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Alghoul H, Farajat FA, Alser O, Snyr AR, Harmon CM, Novotny NM. Intraoperative uses of near-infrared fluorescence spectroscopy in pediatric surgery: A systematic review. J Pediatr Surg 2022; 57:1137-1144. [PMID: 35256157 DOI: 10.1016/j.jpedsurg.2022.01.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 12/31/2021] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The application of near infrared spectroscopy (NIRS) imaging in surgery is growing. This study aimed to systematically review the literature to summarize the intraoperative uses of NIRS in pediatric surgery. METHODS A PRISMA-compliant literature search was conducted in PubMed, Embase, Scopus, and Web of Science from inception to February 2020. Title/abstract and then full-text screening were performed. The Oxford centre for Evidence Based Medicine tool (OCEBM) was used to evaluate the level of evidence of included studies. RESULTS Reviewers identified 53 articles. Of which, 34 studies (64.2%) were case-series and 11 (20.8%) were case reports. Most of the studies (n = 45, 84.9%) were level 4 on the OCEBM tool. The most common uses of NIRS were to visualize the biliary tree and to identify primary and metastatic malignant tissues. Other applications include assessment of perfusion of tissues including bowel anastomoses, and lymphatic surgery. Several advantages of the introduction of NIRS in pediatric surgery exist including having the potential to reduce operative time and intra/post-operative complications. Moreover, NIRS helps in detecting malignant tissues that can be missed by conventional imaging. However, NIRS has important limitations such as difficulty in identification of the biliary tree in obese patients or inflamed gallbladder, detection of small deeply localized malignant tissues, as well as the high cost. CONCLUSIONS NIRS is a promising modality that can be used intraoperatively to augment different pediatric surgical procedures. NIRS has important advantages and limitations compared to conventional surgery, however, more studies are required to evaluate its outcomes and cost-effectiveness. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Heba Alghoul
- Faculty of Medicine, Islamic University of Gaza, Palestine
| | - Farah Al Farajat
- Faculty of Medicine, Jordan University of Science and Technology, Jordan
| | - Osaid Alser
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Andrea Rogers Snyr
- Beaumont Children's and Oakland University William Beaumont School of Medicine, 3535 W 13 Mile Rd, Ste 307, Royal Oak, MI 48073, United States
| | - Carroll M Harmon
- Division of Pediatric Surgery, Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University in Buffalo, NY, United States
| | - Nathan M Novotny
- Beaumont Children's and Oakland University William Beaumont School of Medicine, 3535 W 13 Mile Rd, Ste 307, Royal Oak, MI 48073, United States; Monroe Carell, Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States.
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Dhindsa S, Ghanim H, Jenkins T, Inge TH, Harmon CM, Ghoshal A, Wu Z, McPhaul MJ, Saad F, Dandona P. High prevalence of subnormal testosterone in obese adolescent males: reversal with bariatric surgery. Eur J Endocrinol 2022; 186:319-327. [PMID: 35007209 DOI: 10.1530/eje-21-0545] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Received: 06/08/2021] [Accepted: 01/10/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Obesity in adolescent males is associated with the lowering of total and free testosterone concentrations. Weight loss may increase testosterone concentrations. DESIGN AND METHODS We evaluated the changes in sex hormones following bariatric surgery in 34 males (age range: 14.6-19.8 years) with obesity. These participants were part of a prospective multicenter study, Teen-Longitudinal Assessment of Bariatric Surgery. The participants were followed up for 5 years after surgery. Total testosterone, total estradiol, luteinizing hormone, follicle-stimulating hormone, sex hormone-binding globulin, C-reactive protein, insulin and glucose were measured at baseline, 6 months and annually thereafter. Free testosterone, free estradiol and HOMA2-IR were calculated. RESULTS Study participants lost one-third of their body weight after bariatric surgery, with maximum weight loss achieved at 24 months for most participants. Free testosterone increased from 0.17 (95% CI: 0.13 to 0.20) at baseline to 0.34 (95% CI: 0.30 to 0.38) and 0.27 nmol/L (95% CI: 0.23 to 0.32) at 2 and 5 years (P < 0.001 for both), respectively. Total testosterone increased from 6.7 (95% CI: 4.7 to 8.8) at baseline to 17.6 (95% CI: 15.3 to 19.9) and 13.8 (95% CI: 11.0 to 16.5) nmol/L at 2 and 5 years (P < 0.001), respectively. Prior to surgery, 73% of the participants had subnormal free testosterone (<0.23 nmol/L). After 2 and 5 years, only 20 and 33%, respectively, had subnormal free testosterone concentrations. Weight regain was related to a fall in free testosterone concentrations. CONCLUSIONS Bariatric surgery led to a robust increase in testosterone concentrations in adolescent males with severe obesity. Participants who regained weight had a decline in their testosterone concentrations.
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Affiliation(s)
- Sandeep Dhindsa
- Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York, USA
- Division of Endocrinology, Diabetes and Metabolism, Saint Louis University, St. Louis, Missouri, USA
| | - Husam Ghanim
- Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York, USA
| | - Todd Jenkins
- Division of Pediatric General & Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Thomas H Inge
- University of Colorado, Denver and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Carroll M Harmon
- Division of Pediatric Surgery, John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York, USA
| | - Amit Ghoshal
- Quest Diagnostics, Nichols Institute, Valencia, California, USA
| | - Zengru Wu
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Michael J McPhaul
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Farid Saad
- Gulf Medical University, Research Department, Ajman, UAE
| | - Paresh Dandona
- Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biosciences, University at Buffalo, Buffalo, New York, USA
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Majumdar I, Espino B, Harmon CM. Pediatric multidisciplinary weight management-how can we improve further? Endocrine 2021; 74:723-726. [PMID: 34599694 DOI: 10.1007/s12020-021-02885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Indrajit Majumdar
- Division of Pediatric Endocrinology, Department of Pediatrics, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA.
| | - Brittany Espino
- Division of Pediatric Endocrinology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Carroll M Harmon
- Department of Surgery, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA
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Blakely ML, Tyson JE, Lally KP, Hintz SR, Eggleston B, Stevenson DK, Besner GE, Das A, Ohls RK, Truog WE, Nelin LD, Poindexter BB, Pedroza C, Walsh MC, Stoll BJ, Geller R, Kennedy KA, Dimmitt RA, Carlo WA, Cotten CM, Laptook AR, Van Meurs KP, Calkins KL, Sokol GM, Sanchez PJ, Wyckoff MH, Patel RM, Frantz ID, Shankaran S, D’Angio CT, Yoder BA, Bell EF, Watterberg KL, Martin CA, Harmon CM, Rice H, Kurkchubasche AG, Sylvester K, Dunn JCY, Markel TA, Diesen DL, Bhatia AM, Flake A, Chwals WJ, Brown R, Bass KD, St. Peter SD, Shanti CM, Pegoli W, Skarda D, Shilyansky J, Lemon DG, Mosquera RA, Peralta-Carcelen M, Goldstein RF, Vohr BR, Purdy IB, Hines AC, Maitre NL, Heyne RJ, DeMauro SB, McGowan EC, Yolton K, Kilbride HW, Natarajan G, Yost K, Winter S, Colaizy TT, Laughon MM, Lakshminrusimha S, Higgins RD. Initial Laparotomy Versus Peritoneal Drainage in Extremely Low Birthweight Infants With Surgical Necrotizing Enterocolitis or Isolated Intestinal Perforation: A Multicenter Randomized Clinical Trial. Ann Surg 2021; 274:e370-e380. [PMID: 34506326 PMCID: PMC8439547 DOI: 10.1097/sla.0000000000005099] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to determine which initial surgical treatment results in the lowest rate of death or neurodevelopmental impairment (NDI) in premature infants with necrotizing enterocolitis (NEC) or isolated intestinal perforation (IP). SUMMARY BACKGROUND DATA The impact of initial laparotomy versus peritoneal drainage for NEC or IP on the rate of death or NDI in extremely low birth weight infants is unknown. METHODS We conducted the largest feasible randomized trial in 20 US centers, comparing initial laparotomy versus peritoneal drainage. The primary outcome was a composite of death or NDI at 18 to 22 months corrected age, analyzed using prespecified frequentist and Bayesian approaches. RESULTS Of 992 eligible infants, 310 were randomized and 96% had primary outcome assessed. Death or NDI occurred in 69% of infants in the laparotomy group versus 70% with drainage [adjusted relative risk (aRR) 1.0; 95% confidence interval (CI): 0.87-1.14]. A preplanned analysis identified an interaction between preoperative diagnosis and treatment group (P = 0.03). With a preoperative diagnosis of NEC, death or NDI occurred in 69% after laparotomy versus 85% with drainage (aRR 0.81; 95% CI: 0.64-1.04). The Bayesian posterior probability that laparotomy was beneficial (risk difference <0) for a preoperative diagnosis of NEC was 97%. For preoperative diagnosis of IP, death or NDI occurred in 69% after laparotomy versus 63% with drainage (aRR, 1.11; 95% CI: 0.95-1.31); Bayesian probability of benefit with laparotomy = 18%. CONCLUSIONS There was no overall difference in death or NDI rates at 18 to 22 months corrected age between initial laparotomy versus drainage. However, the preoperative diagnosis of NEC or IP modified the impact of initial treatment.
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MESH Headings
- Drainage
- Enterocolitis, Necrotizing/mortality
- Enterocolitis, Necrotizing/psychology
- Enterocolitis, Necrotizing/surgery
- Feasibility Studies
- Female
- Humans
- Infant, Extremely Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/mortality
- Infant, Premature, Diseases/psychology
- Infant, Premature, Diseases/surgery
- Intestinal Perforation/mortality
- Intestinal Perforation/psychology
- Intestinal Perforation/surgery
- Laparotomy
- Male
- Neurodevelopmental Disorders/diagnosis
- Neurodevelopmental Disorders/epidemiology
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Martin L. Blakely
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jon E. Tyson
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Kevin P. Lally
- Department of Pediatric Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Susan R. Hintz
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Barry Eggleston
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC
| | - David K. Stevenson
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Gail E. Besner
- Department of Pediatric Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Rockville, MD
| | - Robin K. Ohls
- University of New Mexico Health Sciences Center, Albuquerque, NM
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - William E. Truog
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO
| | - Leif D. Nelin
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Brenda B. Poindexter
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Michele C. Walsh
- Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH
| | - Barbara J. Stoll
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Rachel Geller
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Kathleen A. Kennedy
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | - Reed A. Dimmitt
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | - Waldemar A. Carlo
- Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Abbot R. Laptook
- Department of Pediatrics, Women’s & Infants Hospital, Brown University, Providence, RI
| | - Krisa P. Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Kara L. Calkins
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Gregory M. Sokol
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Pablo J. Sanchez
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Myra H. Wyckoff
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ravi M. Patel
- Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ivan D. Frantz
- Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, MA
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Carl T. D’Angio
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Bradley A. Yoder
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Edward F. Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA
| | | | - Colin A. Martin
- Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Carroll M. Harmon
- Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL
- Division of Pediatric Surgery, University of Buffalo, John R. Oishei Children’s Hospital, Buffalo, NY
| | - Henry Rice
- Division of Pediatric General Surgery, Duke University, Durham, NC
| | - Arlet G. Kurkchubasche
- Department of Pediatric Surgery, Hasbro Children’s Hospital, Brown University, Providence, RI
| | - Karl Sylvester
- Department of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - James C. Y. Dunn
- Department of Pediatric Surgery, Stanford University School of Medicine, Palo Alto, CA
- Department of Pediatric Surgery, University of California, Los Angeles, CA
| | - Troy A. Markel
- Department of Pediatric Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Diana L. Diesen
- Department of Pediatric Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Amina M. Bhatia
- Department of Pediatric Surgery, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Alan Flake
- Department of Pediatric Surgery, University of Pennsylvania, Philadelphia, PA
| | - Walter J. Chwals
- Department of Pediatric Surgery, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Rebeccah Brown
- Department of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kathryn D. Bass
- Division of Pediatric Surgery, University of Buffalo, John R. Oishei Children’s Hospital, Buffalo, NY
| | - Shawn D. St. Peter
- Department of Pediatric Surgery, Children’s Mercy Hospital, Kansas City, MO
| | | | - Walter Pegoli
- Department of Pediatric Surgery, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - David Skarda
- Department of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | | | - David G. Lemon
- Department of Pediatric Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Ricardo A. Mosquera
- Department of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX
| | | | | | - Betty R. Vohr
- Department of Pediatrics, Women’s & Infants Hospital, Brown University, Providence, RI
| | - Isabell B. Purdy
- Department of Pediatrics, University of California, Los Angeles, CA
| | - Abbey C. Hines
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | - Nathalie L. Maitre
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Roy J. Heyne
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sara B. DeMauro
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA
| | - Elisabeth C. McGowan
- Department of Pediatrics, Women’s & Infants Hospital, Brown University, Providence, RI
- Department of Pediatrics, Division of Newborn Medicine, Floating Hospital for Children, Tufts Medical Center, Boston, MA
| | - Kimberly Yolton
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | | | - Kelley Yost
- University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Sarah Winter
- Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Matthew M. Laughon
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | | | - Rosemary D. Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
- College of Health and Human Services, George Mason University, Fairfax, VA
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Sukhotnik I, Gork AS, Chen M, Drongowski RA, Coran AG, Harmon CM. Retraction Note to: Effect of a high fat diet on lipid absorption and fatty acid transport in a rat model of short bowel syndrome. Pediatr Surg Int 2021; 37:971. [PMID: 34009453 DOI: 10.1007/s00383-021-04924-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Igor Sukhotnik
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA.
| | - A Semih Gork
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Min Chen
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robert A Drongowski
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Arnold G Coran
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Carroll M Harmon
- C.S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI, USA
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Calabro KA, Harmon CM, Vali K. Fluorescent Cholangiography in Laparoscopic Cholecystectomy and the Use in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2020; 30:586-589. [PMID: 32301652 DOI: 10.1089/lap.2019.0204] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Common bile duct (CBD) injury is one of the most serious complications of laparoscopic cholecystectomy and carries an incidence of 0.3%-0.7%. Recently indocyanine green (ICG) fluorescent cholangiography (FC) has been used as an adjunct to identify the biliary tract during adult laparoscopic cholecystectomy, allowing intraoperative identification of biliary anatomy. The objective of this article is to show its successful use in pediatric laparoscopic cholecystectomies. Method: From July 1, 2017, to November 30, 2018, surgeons at John R. Oishei Children's Hospital and Women and Children's Hospital of Buffalo have been utilizing ICG-FC as an adjunct in patients undergoing laparoscopic cholecystectomy. Thirty-one patients undergoing laparoscopic cholecystectomy had 1 mL of dilute ICG (2.5 mg) injected intravenously in the operating room (OR) before trocar placement. Demographics, intraoperative details, and subjective surgeon data were recorded for elective laparoscopic cholecystectomy cases involving ICG. We hypothesize that use of ICG-FC in the pediatric and adolescent patient population is a safe, reliable, and reproducible adjunct for identification of the biliary tree. Secondary outcomes were to identify rate of biliary anatomy identification, utilization ease, and operative times while using ICG technology in pediatric patients. Results: ICG-FC was used in 31 pediatric laparoscopic cholecystectomies performed by 5 surgeons at our institution. Ages ranged from 6 to 18 years. In all cases, the cystic duct-CBD junction was visualized while performing dissection of the triangle of Calot. No intraoperative complications occurred. Conclusions: ICG-FC provides a noninvasive real-time visualization of the extrahepatic biliary tree in children and adolescents. We demonstrate that ICG-FC can successfully be used as an adjunct in pediatric patients and has the potential to facilitate with the dissection and minimize risk of bile duct injuries during pediatric laparoscopic cholecystectomies.
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Affiliation(s)
- Kristen A Calabro
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Kaveh Vali
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, New York, USA.,Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Abstract
The adrenocorticotropic hormone (ACTH) receptor, known as the melanocortin-2 receptor (MC2R), plays a key role in regulating adrenocortical function. ACTH receptor is a subtype of the melanocortin receptor family which is a member of the G-protein coupled receptor (GPCR) superfamily. ACTH receptor has unique characteristics among MCRs. α-MSH, β-MSH, γ-MSH and ACTH are agonists for MCRs but only ACTH is the agonist for ACTH receptor. In addition, the melanocortin receptor accessory protein (MRAP) is required for ACTH receptor expression at cell surface and function. In this review, we summarized the information available on the relationship between ACTH and ACTH receptor and provide the latest understanding of the molecular basis of the ACTH receptor responsible for ligand selectivity and function.
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Affiliation(s)
- Yingkui Yang
- Department of Surgery, State University of New York at Buffalo, USA.
| | - Carroll M Harmon
- Department of Surgery, State University of New York at Buffalo, USA
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8
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Abstract
Over the past decade, outcomes data have demonstrated the benefit of bariatric surgery in achieving both sustained weight loss and reversal of co-morbidities. Comparing these data to contemporary known risks of adolescent bariatric surgery informs the patients and providers considering bariatric procedures and provides insight into potential ways to reduce and manage complications. The goal of this article is to review the common surgical and postoperative complications following bariatric procedures and discuss approaches to improve their safety. A systematic review identifying bariatric surgery complications in adolescents was conducted. The review focused on the data relevant to adolescent bariatric surgery. However, when necessary, adult studies were used to address the gaps in available pediatric information. The data pertaining to the intraoperative, short term, and long term surgically related and nutritional related complications show that complication are declining with increasing experience. Specific recommendations and strategies to avoid major complications of bariatric surgery in adolescents are offered.
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Affiliation(s)
- Abdulrouf Lamoshi
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Artur Chernoguz
- Floating Hospital for Children at Tufts Medical Center, Pediatric Surgery Division, Boston, MA, USA
| | - Carroll M Harmon
- Oishei Children's Hospital, Pediatric Surgery Department, Buffalo, NY, USA
| | - Michael Helmrath
- Cincinnati Children's Hospital Medical Center, Pediatric Surgery Division, Cincinnati, OH, USA.
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9
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Bout-Tabaku S, Gupta R, Jenkins TM, Ryder JR, Baughcum AE, Jackson RD, Inge TH, Dixon JB, Helmrath MA, Courcoulas AP, Mitchell JE, Harmon CM, Xie C, Michalsky MP. Musculoskeletal Pain, Physical Function, and Quality of Life After Bariatric Surgery. Pediatrics 2019; 144:peds.2019-1399. [PMID: 31744891 PMCID: PMC6889948 DOI: 10.1542/peds.2019-1399] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life. METHODS The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. RESULTS Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS. CONCLUSIONS Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.
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Affiliation(s)
- Sharon Bout-Tabaku
- Sidra Medicine, Doha, Qatar; .,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Resmi Gupta
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Justin R. Ryder
- Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Thomas H. Inge
- Children’s Hospital Colorado, Aurora, Colorado;,University of Colorado, Denver, Colorado
| | - John B. Dixon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | | | | | - James E. Mitchell
- Sanford Research and School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Carroll M. Harmon
- Women and Children’s Hospital, Buffalo, New York;,University of Buffalo, Buffalo, New York; and
| | | | - Marc P. Michalsky
- Nationwide Children’s Hospital, Columbus, Ohio;,The Ohio State University, Columbus, Ohio
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Cairo SB, Zeinali LI, Berkelhamer SK, Harmon CM, Rao SO, Rothstein DH. Down Syndrome and Postoperative Complications in Children Undergoing Intestinal Operations. J Pediatr Surg 2019; 54:1832-1837. [PMID: 30611525 DOI: 10.1016/j.jpedsurg.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Received: 08/07/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This paper intends to evaluate the association between Down Syndrome (DS) and postoperative medical and surgical complications and inpatient postoperative mortality in pediatric patients undergoing intestinal operations. METHODS The 2012 Kids' Inpatient Database was queried to compare short-term postoperative medical and surgical complications and in-patient mortality among patients with DS undergoing intestinal operations to a cohort without DS using inverse probability weighting. Subset analysis was performed for patients undergoing intestinal operations exclusive of gastrostomy placement. Adverse treatment effects were calculated for the outcomes of interest. RESULTS Of 17,026 pediatric patients undergoing intestinal operations, 444 had DS. In unadjusted analysis, medical complications (urinary tract infection, deep venous thrombosis, sepsis, pneumonia) occurred in 7.9% of patients with DS, compared to 14.1% of those without (p < 0.001). Surgical complications (wound disruption, hemorrhage, superficial or deep wound infection) occurred in 3.5% of patients with DS, compared to 4.6% of those without (p = 0.34), and in-patient mortality occurred in 0.3% of patients with DS, compared to 2.7% of those without (p = 0.009). Adverse treatment effects (ATE) calculated after inverse probability weighting demonstrated no difference for medical or surgical complications but a significantly decreased mortality with DS. CONCLUSIONS Contrary to common perception and data extrapolated from the adult literature, pediatric patients with DS have neither higher medical nor surgical complication rates after intestinal operations. Similar to patients undergoing congenital heart surgery, pediatric patients with DS have a lower postoperative inpatient mortality after these general operations compared to those without DS. Mechanisms influencing risks in DS patient remain unknown. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY.
| | - Lida I Zeinali
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sara K Berkelhamer
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Division of Neonatology, John R. Oishei Children's Hospital, Buffalo, NY
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Sri O Rao
- Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; Division of Pediatric Cardiology, John R. Oishei Children's Hospital, Buffalo, NY
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital, Buffalo, NY; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY
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11
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Majumdar I, Espino B, Bianco K, Epstein J, Mamilly L, Harmon CM. Multi-disciplinary weight management compared to routine care in youth with obesity: what else should be monitored? Endocrine 2019; 65:263-269. [PMID: 31250190 DOI: 10.1007/s12020-019-01988-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/15/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Efficacy of multi-disciplinary weight management (MDM) in youth has not been compared to their routine care. OBJECTIVES To compare body mass index z-score (zBMI) and blood test (lab) changes (Δ) in youth before and after MDM and to correlate bio-impedance analysis (BIA) and lab measurements. METHODS We compared zBMI Δ (from referring providers' records), within 3 months prior to MDM, to monthly zBMI Δ after MDM, in a retrospective cohort of youth at a tertiary MDM center. BIA and lab measurements after 6 months, MDM were compared to baseline. RESULTS We reviewed 316 records (12.9 ± 3.5 years, 49% males, 104.8 ± 35.1 kgs). The pre-MDM zBMI Δ (0.02 ± 0.1) was reversed after MDM (-0.03 ± 0.09, visit 2, P < 0.001). The zBMI Δ progressed on follow-up (-0.14 ± 0.05, visit 6). Baseline BIA components correlated with Homeostatic Model Assessment of Insulin resistance (HOMA-IR), triglycerides, and systolic blood pressure. HbA1c, HOMA-IR, and liver functions significantly improved on follow-up. MDM participation showed progressive attrition and dropped to 11.6% at visit 6. CONCLUSION MDM in youth resulted in zBMI and lab improvements compared to their pre-MDM measurements. BIA provided additional outcome measures that correlated with metabolic markers. MDM follow-up was limited by the progressive participant drop-out. Behavioral economic strategies are needed to improve adherence.
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Affiliation(s)
- Indrajit Majumdar
- Division of Endocrinology, Department of Pediatrics, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA.
| | - Brittany Espino
- Department of Pediatrics, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA
| | - Kristina Bianco
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, Hofstra University, Queens, NY, 11549, USA
| | - Jeanette Epstein
- Department of Pediatrics, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA
| | - Leena Mamilly
- Section of Pediatric Endocrinology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Carroll M Harmon
- Department of Surgery, Jacob School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York and John R. Oishei Children's Hospital, Buffalo, NY, 14203, USA
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12
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Casar Berazaluce AM, Gibbons AT, Hanke RE, Ponsky TA, Harmon CM. It Is a Wrap! Or Is It?: The Role of Fundoplication in Infant Feeding Intolerance. J Laparoendosc Adv Surg Tech A 2019; 29:1315-1319. [PMID: 31264917 DOI: 10.1089/lap.2019.0076] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Fundoplication is one of the most common procedures performed by pediatric surgeons, frequently for gastroesophageal reflux with feeding intolerance. No consensus exists in its management, with multiple institutions opting for medical therapy over surgical intervention. Methods: A case-based survey was administered at a national pediatric surgery conference. Clinical vignettes described former-premature infants with reflux and feeding intolerance with or without failure to thrive (FTT), neurological impairment, complex cardiopathy, and respiratory symptoms. Odds ratios (ORs) for fundoplication were calculated from participants' responses. Results: Surgeons elected to perform fundoplication in 14%-74% of cases. The OR for performing fundoplication in the presence of FTT was 1.84 (confidence interval [CI] 1.34-2.54, P = .0002) overall, achieving significance in subgroup analysis for cardiopathy (OR 3.56, CI 1.88-6.71, P = .0001) and neurological impairment (OR 1.79, CI 1.04-3.07, P = .04), but not in the absence of these comorbidities (OR 1.05, CI 0.61-1.83, P = .86). The OR for fundoplication in the presence of neurological impairment was 1.97 (CI 1.34-2.90, P = .0005) and that for cardiopathy was 1.70 (CI 1.20-2.40, P = .003), independent of FTT status. In subgroup analysis, the greatest predictors for fundoplication were neurological impairment with FTT (OR 2.63, CI 1.55-4.48, P = .0004) and complex cardiopathy with FTT and cough/syncope (OR 7.14, CI 4.05-12.58, P < .0001). Presence of cardiopathy without FTT had the overall lowest odds of fundoplication (OR 0.40, CI 0.21-0.78, P = .006). Conclusion: Surgeons tend to perform fundoplication in the presence of FTT and other comorbidities, particularly when these are concurrent. Respiratory symptoms are a strong predictor for fundoplication in patients with complex cardiopathies.
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Affiliation(s)
- Alejandra M Casar Berazaluce
- Department of Surgical Services, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexander T Gibbons
- Department of Surgery, Division of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
| | - Rachel E Hanke
- Department of Surgical Services, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd A Ponsky
- Department of Surgical Services, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Surgery, Division of Pediatric Surgery, Akron Children's Hospital, Akron, Ohio
| | - Carroll M Harmon
- Department of Surgery, Division of Pediatric Surgery, Kaleida Health, John R. Oishei Children's Hospital, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
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13
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Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Brandt ML, Xanthakos SA, Dixon JB, Harmon CM, Chen MK, Xie C, Evans ME, Helmrath MA. Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults. N Engl J Med 2019; 380:2136-2145. [PMID: 31116917 PMCID: PMC7345847 DOI: 10.1056/nejmoa1813909] [Citation(s) in RCA: 186] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bariatric surgery results in weight loss and health improvements in adults and adolescents. However, whether outcomes differ according to the age of the patient at the time of surgery is unclear. METHODS We evaluated the health effects of Roux-en-Y gastric bypass in a cohort of adolescents (161 patients enrolled from 2006 through 2012) and a cohort of adults (396 patients enrolled from 2006 through 2009). The two cohorts were participants in two related but independent studies. Linear mixed and Poisson mixed models were used to compare outcomes with regard to weight and coexisting conditions between the cohorts 5 years after surgery. The rates of death and subsequent abdominal operations and selected micronutrient levels (up to 2 years after surgery) were also compared between the cohorts. RESULTS There was no significant difference in percent weight change between adolescents (-26%; 95% confidence interval [CI], -29 to -23) and adults (-29%; 95% CI, -31 to -27) 5 years after surgery (P = 0.08). After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes (86% vs. 53%; risk ratio, 1.27; 95% CI, 1.03 to 1.57) and of hypertension (68% vs. 41%; risk ratio, 1.51; 95% CI, 1.21 to 1.88). Three adolescents (1.9%) and seven adults (1.8%) died in the 5 years after surgery. The rate of abdominal reoperations was significantly higher among adolescents than among adults (19 vs. 10 reoperations per 500 person-years, P = 0.003). More adolescents than adults had low ferritin levels (72 of 132 patients [48%] vs. 54 of 179 patients [29%], P = 0.004). CONCLUSIONS Adolescents and adults who underwent gastric bypass had marked weight loss that was similar in magnitude 5 years after surgery. Adolescents had remission of diabetes and hypertension more often than adults. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT00474318.).
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Affiliation(s)
- Thomas H Inge
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Anita P Courcoulas
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Todd M Jenkins
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Marc P Michalsky
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mary L Brandt
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Stavra A Xanthakos
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - John B Dixon
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Carroll M Harmon
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mike K Chen
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Changchun Xie
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Mary E Evans
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
| | - Michael A Helmrath
- From the University of Colorado, Denver and Children's Hospital Colorado, Aurora (T.H.I.); University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Cincinnati Children's Hospital Medical Center (T.M.J., S.A.X., M.A.H.) and University of Cincinnati (C.X.), Cincinnati, and Nationwide Children's Hospital and the Ohio State University College of Medicine, Columbus (M.P.M.) - all in Ohio; Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Baker Heart and Diabetes Institute, Melbourne, VIC, Australia (J.B.D.); John R. Oishei Children's Hospital and Jacobs School of Medicine and Biosciences-SUNY University at Buffalo, Buffalo, NY (C.M.H.); the University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.E.E.)
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Yang Y, Chen M, Ventro G, Harmon CM. Amino acid residue L112 in the ACTH receptor plays a key role in ACTH or α-MSH selectivity. Mol Cell Endocrinol 2019; 482:11-17. [PMID: 30553806 DOI: 10.1016/j.mce.2018.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
The adrenocorticotropic hormone (ACTH) receptor, known as the melanocortin-2 receptor (MC2R), plays a key role in regulating adrenocortical function. MC2R is a subtype of the melanocortin receptor family and ACTH is only agonist for MC2R. Our previous result indicates that ACTH1-17 is the minimal peptide required for MC2R activation but DPhe7-ACTH1-17 has no activity at MC2R. In this study, we examined the molecular basis of the MC2R responsible for ligand selectivity using ACTH analogues and MC2R mutagenesis. Our results indicate that substitution of the 3TM of the MC2R with the corresponding region of the MC3R switches DPhe-ACTH1-17 from no activity to agonist. Further experiment indicates that substitution of the amino acid residue leucine to isoleucine in 112 (L112I) of the 3TM of the MC2R changes both DPhe-ACTH1-17 and ACTH1-15 from no activity to agonists. Surprisingly, mutation L112I switches α-MSH from no activity to agonist, suggesting that this residue plays a key role at MC2R for ligand ACTH or α-MSH selectivity.
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Affiliation(s)
- Yingkui Yang
- Department of Surgery, State University of New York at Buffalo, United States.
| | - Min Chen
- Department of Surgery, State University of New York at Buffalo, United States
| | - George Ventro
- Department of Surgery, State University of New York at Buffalo, United States
| | - Carroll M Harmon
- Department of Surgery, State University of New York at Buffalo, United States
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15
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Filipescu R, Powers C, Rothstein DH, Harmon CM, Bass KD. Pediatric vs Adult Trauma Centers: Closing the Gap in Nonoperative Management of Splenic Injury: A National Trauma Data Bank Study. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.556] [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: 10/28/2022]
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Cairo SB, Harmon CM, Rothstein DH. Minimally invasive surgical exposure among US and Canadian pediatric surgery trainees, 2004-2016. J Surg Res 2018; 231:179-185. [PMID: 30278927 DOI: 10.1016/j.jss.2018.05.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/02/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Minimally invasive pediatric surgery has increased in breadth and complexity over the past several decades, with little data on minimally invasive surgery (MIS) training in US and Canadian pediatric surgery fellowship programs. METHODS We performed a time series analysis of Accreditation Council for Graduate Medical Education pediatric surgery fellow case logs from 2003 to 2016. Proportions of cases performed in an MIS fashion as well as per-fellow MIS case averages were recorded over time. RESULTS There was a 30.9% increase in average number of MIS cases per fellow over the study time period. Twenty-three recorded procedures included MIS and open options (17 abdominal, three thoracic, and three genitourinary). The proportion of cases performed using a minimally invasive approach increased by an average of 29.0%, 14.6%, and 47.0% for each of these categories, respectively. Significant variability was observed in specific cases such as laparoscopic and open inguinal hernias, ranging from 0 to 85 and nine to 152 per trainee, respectively, in the final year of data collection. When examining pyloromyotomy, a high-volume procedure with a known increase in the MIS approach, the proportion of cases performed MIS increased by 83.3%. The minimum and maximum number of cases per fellow recorded ranged from 0 to 114 during the eight years in which MIS pyloromyotomy was recorded. CONCLUSIONS MIS case exposure among graduating US and Canadian pediatric survey fellows increased substantially during the study period. More granular data, however, are needed to better define the current operative experience and criteria for determination of competency in advanced MIS.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York.
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, State University of New York, University at Buffalo, Buffalo, New York
| | - David H Rothstein
- Department of Pediatric Surgery, John R. Oishei Children's Hospital of Buffalo, Buffalo, New York; Department of Surgery, State University of New York, University at Buffalo, Buffalo, New York
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17
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Response to Letter to the Editor; Comments on "Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care". Obes Surg 2018; 28:2914-2915. [PMID: 29909516 DOI: 10.1007/s11695-018-3329-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.
| | - Indrajit Majumdar
- Division of Endocrinology/Diabetes, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA.,Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Aurora Pryor
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Stony Brook Medicine, Stony Brook, NY, USA
| | - Alan Posner
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
| | - David H Rothstein
- Department of Pediatric Surgery, John R Oishei Children's Hospital, 1001 Main Street, Buffalo, NY, 14203, USA.,University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Division of Surgery, State University of New York, New York, NY, USA
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Sarwer DB, Dilks RJ, Spitzer JC, Berkowitz RI, Wadden TA, Moore RH, Chittams JL, Brandt ML, Chen MK, Courcoulas AP, Harmon CM, Helmrath MA, Michalsky MP, Xanthakos SA, Zeller MH, Jenkins TM, Inge TH. Changes in Dietary Intake and Eating Behavior in Adolescents After Bariatric Surgery: an Ancillary Study to the Teen-LABS Consortium. Obes Surg 2018. [PMID: 28625002 DOI: 10.1007/s11695-017-2764-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND A growing number of studies suggest that bariatric surgery is safe and effective for adolescents with severe obesity. However, surprisingly little is known about changes in dietary intake and eating behavior of adolescents who undergo bariatric surgery. OBJECTIVE Investigate changes in dietary intake and eating behavior of adolescents with obesity who underwent bariatric surgery (n = 119) or lifestyle modification (LM) (n = 169). SETTING University-based health systems METHODS: A prospective investigation of 288 participants (219 female and 69 male) prior to bariatric surgery or LM and again 6, 12, and 24 months (surgery patients only) after treatment. Measures included changes in weight, macronutrient intake, eating behavior, and relevant demographic and physiological variables. RESULTS Adolescents who underwent bariatric surgery experienced significantly greater weight loss than those who received LM. The two groups differed in self-reported intake of a number of macronutrients at 6 and 12 months from baseline, but not total caloric intake. Patients treated with surgery, compared to those treated with LM, also reported significantly greater reductions in a number of disordered eating symptoms. After bariatric surgery, greater weight loss from postoperative month 6 to 12 was associated with self-reported weight consciousness, craving for sweets, and consumption of zinc. CONCLUSIONS Adolescents who underwent bariatric surgery, compared to those who received LM, reported significantly greater reductions in weight after 1 year. They also reported greater reductions in disordered eating symptoms. These findings provide new information on changes in dietary intake and eating behavior among adolescents who undergo bariatric surgery.
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Affiliation(s)
- David B Sarwer
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19428, USA.
| | - Rebecca J Dilks
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline C Spitzer
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Center for Obesity Research and Education, College of Public Health, Temple University, 3223 N. Broad Street, Suite 175, Philadelphia, PA, 19428, USA
| | - Robert I Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A Wadden
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Renee H Moore
- Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jesse L Chittams
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Mary L Brandt
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mike K Chen
- Division of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama, Birmingham, AL, USA
| | - Anita P Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Michael A Helmrath
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Marc P Michalsky
- Department of Pediatric Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
| | - Stavra A Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Meg H Zeller
- Division of Behavioral Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Todd M Jenkins
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Thomas H Inge
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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19
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Cairo SB, Majumdar I, Pryor A, Posner A, Harmon CM, Rothstein DH. Challenges in Transition of Care for Pediatric Patients after Weight-Reduction Surgery: a Systematic Review and Recommendations for Comprehensive Care. Obes Surg 2018; 28:1149-1174. [DOI: 10.1007/s11695-018-3138-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
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20
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Michalsky MP, Inge TH, Jenkins TM, Xie C, Courcoulas A, Helmrath M, Brandt ML, Harmon CM, Chen M, Dixon JB, Urbina EM. Cardiovascular Risk Factors After Adolescent Bariatric Surgery. Pediatrics 2018; 141:peds.2017-2485. [PMID: 29311357 PMCID: PMC5810605 DOI: 10.1542/peds.2017-2485] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [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] [Accepted: 11/17/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Severely obese adolescents harbor numerous cardiovascular disease risk factors (CVD-RFs), which improve after metabolic and bariatric surgery (MBS). However, predictors of change in CVD-RFs among adolescents have not yet been reported. METHODS The Teen-Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected anthropometric and health status data on 242 adolescents undergoing MBS at 5 centers. Predictors of change in CVD-RFs (blood pressure, lipids, glucose homeostasis, and inflammation) 3 years after Roux-en-Y gastric bypass and vertical sleeve gastrectomy were examined. RESULTS The mean (±SD) age of participants at baseline was 17 ± 1.6 years; 76% were girls, and 72% were white, with a median BMI of 51. Participants underwent Roux-en-Y gastric bypass (n = 161), vertical sleeve gastrectomy (n = 67), or adjustable gastric banding (n = 14). Increasing weight loss was an independent predictor of normalization in dyslipidemia, elevated blood pressure (EBP), hyperinsulinemia, diabetes, and elevated high-sensitivity C-reactive protein. Older participants at time of surgery were less likely to resolve dyslipidemia compared with younger participants, whereas girls were more likely than boys to demonstrate improvements in EBP. Even those participants without frank dyslipidemia or EBP at baseline showed significant improvements in lipid and blood pressure values over time. CONCLUSIONS Numerous CVD-RFs improve among adolescents undergoing MBS. Increased weight loss, female sex, and younger age predict a higher probability of resolution of specific CVD-RFs. The elucidation of predictors of change in CVD-RFs may lead to refinements in patient selection and optimal timing of adolescent bariatric surgery designed to improve clinical outcomes.
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Affiliation(s)
- Marc P. Michalsky
- Nationwide Children’s Hospital, The Ohio State University, Columbus, Ohio
| | - Thomas H. Inge
- University of Colorado, Denver, Colorado and Children’s Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Mary L. Brandt
- Texas Children’s Hospital, College of Medicine, Baylor University, Houston, Texas
| | | | - Mike Chen
- University of Alabama at Birmingham, Birmingham, Alabama
| | - John B. Dixon
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; and
| | - Elaine M. Urbina
- Cincinnati Children’s Hospital, University of Cincinnati, Cincinnati, Ohio
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21
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Abstract
PURPOSE To examine the effects of obesity on specialty-specific surgical outcomes in children. MATERIALS AND METHODS Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis. RESULTS Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures. CONCLUSION Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.
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Affiliation(s)
- A T Train
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
| | - S B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - H A Meyers
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - C M Harmon
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - D H Rothstein
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, The State University of New York, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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22
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Yang Y, Chen M, Ventro G, Harmon CM. Key amino acid residue in Melanocortin-1 receptor (melanocyte α-MSH receptor) for ligand selectivity. Mol Cell Endocrinol 2017; 454:69-76. [PMID: 28579117 DOI: 10.1016/j.mce.2017.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/21/2022]
Abstract
The melanocortin-1 receptor (MC1R) is a subtype of the melanocortin receptor family and NDP-α-MSH is a non-selective agonist for MC1R. The core sequence of NDP-α-MSH, His-Phe-Arg-Trp, is important for ligand binding and biological activities at the melanocortin receptor subtypes (MCRs). A recent study indicates that Trp9 in NDP-α-MSH plays an important role in ligand selectivity. Deletion of Trp9 in NDP-α-MSH (des-Trp9-NDP-α-MSH) resulted in loss of agonist activity at MC4R, although remains agonist activity at MC1R. The molecular basis for this receptor ligand selectivity is unknown. In this study we examined what region of the MC1R is responsible for des-NDP-α-MSH selectivity. Our results indicate that (1) substitution of TM3 of MC4R with the corresponding region of MC1R switches des-Trp9-NDP-α-MSH from no activity to agonist; (2) des-Trp9-NDP-α-MSH exhibits agonistic activity at the L133M mutation of the MC4R; and (3) substitution of non-conserved amino acid residue M128 in TM3 of MC1R significantly reduced des-Trp9-NDP-α-MSH agonist activity. Our results demonstrate that amino acid residue 128 in TM3 of MC1R, or amino acid residue L133 in TM3 of the MC4R, play crucial roles in ligand des-Trp9-NDP-α-MSH selectivity at MC1R or MC4R.
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Affiliation(s)
- Yingkui Yang
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States.
| | - Min Chen
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States
| | - George Ventro
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States
| | - Carroll M Harmon
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States
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23
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Cairo SB, Tabak B, Harmon CM, Bass KD. Novel use of porcine extracellular matrix in recurrent stricture following repair of tracheoesophageal fistula. Pediatr Surg Int 2017; 33:1027-1033. [PMID: 28756526 DOI: 10.1007/s00383-017-4130-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/24/2017] [Indexed: 01/07/2023]
Abstract
Anastomotic stricture is a common complication following repair of esophageal atresia (EA). Many factors are thought to contribute to stricture formation and a variety of management techniques have been developed. In this case report, we describe the treatment of a recurrent anastomotic stricture following repair of long-gap esophageal atresia. Porcine bladder extracellular matrix (ECM) was mounted on a stent and delivered endoscopically to the site of recurrent stricture. An appropriate positioning was confirmed using direct endoscopic visualization and intra-operative fluoroscopy. The patient recovered well with persistent radiographic and functional improvements in previous stricture.
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Affiliation(s)
- Sarah B Cairo
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
| | - Benjamin Tabak
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA
| | - Carroll M Harmon
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, State University of New York School of Medicine and Bioscience, Buffalo, NY, USA
| | - Kathryn D Bass
- Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.,Department of Surgery, University at Buffalo, State University of New York School of Medicine and Bioscience, Buffalo, NY, USA
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24
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Ventro GJ, Yang Y, Chen M, Harmon CM. The molecular impact of omega 3 fatty acids on hepatic pro-inflammatory cytokine signaling. J Pediatr Surg 2017; 52:1020-1025. [PMID: 28433363 DOI: 10.1016/j.jpedsurg.2017.03.031] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 11/15/2022]
Abstract
PURPOSE Parenteral nutrition associated liver disease (PNALD) develops in a subset of children receiving parenteral nutrition for intestinal failure. Omegaven™ is an omega-3 fatty acid (Ω3FA) lipid emulsion high in docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) that can lessen PNALD. Inflammatory cytokines (IL-1, TNF-α, TGF-β) are elevated in PNALD and can decrease paraoxonase 1 protein expression (PON1). We sought to determine the effect of Omegaven™, EPA, and DHA on inflammatory cytokines TNF-α, IL-1, and TGF-β via ERK1/2 and p-Smad2/3 signaling pathways as well as the changes in intracellular PON1 protein expression as a potential mechanism explaining the protective effects of Omegaven™ and Ω3FA. METHODS HepG2 cells were cultured with each cytokine and Omegaven™, or EPA and DHA, or Intralipid™. P-Smad2/3 and PON1 protein levels were measured by Western blotting. ERK1/2 signaling was studied using homogenous time resolved fluorescence. RESULTS Omegaven™ decreased TGF-β mediated Smad2/3 signaling by 30% (70% of control ±12, p<0.03). Omegaven™ decreased IL-1 and TNF-α mediated ERK1/2 signaling (0.49 fold ±0.09, p<0.05 and 0.22±0.05, p<0.05) compared to control. CONCLUSION Our results describe potential mechanisms by which Omegaven™ and Ω3FA can be hepatoprotective in the setting of PNALD by abating inflammatory cytokine signaling.
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Affiliation(s)
- George J Ventro
- State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY; Women and Children's Hospital of Buffalo, Buffalo, NY
| | - Yingkui Yang
- State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY
| | - Min Chen
- State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY
| | - Carroll M Harmon
- State University of New York, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Surgery, Buffalo, NY; Women and Children's Hospital of Buffalo, Buffalo, NY.
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25
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Yang Y, Harmon CM. Molecular signatures of human melanocortin receptors for ligand binding and signaling. Biochim Biophys Acta Mol Basis Dis 2017; 1863:2436-2447. [PMID: 28478228 DOI: 10.1016/j.bbadis.2017.04.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/10/2017] [Accepted: 04/29/2017] [Indexed: 12/29/2022]
Abstract
Human melanocortin receptors (hMCRs) belong to the seven-transmembrane (TM) domain proteins. There are five hMCR subtypes and each of these receptor subtypes has different patterns of tissue expression and physiological function. The endogenous agonists for hMCRs are α-, β-, and γ-MSH and ACTH and endogenous antagonists are Agouti and AGRP which are the only known naturally occurring antagonists for the receptors. These peptides have their own profiles regarding the relative potency for specific hMCR subtype. Extensive studies have been performed to examine the molecular basis of the hMCRs for different ligand binding affinity and potency. Studies indicate that natural ligand α-MSH utilizes conserved amino acid residues for MCR specific binding (orthosteric binding) while synthetic ligands utilize non-conserved amino acid residues for receptor subtype specific binding (allosteric binding). ACTH is the only endogenous agonist for hMC2R and more amino acid residues at hMC2R are required for ACTH binding and signaling. HMCR computer modeling provides the detailed information of ligand and MCR interaction. This review provides the latest understanding of the molecular basis of the hMCRs for ligand binding and signaling. This article is part of a Special Issue entitled: Melanocortin Receptors - edited by Ya-Xiong Tao.
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Affiliation(s)
- Yingkui Yang
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States.
| | - Carroll M Harmon
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY 14203, United States
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26
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Train AT, Dorman RM, Harmon CM. Adolescent Bariatric Surgery: Quality, Outcomes, and Debates. Curr Surg Rep 2017. [DOI: 10.1007/s40137-017-0165-6] [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: 10/20/2022]
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27
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Ryder JR, Edwards NM, Gupta R, Khoury J, Jenkins TM, Bout-Tabaku S, Michalsky MP, Harmon CM, Inge TH, Kelly AS. Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study. JAMA Pediatr 2016; 170:871-7. [PMID: 27429076 PMCID: PMC5904853 DOI: 10.1001/jamapediatrics.2016.1196] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. OBJECTIVE To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. DESIGN, SETTING, AND PARTICIPANTS The Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015. INTERVENTIONS Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). MAIN OUTCOMES AND MEASURES Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). RESULTS Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125-131 to 113 bpm; 95% CI, 110-116), and HR difference (mean, 40 bpm; 95% CI, 36-42 to 34 bpm; 95% CI, 31-37). These changes in time to completion, resting HR, and HR difference persisted at 12 months and 24 months. Posttest HR further improved from 6 months to 12 months (mean, 113 bpm; 95% CI, 110-116 to 108 bpm; 95% CI, 105-111). There were statistically significant reductions in musculoskeletal pain concerns at all points. CONCLUSIONS AND RELEVANCE These data provide evidence that bariatric surgery in adolescents with severe obesity is associated with significant improvement in functional mobility and in the reduction of walking-related musculoskeletal pain up to 2 years after surgery.
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Affiliation(s)
| | | | - Resmi Gupta
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jane Khoury
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Thomas H. Inge
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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28
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Abstract
Biliary disease in children has changed over the past few decades, with a marked rise in incidence-perhaps most related to the parallel rise in pediatric obesity-as well as a rise in cholecystectomy rates. In addition to stone disease (cholelithiasis), acalculous causes of gallbladder pain such as biliary dyskinesia, also appear to be on the rise and present diagnostic and treatment conundrums to surgeons.
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Affiliation(s)
- David H Rothstein
- Department of Pediatric Surgery, Women and Children׳s Hospital of Buffalo, 219 Bryant St, Buffalo, New York 14222; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Carroll M Harmon
- Department of Pediatric Surgery, Women and Children׳s Hospital of Buffalo, 219 Bryant St, Buffalo, New York 14222; Department of Surgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York.
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29
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Gause CD, Hsiung G, Schwab B, Clifton M, Harmon CM, Barsness KA. Advances in Pediatric Surgical Education: A Critical Appraisal of Two Consecutive Minimally Invasive Pediatric Surgery Training Courses. J Laparoendosc Adv Surg Tech A 2016; 26:663-70. [PMID: 27352106 DOI: 10.1089/lap.2016.0249] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mandates for improved patient safety and increasing work hour restrictions have resulted in changes in surgical education. Educational courses increasingly must meet those needs. We sought to determine the experience, skill level, and the impact of simulation-based education (SBE) on two cohorts of pediatric surgery trainees. MATERIALS AND METHODS After Institutional Review Board (IRB) exempt determination, a retrospective review was performed of evaluations for an annual advanced minimally invasive surgery (MIS) course over 2 consecutive years. The courses included didactic content and hands-on skills training. Simulation included neonatal/infant models for rigid bronchoscopy-airway foreign body retrieval, laparoscopic common bile duct exploration, and real tissue diaphragmatic hernia (DH), duodenal atresia (DA), pulmonary lobectomy, and tracheoesophageal fistula models. Categorical data were analyzed with chi-squared analyses with t-tests for continuous data. RESULTS Participants had limited prior advanced neonatal MIS experience, with 1.95 ± 2.84 and 1.16 ± 1.54 prior cases in the 2014 and 2015 cohorts, respectively. The 2015 cohort had significantly less previous experience in lobectomy (P = .04) and overall advanced MIS (P = .007). Before both courses, a significant percentage of participants were not comfortable with DH repair (39%-42%), DA repair (50%-74%), lobectomy (34%-43%), and tracheoesophageal fistula repair (54%-81%). After course completion, > 60% of participants reported improvement in comfort with procedures and over 90% reported that the course significantly improved their perceived ability to perform each operation safely. CONCLUSION Pediatric surgery trainees continue to have limited exposure to advanced MIS during clinical training. SBE results in significant improvement in both cognitive knowledge and trainee comfort with safe operative techniques for advanced MIS.
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Affiliation(s)
- Colin D Gause
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Grace Hsiung
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Ben Schwab
- 2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Matthew Clifton
- 4 Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta , Atlanta, Georgia .,5 Division of Pediatric Surgery, Department of Surgery, Emory University , Children's Hospital of Atlanta, Atlanta, Georgia
| | - Carroll M Harmon
- 6 Division of Pediatric Surgery, Department of Surgery, Women and Children's Hospital of Buffalo , Buffalo, New York.,7 Department of Surgery, State University of New York at Buffalo , Buffalo, New York
| | - Katherine A Barsness
- 1 Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois.,2 Department of Surgery, Northwestern University Feinberg School of Medicine , Chicago, Illinois.,3 Department of Medical Education, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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30
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Ventro G, Chen M, Yang Y, Harmon CM. Molecular impact of omega 3 fatty acids on lipopolysaccharide-mediated liver damage. J Pediatr Surg 2016; 51:1039-43. [PMID: 27072665 DOI: 10.1016/j.jpedsurg.2016.02.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing evidence suggests that omega 3 fatty acid containing lipid emulsions have a beneficial effect on parenteral nutrition associated liver disease (PNALD). However, the cellular and molecular mechanisms responsible for this effect are unclear. In this study, we investigated whether Omegaven™ fish oil emulsion could inhibit lipopolysaccharidase (LPS) mediated liver damage. METHODS We examined the effects of Omegaven™ and LPS alone and synergistically on hepatic paraoxonase 1 (PON1), a potent antioxidant protein, ERK1/2 activity, and TLR4 regulation. RESULTS LPS did not alter PON1 release from HepG2 cells but did significantly decrease PON1 protein synthesis (44%, P<0.05). Omegaven™ alone had no direct effect on PON1 release. However, it did significantly reverse LPS-mediated decrease in PON1 protein levels (control: 100%; LPS alone: 56+/4%; LPS+Omegaven™: 87+/6%, P<0.05). Furthermore, molecular analysis indicated that Omegaven™ blocked LPS-mediated increase in ERK1/2 activity (35% increase), an important LPS signal transduction pathway. TLR4, the receptor for LPS, was down-regulated in the presence of Omegaven™. CONCLUSION Omegaven™ may be beneficial in patients with PNAC because of its ability to reverse LPS-mediated inhibition of antioxidant promoting PON1 expression, and this activity may be in part mediated by the ERK1/2 pathway.
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Affiliation(s)
- George Ventro
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY
| | - Min Chen
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY
| | - Yingkui Yang
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY
| | - Carroll M Harmon
- Department of Surgery, State University of New York at Buffalo, Buffalo, NY.
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Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, Harmon CM, Zeller MH, Chen MK, Xanthakos SA, Horlick M, Buncher CR. Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents. N Engl J Med 2016; 374:113-23. [PMID: 26544725 PMCID: PMC4810437 DOI: 10.1056/nejmoa1506699] [Citation(s) in RCA: 436] [Impact Index Per Article: 54.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Bariatric surgery is increasingly considered for the treatment of adolescents with severe obesity, but few prospective adolescent-specific studies examining the efficacy and safety of weight-loss surgery are available to support clinical decision making. METHODS We prospectively enrolled 242 adolescents undergoing weight-loss surgery at five U.S. centers. Patients undergoing Roux-en-Y gastric bypass (161 participants) or sleeve gastrectomy (67) were included in the analysis. Changes in body weight, coexisting conditions, cardiometabolic risk factors, and weight-related quality of life and postoperative complications were evaluated through 3 years after the procedure. RESULTS The mean (±SD) baseline age of the participants was 17±1.6 years, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 53; 75% of the participants were female, and 72% were white. At 3 years after the procedure, the mean weight had decreased by 27% (95% confidence interval [CI], 25 to 29) in the total cohort, by 28% (95% CI, 25 to 30) among participants who underwent gastric bypass, and by 26% (95% CI, 22 to 30) among those who underwent sleeve gastrectomy. By 3 years after the procedure, remission of type 2 diabetes occurred in 95% (95% CI, 85 to 100) of participants who had had the condition at baseline, remission of abnormal kidney function occurred in 86% (95% CI, 72 to 100), remission of prediabetes in 76% (95% CI, 56 to 97), remission of elevated blood pressure in 74% (95% CI, 64 to 84), and remission of dyslipidemia in 66% (95% CI, 57 to 74). Weight-related quality of life also improved significantly. However, at 3 years after the bariatric procedure, hypoferritinemia was found in 57% (95% CI, 50 to 65) of the participants, and 13% (95% CI, 9 to 18) of the participants had undergone one or more additional intraabdominal procedures. CONCLUSIONS In this multicenter, prospective study of bariatric surgery in adolescents, we found significant improvements in weight, cardiometabolic health, and weight-related quality of life at 3 years after the procedure. Risks associated with surgery included specific micronutrient deficiencies and the need for additional abdominal procedures. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; Teen-LABS ClinicalTrials.gov number, NCT00474318.).
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Affiliation(s)
- Thomas H Inge
- From the Cincinnati Children's Hospital Medical Center (T.H.I., T.M.J., M.A.H., M.H.Z., S.A.X.) and the University of Cincinnati (C.R.B.), Cincinnati, and Nationwide Children's Hospital, Columbus (M.P.M.) - all in Ohio; the University of Pittsburgh Medical Center, Pittsburgh (A.P.C.); Texas Children's Hospital, Baylor College of Medicine, Houston (M.L.B.); Women and Children's Hospital, University of Buffalo, Buffalo, NY (C.M.H.); University of Alabama at Birmingham, Birmingham (M.K.C.); and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (M.H.)
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Lacher M, St Peter SD, Laje P, Harmon CM, Ure B, Kuebler JF. Thoracoscopic CDH Repair—A Survey on Opinion and Experience Among IPEG Members. J Laparoendosc Adv Surg Tech A 2015; 25:954-7. [DOI: 10.1089/lap.2015.0243] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Martin Lacher
- Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Shawn D. St Peter
- Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri
| | - Pablo Laje
- Division of General, Thoracic, and Fetal Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Carroll M. Harmon
- Department of Surgery, State University of New York at Buffalo, Buffalo, New York
| | - Benno Ure
- Center of Pediatric Surgery, Hannover Medical School, Hannover, Germany
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Xanthakos SA, Jenkins TM, Kleiner DE, Boyce TW, Mourya R, Karns R, Brandt ML, Harmon CM, Helmrath MA, Michalsky MP, Courcoulas AP, Zeller MH, Inge TH. High Prevalence of Nonalcoholic Fatty Liver Disease in Adolescents Undergoing Bariatric Surgery. Gastroenterology 2015; 149:623-34.e8. [PMID: 26026390 PMCID: PMC4654456 DOI: 10.1053/j.gastro.2015.05.039] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [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: 07/02/2014] [Revised: 05/14/2015] [Accepted: 05/20/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Little is known about the prevalence of nonalcoholic fatty liver disease (NAFLD) among severely obese adolescents or factors that determine its development. We investigated the prevalence of NAFLD in a multicenter cohort of adolescents undergoing bariatric surgery and the factors associated with it. METHODS We enrolled 242 adolescents undergoing bariatric surgery between March 2007 and February 2012 at 5 tertiary care centers into a multicenter, prospective observational cohort study. Intraoperative core liver biopsies were collected from 165 subjects; 17 were excluded because of insufficient liver tissue or use of hepatotoxic medications, so 148 remained in the study (mean age, 16.8 ± 1.6 years; median body mass index = 52 kg/m(2)). Liver tissues were analyzed by histology using validated criteria. Hepatic gene expression was analyzed in 67 samples. RESULTS NAFLD was present in 59% of this predominantly female (72%), white (68%), non-Hispanic (91%) cohort. Of subjects with NAFLD, 24% had borderline and 10% had definite nonalcoholic steatohepatitis (NASH). Mild fibrosis (stage 2 or lower) was observed in 18% of liver biopsies and stage 3 was observed in 0.7%, but cirrhosis was not detected. Dyslipidemia was present in 78% of subjects, hypertension in 44%, and diabetes in 14%. More severe NAFLD was associated with increasing levels of alanine aminotransferase, fasting glucose level, hypertension (each P < .01), and white blood cell count (P = .04). Only diabetes was associated with detection of fibrosis (odds ratio = 3.56; 95% confidence interval: 1.93-6.56). Microarray analysis associated presence of NASH with altered expression of genes that regulate macrophage chemotaxis, cholesterol absorption, and fatty acid binding. CONCLUSIONS More than half of adolescents undergoing bariatric surgery in this cohort had NAFLD, yet the prevalence of severe or fibrotic NASH was low. Increasing severity of NAFLD was associated with level of alanine aminotransferase and cardiometabolic risk factors, but not body mass index. Based on gene expression analysis, borderline and definite NASH were associated with abnormal immune function, intestinal cholesterol absorption, and lipid metabolism.
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Affiliation(s)
- Stavra A. Xanthakos
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Todd M. Jenkins
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Tawny W. Boyce
- University of New Mexico Cancer Center, Biostatistics Shared Resource, Albuquerque, New Mexico
| | - Reena Mourya
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Rebekah Karns
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary L. Brandt
- Division of Pediatric Surgery, Texas Children’s Hospital, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Carroll M. Harmon
- Division of Pediatric Surgery, Women & Children’s Hospital of Buffalo, University of Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Michael A. Helmrath
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marc P. Michalsky
- Department of Pediatric Surgery, The Ohio State University College of Medicine and Nationwide Children’s Hospital, Columbus, Ohio
| | - Anita P. Courcoulas
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Meg H. Zeller
- Division of Behavioral Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Thomas H. Inge
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Propst M, Colvin C, Griffin RL, Sunil B, Harmon CM, Yannam G, Johnson JE, Smith CB, Lucas AP, Diaz BT, Ashraf AP. DIABETES AND PREDIABETES ARE SIGNIFICANTLY HIGHER IN MORBIDLY OBESE CHILDREN COMPARED WITH OBESE CHILDREN. Endocr Pract 2015; 21:1046-53. [PMID: 26121438 DOI: 10.4158/ep14414.or] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence and characteristics of comorbidities in obese and morbidly obese children with a comparison between the 2 sets of children. METHODS This was a retrospective electronic chart review of obese and morbidly obese children and adolescents as defined by body mass index. We evaluated medical history of comorbid conditions, medication use, and cardiovascular risk markers, including blood pressure, lipid profile, and glycosylated hemoglobin. RESULTS There were 1,111 subjects (African American = 635; non-Hispanic white = 364; Hispanic = 36; others = 86), of which 274 were obese and 837 were morbidly obese children with a mean age of 12.7 ± 3.37 years. Morbidly obese children had a higher prevalence of prediabetes (19.5% of obese versus 27.3% of morbidly obese; P<.0001) and type 2 diabetes (39.8% of obese versus 52.4% of morbidly obese; P<.0001). Use of medications for treatment of asthma was significantly higher in the morbidly obese group compared with the obese group (21% versus 14%; P = .01). CONCLUSION Morbidly obese children have a higher prevalence of diabetes, prediabetes, and use of asthma medications compared with obese children.
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Bout-Tabaku S, Michalsky MP, Jenkins TM, Baughcum A, Zeller MH, Brandt ML, Courcoulas A, Buncher R, Helmrath M, Harmon CM, Chen MK, Inge TH. Musculoskeletal Pain, Self-reported Physical Function, and Quality of Life in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Cohort. JAMA Pediatr 2015; 169:552-9. [PMID: 25915190 PMCID: PMC4551432 DOI: 10.1001/jamapediatrics.2015.0378] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Obesity is associated with chronic musculoskeletal pain and is a risk factor for disability and osteoarthritis. OBJECTIVES To describe the prevalence, sites, and intensity of musculoskeletal pain in adolescents with severe obesity; to evaluate associations between musculoskeletal pain and self-reported physical function as well as weight-related quality of life; and to evaluate the association between musculoskeletal pain and high-sensitivity C-reactive protein level. DESIGN, SETTING, AND PARTICIPANTS Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) is a prospective, observational study that collects standardized data on adolescents undergoing weight loss surgery at 5 US centers. We examined baseline data from this cohort between February 28, 2007, and December 30, 2011. We excluded adolescents with Blount disease and slipped capital femoral epiphyses. A total of 233 participants were included in these analyses. MAIN OUTCOMES AND MEASURES We assessed musculoskeletal pain and pain intensity of the lower back, hips, knees, and ankles/feet using the visual analog scale, categorizing musculoskeletal pain into lower back pain, lower extremity (hips, knees, and feet/ankles combined) pain, and no pain. We assessed self-reported physical function status with the Health Assessment Questionnaire Disability Index and assessed weight-related quality of life with the Impact of Weight on Quality of Life-Kids measure. We adjusted for sex, race, age at surgery, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and clinical depressive symptoms in regression analyses. RESULTS Among the 233 participants, the mean (SD) age at surgery was 17.1 (1.56) years and the median BMI was 50.4. Participants were predominantly female (77%), white (73%), and non-Hispanic (93%). Among the participants, 49% had poor functional status and 76% had musculoskeletal pain. Lower back pain was prevalent (63%), followed by ankle/foot (53%), knee (49%), and hip (31%) pain; 26% had pain at all 4 sites. In adjusted analyses, compared with pain-free participants, those reporting lower extremity pain had greater odds of having poor physical function according to scores on the Health Assessment Questionnaire Disability Index (odds ratio = 2.82; 95% CI, 1.35 to 5.88; P < .01). Compared with pain-free participants, those reporting lower extremity pain had significantly lower Impact of Weight on Quality of Life-Kids total scores (β = -9.42; 95% CI, -14.15 to -4.69; P < .01) and physical comfort scores (β = -17.29; 95% CI, -23.32 to -11.25; P < .01). After adjustment, no significant relationship was observed between musculoskeletal pain and high-sensitivity C-reactive protein level. CONCLUSIONS AND RELEVANCE Adolescents with severe obesity have musculoskeletal pain that limits their physical function and quality of life. Longitudinal follow-up will reveal whether weight loss surgery reverses pain and physical functional limitations and improves quality of life.
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Affiliation(s)
| | - Marc P Michalsky
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Amy Baughcum
- Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary L Brandt
- Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Mike K Chen
- University of Alabama at Birmingham, Birmingham
| | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Michalsky MP, Inge TH, Simmons M, Jenkins TM, Buncher R, Helmrath M, Brandt ML, Harmon CM, Courcoulas A, Chen M, Horlick M, Daniels SR, Urbina EM. Cardiovascular Risk Factors in Severely Obese Adolescents: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study. JAMA Pediatr 2015; 169:438-44. [PMID: 25730293 PMCID: PMC4539530 DOI: 10.1001/jamapediatrics.2014.3690] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 12/25/2022]
Abstract
IMPORTANCE Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. OBJECTIVE To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children's Hospital in Columbus, Ohio; Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio; Texas Children's Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children's Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. MAIN OUTCOMES AND MEASURES This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. RESULTS The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI, 1.26-2.03]; P < .01) and elevated blood pressure (adjusted relative risk = 1.48 [95% CI, 1.16-1.89]; P < .01) were more likely in adolescent boys compared with adolescent girls. White individuals were at greater risk of having elevated triglyceride levels (adjusted relative risk = 1.76 [95% CI, 1.14-2.72]; P = .01) but were less likely to have impaired fasting glucose levels (adjusted relative risk = 0.58 [95% CI, 0.38-0.89]; P = .01). CONCLUSIONS AND RELEVANCE Numerous CVD risk factors are apparent in adolescents undergoing weight-loss surgery. Increasing body mass index and male sex increase the relative risk of specific CVD risk factors. These data suggest that even among severely obese adolescents, recognition and treatment of CVD risk factors is important to help limit further progression of disease.
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Affiliation(s)
| | - Thomas H. Inge
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Todd M. Jenkins
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Mary L. Brandt
- Texas Children’s Hospital, Baylor College of Medicine, Houston
| | | | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Zeller MH, Inge TH, Modi AC, Jenkins TM, Michalsky MP, Helmrath M, Courcoulas A, Harmon CM, Rofey D, Baughcum A, Austin H, Price K, Xanthakos SA, Brandt ML, Horlick M, Buncher R. Severe obesity and comorbid condition impact on the weight-related quality of life of the adolescent patient. J Pediatr 2015; 166:651-9.e4. [PMID: 25556022 PMCID: PMC4344894 DOI: 10.1016/j.jpeds.2014.11.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 09/23/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To assess links between comorbid health status, severe excess weight, and weight-related quality of life (WRQOL) in adolescents with severe obesity and undergoing weight-loss surgery (WLS) to inform clinical care. STUDY DESIGN Baseline (preoperative) data from Teen Longitudinal Assessment of Bariatric Surgery, a prospective multicenter observational study of 242 adolescents with severe obesity (MedianBMI = 50.5 kg/m(2); Meanage = 17.1; 75.6% female; 71.9% white) undergoing WLS, were used to examine the impact of demographics, body mass index (BMI), presence/absence of 16 comorbid conditions, and a cumulative comorbidity load (CLoad) index on WRQOL scores (Impact of Weight on Quality of Life-Kids). RESULTS WRQOL was significantly lower than reference samples of healthy weight, overweight, and obese samples. Of 16 comorbid conditions, the most prevalent were dyslipidemia (74.4%), chronic pain (58.3%), and obstructive sleep apnea (56.6%). Male subjects had a greater CLoad (P = .01) and BMI (P = .01), yet less impairment in total WRQOL (P < .01) than females. CLoad was a significant predictor of male WRQOL. For females, psychosocial (vs physical) comorbidities, BMI, and white race were significant predictors of WRQOL impairment. Less prevalent conditions (eg, stress urinary incontinence) also emerged as contributors to lower WRQOL. CONCLUSIONS WRQOL impairment is substantial for adolescents with severe obesity undergoing WLS, with predictors varying by sex. These patient-data highlight targets for education, support, and adjunctive care referrals before WLS. Furthermore, they provide a comprehensive empirical base for understanding heterogeneity in adolescent WRQOL outcomes after WLS, as weight and comorbidity profiles change over time.
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Affiliation(s)
- Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
| | - Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Avani C Modi
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | | | - Carroll M Harmon
- University of Alabama at Birmingham, Birmingham, AL; University at Buffalo, Buffalo, NY
| | - Dana Rofey
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | | | | | | | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD
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Yang Y, Mishra V, Crasto CJ, Chen M, Dimmitt R, Harmon CM. Third transmembrane domain of the adrenocorticotropic receptor is critical for ligand selectivity and potency. J Biol Chem 2015; 290:7685-92. [PMID: 25605722 DOI: 10.1074/jbc.m114.596122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The ACTH receptor, known as the melanocortin-2 receptor (MC2R), plays an important role in regulating and maintaining adrenocortical function. MC2R is a subtype of the melanocortin receptor (MCR) family and has unique characteristics among MCRs. Endogenous ACTH is the only endogenous agonist for MC2R, whereas the melanocortin peptides α-, β-, and γ-melanocyte-stimulating hormone and ACTH are full agonists for all other MCRs. In this study, we examined the molecular basis of MC2R responsible for ligand selectivity using ACTH analogs and MC2R mutagenesis. Our results indicate that substitution of Phe(7) with D-Phe or D-naphthylalanine (D-Nal(2')) in ACTH(1-24) caused a significant decrease in ligand binding affinity and potency. Substitution of Phe(7) with D-Nal(2') in ACTH(1-24) did not switch the ligand from agonist to antagonist at MC2R, which was observed in MC3R and MC4R. Substitution of Phe(7) with D-Phe(7) in ACTH(1-17) resulted in the loss of ligand binding and activity. Molecular analysis of MC2R indicated that only mutation of the third transmembrane domain of MC2R resulted in a decrease in D-Phe ACTH binding affinity and potency. Our results suggest that Phe(7) in ACTH plays an important role in ligand selectivity and that the third transmembrane domain of MC2R is crucial for ACTH selectivity and potency.
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Affiliation(s)
- Yingkui Yang
- From the Department of Surgery, State University of New York at Buffalo, Buffalo, New York 14203 and
| | | | | | - Min Chen
- From the Department of Surgery, State University of New York at Buffalo, Buffalo, New York 14203 and
| | - Reed Dimmitt
- Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama 35233
| | - Carroll M Harmon
- From the Department of Surgery, State University of New York at Buffalo, Buffalo, New York 14203 and
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Seims AD, Nice TR, Mortellaro VE, Lacher M, Ba'Ath ME, Anderson SA, Beierle EA, Martin CA, Rogers DA, Harmon CM, Chen MK, Russell RT. Routine utilization of single-incision pediatric endosurgery (SIPES): a 5-year institutional experience. J Laparoendosc Adv Surg Tech A 2015; 25:252-5. [PMID: 25594666 DOI: 10.1089/lap.2014.0492] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Single-incision pediatric endosurgery (SIPES) allows operation through one access site, eliminating the multiple sites traditionally used. There are few large series evaluating the versatility of SIPES. The purpose of this study is to review a 5-year single-institution experience with routine SIPES use. PATIENTS AND METHODS This is an Institutional Review Board-approved retrospective analysis of prospectively collected data. All SIPES cases from March 2009 to December 2013 were included. Our database contains demographics, procedure type, operative duration, estimated blood loss, instance of added ports or conversion to open, complications, and follow-up duration. RESULTS Of 1322 SIPES operations performed, most (82.1%) were appendectomies and cholecystectomies. Of 871 (66%) patients seen in follow-up, with a median duration of 26 days, 53 (6.1%) experienced postoperative complications. Forty-two cases (4.8%) were surgical-site infections, of which 4 required drainage. Less frequent complications that required operative intervention include recurrent inguinal hernia (n=4), umbilical hernia (n=3), intraabdominal abscess (n=1), bleeding (n=1), abdominal compartment syndrome (n=1), bowel obstruction (n=1), stitch granuloma (n=1), and persistent postoperative pain (n=1). CONCLUSIONS Operative times and complication rates are comparable to those in prior reported multiport laparoscopic series, allowing safe integration of SIPES into the routine of a surgical practice for most common procedures.
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Inge TH, Boyce TW, Lee M, Kollar L, Jenkins TM, Brandt ML, Helmrath M, Xanthakos SA, Zeller MH, Harmon CM, Courcoulas A, Michalsky MP. Access to care for adolescents seeking weight loss surgery. Obesity (Silver Spring) 2014; 22:2593-7. [PMID: 25234923 DOI: 10.1002/oby.20898] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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] [Received: 04/14/2014] [Accepted: 08/19/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS. METHODS A retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals. RESULTS Records from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m(2) ) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial. CONCLUSIONS Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.
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Affiliation(s)
- Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Yang Y, Chen M, Dimmitt R, Harmon CM. Structural insight into the MC4R conformational changes via different agonist-mediated receptor signaling. Biochemistry 2014; 53:7086-92. [PMID: 25347793 DOI: 10.1021/bi500856x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The melanocortin-4 receptor (MC4R) plays a key role in the regulation of food intake and body weight. Previous studies indicate that α-melanocyte stimulating hormone (α-MSH) binds to MC4R and activates three signal pathways (cAMP, calcium, and mitogen-activated protein kinase pathways), whereas MC4R synthetic agonist THIQ can activate only the cAMP pathway. The molecular basis of the MC4R responsible for different ligand-mediated signaling is unknown. We hypothesize that different MC4R agonists can stabilize different MC4R conformations and result in ligand-mediated signal transduction. In this study, we examined the effect of the MC4R conformational change in cAMP signaling pathways mediated by different agonists by cross-linking two transmembrane helices (TM3 and TM6). We generated and tested 11 single and 8 double mutations that are located at the end of TM3 and beginning of TM6 in MC4R. Our results indicate that (1) single or double mutations of the MC4R did not significantly alter cAMP production induced by NDP-MSH compared to that of wild-type MC4R except single mutation 243H (the mutation 243H significantly decreased cAMP production mediated by NDP-MSH or THIQ due to a low level of receptor expression at the cell surface), (2) the mutation 247H significantly decreased THIQ-mediated cAMP production but not NDP-MSH, and (3) the receptor cAMP signaling pathway activation by THIQ is blocked in the presence of Zn(2+) with the double mutation I150/242H but activation by NDP-MSH is not, suggesting that the activated conformation of MC4R mediated by NDP-MSH and THIQ is different. This study provides insight into the molecular basis of MC4R responsible for receptor signaling mediated by different agonists.
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Affiliation(s)
- Yingkui Yang
- Department of Surgery, State University of New York at Buffalo , Buffalo, New York 14203, United States
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Xiao N, Jenkins TM, Nehus E, Inge TH, Michalsky MP, Harmon CM, Helmrath MA, Brandt ML, Courcoulas A, Moxey-Mims M, Mitsnefes MM. Kidney function in severely obese adolescents undergoing bariatric surgery. Obesity (Silver Spring) 2014; 22:2319-25. [PMID: 25376399 PMCID: PMC4225641 DOI: 10.1002/oby.20870] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/24/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Determine objective measures of kidney function and analyze factors associated with kidney dysfunction in severely obese adolescents undergoing weight loss surgery were described. METHODS Cross-sectional data from 242 adolescent participants in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study before weight loss surgery were analyzed. Kidney status was assessed by measuring urine albumin creatinine ratio to determine microalbuminuria and by calculating serum cystatin C-based estimated glomerular filtration rate (eGFR) to assess kidney function. RESULTS Mean age and median body mass index (BMI) were 17.1 years and 50.5 kg/m(2) , respectively; 76% were females and 65% were non-Hispanic white race. Fourteen percent of the cohort had microalbuminuria, and 3% had macroalbuminuria; 3% had eGFR < 60 ml/min/1.73 m(2) , and 7.1% had eGFR > 150 ml/min/1.73 m(2) . In adjusted analyses, female gender and increasing ferritin levels were significantly associated with the presence of microalbuminuria/macroalbuminuria. Increasing BMI and homeostasis model assessment of insulin resistance values were significantly associated with lower eGFR. CONCLUSIONS A significant number of severely obese adolescents undergoing weight loss surgery have evidence of early kidney dysfunction. Longitudinal studies following weight loss surgery in these individuals are needed to determine whether these kidney abnormalities are reversible following weight loss therapy.
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Affiliation(s)
- Nianzhou Xiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Salas AA, Bhat R, Dabrowska K, Leadford A, Anderson S, Harmon CM, Ambalavanan N, El-Ferzli GT. The value of Pa(CO2) in relation to outcome in congenital diaphragmatic hernia. Am J Perinatol 2014; 31:939-46. [PMID: 24515620 DOI: 10.1055/s-0034-1368088] [Citation(s) in RCA: 15] [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: 10/25/2022]
Abstract
BACKGROUND Postnatal assessment of disease severity is critical for analysis of mortality rates and development of future interventions in congenital diaphragmatic hernia (CDH). OBJECTIVE The objective of this study was to stratify the risk of mortality based on arterial Paco 2. METHODS Retrospective analysis of infants (n = 133) with CDH admitted to a regional extracorporeal membrane oxygenation (ECMO) center in two different periods: period I (1987-1996; n = 46) and period II (2002-2010; n = 87). RESULTS The mortality rate (37%) was similar in both periods (p = 0.98). Paco 2 < 60 mm Hg in the first arterial blood gas (ABG) was an independent predictor of survival in both periods (p = 0.03). The predicted survival rate was 84% if initial Paco 2 was < 55 mm Hg. For infants with initial Paco 2 > 55 mm Hg treated with ECMO (n = 83), the predicted survival rate was 11% if the Paco 2 was > 88 mm Hg before the initiation of ECMO. CONCLUSION Paco 2, a surrogate of lung hypoplasia, may be useful for risk stratification in CDH. Paco 2 < 60 mm Hg in the first ABG may indicate milder pulmonary hypoplasia. A Paco 2 > 80 mm Hg in the first ABG and/or before ECMO may indicate severe pulmonary hypoplasia.
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Affiliation(s)
- Ariel A Salas
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ramachandra Bhat
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Katarzyna Dabrowska
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alicia Leadford
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scott Anderson
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carroll M Harmon
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - George T El-Ferzli
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Colvin CW, Ashraf AP, Griffin RL, Diaz BT, Yannam GR, Johnson JE, Lucas AP, Propst M, Harmon CM. Diabetes Status and Race are Associated with Cardiovascular Risk Markers in Obese Adolescents. Endocr Pract 2014; 21:165-73. [PMID: 25297661 DOI: 10.4158/ep14087.or] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate differences in cardiovascular disease (CVD) risk markers in obese adolescents based on diabetes status and race in order to improve risk-reduction intervention strategies. METHODS This was a retrospective, cross-sectional study of obese adolescents, age 10 to 21 years, who were evaluated at Children's of Alabama between 2000 and 2012. Subjects were classified by glycated hemoglobin (HbA1c) as having normoglycemia, prediabetes, or type 2 diabetes mellitus (T2DM). RESULTS There were a total of 491 African American (AA) or Caucasian American (CA) subjects. Body mass index was not different between HbA1c and racial groups. Compared to subjects with normoglycemia or prediabetes, subjects with T2DM had higher levels of total cholesterol (TC) (178.6 ± 43.8 mg/dL vs. 161.5 ± 32.5 mg/dL vs. 162.4 ± 30.6 mg/dL; P<.0001) and low-density-lipoprotein cholesterol (107.4 ± 39.2 mg/dL vs. 97.0 ± 31.0 mg/dL vs. 97.5 ± 26.9 mg/dL; P = .0073). Compared with AA subjects, CA subjects had lower high-density-lipoprotein cholesterol (HDL-C) levels (40.4 ± 10.4 mg/dL vs. 44.3 ± 11.9 mg/dL; P = .0005) and higher non-HDL-C levels (129.6 ± 36.2 mg/dL vs. 122.5 ± 37.5 mg/dL; P = .0490). Of the characteristics studied, HbA1c had the most significant positive association with dyslipidemia and was strongly correlated with both TC (β, 4.21; P<.0001) and non-HDL-C (β, 4.3; P<.0001). CONCLUSION Obese adolescents with T2DM have more abnormal lipoprotein profiles than those with normoglycemia or prediabetes. Obese CA adolescents have more abnormal lipids than obese AA adolescents. HbA1c was the characteristic most highly associated with abnormal lipoprotein profiles in our subjects. Our results show that CVD risk markers in obese adolescents vary by race and HbA1c concentration.
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Affiliation(s)
- Caroline W Colvin
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama School of Medicine, Birmingham, Alabama
| | - Russell L Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Benjamin Tuanama Diaz
- Division of Pediatric Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
| | - Govardhana Rao Yannam
- Division of Pediatric Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
| | | | - Alan P Lucas
- University of Alabama School of Medicine, Birmingham, Alabama
| | - Matthew Propst
- Ross University School of Medicine, Dominica, West Indies
| | - Carroll M Harmon
- Division of Pediatric Surgery, Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama
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Perger L, Little DC, Muensterer OJ, Chong AJ, Mortellaro VE, Harmon CM. Minimal access laparoscopic surgery for treatment of ulcerative colitis and familial adenomatous polyposis coli in children and adolescents. J Laparoendosc Adv Surg Tech A 2014; 24:731-4. [PMID: 25247476 DOI: 10.1089/lap.2014.0390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Laparoscopic restorative proctocolectomy is standard surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis coli (FAP). Scar burden can be minimized by reducing the number of laparoscopic ports. The aim of this study is to review the authors' experience with reduced-port laparoscopy in this setting and to compare it with conventional laparoscopy using multiple ports. MATERIALS AND METHODS Charts of pediatric patients undergoing colectomy for UC or FAP between 2009 and 2012 were retrospectively reviewed. Patients who had the operation performed through one or two multichannel ports were assigned to the minimal access (MA) study group. Patients who had four or five single-channel ports with or without an additional small laparotomy were assigned to the LAP group. RESULTS Twenty-two patients were identified. Ages at first operation were 2-18 years (median, 13.5 years). There were no conversions to laparotomy and no mortality. Mean operative times for the MA and LAP groups, respectively, were 250 and 284 minutes for abdominal colectomy with end ileostomy (P=.15), 198 and 301 minutes for completion proctectomy with diverting loop ileostomy (DLI) (P=.26), and 455 and 414 minutes for proctocolectomy with ileal pouch-anal anastomosis and DLI (P=.72). A major complication requiring laparotomy occurred in 1 patient (9%) in the MA group and in 2 patients (18%) in the LAP group. CONCLUSIONS Minimal access laparoscopic surgery for UC and FAP is safe and feasible. A slightly larger incision at the ostomy site facilitates extraction of the specimen and extracorporeal construction of a J-pouch. Operative times and hospital stay are comparable to those with multiport laparoscopy.
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Affiliation(s)
- Lena Perger
- 1 McLane's Children's Hospital at Scott & White, Texas A&M College of Medicine , Temple, Texas
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46
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Seims AD, Russell RT, Beierle EA, Chen MK, Anderson SA, Martin CA, Harmon CM. Single-incision pediatric endosurgery (SIPES) splenectomy: what dictates the need for additional ports? Surg Endosc 2014; 29:30-3. [DOI: 10.1007/s00464-014-3648-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/26/2014] [Indexed: 01/03/2023]
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Mathews EK, Griffin RL, Mortellaro V, Beierle EA, Harmon CM, Chen MK, Russell RT. Utility of immature granulocyte percentage in pediatric appendicitis. J Surg Res 2014; 190:230-4. [PMID: 24793450 DOI: 10.1016/j.jss.2014.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/23/2014] [Accepted: 04/03/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute appendicitis is the most common cause of abdominal surgery in children. Adjuncts are used to help clinicians predict acute or perforated appendicitis, which may affect treatment decisions. Automated hematologic analyzers can perform more accurate automated differentials including immature granulocyte percentages (IG%). Elevated IG% has demonstrated improved accuracy for predicting sepsis in the neonatal population than traditional immature-to-total neutrophil count ratios. We intended to assess the additional discriminatory ability of IG% to traditionally assessed parameters in the differentiation between acute and perforated appendicitis. MATERIALS AND METHODS We identified all patients with appendicitis from July 2012-June 2013 by International Classification of Diseases-9 code. Charts were reviewed for relevant demographic, clinical, and outcome data, which were compared between acute and perforated appendicitis groups using Fisher exact and t-tests for categorical and continuous variables, respectively. We used an adjusted logistic regression model using clinical laboratory values to predict the odds of perforated appendicitis. RESULTS A total of 251 patients were included in the analysis. Those with perforated appendicitis had a higher white blood cell count (P=0.0063), C-reactive protein (CRP) (P<0.0001), and IG% (P=0.0299). In the adjusted model, only elevated CRP (odds ratio 3.46, 95% confidence interval 1.40-8.54) and presence of left shift (odds ratio 2.66, 95% confidence interval 1.09-6.46) were significant predictors of perforated appendicitis. The c-statistic of the final model was 0.70, suggesting fair discriminatory ability in predicting perforated appendicitis. CONCLUSIONS IG% did not provide any additional benefit to elevated CRP and presence of left shift in the differentiation between acute and perforated appendicitis.
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Affiliation(s)
- Eleanor K Mathews
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell L Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Vincent Mortellaro
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Elizabeth A Beierle
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Carroll M Harmon
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mike K Chen
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert T Russell
- Department of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
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Zitsman JL, Inge TH, Reichard KW, Browne AF, Harmon CM, Michalsky MP. Pediatric and adolescent obesity: management, options for surgery, and outcomes. J Pediatr Surg 2014; 49:491-4. [PMID: 24650484 DOI: 10.1016/j.jpedsurg.2013.11.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 01/25/2023]
Abstract
The past four decades have witnessed a marked rise in the number of children and adolescents with obesity. Severe obesity has also become increasingly prevalent. More young patients who have obesity are being referred for weight management and weight loss surgery, thus posing new challenges to both the medical personnel who care for them as well as the institutions in which that care is provided. This manuscript is generated from the material presented at the Education Day symposium entitled "Surgical Care of the Obese Child" held at the 42nd Annual Meeting of the American Pediatric Surgical Association in Palm Desert, CA, on May 22, 2011. Herein the presenters at the symposium update the material addressing evaluation of a young person for weight loss surgery (including the team approach to patient evaluation and institutional infrastructure and responsibilities). The procedures most frequently available to young patients with obesity are identified, and current outcomes, trends, and future direction are also discussed.
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Affiliation(s)
- Jeffrey L Zitsman
- Division of Pediatric Surgery, Columbia University Medical Center and Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA.
| | - Thomas H Inge
- Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kirk W Reichard
- Department of Surgery, Nemours A.I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Allen F Browne
- Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
| | - Carroll M Harmon
- Division of Pediatric Surgery, Department of Surgery, Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marc P Michalsky
- Department of Surgery, Division of Pediatric Surgery, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA
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Abstract
The use of eponyms in medicine has a long and captivating tradition, which applies to pediatric surgery as well. Unfortunately, even though these eponyms are widely used, oftentimes the fascinating personalities and lives behind these names remain unrecognized or underappreciated, especially among residents, fellows and younger-generation pediatric surgeons. Therefore, in this article, we review 15 names that are frequently used as eponyms in modern pediatric surgery and hereby enlighten the personalities behind them. Given their particular frequency, we choose the following eponyms: Ramstedt pylorotomy, Nissen fundoplication, Murphy's sign and sequence, McBurney's sign and incision, Meckel's diverticulum, Kasai portoenterostomy, Ladd's procedure, Morgagni and Bochdalek hernia, Ravitch operation, Nuss procedure, Hirschsprung disease, Swenson pullthrough, Peña procedure and Wilms tumor. A detailed description of the historical importance of these personalities and their contribution to our field is given. Without the appropriate historical background, it is difficult for the current younger and next generation pediatric surgeons to grasp the full spectrum of the ongoing progress in our field. Therefore, our article conveys not only important insight into the past, but also provides young surgeons with an important historical perspective essential to understand the current and future developments in modern pediatric surgery.
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Affiliation(s)
- Michael Berger
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Lindwurmstraße 4, 80337, Munich, Germany,
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50
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Inge TH, Zeller MH, Jenkins TM, Helmrath M, Brandt ML, Michalsky MP, Harmon CM, Courcoulas A, Horlick M, Xanthakos SA, Dolan L, Mitsnefes M, Barnett SJ, Buncher R. Perioperative outcomes of adolescents undergoing bariatric surgery: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study. JAMA Pediatr 2014; 168:47-53. [PMID: 24189578 PMCID: PMC4060250 DOI: 10.1001/jamapediatrics.2013.4296] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Severe obesity in childhood is a major health problem with few effective treatments. Weight-loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally invasive procedures. OBJECTIVE To assess the preoperative clinical characteristics and perioperative safety outcomes of severely obese adolescents undergoing WLS. DESIGN, SETTING, AND PARTICIPANTS This prospective, multisite observational study enrolled patients from February 28, 2007, through December 30, 2011. Consecutive patients aged 19 years or younger who were approved to undergo WLS (n = 277) were offered enrollment into the study at 5 academic referral centers in the United States; 13 declined participation and 22 did not undergo surgery after enrollment, thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. MAIN OUTCOMES AND MEASURES This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Reoperations and hospital readmissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. RESULTS The mean (SD) age of participants was 17.1 (1.6) years and the median body mass index (calculated as weight in kilograms divided by height in meters squared) was 50.5. Fifty-one percent demonstrated 4 or more major comorbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of patients, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg, reoperation) were seen in 19 patients (8%). Minor complications (eg, readmission for dehydration) were noted in 36 patients (15%). All reoperations and 85% of readmissions were related to WLS. CONCLUSIONS AND RELEVANCE In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed a favorable short-term complication profile, supporting the early postoperative safety of WLS in select adolescents. Further longitudinal study of this cohort will permit accurate assessment of long-term outcomes for adolescents undergoing bariatric surgery. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00474318.
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Affiliation(s)
- Thomas H Inge
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary L Brandt
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | | | - Anita Courcoulas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary Horlick
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | | | - Larry Dolan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark Mitsnefes
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sean J Barnett
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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