Perception, practice, and barriers toward research among pediatric undergraduates: a cross-sectional questionnaire-based survey.

BACKGROUND: Scientific research activities are crucial for the development of clinician-scientists. However, few people pay attention to the current situation of medical research in pediatric medical students in China. This study aims to assess the perceptions, practices and barriers toward medical research of pediatric undergraduates. METHODS: This cross-sectional study was conducted among third-year, fourth-year and fifth-year pediatric students from Zhejiang University School of Medicine in China via an anonymous online questionnaire. The questionnaires were also received from fifth-year students majoring in other medicine programs [clinical medicine ("5 + 3") and clinical medicine (5-year)]. RESULTS: The response rate of pediatric undergraduates was 88.3% (68/77). The total sample of students enrolled in the study was 124, including 36 students majoring in clinical medicine ("5 + 3") and 20 students majoring in clinical medicine (5-year). Most students from pediatrics ("5 + 3") recognized that research was important. Practices in scientific research activities are not satisfactory. A total of 51.5%, 35.3% and 36.8% of the pediatric students participated in research training, research projects and scientific article writing, respectively. Only 4.4% of the pediatric students contributed to publishing a scientific article, and 14.7% had attended medical congresses. None of them had given a presentation at a congress. When compared with fifth-year students in the other medicine program, the frequency of practices toward research projects and training was lower in the pediatric fifth-year students. Lack of time, lack of guidance and lack of training were perceived as the main barriers to scientific work. Limited English was another obvious barrier for pediatric undergraduates. Pediatric undergraduates preferred to participate in clinical research (80.9%) rather than basic research. CONCLUSIONS: Although pediatric undergraduates recognized the importance of medical research, interest and practices in research still require improvement. Lack of time, lack of guidance, lack of training and limited English were the common barriers to scientific work. Therefore, research training and English improvement were recommended for pediatric undergraduates.

Primary hepatic malignant triton tumor mimicking hepatocellular carcinoma by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging: a case report and literature review.

Background: Malignant Triton tumor (MTT) is a relatively rare subtype of malignant peripheral nerve sheath tumor (MPNST) characterized by rhabdomyosarcoma differentiation. There are no distinct features of MTT, and it is easy to misdiagnose preoperatively. Case presentation: Here, we describe a rare case of primary hepatic MTT in a 56-year-old male who presented with nonspecific abdominal pain for 1 day. Magnetic resonance imaging and abdominal computed tomography revealed an extremely large mass located in the right liver with intratumoral hemorrhage, arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging and the possibility of intrahepatic metastasis. Tumor marker levels revealed only an elevated level of alpha-fetoprotein (AFP: 5304.0 ng/mL). Then, he received transcatheter arterial chemoembolization combined with lenvatinib and pembrolizumab, and he was diagnosed with hepatocellular carcinoma. After 3 months of neoadjuvant therapy, we resected the hepatic cancer and adherent diaphragmatic pleura. MTT was confirmed by postoperative pathology and immunohistochemistry. Conclusion: Despite the preoperative diagnosis of hepatocellular carcinoma with a rising serum AFP level, typical CT and MRI findings, histopathology assessment showing MPNST with rhabdomyosarcoma differentiation confirms the diagnosis of primary hepatic MTT.

Long noncoding RNA signatures in intrauterine infection/inflammation-induced lung injury: an integrative bioinformatics study.

BACKGROUND: Intrauterine infection/inflammation can result in fetal and neonatal lung injury. However, the biological mechanisms of intrauterine infection/inflammation on fetal and neonatal lung injury and development are poorly known. To date, there are no reliable biomarkers for improving intrauterine infection/inflammation-induced lung injury. METHODS: An animal model of intrauterine infection/inflammation-induced lung injury was established with pregnant Sprague-Dawley rats inoculated with Escherichia coli suspension. The intrauterine inflammatory status was assessed through the histological examination of the placenta and uterus. A serial of histological examinations of the fetal and neonatal rats lung tissues were performed. The fetal and neonatal rat lung tissues were harvested for next generation sequencing at embryonic day 17 and postnatal day 3, respectively. Differentially expressed mRNAs and lncRNAs were identified by conducting high-throughput sequencing technique. The target genes of identified differentially expressed lncRNAs were analyzed. Homology analyses for important differentially expressed lncRNAs were performed. RESULTS: The histopathological results showed inflammatory infiltration, impaired alveolar vesicular structure, less alveolar numbers, and thickened alveolar septa in fetal and neonatal rat lung tissues. Transmission electron micrographs revealed inflammatory cellular swelling associated with diffuse alveolar damage and less surfactant-storing lamellar bodies in alveolar epithelial type II cells. As compared with the control group, there were 432 differentially expressed lncRNAs at embryonic day 17 and 125 differentially expressed lncRNAs at postnatal day 3 in the intrauterine infection group. The distribution, expression level, and function of these lncRNAs were shown in the rat genome. LncRNA TCONS_00009865, lncRNA TCONS_00030049, lncRNA TCONS_00081686, lncRNA TCONS_00091647, lncRNA TCONS_00175309, lncRNA TCONS_00255085, lncRNA TCONS_00277162, and lncRNA TCONS_00157962 may play an important role in intrauterine infection/inflammation-induced lung injury. Fifty homologous sequences in Homo sapiens were also identified. CONCLUSIONS: This study provides genome-wide identification of novel lncRNAs which may serve as potential diagnostic biomarkers and therapeutic targets for intrauterine infection/inflammation-induced lung injury.

Role of gut-brain axis in neurodevelopmental impairment of necrotizing enterocolitis.

Necrotizing enterocolitis (NEC) is a common gastrointestinal disease of preterm infants with high morbidity and mortality. In survivors of NEC, one of the leading causes of long-term morbidity is the development of severe neurocognitive injury. The exact pathogenesis of neurodevelopmental delay in NEC remains unknown, but microbiota is considered to have dramatic effects on the development and function of the host brain via the gut-brain axis. In this review, we discuss the characteristics of microbiota of NEC, the impaired neurological outcomes, and the role of the complex interplay between the intestinal microbiota and brain to influence neurodevelopment in NEC. The increasing knowledge of microbial-host interactions has the potential to generate novel therapies for manipulating brain development in the future.

[Analysis of TSC2 gene variant in a neonate with tuberous sclerosis complex].

OBJECTIVE: To explore the clinical characteristics and genetic variant in a neonate with tuberous sclerosis complex (TSC). METHODS: Clinical data of the neonate was collected. Genomic DNA was extracted from peripheral blood samples of the child and his parents and subjected to next-generation sequencing (NGS). RESULTS: The child was noted to have yellowish hair upon birth. NGS revealed that he has harbored a heterozygous c.3914del (p.P1305Rfs*20) frameshifting variant of the TSC2 gene. The variant has probably caused premature termination of translation, resulting in a truncated protein. CONCLUSION: Yellowish hair has rarely been described as the first manifestation of TSC. The c.3914del (p.P1305Rfs*20) variant of the TSC2 gene probably underlay the TSC in this patient.

Impact of the COVID-19 pandemic on infectious disease hospitalizations of neonates at a tertiary academic hospital: a cross-sectional study.

BACKGROUND: To investigate the impact of the coronavirus disease 2019 (COVID-19) pandemic on hospitalizations for neonatal infectious diseases. METHODS: We analyzed data for neonatal inpatients admitted at a tertiary academic hospital with a principal diagnosis of an infectious disease during January 2015 to December 2020. We compared hospitalizations in 2020 (COVID-19 cohort), corresponding with the impact of COVID-19 pandemic and associated containment measures, and the comparable 2015 to 2019 (pre-COVID-19 cohort). RESULTS: 14,468 cases admitted for neonatal infectious diseases were included in our study, with 1201 cases in the COVID-19 cohort and 13,267 cases in the pre-COVID-19 cohort. The leading causes of hospitalizations for neonatal infectious diseases remain being respiratory tract infections (median ratio = 0.461, 95% CI 0.335-0.551), sepsis (median ratio = 0.292, 95% CI 0.263-0.361), gastric intestinal infections (median ratio = 0.095, 95% CI 0.078-0.118) and dermatologic infections (median ratio = 0.058, 95% CI 0.047-0.083). The seasonality of neonatal infectious disease hospitalizations could be obviously observed, with the total number and the overall rate of hospitalizations for neonatal infectious diseases in the first and fourth quarters greater than that of hospitalizations for neonatal infectious diseases in the second and third quarters in each year (1362.67 ± 360.54 vs 1048.67 ± 279.23, P = 0.001; 8176/20020 vs 6292/19369, P < 0.001, respectively). Both the numbers and the proportions of hospitalizations for neonatal infectious diseases in different quarters of the COVID-19 cohort significantly decreased as compared with those forecasted with the data from the pre-COVID-19 cohort: the numbers per quarter (300.25 ± 57.33 vs 546.64 ± 100.43, P-value = 0.006), the first quarter (0.34 vs 0.40, P = 0.002), the second quarter (0.24 vs 0.30, P = 0.001), the third quarter (0.24 vs 0.28, P = 0.024), and the fourth quarter (0.29 vs 0.35, P = 0.003). CONCLUSIONS: Despite the outbreak of the COVID-19 pandemic, the leading causes of hospitalizations for neonatal infectious diseases remain unchanged. The seasonality of neonatal infectious disease hospitalizations could be obviously observed. The numbers as well as the overall rates of hospitalizations for neonatal infectious diseases in the COVID-19 cohort dramatically declined with the impact of the COVID-19 pandemic and its mitigation measures.

Predictive significance of neutrophil-to-lymphocyte and platelet-to-lymphocyte for cytomegalovirus infection in infants less than 3 months: A retrospective study.

BACKGROUND: The aim of this study was to evaluate the predictive value of the hematological parameters in the identification of human cytomegalovirus (CMV) infection in infants less than 3 months. METHODS: A single-center, observational study of infants with CMV infection was conducted retrospectively. Routine blood parameters were analyzed in CMV-infected infants and controls with no differences of birthweight, sex, gestational age at birth, and date of admission. Furthermore, receiver-operating curve was used to assess the predictive value of the hematological parameters for CMV infection. RESULTS: One hundred ninety cases with CMV infection were studied retrospectively. Compared with the control group, there were significant differences in the white blood cell count, neutrophil count, lymphocyte count, platelet count, hemoglobin, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), and lymphocyte-to-monocyte (LMR) for the patients with CMV infection (all p < 0.001). The best predicted values for CMV infection based on the area under the curve (AUC) were NLR and PLR with the optimal cut-off value of 0.28 and 65.36. NLR-PLR score of 0, 1, or 2 based on an elevated NLR (>0.28), an elevated PLR (>65.36), or both. NLR-PLR score for CMV infection prediction yielded higher AUC values than NLR or PLR alone (0.760 vs. 0.689, 0.689; p < 0.001). CONCLUSIONS: The NLR combined with PLR is potentially useful as a predictor of CMV infection in infants less than 3 months.

Effect of the Notch4/Dll4 signaling pathway in early gestational intrauterine infection on lung development.

Intrauterine infection is an important risk factor for bronchopulmonary dysplasia (BPD). BPD is characterized by arrested lung alveolarization and impaired pulmonary vascularization. The Notch4 signaling pathway is a key regulator of vascular remodeling and angiogenesis. Therefore, the presents study investigated the expression of Notch4, delta-like canonical Notch ligand 4 (Dll4) and related factors in an in vivo rat model and in rat pulmonary microvascular endothelial cells (PMVECs) in vitro, to study the mechanisms by which intrauterine infection affects rat lung development. A rat model of intrauterine infection was established by endocervical inoculation with Escherichia scoli on embryonic day 15. The date of birth was counted as postnatal day 0 (P0). Then, the lung tissues were collected from pups at days P3-P14. The expression of Notch4, Dll4 and related factors was measured by reverse transcription-quantitative PCR and western blotting. In addition, the γ-secretase inhibitor DAPT was used to examine the effect of Notch4 signaling on PMVECs. Intrauterine E. coli infection impaired normal lung development, as indicated by decreased microvessel density, fewer alveoli, fewer secondary septa, and larger alveoli compared with the control group. Furthermore, Notch4, Dll4 and NF-κB levels were significantly increased in the E. coli-infected group at P3 compared with the control group. Similarly, the mRNA expression levels of fetal liver kinase 1 (Flk-1, a VEGF receptor) were significantly increased in the E. coli-infected group at P3 and P7. In PMVECs, the inhibition of Notch4 signaling contributed to decreases in lipopolysaccharide (LPS)-induced expression of VEGF and its receptors. Furthermore, the inhibition of Notch4/Dll4 signaling accelerated cell proliferation and decreased the apoptosis rate of LPS-induced PMVECs. LPS-induced NF-κB expression in PMVECs was also attenuated by the Notch4/Dll4 inhibitor. In conclusion, intrauterine E. coli infection impaired normal lung development, possibly through Notch4/Dll4 signaling and effects on VEGF and its receptors.

Neonatal Ureaplasma parvum meningitis complicated with subdural hematoma: a case report and literature review.

BACKGROUND: Neonatal meningitis is a severe infectious disease of the central nervous system with high morbidity and mortality. Ureaplasma parvum is extremely rare in neonatal central nervous system infection. CASE PRESENTATION: We herein report a case of U. parvum meningitis in a full-term neonate who presented with fever and seizure complicated with subdural hematoma. After hematoma evacuation, the seizure disappeared, though the fever remained. Cerebrospinal fluid (CSF) analysis showed inflammation with CSF pleocytosis (1135-1319 leukocytes/µl, mainly lymphocytes), elevated CSF protein levels (1.36-2.259 g/l) and decreased CSF glucose (0.45-1.21 mmol/l). However, no bacterial or viral pathogens in either CSF or blood were detected by routine culture or serology. Additionally, PCR for enteroviruses and herpes simplex virus was negative. Furthermore, the CSF findings did not improve with empirical antibiotics, and the baby experienced repeated fever. Thus, we performed metagenomic next-generation sequencing (mNGS) to identify the etiology of the infection. U. parvum was identified by mNGS in CSF samples and confirmed by culture incubation on mycoplasma identification medium. The patient's condition improved after treatment with erythromycin for approximately 5 weeks. CONCLUSIONS: Considering the difficulty of etiological diagnosis in neonatal U. parvum meningitis, mNGS might offer a new strategy for diagnosing neurological infections.

Intravenous immunoglobulin G in the treatment of ABO hemolytic disease of the newborn during the early neonatal period at a tertiary academic hospital: a retrospective study.

OBJECTIVE: To evaluate the efficacy and safety of intravenous immunoglobulin G (IVIG) in infants with ABO hemolytic disease of the newborn (HDN). METHODS: Infants with moderate-to-severe ABO HDN during early neonatal period (<7 days) at our hospital in 2017 were included in this retrospective study. Patients treated with IVIG and phototherapy were classified as the IVIG group, and those who only received phototherapy were classified as the phototherapy only group. RESULTS: Forty-six patients were classified into the IVIG group and 68 other patients were classified into the phototherapy only group. There was no significant difference in duration of phototherapy, hospitalization periods, needs for exchange transfusion, transfusions, and incidence of bilirubin-induced neurological sequelae between these two groups (P = 0.20, 0.27, 0.65, 0.47, 0.78, respectively). CONCLUSION: It seems unnecessary to expose neonates to IVIG in moderate-to-severe ABO HDN when the available data show no appreciable benefits.

Pancreatic lipomatous hamartoma mimicking other pancreatic tumor: a case report and literature review.

Pancreatic lipomatous hamartoma (PLH) is an extremely rare benign entity that forms a mass-like lesion. PLH lacks distinct features, and can be preoperatively misdiagnosed as a pancreatic tumor with lipomatous components, including pancreatic lipomatosis, lipoma, liposarcoma, and malignant tumors with fatty degeneration. Here, we report a case study of PLH in a 73-year-old male who presented with abdominal pain. Abdominal-enhanced computed tomography and magnetic resonance imaging revealed a 4.3×4-cm solid mass with a lipomatous component in the pancreatic head, and the mass displayed a centripetal pattern of contrast enhancement. The patient was preoperatively diagnosed with pancreatic liposarcoma, and subsequently underwent a pancreatoduodenectomy. The postoperative pathology and immunohistochemical analyses confirmed the diagnosis of PLH, which primarily contained mature adipocytes, small ducts, and a few well-preserved pancreatic acini. Although this disease is rare, we suggest that PLH should be considered during the differential diagnosis of pancreatic lesions with lipomatous components. Consideration of the potential for PLH disease might reduce the number of unnecessary resections.

Gastric duplication cyst lined by pseudostratified columnar ciliated epithelium masquerading as a pancreatic mucinous cystic neoplasm: a case report and literature review.

Gastric duplication cyst (GDC) with a pseudostratified columnar ciliated epithelial (PCCE) is a congenital rare cystic neoplasm, which is often difficult to distinguish from other entities by imaging techniques, and as a consequence it may be wrongly overtreated. We herein report a case of a 52-year-old female incidentally found to have an abdominal mass by ultrasonography and computed tomography. Additionally, endoscopic ultrasonography and fluid analysis were consistent with a pancreatic mucinous cystic neoplasm with a markedly elevated fluid amylase, carcinoembryonic antigen, and carbohydrate antigen 19-9. Then, laparoscopic resection of the cyst originating from the stomach and wedge gastrectomy were performed. Final pathology revealed a GDC with PCCE. In addition, we also performed a literature review of 31 reports of GDC with PCCE. Although rare, GDC lined by PCCE should be included in the differential diagnosis of pancreatic cystic neoplasms or a gastric wall mass.

STK33 Promotes the Growth and Progression of Human Pancreatic Neuroendocrine Tumour via Activation of the PI3K/AKT/mTOR Pathway.

BACKGROUND: Serine/threonine kinase 33 (STK33) has been reported to play an important role in cancer cell proliferation. We investigated the role of STK33 in pancreatic neuroendocrine tumour (PNET) and the underlying mechanisms. METHODS: PNET specimens and adjacent non-tumorous pancreatic tissues from 84 patients who underwent curative surgery for PNET were stained by immunochemistry for STK33. The relationships among STK33 expression, clinicopathological parameters and clinical prognosis were statistically analysed. MTT, scratching, Transwell and apoptosis assays were employed to detect the effects of STK33 knockdown (siSTK33) or STK33 overexpression (pSTK33) on major oncogenic properties of cells of 2 PNET cell lines (BON and QGP-1), and real-time PCR and western blot were used to examine the expression of relevant genes. RESULTS: Relative to its expression in normal pancreatic tissue, STK33 was overexpressed in PNET specimens. Furthermore, STK33 expression was significantly associated with World Health Organization classification (p < 0.001), American Joint Committee on Cancer stage (p < 0.001), lymph node metastasis (p < 0.001), tumour size (p = 0.022), sex (p = 0.003), perineural invasion (p < 0.001) and shorter disease-free survival of patients with PNET (p < 0.001). Enforced STK33 expression promoted PNET cell proliferation, migration and invasion and tumour growth and inhibited cell apoptosis, whereas STK33 depletion exerted the opposite effects. Mechanistic studies revealed that STK33 promoted growth and progression of PNET via activation of the phosphotidylinositol-3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathway. CONCLUSIONS: STK33 plays important roles in the tumour growth and progression of PNET via activation of the PI3K/AKT/mTOR pathway and has potential as a therapeutic target to improve PNET treatment.

Clinical significance of the preoperative main pancreatic duct dilation and neutrophil-to-lymphocyte ratio in pancreatic neuroendocrine tumors (PNETs) of the head after curative resection.

BACKGROUND: The present study aimed to investigate the prognostic significance of preoperative main pancreatic duct dilation and the neutrophil-to-lymphocyte ratio (PD-NLR) in pancreatic neuroendocrine tumors (PNETs) of the head after curative resection. METHODS: Sixty-four consecutive PNETs of the head that underwent curative resection were included in the study. Preoperative main pancreatic duct dilation (PD) was defined as a pancreatic duct dilation greater than 3 mm before surgery. Patients with both PD and an elevated NLR (> 3.13), with PD or elevated NLR, or neither of these characteristics were allocated a PD-NLR score of 2, 1, or 0, respectively. Univariate, multivariate and Kaplan-Meier analyses were used to calculate overall survival (OS) and disease-free survival (DFS). RESULTS: Preoperative PD-NLR score was correlated with tumor size (P = 0.005), T-stage (P = 0.016), lymph node metastasis (P <  0.001), distant metastasis (P = 0.005), type of hormone production (P = 0.006), perineural invasion (P = 0.014), and WHO classification (P <  0.001). Patients with a high PD-NLR score had a significantly poor OS and DFS relative to those with a low PD-NLR score (P <  0.001). In the multivariate analysis, PD-NLR score was an independent predictor of OS and DFS for PNET of the head (both P <  0.05). In the analyses of the various subgroups, preoperative PD-NLR score was also a predictor of OS and DFS. Additionally, the survival predictive capability of PD-NLR score was superior to that of WHO classification. CONCLUSIONS: Despite the retrospective nature and small sample size of the present study, the results suggest that preoperative PD-NLR score can serve as an independent prognostic marker of early survival in patients with PNETs of the head undergoing curative resection. Further large prospective studies are necessary to validate our findings.

Clinical analysis of 17 cases of neonatal osteomyelitis: A retrospective study.

Although acute osteomyelitis is rare in neonates, it might result in severe sequelae such as joint destruction and growth failure if it is not diagnosed and treated early. However, few studies have focused on the clinical features and treatment of this disease.A retrospective review of 17 cases of neonatal osteomyelitis, for which the patients underwent medical treatment alone or combined with surgery at the Children's Hospital of Zhejiang University School of Medicine between January 2009 and September 2016, was conducted. Medical treatment included the use of antibiotics and supportive care. Surgery was performed in cases with subperiosteal abscess (>1 cm) or clinical deterioration despite antibiotic therapy.All of the patients (11 men and 6 women) were term neonates. The main complaints were redness or swelling around the affected bone and fever. The most common sites were the femur (29.4%) and humerus (23.5%). There were 14 (82.35%) cases with positive cultures: Staphylococcus accounted for 71.43% (n = 10), followed by Salmonella (n = 1), Streptococcus pneumoniae (n = 1), Klebsiella pneumoniae (n = 1), and Escherichia coli (n = 1). X-rays (n = 14), ultrasound (n = 6), computed tomography (CT) (n = 5), or magnetic resonance imaging (MRI) (n = 7) were performed. Three of 14 x-rays were not pathological at the onset of the disease, while the positive rate of MRI in detecting osteomyelitis was 100%. Eleven of 17 cases underwent surgical drainage, and higher white blood cell (WBC) counts were found in patients requiring surgery (P < .05). The prognosis for all patients was good without severe sequelae with a mean follow-up period of 49.47 ±â€Š23.43 months.In conclusion, the prognosis of neonatal osteomyelitis with early active treatment is good. MRI is advocated for detecting early osteomyelitis. Additionally, neonates with higher WBC count together with osteomyelitis have an increased risk for surgery.

Effects and molecular mechanisms of intrauterine infection/inflammation on lung development.

BACKGROUND: Intrauterine infection/inflammation plays an important role in the development of lung injury and bronchopulmonary dysplasia (BPD) in preterm infants, While a multifactorial genesis is likely, mechanisms involved in BPD after intrauterine infection/inflammation are largely unknown. Recent studies have suggested microRNAs (miRNAs) are likely to play a role. Therefore, this study aimed to study the effects and mechanisms of intrauterine infection/inflammation on lung development, and to identify miRNAs related to lung injury and BPD. METHODS: An animal model of intrauterine infection/inflammation was established with pregnant SD rats endocervically inoculated with E.coli. The fetal and neonatal rats were observed at embryonic day (E) 17, 19, 21 and postnatal day (P) 1, 3, 7, 14, respectively. Body weight, lung weight, the expression levels of NLRP3, TNF-α, IL-lß, IL-6, VEGF, Collagen I, SP-A, SP-B and SP-C in the lung tissues of fetal and neonatal rats were measured. Expression profiles of 1218 kinds of miRNAs in the lungs of neonatal rats were detected by miRNA microarray technique. Target genes of the identified miRNAs were predicted through online software. RESULTS: Intrauterine infection/inflammation compromised not only weight development but also lung development of the fetal and neonatal rats. The results showed significantly increased expression of NLRP3, TNF-α, IL-1ß, IL-6, Collagen I, and significantly decreased expression of VEGF, SP-A, SP-B and SP-C in the fetal and neonatal rat lung tissues in intrauterine infection group compared to the control group at different observation time point (P < 0.05). Forty-three miRNAs with significant differential expression were identified. Possible target genes regulated by the identified miRNAs are very rich. CONCLUSIONS: Intrauterine infection/inflammation results in lung histological changes which are very similar to those observed in BPD. Possible mechanisms may include NLRP3 inflammasome activation followed by inflammatory cytokines expression up-regulated, inhibiting the expression of pulmonary surfactant proteins, interfering with lung interstitial development. There are many identified miRNAs which target a wide range of genes and may play an important role in the processes of lung injury and BPD.

Laparoscopic spleen-preserving pancreatic resection for epidermoid cyst in an intrapancreatic accessory spleen: case report and literature review.

INTRODUCTION: An epidermoid cyst in an intrapancreatic accessory spleen (ECIPAS) is a rare non-neoplastic cyst, typically occurring in the pancreatic tail. It is difficult to preoperatively differentiate ECIPAS from other types of pancreatic neoplastic cysts. CASE PRESENTATION: We herein report a case of a 32-year-old man with a cystic tumor in the tail of the pancreas. The patient underwent a laparoscopic spleen-preserving distal pancreatectomy, and histological examination revealed the presence of ECIPAS. In addition, we also performed a literature review of 42 case reports of ECIPAS. CONCLUSION: Although the preoperative diagnosis of ECIPAS is relatively difficult, familiarity with the imaging features, the clinical presentation and the location of the cyst could lead to a correct preoperative diagnosis of ECIPAS, which might thereby reduce the number of unnecessary resections.

Role of palliative resection of the primary pancreatic neuroendocrine tumor in patients with unresectable metastatic liver disease: a systematic review and meta-analysis.

BACKGROUND: Treatment for pancreatic neuroendocrine tumors (PNETs) in patients with unresectable metastatic liver disease has long been a controversial issue. This systematic review aims to summarize the existing evidence concerning the value of primary tumor resection in this group of patients. METHODS: A systematic review of the literature and a meta-analysis were performed. The PubMed and Cochrane databases were searched to identify articles that compared palliative primary tumor resection and nonsurgical regimens in patients with PNETs and unresectable liver metastases. Relevant articles were identified in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome was overall survival. The included studies were evaluated for heterogeneity and publication bias. RESULTS: Overall, 10 studies were included in the analysis. No randomized controlled trials (RCTs) were identified. These studies included 1,226 patients who underwent a resection of the primary tumor and 1,623 patients who did not undergo surgery. The median overall survival was 36-137 and 13.2-65 months in the surgical and nonsurgical groups, respectively, and the 5-year overall survival rate was 35.7-83 and 5.4%-50%, respectively, in these two groups. The meta-analysis demonstrated that there was no significant difference in liver tumor burden (odds ratio [OR] =1.51, 95% CI: 0.59-3.89, P=0.39) or tumor grade (OR =2.88, 95% CI: 0.92-9.04, P=0.07) among patients who underwent surgery and nonsurgical therapy. Furthermore, patients who underwent an aggressive surgical approach appeared to have a higher tumor grade. However, the meta-analysis demonstrated that patients who underwent primary tumor resection had better overall survival (P<0.001), with a pooled hazard ratio of 0.36 (95% CI: 0.30-0.45). No publication bias was detected. CONCLUSION: This meta-analysis demonstrates that the palliative resection of the primary tumor in patients with PNETs and unresectable liver metastases can increase survival, although a bias toward a more aggressive surgical approach in patients with better performance status, less advanced disease, or a tumor located in the body or tail of the pancreas appears likely. RCTs with longer follow-up periods are required to confirm the advantages of palliative primary tumor resection for PNETs.

Salmonella osteomyelitis in a previously healthy neonate: a case report and review of the literature.

BACKGROUND: Acute osteomyelitis, which is uncommon in neonates, needs to be quickly diagnosed and treated to avoid devastating sequelae. Therefore, it is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. The most frequently isolated bacterium in neonates with osteomyelitis is Staphylococcus aureus, while Salmonella is an unusual organism causing osteomyelitis and is exceedingly rare in non-sickle cell disease children. CASE PRESENTATION: We report an extremely rare case of neonatal osteomyelitis caused by Salmonella in a neonate, who was previously healthy. We report this case because it was caused by a rare pathogenic germ in newborns and by its non-specific presentation. CONCLUSIONS: Salmonella should be kept in mind in the differential diagnosis of neonatal osteomyelitis. It is important to start antibiotic therapy as soon as possible and to adjust therapy in relation to the susceptibility of the bacterial strain.

Prognostic Significance of Preoperative Neutrophil-to-Lymphocyte Ratio in Surgically Resectable Pancreatic Neuroendocrine Tumors.

BACKGROUND The aim of this study was to evaluate the predictive and prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in pancreatic neuroendocrine tumor (PNET) patients undergoing potentially curative resection. MATERIAL AND METHODS A retrospective review of 172 patients with PNETs was conducted. Kaplan-Meier curves and multivariate Cox proportional models were used to calculate overall survival (OS) and disease-free survival (DFS). The predictive performance of the NLR was compared with other inflammation-based scores and conventional stratification systems using receiver operating characteristic (ROC) curve analysis. RESULTS Elevated NLR and PLR were both associated with advanced AJCC stage and high grade. In the univariate analysis, elevated NLR and PLR were both significantly associated with decreased OS and DFS. In the multivariate analysis, the preoperative NLR, but not the PLR, was an independent risk factor for OS (HR=4.471, 95% CI 1.531-13.054, p=0.006) and DFS (HR=2.531, 95% CI 1.202-5.329, p=0.015). The discriminatory capability of the NLR was superior to that of other inflammation-based scores in OS prediction. Furthermore, the predictive range was expanded by incorporating the NLR into the conventional stratification systems, including the AJCC stage and WHO classification systems. CONCLUSIONS As an independent prognostic factor, an elevated preoperative NLR is superior to the PLR with respect to predicting clinical outcomes in PNET patients undergoing potentially curative resection. The incorporation of the NLR into the existing conventional stratification systems improved the predictive accuracy.