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Cascio S, Kaefer M, Bagli D, Nelson CP, Nieuwhof-Leppink A, Braga LH, Herbst KW, Garriboli M, Kalfa N, Harper L, Fossum M. The importance of animal specificity in animal experimentation, part II: Physiological challenges and opportunities in relation to pediatric urology. J Pediatr Urol 2024; 20:315-317. [PMID: 38238242 DOI: 10.1016/j.jpurol.2023.12.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 04/22/2024]
Abstract
When performing animal experimentation in Pediatric Urology studies, it is important to be aware of physiological differences between species and to understand when relevant disease models are available. Diseased animal models may be more relevant in many cases, rather than performing studies in healthy and normally developed animals. For example, they may be more appropriate for the study of congenital malformations, to investigate the secondary effects of prenatal urinary obstruction, to study the effect of prenatal exposure to endogenous or exogenous factors which may lead to disease, or in testing bioengineered structures. In this short educational article, we aim to describe some disease models that have been used to simulate human pathologies and how, if properly designed, these studies can lead to important new knowledge for human translation. In addition, we also highlight the importance of formulating a research question(s) before deciding on the animal experimental model and species to choose.
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Affiliation(s)
- Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland, Dublin, Ireland
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Anka Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Katherine W Herbst
- Connecticut Children's Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Massimo Garriboli
- Department of Pediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Clinical Medicine, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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2
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Fossum M, Kaefer M, Bagli D, Harper L, Herbst KW, Nelson CP, Braga LH, Nieuwhof-Leppink A, Kalfa N, Garriboli M, Cascio S. The importance of animal specificity in animal experimentation, part I: Anatomy in relation to pediatric urology. J Pediatr Urol 2024; 20:312-314. [PMID: 38199905 DOI: 10.1016/j.jpurol.2023.12.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024]
Abstract
Why and when is animal experimentation relevant? The answer to this question depends on the research question. In this short educational article we aim to raise awareness of the importance of formulating a very specific research question before choosing an animal species. An awareness of anatomical and physiological differences vis-a-vis similarities between species, will increase the potential for obtaining data that is relevant for translation to human conditions.
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Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Center of Cancer and Organ Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine W Herbst
- Division of Urology, Research Institute, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital and Harvard Medical School, MA, United States
| | - Luis H Braga
- Department of Surgery, Division of Urology, McMaster University, McMaster Children's Hospital, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada
| | - Anka Nieuwhof-Leppink
- Department Urotherapy, Wilhelmina Children's Hospital, Part of University Medical Center Utrecht, Netherlands
| | - Nicolas Kalfa
- Department of Pediatric Surgery and Urology, Lapeyronie Hospital, CHU Montpellier, France; UMR1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Massimo Garriboli
- Department of Paediatric Urology, Evelina London Children's Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom
| | - Salvatore Cascio
- Department of Pediatric Surgery, School of Medicine, University College Dublin and Children's Health Ireland at Temple Street, Dublin, Ireland
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Willacy O, Juul N, Taouzlak L, Chamorro CI, Ajallouiean F, Fossum M. A perioperative layered autologous tissue expansion graft for hollow organ repair. Heliyon 2024; 10:e25275. [PMID: 38322882 PMCID: PMC10845913 DOI: 10.1016/j.heliyon.2024.e25275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/03/2024] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
Tissue engineering has not been widely adopted in clinical settings for several reasons, including technical challenges, high costs, and regulatory complexity. Here, we introduce the Perioperative Layered Autologous Tissue Expansion graft (PLATE graft), a composite biomaterial and collagen-reinforced construct with autologous epithelium on one side and smooth muscle tissue on the other. Designed to mimic the structure and function of natural hollow organs, the PLATE graft is unique in that it can be produced in a standard operating theatre and is cost-effective. In this proof-of-principle study, we test its regenerative performance in eight different organs, present biomechanical and permeability tests, and finally explore its in vivo performance in live rabbits.
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Affiliation(s)
- Oliver Willacy
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nikolai Juul
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Loai Taouzlak
- Department of Health Technology, Technical University of Denmark, 2800: Kgs, Lyngby, Denmark
| | - Clara I. Chamorro
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Fatemeh Ajallouiean
- Department of Health Technology, Technical University of Denmark, 2800: Kgs, Lyngby, Denmark
- The Danish National Research Foundation and Villum Foundation's Center for Intelligent Drug Delivery and Sensing Using Microcontainers and Nanomechanics (IDUN), Department of Health Technology, Technical University of Denmark, Ørsted Plads, 2800: Kgs, Lyngby, Denmark
| | - Magdalena Fossum
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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4
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Fossum M, Wu HY. New instructions for authors specific to studies using animal experiments. J Pediatr Urol 2024; 20:3-4. [PMID: 38044220 DOI: 10.1016/j.jpurol.2023.11.020] [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: 11/20/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet and Department of Clinical Medicine, Copenhagen University, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Hsi-Yang Wu
- Hasbro Children's Hospital, Providence, RI, United States.
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5
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Schanstra JP, Decramer S, Buffin-Meyer B, Klein J, Fossum M, Wu HY. Fetal biomarkers for lower urinary tract obstruction secondary to posterior urethral valves. J Pediatr Urol 2024:S1477-5131(24)00014-7. [PMID: 38280830 DOI: 10.1016/j.jpurol.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Today, prenatal diagnosis of congenital urogenital malformations is mostly dependent on anatomical variations found on imaging. However, these findings can mislead us in telling us when to intervene, and about post-natal prognosis. Since many findings are dependent on multiple assessments, delayed diagnosis can occur, leading to less optimal outcomes compared to early intervention. Analyses of fetal urinary biomarkers have been proposed as a method of finding biological changes that are predictive for diagnosis and prognosis in fetuses at risk of kidney disease. We interviewed a group of researchers that have demonstrated that by combining multiple omics traits extracted from fetal urine, the biological variability found in single omics data can be circumvented. By analyzing multiple fetal urine peptides and metabolites at single time point, the prognostic power of postnatal renal outcome in fetuses with lower urinary tract obstruction is significantly increased. In this interview, we inquired about the technical aspects of the tests, challenges, and limitations the research group have come across, and how they envision the future for multi-omics fetal analysis in the clinic.
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Affiliation(s)
- Joost P Schanstra
- National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Metabolic and Cardiovascular Disease, Toulouse, France; University Paul Sabatier, Toulouse III, Toulouse, France
| | - Stéphane Decramer
- National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Metabolic and Cardiovascular Disease, Toulouse, France; University Paul Sabatier, Toulouse III, Toulouse, France; Department of Pediatric Internal Medicine, Rheumatology and Nephrology, Toulouse University Hospital, Toulouse, France; Centre De Référence Des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse University Hospital, Toulouse, France
| | - Bénédicte Buffin-Meyer
- National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Metabolic and Cardiovascular Disease, Toulouse, France; University Paul Sabatier, Toulouse III, Toulouse, France
| | - Julie Klein
- National Institute of Health and Medical Research (INSERM), UMR 1297, Institute of Metabolic and Cardiovascular Disease, Toulouse, France; University Paul Sabatier, Toulouse III, Toulouse, France
| | - Magdalena Fossum
- Dept. of Pediatric Surgery, Center or Organ Diseases and Transplantation, Rigshospitalet, Dept. of Clinical Medicine, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Hsi-Yang Wu
- Division of Urology, Brown University, Providence, RI, USA
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6
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Juul N, Ajalloueian F, Willacy O, Chamorro CI, Fossum M. Advancing autologous urothelial micrografting and composite tubular grafts for future single-staged urogenital reconstructions. Sci Rep 2023; 13:15584. [PMID: 37730755 PMCID: PMC10511703 DOI: 10.1038/s41598-023-42092-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Urogenital reconstructive surgery can be impeded by lack of tissue. Further developments within the discipline of tissue engineering may be part of a solution to improve clinical outcomes. In this study, we aimed to design an accessible and easily assembled tubular graft with autologous tissue, which could be constructed and implanted as a single-staged surgical procedure within the premises of an ordinary operating room. The ultimate goals would be to optimize current treatment-options for long-term urinary diversion. Therefore, we evaluated the optimal composition of a collagen-based scaffold with urothelial micrografts in vitro, and followingly implanted the construct in vivo as a bladder conduit. The scaffold was evaluated in relation to cell regeneration, permeability, and biomechanical properties. After establishing an optimized scaffold in vitro, consisting of high-density collagen with submerged autologous micrografts and reinforced with a mesh and stent, the construct was successfully implanted in an in vivo minipig model. The construct assemblance and surgical implantation proved feasible within the timeframe of a routine surgical intervention, and the animal quickly recovered postoperatively. Three weeks post-implantation, the conduit demonstrated good host-integration with a multilayered luminal urothelium. Our findings have encouraged us to support its use in more extensive preclinical large-animal studies.
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Affiliation(s)
- Nikolai Juul
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Fatemeh Ajalloueian
- Department of Health Technology, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Oliver Willacy
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Clara Ibel Chamorro
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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7
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Juul N, Willacy O, Mamand DR, Andaloussi SE, Eisfeldt J, Chamorro CI, Fossum M. Insights into cellular behavior and micromolecular communication in urothelial micrografts. Sci Rep 2023; 13:13589. [PMID: 37604899 PMCID: PMC10442416 DOI: 10.1038/s41598-023-40049-0] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
Autologous micrografting is a technique currently applied within skin wound healing, however, the potential use for surgical correction of other organs with epithelial lining, including the urinary bladder, remains largely unexplored. Currently, little is known about the micrograft expansion potential and the micromolecular events that occur in micrografted urothelial cells. In this study, we aimed to evaluate the proliferative potential of different porcine urothelial micrograft sizes in vitro, and, furthermore, to explore how urothelial micrografts communicate and which microcellular events are triggered. We demonstrated that increased tissue fragmentation subsequently potentiated the yield of proliferative cells and the cellular expansion potential, which confirms, that the micrografting principles of skin epithelium also apply to uroepithelium. Furthermore, we targeted the expression of the extracellular signal-regulated kinase (ERK) pathway and demonstrated that ERK activation occurred predominately at the micrograft borders and that ERK inhibition led to decreased urothelial migration and proliferation. Finally, we successfully isolated extracellular vesicles from the micrograft culture medium and evaluated their contents and relevance within various enriched biological processes. Our findings substantiate the potential of applying urothelial micrografting in future tissue-engineering models for reconstructive urological surgery, and, furthermore, highlights certain mechanisms as potential targets for future wound healing treatments.
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Affiliation(s)
- Nikolai Juul
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Harpestrengs Vej 4C, 2100, Copenhagen, Denmark.
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Oliver Willacy
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Harpestrengs Vej 4C, 2100, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Doste R Mamand
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jesper Eisfeldt
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Clara I Chamorro
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Harpestrengs Vej 4C, 2100, Copenhagen, Denmark
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Laboratory of Tissue Engineering, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Henrik Harpestrengs Vej 4C, 2100, Copenhagen, Denmark.
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Laboratory of Tissue Engineering, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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8
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Nordgren A, Lindstrand A, Wu HY, Fossum M. Precision medicine and rare diseases in pediatric urology. J Pediatr Urol 2023; 19:335-338. [PMID: 37002030 DOI: 10.1016/j.jpurol.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/09/2023]
Abstract
Precision Medicine holds promise for helping us manage specific phenotypes of common diseases. For rare diseases such as hypospadias, DSD, and pediatric solid tumors, it can also reveal underlying risk factors and pathogenesis. Professors Ann Nordgren and Anna Lindstrand share their experiences in the development and ongoing initiatives of the Swedish national project on Precision Medicine and how it could change the care of pediatric urology patients.
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Affiliation(s)
- Ann Nordgren
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Institute of Biomedicine, Department of Laboratory Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Lindstrand
- Department of Molecular Medicine and Surgery, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden; Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden.
| | - Hsi-Yang Wu
- Division of Urology, Brown University, Providence, RI, USA.
| | - Magdalena Fossum
- Department of Women's and Children's Health, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden; Laboratory of Tissue Engineering Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark.
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9
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Chamorro CI, Wu HY, Fossum M. What the editors are reading - Section of basic science. J Pediatr Urol 2023:S1477-5131(23)00138-9. [PMID: 37183083 DOI: 10.1016/j.jpurol.2023.04.010] [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] [Received: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Clara I Chamorro
- Department of Women's and Children's Health, Karolinska Institutet, Sweden
| | - Hsi-Yang Wu
- Section of Pediatric Urology, Hasbro Children's Hospital, Alpert Medical School at Brown University, USA
| | - Magdalena Fossum
- Department of Women's and Children's Health, Karolinska Institutet, Sweden; Department of Pediatric Surgery, Rigshospitalet and Department of Health Sciences, Copenhagen University, Denmark.
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10
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Rawashdeh YF, Hvistendahl GM, Thorup J, Fossum M. [Not Available]. Ugeskr Laeger 2023; 185:V09220582. [PMID: 37057699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Paediatric urology is a subspeciality of urology, with close links to paediatric surgery. This review concludes that a holistic life-long approach to management in highly specialised treatment centres is essential for many of the rare congenital conditions - in Denmark, paediatric urology is centralised to two institutions: Rigshospitalet in Copenhagen and Aarhus University Hospital in Aarhus. Other than performing basic urology in paediatric patients, both centres specialise in complex and rare urological conditions and thus have been accredited by the European Reference Network on rare diseases through the eUrogen collaboration. Patient populations have covered span from prenatal to childhood, transition and for some anomalies, even into adulthood.
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Affiliation(s)
- Yazan F Rawashdeh
- Børneurologisk Sektion, Urinvejskirurgisk Afdeling, Aarhus Universitetshospital
- Institut for Klinisk Medicin, Aarhus Universitet
| | - Gitte M Hvistendahl
- Børneurologisk Sektion, Urinvejskirurgisk Afdeling, Aarhus Universitetshospital
| | - Jørgen Thorup
- Sektion for Børnekirurgi, Afdeling for Organkirurgi og Transplantation, Københavns Universitetshospital - Rigshospitalet
- Institut for Klinisk Medicin, Københavns Universitet
| | - Magdalena Fossum
- Sektion for Børnekirurgi, Afdeling for Organkirurgi og Transplantation, Københavns Universitetshospital - Rigshospitalet
- Institut for Klinisk Medicin, Københavns Universitet
- Institutionen för kvinnors och barns hälsa, Karolinska Institutet, Sverige
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11
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Szymanski KM, Kaefer M, Fossum M, Kalfa N, Herbst KW, Braga LH, Cascio S, Garriboli M, Nelson CP, Nieuwhoff-Leppink A, Bagli D, Harper L. What are validated questionnaires and which ones measure quality of life? J Pediatr Urol 2023:S1477-5131(23)00121-3. [PMID: 37080794 DOI: 10.1016/j.jpurol.2023.03.034] [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] [Received: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 04/22/2023]
Affiliation(s)
- Konrad M Szymanski
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Magdalena Fossum
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luis H Braga
- McMaster University/Department of Surgery/Urology, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Salvatore Cascio
- Department of Paediatric Urology, Children's Health Ireland at Temple Street, Dublin, Ireland; University College Dublin, Ireland
| | - Massimo Garriboli
- Paediatric Urology, Evelina London Children's Hospital, London, United Kingdom; Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, United Kingdom
| | - Caleb P Nelson
- Urology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115, United States
| | - Anka Nieuwhoff-Leppink
- Department Psychology, Urotherapy and Urology Section, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
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12
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Nordenskjöld A, Arkani S, Pettersson M, Winberg J, Cao J, Fossum M, Anderberg M, Barker G, Holmdahl G, Lundin J. Copy number variants suggest different molecular pathways for the pathogenesis of bladder exstrophy. Am J Med Genet A 2023; 191:378-390. [PMID: 36349425 PMCID: PMC10100507 DOI: 10.1002/ajmg.a.63031] [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] [Received: 07/04/2022] [Revised: 08/05/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
Bladder exstrophy is a rare congenital malformation leaving the urinary bladder open in the midline of the abdomen at birth. There is a clear genetic background with chromosome aberrations, but so far, no consistent findings apart from 22q11-duplications detected in about 2%-3% of all patients. Some genes are implicated like the LZTR1, ISL1, CELSR3, and the WNT3 genes, but most are not explained molecularly. We have performed chromosomal microarray analysis on a cohort of 140 persons born with bladder exstrophy to look for submicroscopic chromosomal deletions and duplications. Pathogenic or possibly pathogenic microdeletions or duplications were found in 16 patients (11.4%) and further 9 with unknown significance. Two findings were in regions linked to known syndromes, two findings involved the same gene (MCC), and all other findings were unique. A closer analysis suggests a few gene networks that are involved in the pathogenesis of bladder exstrophy; the WNT-signaling pathway, the chromosome 22q11 region, the RIT2 and POU families, and involvement of the Golgi apparatus. Bladder exstrophy is a rare malformation and is reported to be associated with several chromosome aberrations. Our data suggest involvement of some specific molecular pathways.
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Affiliation(s)
- Agneta Nordenskjöld
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Pediatric Surgery, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Samara Arkani
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Urology, Danderyds Hospital, Danderyd, Sweden
| | - Maria Pettersson
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Winberg
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jia Cao
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Surgery, Copenhagen University, Righospitalet, København, Denmark
| | - Magnus Anderberg
- Department of Pediatric Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Gillian Barker
- Department of Pediatric Surgery, Uppsala Academic Hospital, Uppsala, Sweden
| | - Gundela Holmdahl
- Department of Women's and Children's Health, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Pediatric Surgery, Astrid Lindgren Children Hospital, Karolinska University Hospital, Stockholm, Sweden.,Sahlgrenska Academy, Women's and Children's Health, Gothenburg, Sweden.,Department of Pediatric Surgery, Queen Silvia's Children's Hospital, Gothenburg, Sweden
| | - Johanna Lundin
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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13
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Phillips L, Dennermalm N, Örtqvist L, Engberg H, Holmdahl G, Fossum M, Möller A, Nordenskjöld A. A qualitative content analysis of the experience of hypospadias care: The importance of owning your own narrative. Front Pediatr 2023; 11:1118586. [PMID: 36873641 PMCID: PMC9982152 DOI: 10.3389/fped.2023.1118586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/31/2023] [Indexed: 02/19/2023] Open
Abstract
OBJECTIVES There is a lack of studies on men's individual experiences of living with hypospadias. We aimed to explore the personal experiences of having hypospadias in relation to healthcare and surgery. SUBJECTS AND METHODS Purposive sampling was used to include men (aged 18 and over) with hypospadias representing different phenotypes (from distal to proximal) and ages in order to maximise the variation and richness of our data. Seventeen informants, aged 20-49, were included in the study. In-depth semi-structured interviews were conducted between 2019 and 2021. Inductive qualitative content analysis was used to analyse the data. RESULTS We identified three categories: (1) Having surgery, which comprised the decision to operate, the experience of having surgery, and the outcomes of surgery; (2) Going to the doctor, which focused on follow-up care, re-entering care in adolescence or adulthood, and the experience of healthcare interactions; (3) Being informed, both about hypospadias in general, as well as about your specific body and medical history. There was overall a large variation in experiences. The latent theme across the data was the importance of owning your own narrative. CONCLUSION The experience of men with hypospadias in healthcare is complex and varied, highlighting the difficulty of fully standardised care. Based on our results, we suggest that follow-up should be offered in adolescence, and that ways of accessing care for late onset complications be made clear. We further suggest clearer consideration for the psychological and sexual aspects of hypospadias. Consent and integrity in all aspects and all ages of hypospadias care should be adapted to the maturity of the individual. Access to trustworthy information is key, both directly from educated healthcare staff and if possible, from websites or patient-led forums. Healthcare can play a key role in providing the growing individual with tools to understand and address concerns that may develop relating to their hypospadias through life, giving them ownership over their own narrative.
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Affiliation(s)
- Lottie Phillips
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Lisa Örtqvist
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hedvig Engberg
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Gundela Holmdahl
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery and Faculty of Health and Medical Sciences, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Anders Möller
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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14
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Fossum M, Kaefer M, Herbst KW, Harper L, Beckers GMA, Nelson CP, Garriboli M, Nieuwhof-Leppink A, Bagli D, Kalfa N. The orchestration of gene expression and the editing role of microRNA. J Pediatr Urol 2022:S1477-5131(22)00631-3. [PMID: 36653199 DOI: 10.1016/j.jpurol.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022]
Abstract
In this short educational communication the ESPU Research Committee presents the role of non-coding RNA and how these can affect gene expression. In particular we discuss the role of microRNA on post transcriptional changes and how these may cause pathological conditions within Pediatric Urology and how microRNA could be useful in future clinical practice.
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Affiliation(s)
- M Fossum
- Department of Pediatric Surgery, Rigshospitalet, Dept of Medical Sciences, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | | | - C P Nelson
- Department of Urology, Boston Children's Hospital and Department of Surgery, Harvard Medical School, Harvard University, Boston, MA, USA
| | - M Garriboli
- Department of Paediatric Urology, Evelina Children's Hospital, Guy's and St. Thomas NHS Foundation Trust, London, United Kingdom
| | - A Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, Montpellier, France
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15
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Hildorf SE, Clasen-Linde E, Cortes D, Fossum M, Thorup J. The positive predictive value of using fsh and Inhibin-B serum levels to diagnose gonadotropin insufficiency in bilateral cryptorchid boys is high. J Pediatr Urol 2022; 18:844.e1-844.e7. [PMID: 36404197 DOI: 10.1016/j.jpurol.2022.10.031] [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: 01/27/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022]
Abstract
AIM OF STUDY Despite early surgery, many boys with bilateral cryptorchidism at surgery have a reduced number of germ cells per tubular cross-section (G/T) in testicular biopsies and/or low inhibin-B with no elevated follicle-stimulating hormone (FSH) as expected based on a normal gonadotropin feed-back mechanism. Such boys have a high risk of later infertility because of insufficient gonadotropin stimulation and may benefit from adjuvant hormonal treatment. Testicular biopsies are not always wanted or accepted. The study aim was to investigate the value of a low inhibin-B and normal FSH to identify patients that might benefit from adjuvant hormonal treatment avoiding the need for testicular biopsy. METHODS A series of boys with cryptorchidism were evaluated with serum levels of inhibin-B and FSH in relation to G/T in testicular biopsies, which were compared to previously published age-matched normal control values. RESULTS A total of 365 boys who underwent bilateral orchidopexy between 0.4 and 7.8 (median: 2) years of age were included. Twenty-seven (7%) patients had increased FSH and low G/T, whereas 11 of these also had low inhibin-B indicating hypergonadotropic hypogonadism. Moreover, 85 (23%) patients between 0.75 and 7.5 (median: 2) years of age had both low G/T (median: 0.3) and low inhibin-B (median: 56 pg/ml) but normal FSH (median: 0.6 U/l) indicating a gonadotropin insufficiency. Three patients with normal FSH and low inhibin B had normal G/T. DISCUSSION Our study shows that if surgeons prefer to avoid testicular biopsies and only wish to rely on hormonal parameters (low inhibin-B and normal FSH) in order to diagnose a gonadotropin insufficiency as the cause of hypogonadism, they will identify only about 30% of such cases and overlook about 70% of patients sharing the same endocrinopathy. In addition, if surgeons treat patients for gonadotropin insufficiency only based on low inhibin-B and normal FSH they will solely treat patients with gonadotropin insufficiency and would not overtreat patients. CONCLUSION Adjuvant hormonal treatment was indicated by a gonadotropin insufficiency discerned in 23% of boys with bilateral cryptorchidism. Without histology, the clinicians are left with more difficult clinical judgments to identify patients for adjuvant hormonal treatment. The positive predictive value of low inhibin-B and normal FSH corroborated by low G/T was 0.97 (85/85 + 3), but the sensitivity was low (0.30).
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Affiliation(s)
- Simone E Hildorf
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Hvidovre, Denmark
| | - Magdalena Fossum
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jorgen Thorup
- Department of Paediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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16
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Souche E, Beltran S, Brosens E, Belmont JW, Fossum M, Riess O, Gilissen C, Ardeshirdavani A, Houge G, van Gijn M, Clayton-Smith J, Synofzik M, de Leeuw N, Deans ZC, Dincer Y, Eck SH, van der Crabben S, Balasubramanian M, Graessner H, Sturm M, Firth H, Ferlini A, Nabbout R, De Baere E, Liehr T, Macek M, Matthijs G, Scheffer H, Bauer P, Yntema HG, Weiss MM. Recommendations for whole genome sequencing in diagnostics for rare diseases. Eur J Hum Genet 2022; 30:1017-1021. [PMID: 35577938 PMCID: PMC9437083 DOI: 10.1038/s41431-022-01113-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/21/2022] [Indexed: 12/23/2022] Open
Abstract
In 2016, guidelines for diagnostic Next Generation Sequencing (NGS) have been published by EuroGentest in order to assist laboratories in the implementation and accreditation of NGS in a diagnostic setting. These guidelines mainly focused on Whole Exome Sequencing (WES) and targeted (gene panels) sequencing detecting small germline variants (Single Nucleotide Variants (SNVs) and insertions/deletions (indels)). Since then, Whole Genome Sequencing (WGS) has been increasingly introduced in the diagnosis of rare diseases as WGS allows the simultaneous detection of SNVs, Structural Variants (SVs) and other types of variants such as repeat expansions. The use of WGS in diagnostics warrants the re-evaluation and update of previously published guidelines. This work was jointly initiated by EuroGentest and the Horizon2020 project Solve-RD. Statements from the 2016 guidelines have been reviewed in the context of WGS and updated where necessary. The aim of these recommendations is primarily to list the points to consider for clinical (laboratory) geneticists, bioinformaticians, and (non-)geneticists, to provide technical advice, aid clinical decision-making and the reporting of the results.
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Affiliation(s)
- Erika Souche
- Center for Human Genetics, KU Leuven, Gasthuisberg, Laboratory for Molecular Diagnosis, Leuven, Belgium
| | - Sergi Beltran
- CNAG-CRG, Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona (UB), Barcelona, Spain
| | - Erwin Brosens
- Erasmus MC University Medical Center - Sophia Children's Hospital, Department of Clinical Genetics, Rotterdam, The Netherlands
| | - John W Belmont
- Illumina, Inc., Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Magdalena Fossum
- Dept of Pediatric Surgery, Rigshospitalet, Faculty of Health and Medical Sciences, Copenhagen University, Denmark, Dept. of Women's and Children's health, Karolinska Institute, Stockholm, Sweden
| | - Olaf Riess
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Christian Gilissen
- Department of Human Genetics and Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, 6525 GA, The Netherlands
| | | | - Gunnar Houge
- Department of Medical Genetics, Haukeland University Hospital, 5021, Bergen, Norway
| | - Marielle van Gijn
- Department of Genetics, University Medical Center Groningen, University Groningen, Groningen, The Netherlands
| | - Jill Clayton-Smith
- Manchester Centre For Genomic Medicine, University of Manchester, St Mary's Hospital, Manchester, M13 9WL, UK
- Division of Evolution and Genomic Sciences School of Biological Sciences University of Manchester, Manchester, UK
| | - Matthis Synofzik
- Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Nicole de Leeuw
- Department of Human Genetics, and Donders Centre for Cognitive Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zandra C Deans
- Genomics Quality Assessment, NHS Lothian, Edinburgh, Scotland
| | - Yasemin Dincer
- Lehrstuhl für Sozialpädiatrie, Technische Universität München, Munich, Germany
- Zentrum für Humangenetik und Laboratoriumsdiagnostik (MVZ), Martinsried, Germany
| | | | - Saskia van der Crabben
- Amsterdam University Medical Centers, location AMC, Department of Clinical Genetics, Amsterdam, The Netherlands
| | - Meena Balasubramanian
- Highly Specialised Osteogenesis Imperfecta Service and Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK
- Department of Oncology & Metabolism, University of Sheffield, Sheffield, UK
| | - Holm Graessner
- University Hospital Tübingen, Institute for Medical Genetics and Applied Genomics and Centre for Rare Diseases, Calwerstr. 7, 72076, Tübingen, Germany
| | - Marc Sturm
- Institute of Medical Genetics and Applied Genomics, University of Tübingen, Tübingen, Germany
| | - Helen Firth
- Dept of Clinical Genetics, Box 134, Cambridge University Hospitals, Cambridge, UK
| | - Alessandra Ferlini
- Unit of Medical Genetics, University Hospital & Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rima Nabbout
- Pediatric Neurology. reference centre for rare epilepsies. Hôpital Necker Enfants malades, APHP, Université de Paris, Institut Imagine (INSERM UMR 1163), Paris, France
| | - Elfride De Baere
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Thomas Liehr
- Jena University Hospital, Friedrich Schiller University, Institute of Human Genetics, Jena, Germany
| | - Milan Macek
- Department of biology and medical genetics, 2nd Faculty of Medicine Charles University and University hospital Motol, Prague, Czechia
| | - Gert Matthijs
- Center for Human Genetics, KU Leuven, Gasthuisberg, Laboratory for Molecular Diagnosis, Leuven, Belgium
| | - Hans Scheffer
- Radboud university medical center, Department of Human Genetics, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Peter Bauer
- CENTOGENE GmbH, Am Strande 7, 18055, Rostock, Germany
| | - Helger G Yntema
- Radboud university medical center, Department of Human Genetics, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marjan M Weiss
- Radboud university medical center, Department of Human Genetics, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
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17
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Bagli D, Fossum M, Harper L, Herbst K, Nieuwhof-Leppink A, Beckers GMA, Kalfa N, Kaefer M. Epigenetics: Through the pediatric urology looking glass. J Pediatr Urol 2022; 18:464-465. [PMID: 35798630 DOI: 10.1016/j.jpurol.2022.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Magdalena Fossum
- Department of Pediatric Surgery, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Anka Nieuwhof-Leppink
- Department Psychology, Urotherapy and Urology Section, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | | | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, and Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France; Institut Debrest de Santé Publique IDESP, UMR INSERM - Université Montpellier, France
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
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18
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Juul N, Cazals A, Hofmann A, Amesty V, Verkauskas G, Dobrowolska-Glazar B, Holmdahl G, Escolino M, Birraux J, Kovacs T, Kalfa N, Fossum M. How the First Year of COVID-19 Affected Elective Pediatric Urology Patients: A Longitudinal Study Based on Waiting Lists and Surveys From 10 European Centers. Front Public Health 2022; 10:874758. [PMID: 35570885 PMCID: PMC9096088 DOI: 10.3389/fpubh.2022.874758] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction COVID-19 impacted healthcare systems worldwide, and elective surgical activity was brought to a minimum. Although children were not primarily affected by the disease, pediatric urology was halted by clinical closedown and staff allocation. We aimed to document how these prioritizations affected waiting lists, and to investigate how European centers dealt with the challenge of these logistical and financial prioritizations. Materials and Methods This was a 1-year prospective study, starting March 2020. Participants were surveyed at 3-month intervals about waiting lists for several common procedures as well as OR capacity and funding. Further, centers retrospectively reported on surgical and outpatient activity rates during 2019–2021. Waiting list tendencies were evaluated in relation to study baseline. Results A marked decrease in surgical and outpatient activity was seen in the spring of 2020. Some included pediatric urology centers were able to increase their budget (15%) and staff working hours (20%) during part of the study period. Still, at the end of the study, the centers had increased the total number of patients on waiting lists with 11%, whereas the average days on waiting lists had accumulated with 73%, yielding a total of 6,102 accumulated waiting days in the study population. Centers with decreased resources had markedly negative effects on waiting lists. Conclusions Correlations between COVID-19 derived burdening of healthcare systems and the availability of pediatric urology greatly depends on the prioritizations made at individual centers. Ongoing monitoring of these correlations is warranted to safely avoid unnecessary negative impact on the pediatric population.
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Affiliation(s)
- Nikolai Juul
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Aurélie Cazals
- Service de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France
| | - Aybike Hofmann
- Department of Pediatric Urology, KUNO Clinic St. Hedwig, University Medical Center, Regensburg, Germany
| | - Virginia Amesty
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Gilvydas Verkauskas
- Children's Surgery, Orthopedics and Traumatology Center, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Gundela Holmdahl
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Maria Escolino
- Pediatric Surgery and Urology Unit, Federico II University Hospital, Naples, Italy
| | - Jacques Birraux
- Service de Chirurgie de l'Enfant et de l'Adolescent, Centre Universitaire romand de Chirurgie Pédiatrique, Hôpitaux Universitaire de Genève, Genève, Switzerland
| | - Tamas Kovacs
- Division of Pediatric Surgery, Department of Pediatrics, Albert Szent-Gyorgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Nicolas Kalfa
- Service de Chirurgie Viscérale et Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Montpellier, France.,Université de Montpellier, Institut Debrest de Santé Publique IDESP, UMR INSERM, Montpellier, France
| | - Magdalena Fossum
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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19
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Ladefoged MR, Korang SK, Hildorf SE, Oehlenschlæger J, Poulsen S, Fossum M, Lausten-Thomsen U. Necessity of Prophylactic Extrapleural Chest Tube During Primary Surgical Repair of Esophageal Atresia: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:849992. [PMID: 35372168 PMCID: PMC8971748 DOI: 10.3389/fped.2022.849992] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/21/2022] [Indexed: 11/22/2022] Open
Abstract
Background Esophageal atresia is corrected surgically by anastomosing and recreating esophageal continuity. To allow the removal of excess fluid and air from the anastomosis, a prophylactic and temporary intraoperative chest tube (IOCT) has traditionally been placed in this area during surgery. However, whether the potential benefits of this prophylactic IOCT overweigh the potential harms is unclear. Objective To assess the benefits and harms of using a prophylactic IOCT during primary surgical repair of esophageal atresia. Data Sources We conducted a systematic review with a meta-analysis. We searched Cochrane Central Register of Controlled Trials (2021, Issue 12), MEDLINE Ovid, Embase Ovid, CINAHL, and Science Citation Index Expanded and Conference Proceedings Citation Index-(Web of Science). Search was performed from inception until December 3rd, 2021. Study Selection Randomized clinical trials (RCT) assessing the effect of a prophylactic IOCT during primary surgical repair of esophageal atresia and observational studies identified during our searches for RCT. Data Extraction and Synthesis Two independent reviewers screened studies and performed data extraction. The certainty of the evidence was assessed by GRADE and ROBINS-I. PROSPERO Registration A protocol for this review has been registered on PROSPERO (CRD42021257834). Results We included three RCTs randomizing 162 neonates, all at overall "some risk of bias." The studies compared the placement of an IOCT vs. none. The meta-analysis did not identify any significant effect of profylacitic IOCT, as confidence intervals were compatible with no effect, but the analyses suggests that the placement of an IOCT might lead to an increase in all-cause mortality (RR 1.66, 95% CI 0.76-3.65; three trials), serious adverse events (RR 1.08, 95% CI 0.58-2.00; three trials), intervention-requiring pneumothorax (RR 1.65, 95% CI 0.28-9.50; two trials), and anastomosis leakage (RR 1.66, 95% CI 0.63-4.40). None of our included studies assessed esophageal stricture or pain. Certainty of evidence was very low for all outcomes. Conclusions Evidence from RCTs does not support the routine use of a prophylactic IOCT during primary surgical repair of esophageal atresia.
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Affiliation(s)
- Martin Riis Ladefoged
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steven Kwasi Korang
- Copenhagen Trial Unit, Department 7812, Centre for Clinical Intervention Research, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Anesthesiology Critical Care Medicine, Childrens Hospital Los Angeles, Los Angeles, CA, United States
| | - Simone Engmann Hildorf
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jacob Oehlenschlæger
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Poulsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magdalena Fossum
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Paediatric Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ulrik Lausten-Thomsen
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Hildorf S, Clasen-Linde E, Cortes D, Fossum M, Thorup J. Serial Inhibin B Measurements in Boys with Congenital Monorchism Indicate Compensatory Testicular Hypertrophy in Early Infancy. Eur J Pediatr Surg 2022; 32:34-41. [PMID: 34847577 DOI: 10.1055/s-0041-1739417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/19/2022]
Abstract
AIM Congenital monorchism is considered a condition in which an initially normal testis has existed but subsequently atrophied and disappeared due to a third trimester catastrophe (presumably torsion). Since inhibin B concentrations appear related to Sertoli and germ cells number, we evaluated pre- and postoperative inhibin B of boys with congenital monorchism to determine whether the well-known hypertrophy of the contralateral testis was reflected in inhibin B concentrations. MATERIALS AND METHODS Twenty-seven boys consecutively diagnosed with congenital monorchism (median age 12 months) underwent follow-up with reproductive hormones 1 year postoperatively (median age 25 months). The results were compared with inhibin B of 225 boys with congenital nonsyndromic unilateral cryptorchidism, by converting values to multiple of the median (MoM) for age in normal boys. RESULTS Ten boys (37%) had blind-ending vessels and ductus deferens (vanished testis) and the remaining (63%) had testicular remnants. At the time of diagnostic procedure, monorchid boys did not have significantly lower inhibin B (median 114, range 20-208) than unilateral cryptorchid boys (136, 47-393) (p = 0.27). During follow-up, MoM values of inhibin B increased in monorchid boys (median 0.59 to 0.98) and in unilateral cryptorchid boys (0.69 to 0.89) (both p < 0.0001). Compared with the concentration at surgery, an additional 44% monorchid boys had inhibin B MoM values higher than 1.0, whereas only additional 23% of unilateral cryptorchid boys exhibited such values (p = 0.04). CONCLUSION Generally, inhibin B MoM values were normalized during follow-up in boys with congenital monorchism, reflecting compensatory hypertrophy within the first 2.5 years of life. The compensatory capacity to increase was better in monorchism than in unilateral cryptorchidism.
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Affiliation(s)
- Simone Hildorf
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Dina Cortes
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatric Surgery, Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Jorgen Thorup
- Department of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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21
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Juul N, Fossum M, Wu HY. What the editors are reading - Basic science. J Pediatr Urol 2022; 18:94-95. [PMID: 35131197 DOI: 10.1016/j.jpurol.2021.12.020] [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] [Received: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Nikolai Juul
- Department of Pediatric Surgery, Copenhagen University Rigshospitalet, Denmark.
| | - Magdalena Fossum
- Copenhagen University Rigshospitalet, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Sweden.
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22
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Juul N, Persad E, Willacy O, Thorup J, Fossum M, Reinhardt S. Robot-Assisted vs. Open Appendicovesicostomy in Pediatric Urology: A Systematic Review and Single-Center Case Series. Front Pediatr 2022; 10:908554. [PMID: 35685916 PMCID: PMC9171498 DOI: 10.3389/fped.2022.908554] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/02/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Appendicovesicostomy (APV) is the preferred choice of continent catheterizable channels in pediatric urology. The introduction of robot-assisted laparoscopic techniques has been correlated to superior cosmesis and convalescence and is now increasingly implemented for APV procedures. We aimed to perform a systematic review of the literature comparing open vs. robotic APV regarding possible differences in postoperative outcomes and to evaluate these findings with our own initial experiences with robotic APV compared to our previous open procedures. METHODS We evaluated the first five patients undergoing robotic APV at our institution and compared 1-year outcomes with a consecutive series of 12 patients undergoing open APV. In a systematic literature review, we screened studies from PubMed, EMBASE, and CENTRAL comparing open and robotic APV in pediatric urology (current to December 2021) and performed meta-analyses on postoperative outcomes comparing the two groups and evaluated the grade of evidence. RESULTS We found significantly shortened postoperative length of stay in the robotic group (p = 0.001) and comparable 1-year complication rates in robotic vs. open APV patients. We systematically screened 3,204 studies and ultimately included three non-randomized studies comparing postoperative outcomes of robotic and open APV for quantitative analysis. The open and robotic approaches performed equally well regarding overall postoperative complications, surgical reintervention, and stomal stenosis. Two of the included studies reported comparable stomal continence rates and shortened postoperative length of stay in the robotic group, in agreement with the findings in our own series. CONCLUSION Robotic APV is equally safe to the conventional open approach with additional advantages in postoperative hospitalization length.
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Affiliation(s)
- Nikolai Juul
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emma Persad
- Department of Evidence-Based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Oliver Willacy
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jorgen Thorup
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Magdalena Fossum
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Reinhardt
- Division of Pediatric Surgery, Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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23
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Juul N, Willacy O, Maagaard M, Olsen T, Ek J, Ifaoui I, Fossum M. Simultaneous debut of spontaneous intestinal perforation in a pair of preterm monozygotic twins assessed by whole genome sequencing. Journal of Pediatric Surgery Case Reports 2022. [DOI: 10.1016/j.epsc.2021.102123] [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: 11/24/2022] Open
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24
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Kaefer M, Bagli D, Kalfa N, Beckers GMA, Harper L, Herbst K, Nieuwhof-Leppink A, Fossum M. Genetics: The diagnostic frontier in pediatric urology. J Pediatr Urol 2021; 17:803-804. [PMID: 34607751 DOI: 10.1016/j.jpurol.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
In the course of human history few scientific breakthroughs can rival the importance of the discovery of DNA. Our ever increasing ability to unravel the secrets contained in this molecule allow new insight in to the etiology and eventual treatment of human conditions ranging from congenital structural disorders to cancer. It is the focus of this article to touch upon sequencing technologies and their potential to provide information that can revolutionize healthcare.
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Affiliation(s)
- Martin Kaefer
- Riley Hospital for Children, Pediatric Urology, Indiana University, Indianapolis, IN, United States.
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pediatrique, Hopital Lapeyronie, CHU de Montpellier, Universite de Montpellier, France
| | - Goedele M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Luke Harper
- Service de Chirurgie Pediatrique, Hopital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Katherine Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Anka Nieuwhof-Leppink
- University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, Netherlands
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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25
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Djurhuus JC, Wu HY, Fossum M. A conversation on how animal experimental studies allies with translational medicine. J Pediatr Urol 2021; 17:622-629. [PMID: 34420875 DOI: 10.1016/j.jpurol.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
Basis science research in pediatric urology studies physiological questions in animal models to provide new data on how to treat patients. We sat down with Jens-Christian Djurhuus to discuss both practical and philosophical questions on how to best perform basic science research. Initial questions such as "What type of questions are best studied in animal models?" and "Which animal model should I use?" help us answer the basic question of "What is a good research topic?". To take advantage of his experience leading a research team, we went on to discuss "How do you lead a research team?" and "How do we make sure that basic science research translates to clinical practice?". As research funding becomes scarce, we thank Professor Djurhuus for his insights on how to focus basic science research on relevant topics that are easily translatable to the care of children.
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Affiliation(s)
| | - His-Yang Wu
- Brown University, Division of Urology, Providence, RI, USA
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet. Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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26
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Harper L, Bagli D, Kaefer M, Kalfa N, Beckers GMA, Nieuwhof-Leppink AJ, Fossum M, Herbst KW. COVID-19 and research in pediatric urology. J Pediatr Urol 2021; 17:569-570. [PMID: 33966999 PMCID: PMC8053218 DOI: 10.1016/j.jpurol.2021.04.004] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/11/2021] [Indexed: 11/07/2022]
Abstract
COVID-19 began in December 2019 then spread worldwide. Providers, including pediatric urologists, had to adapt their clinical processes, and many non-covid research activities were suspended. COVID-19 impacts how research is financed, performed, and published, and is itself the subject of intense research. We present current research and publications specifically related to the urinary tract and the pediatric population.
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada.
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States.
| | - N Kalfa
- Department of Pediatric Urology and Pediatric Surgery, Hopital Lapeyronie, CHU de Montpellier et Université de Montpellier, France and Institut Desbrest d'Epidemiologie et de Santé Publique IDESP, Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - M Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
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27
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Wu HY, Willacy O, Fossum M. What the Editors are reading - Basic science. J Pediatr Urol 2021; 17:271-272. [PMID: 33358556 DOI: 10.1016/j.jpurol.2020.12.010] [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] [Received: 12/08/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022]
Affiliation(s)
| | | | - Magdalena Fossum
- Copenhagen University Rigshospitalet, Denmark; Karolinska Institutet, Sweden
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28
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Hildorf S, Cortes D, Clasen-Linde E, Fossum M, Thorup J. The impact of early and successful orchidopexy on hormonal follow-up for 208 boys with bilateral non-syndromic cryptorchidism. Pediatr Surg Int 2021; 37:339-345. [PMID: 33423103 DOI: 10.1007/s00383-020-04820-y] [Citation(s) in RCA: 4] [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] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Inhibin-B is produced by Sertoli cells and decreased values might be associated with impaired fertility potential. The aim of the study was to evaluate the impact of bilateral orchidopexy on serum inhibin-B and follicle-stimulating hormone (FSH). METHODS A cohort study including 208 bilateral cryptorchid boys (median age: 1.7 year) was evaluated with serum inhibin-B and FSH in relation to histological parameters. Based on the fertility potential, the boys were divided into three subgroups. At follow-up (median age: 2.7 years) the boys were evaluated with FSH and in case of inhibin-B using multiple of the median (MoM). RESULTS Inhibin-B MoM improved significantly at follow-up. In 32 boys with high FSH at orchidopexy 63% normalized FSH and 59% increased MoM inhibin-B, but 31% had impaired inhibin-B at follow-up. In 105 boys with transient hypogonadotropic hypogonadism, 52% increased inhibin-B MoM but 31% had impaired inhibin-B at follow-up. In 71 boys with normal FSH, inhibin-B, and G/T, 54% increased inhibin-B MoM and 15% had impaired inhibin-B at follow-up. The effect of the surgery was best in patients younger than 1 year. CONCLUSION Orchidopexy, especially before 1 year of age, improves the fertility potential in bilateral cryptorchidism. At follow-up, 26% (54/208) had a risk of infertility based on inhibin-B.
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Affiliation(s)
- Simone Hildorf
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark. .,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Dina Cortes
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics and Adolescence Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jorgen Thorup
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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29
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Amesty MV, Chamorro CI, López-Pereira P, Martínez-Urrutia MJ, Sanz B, Rivas S, Lobato R, Fossum M. Creation of Tissue-Engineered Urethras for Large Urethral Defect Repair in a Rabbit Experimental Model. Front Pediatr 2021; 9:691131. [PMID: 34239850 PMCID: PMC8258112 DOI: 10.3389/fped.2021.691131] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction: Tissue engineering is a potential source of urethral substitutes to treat severe urethral defects. Our aim was to create tissue-engineered urethras by harvesting autologous cells obtained by bladder washes and then using these cells to create a neourethra in a chronic large urethral defect in a rabbit model. Methods: A large urethral defect was first created in male New Zealand rabbits by resecting an elliptic defect (70 mm2) in the ventral penile urethra and then letting it settle down as a chronic defect for 5-6 weeks. Urothelial cells were harvested noninvasively by washing the bladder with saline and isolating urothelial cells. Neourethras were created by seeding urothelial cells on a commercially available decellularized intestinal submucosa matrix (Biodesign® Cook-Biotech®). Twenty-two rabbits were divided into three groups. Group-A (n = 2) is a control group (urethral defect unrepaired). Group-B (n = 10) and group-C (n = 10) underwent on-lay urethroplasty, with unseeded matrix (group-B) and urothelial cell-seeded matrix (group-C). Macroscopic appearance, radiology, and histology were assessed. Results: The chronic large urethral defect model was successfully created. Stratified urothelial cultures attached to the matrix were obtained. All group-A rabbits kept the urethral defect size unchanged (70 ± 2.5 mm2). All group-B rabbits presented urethroplasty dehiscence, with a median defect of 61 mm2 (range 34-70). In group-C, five presented complete correction and five almost total correction with fistula, with a median defect of 0.3 mm2 (range 0-12.5), demonstrating a significant better result (p = 7.85 × 10-5). Urethrography showed more fistulas in group-B (10/10, versus 5/10 in group-C) (p = 0.04). No strictures were found in any of the groups. Group-B histology identified the absence of ventral urethra in unrepaired areas, with squamous cell metaplasia in the edges toward the defect. In group-C repaired areas, ventral multilayer urothelium was identified with cells staining for urothelial cell marker cytokeratin-7. Conclusions: The importance of this study is that we used a chronic large urethral defect animal model and clearly found that cell-seeded transplants were superior to nonseeded. In addition, bladder washing was a feasible method for harvesting viable autologous cells in a noninvasive way. There is a place for considering tissue-engineered transplants in the surgical armamentarium for treating complex urethral defects and hypospadias cases.
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Affiliation(s)
| | - Clara Ibel Chamorro
- Department of Women's and Children's Health, Bioclinicum J10:20, Karolinska Institutet, Stockholm, Sweden
| | - Pedro López-Pereira
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Beatriz Sanz
- Department of Cell Culture, IdiPAZ Instituto de Investigación Hospital Universitario La Paz, Madrid, Spain
| | - Susana Rivas
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Roberto Lobato
- Department of Pediatric Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Magdalena Fossum
- Department of Women's and Children's Health, Bioclinicum J10:20, Karolinska Institutet, Stockholm, Sweden.,Division of Pediatric Surgery, Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Health Sciences, Copenhagen University, Copenhagen, Denmark
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30
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Hildorf S, Cortes D, Gül M, Dong L, Kristensen SG, Jensen CFS, Clasen-Linde E, Fedder J, Andersen CY, Hoffmann ER, Sønksen J, Fossum M, Thorup J. Parental Acceptance Rate of Testicular Tissue Cryopreservation in Danish Boys with Cryptorchidism. Sex Dev 2020; 13:246-257. [PMID: 33080598 DOI: 10.1159/000511158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Abstract
Despite orchidopexy within the first year of life, 20-25% of boys with nonsyndromic cryptorchidism may risk infertility according to histological and hormonal data obtained during surgery. The aim of this study was to evaluate the acceptance rate of testicular tissue cryopreservation among parents of prepubertal boys with cryptorchidism. Fourteen boys with cryptorchidism and high infertility risk were offered cryopreservation as an additional procedure after orchidopexy based on abnormal histopathological findings at primary surgery, whereas 27 boys with bilateral cryptorchidism were offered cryopreservation at the initial orchidopexy. A total of 90% of parents (37/41, 13/14, and 24/27) gave consent to perform cryopreservation, despite being well-informed that the procedural efficacy is largely unproven and may only be needed in about 20% of cases. The number of germ cells per tubule cross-section was 0.03-1.70 (median 0.37) and 22 boys (54%, 22/41) had a value below the lower range. Twelve boys (29%, 12/41) had no type A dark spermatogonia in their biopsy. Cryopreservation of testicular tissue is the first step to introduce spermatogonial stem cell-based therapy into clinical male infertility treatment. At the time of orchidopexy, a testicular biopsy can be collected to ascertain the infertility risk, and it may be an option for boys with bilateral cryptorchidism to have spermatogonial stem cells frozen as a fertility reserve.
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Bägli D, Beckers G, Fossum M, Harper L, Herbst K, Kaefer M, Kalfa N, Nieuwhof-Leppink A. To: Adult and pediatric urology department/division chairs and pediatric urology fellowship programme directors. J Pediatr Urol 2020; 16:731-732. [PMID: 32830061 DOI: 10.1016/j.jpurol.2020.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 11/29/2022]
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32
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Herbst KW, Beckers GMA, Harper L, Bägli DJ, Nieuwhof-Leppink AJ, Kaefer M, Fossum M, Kalfa N. Don't be mean, be above average: Understanding data distribution and descriptive statistics. J Pediatr Urol 2020; 16:712. [PMID: 33011086 DOI: 10.1016/j.jpurol.2020.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/28/2022]
Affiliation(s)
- K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France
| | - D J Bägli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB, Utrecht, the Netherlands
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France
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33
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Affiliation(s)
- L Harper
- Department of Pediatric Urology and Pediatric Surgery, Hopital Pellegrin-Enfants, CHU Bordeaux, France.
| | - N Kalfa
- Service de chirurgie et urologie pédiatrique, hôpital Lapeyronie, CHU de Montpellier et Université de Montpellier, France.
| | - G M A Beckers
- Department of Urology, Section of Pediatric Urology, AmsterdamUMC, Location VUmc, Amsterdam, the Netherlands.
| | - M Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN, USA.
| | - A J Nieuwhof-Leppink
- Department of Medical Psychology and Social Work, Urology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO box 85090, 3508 AB, Utrecht, the Netherlands.
| | - Magdalena Fossum
- Department of Pediatric Surgery, Copenhagen University Hospital Rigshospitalet, DK-2100, Denmark; Department of Women's and Children's Health, Bioclinicum, Floor 10, Karolinska Institutet, SE-171 76, Stockholm, Sweden.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA.
| | - D Bagli
- Hospital for Sick Chidlren, Univeristy of Toronto, Canada.
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34
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Kaefer M, Kalfa N, Herbst KW, Harper L, Beckers GM, Bagli D, Fossum M. How to more effectively determine what is true: The limits of intuition. J Pediatr Urol 2020; 16:495-496. [PMID: 32493668 DOI: 10.1016/j.jpurol.2020.05.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/05/2020] [Indexed: 11/18/2022]
Abstract
The plethora of scientific data and explosion of published materials often leave it challenging to develop a clear and concise overview of many scientific topics. A number of factors may contribute to our misunderstanding. It is the focus of this article to describe primary reasons for failure to establish a clear, factual and functional understanding regarding scientific areas of inquiry.
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Affiliation(s)
- Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Nicolas Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Goedele Ma Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Fossum M. Editorial comment on urinary markers related to UPJO "A novel urinary biomarker protein panel to identify children with ureteropelvic junction obstruction-A pilot study". J Pediatr Urol 2020; 16:467-468. [PMID: 32713790 DOI: 10.1016/j.jpurol.2020.06.031] [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: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Magdalena Fossum
- Dept of Women's and Children's Health, Karolinska Institutet, 171 76 Stockholm, Sweden; Dept of Pediatric Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen 2100 Denmark.
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Fossum M, Najimi N, Whitesell P. 0617 Optimization of OSA Screening in a Black Population. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Racial disparities in the prevalence and severity of Obstructive Sleep Apnea (OSA) in Black Americans may play an important contributory role in the increased burden of cardiometabolic disease experienced by this population. Effective screening for OSA could permit early recognition and treatment, thereby preventing future the adverse cardiovascular outcomes which contribute to a decreased life expectancy. The STOP-BANG questionnaire is a validated screening tool for OSA as demonstrated in many populations and settings. Unfortunately, Blacks have typically been underrepresented in studies evaluating the sensitivity and specificity of the tool. Potentially unique biologic and psychosocial factors may affect the phenotypic expression of OSA and influence the performance of the STOP-BANG. Data are needed regarding the reliability of the tool for this population and potentially modifications to optimize its usefulness.
Methods
Data were from 204 patients evaluated at the Howard University Hospital Sleep Disorder Center between April 2018 and June 2019. Records were reviewed for demographic information, body mass index (BMI), neck circumference, and medical history, including the presence of snoring, tiredness/sleepiness, observed apneas, and hypertension and results of sleep study testing. Data were analyzed using SPSS software. Subcomponents of the STOP-BANG scoring criteria were adjusted to improve performance.
Results
Mean age was 48.5. 62% of subjects were female and mean BMI was 40.2 The mean ESS was 9.9. The mean AHI was 27.7 with a prevalence of mild or greater OSA (AHI >5) of 80%. Scoring of the STOP-BANG using a criterion of 3 or greater as indicating increased risk demonstrated a sensitivity of 90%, specificity of 8%, PPV of 80%, and NPV of 17%. Performance was worse for women then men. Multiple adjustments to scoring were evaluated to improve accuracy.
Conclusion
Similar to its performance in other populations, the STOP-BANG demonstrated high sensitivity but very poor specificity and overall poor accuracy in a Black population referred for Sleep Medicine Consultation to an urban university hospital. Performance was worse for women than men. Modifications are presented to try to improve performance and the clinical utility for this population.
Support
Howard University RCMI
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Affiliation(s)
- M Fossum
- Howard University, Washington, DC
| | - N Najimi
- Howard University, Washington, DC
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Chamorro CI, Reinfeldt Engberg G, Fossum M. Molecular and histological studies of bladder wound healing in a rodent model. Wound Repair Regen 2020; 28:293-306. [PMID: 32011053 DOI: 10.1111/wrr.12797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/27/2019] [Accepted: 01/16/2020] [Indexed: 01/01/2023]
Abstract
The field of regenerative medicine encounters different challenges. The success of tissue-engineered implants is dependent on proper wound healing. Today, the process of normal urinary bladder wound healing is poorly characterized. We aspired to explore and elucidate the natural response to injury in an in vivo model in order to further optimize tissue regeneration in future studies. In this study, we aimed to characterize histological and molecular changes during normal healing in a rat model by performing a standardized incisional wound followed by surgical closure. We used a rodent model (n = 40) to follow the healing process in the urinary bladder for 28 days. Surgical exposure of the bladder without incision (n = 40) was performed in controls. Histological characterization and western blot analyses of proteins was carried out using specific staining and markers for inflammation, proliferation, angiogenesis, and tissue maturation. For the molecular characterization of gene expression total RNA was collected for RT2 -PCR in wound healing pathway arrays. Analysis of histology revealed distinct, but overlapping, phases of healing with a local inflammatory response (days 1-8) simultaneous with a rapid formation of granulation tissue and proliferation (days 2-8). We also identified significant changes in gene expression related to inflammation, proliferation, and extracellular matrix formation. Healing of an incisional wound in a rodent urinary bladder demonstrated that all the classical phases of wound healing: hemostasis, inflammation, proliferation followed by tissue maturation were present. Our data suggest that the bladder and the skin share similar molecular signaling during wound healing, although we noted differences in the duration of each phase compared to previous studies in rat skin. Further studies will address whether our findings can be extrapolated to the human bladder.
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Affiliation(s)
- Clara I Chamorro
- Department of Women's and Children's Health, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gisela Reinfeldt Engberg
- Department of Women's and Children's Health, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Surgery, Uppsala University Children's Hospital, Uppsala, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health, Center of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Highly Specialized Pediatric Surgery and Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Harper L, Herbst KW, Bagli D, Kaefer M, Beckers GMA, Fossum M, Kalfa N. The battle between fake news and science. J Pediatr Urol 2020; 16:114-115. [PMID: 32094094 DOI: 10.1016/j.jpurol.2019.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/25/2019] [Accepted: 12/03/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France.
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - M Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
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Bagli D, Herbst KW, Harper L, Beckers G, Kaefer M, Kalfa N, Fossum M. Further medical experience will be required to validate these results: How experience -based medicine shapes the validity of medical evidence. J Pediatr Urol 2020; 16:112-113. [PMID: 31836435 DOI: 10.1016/j.jpurol.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022]
Abstract
This communication contextualizes the importance of clinical experience or experience-based medicine within the current paradigm of evidence-based medicine, complementing our previously published series of five short educational articles on evidence-based medicine. Previously we focused on optimizing medical decisions using publications of well-conducted research. Previous commentaries included a backgrounder, the hierarchy of evidence, data acquisition, tools for critical appraisal, and clinical use of evidence based medicine.
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Affiliation(s)
- Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - Katherine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Goedele Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Nicolas Kalfa
- Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université, de Montpellier, France
| | - Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Winberg J, Gustavsson P, Sahlin E, Larsson M, Ehrén H, Fossum M, Wester T, Nordgren A, Nordenskjöld A. Pathogenic copy number variants are detected in a subset of patients with gastrointestinal malformations. Mol Genet Genomic Med 2019; 8:e1084. [PMID: 31837127 PMCID: PMC7005659 DOI: 10.1002/mgg3.1084] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/30/2019] [Accepted: 11/11/2019] [Indexed: 12/14/2022] Open
Abstract
Background Gastrointestinal atresias and urological defects are main causes of pediatric surgery in infants. As copy number variants (CNVs) have been shown to be involved in the development of congenital malformations, the aim of our study was to investigate the presence of CNVs in patients with gastrointestinal and urological malformations as well as the possibility of tissue‐specific mosaicism for CNVs in the cohort. Methods We have collected tissue and/or blood samples from 25 patients with anorectal malformations, esophageal atresia, or hydronephrosis, and screened for pathogenic CNVs using array comparative genomic hybridization (array‐CGH). Results We detected pathogenic aberrations in 2/25 patients (8%) and report a novel possible susceptibility region for esophageal atresia on 15q26.3. CNV analysis in different tissues from the same patients did not reveal evidence of tissue‐specific mosaicism. Conclusion Our study shows that it is important to perform clinical genetic investigations, including CNV analysis, in patients with congenital gastrointestinal malformations since this leads to improved information to families as well as an increased understanding of the pathogenesis.
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Affiliation(s)
- Johanna Winberg
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Peter Gustavsson
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Ellika Sahlin
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Larsson
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Woman and Child Health and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Ehrén
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Woman and Child Health and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Woman and Child Health and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Wester
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Woman and Child Health and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ann Nordgren
- Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden
| | - Agneta Nordenskjöld
- Pediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Woman and Child Health and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
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Fossum M, Herbst KW, Kaefer M, Harper L, Castagnetti M, Beckers G, Kalfa N, Bagli D. Evidence-based medicine V: how to use in clinical practice. J Pediatr Urol 2019; 15:568-569. [PMID: 31519481 DOI: 10.1016/j.jpurol.2019.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
In this penultimate installment in the educational series on evidence-based medicine, the Research Committee of the European Society of Pediatric Urology will focus on clinical application. In previous communications, optimizing medical decisions was focused on through the use of well-conducted research publications, and the topics of background, hierarchy of evidence, information acquisition, and critical appraisal tools were covered. The goal is to guide the clinician in using evidentiary tools for setting up a clinical question, finding appropriate information, searching appropriate databases, and evaluating the results with the patient in mind.
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Affiliation(s)
- Magdalena Fossum
- Department of Pediatric Surgery, Surgical Clinic C, Copenhagen University Hospital Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Kathrine W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - Martin Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - Luke Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - Marco Castagnetti
- Section of Pediatric Urology, Department of Surgical, Oncological and Gastroeneterological Sciences, University Hospital of Padova, Padua, Italy
| | - Goedele Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - Nicolas Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - Darius Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
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Buffin-Meyer B, Klein J, van der Zanden LFM, Levtchenko E, Moulos P, Lounis N, Conte-Auriol F, Hindryckx A, Wühl E, Persico N, Oepkes D, Schreuder MF, Tkaczyk M, Ariceta G, Fossum M, Parvex P, Feitz W, Olsen H, Montini G, Decramer S, Schanstra JP. The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design. Clin Kidney J 2019; 13:371-379. [PMID: 32699617 PMCID: PMC7367108 DOI: 10.1093/ckj/sfz107] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease.
A major issue in the management of PUV is prenatal prediction of postnatal renal
function. Fetal ultrasound and fetal urine biochemistry are currently employed for this
prediction, but clearly lack precision. We previously developed a fetal urine peptide
signature that predicted in utero with high precision postnatal renal
function in fetuses with PUV. We describe here the objectives and design of the
prospective international multicentre ANTENATAL (multicentre validation of a fetal urine
peptidome-based classifier to predict postnatal renal function in posterior urethral
valves) study, set up to validate this fetal urine peptide signature. Methods Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until
2023 in >30 European centres endorsed and supported by European reference networks
for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The
endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05,
1–β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400
patients need to be enrolled to validate the previously reported sensitivity and
specificity of the peptide signature. Results In this largest multicentre study of antenatally detected PUV, we anticipate bringing a
novel tool to the clinic. Based on urinary peptides and potentially amended in the
future with additional omics traits, this tool will be able to precisely quantify
postnatal renal survival in PUV pregnancies. The main limitation of the employed
approach is the need for specialized equipment. Conclusions Accurate risk assessment in the prenatal period should strongly improve the management
of fetuses with PUV.
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Affiliation(s)
- Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Loes F M van der Zanden
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Levtchenko
- Department of Development & Regeneration, KU Leuven, Leuven, Belgium
| | | | - Nadia Lounis
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - Françoise Conte-Auriol
- Unité de Recherche Clinique Pédiatrique, Module Plurithématique Pédiatrique du Centre D'Investigation Clinique Toulouse 1436, Hôpital des Enfants, CHU Toulouse, Toulouse, France
| | - An Hindryckx
- Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Elke Wühl
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicola Persico
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy.,Sergio Bonelli Centre for the Prevention of Renal Failure from Fetal to Pediatric Age, Fondazione Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dick Oepkes
- Department of Prenatal Diagnosis and Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel F Schreuder
- Department of Pediatric Nephrology, Radboudumc Amalia Children's Hospital, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Marcin Tkaczyk
- Department of Pediatrics, Immunology and Nephrology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Gema Ariceta
- Servei de Nefrologia Pediátrica Hospital, Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Magdalena Fossum
- Section of Pediatric Urology, Department of Highly Specialized Pediatric Surgery and Pediatric Medicine, Karolinska University Hospital and Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Paloma Parvex
- Pediatric Nephrology, Unité Romande de Néphrologie Pédiatrique, Hôpitaux Universitaire Genève (HUG), Genève, Switzerland
| | - Wout Feitz
- For ERN eUROGEN, Department of Urology, Radboudumc Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henning Olsen
- For ERN eUROGEN, Paediatric Urology, Department of Urology, Aarhus University Hospital & Aarhus University, Aarhus, Denmark
| | - Giovanni Montini
- For ERN ERKNet, Pediatric Nephrology-Centro Sergio Bonelli for the Prevention and Treatment of Urinary Tract Malformations, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France.,Service de Néphrologie Pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.,Centre De Référence des Maladies Rénales Rares du Sud-Ouest (SORARE), Toulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institut of Cardiovascular and Metabolic Disease, Toulouse, France.,Université Toulouse III Paul-Sabatier, Toulouse, France
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Kaefer M, Castagnetti M, Herbst K, Bagli D, Beckers GMA, Harper L, Kalfa N, Fossum M. Evidence-based medicine III: level of evidence. J Pediatr Urol 2019; 15:407-408. [PMID: 31130505 DOI: 10.1016/j.jpurol.2019.04.012] [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: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 11/17/2022]
Abstract
The present article is the third installment in a five-part series related to evidence-based medicine (EBM) provided by the European Society for Paediatric Urology Research Committee. It will present the different levels of evidence (i.e. systematic review, randomized controlled trial, cohort study) available to clinicians and researchers and describe the strengths of each study type. While EBM provides a valuable construct to aid in medical decision-making, it remains imperative that this information be interpreted and applied in the clinical context with a good dose of common sense.
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Affiliation(s)
- M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - M Castagnetti
- Section of Pediatric Urology, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padua, Italy
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - N Kalfa
- Service de Chirurgie et Urologie Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Beckers GMA, Herbst K, Kaefer M, Harper L, Castagnetti M, Bagli D, Kalfa N, Fossum M. Evidence Based Medicine IV: how to find an evidence-based answer to a clinical question? Make a critically appraised topic! J Pediatr Urol 2019; 15:409-411. [PMID: 31266683 DOI: 10.1016/j.jpurol.2019.05.009] [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: 05/04/2019] [Accepted: 05/08/2019] [Indexed: 02/04/2023]
Abstract
This manuscript is the fourth in a five part series related to evidence based medicine (EBM) provided by the European society of pediatric urology (ESPU) research committee. It will present a way to come to a quick and critical appraisal of available evidence on a specific topic: a CAT (critically appraised topic). The way how to write a cat is described for interventions to be compared to a control group, and for other, more generalized clinical questions. While systematic reviews provide a throughout overview of all evidence available, a CAT provides a shorter way to come to quick insights based on EBM.
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Affiliation(s)
- G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands.
| | - K Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - D Bagli
- Division of Urology, Department of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Chamorro CI, Asghar M, Ekblad Å, Färnert A, Götherström C, Fossum M. Urothelial cell senescence is not linked with telomere shortening. J Tissue Eng Regen Med 2019; 13:1518-1527. [PMID: 31117156 DOI: 10.1002/term.2900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/11/2018] [Revised: 04/09/2019] [Accepted: 05/15/2019] [Indexed: 11/11/2022]
Abstract
The success of regenerative medicine relies in part on the quality of the cells implanted. Cell cultures from cells isolated from bladder washes have been successfully established, but molecular changes and cell characteristics have not been explored in detail. In this work, we analysed the role of telomere shortening in relation to the regenerative potential and senescence of cells isolated from bladder washes and expanded in culture. We also analysed whether bladder washes would be a potential source for attaining stem cells or promoting stem cell proliferation by using two different substrates to support their growth: a feeder layer of growth-arrested murine fibroblasts J2 3T3 cells and a xeno-free human recombinant laminin-coated surface. We found no association between telomere shortening and senescence in urothelial cells in vitro. Urothelial cells had a stable telomere length and expressed mesenchymal stem cells markers but failed to differentiate into bone or adipocytes. Feeder layer showed an advantage to laminin-coated surfaces in respect to proliferative capacity with the expense of risking that feeder layer cells could persist in later passages. This emphasizes the importance of using carefully controlled culture conditions and molecular quality controls before autotransplantation in future clinical settings. In conclusion, urothelial cells isolated by bladder washes show regenerative potential that need further understanding. Senescence in vitro might be due to cellular stress, and if so, further improvements in culture conditions may lead to longer cell life and higher proliferative capacity.
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Affiliation(s)
- Clara Ibel Chamorro
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Pediatric Urology, Department of Highly Specialized Pediatric Surgery and Pediatric Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatric Surgery, Faculty of Health Science, University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Muhammad Asghar
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Åsa Ekblad
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Division of Pediatric Urology, Department of Highly Specialized Pediatric Surgery and Pediatric Medicine, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Pediatric Surgery, Faculty of Health Science, University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark
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Castagnetti M, Herbst KW, Bagli D, Beckers GMA, Harper L, Kaefer M, Kalfa N, Fossum M. EBM II: How to perform a literature search. J Pediatr Urol 2019; 15:268-269. [PMID: 30956125 DOI: 10.1016/j.jpurol.2019.03.006] [Citation(s) in RCA: 1] [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] [Received: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
The present article is a second part related to evidence based medicine (EBM) in a series of five by the European society for paediatric urology (ESPU) research committee. It will present the different databases/search engines available to clinicians and researchers and describe strategies to focus the search to one's particular needs. Indeed, databases/search engines used and search strategy should vary according to the goal of the research. If the aim is to address a clinical problem, the search should allow to identify a small number of most pertinent articles (high specificity); if the search is for research purposes, instead, it should ensure no meaningful articles are overlooked (high sensitivity).
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Affiliation(s)
- M Castagnetti
- Section of Pediatric Urology, University Hospital of Padova, Padua, Italy
| | - K W Herbst
- Division of Urology, Department of Research, Connecticut Children's Medical Center, Hartford, CT, United States
| | - D Bagli
- Division of Urology, Departments of Surgery and Physiology, University of Toronto, Developmental and Stem Cell Biology, The Hospital for Sick Children and Research Institute, Toronto, Ontario, Canada
| | - G M A Beckers
- Department of Urology, Pediatric Urology Section, Amsterdam University Medical Centre Location VUmc, Amsterdam, the Netherlands
| | - L Harper
- Service de Chirurgie Pédiatrique, Hôpital Pellegrin-Enfants, CHU de Bordeaux, France
| | - M Kaefer
- Riley Hospital for Children, Indiana University, Indianapolis, IN, United States
| | - N Kalfa
- Service de Chirurgie Urologique Pédiatrique, Hôpital Lapeyronie, CHU de Montpellier, Université, de Montpellier, France
| | - M Fossum
- Division of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Kaefer M, Beckers G, Gobet R, El-Ghoneimi A, Fossum M. How the ESPU grades clinical abstracts. J Pediatr Urol 2018; 14:451-452. [PMID: 30181100 DOI: 10.1016/j.jpurol.2018.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
The ability to consistently review abstracts in an unbiased and objective fashion is a skill that most academics hope to master. However, robust standardized rating systems are sparse, with most scientific boards leaving the task of rating abstracts poorly defined and at the whim of the reviewer. In an effort to bring consistency to this process, in 2013, the ESPU board adopted an abstract rating system that has been previously used in the field of plastic surgery and orthopedics. (van der Steen et al., 2004; Poolman et al., 2007). The aim of this manuscript is to outline this practice.
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Affiliation(s)
- Martin Kaefer
- Department of Pediatric Urology, Riley Children's Hospital, Indiana University, Indianapolis, IN, USA
| | - Goedele Beckers
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rita Gobet
- Department of Pediatric Urology, Kinderspital, Zürich, Switzerland
| | | | - Magdalena Fossum
- Department of Pediatric Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Dept. of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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Ajalloueian F, Lemon G, Hilborn J, Chronakis IS, Fossum M. Bladder biomechanics and the use of scaffolds for regenerative medicine in the urinary bladder. Nat Rev Urol 2018; 15:155-174. [DOI: 10.1038/nrurol.2018.5] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Affiliation(s)
- G M A Beckers
- Department of Urology, Pediatric Urology Section, VU University Medical Center, Amsterdam, The Netherlands.
| | - M Fossum
- Department of Pediatric Surgery, Section of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - M Kaefer
- Indiana University, 702 Barnhill Drive, Suite 4230, Indianapolis, IN, USA
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Ekblad Å, Westgren M, Fossum M, Götherström C. Fetal subcutaneous cells have potential for autologous tissue engineering. J Tissue Eng Regen Med 2018; 12:1177-1185. [PMID: 29327490 DOI: 10.1002/term.2639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/12/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 12/19/2022]
Abstract
Major congenital malformations affect up to 3% of newborns. Infants with prenatally diagnosed soft tissue defects should benefit from having autologous tissue readily available for surgical implantation in the perinatal period. In this study, we investigate fetal subcutaneous cells as cellular source for tissue engineering. Fetal subcutaneous biopsies were collected from elective terminations at gestational Week 20-21. Cells were isolated, expanded, and characterized in vitro. To determine cell coverage, localization, viability, and proliferation in different constructs, the cells were seeded onto a matrix (small intestine submucosa) or in collagen gel with or without poly(ε-caprolactone) mesh and were kept in culture for up to 8 weeks before analysis. Angiogenesis was analysed through a tube-forming assay. Fetal subcutaneous cells could be expanded until 43 ± 3 population doublings, expressed mesenchymal markers, and readily differentiate into adipogenic and osteogenic lineages. The cells showed low adherence to small intestine submucosa and did not migrate deep into the matrix. However, in collagen gels, the cells migrated into the gel and proliferated with sustained viability for up to 8 weeks. The cells in the matrices expressed Ki67, CD73, and α-smooth muscle actin but not cytokeratin or CD31. Fetal cells derived from subcutaneous tissue demonstrated favourable characteristics for preparation of autologous tissue transplants before birth. Our study supports the theory that cells could be obtained from the fetus during pregnancy for tissue engineering purposes after birth. In a future clinical situation, autologous transplants could be used for reconstructive surgery in severe congenital malformations.
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Affiliation(s)
- Åsa Ekblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Westgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Magdalena Fossum
- Department of Women's and Children's Health at Centre of Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Patient area Children with diseases of the abdomen and blood or cancer, Section of Urology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Götherström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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