HXI (United States)

To determine the factors associated with an increased risk for severe steatosis (SS) and establish the Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) as a screening tool. A cross-sectional study was performed in obese children to assess the relationship between the metabolic syndrome (MetS) and glucose metabolism alterations (GMA) and the risk for severe steatosis. A total of 94 children (51 males) aged from six to 14 years were included. Thirteen children (14.8%) had severe steatosis (SS). The anthropometric variables associated with SS included body mass index (BMI) (SS 34.1 vs non-SS 29.7, p = 0.005), waist circumference (cm) (100 vs 92.5, p = 0.015) and hip circumference (cm) (108 vs 100, p = 0.018). The blood parameters included alanine aminotransferase (ALT) (UI/dl) (27 vs 21, p = 0.002), gamma-glutamil transpeptidase (GGT) (UI/dl) (16 vs 15, p = 0.017), fasting glycemia (mg/dl) (96 vs 88, p = 0.006), fasting insulin (UI/dl) (25 vs 15.3, p < 0.001) and HOMA-IR score (7.1 vs 3.7, p < 0.001). Eighteen children with MetS were found to be at an increased risk for severe steatosis (odds ratio [OR] 11.36, p < 0.001). After receiver operating characteristic (ROC) curve analysis, the best area under the curve (AUC) was obtained for HOMA-R of 0.862. The HOMA-R 4.9 cut-off value had a 100% sensitivity (CI 95%: 96.2-100) and 67.9% specificity (CI 95%: 57.1-78.7) for severe steatosis. The presence of MetS and glucose metabolism alterations are risk factors for severe steatosis. The 4.9 cut-off value for HOMA-IR may be a risk factor for severe steatosis in obese children.

Introduction: Newborns with congenital esophageal atresia and a distal tracheoesophageal fistula undergo repair by several different approaches, the newest of which is thoracoscopic.The fistula is frequently occluded using a small polymer or titanium clip at the point of insertion into the trachea. Case Description:We report the case of a 1-day-old male newborn with proximal esophageal atresia and a distal tracheoesophageal fistula who underwent thoracoscopic repair and who then presented with respiratory distress 10 weeks later.The polymer Hem-o-lok clip (Weck Surgical Instruments [Teleflex Medical], Durham, North Carolina) used to ligate the tracheoesophageal fistula eroded through the membranous trachea, causing partial airway obstruction.Discussion: This case represents a previously unreported complication of the use of polymer clips in esophageal atresia repair.The possibility of airway obstruction after thoracoscopic repair of esophageal atresia with a tracheoesophageal fistula should raise concern among pediatric surgeons and prompt further study into the use of plastic clips for this type of procedure.

We described an adaptive denoising method to improve image quality in a wavelet-based image compression process that uses dithered quantization. In our method, the second-order moment of the quantization noise is made independent of the signal by random quantization. Then, the quantization noise is reduced by thresholding wavelet coefficients. We first obtained a fixed threshold using any known technique. Then, a neighborhood is searched for the optimal threshold to optimize some cost function.