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1.
Int J Mol Sci ; 24(17)2023 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-37686439

RESUMO

This study investigated the interplay between transforming growth factor beta (TGF-ß1/T1 and TGF-ß3/T3), and sex hormone receptors using our 3D in vitro cornea stroma model. Primary human corneal fibroblasts (HCFs) from healthy donors were plated in transwells at 106 cells/well and cultured for four weeks. HCFs were supplemented with stable vitamin C (VitC) and stimulated with T1 or T3. 3D construct proteins were analyzed for the androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα) and beta (ERß), luteinizing hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), gonadotropin-releasing hormone receptor (GnRHR), KiSS1-derived peptide receptor (KiSS1R/GPR54), and follicle-stimulating hormone subunit beta (FSH-B). In female constructs, T1 significantly upregulated AR, PR, ERα, FSHR, GnRHR, and KiSS1R. In male constructs, T1 significantly downregulated FSHR and FSH-B and significantly upregulated ERα, ERß, and GnRHR. T3 caused significant upregulation in expressions PR, ERα, ERß, LHR, FSHR, and GNRHR in female constructs, and significant downregulation of AR, ERα, and FSHR in male constructs. Semi-quantitative Western blot findings present the interplay between sex hormone receptors and TGF-ß isoforms in the corneal stroma, which is influenced by sex as a biological variable (SABV). Additional studies are warranted to fully delineate their interactions and signaling mechanisms.


Assuntos
Substância Própria , Fator de Crescimento Transformador beta3 , Humanos , Feminino , Masculino , Receptor alfa de Estrogênio , Receptores de Kisspeptina-1 , Receptor beta de Estrogênio/genética , Fator de Crescimento Transformador beta1/genética , Fator de Crescimento Transformador beta , Hormônio Foliculoestimulante
2.
Trends Genet ; 39(10): 715-716, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37419698

RESUMO

The mechanisms that underlie increased cryptic transcription during senescence and aging have been poorly understood. Sen et al. recently identified cryptic transcription start sites (cTSSs) and chromatin state changes that may contribute to cTSS activation in mammals. Their results indicate that enhancer-promoter conversion may drive cryptic transcription in senescence.


Assuntos
Envelhecimento , Cromatina , Animais , Cromatina/genética , Envelhecimento/genética , Regiões Promotoras Genéticas , Sequências Reguladoras de Ácido Nucleico , Mamíferos/genética , Transcrição Gênica
3.
Exp Eye Res ; 224: 109242, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36084727

RESUMO

Extracellular vesicles (EVs) are lipid-bound vesicles that originate from the endosomal system or budded off from the plasma membrane. EVs are involved in cell-cell communication via transporting DNA, RNA, and proteins from one cell to another. Tear EVs (tEVs) have been reported in dry eye, SjÓ§gren's Syndrome, and primary open-angle glaucoma. In this study, we sought to investigate the presence of tEVs in relation to keratoconus (KC). Tears were passively collected from the lateral meniscus from 10 healthy (5 males and 5 females) and 9 KC (4 males and 5 females) subjects. Tear samples were processed and analyzed using the ExoView™ R100. Statistical analysis was performed using a Mann-Whitney U non-parametric Student's t-test. All tEVs, in both Healthy and KC subjects, showed a CD9+ dominant tEV cohort independent of sex. A significant decrease in CD63+/CD9+ and CD63+/CD81+/CD9+ was found in the male KC tEVs (p < 0.05), but not in females compared to their healthy counterparts. Neither Healthy nor KC tEVs showed differences in the total number of tEVs, however significant differences were identified between the sexes (p < 0.05), with males having a higher number of tEVs. tEVs diameters ranged from 50 to 200 nm, in both Healthy and KC cohorts, with the majority in the 50-80 nm range suggesting exosome-dominant cohorts. To our knowledge, this is the first time, to date, that tEVs have been isolated and characterized in KCs. While further studies are warranted, the tEVs differences between KC and Healthy subjects suggest a potential role for tEVs in KC pathogenesis.


Assuntos
Vesículas Extracelulares , Glaucoma de Ângulo Aberto , Ceratocone , Feminino , Masculino , Humanos , Ceratocone/metabolismo , Glaucoma de Ângulo Aberto/metabolismo , Lágrimas/metabolismo , Vesículas Extracelulares/metabolismo , RNA/genética , RNA/metabolismo , Lipídeos
4.
Brief Funct Genomics ; 21(1): 56-61, 2022 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-34050364

RESUMO

Cryptic transcription, the initiation of transcription from non-promoter regions within a gene body, is a type of transcriptional dysregulation that occurs throughout eukaryotes. In mammals, cryptic transcription is normally repressed at the level of chromatin, and this process is increased upon perturbation of complexes that increase intragenic histone H3 lysine 4 methylation or decrease intragenic H3 lysine 36 methylation, DNA methylation, or nucleosome occupancy. Significantly, similar changes to chromatin structure occur during aging, and, indeed, recent work indicates that cryptic transcription is elevated during aging in mammalian stem cells. Although increased cryptic transcription is known to promote aging in yeast, whether elevated cryptic transcription also contributes to mammalian aging is unclear. There is ample evidence that perturbations known to increase cryptic transcription are deleterious in embryonic and adult stem cells, and in some cases phenocopy certain aging phenotypes. Furthermore, an increase in cryptic transcription requires or impedes pathways that are known to have reduced function during aging, potentially exacerbating other aging phenotypes. Thus, we propose that increased cryptic transcription contributes to mammalian stem cell aging.


Assuntos
Cromatina , Lisina , Envelhecimento/genética , Animais , Cromatina/metabolismo , Proteínas de Ligação a DNA/metabolismo , Histonas/metabolismo , Lisina/genética , Lisina/metabolismo , Mamíferos/genética , Saccharomyces cerevisiae/genética , Transcrição Gênica
5.
Nat Aging ; 1(8): 684-697, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34746802

RESUMO

A repressive chromatin state featuring trimethylated lysine 36 on histone H3 (H3K36me3) and DNA methylation suppresses cryptic transcription in embryonic stem cells. Cryptic transcription is elevated with age in yeast and nematodes, and reducing it extends yeast lifespan, though whether this occurs in mammals is unknown. We show that cryptic transcription is elevated in aged mammalian stem cells, including murine hematopoietic stem cells (mHSCs) and neural stem cells (NSCs) and human mesenchymal stem cells (hMSCs). Precise mapping allowed quantification of age-associated cryptic transcription in hMSCs aged in vitro. Regions with significant age-associated cryptic transcription have a unique chromatin signature: decreased H3K36me3 and increased H3K4me1, H3K4me3, and H3K27ac with age. Genomic regions undergoing such changes resemble known promoter sequences and are bound by TBP even in young cells. Hence, the more permissive chromatin state at intragenic cryptic promoters likely underlies increased cryptic transcription in aged mammalian stem cells.


Assuntos
Cromatina , Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Células-Tronco Neurais , Animais , Humanos , Camundongos , Envelhecimento/genética , Cromatina/genética , Metilação de DNA/genética , Células-Tronco Embrionárias/metabolismo , Células-Tronco Hematopoéticas/metabolismo , Células-Tronco Neurais/metabolismo , Células-Tronco Mesenquimais/metabolismo , Transcrição Gênica
6.
Nat Commun ; 11(1): 6235, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33277483

RESUMO

The extensive array of morphological diversity among animal taxa represents the product of millions of years of evolution. Morphology is the output of development, therefore phenotypic evolution arises from changes to the topology of the gene regulatory networks (GRNs) that control the highly coordinated process of embryogenesis. A particular challenge in understanding the origins of animal diversity lies in determining how GRNs incorporate novelty while preserving the overall stability of the network, and hence, embryonic viability. Here we assemble a comprehensive GRN for endomesoderm specification in the sea star from zygote through gastrulation that corresponds to the GRN for sea urchin development of equivalent territories and stages. Comparison of the GRNs identifies how novelty is incorporated in early development. We show how the GRN is resilient to the introduction of a transcription factor, pmar1, the inclusion of which leads to a switch between two stable modes of Delta-Notch signaling. Signaling pathways can function in multiple modes and we propose that GRN changes that lead to switches between modes may be a common evolutionary mechanism for changes in embryogenesis. Our data additionally proposes a model in which evolutionarily conserved network motifs, or kernels, may function throughout development to stabilize these signaling transitions.


Assuntos
Embrião não Mamífero/metabolismo , Regulação da Expressão Gênica no Desenvolvimento , Redes Reguladoras de Genes , Ouriços-do-Mar/genética , Estrelas-do-Mar/genética , Animais , Embrião não Mamífero/embriologia , Evolução Molecular , Gastrulação/genética , Mesoderma/embriologia , Mesoderma/metabolismo , Modelos Genéticos , Ouriços-do-Mar/embriologia , Especificidade da Espécie , Estrelas-do-Mar/embriologia , Fatores de Transcrição/genética
8.
J Pediatr Surg ; 54(1): 65-69, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30343976

RESUMO

BACKGROUND: Gastroschisis, a surgical condition requiring complex interdisciplinary care, may benefit from treatment at higher volume centers. Recent studies on surgical volume and outcomes have conflicting findings. METHODS: Data were collected prospectively on newborns ≥1500 g with gastroschisis born 2009-2015, admitted to 159 US centers, and separated into terciles based on number of annual gastroschisis repairs. Infants transferred after gastroschisis repair were excluded. RESULTS: There were 4663 infants included: 307 from 53 low, 1201 from 55 medium, and 3155 from 51 high volume centers. Infants at high volume centers had higher rates of intestinal atresia (P = 0.04) and outborn status (P < 0.0001). Outborn infants (N = 1134) had higher rates of gastrostomy/jejunostomy placement (P < 0.001). Mortality was universally low (2.0% low, 2.4% medium, and 1.7% high; 2.0% outborn and 1.9% inborn). On multivariate analysis, mortality, sepsis rates, and length of stay did not differ by center volume. Outborn status was associated with longer length of stay (P = 0.001), not mortality or sepsis. CONCLUSION: Infant characteristics and management vary based on gastroschisis surgical volume and transfer status. Center volume and early transfers were not associated with mortality. Further investigation to identify subsets of gastroschisis infants who would benefit from care at higher volume centers is warranted. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: Level II.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Gastrosquise/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Bases de Dados Factuais , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Feminino , Gastrosquise/mortalidade , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Prospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/etiologia , Taxa de Sobrevida , Resultado do Tratamento , Estados Unidos
9.
J Pediatr Surg ; 53(6): 1197-1202, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29627178

RESUMO

PURPOSE: The purpose of this study was to examine postnatal growth outcomes and predictors of growth failure at 18-24months corrected age among extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to survivors without NEC. METHODS: Data were collected prospectively on ELBW (22-27weeks gestation or 401-1000g birth weight) infants born 2000-2013 at 46 centers participating in the Vermont Oxford Network follow-up project. Severe growth failure was defined as <3rd percentile weight-for-age. RESULTS: There were 9171 evaluated infants without NEC, 416 with medical NEC, and 462 with surgical NEC. Rates of severe growth failure at discharge were higher among infants with medical NEC (56%) and surgical NEC (61%), compared to those without NEC (36%). At 18-24months follow-up, rates of severe growth failure decreased and were similar between without NEC (24%), medical NEC (24%), and surgical NEC (28%). On multivariable analysis, small for gestational age, chronic lung disease, severe intraventricular hemorrhage or cystic periventricular leukomalacia, severe growth failure at discharge, and postdischarge tube feeding predicted <3rd percentile weight-for-age at follow-up. CONCLUSIONS: ELBW survivors of NEC have higher rates of severe growth failure at discharge. While NEC is not associated with severe growth failure at follow-up, one quarter of ELBW infants have severe growth failure at 18-24months. TYPE OF STUDY: Prognosis study. LEVEL OF EVIDENCE: II.


Assuntos
Enterocolite Necrosante/fisiopatologia , Transtornos do Crescimento/etiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Doenças do Prematuro/fisiopatologia , Nutrição Enteral , Enterocolite Necrosante/complicações , Enterocolite Necrosante/terapia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/terapia , Masculino , Alta do Paciente , Sobreviventes
10.
JPEN J Parenter Enteral Nutr ; 42(1): 239-246, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29505141

RESUMO

PURPOSE: Severe combined immunodeficiency (SCID) screening by T-cell receptor excision circles (TREC) has been part of Massachusetts routine newborn screening since 2009. Tetratricopeptide repeat domain 7A gene (TTC7A) mutations responsible for hereditary multiple intestinal atresia with combined immunodeficiency (MIA-CID) were also recently identified. We reviewed newborn SCID screening among infants with intestinal failure and correlated results with patient characteristics and outcomes. METHODS: Records of infants with severe intestinal failure and available newborn screen results treated at a single center 2009-2016 were reviewed retrospectively. Patients with 1 or more positive SCID screens (<252 TREC copies/µL) were compared with those without positive screens. TREC copies/µL were compared with population norms. RESULTS: Of 70 included infants, 34% had newborn screens with TREC <252 copies/µL, compared with 0.3% of the general population; TREC levels for the cohort were lower than the general population (p<0.001). Of those with positive screens, 42% had prior or subsequent negative screening, 8% had no further workup, and 50% had flow cytometry showing: severe T-cell lymphopenia (absolute CD3+ <1500 cells/mcL) in 8, 3 of whom had TTC7A mutation-associated MIA-CID. Four had CD3+ >1500 cells/mcL. MIA-CID patients had the lowest serum citrulline in the cohort; 4 of the 8 patients with CD3+ <1500 cells/mcL on flow cytometry had newborn screening notable for severe hypocitrullinemia (<3 µM). CONCLUSION: Infants with intestinal failure have lower TREC copies/µL than the general population; one-third had levels concerning for SCID, and 11% were diagnosed with severe T-cell lymphopenia. The clinical implications and etiology of this phenomenon remain unknown, but may be related to hypocitrullinemia.


Assuntos
Enteropatias/complicações , Enteropatias/patologia , Triagem Neonatal/métodos , Imunodeficiência Combinada Severa/complicações , Imunodeficiência Combinada Severa/diagnóstico , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Intestinos/patologia , Masculino , Estudos Retrospectivos
11.
JPEN J Parenter Enteral Nutr ; 42(2): 361-370, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29443397

RESUMO

BACKGROUND: We used the 15 N glycine urinary end-product enrichment technique to quantify whole body protein turnover following thoracic surgery. MATERIALS AND METHODS: A single dose of 15 N glycine (2 mg/kg) was administered orally on postoperative day 1 to children (1-18 years) following thoracic surgery. 15 N enrichment of ammonia and urea was measured in mixed urine after 12 and 24 hours, respectively, and protein synthesis, breakdown, and net balance determined. Nitrogen balance (dietary intake minus urinary excretion) was calculated. Urinary 3-methylhistidine:creatinine ratio was measured as a marker of skeletal muscle protein breakdown. RESULTS: We enrolled 19 subjects-median (interquartile range): age, 13.8 years (12.2-15.1); weight, 49.2 kg (38.4-60.8)-who underwent thoracotomy (n = 12) or thoracoscopic (n = 7) surgery. Protein synthesis and breakdown by 15 N enrichment were 7.1 (5.5-9) and 7.1 (5.6-9) g·kg-1 ·d-1 with ammonia (12 hours) as the end product, and 5.8 (3.8-6.7) and 6.7 (4.5-7.6) with urea (24 hours), respectively. Net protein balance by the 15 N glycine and urinary urea nitrogen methods were -0.34 (-0.47, -0.3) and -0.48 (-0.65, -0.28) g·kg-1 ·d-1 , respectively (rs = 0.828, P < .001). Postoperative change in 3-methylhistidine:creatinine ratio did not correlate significantly with protein breakdown or balance. CONCLUSION: The single-dose oral administration of 15 N glycine stable isotope with measurement of urinary end-product enrichment is a feasible and noninvasive method to investigate whole body protein turnover in children. After major surgery, children manifest increased protein turnover and net negative balance due to increased protein breakdown.


Assuntos
Creatinina/urina , Glicina/administração & dosagem , Metilistidinas/urina , Complicações Pós-Operatórias/urina , Proteínas/metabolismo , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adolescente , Amônia/urina , Biomarcadores/urina , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Isótopos de Nitrogênio/administração & dosagem , Projetos Piloto , Reprodutibilidade dos Testes , Ureia/urina
12.
JPEN J Parenter Enteral Nutr ; 42(5): 913-919, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29338079

RESUMO

BACKGROUND: We aimed to describe nutrient intake and growth in infants with gastroschisis and identify factors associated with impaired growth. METHODS: Retrospective study of neonates who underwent gastroschisis repair from 2010 to 2015. Nutrient intake and weight-for-age z scores (WAZ) were recorded. RESULTS: Data from 60 eligible infants with median (Q1, Q3) gestational age of 36 weeks (35, 37) and birth weight 2418 g (2098, 2665) were analyzed. Median WAZ decreased from -0.71 (-1.08, -0.17) at birth to -1.08 (-1.58, -0.63) at discharge (P < .001); 30% experienced a >1.0 decline in WAZ. Parenteral nutrition (PN) was initiated soon after birth, and 14 (23%) patients had severe intestinal failure. Fourteen patients (23%) experienced central line-associated bloodstream infection (CLABSI) at a rate of 5.0 per 1000 catheter days. Factors independently associated with lower discharge WAZ and greater WAZ decline were CLABSI (P = .02) and prematurity (P = .02). By day 7, energy and protein intake were 90-100 kcal/kg/day and 3 g/kg/day, respectively. Median age to achieve enteral autonomy was 36 days (22, 82). Atresias, CLABSI, prematurity, and staged closure were associated with delayed enteral autonomy (P < .01). Among 34 patients with 1-year follow-up, WAZ improved from -1.16 (-1.74, -0.65) at discharge to 0.19 (-0.80, 0.61) at 12 months (P < .001). CONCLUSION: Infants with gastroschisis are dependent on PN and have a significant decline in WAZ during their hospital stay, predicted by prematurity and CLABSI. Efforts to prevent CLABSI and optimize enteral autonomy must be prioritized in this cohort.


Assuntos
Gastrosquise/terapia , Apoio Nutricional/métodos , Aumento de Peso , Peso ao Nascer , Ingestão de Energia , Feminino , Seguimentos , Gastrosquise/complicações , Gastrosquise/cirurgia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/crescimento & desenvolvimento , Terapia Intensiva Neonatal , Masculino , Estado Nutricional , Nutrição Parenteral/efeitos adversos , Estudos Retrospectivos , Sepse/etiologia
13.
Semin Pediatr Surg ; 26(5): 328-335, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29110830

RESUMO

Management of pediatric intestinal failure has evolved in recent decades, with improved survival since the advent of specialized multidisciplinary intestinal failure centers. Though sepsis and intestinal failure associated liver disease still contribute to mortality, we now have growing data on the long-term outcomes for this population. While intestinal adaptation and parenteral nutrition weaning is most rapid during the first year on parenteral support, achievement of enteral autonomy is possible even after many years as energy and protein requirements decline dramatically with age. Intestinal transplant is an option for patients experiencing complications of long-term parenteral nutrition who are expected to have permanent intestinal failure, but outcomes are hindered by immunosuppression-related complications. Much of the available data comes from single center retrospective reports, with variable inclusion criteria, intestinal failure definitions, and follow-up durations; this limits the ability to analyze outcomes and identify best practices. As most children now survive long-term, the focus of management has shifted to the avoidance and management of comorbidities, support of normal growth and development, and optimization of quality of life for these medically and surgically complex patients.


Assuntos
Enteropatias/complicações , Enteropatias/terapia , Criança , Nutrição Enteral , Humanos , Enteropatias/diagnóstico , Enteropatias/mortalidade , Intestinos/transplante , Nutrição Parenteral , Qualidade de Vida , Síndrome do Intestino Curto/complicações , Síndrome do Intestino Curto/mortalidade , Síndrome do Intestino Curto/terapia , Transição para Assistência do Adulto , Resultado do Tratamento
14.
J Pediatr Surg ; 2017 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-29111080

RESUMO

BACKGROUND: Necrotizing enterocolitis (NEC) is classically a disease of prematurity, with less reported regarding morbidity and mortality of this disease among other infants. METHODS: Data were prospectively collected from 2009 to 2015 at 252 Vermont Oxford Network member centers on neonates with birth weight>2500g admitted to a participating NICU within 28days of birth. RESULTS: Of 1629 neonates with NEC, gestational age was 37 (36, 39) weeks, and 45% had major congenital anomalies, most commonly gastrointestinal defects (20%), congenital heart defects (18%), and chromosomal anomalies (7%). For the 23% of infants who had surgery for NEC, mortality and length of stay were 23% and 63 (36, 94) days versus 8% and 34 (22, 61) days in medical NEC. Independent predictors of mortality were congenital heart defects (p<0.0001), chromosomal abnormalities (p<0.05), other congenital malformations (p<0.001), surgical NEC (p<0.0001), and sepsis (p<0.05). All of these in addition to gastrointestinal defects were independent predictors of increased length of stay. Nutritional morbidity at discharge included 6% receiving no enteral feeds and 27% who were <10th percentile weight-for-age. CONCLUSIONS: Major congenital anomalies are present in nearly half of >2500g birth weight infants diagnosed with necrotizing enterocolitis. Morbidity and mortality increase with sepsis, surgical disease, and congenital anomalies. TYPE OF STUDY: Prognosis Study. LEVEL OF EVIDENCE: Level II.

15.
Gastroenterol Res Pract ; 2017: 7182429, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29075290

RESUMO

BACKGROUND: A relationship between intestinal motility and ileostomy prolapse has been suggested but not demonstrated objectively. AIMS: This study evaluated the association between ileostomy prolapse and intestinal dysmotility in children. METHODS: IRB-approved retrospective review of 163 patients with ileostomies (1998-2014) at a single institution. Patients were categorized as having clinical dysmotility as a primary diagnosis (n = 33), clinically suspected dysmotility based on underlying diagnosis (n = 60), or intestinal dysmotility unlikely (n = 70) at the time of ileostomy present. Intestinal manometry was categorized as normal (n = 13) or abnormal (n = 10). Primary outcome was pathologic stoma prolapse. Multivariate analysis using a logistic regression model and log-rank test to compare stoma prolapse rates over time between motility groups were used. RESULTS: Clinical diagnosis of dysmotility (p ≤ 0.001) and manometric findings of dysmotility (p = 0.024) were independently associated with stoma prolapse. Clinical dysmotility correlated with manometric findings (κ = 0.53). Prolapse occurred in 42% of patients with dysmotility, 34% of patients with suspected dysmotility, and 24% of patients with normal motility. One-year prolapse-free stoma "survival" was 45% for dysmotility, 72% for suspected dysmotility, and 85% for intestinal dysmotility unlikely groups (p = 0.006). CONCLUSIONS: Children with intestinal dysmotility are at great risk for stoma prolapse. Intestinal manometry could help identify these patients preoperatively.

16.
J Pediatr Surg ; 52(12): 1921-1924, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28987713

RESUMO

PURPOSE: Small bowel length is the most reliable predictor of enteral independence in pediatric short bowel syndrome. Retrospectively measured bowel lengths on upper GI with small bowel follow-through (UGI/SBFT) were compared to operative measurements. METHODS: A pediatric radiologist and surgical trainees blinded to operative measurements retrospectively analyzed UGI/SBFT studies using the digital radiography curved measurement tool. Children with SBS and severe intestinal failure (parenteral nutrition >90days) at a multidisciplinary intestinal failure program 2002-2015 were included. Data were expressed as median (Q1, Q3). RESULTS: Thirty-six children aged 0.8 (0.4, 3.7) years were analyzed. Fifty-six percent had intestinal malrotation, and 58% had prior serial transverse enteroplasty. Studies were conducted within 10 (7, 20) days of surgery. Intraoperative bowel length was 90cm (45, 142), while UGI/SBFT measurement by radiologist was 45cm (28, 63), with a mean difference of 47cm (SD 58cm, p<0.001) and a mean percent error of 50%. Radiographic assessment underestimated intestinal length in 83% of patients. CONCLUSION: Bowel length measured retrospectively from upper GI with small bowel follow-through studies usually underestimated intraoperative bowel length. The limits of agreement were too wide for this technique to be clinically useful. Operative measurement remains necessary to assess intestinal length and rehabilitation potential. TYPE OF STUDY: Study of Diagnostic Test. LEVEL OF EVIDENCE: Level III.


Assuntos
Atresia Intestinal/diagnóstico por imagem , Intestino Delgado/anormalidades , Intestino Delgado/diagnóstico por imagem , Síndrome do Intestino Curto/diagnóstico por imagem , Pré-Escolar , Anormalidades do Sistema Digestório/diagnóstico por imagem , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Seguimentos , Humanos , Lactente , Atresia Intestinal/cirurgia , Volvo Intestinal/diagnóstico por imagem , Intestino Delgado/cirurgia , Masculino , Estudos Retrospectivos , Síndrome do Intestino Curto/cirurgia
17.
J Pediatr Surg ; 2017 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-29079317

RESUMO

PURPOSE: This study characterizes neurodevelopmental outcomes and healthcare needs of extremely low birth weight (ELBW) survivors of necrotizing enterocolitis (NEC) compared to ELBW infants without NEC. METHODS: Data were collected prospectively on neonates born 22-27weeks' gestation or 401-1000g at 47 Vermont Oxford Network member centers from 1999 to 2012. Detailed neurodevelopmental evaluations were conducted at 18-24months corrected age. Information regarding rehospitalizations, postdischarge surgeries, and feeding was also collected. "Severe neurodevelopmental disability" was defined as: bilateral blindness, hearing impairment requiring amplification, inability to walk 10 steps with support, cerebral palsy, and/or Bayley Mental or Psychomotor Developmental Index <70. Diagnosis of NEC required both clinical and radiographic findings. RESULTS: There were 9063 children without NEC, 417 with medical NEC, and 449 with surgical NEC evaluated. Significantly higher rates of morbidity were observed among infants with a history of NEC. Those with surgical NEC were more frequently affected across all outcome measures at 18-24months corrected age: 38% demonstrated severe neurodevelopmental disability, nearly half underwent postdischarge operations, and a quarter required tube feeding at home. CONCLUSION: At 18-24months, extremely low birth weight survivors of necrotizing enterocolitis were at markedly increased risk (p<0.001) for severe neurodevelopmental disability, postdischarge surgery, and tube feeding. LEVEL OF EVIDENCE: II (prospective cohort study with <80% follow-up rate).

18.
J Pediatr ; 188: 192-197.e6, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28712519

RESUMO

OBJECTIVE: To quantify outcomes and analyze factors predictive of morbidity and mortality in infants with gastroschisis. STUDY DESIGN: Clinical data regarding neonates with gastroschisis born between 2009 and 2014 were prospectively collected at 175 North American centers. Multivariate regression was used to assess risk factors for mortality and length of stay (LOS). RESULTS: Gastroschisis was diagnosed in 4420 neonates with median birth weight 2410 g (IQR 2105-2747). Survival (discharge home or alive in hospital at 1 year) was 97.8% with a 37 day median LOS (IQR 27-59). Sepsis, defined by positive blood or cerebrospinal fluid culture, was the only significant independent predictor of mortality (P = .04). Significant independent determinants of LOS and the percentage of neonates affected were as follows: bowel resection (9.8%, P < .0001), sepsis (8.6%, P < .0001), presence of other congenital anomalies (7.6%, including 5.8% with intestinal atresias, P < .0001), necrotizing enterocolitis (4.5%, P < .0001), and small for gestational age (37.3%, P = .0006). Abdominal surgery in addition to gastroschisis repair occurred in 22.3%, with 6.4% receiving gastrostomy or jejunostomy tubes and 6.3% requiring ostomy creation. At discharge, 57.0% were less than the 10th percentile weight for age. The mode of delivery (52.4% cesarean delivery) was not associated with any differences in outcome. CONCLUSIONS: Although neonates with gastroschisis have excellent overall survival they remain at risk for death from sepsis, prolonged hospitalization, multiple abdominal operations, and malnutrition at discharge. Outcomes appear unaffected by the use of cesarean delivery. Further opportunities for quality improvement include sepsis prevention and enhanced nutritional support.


Assuntos
Gastrosquise/epidemiologia , Gastrosquise/cirurgia , Estudos de Coortes , Anormalidades Congênitas/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Enterocolite Necrosante/epidemiologia , Feminino , Gastrostomia/estatística & dados numéricos , Humanos , Transtornos da Nutrição do Lactente/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Atresia Intestinal/epidemiologia , Atresia Intestinal/cirurgia , Jejunostomia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , América do Norte/epidemiologia , Fatores de Risco , Sepse/mortalidade
19.
Proc Natl Acad Sci U S A ; 114(23): 5870-5877, 2017 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-28584090

RESUMO

Establishing a timeline for the evolution of novelties is a common, unifying goal at the intersection of evolutionary and developmental biology. Analyses of gene regulatory networks (GRNs) provide the ability to understand the underlying genetic and developmental mechanisms responsible for the origin of morphological structures both in the development of an individual and across entire evolutionary lineages. Accurately dating GRN novelties, thereby establishing a timeline for GRN evolution, is necessary to answer questions about the rate at which GRNs and their subcircuits evolve, and to tie their evolution to paleoenvironmental and paleoecological changes. Paleogenomics unites the fossil record and all aspects of deep time, with modern genomics and developmental biology to understand the evolution of genomes in evolutionary time. Recent work on the regulatory genomic basis of development in cidaroid echinoids, sand dollars, heart urchins, and other nonmodel echinoderms provides an ideal dataset with which to explore GRN evolution in a comparative framework. Using divergence time estimation and ancestral state reconstructions, we have determined the age of the double-negative gate (DNG), the subcircuit which specifies micromeres and skeletogenic cells in Strongylocentrotus purpuratus We have determined that the DNG has likely been used for euechinoid echinoid micromere specification since at least the Late Triassic. The innovation of the DNG thus predates the burst of post-Paleozoic echinoid morphological diversification that began in the Early Jurassic. Paleogenomics has wide applicability for the integration of deep time and molecular developmental data, and has wide utility in rigorously establishing timelines for GRN evolution.


Assuntos
Evolução Biológica , Redes Reguladoras de Genes , Strongylocentrotus purpuratus/genética , Animais , Genômica , Filogenia
20.
J Pain Res ; 10: 763-774, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28405172

RESUMO

Mitogen-activated protein kinase (MAPK) phosphatase-3 (MKP-3) and its substrates (extracellular signal-regulated kinase [ERK] and p38) play an important role in pathophysiological mechanisms of acute postoperative and chronic neuropathic pain in the spinal cord. This study aimed to understand the role of MKP-3 and its target MAPKs at the site of surgical incision in nociceptive behavior. Wild-type (WT) and MKP-3 knockout (KO) mice underwent unilateral plantar hind paw incision. Mechanical allodynia was assessed by using von Frey filaments. Peripheral ERK-1/2 and p38 phosphorylation were measured by Western blot. Cell infiltration was determined using hematoxylin and eosin histological staining. Peripheral phosphorylated ERK-1/2 (p-ERK-1/2) inhibition was performed in MKP-3 KO mice. In WT mice, mechanical hypersensitivity was observed on postoperative day 1 (0.69±0.17 g baseline vs 0.13±0.08 g day 1), which resolved normally by postoperative day 12 (0.46±0.08 g, N=6). In MKP-3 KO mice, this hypersensitivity persisted at least 12 days after surgery (0.19±0.06 g; N=6). KO mice displayed higher numbers of infiltrating cells (51.4±6 cells/0.1 mm2) than WT mice (8.7±1.2 cells/0.1 mm2) on postoperative day 1 (vs 5-6 cells/0.1 mm2 at baseline) that returned to baseline 12 days after surgery (10-12 cells/0.1 mm2). In WT mice, peripheral p-p38 and p-ERK-1/2 expression increased (5- and 3-fold, respectively) on postoperative days 1 and 5, and returned to basal levels 7-12 days after surgery (N=3 per group). Peripheral p-p38 levels in MKP-3 KO mice followed a similar expression pattern as WT mice. Peripheral p-ERK-1/2 levels in MKP-3 KO mice remained elevated 12 days after surgery (2.5-fold, N=3 per group). Administration of PD98059 (MEK inhibitor, N=8, vehicle N=9) reduced p-ERK-1/2 expression in the incised tissue and blocked hypersensitivity in MKP-3 KO mice (N=6). The findings of this study suggest that MKP-3 is pivotal for normal resolution of acute postoperative allodynia, through the regulation of peripheral p-ERK-1/2.

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