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The SMML, de Meij TGJ, Budding AE, Bakx R, van der Lee JH, Poort L, Cense HA, Heij HA, van Heurn LWE, Gorter RR. The potential of rectal swabs to differentiate simple and complex appendicitis in children with a microbiota-based test. Eur J Pediatr 2022; 181:4221-4226. [PMID: 36195698 PMCID: PMC9649451 DOI: 10.1007/s00431-022-04627-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 05/22/2022] [Accepted: 09/12/2022] [Indexed: 11/24/2022]
Abstract
Currently, accurate biomarkers differentiating simple (phlegmonous) from complex (gangrenous and/or perforated) appendicitis in children are lacking. However, both types may potentially require different treatment strategies, and the search for diagnostic modalities remains warranted. Previously, we demonstrated a distinct microbiota (both an increased bacterial diversity and abundance) in the appendix of children with complex compared to simple appendicitis. From the same cohort of patients we have collected 35 rectal swabs under general anesthesia prior to appendectomy and microbiota analysis was performed by IS-pro, a 16S-23S rDNA-based clinical microbiota profiling technique. Using the obtained IS-profiles, we performed cluster analyses (UPGMA), comparison of diversity (Shannon Diversity Index) and intensity (abundance in relative fluorescence units) on phylum level, and comparison on species level of bacteria between simple and complex appendicitis. Regarding these analyses, we observed no clear differences between simple and complex appendicitis. However, increased similarity of the microbial composition of the appendix and rectal swab was found within children with complex compared to simple appendicitis. Furthermore, PLS-DA regression analysis provided clear visual differentiation between simple and complex appendicitis, but the diagnostic power was low (highest AUC 0.65). Conclusion: Microbiota analysis of rectal swabs may be viable to differentiate between simple and complex appendicitis prior to surgery as a supervised classification model allowed for discrimination of both types. However, the current diagnostic power was low and further validation studies are needed to assess the value of this method. What is Known: • Simple and complex appendicitis in children may require different treatment strategies, but accurate preoperative biomarkers are lacking. • Clear differentiation can be made between both types in children based upon the microbial composition in the appendix. What is New: • Increased similarity was found between the microbial composition of the appendix and rectal swab within children with complex compared to simple appendicitis. • Using a supervised classification model rectal swabs may be viable to discriminate between simple and complex appendicitis, but the diagnostic power was low.
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Affiliation(s)
- Sarah-May M. L. The
- grid.414503.70000 0004 0529 2508Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Tim G. J. de Meij
- grid.414503.70000 0004 0529 2508Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands ,Amsterdam Gastroenterology and Metabolism Research Insititute, Amsterdam, The Netherlands
| | | | - Roel Bakx
- grid.414503.70000 0004 0529 2508Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Johanna H. van der Lee
- grid.414503.70000 0004 0529 2508Pediatric Clinical Research Office, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,grid.491299.e0000 0004 0448 3177Dutch Knowledge Institute, Federation of Medical Specialists, Utrecht, 3528 BL The Netherlands
| | | | - Huib A. Cense
- grid.415746.50000 0004 0465 7034Department of Surgery, Red Cross Hospital, Beverwijk, 1942 LE The Netherlands
| | - Hugo A. Heij
- grid.414503.70000 0004 0529 2508Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands
| | - L. W. Ernst van Heurn
- grid.414503.70000 0004 0529 2508Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands ,Amsterdam Gastroenterology and Metabolism Research Insititute, Amsterdam, The Netherlands
| | - Ramon R. Gorter
- grid.414503.70000 0004 0529 2508Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, 1105 AZ The Netherlands ,Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands ,Amsterdam Gastroenterology and Metabolism Research Insititute, Amsterdam, The Netherlands
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Gorter RR, Wassenaar ECE, de Boer OJ, Bakx R, Roelofs JJTH, Bunders MJ, van Heurn LWE, Heij HA. Composition of the cellular infiltrate in patients with simple and complex appendicitis. J Surg Res 2017. [PMID: 28624043 DOI: 10.1016/j.jss.2017.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND It is now well established that there are two types of appendicitis: simple (nonperforating) and complex (perforating). This study evaluates differences in the composition of the immune cellular infiltrate in children with simple and complex appendicitis. MATERIALS AND METHODS A total of 47 consecutive children undergoing appendectomy for acute appendicitis between January 2011 and December 2012 were included. Intraoperative criteria were used to identify patients with either simple or complex appendicitis and were confirmed histopathologically. Immune histochemical techniques were used to identify immune cell markers in the appendiceal specimens. Digital imaging analysis was performed using Image J. RESULTS In the specimens of patients with complex appendicitis, significantly more myeloperoxidase positive cells (neutrophils) (8.7% versus 1.2%, P < 0.001) were detected compared to patients with a simple appendicitis. In contrast, fewer CD8+ T cells (0.4% versus 1.3%, P = 0.016), CD20 + cells (2.9% versus 9.0%, P = 0.027), and CD21 + cells (0.2% versus 0.6%, P = 0.028) were present in tissue from patients with complex compared to simple appendicitis. CONCLUSIONS The increase in proinflammatory innate cells and decrease of adaptive cells in patients with complex appendicitis suggest potential aggravating processes in complex appendicitis. Further research into the underlying mechanisms may identify novel biomarkers to be able to differentiate simple and complex appendicitis.
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Affiliation(s)
- Ramon R Gorter
- Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands.
| | - Emma C E Wassenaar
- Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands
| | - Onno J de Boer
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Roel Bakx
- Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands
| | - Joris J T H Roelofs
- Department of Pathology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Madeleine J Bunders
- Department of Paediatrics, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental immunology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - L W Ernst van Heurn
- Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands
| | - Hugo A Heij
- Department of Paediatric Surgery, Paediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC and VU University Medical Centre, Amsterdam, The Netherlands
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de Boer JD, Kopp WH, Ooms K, Haase-Kromwijk BJ, Krikke C, de Jonge J, van Heurn LWE, Baranski AG, van der Vliet JA, Braat AE. Abdominal organ procurement in the Netherlands - an analysis of quality and clinical impact. Transpl Int 2017; 30:288-294. [PMID: 27992973 DOI: 10.1111/tri.12906] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/01/2016] [Accepted: 12/12/2016] [Indexed: 12/11/2022]
Abstract
Between March 2012 and August 2013, 591 quality forms were filled out for abdominal organs in the Netherlands. In 133 cases (23%), there was a discrepancy between the evaluation from the procuring and transplanting surgeons. Injuries were seen in 148 (25%) organs of which 12 (2%) led to discarding of the organ: one of 133 (0.8%) livers, five of 38 (13%) pancreata and six of 420 (1.4%) kidneys (P < 0.001). Higher donor BMI was a risk factor for procurement-related injury in all organs (OR: 1.06, P = 0.011) and donor after cardiac death (DCD) donation in liver procurement (OR: 2.31, P = 0.034). DCD donation is also associated with more pancreata being discarded due to injury (OR: 10.333, P = 0.046). A higher procurement volume in a centre was associated with less injury in pancreata (OR = -0.95, P = 0.013) and kidneys (OR = -0.91, P = 0.012). The quality form system efficiently monitors the quality of organ procurement. Although there is a relatively high rate of organ injury, the discard rate is low and it does not significantly affect 1-year graft survival for any organ. We identified higher BMI as a risk factor for injury in abdominal organs and DCD as a risk factor in livers. A higher procurement volume is associated with fewer injuries.
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Affiliation(s)
- Jacob D de Boer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Dutch Transplant Foundation, Leiden, The Netherlands
| | - Wouter H Kopp
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Kirsten Ooms
- Dutch Transplant Foundation, Leiden, The Netherlands
| | | | - Christina Krikke
- Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Jeroen de Jonge
- Department of Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - L W Ernst van Heurn
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andre G Baranski
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J Adam van der Vliet
- Department of Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Andries E Braat
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Mauritz FA, Stellato RK, van Heurn LWE, Siersema PD, Sloots CEJ, Houwen RHJ, van der Zee DC, van Herwaarden-Lindeboom MYA. Laparoscopic antireflux surgery increases health-related quality of life in children with GERD. Surg Endosc 2016; 31:3122-3129. [PMID: 27864715 PMCID: PMC5501913 DOI: 10.1007/s00464-016-5336-5] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/02/2016] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Improving health-related quality of life (HRQoL) is increasingly recognized as an essential part of patient care outcome. Little is known about the effect of laparoscopic antireflux surgery (LARS) on the HRQoL in the pediatric patients. The aims of this study were to evaluate the effect of LARS on HRQoL in children with gastroesophageal reflux disease (GERD) and to identify predictors that influence HRQoL outcome after LARS. METHODS Between 2011 and 2013, 25 patients with therapy-resistant GERD [median age 6 (2-18) years] were included prospectively. Caregivers and children with normal neurodevelopment (>4 years) were asked to fill out the validated PedsQL 4.0 Generic Core Scales before and 3-4 months after LARS. RESULTS The PedsQL was completed by all caregivers (n = 25) and 12 children. HRQoL total score improved significantly after LARS, both from a parental (p = 0.009) and child's perspective (p = 0.018). The psychosocial health summary and physical health summary scores also improved significantly after LARS. HRQoL before and after LARS was significantly lower in children with impaired neurodevelopment (p < 0.001). However, neurodevelopment did not influence the effect of LARS on HRQoL. The only significant predictor for improvement in HRQoL after LARS was age at the time of operation (p = 0.001). CONCLUSIONS HRQoL significantly improves after LARS. Although children with impaired neurodevelopment had lower overall HRQoL, neurodevelopment by itself does not predict inferior improvement in HRQoL after LARS. Older children have a more favorable HRQoL outcome after LARS compared to younger children. This may suggest caution when considering LARS in younger GERD patients.
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Affiliation(s)
- Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands. .,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W Ernst van Heurn
- Department of Pediatric Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cornelius E J Sloots
- Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus MC, Rotterdam, The Netherlands
| | - Roderick H J Houwen
- Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Maud Y A van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room: KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Hageman D, Kooman JP, Lancé MD, van Heurn LWE, Snoeijs MGJ. [Acute kidney injury]. Ned Tijdschr Geneeskd 2012; 156:A5057. [PMID: 23231871] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
'Acute kidney injury' is modern terminology for a sudden decline in kidney function, and is defined by the RIFLE classification (RIFLE is an acronym for Risk, Injury, Failure, Loss and End-stage kidney disease). Acute kidney injury occurs as a result of the combination of reduced perfusion in the kidney, systemic inflammation, and the administration of nephrotoxic drugs. Patients with chronic renal damage, advanced age, diabetes mellitus or heart failure are at an increased risk of acute kidney injury. In the short term, acute kidney injury leads to a markedly increased risk of death; the long-term effect of acute kidney injury is a permanent loss of renal microcirculation which could result in chronic renal disease. Certain biomarkers in the urine offer new possibilities for detecting acute kidney injury in its early stage. Treatment of patients with acute kidney injury is currently supportive in nature. The optimisation of a patient's haemodynamics results in a reduction of the occurrence of acute kidney injury during extensive surgical procedures. A promising treatment aimed at preventing acute kidney injury is called 'remote ischaemic pre-conditioning'.
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