Gene expression profiling in necrotizing enterocolitis reveals pathways common to those reported in Crohn's disease

BACKGROUND

Necrotizing enterocolitis (NEC) is the most frequent life-threatening gastrointestinal disease experienced by premature infants in neonatal intensive care units. The challenge for neonatologists is to detect early clinical manifestations of NEC. One strategy would be to identify specific markers that could be used as early diagnostic tools to identify preterm infants most at risk of developing NEC or in the event of a diagnostic dilemma of suspected disease. As a first step in this direction, we sought to determine the specific gene expression profile of NEC.

METHODS

Deep sequencing (RNA-Seq) was used to establish the gene expression profiles in ileal samples obtained from preterm infants diagnosed with NEC and non-NEC conditions. Data were analyzed with Ingenuity Pathway Analysis and ToppCluster softwares.

RESULTS

Data analysis indicated that the most significant functional pathways over-represented in NEC neonates were associated with immune functions, such as altered T and B cell signaling, B cell development, and the role of pattern recognition receptors for bacteria and viruses. Among the genes that were strongly modulated in neonates with NEC, we observed a significant degree of similarity when compared with those reported in Crohn's disease, a chronic inflammatory bowel disease.

CONCLUSIONS

Gene expression profile analysis revealed a predominantly altered immune response in the intestine of NEC neonates. Moreover, comparative analysis between NEC and Crohn's disease gene expression repertoires revealed a surprisingly high degree of similarity between these two conditions suggesting a new avenue for identifying NEC biomarkers.

Priapism in a sickle cell prepuberal child

Between 1985 and 1995, six sickle cell children listed SS were hospitalized in our department for priapism persisting after 24 hours of medical treatment. Two cases regressed after 6 hours of treatment follow-up. Four children were treated by a corpus cavernosum puncture, through the gland, leading to priapism detumescence in 3 cases. In one of our cases, the persistence of priapism induced us to perform a spongiocavernous anastomosis at the 72nd hour. One of the children developed a cerebrovascular accident 10 days after the beginning of the priapism. The other children have been re-examined. They have not presented any reccurence and have normal erection after puberty. Starting from a literature review, we explain the principles we adopted. The physiopathology of priapism in sickle cell patients remains unclear, for both high and low flows do exist. In addition to the risks related to blood products, the treatment by transfusional exchange involves neurological risks and must not delay any surgery. Analgesic treatment is often required. Corpus cavernosum puncture is efficient, with no fibrosis risk. In case of failure, a cavernospongious shunt, with a biopsy needle, can be performed at the same time. Surgical anastomoses are then proposed in case of priapism persistence. General evolution is satisfactory. But the sickle cell patient's priapism needs a long-term follow-up in order to recognise any minor recurrences. The latter could be the principal cause of fibrosis and impotency.

Congenital fibrous hamartoma of the hand: a case report

A patient with a rare localization of a congenital fibrous hamartoma of the hand is described, and the differential diagnosis is discussed. A review of the literature shows the rare frequency of localization of this lesion on the limb extremities.

[Pubic osteitis caused by Salmonella indiana. Apropos of a case]

INTRODUCTION

The authors report the case of a pubic osteomyelitis caused by a salmonella indiana bacterium in a 12 year old child.

CLINICAL CASE

A post traumatic left side pubic pain in a 12 year old child was associated to feverish and inflammatory syndrome, without any predisposing factor. Salmonella Indiana bacterium was found in fecal samples. Radiographs showed an asymetry of the iliopubic branches and an irregularity of the upper left border of the pubic branch. Bone scan showed a public hyperfixation and CT revealed a left-sided pubic osteolysis. The bacteriological examination of the osseous biopsy confirmed the presence of Salmonella Indiana bacterium. Recovery was obtained within 5 months with intravenous antibiotherapy.

DISCUSSION

Since 1987, an increase of minor salmonella infections and particularly of Salmonella Indiana bacterium can be observed in metropolitan France (250 isolated in 1991). This increase is not experienced in Martinique. The contamination mode is yet unknown and the osseous localization is secondary to bacteriema. The patient had no predisposition excepted a chronic digestive carrier. This localization is unfrequent in children. The diagnostic has been achieved by bacteriological samples and osseous biopsy. The treatment based was on third generation cephalosporins and on quinolones.