Invited Commentary on “Transamniotic fetal mRNA vaccination: Active immunization against Zika virus in a rodent model”

Journal of Pediatric Surgery · 2026-01-28

Eosinophilic esophagitis after tracheoesophageal fistula repair

Journal of Pediatric Surgery · 2026-02-05 · 1 citations

PURPOSE: Eosinophilic esophagitis (EOE) is a known complication in children with esophageal atresia (EA) and tracheoesophageal fistula (TEF) following repair. Knowledge of EOE prevalence and characteristics among children following EA/TEF repair is limited. This study evaluates the prevalence, time to diagnosis, and clinical characteristics associated with EOE after EA/TEF repair. METHODS: We identified a retrospective cohort of primary EA/TEF patients who underwent repair from Jan 1, 2017, to Nov 1, 2023 at a single institution. Long-term follow-up was obtained through our Esophageal and Airway Clinic (EAC) and chart review. EOE diagnosis was defined as >15 eosinophils per high-power field on endoscopic-directed biopsy. RESULTS: (1) = 3.82, p = 0.05). CONCLUSION: In this large cohort of postoperative primary EA/TEF patients we found a high rate of EOE. EOE patients required earlier and more frequent stricture dilations. Our results exemplify the still-undefined physiologic interplay between the underlying pathophysiology of the esophagus after EA/TEF repair and development of EOE. LEVEL OF EVIDENCE: III (retrospective cohort study).

Invited Commentary on Moturu, et al.: Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study

Journal of Pediatric Surgery · 2025-01-20

Medication Adherence Before and After Conversion to LCP-Tacrolimus from Immediate Release Tacrolimus in Pediatric Solid Organ Transplant Recipients

American Journal of Transplantation · 2025-08-01

Case of neonate with total intestinal hirschsprung disease managed with a proximal jejunostomy

Intestinal failure. · 2025-01-01

Background: Hirschsprung disease (HD) is a congenital disorder of the enteric nervous system, and its management will differ clinically depending on the degree of aganglionosis. Total intestinal HD (TIHD) is a rare variant, accounting for < 1 % of all cases, and is defined as aganglionosis of nearly the entire intestine with less than 20 cm of ganglionated small bowel past the ligament of Treitz (LOT). TIHD can be challenging to manage with high risk for chronic intestinal failure. Case report: Ours is a neonate confirmed pathologically to have total intestinal aganglionosis, surgically managed with a jejunostomy formed at 40 cm distal to LOT. Conclusion: Case of TIHD that has benefitted from a proximal diverting jejunostomy.

Secondary Undertriage of Severely Injured Trauma Patients Across the US

Journal of the American College of Surgeons · 2025-08-19 · 4 citations

BACKGROUND: Secondary triage is a critical mechanism through which severely injured patients presenting to lower-resource hospitals are transferred to high-resource trauma centers, and is associated with improved survival. We conducted a contemporary, nationally representative analysis to quantify the volume of severely injured patients not transferred to higher-level care and to identify predictors of non-transfer. STUDY DESIGN: Retrospective cohort study using the 2019 Nationwide Emergency Department Sample of all adult trauma patients with an Injury Severity Score (ISS) >15 who first presented to a Level III or non-trauma center (NTC). Primary outcome was non-transfer, defined as admission to the Level III or NTC from the ED. Multivariable generalized linear models were developed to determine patient- and hospital-level predictors of non-transfer. RESULTS: Among 146,816 encounters, 84,695 (58%) patients were not transferred, reflecting secondary undertriage. Independent patient predictors of non-transfer included increasing age (≥80 years aOR 1.68, 95% CI 1.43-1.97) and public insurance (Medicare aOR 1.76 (95% CI 1.54, 2.02), Medicaid aOR 1.44, (95% CI 1.27, 1.65)). Hospital-level predictors included Level III trauma designation (aOR 2.93, 95% CI 2.10, 4.08) and metropolitan location (aOR 5.21, 95% CI 3.43-7.92). These predictors persisted in sub-analysis of patients with ISS ≥ 25. CONCLUSION: 1 in 3 severely injured trauma patients in the US are first treated at level III or NTCs, of which over half are not transferred to higher level trauma centers. Hospital factors including metropolitan location and Level III designation were the strongest predictors of non-transfer. These findings support the development of inclusive state trauma systems, that incorporate all acute care hospitals - including NTCs - in trauma registries and regional quality improvement initiatives.

Safety of Erythropoiesis-Stimulating Agents for Pediatric Berlin EXCOR VAD Patients

The Journal of Heart and Lung Transplantation · 2024-04-01

An explainable long short-term memory network for surgical site infection identification

Surgery · 2024-04-18 · 5 citations

Cost and Late Hospital Care of Publicly Insured Children After Appendectomy

Journal of Surgical Research · 2024-03-01 · 3 citations

Validation of administrative health data for the identification of endometriosis diagnosis

Human Reproduction · 2024-12-20 · 3 citations

STUDY QUESTION: How do endometriosis diagnoses and subtypes reported in administrative health data compare with surgically confirmed disease? SUMMARY ANSWER: For endometriosis diagnosis, we observed substantial agreement and high sensitivity and specificity between administrative health data-International Classification of Diseases (ICD) 9 codes-and surgically confirmed diagnoses among participants who underwent gynecologic laparoscopy or laparotomy. WHAT IS KNOWN ALREADY: Several studies have assessed the validity of self-reported endometriosis in comparison to medical record reporting, finding strong confirmation. We previously reported high inter- and intra-surgeon agreement for endometriosis diagnosis in the Endometriosis, Natural History, Diagnosis, and Outcomes (ENDO) Study. STUDY DESIGN, SIZE, DURATION: In this validation study, participants (n = 412) of the Utah operative cohort of the ENDO Study (2007-2009) were linked to medical records from the Utah Population Database (UPDB) to compare endometriosis diagnoses from each source. The UPDB is a unique database containing linked data on over 11 million individuals, including statewide ambulatory and inpatient records, state vital records, and University of Utah Health and Intermountain Healthcare electronic healthcare records, capturing most Utah residents. PARTICIPANTS/MATERIALS, SETTING, METHODS: The ENDO operative cohort consisted of individuals aged 18-44 years with no prior endometriosis diagnosis who underwent gynecologic laparoscopy or laparotomy for a variety of surgical indications. In total, 173 women were diagnosed with endometriosis based on surgical visualization of disease, 35% with superficial endometriosis, 9% with ovarian endometriomas, and 14% with deep infiltrating endometriosis. Contemporary administrative health data from the UPDB included ICD diagnostic codes from Utah Department of Health in-patient and ambulatory surgery records and University of Utah and Intermountain Health electronic health records. MAIN RESULTS AND THE ROLE OF CHANCE: For endometriosis diagnosis, we found relatively high sensitivity (0.88) and specificity (0.87) and substantial agreement (Kappa [Κ] = 0.74). We found similarly high sensitivity, specificity, and agreement for superficial endometriosis (n = 143, 0.86, 0.83, Κ = 0.65) and ovarian endometriomas (n = 38, 0.82, 0.92, Κ = 0.58). However, deep infiltrating endometriosis (n = 58) had lower sensitivity (0.12) and agreement (Κ = 0.17), with high specificity (0.99). LIMITATIONS, REASONS FOR CAUTION: Medication prescription data and unstructured data, such as clinical notes, were not included in the UPDB data used for this study. These additional data types could aid in detection of endometriosis. Most participants were white or Asian with Hispanic ethnicity reported 11% of the time, which may limit generalizability to some US states. Additionally, given that participants whose administrative health records we utilized were also part of the ENDO Study, the surgeons may have been more vigilant in diagnostic coding due to the operative forms they completed for the ENDO Study, which may have led to increased validity. However, the codes compared in the UPDB would have been entered by medical coders as part of standard clinical practice. WIDER IMPLICATIONS OF THE FINDINGS: We observed substantial agreement between administrative health data and surgically confirmed endometriosis diagnoses overall, and for superficial and ovarian endometrioma subtypes. These findings may provide reassurance to researchers using administrative healthcare records to assess risk factors and long-term health outcomes of endometriosis. Our findings corroborate prior research that demonstrates high specificity but low sensitivity for deep infiltrating endometriosis, indicating deep infiltrating endometriosis is not reliably annotated in administrative healthcare data. This suggests that medical record-based deep infiltrating endometriosis diagnoses may be suitable for etiologic studies but not for surveillance or detection studies. STUDY FUNDING/COMPETING INTEREST(S): The original ENDO Study was funded by the Intramural Research Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health (contracts NO1-DK-6-3428; NO1-DK-6-3427; 10001406-02). We acknowledge partial support for the UPDB through grant P30 CA2014 from the National Cancer Institute, University of Utah and from the University of Utah's program in Personalized Health and Center for Clinical and Translational Science. This research was also supported by the NCRR grant, 'Sharing Statewide Health Data for Genetic Research' (R01 RR021746, G. Mineau, PI) with additional support from the Utah Department of Health and Human Services, University of Utah. Additionally, this research was supported by the Utah Cancer Registry, which is funded by the National Cancer Institute's SEER Program, Contract No. HHSN261201800016I, the US Centers for Disease Control and Prevention's National Program of Cancer Registries, Cooperative Agreement No. NU58DP007131, with additional support from the University of Utah and Huntsman Cancer Foundation. Research reported in this publication was also supported by the National Institutes of Health (Award Numbers R01HL164715 [to L.V.F., K.C.S., and A.Z.P.] and K01AG058781 [to K.C.S.]), by the Huntsman Cancer Institute's Breast and Gynecologic Cancers Center, and by the Doris Duke Foundation's COVID-19 Fund to Retain Clinical Scientists funded by the American Heart Association. A.C.K. was supported by Training Grant Number 5T15LM007124 from the National Library of Medicine to K.E. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other sponsors. There are no competing interests among any of the authors. TRIAL REGISTRATION NUMBER: N/A.