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Expression of programmed death-1 and its ligands in the liver of biliary atresia

World Journal of pediatrics 2017年第6期13卷 604-610页

作者： Pan-Liang Wang Jun Wang Ying Zhou Xiao-Song Chen Ke-Jun Zhou Jie Wen Jian-Jun Zhang Wei Cai department of pediatric surgery Xinhua HospitalSchool of MedicineShanghai Jiaotong UniversityShanghaiChina department of Transplantation and Hepatic surgery Renji HospitalSchool of MedicineShanghai Jiaotong UniversityShanghaiChina Shanghai Key Laboratory of pediatric Gastroenterology and Nutrition ShanghaiChina department of pediatric surgery Xinhua HospitalSchool of MedicineShanghai Jiaotong UniversityShanghaiChina Shanghai Key Laboratory of pediatric Gastroenterology and Nutrition ShanghaiChina Shanghai Institute of pediatric Research ShanghaiChina

Background:An aberrant immune response is the predominant pathogenetic factor in biliary atresia (BA).Programmed death-1 (PD-1) and its two ligands,programmed death ligand-1 and programmed death ligand-2 (PD-L1 and PD-L2,respectively) play an important inhibitory role in immune reactions.We aimed to illustrate the expression of these molecules in BA.Methods:Liver specimens were obtained from infants with BA during the Kasai procedure (early BA) and fiver transplantation (late BA).Intrahepatic expression of PD-1,PD-L1,and PD-L2 were examined by immunostaining and compared with that in patients with neonatal hepatitis syndrome and normal controls.The correlation between the expression levels of these molecules in the liver and clinicopathological parameters was analyzed for each group.Results:Enhanced expression of PD-1 and its ligands occurred in the livers with early BA.In the BA-affected livers,PD-1 was correlated with the degree of peri-bifiary inflammation,while PD-L2 was linked more directly with portal fibrosis.None of the three molecules was correlated with the prognosis of the Kasai procedure in patients with early BA.Conclusion:Only PD-1 and PD-L1 are involved in the immune reactions of early BA.Elucidation of the detailed role of PD-L2 in BA requires further research.

关键词： biliary atresia immunostaining liver neonatal hepatitis syndrome programmed death-1

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Efficacy of adhesive strapping on umbilical hernia in children:a systematic review and meta-analysis of cohort studies

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World Journal of pediatric surgery 2023年第4期6卷 206-216页

作者： Takuya Sugimoto Kazunori Tahara Koshi Uchida Kazuhiko Yoshimoto department of pediatric surgery Japanese Red Cross Kumamoto HospitalKumamotoJapan

Background Although adhesive strapping(AS)for pediatric umbilical hernia(UH),which was once obsolete,has been reconsidered as a common practice in Japan,its efficacy is still unclear.This study aimed to evaluate its efficacy by reviewing related articles.Methods A comprehensive literature search of PubMed,Cochrane,Google Scholar,and Igaku Chuo Zasshi via Ichushi-Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Cohort studies reporting on the UH closure rate after AS compared with observation-only management were included.Results A total of 10 cohort studies were included,and the overall UH closure rate was not statistically significant(p=0.31,risk ratio(RR)=0.76,95%confidence interval(CI)0.45 to 1.28).However,there were significant differences in the UH closure rate at the age of 6 months(p<0.01,RR=0.55,95%CI 0.41 to 0.75)and the efficacy of preventing protruding umbilici with redundant skin(p=0.049,RR=0.16,95%CI 0.03 to 0.99).Conclusions Although the efficacy of AS on UH compared with observation-only management did not differ in terms of the UH closure rate,the application of AS may be effective for faster UH closure and the prevention of protruding umbilici.However,due to the high heterogeneity of the study,further large-scale studies,particularly randomized controlled trials,are warranted to reach a conclusion.

关键词： hernia prevention closure

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Mechanisms of gastrointestinal barrier dysfunction in COVID-19 patients

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World Journal of Gastroenterology 2023年第15期29卷 2283-2293页

作者： Weijie Xue Masaki Honda Taizo Hibi department of Transplantation and pediatric surgery Kumamoto UniversityKumamoto 860-8556Japan

Coronavirus disease 2019(COVID-19)caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has become a major global public health event,resulting in a significant social and economic burden.Although COVID-19 was initially characterized as an upper respiratory and pulmonary infection,recent evidence suggests that it is a complex disease including gastrointestinal symptoms,such as diarrhea,nausea,and vomiting.Moreover,it remains unclear whether the gastrointestinal symptoms are caused by direct infection of the gastrointestinal tract by SARS-CoV-2 or are the result of systemic immune activation and subsequent dysregulation of homeostatic mechanisms.This review provides a brief overview of the mechanisms by which SARS-CoV-2 disrupts the integrity of the gastrointestinal barrier including the mechanical barrier,chemical barrier,microbial barrier,and immune barrier.

关键词： Gastrointestinal barrier dysfunction SARS-CoV-2 COVID-19 Angiotensinconverting enzyme 2 Microbiome Immune cells

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pediatric intestinal motility disorders

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World Journal of Gastroenterology 2015年第33期21卷 9683-9687页

作者： Stefan Gfroerer Udo Rolle department of pediatric surgery and pediatric Urology Goethe-University Frankfurt/M.60590 Frankfurt/M.Germany

pediatric intestinal motility disorders affect many children and thus not only impose a significant impact on pediatric health care in general but also on the quality of life of the affected patient.Furthermore,some of these conditions might also have implications for adulthood.pediatric intestinal motility disorders frequently present as chronic constipation in toddler age children.Most of these conditions are functional,meaning that constipation does not have an organic etiology,but in 5% of the cases,an underlying,clearly organic disorder can be identified.Patients with organic causes for intestinal motility disorders usually present in early infancy or even right after birth.The most striking clinical feature of children with severe intestinal motility disorders is the delayed passage of meconium in the newborn period.This sign is highly indicative of the presence of Hirschsprung disease(HD),which is the most frequent congenital disorder of intestinal motility.HD is a rare but important congenital disease and the most significant entity of pediatric intestinal motility disorders.The etiology and pathogenesis of HD have been extensively studied over the last several decades.A defect in neural crest derived cell migration has been proven as an underlying cause of HD,leading to an aganglionic distal end of the gut.Numerous basic science and clinical research related studies have been conducted to better diagnose and treat HD.Resection of the aganglionic bowel remains the gold standard for treatment of HD.Most recent studies show,at least experimentally,the possibility of a stem cell based therapy for HD.This editorial also includes rare causes of pediatric intestinal motility disorders such as hypoganglionosis,dysganglionosis,chronic intestinal pseudo-obstruction and ganglioneuromatosis in multiple endocrine metaplasia.Underlying organic pathologies are rare in pediatric intestinal motility disorders but must be recognized as early as possible.

关键词： Intestinal motility disorder Children Hirschsprung

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Wound dehiscence with continuous versus interrupted mass closure of transverse incisions in children with absorbable suture:a randomized controlled trial

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World Journal of pediatric surgery 2019年第2期2卷 9-14页

作者： Safwan Khan Muhammad Saleem Nabila Talat department of pediatric surgery Armed Forces Hospital Southern RegionKhamis MushaytSaudi Arabia department of pediatric surgery The Children's Hospital and The Institute of Child HealthLahorePakistan

Introduction Numerous meta-analyses done on adults suggest superiority of continuous mass closure technique,but any such study does not exist for the pediatric age group.The results in adults cannot be applied to pediatrics because of numerous physiologic and anatomic differences.Methods This is a single-blinded,randomized controlled trial,1:1 parallel groups,that compares the frequency of dehiscence between the interrupted and continuous mass closure techniques for transverse incisions in pediatric patients.The age range was from birth to 12 years.We sampled 350 patients undergoing emergency or elective exploratory laparotomies in our pediatric surgery unit.Blocked randomization was used and only the patients remained blinded during the intervention.One group was closed with interrupted mass closure(group A)and the other group with continuous mass closure technique(group B).We had to drop 50 patients for not meeting the inclusion criteria.results The wound dehiscence rate for group A was 1.34%(4 patients)and for group B was 3.0%(9 patients).Significance was calculated usingχ^(2)(p<0.156).The global wound dehiscence rate was 4.34%(13 patients).The maximum number of patients dehisced on the fifth postoperative day,while the range was 4-11 days.The only statistically significant confounding factor was wound classification(p<0.002).Discussion Statistically there is no significant difference between interrupted and continuous mass closures techniques in terms of wound dehiscence.The dirty wounds are at a maximum risk of developing wound dehiscence irrespective of the technique used.We need to strictly adhere to the basic principles of closure especially when dealing with dirty wounds.trial registration number TCTR20150318001.

关键词： wound closure interrupted

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3D Non-Fluoroscopic Cryoablation of Right-Sided Accessory Pathways in Children:Monocentric Study and Literature Review

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Congenital Heart Disease 2021年第6期16卷 561-572页

作者： Fabrizio Drago Irma Battipaglia Pietro Paolo Tamborrino Luigina Porco Camilla Calvieri Mario Salvatore Russo Vincenzo Pazzano Romolo Remoli Massimo Stefano Silvetti pediatric Cardiology and Cardiac Arrhythmias Unit Department of Pediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly

Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our group.The aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping systems.Methods and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our Institution.Fifteen(14.7%)patients had previously undergone catheter ablation.Acute procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications occurred.During follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had recurrences.Recurrences were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the children.Recurrence rates are not high and patients can be retreated with cryo-energy with higher success rates.

关键词： 3D Mapping accessory pathway children cryoablation pediatric tachyarrhythmias

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Neonatal pneumothorax in congenital diaphragmatic hernia:Be wary of high ventilatory pressures

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World Journal of pediatric surgery 2022年第3期5卷 154-161页

作者： Nathan Rubalcava Gabriella A Norwitz Aimee G Kim Gary Weiner Niki Matusko Meghan A Arnold George B Mychaliska Erin E Perrone pediatric surgery University of MichiganAnn ArborMichiganUSA Section of Neonatology Department of PediatricsUniversity of MichiganAnn ArborMichiganUSA department of surgery University of MichiganAnn ArborMichiganUSA

Background Patients with congenital diaphragmatic hernia(CDH)require invasive respiratory support and higher ventilator pressures may be associated with barotrauma.We sought to evaluate the risk factors associated with pneumothorax in CDH neonates prior to repair.Methods Weretrospectivelyreviewednewborns born withCDHbetween 2014and 2019who developeda pneumothorax,and we matched these cases to patients with CDH without pneumothorax.Results Twenty-sixpatientswere included(n=13per group).The pneumothorax group required extracorporeal life support(ECLS)more frequently(85%vs 54%,p=0.04),particularly among type A/B defects(31%vs 7%,p=0.01).The pneumothorax group had higher positive end-expiratory pressure(PEEP)within 1 hour of birth(p=0.02),at pneumothorax diagnosis(p=0.003),and at ECLS(p=0.02).The pneumothorax group had a higher mean airway pressure(Paw)at birth(p=0.01),within 1 hour of birth(p=0.01),and at pneumothorax diagnosis(p=0.04).Using multiple logistic regression with cluster robust SEs,higher Paw(OR 2.2,95%Cl 1.08 to 3.72,p=0.03)and PEEP(OR 1.8,95%CI 1.15 to 3.14,p=0.007)were associated with an increased risk of developing pneumothorax.There was no difference in survival(p=0.09).Conclusions Development of a pneumothorax in CDH neonates is independently associated with higher Paw and higher PEEP.A pneumothorax increases the likelihood of treated with ECLS,even with smaller defect.

关键词： PEEP pneumothorax diagnosis

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Altered microRNA expression profiles in a rat model of spina bifida

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Neural Regeneration Research 2016年第3期11卷 502-507页

作者： Pan Qin Lin Li Da Zhang Qiu-liang Liu Xin-rang Chen He-ying Yang Ying-zhong Fan Jia-xiang Wang department of pediatric surgery First Affiliated Hospital of Zhengzhou University department of Dermatology Zhengzhou Children's Hospital

Micro RNAs（mi RNAs） are dynamically regulated during neurodevelopment,yet few reports have examined their role in spina bifida.In this study,we used an established fetal rat model of spina bifida induced by intragastrically administering olive oil-containing all-trans retinoic acid to dams on day 10 of pregnancy.Dams that received intragastric administration of all-trans retinoic acid-free olive oil served as controls.The mi RNA expression profile in the amniotic fluid of rats at 20 days of pregnancy was analyzed using an mi RNA microarray assay.Compared with that in control fetuses,the expression of mi RNA-9,mi RNA-124 a,and mi RNA-138 was significantly decreased（〉 2-fold）,whereas the expression of mi RNA-134 was significantly increased（〉 4-fold） in the amniotic fluid of rats with fetuses modeling spina bifida.These results were validated using real-time quantitative reverse-transcription polymerase chain reaction.Hierarchical clustering analysis of the microarray data showed that these differentially expressed mi RNAs could distinguish fetuses modeling spina bifida from control fetuses.Our bioinformatics analysis suggested that these differentially expressed mi RNAs were associated with many cytological pathways,including a nervous system development signaling pathway.These findings indicate that further studies are warranted examining the role of mi RNAs through their regulation of a variety of cell functional pathways in the pathogenesis of spina bifida.Such studies may provide novel targets for the early diagnosis and treatment of spina bifida.

关键词： nerve regeneration spina bifida amniotic fluid all-trans retinoic acid microarray micro RNA reverse transcription-polymerase chain reaction MAPK neural regeneration

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Commentary on"Spongiosum-combined glanuloplasty reduces glans complications after proximal hypospadias repair"

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Asian Journal of Andrology 2022年第6期24卷 675-675页

作者： Sachit Anand HiseyinÖzbey department of pediatric surgery Kokilaben Dhirubhai Ambani HospitalMumbaiMaharashtra 400053India department of pediatric surgery Division of Pediatric Urology and AndrologyI.M.Sechenov First Moscow State Medical UniversityMoscow 119435Russia

Dear Editor,We read the recent article by Lyu et al.^(1)with great interest and appreciate their efforts in describing a new technique for glansplasty in children with proximal hypospadias.In this article,the images that locate the diverted corpus spongiosum are almost the same as those described using the glanular-frenular collar(GFC)technique.^(2)We would therefore like to thank the authors for adopting the GFC technique as a model for their reconstructive technique.

关键词： technique. thank proximal

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pediatric Cardiac Surgical Patterns of Practice and Outcomes in Europe and China:An Analysis of the European Congenital Heart Surgeons Association Congenital Heart surgery Database

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Congenital Heart Disease 2021年第1期16卷 17-25页

作者： Claudia Herbst Haibo Zhang Renjie Hu Jürgen Hörer Masamichi Ono Vladimiro Vida Tjark Ebels Andrzej Kansy Jeffrey P.Jacobs Zdzislaw Tobota Bohdan Maruszewski department of surgery Division of Cardiac Surgery and Pediatric Heart CenterMedical University ViennaViennaAustria department of pediatric Cardiothoracic surgery Shanghai Children’s Medical CenterShanghai Jiaotong University School of MedicineShanghaiChina department for Congenital and pediatric Heart surgery German Heart Center MunichTechnische Universität MünchenDivision for Congenital and Pediatric Heart SurgeryUniversity Hospital of MunichLudwig-Maximilians-UniversitätMunichGermany pediatric and Cardiac surgery Unit Department of Cardio Thoracic Vascular Sciences and Public HealthUniversity of PaduaPaduaItaly department of Cardiothoracic surgery University Medical Center GroningenGroningenThe Netherlands Cardiothoracic surgery Amsterdam University Medical CenterAmsterdamThe Netherlands pediatric Cardiothoracic surgery Children’s Memorial Health InstituteWarsawPoland St.Petersburg FLUSA

Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of surgical data from both Europe and China.The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD.Methods:We examined all European(125 centers,58,261 operations)and Chinese(13 centers,23,920 operations)data in the ECHSA-CHSD from 2006-2018.Operative mortality,postoperative length of stay,median patient age and weight were calculated for the ten benchmark operations for China and Europe,respectively.Results:Benchmark procedure distribution frequencies differed between Europe and China.In China,ventricular septal defect repair comprised approximately 70%of procedures,while Norwood operations comprised less than one percent of all procedures.Neonatal cardiac procedures were rare in China overall.For procedures in STAT mortality category 1,Chinese centers had lower operative mortality rates,while procedures in categories 3 and 5 mortality is lower in European centers.Operative mortality over the time period decreased from 3.89%to 1.64%for the whole cohort,with a sharper decline in China.This drop coincides with an increase of submitted procedures over this 13-year-period.Conclusion:Chinese centers had higher programmatic volume of congenital heart surgeries,while European centers have a more complex case mix.Palliation for patients with functionally univentricular heart was performed less commonly in China.These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.

关键词： Outcomes congenital heart surgery China Europe database

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