Calprotectin levels in necrotizing enterocolitis: a systematic review of the literature.

BACKGROUND: Fecal calprotectin has been extensively investigated as a screening marker for the detection of necrotizing enterocolitis (NEC). However, there is a complete lack of consensus regarding its efficacy as a diagnostic test. OBJECTIVE: The purpose of the present systematic review is to evaluate the effectiveness of fecal calprotectin as a screening marker for the detection of NEC. MATERIALS AND METHODS: We conducted a systematic review of studies published in the Medline (1966-2016), Scopus (2004-2016), ClinicalTrials.gov (2008-2016), Cochrane Central Register of Controlled Trials CENTRAL (1999-2016), and Google Scholar (2004-2016) databases, combined with studies found in the reference lists of the included studies. All prospective and retrospective observational cohort studies were included. RESULTS: Thirteen studies that included 601 neonates were identified in the international literature. The presence and severity of NEC was evaluated with the modified Bell's criteria. Ten studies found significantly elevated fecal calprotectin levels among infants with NEC (p < 0.05). One study found that this effect was observed irrespective of the stage of the disease. Five studies evaluated the efficacy of fecal calprotectin as a diagnostic test. The reported sensitivity ranged between 76 and 100 %, and the specificity varied from 39 to 96.4 %. However, the proposed cut-off values were not similar. CONCLUSION: Current evidence suggests that fecal calprotectin is elevated in newborns suffering from NEC. However, its significance as an early screening marker remains unknown. Future studies are needed and should focus on the identification of specific cut-off values.

An explanation of the pathophysiology of adverse neurodevelopmental outcomes in iron deficiency.

Iron deficiency (ID) is a major public health problem worldwide among children aged 0-12 months. Several factors seem to contribute to the iron-deficient state in infancy, including insufficient antenatal and neonatal iron supplementation, exclusive breastfeeding, and early umbilical cord clamping after birth. The most concerning complications of ID, except for anemia, are related to altered long-term neurodevelopment. Clinical studies have shown a negative impact of ID anemia on fetal and neonatal behavior including impairments of motor maturity, autonomic response, memory/learning, and mood. ID-induced defects during infancy seem to persist later in life, even after ID treatment. The underlying mechanisms involve dysfunctional myelination, neurotransmission alterations, and altered synaptogenesis and/or dendritogenesis. The purpose of the present review is to summarize these mechanisms and to provide recommendations for future clinical research in the field.

Retention of cervical cerclage after preterm premature rupture of the membranes: a critical appraisal.

PURPOSE: The present meta-analysis aims to assess the efficacy of cervical cerclage retention after the occurrence of preterm premature rupture of the membranes by analyzing the observed maternal and neonatal perinatal outcomes. METHODS: We searched Medline (1966-2014), Scopus (2004-2014), Clinicaltrials.org (1997-2014), Cochrane Central Register of Controlled Trials (CENTRAL) (1999-2014) and Google Scholar (2004-2014) search engines, as well as reference lists from all included studies. The statistical analysis was performed using the RevMan software. RESULTS: Six studies were finally included in the present review, involving 293 parturient. Cerclage retention did not significantly prolong the gestational latency period (MD 2.56 days, 95% CI - 1.06, 6.71). It did, however, increased the rates of delivery after the first 48 h (OR 6.27, 95% CI 1.08, 36.24). As a technique, it did not significantly increase the rates of neonatal sepsis (OR 1.42, 95% CI 0.65, 3.12) or the neonatal death rates (OR 1.09, 95% CI 0.48, 2.47).Maternal chorioamnionitis was, however, significantly more prevalent among women offered cerclage retention (OR 1.78, 95% CI 1.02, 3.12), although the same was not observed in the case of postpartum endometritis (REM OR 4.73, 95 % CI 0.74, 30.09). CONCLUSIONS: Current evidence is insufficient to support the retention of cervical cerclage after the occurrence of PPROM, therefore, its implementation should be exceptionally instituted in everyday clinical practice, until further evidence becomes available.

Mammary gland epithelial changes in thyroidectomized female rats.

PURPOSE: Numerous clinical studies have addressed the relationship of hypothyroidism and breast cancer with conflicting results. In the present experimental study we sought to determine whether absolute hypothyroidism established for a long period of time leads to epithelial alterations of the mammary gland. METHODS: Thirty five female Wistar rats were allocated to be subjected to either thyroidectomy (N=20) or not (N=15). The rats were kept alive for a period of 3 months in a weather controlled environment. Serum T3, T4, follicular stimulating hormone (FSH) and estradiol levels were measured at baseline and 10 days after thyroidectomy. Mammary glands were obtained at the end of the experiment and reviewed by an expert pathologist. RESULTS: Both serum FSH and estradiol levels were lower 10 days after thyroidectomy; however, only FSH values were significantly lower in the thyroidectomized animals. Pathological analysis revealed significantly increased atrophy and periductal fibrosis of the mammary gland among thyroidectomized animals. CONCLUSION: This is the first in vivo experimental study that reveals an association between the thyroid and mammary glands. Future studies should address the proteomic relationship that connects them.

Fetal alcohol spectrum disorders and cognitive functions of young children.

Fetal alcohol spectrum disorder (FASD) is one of the main causes of mental retardation worldwide. Nearly 1% of children in North America are affected from antenatal exposure to ethanol. Its economic burden in industrialized countries is increasing. It is estimated that, in the United States, 4.0 billion dollars are annually expended in the treatment and rehabilitation of these patients. As a pathologic entity, they present with a broad symptomatology. Fetal alcohol syndrome (FAS) is the most readily recognized clinical manifestation of these disorders. Various factors seem to contribute in the pathogenesis of FASD-related cognitive disorders. During the last 20 years, several potential pretranslational and posttranslational factors have been extensively studied in various experimental animal models. Research has specifically focused on several neurotransmitters, insulin resistance, alterations of the hypothalamic-pituitary-adrenal (HPA) axis, abnormal glycosylation of several proteins, oxidative stress, nutritional antioxidants, and various epigenetic factors. The purpose of the present review is to summarize the clinical manifestations of this disorder during childhood and adolescence and to summarize the possible pathophysiologic and epigenetic pathways that have been implicated in the pathophysiology of FASD.

Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis.

PURPOSE: This study carried out a meta-analysis to compare immediate surgery (IS) with conservative treatment (CT) of complicated acute appendicitis (CAA) in children. METHODS: Systematic literature research was performed for relevant studies published from 1969 to date. Trials of IS compared with CT were included. Outcomes of interest were postoperative morbidity and length of hospital stay (LOS). RESULTS: Fifteen trials were studied (1.243 patients). CT achieved better rates of any complication type (odds ratio [OR] 0.22, [95% confidence interval (CI): 0.14, 0.38], p = 0.001) and wound infection (OR: 0.40 [95% CI: 0.17, 0.96], p = 0.041). Neither intraabdominal abscess (OR: 1.03 [95% CI: 0.31, 3.37], p = 0.958) nor postoperative ileus (OR: 0.29 [95% CI: 0.06, 1.44], p = 0.130) was affected by the treatment option. The polled difference in LOS showed a trend for shorter LOS in the IS group (standard mean difference [SMD]: 0.25 [95% CI: 0.07, -0.43], p = 0.007). CONCLUSIONS: IS was associated with shorter LOS, while overall complication rates and wound infection declined significantly with CT. The development of intraabdominal abscess and postoperative ileus was not affected by the treatment of choice. The heterogeneity of most studies depicts the need for randomized controlled trials (RCTs) to discover safe management of CAA in children. LEVEL OF EVIDENCE: III: Type of study: Meta-analysis.

Prenatal cocaine exposure and its impact on cognitive functions of offspring: a pathophysiological insight.

It is estimated that approximately 0.5%-3% of fetuses are prenatally exposed to cocaine (COC). The neurodevelopmental implications of this exposure are numerous and include motor skill impairments, alterations of social function, predisposition to anxiety, and memory function and attention deficits; these implications are commonly observed in experimental studies and ultimately affect both learning and IQ. According to previous studies, the clinical manifestations of prenatal COC exposure seem to persist at least until adolescence. The pathophysiological cellular processes that underlie these impairments include dysfunctional myelination, disrupted dendritic architecture, and synaptic alterations. On a molecular level, various neurotransmitters such as serotonin, dopamine, catecholamines, and γ-aminobutyric acid seem to participate in this process. Finally, prenatal COC abuse has been also associated with functional changes in the hormones of the hypothalamic-pituitary-adrenal axis that mediate neuroendocrine responses. The purpose of this review is to summarize the neurodevelopmental consequences of prenatal COC abuse, to describe the pathophysiological pathways that underlie these consequences, and to provide implications for future research in the field.

Double versus single cervical cerclage for the prevention of preterm births.

OBJECTIVE: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes. METHODS: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines. RESULTS: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34 weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28 weeks (645 cases, OR 0.43, 95% CI 0.26-0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37 weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82). CONCLUSIONS: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.

The combined effect of MC4R and FTO risk alleles on childhood obesity in Greece.

OBJECTIVE: Single nucleotide polymorphism (SNP) risk alleles of obesogenic genes, such as the fat mass and obesity-associated protein (FTO) and the melanocortin-4 receptor (MC4R) gene, have been described in both paediatrics and adult populations. The aim of this study was to investigate the combined effect of FTO and MC4R risk alleles on the obese phenotype and metabolic profile of young children and adolescents of Greek origin. DESIGN: One hundred and fifty-three overweight and obese Greek children (mean age 11.08±2.23 years) and 151 age-matched normal-weight controls were enrolled. Along with anthropometric and standard biochemical profile genetic analysis for the high-risk rs9939609 A allele of the FTO gene and the high-risk C allele of the rs17782313 polymorphism downstream of the MC4R gene were investigated in all participants. RESULTS: The combined presence of three or more high-risk alleles of both the FTO and MC4R genes confers a 4-fold higher risk for obesity in children and adolescents of Greek origin, although these risk alleles have no impact on the metabolic alterations observed in these obese children and adolescents. CONCLUSIONS: There is a synergistic effect of the high-risk alleles of the FTO and MC4R genes on the obese phenotype, while no impact on the metabolic abnormalities was observed in Greek obese children and adolescents.