The MTS is a reliable system of triage in the emergency department.

Cystic fibrosis (CF) is a lifelong, inflammatory multi-organ disease and the most common lethal, genetic condition in Caucasian populations, with a median survival rate of 41.5 years. Pulmonary disease, characterized by infective exacerbations, bronchiectasis and increasing airway insufficiency is the most serious manifestation of this disease process, currently responsible for over 80% of CF deaths. Chronic dysregulation of the innate immune and host inflammatory response has been proposed as a mechanism central to this genetic condition, primarily driven by the nuclear factor κB (NF-κB) pathway. Chronic activation of this transcription factor complex leads to the production of pro-inflammatory cytokines and mediators such as IL-6, IL-8 and TNF-α. A20 has been described as a central and inducible negative regulator of NF-κB. This intracellular molecule negatively regulates NF-κB-driven pro-inflammatory signalling upon toll-like receptor activation at the level of TRAF6 activation. Silencing of A20 increases cellular levels of p65 and induces a pro-inflammatory state. We have previously shown that A20 expression positively correlates with lung function (FEV₁%) in CF. Despite improvement in survival rates in recent years, advancements in available therapies have been incremental. We demonstrate that the experimental use of naturally occurring plant diterpenes such as gibberellin on lipopolysaccharide-stimulated cell lines reduces IL-8 release in an A20-dependent manner. We discuss how the use of a novel bio-informatics gene expression connectivity-mapping technique to identify small molecule compounds that similarly mimic the action of A20 may lead to the development of new therapeutic approaches capable of reducing chronic airway inflammation in CF.

We have demonstrated that medical students possess the skills to develop and facilitate their own educational projects. Non-clinical, student-led community projects have the potential to be reproduced using recognised frameworks and guidelines to complement the current undergraduate medical curriculum.

We report the case of a 17-year-old girl who presented to the accident and emergency department with dysuria and foul smelling, bloody discharge from her umbilicus. The definitive diagnosis was that of a patent urachus, which is a fistulous communication between the bladder and the umbilicus, usually diagnosed in early infancy. The incidence of a patent urachus is approximately 1 in 70,000 in the general population. It is highly likely that removal of a recent belly button piercing resulted in the acute presentation by completing the fistulous tract to the skin. This case is of clinical relevance as the diagnosis was missed 18 months prior with a milder presentation. The recommended treatment option is surgical excision due to the potential risk of malignant change, with urachal adenocarcinoma accounting for 0.3% of all bladder cancers.

BackgroundSpecific Image Defined Risk Factors (IDRF) may be of more relevance to the pediatric surgical oncologist than simply the presence of any IDRF. The aim of this study was to correlate IDRF with surgical complications with reference to vascular encasement IDRF and the grade of complication.MethodsWe searched the New Zealand Children’s Cancer Registry for all cases of neuroblastoma treated at a single pediatric oncology center between January 2007 – February 2021 and reviewed the pre-treatment axial imaging for IDRF status. Surgical complications were scored by Clavien-Dindo grade and correlated with the number of IDRF and with the subset of vascular encasement IDRF.ResultsOf 101 patients, 77 were IDRF positive. In total, 74 underwent surgical resection and 32 (43.2%) had a surgical complication. Complications were related to the number of IDRF (OR 1.33, 95% CI 1.05 – 1.73, p = 0.02) and the subgroup of vascular encasement IDRF (OR 1.78, 95% CI 1.12 – 3.04, p = 0.01) but were not significantly correlated with the subgroup of non-vascular encasement IDRF. We report three cases of chyle leak associated with tumor encasing the origin of the celiac axis and/or the superior mesenteric artery.ConclusionsThe vascular encasement IDRF subgroup is potentially a more useful prognostic indicator of surgical complications than non-vascular IDRF. More studies are needed to correlate specific IDRF with specific surgical complications to aid operative decision making.Level of evidenceLevel IIIHighlightsImage Defined Risk Factors (IDRF) in neuroblastoma correlate with survival, completeness of resection, and surgical complications.Complications correlate specifically with the subset of vascular encasement IDRF. Chylous ascites was a specific complication associated with encasement of the celiac and superior mesenteric vessels.