Gastric Peroral Endoscopic Pyloromyotomy for Infants With Congenital Hypertrophic Pyloric Stenosis.

INTRODUCTION: Congenital hypertrophic pyloric stenosis (CHPS), the most common infantile disease requiring surgical intervention, is routinely treated with open or laparoscopic pyloromyotomy. Recently, gastric peroral endoscopic pyloromyotomy (G-POEM) has been used for adult gastroparesis. We aimed to evaluate the efficacy and safety of G-POEM in treating infantile CHPS. METHODS: We reviewed data from 21 G-POEM-treated patients at 3 tertiary children's endoscopic centers in China between January 2019 and December 2020. Clinical characteristics, procedure-related parameters, perioperative management, and follow-up outcomes were summarized. RESULTS: G-POEM was performed successfully in all patients. The median operative duration was 49 (14-150) minutes. The submucosal tunnels were successfully established along the greater curvature of the stomach in 19 cases, and 2 cases were switched to the lesser curvature because of difficulty. No perioperative major adverse events occurred. Minor adverse events included inconsequential mucosal injury in 5 cases and unsatisfactory closure of the mucosal incision in 1 case. Upper gastrointestinal contrast radiography in all patients showed smooth passage of the contrast agent through the pylorus on postoperative day 3. The growth curves of the patients reached normal levels 3 months after the procedure. No recurrent clinical symptoms occurred in any patient during the median follow-up period of 25.5 (14-36) months. DISCUSSION: G-POEM is feasible, safe, and effective for infants with CHPS, with satisfactory clinical responses over a short-term follow-up. Further multicenter studies should be performed to compare the long-term outcomes of this minimally invasive technique with open or laparoscopic pyloromyotomy.

miR-425-5p improves inflammation and septic liver damage through negatively regulating the RIP1-mediated necroptosis.

OBJECTIVE AND DESIGN: Sepsis, a systemic inflammatory response syndrome, is still a common cause of death even the patients who are in the intensive care unit. Alleviating septic liver damage may be effective in improving sepsis. Necroptosis and miRNAs have been regarded as a potential target in sepsis. MATERIAL OR SUBJECTS: The aim of this work is to explain the potential role of miR-425-5p in septic liver damage. LPS was intraperitoneal-injection to C57BL/6 mice for sepsis, and hepatocytes treated with septic serum in vitro. H&E staining for histological evaluation, luciferase reporter assay for target validation, and qRT-PCR, WB, and ELISA analysis for assessment of miR-425-5p, RIP1, inflammatory factors, and LDH levels. RESULTS: Down-regulated miR-425-5p and up-regulated RIP1/RIP3 were in LPS-induced sepsis mice. Liver damage, RIP1-mediated necroptosis, IL-1ß, and TNF-α were suppressed by miR-425-5p agomiR, but further aggravated by miR-425-5p antagomiR. Furthermore, we demonstrated miR-425-5p targeted the 3'UTR of RIP1 mRNA to inhibit RIP1 expression and activated RIP1 reversed miR-425-5p-induced suppression of necroptosis and inflammation in septic hepatocytes. CONCLUSIONS: The data suggest miR-425-5p negatively controls the RIP1-mediated necroptotic signaling cascades and inflammation, and sepsis-related liver damage. miR-425-5p/RIP1 axis is a potential therapeutic strategy for sepsis-related liver damage through necroptosis and inflammation.

Effect of live combined Bifidobacterium and Lactobacillus tablets combined with Soave radical operation on postoperative intestinal flora and immune function in children with Hirschsprung disease.

OBJECTIVE: To investigate the effects of live combined Bifidobacterium and Lactobacillus tablets combined with Soave radical operation on postoperative intestinal flora and immune function in children with Hirschsprung disease (HD). METHODS: A total of 126 cases in the Xi'an Children's Hospital from January 2018-December 2021 were retrospective analyzed. Among them, 60 cases treated with Soave radical operation alone were the control group (CG), and the other 66 cases with live combined Bifidobacterium and Lactobacillus tablets and Soave radical operation were set as the observation group (OG). We compared the treatment efficacy, adverse effects, defecation function, and the number of intestinal flora and IgG and IgA levels at the time of admission and after 3 months of treatment between both groups of children. RESULTS: The efficacy efficiency and excellent defecation function rate were dramatically higher in the OG than in the CG after treatment (P<0.05). The bifidobacteria, lactobacilli and enterococcus faecalis were dramatically higher in the OG than in the CG after treatment (P<0.05), and the E. coli was dramatically lower than in the CG (P<0.05). After treatment, IgA and IgG in the OG were higher than those in the CG (P<0.05), and the incidence of postoperative complications was lower than that in the CG (P<0.05). CONCLUSION: Live combined Bifidobacterium and Lactobacillus tablets combined with Soave radical operation can effectively improve intestinal flora dysbiosis and immune function in children with HD. It has a better effect on the ability to defecate and a marked effect on the prevention of complications, which has a high clinical application value.

Pathological prognosis classification of patients with neuroblastoma using computational pathology analysis.

Neuroblastoma is the most common extracranial solid tumor in early childhood. International Neuroblastoma Pathology Classification (INPC) is a commonly used classification system that provides clinicians with a reference for treatment stratification. However, given the complex and subjective assessment of the INPC, there will be inconsistencies in the analysis of the same patient by multiple pathologists. An automated, comprehensive and objective classification method is needed to identify different prognostic groups in patients with neuroblastoma. In this study, we collected 563 hematoxylin and eosin-stained histopathology whole-slide images from 107 patients with neuroblastoma who underwent surgical resection. We proposed a novel processing pipeline for nuclear segmentation, cell-level image feature extraction, and patient-level feature aggregation. Logistic regression model was built to classify patients with favorable histology (FH) and patients with unfavorable histology (UH). On the training/test dataset, patient-level of nucleus morphological/intensity features and age could correctly classify patients with a mean area under the receiver operating characteristic curve (AUC) of 0.946, a mean accuracy of 0.856, and a mean Matthews Correlation Coefficient (MCC) of 0.703,respectively. On the independent validation dataset, the classification model achieved a mean AUC of 0.938, a mean accuracy of 0.865 and a mean MCC of 0.630, showing good generalizability. Our results suggested that automatically derived image features could identify the differences in nuclear morphological and intensity between different prognostic groups, which could provide a reference to pathologists and facilitate the evaluation of the pathological prognosis in patients with neuroblastoma.

Changes of ECM and CAM gene expression profile in the cirrhotic liver after HCV infection: analysis by cDNA expression array.

AIM: We aimed to observe the expression of extracellular matrix (ECM) and cellular adhesion molecules (CAM) in cirrhotic liver tissues after hepatitis C virus (HCV) infection. METHODS: Twelve patients with post HCV inflammatory liver cirrhosis were selected to evaluate their liver function and other virological, pathological parameters. Then three specimens of cirrhotic patients whose health assessment results and laboratory data were similar and three normal liver specimens explanted from liver grafts prepared for liver transplantation were chosen for investigating gene expression of ECM and CAM using cDNA expression array. RESULTS: The cDNA array assay revealed 36.7% (36/96) of genes with changes, in which 26.3% (26/96) was up-regulated and 10.1% (10/96) was down-regulated. Integrin (ITGA), collagen (COL), ADAMTS were identified as the characteristic changes of ECM and CAM gene expression levels. ITGA were demonstrated beta1 and beta2 sub-section changed in liver cirrhosis. CONCLUSION: ECM and CAM play an important role in the progression of liver cirrhosis after HCV infection. The capital mechanism is related to the inflammatory cells infiltration, the activation and transformation of ECM producing cells and the imbalance between production and elimination of ECM.