GR-ConvNet v2: A Real-Time Multi-Grasp Detection Network for Robotic Grasping.

We propose a dual-module robotic system to tackle the problem of generating and performing antipodal robotic grasps for unknown objects from the n-channel image of the scene. We present an improved version of the Generative Residual Convolutional Neural Network (GR-ConvNet v2) model that can generate robust antipodal grasps from n-channel image input at real-time speeds (20 ms). We evaluated the proposed model architecture on three standard datasets and achieved a new state-of-the-art accuracy of 98.8%, 95.1%, and 97.4% on Cornell, Jacquard and Graspnet grasping datasets, respectively. Empirical results show that our model significantly outperformed the prior work with a stricter IoU-based grasp detection metric. We conducted a suite of tests in simulation and the real world on a diverse set of previously unseen objects with adversarial geometry and household items. We demonstrate the adaptability of our approach by directly transferring the trained model to a 7 DoF robotic manipulator with a grasp success rate of 95.4% and 93.0% on novel household and adversarial objects, respectively. Furthermore, we validate the generalization capability of our pixel-wise grasp prediction model by validating it on complex Ravens-10 benchmark tasks, some of which require closed-loop visual feedback for multi-step sequencing.

Risk Prediction Scoring System to Predict the Postsurgical Outcomes of Biliary Atresia.

AIM: To find out association between liver function, liver histopathology and outcomes of biliary atresia (BA) following Kasai Portoenterostomy (KPE). MATERIALS AND METHODS: This is a retrospective study of children who underwent KPE at a single institute by single surgeon. The patient records analyzed and data of complete blood counts, liver function tests, coagulation profile and histopathology reports collected. The outcomes recorded as alive and jaundice free, alive but jaundiced, and deceased. Statistical analysis done using SPSS 23. OBSERVATIONS: Total of 148 children operated during January 2000 to December 2018. Of these, 26 matched inclusion criteria. The parameters assessed were percentage of direct bilirubin, ratios of Aspartate transaminase (AST) to Alanine transaminase (ALT); Gamma glutamyl transferase (GGT) to AST; GGT to ALT and Aspartate transaminase to platelet ratio index (APRi). Among histopathology reports, fibrosis grade and bile ductular size noted. Among 26, 16 alive and ten are deceased. Among 16 alive, all are jaundice free. Of the parameters, ratio of AST to ALT, APRi and grade of fibrosis found statistically significant and further analysis showed if AST to ALT ratio < 2.1, APRi < 1.8 and grade of fibrosis < four, irrespective of age at surgery, had 96.2 % probability of successful KPE. Based on these observations, a scoring system and risk prediction model constructed based on Receiver operating characteristic (ROC) curves which are first in BA management. RESULTS AND CONCLUSION: Although numbers are sufficient for statistical analysis, we further intend to validate the scoring system in a prospective trial. BA children can be subjected to risk prediction model and KPE performed in those who have a score less than seven and offered to those with score between eight and 16 out of 20. KEY MESSAGE: The scoring system and risk prediction model can guide in the management and post-operative follow up of children with biliary atresia.

Balloon venoplasty as primary modality of treatment in children with Budd-Chiari syndrome.

INTRODUCTION: Budd-Chiari syndrome (BCS) is a rare condition affecting children. It is characterized by occlusion of venous outflow from liver at the level of hepatic veins (HV) or inferior vena cava (IVC). The management of BCS in children revolves around forming new collaterals for venous outflow or by elimination of blockage in the venous outflow tracts. These can be achieved by balloon venoplasty (BV), transjugular intrahepatic portosystemic shunting (TIPSS) or open shunt surgeries. AIM: The aim of this study is to evaluate the management of BCS in children with balloon venoplasty as primary modality of treatment. MATERIALS AND METHODS: This is a retrospective study which includes children diagnosed with BCS managed by balloon venoplasty by a single surgeon at a single institute. Once confirmed, the child was posted for balloon venoplasty and liver biopsy. When venoplasty was successful, child was subsequently heparinized and dose titrated. Routine follow up was mandated and dose adjustments were continued during follow up. In case of unsuccessful venoplasty, depending on the liver biopsy report, shunt procedure or liver transplantation is offered to patients. An algorithm was then designed for management of BCS in children. RESULTS: A total of 35 children who underwent evaluation of symptoms associated with Budd-Chiari syndrome were included in the study. Of all the children, 14 are alive and symptom free, 9 are deceased and 12 lost to follow up. Hepatic vein was the most common site of obstruction (85%), followed by both IVC and HV (15%). Overall, in 35 children, 26 had a successful balloon venoplasty, in 3 venoplasty was not done (2 spontaneous resolution and 1 died awaiting), in 6 it was unsuccessful (3 technical failures: 1 underwent TIPSS and 2 lost to follow up, 3 clinical failures: portocaval shunt for failed venoplasty). CONCLUSION: Budd-Chiari syndrome is a rare condition affecting children. Balloon venoplasty as a primary modality of treatment for BCS is a promising option for management in children. Early and aggressive use of radiological intervention can help achieve recanalization in children. TYPE OF STUDY: Clinical research paper. LEVEL OF EVIDENCE: Level IV.

Rare Association of Isolated Microphthalmia with Anorectal Malformation.

Anorectal malformations (ARMs) have coexisting congenital anomalies. These can affect the overall prognosis. Anomalous craniofacial associations are less common. Recently, we managed two patients of ARM associated with unilateral microphthalmia, without any other major systemic anomalies. This was found to be a rare association on extensive literature search.

Role of Chemoports in Children with Hematological/Solid Tumor Malignancies - Technical Implications and Complications: An Institutional Experience.

AIM: The aim of this retrospective analysis was to identify the variously related complications and to study preventive and therapeutic measures for these complications. MATERIALS AND METHODS: A total of 72 catheters were inserted in 69 patients (mean follow-up of 1140 days) from December 2002 to May 2017. Sixty-four children were diagnosed to have hematological malignancies, and five children had solid tumors. The youngest child was 2 months of age, and the oldest was 15 years, 5 months. Records were analyzed retrospectively for the age, indication, route of insertion, and postoperative complications. A protocol-based insertion and postinsertion handling by trained nursing staff/doctors were instituted, including a periodic training program for those concerned. RESULTS: Chemoport-related complications were infection in 3 (4.16%), necessitating port removal in one patient. The rest were managed by antibiotic-lock therapy. The other problems were catheter tip occlusion in 1 (1.38%) and extravasation in two patients (2.77%) leading to a sterile collection around the port chamber. An unsightly scar in 4 (5.55%) and granuloma formation at scar site in 1 (1.38%) patient were noted. CONCLUSION: Totally implantable chemoports are preferred in children with solid and hematological malignancies because of decreased pain, the rate of infection, and ability to maintain patency for the long term. Despite significant advantages over other types of central venous access, chemoports have their own complications. It was also noted that the rate of complications could be minimized by periodic training of all the personnel concerned and following protocol-based handling of ports.

Scrotoschisis: A rare cause of acute scrotum in neonates.

Spontaneous extrusion of the testis from the scrotum is a very rare cause of acute scrotum in neonates. It has been described as scrotoschisis in few case reports. The exact etiology of this condition is not known. Replacing the testes and repair of scrotum is needed and associated with good prognosis. We report two cases that presented in a short interval to us with a review of the literature.

Role of laparoscopy in the management of neonatal ovarian cysts.

AIM: Ovarian cysts in the newborn period are simple cysts which resolve on their own. Complications like torsion leading to loss of ovarian units are well documented. Surgical treatment should always be performed in a way to protect the ovaries and to ensure future fertility. The aim of this study was to study the safety and efficacy of laparoscopic management of neonatal ovarian cysts. MATERIALS AND METHODS: Neonates with ovarian cysts over last 6 years were retrospectively studied. Thirty seven ovarian cysts were detected antenatally and 32 of them persisted postnatally. All babies were asymptomatic. Nine babies with cyst size more than 5cms underwent laparoscopic deroofing, fenestration or cystectomy; the rest 23 babies were managed conservatively. Sonographic monitoring was done at monthly interval for change in contents, echogenicity of walls and features of torsion. Follow up was done with USG at 3 and 6 months and MRI after 1 year. RESULTS: No procedure related complications were seen in the laparoscopy group and no loss of ovarian units were seen in 1 year follow-up. In the observation group, cysts resolved in 3- 12 months period. Three babies developed complications and 4(17%) ovarian units were lost. CONCLUSION: Ovarian cysts are the most frequent among intra-abdominal cysts in newborns. Neonatal ovarian cysts are known to resolve spontaneously. Laparoscopic management of these cysts is safe and efficacious even in neonatal age and should be the treatment of choice when indicated.

Unusual cause of esophageal obstruction in a neonate presenting as esophageal atresia.

Esophageal atresia is the commonest cause of obstruction to esophageal lumen in neonates. Foreign bodies in newborns are extremely rare. We report a rare case of esophageal obstruction closely mimicking atresia due to foreign bodies inserted in a female neonate with homicidal intension.