Laparoscopic vs. laparoscopically assisted pediatric inguinal hernia repair: a systematic review.

This systematic review aims to compare the two major principles of laparoscopic pediatric inguinal hernia repair: totally laparoscopic repairs (LR) and laparoscopically assisted repairs (LAR), to find out the optimal approach for pediatric patients. A systematic literature search was performed via Pubmed, Embase MEDLINE, and Cochrane databases on all studies published in the last 20 years reporting outcomes on these principles including recurrences, complications, and operative time. Prospective studies for either principle or retrospective comparative studies were considered eligible. Fischer's exact and Student's t test were used for statistical analysis with p value < 0.05 considered statistically significant. Twenty-one studies, including two thousand one hundred and ninety-six patients (LR: 1008), of ages ranging from 9 days to 18 years-old and a male to female ratio of 2.55:1, met our inclusion criteria. Follow-up period varied from 3 months to 8 years. Recurrence rates were similar between the two categories (LR: 1.68% vs. LAR: 1.59%, p > 0.05). As regards post-operative complications, transient hydrocele development was higher in laparoscopic repairs (LAR: 1.01% vs. LR: 3.17% p < 0.005) while wound healing problems were more frequent in laparoscopically assisted repairs (LAR: 1.17% vs. LR: 0.30%, p = 0.019). Mean operative time was lower in laparoscopically assisted repairs both in unilateral (LAR: 21.49 ± 13.51 vs. LR: 29.73 ± 11.05, p = 0.131) and bilateral cases (LAR: 28.01 ± 15.08 vs. LR: 39.48 ± 16.35, p = 0.101) but without statistically significant difference. Both principles are equally effective and safe as their recurrence and overall complications rates are equivalent. Transient hydrocele occurs more often in laparoscopic repairs while wound healing problems are associated mostly with laparoscopically assisted repairs.

Physiological reactivity to fear moderates the relation between parenting distress with conduct and prosocial behaviors.

This study investigated whether the associations between parental distress with conduct problems (CPs) and prosocial behaviors (PBs) are moderated by children's skin conductance (SC) and heart rate (HR) reactivity to fear. Participants were 147 Greek-Cypriot children (Mage  = 7.30, 44.2% girls), selected from a larger screening sample (data were collected from 2015 to 2018). Longitudinal associations suggested that children with high HR reactivity to fear were more likely to display PB, whereas those with low SC reactivity were more likely to engage in CP behaviors. In contrast, interaction effects suggested that children high on SC reactivity to fear were more susceptible to the effects of parental distress, as indicated by their higher vulnerability to engage in CP (cross-sectionally) behaviors and their lower scores on PB (cross-sectionally and longitudinally).

Rectal Lipoma in a 4-Year-Old Boy Presenting with Anal Prolapse.

Colonic lipomas, even though rare, are the most common intramural tumor and the second-most common benign tumor of the colon after adenomatous polyps. We present the case of a 4-year-old boy with a large rectal lipoma causing anal prolapse, bleeding, and constipation, to discuss differential diagnostic problems and the proper management. A 4-year-old boy presented with symptoms of anal prolapse and constipation. Anal prolapse was accompanied by a tumor that occasionally was bleeding. Computed tomography was performed to determine the origin of the tumor and its relations with the surrounding tissues. Excision of the mass was performed through retraction through the anus and the anal wall was closed with sutures. Histopathological findings revealed a submucosal lipoma of a 5 cm diameter, with the erosions of the overlying mucosa. The patient was discharged after 3 days with no postoperative complications. Colonic lipomas, even though rare, are the second-most common benign tumor of the colon. Essential reasons for the resection are the potential complications, such as abdominal pain, change in bowel pattern, bleeding, obstruction, intussusception, perforation, and rarely transformation into a liposarcoma. Resection is performed endoscopically if the tumor is <2 cm in diameter and has a narrow base that allows safe ligation. Otherwise, the open procedure should be considered. In our case, prolapse of the mass through the anal canal allowed the transanal resection.

In the eyes of the beholder: investigating the effect of visual probing on accuracy and gaze fixations when attending to facial expressions among primary and secondary callous-unemotional variants.

Individuals with callous-unemotional (CU) traits show deficits in facial emotion recognition. According to preliminary research, this impairment may be due to attentional neglect to peoples' eyes when evaluating emotionally expressive faces. However, it is unknown whether this atypical processing pattern is unique to established variants of CU traits or modifiable with intervention. This study examined facial affect recognition and gaze patterns among individuals (N = 80; M age = 19.95, SD = 1.01 years; 50% female) with primary vs secondary CU variants. These groups were identified based on repeated measurements of conduct problems, CU traits, and anxiety assessed in adolescence and adulthood. Accuracy and number of fixations on areas of interest (forehead, eyes, and mouth) while viewing six dynamic emotions were assessed. A visual probe was used to direct attention to various parts of the face. Individuals with primary and secondary CU traits were less accurate than controls in recognizing facial expressions across all emotions. Those identified in the low-anxious primary-CU group showed reduced overall fixations to fearful and painful facial expressions compared to those in the high-anxious secondary-CU group. This difference was not specific to a region of the face (i.e. eyes or mouth). Findings point to the importance of investigating both accuracy and eye gaze fixations, since individuals in the primary and secondary groups were only differentiated in the way they attended to specific facial expression. These findings have implications for differentiated interventions focused on improving facial emotion recognition with regard to attending and correctly identifying emotions.

Neurophysiological markers associated with heterogeneity in conduct problems, callous unemotional traits, and anxiety: Comparing children to young adults.

Evidence from physiological studies has been integral in many causal theories of behavioral and emotional problems. However, this evidence is hampered by the heterogeneity characterizing these problems. The current study adds to prior work by identifying neuro-physiological markers associated with heterogeneity in conduct problems (CP), callous-unemotional (CU) traits, and anxiety. Participants were classified into the following groups: (a) low risk, (b) anxious (predominately high anxiety), (c) primary (scored high on CP and CU traits but low on anxiety), and (d) secondary (high anxiety, CU traits, and CP). Developmental differences were also examined by including two different samples assessed during young adulthood (Study 1: n = 88; Mage = 19.92; 50% female) and childhood (Study 2: n = 72; Mage = 5.78, SD = 1.33; 39 males). Participants in both studies were recruited from community samples (Study 1: n = 2,306; Mage = 16, SD = .89; Study 2: n = 850; Mage = 5.01, SD = .95). Physiological responses (heart rate, skin conductance, startle modulation) were recorded while children and adults watched negative affective and neutral scenes. Medial prefrontal activation (oxygenated hemoglobin) was also measured in young adults. Findings suggested that individuals in the secondary and anxious psychopathy groups showed higher physiological arousal and startle reactivity to violent, fearful, and anger stimuli compared to individuals in the primary psychopathy group. In contrast, primary and secondary psychopathy groups showed similar physiological reactions to sad stimuli assessed during childhood. Also, young adults in the primary and secondary subtypes showed lower medial prefrontal cortex activation to violent stimuli compared to the anxious group. These findings provide evidence for the value of a multidomain approach for identifying neurophysiological mechanisms that can inform prevention and treatment efforts. (PsycINFO Database Record

Callous-unemotional, impulsive-irresponsible, and grandiose-manipulative traits: Distinct associations with heart rate, skin conductance, and startle responses to violent and erotic scenes.

The present study aimed to examine whether callous-unemotional, grandiose-manipulative, and impulsive-irresponsible dimensions of psychopathy are differentially related to various affective and physiological measures, assessed at baseline and in response to violent and erotic movie scenes. Data were collected from young adults (N = 101) at differential risk for psychopathic traits. Findings from regression analyses revealed a unique predictive contribution of grandiose-manipulative traits in particular to higher ratings of positive valence for violent scenes. Callous-unemotional traits were uniquely associated with lower levels of sympathy toward victims and lower ratings of fear and sadness during violent scenes. All three psychopathy dimensions and the total psychopathy scale showed negative zero-order correlations with heart rate at baseline, but regression analyses revealed that only grandiose manipulation was uniquely predictive of lower baseline heart rate. Grandiose manipulation was also significantly associated with lower baseline skin conductance. Regarding autonomic activity, findings resulted in a unique negative association between grandiose manipulation and heart rate activity in response to violent scenes. In contrast, the impulsive-irresponsible dimension was positively related with heart rate activity to violent scenes. Finally, findings revealed that only callous-unemotional traits were negatively associated with startle potentiation in response to violent scenes. No associations during erotic scenes were identified. These findings point to unique associations between the three assessed dimensions of psychopathy with physiological measures, indicating that grandiose manipulation is associated with hypoarousal, impulsive irresponsibility with hyperarousal, and callous-unemotional traits with low emotional and fear responses to violent scenes.