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The aim of this study is to investigate the potential impact of catheterization on intimal hyperplasia and explore the efficacy of Paclitaxel loaded PLGA nanoparticles (PTX-NPs) in preventing stenosis at the site of venous injury. Under general anesthesia, Central Venous Catheters were inserted into the rat's right internal jugular veins (IJV) using the cut-down technique. Twenty bare catheters (C) and twenty PTX-NPs coated catheters (P) were assigned to one of four groups (C2, C4, P2, or P4) based on catheter type and expected survival time. 2 or 4 weeks after surgery, IJVs were completely harvested by formalin fixation and gelatin infusion and slides were stained with H&E (Haematoxylin and Eosin) and Masson's technique. The P2 (Paclitaxel coating, 2 weeks) group showed the most proliferation among the four groups and the P4 (Paclitaxel coating, 4 weeks) showed a tendency to decrease proliferation. Additionally, the lumen size in the P4 group was about 6% smaller than in the P2 group, and there was a lower prevalence of stenotic grade in the P4 group. Our study suggests that PTX-NPs coated catheters may be effective in preventing venous stenosis if the intended usage is prolonged, rather than for a short-term period. Schematic representation of catheter functionalization and coating of PTX-NPs on Catheter [ABSTRACT FROM AUTHOR]

Protease-activated receptor-1 (PAR1) is highly expressed in murine colonic smooth muscles. Responses to PAR1 activation are complex and result from responses in multiple cell types. We investigated whether PAR1 responses are altered in inflamed colon induced by dextran sodium sulfate (DSS)-treatment. Colitis was induced in C57BL/6 mice by administration of 3% DSS in drinking water for 7 days. Measurements of isometric force, transmembrane potentials from impaled smooth muscle cells, quantitative PCR and Western blots were performed. Thrombin, an activator of PAR1, caused transient hyperpolarization and relaxation of untreated colons, but these responses decreased in DSS-treated colons. Apamin caused depolarization and increased contractions of muscles from untreated mice. This response was decreased in DSS-treated colons. Expression of Kcnn3 and Pdgfra also decreased in DSS-treated muscles. A second phase of thrombin responses is depolarization and increased contractions in untreated muscles. However, thrombin did cause depolarization in DSS-treated colon, yet it increased colonic contractions. The latter effect was associated with enhanced expression of MYPT1 and CPI-17. The propagation velocity and frequency of colonic migrating motor complexes in DSS-treated colon was significantly higher compared to control colons. In summary, DSS treatment causes loss of transient relaxations due to downregulation of SK3 channels in PDGFRα+ cells and may increase contractile responses due to increased Ca2+ sensitization of smooth muscle cells via PAR1 activation. [ABSTRACT FROM AUTHOR]

Obesity is a critical risk factor of several life-threatening diseases and the prevalence in adults has dramatically increased over the past ten years. In the USA the age-adjusted prevalence of obesity in adults was 42.4%, i.e., with a body mass index (BMI, weight (kg)/height (m)2) that exceeds 30 kg/m2. Obese individuals are at the higher risk of obesity-related diseases, co-morbid conditions, lower quality of life, and increased mortality more than those in the normal BMI range i.e., 18.5–24.9 kg/m2. Surgical treatment continues to be the most efficient and scientifically successful treatment for obese patients. Sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a relatively new gastric procedure to reduce body weight but is now the most popular bariatric operation. To date there have been few studies examining the changes in the cellular components and pacemaker activity that occur in the gastric wall following VSG and whether normal gastric activity recovers following VSG. In the present study we used a murine model to investigate the chronological changes of gastric excitability including electrophysiological, molecular and morphological changes in the gastric musculature following VSG. There is a significant disruption in specialized interstitial cells of Cajal in the gastric antrum following sleeve gastrectomy. This is associated with a loss of gastric pacemaker activity and post-junctional neuroeffector responses. Over a 4-month recovery period there was a gradual return in interstitial cells of Cajal networks, pacemaker activity and neural responses. These data describe for the first time the changes in gastric interstitial cells of Cajal networks, pacemaker activity and neuroeffector responses and the time-dependent recovery of ICC networks and normalization of motor activity and neural responses following VSG. [ABSTRACT FROM AUTHOR]

Black garlic (BG) is a newly explored food stuff obtained via fermentation of raw, healthy garlic, especially in Asian countries. Interstitial cells of Cajal (ICC) are the pacemaker cells of gastrointestinal (GI) motility. The purpose of this study was to investigate the effects of BG extract on the pacemaker potentials of the ICC in the small intestines of mice and the possibility of controlling GI motility. The antioxidant activity of BG extract was also investigated. The whole-cell electrophysiological method was used to measure pacemaker potentials of the ICC in vitro, whereas GI motility was measured using the intestinal transit rate (ITR) in vivo. BG extract depolarized the pacemaker potentials of the ICC. Y25130 and RS39604 5-HT receptor antagonists could not inhibit the effect of BG extract on the pacemaker potentials of the ICC, whereas the 5-HT receptor antagonist SB269970 could. Pre-treatment with external Na+ (5 mM) or Ca2+-free solution inhibited the BG extract-induced depolarization of the ICC. With SB203580, PD98059, or c-jun NH2-terminal kinase II inhibitor pre-treatment, BG extract did not induce pacemaker potential depolarization. Moreover, the ITR values were increased by BG extract. Elevation of the ITR due to BG extract was related with increased protein expression of the 5-HT7 receptors. In addition, BG extract showed antioxidant activity. Collectively, these results highlight the ability of BG extract to regulate GI motility and the possibility of using it to develop GI motility modulators in the future. Moreover, BG showed immense potential as an antioxidant. [ABSTRACT FROM AUTHOR]

Background: Forme fruste choledochal cyst (FFCC), characterized by a minimally dilated common bile duct (CBD) and associated pancreaticobiliary maljunction (PBM), is difficult to diagnose in a timely manner in clinical practice. However, endoscopic retrograde cholangiopancreatography (ERCP) can clearly delineate CBD and PBM. Hence, we evaluated the value of ERCP in the diagnosis and management of FFCC. Methods: The medical records of patients diagnosed with FFCC were retrospectively reviewed. From January 2003 to December 2010, patients underwent surgery without ERCP (non‐ERCP group); from January 2011, all patients underwent pre‐operative ERCP (ERCP group). Demographics, laboratory results, perioperative data and post‐operative complications were compared between the two groups. Results: There were 24 patients in the ERCP group and 11 in the non‐ERCP group. Laboratory data improved to a greater extent after ERCP. ERCP was superior to both magnetic resonance cholangiopancreatography and ultrasonography in delineating CBD and PBM. In the ERCP group, 20 of the 24 patients were noted to have filling defects in the biliary tract and underwent pre‐operative endoscopic sphincterotomy. Intra‐operative blood loss was lower and transfusion less frequent in the ERCP group (P < 0.05). There were no ERCP‐related complications. Conclusions: ERCP can accurately delineate the minimal CBD dilatation, associated pancreaticobiliary tract abnormalities and PBM of FFCC. ERCP can improve the perioperative and post‐operative results of paediatric patients with FFCC. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to review our experience of pediatric appendectomy performed by either a general surgeon (GS) or a pediatric surgeon (PS) to determine any differences in outcomes. Methods: We reviewed the medical records of pediatric appendicitis patients, 4 years before (GS group, 2007-2010) and after (PS group, 2011-2014) the introduction of a pediatric surgical practice. The records were reviewed for the following variables: operation time, length of hospital stay, complications, readmission in ≤30 days, type of operation, negative for appendicitis, drainage, open conversion, and reoperation in ≤30 days. Results: Over 8 years, 400 patients were operated on for acute appendicitis, with the PS group comprising 61 % ( N = 244) of patients. The operation time (55.1 vs 43.2 min, p = 0.0001) and postoperative length of hospital stay (3.5 vs 2.7 days, p = 0.001) were shorter, more patients were treated by laparoscopy (61.3 vs 91.2 %, p = 0.0001), and a fewer patients required peritoneal drainage (29.5 vs 63.2 %, p = 0.023) in the PS group than in the GS group. The negative appendectomy rate was slightly lower in the PS group, but not to a statistically significant degree. Conclusion: The patients in the PS group enjoyed a reduced operation time and length of hospital stay, greater likelihood of laparoscopic operation, and less peritoneal drainage than the patients in the GS group. [ABSTRACT FROM AUTHOR]

Because a high viral load may be seen in pediatric patients who are either asymptomatic or have mild symptoms, preoperative COVID-19 screening is essential regardless of the presence or absence of visible symptoms or risk stratification before surgery [[2]]. Dear Editor: We read with interest the article entitled, "Early experience with universal preoperative and preprocedural screening for COVID-19 in low-risk pediatric surgical patients requiring general anesthesia", by Sii et al. [[1]], which was published in the October 2020 issue of I Pediatric Surgery International i . [Extracted from the article]

Background: The jugular vein cutdown for a totally implantable central venous port (TICVP) has 2 disadvantages: 2 separate incisions are needed and the risk for multiple vein occlusions. We sought to evaluate the feasibility of a cephalic vein (CV) cutdown in children.Methods: We prospectively followed patients who underwent a venous cutdown for implantation of a TICVP between Jan. 1, 2002, and Dec. 31, 2006. For patients younger than 8 months, an external jugular vein cutdown was initially tried without attempting a CV cutdown. For patients older than 8 months, a CV cutdown was tried initially. We recorded information on age, weight, outcome of the CV cutdown and complications.Results: During the study period, 143 patients underwent a venous cutdown for implantation of a TICVP: 25 younger and 118 older than 8 months. The CV cutdown was successful in 73 of 118 trials. The 25th percentile and median body weight for 73 successful cases were 15.4 kg and 28.3 kg, respectively. There was a significant difference in the success rate using the criterion of 15 kg as the cutoff. The overall complication rate was 8.2%.Conclusion: The CV cutdown was an acceptable procedure for TICVP in children. It could be preferentially considered for patients weighing more than 15 kg who require TICVP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to analyze the survival of patients with biliary atresia (BA) after Kasai operation and liver transplantation (LT) and to analyze the factors affecting survival. Methods: Seventy-two patients diagnosed with BA were operated on between April 1995 and December 2009 and retrospectively analyzed. Results: Out of the 72 patients, 59 received Kasai operation and 13 received LT without prior Kasai operation. Twenty-seven patients received LT after Kasai operation. Survival with native liver was 39 % at 10 years. With the application of LT, overall 10-year survival for patients with BA was 94.9 %. Among patients alive with native livers after Kasai operation, 14 patients (58.3 %) have at least one complication associated with biliary cirrhosis and portal hypertension. Age at which Kasai operation was performed (60 days) and postoperative normalization of bilirubin were independent risk factors for survival with the native liver, according to multivariate analysis (HR 2.90, p = 0.033 and HR 9.89, p = 0.002). Conclusions: Survival of BA patients has greatly increased in the era of LT. However, many patients surviving with native livers after Kasai operation continue to have signs of biliary cirrhosis and abnormal liver function. [ABSTRACT FROM AUTHOR]

Purpose: With the widespread use of the obstetrical ultrasound, identification of a fetal suprarenal mass has become more common. Most of these masses prove to be congenital neuroblastomas (CNB), but the diagnosis is often confused with other benign lesions and the postnatal management remains to be controversial.Methods: The medical records of 18 patients that underwent primary surgical excision for an antenatally detected suprarenal mass, between January 1995 and April 2009, were reviewed. The clinical, radiological, surgical, and pathological data were collected. Staging evaluation was performed after histological confirmation of the CNB.Results: There were 13 cases of CNB, 1 adrenal cyst, 2 adrenal hemorrhages, and 2 pulmonary sequestrations. The differential diagnosis was impossible before surgery. Most of the CNBs were stage I (N = 11), with 1 stage IV and 1 stage IV-S. Four patients (3 stage I and 1 stage IV-S) had more than one copy of N-myc gene. The stage I patients were cured by surgery alone, and stage IV patients underwent nine cycles of adjuvant chemotherapy and currently have no evidence of disease. The five benign lesions were cured with excision alone. There were no postoperative complications.Conclusion: For early diagnosis and treatment, surgical excision should be considered as the primary therapy for an antenatally detected suprarenal mass. The surgery can be safely performed during the neonatal period and provides a cure in most cases. [ABSTRACT FROM AUTHOR]

Purpose: For International Neuroblastoma Staging System (INSS) stages III or IV neuroblastoma (intermediate or high risk), complete excision of the primary tumor is not always feasible. Most current studies on the treatment outcome of these patients have reported on the complete excision status. The aim of this study is to review the treatment outcome after the incomplete resection.Methods: The medical records of 37 patients that underwent incomplete resection between January 1986 and December 2005 were reviewed retrospectively. Incomplete resection was assessed by review of the operative notes and postoperative computerized tomography. Age, gender, tumor location, INSS stage, N-myc gene copy number, pre- and postoperative therapy, and treatment outcome were reviewed. The treatment outcome was evaluated according to the postoperative treatment protocol in the high-risk group.Results: Intermediate-risk patients were treated with conventional chemotherapy, isotretinoin (ITT) and interleukin-2 (IL-2). High-risk patients were treated with peripheral blood stem cell transplantation (PBSCT), ITT, and IL-2 (N = 11). Before the introduction of PBSCT, the high-risk patients were also treated with the conventional chemotherapy (N = 19). Intermediate-risk patients (N = 5) currently have no evidence of disease (NED). For the high-risk patients (N = 32), 19 patients were treated with chemotherapy alone; 15 patients died of their disease while four patients currently have an NED status. Eight of 11 patients that underwent PBSCT are currently alive.Conclusions: For intermediate risk, conventional chemotherapy appears to be acceptable treatment. However, for high-risk patients, every effort should be made to control residual disease including the use of myeloablative chemotherapy, differentiating agents and immune-modulating agents. [ABSTRACT FROM AUTHOR]

Abnormalities of the intra-abdominal umbilical venous connections are rare congenital vascular anomalies. We report a case of an aneurismal dilatation of an umbilical vein directly connected to the portal vein, vital for the delivery of placental blood in the fetus. A term female newborn presented with a dilated umbilical vein detected by prenatal ultrasound. CT angiography revealed an aneurismal dilatation of a vascular structure, from the umbilical ring to the main portal vein. Follow-up CT angiography showed thrombus progression up to the level of SMV inlet. A laparotomy revealed that the normal course of the umbilical vein was absent. The aneurysm was resected and no thrombus was noted in the aneurysm. Post-operative ultrasound revealed an isolated thrombus at the right main portal vein that resolved spontaneously on the follow-up ultrasound. At the 6-month post-operative follow-up, the baby was well and without complications. Although not evaluated for the presence of a ductus venosus, this anomalous umbilical-portal venous connection might have been associated with an absent ductus venosus. [ABSTRACT FROM AUTHOR]

Lipoblastoma is a benign tumor and usually does not require radical operation for complete excision. We describe here a case of a retroperitoneal lipoblastoma with a massive intratumoral aneurysmal vessel. [ABSTRACT FROM AUTHOR]

Moon S-B, Jung S-M, Kwon C-H, Kim S-J, Joh J-W, Seo J-M, Lee S-K. Posteromedial diaphragmatic hernia following pediatric liver transplantation. Abstract: Diaphragmatic hernia is a rare complication following pediatric LT. Here, four children who developed right-sided posteromedial diaphragmatic hernias after LT are reported. The primary disease was biliary atresia in two patients, hemangioendothelioma in one, and angiosarcoma in one patient. All of the patients underwent living-donor LT using a left lateral graft. The patients presented with abdominal and/or pulmonary signs and symptoms. The diaphragmatic hernias were diagnosed at 28 days to seven months post-transplant by standard radiographs or chest CT. The defects were located at the posteromedial aspect of the diaphragm and were closed by primary closure. After diaphragm repair, the post-operative course was unremarkable and there were no recurrences. Thermal or mechanical injuries to the bare area, especially in cases of excessive adhesion between the liver and diaphragm after Kasai operation, were the possible causes of the posteromedial diaphragmatic hernia after pediatric LT. [ABSTRACT FROM AUTHOR]