp point around 1980. (2) The concentration degree (Cd) index of runoff 1 in the small watershed in the northern part of the Lake Issyk-Kull basin has increased but not significantly, and the Cd index of precipitation and runoff 2 showed an insignificant decrease. (3) The Cd index of runoff 1 in the small watershed in the northern part of Lake Issyk-Kull basin existed for 10 years and 18 years, and the Cd index of River 2 existed for 9 years and 13 years. In contrast, the precipitation Cd index was significant at 4- and 15-year cycles. (4) On multiple time scales, they have a significant negative correlation between the runoff and precipitation in the small watershed in the northern part of the Lake Issyk-Kul basin from May to September.

Gallstones ileus in young patient with incidental finding a small bowl carcinoid tumour

Gallstone ileus in young patient with incidental finding carcinoid of small bowel identified during exploration for proximal stones, both pathologies have no known pathological reasons to be associated with each other. We present a case of a 45-year-old male who presented with small bowel obstruction as an emergency. At laparotomy we found gall stone impacted in mid ileum and during exploration to exclude multiple proximal stones, small carcinoid identified in mid jejunum. Segmental small bowel resection was performed without disturbing the biliary pathology. Gallstone ileus may manifest in the younger population, and in the course of searching the small bowel to eliminate the presence of multiple stones proximal to the site of the impacted gallstone ileus other pathology may detected for which we incidentally identified asymptomatic carcinoid such case has never been reported before. Importance of a thorough laparotomy is emphasized.

Prognostic factors to identify resolution of small bowel obstruction without need for operative management: systematic review

ObjectivesTo identify imaging, clinical, and laboratory variables potentially prognostic for surgical management of small bowel obstruction.MethodsTwo researchers systematically reviewed indexed literature 2001–2021 inclusive for imaging, clinical, and laboratory variables potentially predictive of surgical management of small bowl obstruction and/or ischaemia at surgery, where performed. Risk of bias was assessed. Contingency tables for variables reported in at least 5 studies were extracted and meta-analysed to identify strong evidence of association with clinical outcomes, across studies.ResultsThirty-one studies were ultimately included, reporting 4638 patients (44 to 313 per study). 11 (35%) studies raised no risk of bias concerns. CT was the modality reported most (29 studies, 94%). Meta-analysis of 21 predictors identified 5 strongly associated with surgical intervention, 3 derived from CT (peritoneal free fluid, odds ratio [OR] 3.24, 95%CI 2.45 to 4.29; high grade obstruction, OR 3.58, 95%CI 2.46 to 5.20; mesenteric inflammation, OR 2.61, 95%CI 1.94 to 3.50; abdominal distension, OR 2.43, 95%CI 1.34 to 4.42; peritonism, OR 3.97, 95%CI 2.67 to 5.90) and one with conservative management (previous abdominopelvic surgery, OR 0.58, 95%CI 0.40 to 0.85). Meta-analysis of 10 predictors identified 3 strongly associated with ischaemia at surgery, 2 derived from CT (peritoneal free fluid, OR 3.49, 95%CI 2.28 to 5.35; bowel thickening, OR 3.26 95%CI 1.91 to 5.55; white cell count, OR 4.76, 95%CI 2.71 to 8.36).ConclusionsSystematic review of patients with small bowel obstruction identified four imaging, three clinical, and one laboratory predictors associated strongly with surgical intervention and/or ischaemia at surgery.Clinical relevance statementVia systematic review and meta-analysis, we identified imaging, clinical, and laboratory predictors strongly associated with surgical management of small bowel obstruction and/or ischaemia. Multivariable model development to guide management should incorporate these since they display strong evidence of potential utility.Key Points• While multivariable models incorporating clinical, laboratory, and imaging factors could predict surgical management of small bowel obstruction, none are used widely.• Via systematic review and meta-analysis we identified imaging, clinical, and laboratory variables strongly associated with surgical management and/or ischaemia at surgery.• Development of multivariable models to guide management should incorporate these predictors, notably CT scanning, since they display strong evidence of potential utility.

Diet Therapy Using a Small Rice Bowl among Japanese Men with Diabetes: A Randomized Controlled Trial.

This study aimed to investigate the effectiveness at 1 and 3 months of using a smaller rice bowl for diet therapy among Japanese men with type 2 diabetes. A parallel-group randomized controlled trial was conducted at a medical clinic in Japan. The participants were men with type 2 diabetes mellitus, aged 20-80 years, with glycosylated hemoglobin <8.5%, and who ate rice one or more times per day at home. The intervention group (36 men) received a small rice bowl from which to eat the usual diet therapy, and the control group (38 men) received only the usual diet therapy. The changes in weight and body mass index among the intervention group at 1 month were significantly higher than those in the control group. There were no significant differences between the two groups at 3 months. The effects of using a small rice bowl were minor and short-term.

Demystifying Small Concha-type Microtia: Advancements in Classification and Surgical Approach.

The accurate identification of microtia type is foundational to preoperative planning and intraoperative strategies for auricular reconstruction using an autologous costal cartilage framework. Although the repair of lobule type microtia has similarities to that of small concha-type, the latter has specific nuances that must be considered to optimize functional and aesthetic outcomes. The article describes the senior author's advancements in repair of all microtia types: use of an "auricular rectangle" to determine ideal ear placement, W-flap manipulation for vestige transposition, and skin trimming. The additional focus on small concha-type microtia addresses common errors in identification and reconstruction of the conchal bowl.

Embryonic and larval development of the commercially important freshwater fish gobi, Glossogobius giuris (Hamilton, 1822)

The present study was carried out to investigate the embryonic and larval development of the commercially important freshwater fish gobi (Glossogobius giuris) in laboratory conditions at the Mini Hatchery cum Breeding Complex of the Department of Fisheries Biology and Genetics under the Faculty of Fisheries, Bangladesh Agricultural University (BAU), Mymensingh. Healthy broodstocks of both female and male gobi were collected from the grow-out ponds. Matured eggs and sperms were obtained through the induction of spawning by the injection of PG (pituitary gland) hormones. Fertilization was done by mixing of a few drops of sperm suspensions into the egg mashes in a small plastic bowl and washing several times to remove the excess sperm and unfertilized eggs. Fertilized eggs were then collected and incubated in a mini circular cemented tank with the provision of a continuous water supply. At least 10 fertilized eggs undergoing embryonic development were continuously monitored for studying the daily changes in their development. Fertilized eggs were collected randomly up to the morula stage every 4-5 h, and then after every 1 h interval until hatching and every 4 h after hatching. Soon after fertilization, the eggs were swelled, extended longitudinally, and became adhesive and light brownish to transparent in color. The unfertilized egg did not change in size and shape, rather turned whitish in color and became demersal. At fertilization, the length of eggs was increased from 0.6 to 3.0 mm and width from 0.3 to 0.5 mm, having a tendency to attach to the substrates or the shelters provided. The first cleavage of eggs has occurred within 1.3-2.5 h at 27.0 ± 1.0 °C. The development of the embryos of Gobi occurred about 15 h post-fertilization at 27.0-29.0 °C. The stages of embryonic development were observed with cleavage, followed by morula, blastula, gastrula, yolk plug stage, organogenesis and until hatching of non-pigmented larvae. Hatching started from 35 to 48 h post-fertilization and was completed within 5-6 h at the same temperature range, as all embryos did not hatch out at a time. Newly hatched larvae were measured to be 0.50-0.60 mm in length. The yolk sac was completely absorbed in 48-50 h during larval development and when the hatchlings reached 1.60 ± 0.02 mm in total length; they then started feeding within 48-60 h post-hatching. The findings of the present study have not only provided valuable information on the embryonic and larval development of gobi (G. giuris) but would immensely be helpful towards the establishment of large-scale seed production techniques for aquaculture and conservation of this important fishery.

P7.01: Selecting Candidates for Multi-Visceral Transplantation in Neuroendocrine Tumors (NET) of the Gastrointestinal Tract: A Review of Two Cases

Introduction: Neuroendocrine tumors (NETs) are rare neoplasms arising neurologic or endocrine tissues. These tumors can be seen in nearly any organ system, though they mostly would be present in the gastrointestinal and respiratory systems. In this study, we report two cases of multi-visceral transplantations (MVT) in NET and discuss our indications for MVT among NET patients. Methods and Results: Case 1: A 44-year-old lady referred with a complaint of acute abdominal pain and small bowel obstruction symptoms in June 2018. In laparotomy, an obstructive jejunal mass, a huge retroperitoneal lesion involving the mesentery and liver, was found. A partial resection of the jejunal mass and palliative anastomosis of the bowel was performed. Histopathologic examinations revealed a well-differentiated NET [G1 (ki67:1%)]. The patient underwent MVT. She developed an entero-cutaneous fistula ten days after the surgery which was managed. After which the patient was relatively well till February 2021, when she was admitted with severe watery diarrhea. Severe mucosal ulcerations were seen in endoscopy, and rejection was confirmed through pathologic assessments. The patient died despite our efforts. Case 2: A 46-year-old man who had been suffering from vague abdominal pain and dyspepsia was referred to our clinic in February 2021. He gave a history of 5 kilograms weight loss in the preceding six months. Computed tomography (CT) showed a large lobulated heterogeneously enhancing mass about 150*90 mm in the pancreas with extension to the liver hilum and involvement of spleen and stomach, and signs of partial port vein thrombosis. The pathologist reported a well-differentiated NET (G2, ki67<15%, mitosis 1-2/10 HPF). Exploratory laparotomy, performed in May 2021, showed locally advanced pancreatic NET with celiac encasement and involvement of stomach and colon and portal vein thrombosis with varicose veins and portal hypertension, but no evidence of hepatic metastases. MVT was performed in June 2021. The grafts, including stomach, duodenum, liver, pancreas, and small bowel, were implanted. One month later, the patient complained of diarrhea, 3rd-grade acute T-cell rejection, in a small bowl biopsy was reported. However, the liver biopsy was insignificant. Favorably the patient responded well to the treatment, and after six months, closure of ostomy was performed. The patient is alive and well to this day. Conclusion: We propose the following criteria for MVTx in NETs: Well-differentiated NETs; absence of progression in the last six months; extensive porto-mesenteric thrombosis; intestinal failure with liver metastases; Both superior mesenteric artery and celiac trunk involvement; absence of extra-abdominal involvement that is confirmed by Ga-68 dotatate scan. We should note that this was a case report and larger series are required to support our conclusion.

Sigmoid Diverticulis

Sigmoid diverticulitis is a complication of colonic diverticulosis, and one of the presentations of diverticular disease. It is a very common pathology in Western countries due to the lack of fiber content in diets, leading sigmoid colon to make strong contractions and end up but formation of diverticula, with a very high risk of inflammation and infection. It mainly interests people over 45 years old, without any gender preference. The reflex is to always think of a sigmoid diverticulitis in front of an acute pain of the left iliac fossa with fever, leukocytosis, and supplement with an emergency scanner and failing that an abdomino-pelvic ultrasound. Imaging plays a vital role in both positive diagnosis and diagnosis of complications .Main complication are fistula, peritonitis, small bowl obstruction, abcess, and rarely portal venous pylephlebitis. Although CT is the modality of choice for the diagnosis and staging of colonic diverticulitis, it commonly shows sigmoid wall thinckening, fat stranding, and diverticulos appearing like aeric addition image (Figure A and B). Main differential diagnosis is colorectal carcinoma and acute appenditics. Acute non complicated sigmois is treated with antibiotherapy with a colonoscopy after recovery, when it’is complicated, elective and emergency surgery is a priority.

Grave 6 from Trogir’s Dobrić necropolis | Grob 6 z nekropole Dobrić v Trogirju

This paper covers the finds dated to Late Antiquity from grave 6 in the Roman necropolis in Trogir’s Dobrić section, which was partially excavated in the 1980s. A portion of the goods from this sporadically excavated necropolis are held in the Archaeological Museum in Split. Documentation is lacking. However, in the case of three items, there is confirmation that they are from grave 6, and they have been dated to the period from the latter half of the 4th to the first half of the 5th century: a ceramic oil-lamp, a glass bottle, and a glass bowl. The small glass bowl with engraved decoration is particularly interesting. It stands out among similar bowls in terms of its decoration and small dimensions.

Study Of Lemang Kancung Beruk At Dusun Baru Lempur Village Kerinci Regency

This research to learn and gain deeper knowledge about lemang kancung beruk at Dusun Baru Lempur village, Kerinci Regency. This Lemang is liked by the public because of its different taste and unique shape where the packaging is wrapped in a kantong semar(nepenthes). The purpose of this study was to identify materials, equipment, study processing techniques, describe variants and utility of lemang kancung beruk at Dusun Baru Lempur village. This type of research is qualitative research. The research data were obtained from local community women who are experts in making lemang kancung beruk at traditional events and local community women who are proficient and have made lemang kancung beruk for various events. Data analysis that is data reduction, data presentation, conclusions and verification. The results of the study concluded that the ingredients used included white glutinous rice, black sticky rice, red sticky rice, coconut milk, salt and kantong semar(nepenthes). The tools used are a small bowl, large bowl, spoon, steamer and gas stove. The processing technique are use steaming.

Unusual Presentation of Bouveret Syndrome Resulting in Both Gastric Outlet Obstruction and Small Bowel Obstruction with Perforation

Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day’s duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for choledocholithiasis with acute cholangitis in her home country, Scotland. Unfortunately, while visiting family in the United States, her PTCD became dislodged, and she developed progressive worsening abdominal pain. Computerized tomography of her abdomen showed pneumobilia, perigastric inflammation, a contracted gallbladder, small bowl inflammation with a likely transition point at the mid-jejunum, and a probable duodenal mass. The patient underwent an exploratory laparotomy with intraoperative findings of choledochoduodenal fistula with coincident gastric and small bowel obstruction (SBO) secondary to three large, mixed gallstones. One 3 cm gallstone was located at the pylorus and two (2.3 and 3 cm) gallstones were isolated in the mid-jejunum, with one of those causing isolated transmural pressure necrosis with subsequent perforation. Bouveret syndrome is a rare cause of gastric outlet obstruction (GOO) that manifests via an acquired cholecystoenteric fistula. Our patient presented with a concomitant GOO and SBO with perforation of the mid-jejunum. Timely diagnosis of Bouveret syndrome is essential, as most causes require emergent surgical intervention.

Диалектные названия посуды башкирского языка, восходящие к алтайской эпохе

This article discusses the Altai layer of names of dishes in the etymological aspect. The established volume of the article does not allow to analyze all the names of household vessels of 47М.Р. Валиева Turkic Studies Journal 2 (2022) 35-47the Bashkir language dating back to the Altaic era, therefore, polysemantic lexemes were chosen – ыҙыс/ыҙас ‘dishes’, күнәк ‘milk pail; bucket’, ҡупы ‘small bowl; bowl’, ҡap ‘bag, sack (matting); box, container, receptacle, case; cup, vessel; pod, shell, coating, rind, skin, scales (of reptiles); placenta’ and other cognates that refer to this ancient lexical stratum of the Turkic languages. Comparative historical studies, lexico-semantic, semantic-structural and etymological analyzes of the names of containers make it possible to discover ancient roots and foundations dating back to the reconstructed Altai forms, which are contained in the well-known dictionary of S.A. Starostin, A.V. Dybo, O.A. Mudrak «An Etymological Dictionary of Altaic Languages». Structurally, many household terms consist of monosyllabic and disyllabic roots. The Bashkir layer itself was formed on the basis of the ancient Turkic vocabulary, phonetic transitions, changes and derivational potential of the Bashkir language. Research on the original forms and etymons of modern names of dishes ыҙыс/ыҙас, күнәк, ҡупы, ҡапmade it possible to establish a chronological connection between the ancient Turkic, Proto-Turkic, Altai forms: ыҙыс &lt; *ïðïš &lt; *ēdiĺ ‘ware’; kүnәk &lt; *kȫjnek ‘bucket, vessel’ &lt; *k ̔ōńi – ‘ladle’; ҡap // ҡab(ы) // ҡуп(ы) &lt; *qav, *kab and the Proto-Altaic form *k ̔àp ̔à in the meanings ‘box, package, chest, bag, vessel, dugout hollow tree, dugout boat’.Also the article pays special attention to the description of various areal and dialect semantics, everyday functions and forms of vessel names, which are recorded and stored in the card stock of the Linguistics Department of the Order of the Badge of Honor of the Institute of History, Language and Literature of the Ufa Federal Research Center of the Russian Academy of Sciences, and are also presented in the consolidated «Dialectological Dictionary of the Bashkir Language» (see lit.). In addition, various dictionaries of the Turkic, Mongolian and Finno-Ugric languages, various dialectological studies, reports, scientific works on ethnography, folklore and multi-volume books of Bashkir folk art were used as comparative material.

Causes and Management Outcome of Small Intestinal Obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia, 2017.

Background Small bowel obstruction is a common and dangerous surgical emergency which is associated with high morbidity and mortality if not managed appropriately and timely. Objective To determine the causes and management outcome of small bowel obstruction in Nekemte Referral Hospital, Nekemte, Ethiopia. Method Institution-based retrospective cross-sectional study design was used. Three-year data (from January 1, 2014, to December 30, 2016) were collected from July 1 to August 30, 2017. Data were collected from medical records and checked for any inconsistency, coded, and entered into SPSS version 20 for analysis. Descriptive, binary, and multivariate logistic regression analyses were used. On binary logistic regression analysis, variables with p ≤ 0.25 were selected as a candidate for multivariate logistic regression analysis. The level of statistical significance was set at p ≤ 0.05. Results With 100% response rate, records of 211 patients with small intestinal obstruction were retrieved for analysis. One hundred thirty-seven (64.9%) were males. The commonest cause of small bowel obstruction was adhesion (35.1%). More than a quarter (26.5%) participants developed postoperative complications, and wound infection was the commonest postoperative complication (49.2%). A majority (84.8%) of patients improved and were discharged, and the rest 15.2% of patients died. Sex (AOR = 3.98, 95% CI: 1.51–10.52), duration of illness before surgical intervention (AOR = 4.4, 95% CI: 1.69–11.45), level of hematocrit (AOR = 4.25, 95% CI: 1.56–11.57), types of intestinal obstruction (AOR = 3.73, 95% CI: 1.09–12.64), and length of hospital stay (AOR = 4.69, 95% CI: 1.82–12.07) were independent predictors of the management outcome of patients with small bowl obstruction. Conclusion Small bowel obstruction is a commonly encountered surgical emergency. Adhesion, small bowel volvulus, and intussusception were the leading causes of small bowel obstruction, respectively.

Laparoscopic Versus Open Ladd's Procedure for Intestinal Malrotation in Infants and Children: A Systematic Review and Meta-Analysis.

Aim: To compare clinical outcomes in infants and children with intestinal malrotation who were treated by laparoscopic or open Ladd's. Methods: PubMed, EMBASE, and Cochrane library were searched for studies comparing laparoscopy with open Ladd's for intestinal volvulus through January 5, 2021. Search terms were confined to Title/Abstract: "Intestinal Volvulus" OR "Intestinal malrotation" AND "Laparoscopy" AND "Laparotomy." Randomized controlled trials (RCTs) and retrospective studies comparing laparoscopy with open Ladd's in neonates, infants, or children were included. Outcomes evaluated included operative time, time to full feeds, length of hospital stay, rate of conversion, reoperation, overall postoperative complications, postoperative adhesive small bowel obstruction, and postoperative volvulus. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MDs) were measured for continuous variables. Results: Fourteen studies were included, comprising 444 patients who underwent laparoscopic approach and 1422 patients who underwent open procedure. Laparoscopy group had shorter operative time (MD = -14.44 minutes, 95% confidence interval [CI] = -20.79 to -8.09, P < .00001), hospital stay (MD = -4.57 days, 95% CI = -7.58 to -1.56, P = .003), and time to full feeds (MD = -3.00 days, 95% CI = -3.80 to -2.19, P < .00001). Laparoscopic Ladd's procedure had less overall postoperative complications (OR = 0.35, 95% CI = 0.19-0.65, P = .0009), less postoperative adhesive small bowl obstruction (OR = 0.37, 95% CI = 0.19-0.74, P = .005), and more postoperative volvulus (OR = 2.97, 95% CI = 1.23-7.13, P = .02). There was no difference in incidence of reoperation rate (OR = 2.04, 95% CI = 0.96-4.33, P = .06). Conclusion: Laparoscopic procedure is superior to open Ladd's in operative time, hospital stay, time to full feeds, overall postoperative complication, and postoperative adhesive small bowel obstruction. However, more RCTs with adequate follow-up are needed to overcome the limitations of our study.

Kinematic descriptions of upper limb function using simulated tasks in activities of daily living after stroke.

Assessment of upper limb function poststroke is critical for clinical management and determining the efficacy of interventions. We designed a unilateral upper limb task to simulate activities of daily living to examine how chronic stroke survivors manage reaching, grasping and handling skills simultaneously to perform the functional task using kinematic analysis. The aim of the study was to compare the motor strategies for performing a functional task between paretic and nonparetic arms. Sixteen chronic stroke survivors were instructed to control an ergonomic spoon to transfer liquid from a large bowl to a small bowl using paretic or nonparetic arm. Kinematic data were recorded using a Vicon motion capture system. Outcome measures included movement duration, relative timing, path length, joint excursions, and trial-to-trial variability. Results showed that movement duration, spoon path length, and trunk path length increased significantly when participants used paretic arm to perform the task. Participants tended to reduce shoulder and elbow excursions, and increase trunk excursions to perform the task with paretic arm and altered the relative timing of the task. Although participants used different motor strategies to perform the task with their paretic arms, we did not find the significant differences in trial-to trial variability of joint excursions between paretic and nonparetic arms. The results revealed differences in temporal and spatial aspects of motor strategies between paretic and nonparetic arms. Clinicians should explore the underlying causes of pathological movement patterns and facilitate preferred movement patterns of paretic arm.

For Modern Children

For Modern Children

Abstract 2183: Genomic profiling of small bowl adenocarcinoma reveals targetable mutations in multiple signaling pathways

Abstract Background: Small bowel adenocarcinoma (SBA) is a rare malignancy of the gastrointestinal (GI) tract without approved targeted therapy. Because the treatment approaches for colorectal cancer showed limited efficacy in SBA, the NCCN guide strongly encourages SBA patients to participate in clinical trials. The identification of targetable mutations through genomic profiling will gain new insights into the etiology of SBA and enable physicians to select the matched trials for patients. Methods: To characterize actionable targets in 50 Chinese SBA patients, a 830-gene next-generation sequencing panel was applied to assess the mutational status of their tumor tissues, including SNV, insertions/deletions, CNV and re-arrangements. Also, paired genomic DNA sample was extracted and analyzed by a 139-gene NGS panel to identify pathogenic germline variants. Results: The most frequently mutated genes in this SBA cohort were TP53 (68%), KRAS (56%), APC (38%), SMAD4 (20%), CTNNB1 (16%), ARID2 (14%), FAT3 (12%), FBXW7 (12%), KMT2C (12%) and PIK3CA (12%). Potentially targetable alterations include BRAF (10%), MDM2 (10%), ERBB2/HER2 (8%), PIK3CA (4%) and MAP2K1 (4%). Except one V600E mutation, all mutations in BRAF are either type 2 (L597R) or type 3 (N581S and D594N) which were sensitive to MEK inhibitor trametinib. We also found two MAP2K1 activating mutations (K57E and K57N) which can be targeted by trametinib. ERBB2/HER2 was highly amplified in one patient (copy number 25) and ERBB2/HER2 driver mutations were seen in 3 (6%) patients including V842I (n =2) and V777L (n =1). These four patients were good candidates for HER2-targeted therapy clinical trials. We also observed two activating PIK3CA mutations (R108H and G364R) which may be sensitive to PIK3CA inhibitor alpelisib. In addition, we observed targetable gene amplification of MDM2 (n =1) and FGF3/4/19 (n =2). Interestingly, one patient carried an activating ZKSCAN1-MET fusion gene which can be targeted by FDA-approved MET inhibitor carbozantinib. Among 46 patients with available MSI status, two were designated as microsatellite instability. The median TMB of microsatellite stable patients was 3.7 mutations/Mb. Lastly, we observed five deleterious germline mutations, two for SBDS, one each for APC, ERCC5 and MLH1. Overall, at least 18 (36%) patients harbored potentially actionable genetic mutations. Conclusions: The mutational landscape of our SBA cohort provided compelling evidence that multiple signaling pathways play a role in the pathogenesis of SBA and many driver mutations in these pathways are targetable. Our findings indicated that SBA patients should participate in matched clinical trials for better management of this disease. Citation Format: Rong Liu, Xiaomo Li, Zhiming Zhao, Tonghui Ma, Fei Wang, Si Liu. Genomic profiling of small bowl adenocarcinoma reveals targetable mutations in multiple signaling pathways [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2183.