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Jeropoulos RM, Joshi D, Aldeiri B, Davenport M. Surgical and Endoscopic Intervention for Chronic Pancreatitis in Children: The Kings College Hospital Experience. Children (Basel) 2024; 11:74. [PMID: 38255387 PMCID: PMC10813922 DOI: 10.3390/children11010074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024]
Abstract
Paediatric chronic pancreatitis (CP) is a rare and debilitating pathology that often requires invasive diagnostics and therapeutic interventions either to address a primary cause such as a pancreaticobiliary malunion or to deal with secondary complications such as chronic pain. Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are two endoscopic modalities that have an established diagnostic role in paediatric CP, and their therapeutic utilisation is increasing in popularity. Surgical decompression of the obstructed and dilated pancreatic duct plays a role in alleviating pancreatic duct hypertension, a common association in CP. Surgery equally has a role in certain anatomical abnormalities of the pancreaticobiliary draining system, or occasionally in some CP complications such as drainage of a symptomatic pancreatic pseudocyst.
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Affiliation(s)
- Renos M. Jeropoulos
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Deepak Joshi
- Institute of Liver Studies, King’s College Hospital, London SE5 9RS, UK;
| | - Bashar Aldeiri
- Department of Paediatric Surgery, Chelsea and Westminster Hospital, London SW10 9NH, UK; (R.M.J.); (B.A.)
| | - Mark Davenport
- Department of Paediatric Surgery, Kings College Hospital, London SE5 9RS, UK
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Aldeiri B, Si T, Huang Z, Torner N, Ma Y, Davenport M, Hadzic N. Matrix Metalloproteinase-7 and Osteopontin Serum Levels as Biomarkers for Biliary Atresia. J Pediatr Gastroenterol Nutr 2023; 77:97-102. [PMID: 37326848 DOI: 10.1097/mpg.0000000000003792] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Matrix metallopeptidase-7 (MMP-7) and osteopontin (OPN) are important components in the pathophysiology of fibrosis in biliary atresia (BA). There has been much recent interest in MMP-7 serum level in the diagnosis of BA. We aimed to assess the diagnostic accuracy and prognostic value of both MMP-7 and OPN in a Western BA study. METHODS Diagnostic value was assessed by comparison of serum MMP-7 and OPN levels in infants with BA and age-matched cholestatic controls. Prognostic value was assessed through subsequent clearance of jaundice (COJ) and need for liver transplantation (LT). RESULTS Serum was assessed from 32 BA and 27 controls. Median MMP-7 was higher in BA (96.4 vs 35 ng/mL; P < 0.0001) with an optimal cut-off value of 69 ng/mL. Sensitivity and specificity was 68% and 93%, respectively [negative predictive value (NPV) = 71%]. Similarly, median OPN was higher in BA (1952 vs 1457 ng/mL; P = 0.0001) and an optimal cut-off of 1611 ng/mL. Sensitivity and specificity was 84% and 78%, respectively (NPV = 81%). MMP-7 level correlated positively with Ishak liver fibrosis score (r = 0.27, P = 0.04). Neither MMP-7 (70 vs 100 ng/mL; P = 0.2) nor OPN (1969 vs 1939 ng/mL; P = 0.3) were predictive of COJ, or need for LT (99 vs 79 ng/mL; P = 0.7, and 1981 vs 1899 ng/mL; P = 0.2), respectively. CONCLUSIONS MMP-7 and OPN may have contributory value in the diagnosis of BA, but remain far of the "gold standard" role. Much more prospective data are required and collaborative multi-center initiatives should be the next logical steps.
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Affiliation(s)
- Bashar Aldeiri
- From the Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, UK
| | - Tengfei Si
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Zhenlin Huang
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Núria Torner
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Yun Ma
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Mark Davenport
- From the Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London, UK
- Institute of Liver Studies, King's College Hospital, London, UK
| | - Nedim Hadzic
- Institute of Liver Studies, King's College Hospital, London, UK
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Neville JJ, Aldeiri B. Drain placement in paediatric complicated appendicitis: a systematic review and meta-analysis. Pediatr Surg Int 2023; 39:171. [PMID: 37031267 DOI: 10.1007/s00383-023-05457-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/10/2023]
Abstract
Children undergoing appendicectomy for complicated appendicitis are at an increased risk of post-operative morbidity. Placement of an intra-peritoneal drain to prevent post-operative complications is controversial. We aimed to assess the efficacy of prophylactic drain placement to prevent complications in children with complicated appendicitis. A systematic review was performed in accordance with PRISMA guidelines. Cochrane, MEDLINE and Web of Science databases were searched from inception to November 2022 for studies directly comparing drain placement to no drain placement in children ≤ 18 years of age undergoing operative treatment of complicated appendicitis. A total of 5108 children with complicated appendicitis were included from 16 studies; 2231 (44%) received a drain. Placement of a drain associated with a significantly increased risk of intra-peritoneal abscess formation (odds ratio [OR] 1.61, 95% confidence interval [CI] 1.16-2.24, p = 0.004) but there was no significant difference in wound infection rate (OR 1.46, 95% CI 0.74-2.88, p = 0.28). Length of stay was significantly longer in the drain group (mean difference 2.02 days, 95% CI 1.14-2.90, p < 0.001). Although the quality and certainty of the available evidence is low, prophylactic drain placement does not prevent intra-peritoneal abscess following appendicectomy in children with complicated appendicitis.
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Affiliation(s)
- J J Neville
- Department of Paediatric Surgery, University Surgery Unit, University Hospitals Southampton, Southampton, UK.
| | - B Aldeiri
- Department of Paediatric Surgery, Chelsea Children's Hospital, Chelsea and Westminster Hospital Trust, London, UK
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Zulli A, Coletta R, Aldeiri B, Morabito A. Intestinal Bowel Lengthening within the First 6 Months of Life: Institutional Experience and Review of the Literature. J Indian Assoc Pediatr Surg 2023; 28:103-110. [PMID: 37197243 PMCID: PMC10185026 DOI: 10.4103/jiaps.jiaps_204_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/12/2022] [Accepted: 03/26/2022] [Indexed: 05/19/2023] Open
Abstract
Background Management of short bowel syndrome in children has been surrounded by much debate with timing of the lengthening procedure still controversial. Early bowel lengthening procedure (EBLP) has been defined as any bowel lengthening procedure performed before 6 months of age. The purpose of this paper is to report the institutional experience in EBLP and to review the literature on this subject to identify common indications. Methods An institutional retrospective analysis of all the intestinal lengthening procedures was performed. Furthermore, an Ovid/Embase search regarding children who underwent bowel lengthening in the past 38 years was conducted. Primary diagnosis, age at procedure, type of procedure, indication, and outcome were analyzed. Results Ten EBLP were performed in Manchester from 2006 to 2017. Median age at surgery was 121 days (102-140), preoperative small bowel (SB) length was 30 cm (20-49) while postoperative SB length was 54 cm (40-70), with a median increased bowel length of 80%. Ninety-seven papers were reviewed, with more than 399 lengthening procedures performed. Twenty-nine papers matched criteria with more than 60 EBLP were observed of which 10 were performed in a single center from 2006 to 2017. EBLP was performed due to SB atresia, to excessive bowel dilatation or failure to enteral feeds, at a median age of 60 days (1-90). Serial transverse enteroplasty was the most frequent procedure used lengthening the bowel from 40 cm (29-62.5) to 63 cm (49-85), with a median increased bowel length of 57%. Conclusions This study confirms that no clear consensus on indication or timing to perform early SB lengthening is reported. According to the gathered data, EBLP should be considered, only in cases of actual necessity after review of qualified intestinal failure center.
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Affiliation(s)
- Andrea Zulli
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Bashar Aldeiri
- Department of Pediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Florence, Italy
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Aldeiri B, Giamouris V, Pushparajah K, Miller O, Baker A, Davenport M. Cardiac-associated biliary atresia (CABA): a prognostic subgroup. Arch Dis Child 2021; 106:68-72. [PMID: 32690577 DOI: 10.1136/archdischild-2020-319122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the range of concurrent cardiac malformations in biliary atresia (BA) while providing a functional framework of risk. METHODS Demographic and variables were collected from a prospectively maintained single-centre database. Infants were grouped according to a cardiac functional framework (A=acyanotic, B=cyanotic and C=insignificant shunt). Primary outcome was set as clearance of jaundice (bilirubin ≤20 μmol/L) following Kasai portoenterostomy (KPE). Native liver survival and overall actuarial survival were compared with a date-matched control infant with BA (n=77). P value <0.05 was regarded as significant. RESULTS 524 infants with histologically confirmed BA were treated between January 1999 and December 2018, 37 (7%) had a concurrent cardiac anomaly (A: n=23 (62%), B: n=10 (27%), C: n=4 (11%)). Infants with biliary atresia splenic malformation (BASM) or cat-eye syndrome (CES) contributed over half of the cases (21/37; 57%).Overall, 20 (54%) infants cleared jaundice (vs 50/77 (65%) controls; p=0.2), but with higher mortality compared with the non-cardiac controls (15/37 (40%) vs 3/77 (4%); HR 15.5 (95% CI 5.5 to 43.4); p<0.00001). Infants requiring cardiac intervention in the first year of life (n=15) were more likely to clear jaundice (6/7 vs 2/8; p=0.04) and had a trend towards higher survival (6/7 vs 3/8; p=0.1) when KPE followed cardiac surgery. Yet, the type of cardiac pathology did not impact clearance of jaundice or mortality. CONCLUSION We propose the term cardiac-associated biliary atresia (CABA) as a high-risk group. We believe that restorative cardiac surgery should precede KPE wherever possible to improve outcome.
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Affiliation(s)
- Bashar Aldeiri
- Department of Paediatric Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Vangelis Giamouris
- Department of Paediatric Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Kuberan Pushparajah
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,School of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Owen Miller
- Department of Congenital Heart Disease, Evelina London Children's Hospital, London, UK.,Faculty of Life Sciences & Medicine, Kings College London, London, UK
| | - Alastair Baker
- Department of Paediatric Hepatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital NHS Foundation Trust, London, UK
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Aldeiri B, Davidson JR, Eaton S, Coletta R, Cardoso Almeida A, Long AM, Knight M, Cross KM, Chouikh T, Iacobelli BD, Sarnacki S, Bagolan P, Cretolle C, Siminas S, Curry JI, Morabito A, De Coppi P. Variations in the Detection of Anorectal Anomalies at Birth among European Cities. Eur J Pediatr Surg 2020; 30:287-292. [PMID: 31039595 DOI: 10.1055/s-0039-1687868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers. MATERIALS AND METHODS All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics. RESULTS Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth. CONCLUSION Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.
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Affiliation(s)
- Bashar Aldeiri
- Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Joseph R Davidson
- Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom
| | - Simon Eaton
- Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom
| | - Riccardo Coletta
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Italy
| | - Andre Cardoso Almeida
- Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Anna-May Long
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kate M Cross
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Taieb Chouikh
- Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
| | - Barbara Daniela Iacobelli
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
| | - Pietro Bagolan
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Research Hospital, Rome, Italy
| | - Celia Cretolle
- Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
| | - Sotirios Siminas
- Department of Paediatric and Neonatal Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Joe I Curry
- Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Antonino Morabito
- Department of Pediatric Surgery, Meyer Children's Hospital, University of Florence, Italy
| | - Paolo De Coppi
- Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom.,Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Abstract
AIM The aim of this study was to report our initial experience using spiral intestinal lengthening and tailoring (SILT) technique in selected cases of short bowel syndrome (SBS). MATERIALS AND METHODS We analyzed all cases of SBS underwent SILT in our unit since the introduction of the procedure in 2012. We retrospectively analyzed patients' demographics, pre- and postprocedure bowel length, surgical complications, and postoperative parenteral nutrition (PN) requirements. Data were compared using independent samples, Mann-Whitney's U-test. RESULTS Five children with SBS underwent SILT between 2012 and 2017. Median age at procedure was 8.3 months (4.5-16). Preoperative small bowel length measured a median of 22 cm (17.5-50) with a median diameter of 4 cm (3.5-4.6). SILT allowed a median increase in length of 56% (10-15 cm; p = 0.03) and tailoring of the dilated segment providing a reduction in diameter of 50% (4.3-2.1 cm; p = 0.01). No major complications related to SILT were encountered and none of the children required further surgical intervention following a median follow-up of 26 months (14.5-41). Interestingly, we observed a significant reduction of PN requirement at 6 months (p = 0.008) associated with liver function preservation during the follow-up period. CONCLUSION In our experience, SILT is a promising adjunct in the surgical management of SBS. It can be used to tailor and lengthen mildly dilated segments of the bowel where other procedures are technically challenging, with a view to reduce the risk of intestinal failure associated liver disease and thereby improving chances for quality survival. Further studies are needed to investigate long-term outcomes of SILT in pediatric SBS.
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Affiliation(s)
- Riccardo Coletta
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Bashar Aldeiri
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Antonino Morabito
- Department of Paediatric Surgery, Universita Degli Studi di Firenze Scuola di Scienze Della Salute Umana, Firenze, Toscana, Italy
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Coletta R, Aldeiri B, Jackson R, Morabito A. Total esophagogastric dissociation (TEGD): Lessons from two decades of experience. J Pediatr Surg 2019; 54:1214-1219. [PMID: 30898397 DOI: 10.1016/j.jpedsurg.2019.02.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Total esophagogastric dissociation (TEGD) has been performed in our institution since 1994, predating its published description by Bianchi in 1997. Originally it was considered a rescue procedure when conventional antireflux surgery failed. Recently TEGD has been considered a viable primary option for the treatment of gastroesophageal reflux disease (GERD) in severely neurological impaired (NI) patients. We describe our institution's experience of TEGD in this selected cohort of patients. METHODS An institutional retrospective review was performed detailing our total experience of open TEGD between 1994 and 2015 in severely neurologically impaired (NI) patients. Demographic, complications, and outcome were analyzed. RESULTS Sixty-six NI patients underwent TEGD between 1994 and 2015 (39 female). Primary TEGD was performed in forty-nine patients (74.2%), while the remainder were rescue procedures following the failure of previous antireflux surgery. In 98% of cases no recurrence of clinically significant reflux was reported. The mean hospital length of stay was 10.2 days. There were sixteen reported complications in twelve patients representing 18.2% of the cohort. One death was attributable to the procedure (1.5%). Median follow-up was 31.6 months (range, 1.3-137.9 months). CONCLUSION TEGD appears to be a valid surgical option to treat severe GERD in severely neurologically impaired children, both as a primary procedure and as a rescue procedure following failure of anti-reflux surgery. Further studies comparing TEGD versus laparoscopic fundoplication are desirable to understand which of these procedures can be the most effective in this compromised group of patients. TYPE OF STUDY Retrospective study Level of evidence: IV.
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Affiliation(s)
- Riccardo Coletta
- Department of Paediatric Surgery, Meyer Children's Hospital, Florence, Italy.
| | - Bashar Aldeiri
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Meyer, United Kingdom
| | - Raef Jackson
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Meyer, United Kingdom
| | - Antonino Morabito
- Department of Paediatric Surgery, Meyer Children's Hospital, Florence, Italy; Department of Paediatric Surgery, Royal Manchester Children's Hospital, Meyer, United Kingdom; Department of NEUROFARBA, University of Florence, Florence, Italy
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Aldeiri B, Coletta R, Morabito A. “First STEP” or Nature Deserves a Second Chance! Systematic Literature Review and Meta-analysis. J Neonatal Surg 2018. [DOI: 10.21699/jns.v7i3.737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aim: Surgical management of short bowel syndrome (SBS) in children is challenging. Recently, more authors are advocating for the neonatal serial transverse enteroplasty procedure (STEP) in SBS quoting the term “primary STEP” or “first STEP.” This review sought to identify the current published indications for neonatal STEP and to analyze their subsequent outcomes.Methods: We performed an OVID MEDLINE/ EMBASE search using the keywords: (Bowel, enteroplasty, intestinal lengthening, STEP, and short bowel) limited to children since the introduction of STEP in 2003 prospero systematic review registration number (CRD42017076955).Results: Thirteen papers matched our search criteria, and accurate data were available from 10 papers. A total of 26 cases had a STEP procedure at a median age of 2.5 days. The primary diagnosis was Jejunal atresia (62%), gastroschisis (19%), gastroschisis with atresia (15%), and midgut volvulus (4%). Almost a third (7/23) of the cases did not meet the anatomical definition of SBS and had a pre STEP residual small bowel (SB) length of ≥50 cm. Only 6 cases (26%) achieved enteral autonomy after the “first STEP,” interestingly in half the pre STEP SB length was ≥90 cm, 13 (56%) required a second STEP, 9 (40%) are still parenteral nutrition dependant, 4 more cases achieved enteral autonomy following a second STEP, 3 infants died, and one required SB transplantation. Significant post-operative complications were reported in four cases, and bowel redilatation occurred in almost all true SBS cases.Conclusion: Redilatation following “first STEP” is very common, may influence the ability to achieve enteral autonomy and generally necessitates further surgical intervention. The limited current evidence does not support the widespread use of STEP in the neonatal period. STEP can be a method of mucosal-sparing tailoring procedure; however, its outcomes in primary bowel lengthening in the neonatal period are yet to be established, and further studies are required before it is widely adopted.
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Aldeiri B, Roostalu U, Albertini A, Behnsen J, Wong J, Morabito A, Cossu G. Abrogation of TGF-beta signalling in TAGLN expressing cells recapitulates Pentalogy of Cantrell in the mouse. Sci Rep 2018; 8:3658. [PMID: 29483576 PMCID: PMC5826924 DOI: 10.1038/s41598-018-21948-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/12/2018] [Indexed: 01/21/2023] Open
Abstract
Pentalogy of Cantrell (PC) is a rare multi-organ congenital anomaly that impedes ventral body wall closure and results in diaphragmatic hernia, intra- and pericardial defects. The underlying cellular and molecular changes that lead to these severe developmental defects have remained unknown largely due to the lack of representative animal models. Here we provide in depth characterization of a mouse model with conditional ablation of TGFβRII in Transgelin (Tagln) expressing cells. We show that Tagln is transiently expressed in a variety of cells that participate in the embryonic development and patterning of ventral structures. Genetic ablation of TGFβRII in these cells leads to ventral midline closure defect, diaphragmatic hernia, dilated cardiac outflow tract and aberrant cardiac septation, providing a reliable model to study the morphological changes leading to PC. We show that myogenisis in the diaphragm is independent of TGFβ and the diaphragmatic hernia arises from fibroblast-specific migration defect. In the dorsal body wall Tagln expression is initiated after the closure process, revealing a remarkable difference between ventral and dorsal body walls development. Our study demonstrates the use of micro-CT scanning to obtain a 3-dimensional high-resolution overview of embryonic anomalies and provides the first mechanistic insight into the development of PC.
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Affiliation(s)
- Bashar Aldeiri
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. .,Royal Manchester Children's Hospital, Manchester, UK.
| | - Urmas Roostalu
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alessandra Albertini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCSS, San Raffaele Scientific Institute, Milan, Italy
| | - Julia Behnsen
- Henry Moseley X-Ray Imaging Facility, The University of Manchester, Manchester, UK
| | - Jason Wong
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester University Hospitals, Wythenshawe Hospital, Manchester, UK
| | - Antonino Morabito
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester, UK
| | - Giulio Cossu
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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11
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Roostalu U, Aldeiri B, Albertini A, Humphreys N, Simonsen-Jackson M, Wong JKF, Cossu G. Distinct Cellular Mechanisms Underlie Smooth Muscle Turnover in Vascular Development and Repair. Circ Res 2017; 122:267-281. [PMID: 29167274 PMCID: PMC5771686 DOI: 10.1161/circresaha.117.312111] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022]
Abstract
Supplemental Digital Content is available in the text. Rationale: Vascular smooth muscle turnover has important implications for blood vessel repair and for the development of cardiovascular diseases, yet lack of specific transgenic animal models has prevented it’s in vivo analysis. Objective: The objective of this study was to characterize the dynamics and mechanisms of vascular smooth muscle turnover from the earliest stages of embryonic development to arterial repair in the adult. Methods and Results: We show that CD146 is transiently expressed in vascular smooth muscle development. By using CRISPR-Cas9 genome editing and in vitro smooth muscle differentiation assay, we demonstrate that CD146 regulates the balance between proliferation and differentiation. We developed a triple-transgenic mouse model to map the fate of NG2+CD146+ immature smooth muscle cells. A series of pulse-chase experiments revealed that the origin of aortic vascular smooth muscle cells can be traced back to progenitor cells that reside in the wall of the dorsal aorta of the embryo at E10.5. A distinct population of CD146+ smooth muscle progenitor cells emerges during embryonic development and is maintained postnatally at arterial branch sites. To characterize the contribution of different cell types to arterial repair, we used 2 injury models. In limited wire-induced injury response, existing smooth muscle cells are the primary contributors to neointima formation. In contrast, microanastomosis leads to early smooth muscle death and subsequent colonization of the vascular wall by proliferative adventitial cells that contribute to the repair. Conclusions: Extensive proliferation of immature smooth muscle cells in the primitive embryonic dorsal aorta establishes the long-lived lineages of smooth muscle cells that make up the wall of the adult aorta. A discrete population of smooth muscle cells forms in the embryo and is postnatally sustained at arterial branch sites. In response to arterial injuries, existing smooth muscle cells give rise to neointima, but on extensive damage, they are replaced by adventitial cells.
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Affiliation(s)
- Urmas Roostalu
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.).
| | - Bashar Aldeiri
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
| | - Alessandra Albertini
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
| | - Neil Humphreys
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
| | - Maj Simonsen-Jackson
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
| | - Jason K F Wong
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
| | - Giulio Cossu
- From the Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology, Medicine and Health, (U.R., B.A., A.A., J.K.F.W., G.C.) and Transgenic Core Research Facility, Faculty of Biology, Medicine and Health (N.H., M.S.-J.), University of Manchester, United Kingdom; and Plastic Surgery Department, Wythenshawe Hospital, Manchester University NHS Foundation Trust, United Kingdom (J.K.F.W.)
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Aldeiri B, Roostalu U, Albertini A, Wong J, Morabito A, Cossu G. Transgelin-expressing myofibroblasts orchestrate ventral midline closure through TGFβ signalling. Development 2017; 144:3336-3348. [PMID: 28807903 PMCID: PMC5612253 DOI: 10.1242/dev.152843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/04/2017] [Indexed: 01/09/2023]
Abstract
Ventral body wall (VBW) defects are among the most common congenital malformations, yet their embryonic origin and underlying molecular mechanisms remain poorly characterised. Transforming growth factor beta (TGFβ) signalling is essential for VBW closure, but the responding cells are not known. Here, we identify in mouse a population of migratory myofibroblasts at the leading edge of the closing VBW that express the actin-binding protein transgelin (TAGLN) and TGFβ receptor (TGFβR). These cells respond to a temporally regulated TGFβ2 gradient originating from the epithelium of the primary body wall. Targeted elimination of TGFβR2 in TAGLN+ cells impairs midline closure and prevents the correct subsequent patterning of the musculature and skeletal components. Remarkably, deletion of Tgfbr2 in myogenic or chondrogenic progenitor cells does not manifest in midline defects. Our results indicate a pivotal significance of VBW myofibroblasts in orchestrating ventral midline closure by mediating the response to the TGFβ gradient. Altogether, our data enable us to distinguish highly regulated epithelial-mesenchymal signalling and successive cellular migration events in VBW closure that explain early morphological changes underlying the development of congenital VBW defects. Summary: A population of migratory myofibroblasts at the leading edge of the closing ventral body wall expresses cytoskeletal components and TGFβR2 and responds to an epithelial TGFβ2 morphogen gradient to drive midline closure.
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Affiliation(s)
- Bashar Aldeiri
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,Royal Manchester Children's Hospital, Manchester M13 9WL, UK
| | - Urmas Roostalu
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Alessandra Albertini
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Jason Wong
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,University Hospitals of South Manchester, Manchester M23 9LT, UK
| | - Antonino Morabito
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK.,Royal Manchester Children's Hospital, Manchester M13 9WL, UK
| | - Giulio Cossu
- Manchester Academic Health Science Centre, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
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Arnaud A, Capito C, de Castro L, Aldeiri B, Rex D, Eaton S, Iardly I, Pierro A, Kiely E, Curry J, Cross K, de Coppi P. SFCP CO-04 - Procédure de Ladd coelioscopique pour malrotation intestinale, une approche controversée. Arch Pediatr 2014. [DOI: 10.1016/s0929-693x(14)71642-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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