PDF file - 111K, Additional description of materials, methods, and techniques, including binding studies, andibodies used, flow cytometry analysis, and gene sequencing information.

XLSX file - 17K, Gene Ontology (GO) analysis of gene sets regulated by Cyclin D1 and CDK4 silencing.

PDF file - 67K, Model for CD114+ and CD114- cells in neural crest development.

<p>PDF file - 52K, MicroRNA expression defined by small-RNA sequencing in three neuroblastoma cell lines.</p>

PDF file - 1479K, Flow cytometry demonstrating specificity of CD114 staining and active binding of wild-type G-CSF ligand in both mouse and human neuroblastoma tumors.

<p>PDF file - 57K, 25 microRNAs upregulated in CD114+ cells from 3 neuroblastoma cell lines (IMR-32, LA-N-5, NGP) for gene pathway prediction using two independent software tools.</p>

PDF file - 858K, The CD114 subpopulation is distinct from other reported markers of tumor initiating cells in neuroblastoma.

PDF file - 77K, CHAF1A expression correlates with stage of disease.

PDF file - 57K, In vitro effects of CHAF1A silencing on proliferation.

<p>PDF file - 41K, QPCR validation of genes from the CD114+ and CD114- cell populations.</p>

XLSX file - 14K, Kegg, Biocarta and Oncogenic Pathways GSEA analysis.

PDF file - 45K, Xenografts tumor growth is proportional to CHAF1A protein levels.

PDF file - 53K, Effect of retinoic acid (RA) treatment on neuroblastoma cells.

<p>PDF file - 90K, Ingenuity curated microRNA target genes. Gene target components of KEGG pathways as determined with Ingenuity miRPATH microRNA Target Filter analysis of experimentally validated microRNA-mRNA target interactions.</p>

PDF file - 54K, Analysis of xenograft tumors derived from CD114+/CD114- mixing studies.

We read with great interest the recent article from Howk et al., identifying the successful use of esophageal impedance planimetry (EndoFLIP) during laparoscopic myotomy without fundoplication in pediatric patients with achalasia [ [1] Howk A.A. Clifton M.S. Garza J.M. et al. Impedance planimetry (EndoFLIP) assisted laparoscopic esophagomyotomy in pediatric population. J Pediatr Surg. 2022; https://doi.org/10.1016/j.jpedsurg.2022.05.004 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. In support of the findings of Howk et al., we wanted to share our institution's recent pediatric experience of combined intraoperative high resolution esophageal manometry and EndoFLIP during laparoscopic Heller myotomy with Dor fundoplication. In the evaluation of 9 children (median age 14y, 66% female), we found significant pre-procedure vs. post-procedure changes (even with Dor fundoplication) in mean esophageal planimetry values including distensibility (1.6 vs. 8.1 mm2/mm Hg, p = 0.01), diameter (6.1 vs. 10.3 mm, p = 0.01), and cross-sectional area (31 vs. 110 mm2, p = 0.004). With esophageal manometry we identified mean LES pressure changes from 33 to 14 mmHg (p < 0.001). Anecdotally, we have found that manometry helps to identify areas of persistently high EGJ pressure which can then be targeted for further division, as well as to ensure EGJ pressures remain lowered even after the fundoplication procedure. We agree with Howk et al. that EndoFLIP may also allow for intraoperative evaluation of myotomy sufficiency. Combining EndoFLIP with esophageal manometry may offer complementary data for further optimization of myotomy and fundoplication. We look forward to evaluating long-term outcomes such as recurrent dysphagia or reflux when using EndoFLIP and esophageal manometry as supportive intraoperative evaluations in children with achalasia undergoing Heller myotomy.

IntroductionPediatric patients with complex colorectal and genitourinary conditions often require coordinated multidisciplinary care; however, this coordinated care can be hard to structure and deliver. The purpose of this paper is to review the development and implementation of a multidisciplinary colorectal and pelvic health program, one year after the program's initiation.MethodsThis is an observational retrospective 1-year study (10/1/2017 to 9/30/2018). In fiscal year (FY) 2018, a multidisciplinary colorectal and pelvic health program was initiated.The program development incorporated bimonthly team meetings, educational conferences, and initiation of three clinics: a complex colorectal and genitourinary reconstruction clinic, a bowel management clinic, and a colonic motility clinic. Conditions treated included complex anorectal and cloacal malformations, Hirschsprung disease, and idiopathic constipation. The fiscal year was selected to provide comparative administrative data after program implementation.ResultsDuring the study period, 121 patients underwent comprehensive collaborative evaluation of which 58 (47%) were new to the institution compared to 12 (19%) new patients in the previous year (p < 0.001). In FY 2018, there were 130 procedures performed and 512 collaborative visits with an average of 47 visits per month. This was a 3.4-fold increase in visits compared to FY2017 (171 visits). Of the new patients, 60% (35/58), traveled a median of 181 miles, representing 33 statewide counties, and 4 states compared to a median of 93 miles in the previous fiscal year (p = 0.004).ConclusionThe development of a colorectal and pelvic health program is feasible and requires a collaborative approach, necessitating multiple service lines within an institution. Program creation and implementation can result in rapid institutional clinical growth by filling a local and regional need through coordinated multidisciplinary care.Level of evidenceIV