Journal of pediatric surgery最新文献

{"title":"Medium-to Long-term Outcomes of Rex Shunt in 105 Children With Extrahepatic Portal Vein Obstruction in China","authors":"Jieqin Wang ,&nbsp;Yu Ning ,&nbsp;Huifang Ren ,&nbsp;Miao Hong ,&nbsp;Fuyu You ,&nbsp;Xiaoling Bai ,&nbsp;Xiaopan Chang ,&nbsp;Qifeng Liang ,&nbsp;Jiankun Liang ,&nbsp;Zhe Wen","doi":"10.1016/j.jpedsurg.2024.161930","DOIUrl":"10.1016/j.jpedsurg.2024.161930","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of our study was to analyze the medium-to long-term outcomes of Rex shunts in a large series of children with extrahepatic portal vein obstruction (EHPVO).</div></div><div><h3>Methods</h3><div>The clinical data of 105 children aged between 6 months and 16 years with EHPVO who underwent Rex shunt between October 2014 and June 2021 at our center were retrospectively reviewed after more than 2 years of follow-up.</div></div><div><h3>Results</h3><div>The overall patency rate of the Rex shunt was 91.43% (96/105) during a median follow-up of 41 months (range, 24–98 months). Eighty-seven (82.86%) of the 105 patients underwent classical Rex shunt with internal jugular vein (IJV) bypass, and the remaining 18 patients (17.14%) underwent modified Rex shunt with intra-abdominal vein bypass. Patients with a patent shunt experienced portal hypertension resolution, which was characterized by a reduction in portal pressure, disappearance of variceal bleeding, relief of gastroesophageal varices, and relief of splenomegaly or hypersplenism. The rate of Rex shunt thrombosis in our center was 8.57% (9/105), and a repeat Rex shunt was effective for the treatment of graft thrombosis. Anastomotic stenosis occurred in 14.26% (15/105) of the children, 38.46% (5/13) of whom received successful endovascular intervention therapy and experienced remission of portal hypertension symptoms. The patency rate of the classical Rex shunt was higher than that of the modified Rex shunt (97.70% vs. 61.11%), whereas the rate of vascular complications, including anastomotic stenosis and graft thrombosis, of the classical Rex shunt was lower than that of the modified Rex shunt (11.49% vs. 77.78%). Further comparison revealed that the risk of vascular complications was substantially greater in the modified Rex shunt group than in the classical Rex shunt group in the nonadjusted model, minimally adjusted model, and fully adjusted model (RR ranged from 6.77 to 7.07, all <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The Rex shunt provides medium-to long-term benefits for children with EHPVO. The classical Rex shunt with IJV bypass provides the best patency rate and the fewest vascular complications.</div></div><div><h3>Levels of Evidence</h3><div>Ⅲ</div></div><div><h3>Type of Study</h3><div>Retrospective comparative study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161930"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142381142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Connect & Share”: Collaboratively Addressing Moral Distress Among Pediatric Surgeons","authors":"Jason P. Sulkowski,&nbsp;Mindy B. Statter,&nbsp;Terry L. Buchmiller","doi":"10.1016/j.jpedsurg.2024.161978","DOIUrl":"10.1016/j.jpedsurg.2024.161978","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161978"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of External Ventricular Drains for Neuromonitoring and Traumatic Brain Injury Treatment in Pediatric Patients Outside of Intensive Care Units: A Single-Institution Retrospective Study","authors":"Matthew C. Findlay ,&nbsp;Katie W. Russell ,&nbsp;Samuel A. Tenhoeve ,&nbsp;Monica Owens ,&nbsp;Rajiv R. Iyer ,&nbsp;Robert J. Bollo","doi":"10.1016/j.jpedsurg.2024.161993","DOIUrl":"10.1016/j.jpedsurg.2024.161993","url":null,"abstract":"<div><h3>Background</h3><div>Most pediatric hospitals manage patients who require external ventricular drains (EVDs) exclusively within pediatric intensive care units (PICUs) because of institutional protocols. Our institution commonly manages patients with EVDs on the neurotrauma floor (NTF). We evaluated whether this practice results in more EVD-associated complications.</div></div><div><h3>Methods</h3><div>A retrospective cohort study at our Level 1 pediatric trauma center identified all trauma patients ≤18 years old who received an EVD in 2018–2023. Demographics, presenting characteristics, in-hospital management, and EVD management details were recorded. The primary outcome was EVD-related complication events.</div></div><div><h3>Results</h3><div>Of the 81 patients who had EVDs placed after neurotrauma, 45 had their EVD managed exclusively in the PICU (PICU-EVD) and 36 had their EVD for some time while on the NTF (NTF-EVD). The groups were similar in sex (p = 0.87) and age (p = 0.054). PICU-EVD patients underwent fewer neurosurgeries (55.6% vs. 77.8%, p = 0.04) but spent more time on ventilators (10.6 ± 8.7 days vs. 6.4 ± 4.8, p = 0.02) and in the PICU (11.8 ± 9.0 days vs. 8.4 ± 5.9, p = 0.02). Total hospital stay was similar between groups (p = 0.44). NTF-EVD patients were on the drain longer (9.0 ± 7.4 days vs. 13.1 ± 9.1, p = 0.03), including 5.9 days on the NTF. Four EVD-related complications occurred overall: 2 accidental dislodgements and 2 cerebrospinal fluid leaks. EVD complication rates were similar on the NTF and PICU (2.2% vs. 8.3%, p = 0.21). All complications occurred late in the hospital course and were minor. A Poisson regression model comparing complication rates between PICU-only and NTF management (433 vs. 441 catheter days, respectively) found a complication rate of 6.8 per 1000 catheter days in the NTF group versus 2.3 per 1000 catheter days in the PICU-only group, yielding a rate ratio of 2.95 (95% confidence interval 0.29–30.4, p = 0.35). However, this difference was not statistically significant.</div></div><div><h3>Conclusion</h3><div>Our center routinely discharges patients from the PICU to the NTF with EVDs in place. This practice may be associated with no increased risk or rate of EVD-related complications compared to PICU-only management.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161993"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline","authors":"Aaron Cunningham ,&nbsp;Terence Camilon ,&nbsp;Stephanie Chao","doi":"10.1016/j.jpedsurg.2024.161984","DOIUrl":"10.1016/j.jpedsurg.2024.161984","url":null,"abstract":"<div><h3>Introduction</h3><div>Dog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given?</div></div><div><h3>Methods</h3><div>A structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed.</div></div><div><h3>Results</h3><div>A total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days.</div></div><div><h3>Conclusion</h3><div>High-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed.</div></div><div><h3>Level of Evidence</h3><div>Level II – systematic review.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161984"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping it Out: The Use of Laparoscopy After Penetrating Trauma in Stable Children","authors":"Utsav M. Patwardhan ,&nbsp;Casey R. Erwin ,&nbsp;Alexandra S. Rooney ,&nbsp;Bryan Campbell ,&nbsp;Benjamin Keller ,&nbsp;Andrea Krzyzaniak ,&nbsp;Vishal Bansal ,&nbsp;Michael J. Sise ,&nbsp;Michael J. Krzyzaniak ,&nbsp;Romeo C. Ignacio Jr.","doi":"10.1016/j.jpedsurg.2024.161983","DOIUrl":"10.1016/j.jpedsurg.2024.161983","url":null,"abstract":"<div><h3>Introduction</h3><div>In stable children with penetrating abdominal trauma, literature regarding the use of laparoscopy (LAP) remains limited. Given increasing evidence in favor of LAP for selective adult trauma patients, we reviewed contemporary practices and outcomes in pediatric trauma patients.</div></div><div><h3>Methods</h3><div>The American College of Surgeons (ACS) Trauma Quality Programs data was utilized to identify children (&lt;18 years) from 2016 to 2021 with a penetrating abdominal injury who underwent surgery within 24 h of admission. Patients with non-abdominal abbreviated injury score (AIS) ≥3, Glasgow Coma Scale (GCS) &lt; 13, or instability using a shock index pediatric adjusted (SIPA) cutoff were excluded. Patients were compared based on whether they had LAP, open, or laparoscopic converted to open (LCO) exploration. Primary outcomes were length of stay (LOS) and complications, including missed injuries.</div></div><div><h3>Results</h3><div>Among 1945 patients who underwent abdominal surgery for penetrating trauma, 32% were stabbed and 68% had gunshot wounds (GSW). LAP occurred in 235 (12%) and LCO in 145 (7.4%) patients. The proportion of LAP did not change over the study period. LAP was used more in patients presenting with stab wounds than GSW (24 vs. 7%, p &lt; .01). There was higher use of LAP at pediatric centers (p &lt; .01). Although there was no difference in mortality or complications by operative type, open patients were more severely injured, had a longer LOS (p &lt; .01), and had more subsequent procedures (11% of open, 2 % LAP, 7% LCO, p &lt; .01).</div></div><div><h3>Conclusion</h3><div>In stable children with penetrating abdominal trauma, LAP is most often utilized after stabbing and at pediatric trauma centers, but its overall use remains uncommon. LAP patients had lower rates of subsequent procedures and no increase in unexpected operations suggesting low rates of missed injuries. Criteria are needed to identify stable patients presenting after penetrating trauma who can benefit from a LAP approach.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161983"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Objective Evaluation of Intraoperative and Postoperative Pain in Infants Undergoing Open Inguinal Herniotomy and Laparoscopic Inguinal Hernia Repair Using the Newborn Infant Parasympathetic Evaluation (NIPE™) Monitor","authors":"Mahesh Sakthivel ,&nbsp;Tanay Bapna ,&nbsp;Svetlana Ivanic ,&nbsp;Cassandra Lang ,&nbsp;Ramesh M. Nataraja ,&nbsp;Maurizio Pacilli","doi":"10.1016/j.jpedsurg.2024.07.036","DOIUrl":"10.1016/j.jpedsurg.2024.07.036","url":null,"abstract":"<div><h3>Purpose</h3><div>The heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) monitor is an objective, non-invasive tool for the assessment of pain in children under 2 years of age. The aim of this study was to objectively compare pain in infants undergoing open and laparoscopic inguinal hernia surgery using the NIPE monitor.</div></div><div><h3>Method</h3><div>This prospective observational study included neonates and infants (&lt;2 years of age) undergoing elective open inguinal herniotomy and laparoscopic inguinal hernia repair under general anaesthesia with a caudal block. The NIPE monitor was connected to the electrocardiogram monitor with continuous monitoring performed intraoperatively, and postoperatively in the Post Anaesthesia Care Unit. The NIPE index was recorded at different intraoperative steps. The median NIPE index (NIPE_m) was calculated for the entire procedure and postoperative period. The NIPE index ranges from 0 to 100; lower values indicate greater levels of pain, values &lt; 50 indicate severe pain. P values &lt; 0.05 were considered significant.</div></div><div><h3>Results</h3><div>There were 40 infants recruited: 27 underwent open herniotomy and 13 underwent laparoscopic repair. Intraoperatively, NIPE_m was found to be significantly lower in the laparoscopic group (59.00 vs. 77.00, p = 0.0018). Postoperatively, NIPE_m was also found to be significantly lower in the laparoscopic group (49.00 vs. 57.50, p = 0.0001).</div></div><div><h3>Conclusion</h3><div>This is the first study to objectively demonstrate that laparoscopic inguinal hernia repair is more painful intraoperatively and leads to greater levels of pain in the early postoperative period compared to open inguinal herniotomy. This difference might explained by painful stimuli in anatomical areas not covered by the caudal block.</div></div><div><h3>Type of study</h3><div>Treatment Study/Prospective Study.</div></div><div><h3>Level of evidence</h3><div>Level II.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161651"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unnecessary Scans Lead to Unnecessary Re-scans: Evaluating Clinical Management of Low and Intermediate Risk Pediatric Traumatic Brain Injuries","authors":"Rachel Rivero ,&nbsp;Isabelle L. Curran ,&nbsp;Zane Hellmann ,&nbsp;Madeleine Carroll ,&nbsp;Matthew Hornick ,&nbsp;Daniel Solomon ,&nbsp;Michael DiLuna ,&nbsp;Patricia Morrell ,&nbsp;Emily Christison-Lagay","doi":"10.1016/j.jpedsurg.2024.162097","DOIUrl":"10.1016/j.jpedsurg.2024.162097","url":null,"abstract":"<div><h3>Background</h3><div>The Pediatric Emergency Care Applied Research Network (PECARN) guidelines provide an algorithm to select patients with mild head trauma at highest risk for clinically important traumatic brain injury (ciTBI) in whom computed tomography (CT) would facilitate management. Failure to follow PECARN criteria exposes children to unnecessary radiation and contributes to increasing hospital costs, length of stay, and parental anxiety. We sought to evaluate the subsequent allocation of resources to low and intermediate risk group patients who underwent an initial Head CT - which was not indicated by PECARN guidelines but which identified cranial or intracranial injury.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of children ≤16 years old with head injury (GCS ≥14) between 2016 and 2021. Children with neurological deficits, penetrating head trauma, anticoagulation, or non-accidental trauma were excluded. Demographics, imaging results, PECARN risk category, and need for neurosurgical intervention were collected.</div></div><div><h3>Results</h3><div>There were 70 low risk patients who had positive findings on CT, however none demonstrated clinically significant progression on repeat imaging that necessitated medical or surgical intervention. Of 319 intermediate risk patients with evidence of skull fracture or intracranial injury on CT, only one required intervention. The decision to intervene was made based on clinical changes and was not influenced by repeat imaging.</div></div><div><h3>Discussion</h3><div>Despite PECARN guidelines, cross-sectional imaging remains overused. Identification of small foci of clinically non-actionable intracranial bleeding in patients who do not meet initial PECARN criteria frequently prompts further cross-sectional imaging without benefit. This suggests that routine interval imaging may not be necessary in the neurologically stable child with low-risk injury.</div></div><div><h3>Type of study</h3><div>Retrospective cohort study.</div></div><div><h3>Level of evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162097"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can Ultrasound Reliably Detect Complicated Appendicitis in Pediatric Patients?","authors":"Mohamed Zouari,&nbsp;Manel Belhajmansour,&nbsp;Oumaima Jarboui,&nbsp;Najoua Ben Kraiem,&nbsp;Mahdi Ben Dhaou","doi":"10.1016/j.jpedsurg.2024.161885","DOIUrl":"10.1016/j.jpedsurg.2024.161885","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161885"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver Mitochondrial Morphology and Gene Expression as Markers of Liver Reserve: Prognostic Implications for Native Liver Survival in Biliary Atresia","authors":"Takashi Fujimoto ,&nbsp;Hiroki Goto ,&nbsp;Masataka Hida ,&nbsp;Koichi Tsuboi ,&nbsp;Takamasa Suzuki ,&nbsp;Hisae Iida ,&nbsp;Ayaka Fukada ,&nbsp;Sakika Shimizu ,&nbsp;Yu Ebata ,&nbsp;Koki Nikai ,&nbsp;Junya Ishii ,&nbsp;Masahiro Takeda ,&nbsp;Asuka Ishiyama ,&nbsp;Soichi Shibuya ,&nbsp;Yuta Yazaki ,&nbsp;Nana Nakazawa-Tanaka ,&nbsp;Go Miyano ,&nbsp;Tadaharu Okazaki ,&nbsp;Toshihiro Yanai ,&nbsp;Masahiko Urao ,&nbsp;Kazuto Suda","doi":"10.1016/j.jpedsurg.2024.07.033","DOIUrl":"10.1016/j.jpedsurg.2024.07.033","url":null,"abstract":"<div><h3>Purpose</h3><div>Hepatocyte mitochondrial morphology and gene expression were compared between biliary atresia (BA), infantile cholestasis (IC), and normal liver (NL) as prognostic indicators.</div></div><div><h3>Methods</h3><div>Specimens of liver at portoenterostomy (PE) for BA, from intrahepatic bile duct paucity patients for IC, and from choledochal cyst or hepatoblastoma patients for NL were collected prospectively (P) beginning in 2021 (P-BA = 11, P-IC = 9, P-NL = 7) and retrospectively (R) from paraffin-embedded tissue going back to 1981 (R-BA = 25, R-IC = 9, R-NL = 4). The P-cohort had transmission electron microscopy (TEM) to image mitochondria, immunoblotting for heat shock protein 60 (HSP60), and quantitative PCR (qPCR) for HSP60 and mitochondrial functional genes. Both cohorts had immunofluorescence for HSP60 quantified as a ratio to albumin-positive hepatocytes (ALB) with HSP60/ALB&lt;1.0 as a cutoff limit using ImageJ.</div></div><div><h3>Results</h3><div>HSP60 was significantly lower in BA/IC than NL on qPCR (BA: <em>p</em> &lt; 0.01, IC: <em>p</em> &lt; 0.05) and lower in BA than IC/NL on immunoblotting (<em>p</em> &lt; 0.05). HSP60/ALB was significantly lower in BA than NL/IC (<em>p</em> &lt; 0.001). Despite BA subjects being matched for types of BA and ages at PE, HSP60/ALB did not correlate with jaundice clearance (JC; T-Bil&lt;1.2 mg/dL) but was significantly higher in native liver survivors (NLS) after PE compared with liver transplant (LTx) cases (<em>p</em> &lt; 0.05) and significantly lower in LTx cases achieving JC than NLS achieving JC (<em>p</em> &lt; 0.05). TEM showed BA had significantly more mitochondrial inclusion bodies (<em>p</em> &lt; 0.05) and significantly larger cristae (<em>p</em> &lt; 0.01) than IC/NL. qPCR in BA showed significant repression of mitochondrial functional genes for mRNA stabilization and energy facilitation.</div></div><div><h3>Conclusion</h3><div>HSP60/ALB correlates with NLS after PE for BA.</div></div><div><h3>Level of evidence</h3><div>II</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161648"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141845485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LncRNA MEG9 Promotes Inflammation and Liver Fibrosis Through S100A9 in Biliary Atresia","authors":"Lingdu Meng ,&nbsp;Junfeng Wang ,&nbsp;Huifen Chen ,&nbsp;Jiajie Zhu ,&nbsp;Fanyang Kong ,&nbsp;Gong Chen ,&nbsp;Rui Dong ,&nbsp;Shan Zheng","doi":"10.1016/j.jpedsurg.2024.07.018","DOIUrl":"10.1016/j.jpedsurg.2024.07.018","url":null,"abstract":"<div><h3>Background</h3><div>The pathogenesis of biliary atresia (BA) remains elusive. We aimed to investigate the role of long noncoding RNA (lncRNA) <em>MEG9</em> in BA.</div></div><div><h3>Methods</h3><div>LncRNA microarray was conducted to identify differentially expressed lncRNAs in three BA and three para-hepatoblastoma liver tissues. RT-qPCR validated the results. Human intrahepatic bile duct epithelial cells (HIBECs) were stably transfected with lncRNA <em>MEG9</em> knockdown/overexpression to investigate its cellular localization and function. RNA sequencing (RNA-seq), differentially expressed genes (DEGs) analysis and gene set enrichment analysis were applied to <em>MEG9</em>-overexpresed HIBECs. RNA pull-down and mass spectrometry explored the interacting protein of <em>MEG9</em>, while clinical information was reviewed.</div></div><div><h3>Results</h3><div>436 differentially expressed lncRNAs were identified, with <em>MEG9</em> highly upregulated in BA. RT-qPCR further confirmed <em>MEG9</em>'s overexpression in BA and diagnostic potential (AUC = 0.9691). <em>MEG9</em> was predominantly located in the nucleus and significantly promoted cell proliferation and migration. RNA-seq revealed inflammation- and extracellular matrix-related pathways enriched in <em>MEG9</em>-overexpressing HIBECs, with upregulated cytokine genes like <em>CXCL6</em> and <em>IL6</em>. MMP-7 and collagen I were also overexpressed. Furthermore, 38 proteins were identified to specifically interact with <em>MEG9</em>, and <em>S100A9</em> was highly expressed in cell models. <em>S100A9</em> was also significantly upregulated in BA liver tissue and correlated with <em>MEG9</em> expression (r = 0.313, p &lt; 0.05), albumin level (r = −0.349, p &lt; 0.05), and platelet level (r = −0.324, p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div><em>MEG9</em> influences cholangiocyte proliferation, migration, and cytokine production, potentially regulating BA inflammation and fibrosis via <em>S100A9</em> interaction.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161633"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141849972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}