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Young KC, Schmidt AF, Tan AW, Sbragia L, Elsaie A, Shivanna B. Pathogenesis and Physiologic Mechanisms of Neonatal Pulmonary Hypertension: Preclinical Studies. Clin Perinatol 2024; 51:21-43. [PMID: 38325942 DOI: 10.1016/j.clp.2023.11.004] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Neonatal pulmonary hypertension (PH) is a devastating disorder of the pulmonary vasculature characterized by elevated pulmonary vascular resistance and mean pulmonary arterial pressure. Occurring predominantly because of maldevelopment or maladaptation of the pulmonary vasculature, PH in neonates is associated with suboptimal short-term and long-term outcomes because its pathobiology is unclear in most circumstances, and it responds poorly to conventional pulmonary vasodilators. Understanding the pathogenesis and pathophysiology of neonatal PH can lead to novel strategies and precise therapies. The review is designed to achieve this goal by summarizing pulmonary vascular development and the pathogenesis and pathophysiology of PH associated with maladaptation, bronchopulmonary dysplasia, and congenital diaphragmatic hernia based on evidence predominantly from preclinical studies. We also discuss the pros and cons of and provide future directions for preclinical studies in neonatal PH.
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Affiliation(s)
- Karen C Young
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA.
| | - Augusto F Schmidt
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA
| | - April W Tan
- Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Batchelor Children's Research Institute, 1580 North West 10th Avenue, RM-345, Miami, Fl 33136, USA
| | - Lourenco Sbragia
- Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes 3900, 10th Floor, Monte Alegre14049-900, Ribeirao Preto SP, Brazil
| | - Ahmed Elsaie
- Ascension Via Christi St.Joseph Hospital, 3rd Floor, section of Neonatology, 3600 East Harry StreetWichita, KS 67218, USA; Department of Pediatrics, Cairo University, Cairo 11956, Egypt
| | - Binoy Shivanna
- Division of Neonatology, Department of Pediatrics, 6621 Fannin Street, MC: WT 6-104, Houston, TX 77030, USA
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Nour ALA, Fabro AT, Batah SS, Oria M, Peiro JL, Sbragia L. The myocardial capillary network is altered in congenital diaphragmatic hernia in the fetal rabbit model. Braz J Med Biol Res 2023; 56:e12521. [PMID: 37194833 DOI: 10.1590/1414-431x2023e12521] [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] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 05/18/2023] Open
Abstract
Congenital diaphragmatic hernia (CDH) is associated with thoracic compression of the lungs and heart caused by the herniated abdominal content, leading to cardiac modifications including pressure and vascular changes. Our aim was to investigate the experimental immunoexpression of the capillary proliferation, activation, and density of Ki-67, VEGFR2, and lectin in the myocardium after surgical creation of a diaphragmatic defect. Pregnant New Zealand rabbits were operated on the 25th gestational day in order to create left-sided CDH (LCDH, n=9), right-sided CDH (RCDH, n=9), and Control (n=9), for a total of 27 fetuses in 19 pregnant rabbits. Five days after the procedure, animals were sacrificed, and histology and immunohistochemistry studies of the harvested hearts were performed. Total body weight and heart weight were not significantly different among groups (P=0.702 and 0.165, respectively). VEGFR2 expression was increased in both ventricles in the RCDH group (P<0.0001), and Ki-67 immunoexpression was increased in the left ventricle in the LCDH group compared to Control and RCDH groups (P<0.0001). In contrast, capillary density was reduced in the left ventricle in the LCDH compared to the Control and RCDH groups (P=0.002). Left and right ventricles responded differently to CDH in this model depending on the laterality of the diaphragmatic defect. This surgical model of diaphragmatic hernia was associated with different expression patterns of capillary proliferation, activation, and density in the myocardium of the ventricles of newborn rabbits.
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Affiliation(s)
- A L A Nour
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A T Fabro
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S S Batah
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M Oria
- University of Cincinnati Medical College, Cincinnati Fetal Care Center, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - J L Peiro
- University of Cincinnati Medical College, Cincinnati Fetal Care Center, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - L Sbragia
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Gualberto IJN, Medeiros GA, Santos MV, da Silva Lopes L, Machado HR, Sbragia L. Is there a role in the central nervous system development for using corticosteroids to treat meningomyelocele and hydrocephalus? Childs Nerv Syst 2022; 38:1849-1854. [PMID: 35907004 DOI: 10.1007/s00381-022-05615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Myelomeningocele (MMC) is the most frequent neural tube defect and is frequently associated (around 80% of cases) with hydrocephalus (HC). Both diseases can have severe clinical consequences, insomuch as they require surgical treatment whose complications are not negligible, either when performed in utero or after birth. Therefore, clinical therapies that could have an impact on the incidence and progression of MMC and HC would be certainly valuable; however, this is not the current picture, and there are no effective pharmacological treatments for such patients to this day. AIM AND METHODS Therefore, knowing that an inflammatory process comes associated with these disorders, mostly due to nervous tissue distension, the present article aimed at reviewing the role of corticosteroids in reducing inflammation and thus improving the outcome of patients with HC and MMC, considering the well-established anti-inflammatory effects of CS. RESULTS The systematic review performed herein has found varying results regarding the role of steroids (even though a positive trend was observed) on the treatment and prevention of hydrocephalus, whereas for MMC. CONCLUSION There are many reports demonstrating beneficial effects of CS therapy, from a clinical and histopathological point of view.
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Affiliation(s)
- I José Nogueira Gualberto
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - G Araújo Medeiros
- Bauru Medical School, Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - M Volpon Santos
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L da Silva Lopes
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - H Rubens Machado
- Division of Pediatric Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - L Sbragia
- Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes 3900, 10th floor, Ribeirão Preto, São Paulo, Brazil.
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Canesin WC, Volpe FAP, Gonçalves-Ferri WA, Manso PH, Aragon DC, Sbragia L. Primary peritoneal drainage in neonates with necrotizing enterocolitis associated with congenital heart disease: a single experience in a Brazilian tertiary center. ACTA ACUST UNITED AC 2021; 54:e10220. [PMID: 34076139 PMCID: PMC8186373 DOI: 10.1590/1414-431x2020e10220] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.
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Affiliation(s)
- W C Canesin
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F A P Volpe
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - W A Gonçalves-Ferri
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P H Manso
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D C Aragon
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Laboratório de Cirurgia Experimental Fetal "Michael Harrison", Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anantomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Figueira RL, Gonçalves FL, Prado AR, Ribeiro MC, Costa KM, Silva OCE, Sbragia L. Ventilation-induced changes correlate to pulmonary vascular response and VEGF, VEGFR-1/2, and eNOS expression in the rat model of postnatal hypoxia. ACTA ACUST UNITED AC 2018; 51:e7169. [PMID: 30304094 PMCID: PMC6180352 DOI: 10.1590/1414-431x20187169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 07/24/2018] [Indexed: 11/22/2022]
Abstract
Neonatal asphyxia occurs due to reduction in oxygen supply to vital organs in the newborn. Rapid restoration of oxygen to the lungs after a long period of asphyxia can cause lung injury and decline of respiratory function, which result from the activity of molecules that induce vascular changes in the lung such as nitric oxide (NO) and vascular endothelial growth factors (VEGF). In this study, we evaluated the pulmonary and vascular morphometry of rats submitted to the model of neonatal asphyxia and mechanical ventilation, their expression of pulmonary VEGF, VEGF receptors (VEGFR-1/VEGFR-2), and endothelial NO synthase (eNOS). Neonate Sprague-Dawley rats (CEUA #043/2011) were divided into four groups (n=8 each): control (C), control submitted to ventilation (CV), hypoxia (H), and hypoxia submitted to ventilation (HV). The fetuses were harvested at 21.5 days of gestation. The morphometric variables measured were body weight (BW), total lung weight (TLW), left lung weight (LLW), and TLW/BW ratio. Pulmonary vascular measurements, VEGFR-1, VEGFR-2, VEGF, and eNOS immunohistochemistry were performed. The morphometric analysis showed decreased TLW and TLW/BW ratio in HV compared to C and H (P<0.005). Immunohistochemistry showed increased VEGFR-2/VEGF and decreased VEGFR-1 expression in H (P<0.05) and lower eNOS expression in H and HV. Median wall thickness was increased in H, and the expression of VEGFR-1, VEGFR-2, VEGF, and eNOS was altered, especially in neonates undergoing H and HV. These data suggested the occurrence of arteriolar wall changes mediated by NO and VEGF signaling in neonatal hypoxia.
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Affiliation(s)
- R L Figueira
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L Gonçalves
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A R Prado
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M C Ribeiro
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - K M Costa
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O Castro E Silva
- Laboratório de Transplante de Fígado, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Laboratório de Cirurgia Fetal e Neonatal, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Oria M, Figueira RL, Scorletti F, Sbragia L, Owens K, Li Z, Pathak B, Corona MU, Marotta M, Encinas JL, Peiro JL. CD200-CD200R imbalance correlates with microglia and pro-inflammatory activation in rat spinal cords exposed to amniotic fluid in retinoic acid-induced spina bifida. Sci Rep 2018; 8:10638. [PMID: 30006626 PMCID: PMC6045622 DOI: 10.1038/s41598-018-28829-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 06/27/2018] [Indexed: 01/04/2023] Open
Abstract
Spina bifida aperta is a congenital malformation characterized by the failure of neural tube closure resulting in an unprotected fetal spinal cord. The spinal cord then undergoes progressive damage, likely due to chemical and mechanical factors related to exposure to the intrauterine environment. Astrogliosis in exposed spinal cords has been described in animal models of spina bifida during embryonic life but its relationship with neuroinflammatory processes are completely unknown. Using a retinoic acid-induced rat model of spina bifida we demonstrated that, when exposed to amniotic fluid, fetal spinal cords showed progressive astrogliosis with neuronal loss at mid-gestation (E15) compared to unexposed spinal cords. The number of microglial cells with a reactive phenotype and activation marker expression increased during gestation and exhibited progressive disruption in the inhibitory immune ligand-receptor system. Specifically we demonstrate down-regulation of CD200 expression and up-regulation of CD200R. Exposed spinal cords demonstrated neuroinflammation with increased tissue water content and cytokine production by the end of gestation (E20), which correlated with active Caspase3 expression in the exposed layers. Our findings provide new evidence that microglia activation, including the disruption of the endogenous inhibitory system (CD200-CD200R), may participate in the pathogenesis of spina bifida through late gestation.
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Affiliation(s)
- Marc Oria
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA.
| | - Rebeca L Figueira
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA.,Laboratory of Experimental Fetal Surgery "Michael Harrison", Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo-USP, Ribeirao Preto, Brazil
| | - Federico Scorletti
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Lourenco Sbragia
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA.,Laboratory of Experimental Fetal Surgery "Michael Harrison", Division of Pediatric Surgery, Department of Surgery and Anatomy, Ribeirao Preto Medical School, University of Sao Paulo-USP, Ribeirao Preto, Brazil
| | - Kathryn Owens
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Zhen Li
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Bedika Pathak
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Maria U Corona
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Mario Marotta
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
| | - Jose L Encinas
- Department of Pediatric Surgery, La Paz University Hospital, Madrid, Spain
| | - Jose L Peiro
- Center for Fetal and Placental Research, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH, USA
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Callejas GH, Figueira RL, Gonçalves FLL, Volpe FAP, Zuardi AW, Crippa JA, Hallak JE, Sbragia L. Maternal administration of cannabidiol promotes an anti-inflammatory effect on the intestinal wall in a gastroschisis rat model. ACTA ACUST UNITED AC 2018; 51:e7132. [PMID: 29561958 PMCID: PMC5875904 DOI: 10.1590/1414-431x20177132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/19/2017] [Indexed: 01/08/2023]
Abstract
Gastroschisis (GS) is an abdominal wall defect that results in histological and morphological changes leading to intestinal motility perturbation and impaired absorption of nutrients. Due to its anti-inflammatory, antioxidant, and neuroprotective effects, cannabidiol (CBD) has been used as a therapeutic agent in many diseases. Our aim was to test the effect of maternal CBD in the intestine of an experimental model of GS. Pregnant rats were treated over 3 days with CBD (30 mg/kg) after the surgical induction of GS (day 18.5 of gestation) and compared to controls. Fetuses were divided into 4 groups: 1) control (C); 2) C+CBD (CCBD); 3) gastroschisis (G), and 4) G+CBD (GCBD). On day 21.5 of gestation, the fetuses were harvested and evaluated for: a) body weight (BW), intestinal weight (IW), and IW/BW ratio; b) histometric analysis of the intestinal wall; c) immunohistochemically analysis of inflammation (iNOS) and nitrite/nitrate level. BW: GCBD was lower than CCBD (P<0.005), IW and IW/BW ratio: GCBD was smaller than G (P<0.005), GCBD presented lower thickness in all parameters compared to G (P<0.005), iNOS and nitrite/nitrate were lower concentration in GCBD than to G (P<0.005). Maternal use of CBD had a beneficial effect on the intestinal loops of GS with decreased nitrite/nitrate and iNOS expression.
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Affiliation(s)
- G H Callejas
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R L Figueira
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L L Gonçalves
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F A P Volpe
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A W Zuardi
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J A Crippa
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J E Hallak
- Departmento de Neurociências e Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Laboratório de Cirurgia Experimental Fetal e Neonatal "Michael Harrison" Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Figueira RL, Gonçalves FL, Simões AL, Bernardino CA, Lopes LS, Castro E Silva O, Sbragia L. Brain caspase-3 and intestinal FABP responses in preterm and term rats submitted to birth asphyxia. ACTA ACUST UNITED AC 2017; 49:S0100-879X2016000700703. [PMID: 27356106 PMCID: PMC4926528 DOI: 10.1590/1414-431x20165258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/21/2016] [Indexed: 11/22/2022]
Abstract
Neonatal asphyxia can cause irreversible injury of multiple organs resulting in
hypoxic-ischemic encephalopathy and necrotizing enterocolitis (NEC). This injury is
dependent on time, severity, and gestational age, once the preterm babies need
ventilator support. Our aim was to assess the different brain and intestinal effects
of ischemia and reperfusion in neonate rats after birth anoxia and mechanical
ventilation. Preterm and term neonates were divided into 8 subgroups (n=12/group): 1)
preterm control (PTC), 2) preterm ventilated (PTV), 3) preterm asphyxiated (PTA), 4)
preterm asphyxiated and ventilated (PTAV), 5) term control (TC), 6) term ventilated
(TV), 7) term asphyxiated (TA), and 8) term asphyxiated and ventilated (TAV). We
measured body, brain, and intestine weights and respective ratios [(BW), (BrW), (IW),
(BrW/BW) and (IW/BW)]. Histology analysis and damage grading were performed in the
brain (cortex/hippocampus) and intestine (jejunum/ileum) tissues, as well as
immunohistochemistry analysis for caspase-3 and intestinal fatty acid-binding protein
(I-FABP). IW was lower in the TA than in the other terms (P<0.05), and the IW/BW
ratio was lower in the TA than in the TAV (P<0.005). PTA, PTAV and TA presented
high levels of brain damage. In histological intestinal analysis, PTAV and TAV had
higher scores than the other groups. Caspase-3 was higher in PTAV (cortex) and TA
(cortex/hippocampus) (P<0.005). I-FABP was higher in PTAV (P<0.005) and TA
(ileum) (P<0.05). I-FABP expression was increased in PTAV subgroup (P<0.0001).
Brain and intestinal responses in neonatal rats caused by neonatal asphyxia, with or
without mechanical ventilation, varied with gestational age, with increased
expression of caspase-3 and I-FABP biomarkers.
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Affiliation(s)
- R L Figueira
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L Gonçalves
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A L Simões
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C A Bernardino
- Neurocirurgia, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L S Lopes
- Neurocirurgia, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - O Castro E Silva
- Divisão de Transplante, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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9
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Varisco BM, Sbragia L, Chen J, Scorletti F, Joshi R, Wong HR, Lopes-Figueira R, Oria M, Peiro J. Excessive Reversal of Epidermal Growth Factor Receptor and Ephrin Signaling Following Tracheal Occlusion in Rabbit Model of Congenital Diaphragmatic Hernia. Mol Med 2016; 22:398-411. [PMID: 27452320 DOI: 10.2119/molmed.2016.00121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/04/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) causes severe pulmonary hypoplasia from herniation of abdominal contents into the thorax. Tracheal occlusion (TO) for human CDH improves survival, but morbidity and mortality remain high, and we do not fully understand the cellular pathways and processes most severely impacted by CDH and TO. We created a left diaphragmatic hernia (DH) in rabbit fetuses with subsequent TO and collected left lung sections for NextGen mRNA sequencing. DH, TO, and DHTO fetuses had comparable body and organ growth to control except for lower lung weights in DH (p<0.05). Of 13,687 expressed genes, DHTO had 687 differentially expressed genes compared to DH, but no other group-group comparison had more than 10. Considering genes in combination, many of the genes reduced in DH were more highly expressed in DHTO than in control. Benchmarking fetal rabbit lung gene expression to published lung development data, both DH and DHTO lungs were more highly correlated with the gene expression of immature lung. DNA synthesis was upregulated in DHTO compared to DH and ribosome and protein synthesis pathways were downregulated. DH reduced total and epithelial cell proliferation by half and two-thirds respectively, and DHTO increased proliferation by 2.5 and 3.4-fold respectively. Signaling pathways downregulated by DH and upregulated in DHTO were epidermal growth factor receptor signaling, ephrin signaling, and cell migration; however, levels of ephrin and EGFR signaling in DHTO exceeded that of control. Identification and inhibition of the ligands responsible for this dysregulated signaling could improve lung development in CDH.
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Affiliation(s)
- Brian M Varisco
- Cincinnati Children's Hospital Medical Center (CCHMC) Division of Critical Care Medicine
| | - Lourenco Sbragia
- CCHMC Division of Pediatric General and Thoracic Surgery.,The Center for Fetal, Cellular, and Molecular Therapy (CCHMC)
| | - Jing Chen
- CCHMC Division of Biomedical Informatics
| | - Federico Scorletti
- CCHMC Division of Pediatric General and Thoracic Surgery.,The Center for Fetal, Cellular, and Molecular Therapy (CCHMC)
| | - Rashika Joshi
- Cincinnati Children's Hospital Medical Center (CCHMC) Division of Critical Care Medicine
| | - Hector R Wong
- Cincinnati Children's Hospital Medical Center (CCHMC) Division of Critical Care Medicine
| | - Rebecca Lopes-Figueira
- CCHMC Division of Pediatric General and Thoracic Surgery.,The Center for Fetal, Cellular, and Molecular Therapy (CCHMC)
| | - Marc Oria
- CCHMC Division of Pediatric General and Thoracic Surgery.,The Center for Fetal, Cellular, and Molecular Therapy (CCHMC)
| | - Jose Peiro
- CCHMC Division of Pediatric General and Thoracic Surgery.,The Center for Fetal, Cellular, and Molecular Therapy (CCHMC)
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10
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Abstract
Persistent cloaca malformation is the most severe type of anorectal and urogenital malformation. Decisions concerning the surgical treatment for this condition are taken during the first hours of life and may determine the quality of life of these patients. Thus, prenatal diagnosis becomes important for a prompt and efficient management of the fetus and newborn, and accurate counseling of the parents regarding its consequences and the future of the baby. Careful evaluation by ultrasonography, and further in-depth analysis with MRI, allow prenatal detection of characteristic findings, which can lead to diagnose or at least suspect this condition. We reviewed our experience and the literature in order to highlight the most important clues that can guide the physician in the differential diagnosis.
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Affiliation(s)
- Jose L Peiro
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Ave, MLC 11025, Cincinnati, Ohio 45229-3039.
| | - Federico Scorletti
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Ave, MLC 11025, Cincinnati, Ohio 45229-3039
| | - Lourenco Sbragia
- Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Ave, MLC 11025, Cincinnati, Ohio 45229-3039
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11
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Capeto FA, Lima FJB, Okoba W, Ramos FL, Messias TFA, Rigonatto GA, Sbragia L, Magalhães PJC, Melo-Filho AA. Contractile profile of esophageal and gastric fundus strips in experimental doxorubicin-induced esophageal atresia. Braz J Med Biol Res 2015; 48:458-64. [PMID: 25760030 PMCID: PMC4445670 DOI: 10.1590/1414-431x20144305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 12/11/2014] [Indexed: 01/13/2023] Open
Abstract
Esophageal atresia (EA) is characterized by esophageal and gastric motility changes
secondary to developmental and postsurgical damage. This study evaluated the
in vitro contractile profile of the distal esophagus and gastric
fundus in an experimental model of EA induced by doxorubicin (DOXO). Wistar pregnant
rats received DOXO 2.2 mg/kg on the 8th and 9th gestational days. On day 21.5,
fetuses were collected, sacrificed, and divided into groups: control, DOXO without EA
(DOXO-EA), and DOXO with EA (DOXO+EA). Strips from the distal esophagus and gastric
fundus were mounted on a wire myograph and isolated organ-bath system, respectively,
and subjected to increasing concentrations of carbamylcholine chloride (carbachol,
CCh). The isolated esophagus was also stimulated with increasing concentrations of
KCl. In esophagus, the concentration-effect curves were reduced in response to CCh in
the DOXO+EA and DOXO-EA groups compared to the control group (P<0.05). The maximum
effect values (Emax) for DOXO+EA and DOXO-EA were significantly lower than
control (P<0.05), but the half-maximal effective concentration (EC50)
values were not significantly different when the three groups were compared
(P>0.05). In response to KCl, the distal esophagus samples in the three groups
were not statistically different with regard to Emax or EC50
values (P>0.05). No significant difference was noted for EC50 or
Emax values in fundic strips stimulated with CCh (P>0.05). In
conclusion, exposure of dams to DOXO during gestation inhibited the contractile
behavior of esophageal strips from offspring in response to CCh but not KCl,
regardless of EA induction. The gastric fundus of DOXO-exposed offspring did not have
altered contractile responsiveness to cholinergic stimulation.
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Affiliation(s)
- F A Capeto
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - F J B Lima
- Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - W Okoba
- Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - F L Ramos
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - T F A Messias
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - G A Rigonatto
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - L Sbragia
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - P J C Magalhães
- Departamento de Fisiologia e Farmacologia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
| | - A A Melo-Filho
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, CE, Brasil
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12
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Manso PH, Figueira RL, Prado CM, Gonçalves FL, Simões ALB, Ramos SG, Sbragia L. Early neonatal echocardiographic findings in an experimental rabbit model of congenital diaphragmatic hernia. ACTA ACUST UNITED AC 2015; 48:234-9. [PMID: 25651459 PMCID: PMC4381943 DOI: 10.1590/1414-431x20144184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/13/2014] [Indexed: 12/22/2022]
Abstract
This study aimed to demonstrate that congenital diaphragmatic hernia (CDH) results in
vascular abnormalities that are directly associated with the severity of pulmonary
hypoplasia and hypertension. These events increase right ventricle (RV) afterload and
may adversely affect disease management and patient survival. Our objective was to
investigate cardiac function, specifically right ventricular changes, immediately
after birth and relate them to myocardial histological findings in a CDH model.
Pregnant New Zealand rabbits underwent the surgical procedure at 25 days of gestation
(n=14). CDH was created in one fetus per horn (n=16), and the other fetuses were used
as controls (n=20). At term (30 days), fetuses were removed, immediately dried and
weighed before undergoing four-parameter echocardiography. The lungs and the heart
were removed, weighed, and histologically analyzed. CDH animals had smaller total
lung weight (P<0.005), left lung weight (P<0.005), and lung-to-body ratio
(P<0.005). Echocardiography revealed a smaller left-to-right ventricle ratio
(LV/RV, P<0.005) and larger diastolic right ventricle size (DRVS, P<0.007).
Histologic analysis revealed a larger number of myocytes undergoing mitotic division
(186 vs 132, P<0.05) in CDH hearts. Immediate RV dilation of CDH
hearts is related to myocyte mitosis increase. This information may aid the design of
future strategies to address pulmonary hypertension in CDH.
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Affiliation(s)
- P H Manso
- Departamento de Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R L Figueira
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Prado
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F L Gonçalves
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A L B Simões
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - S G Ramos
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Sbragia
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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13
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Abstract
Progress in the last three decades in prenatal genetic diagnosis and advancement in prenatal imaging and characterization of fetal anomalies have allowed better preparation in family counseling and afforded the opportunity to consider prenatal treatment for congenital defects that would have fatal outcomes, among them the fetal tumors. Advances in fetal therapy and surgical approaches including minimally invasive procedures, have permitted not just the survival of rare tumor cases but improved long-term outcomes. In this review, we described some of the most common fetal tumors and their recommended management with emphasis on in utero treatment options.
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Affiliation(s)
- Jose L Peiro
- Cincinnati Children's Hospital Medical Center (CCHMC), 3333 Burnet Avenue, MLC 11025, Cincinnati, Ohio 45229-3039, USA.
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14
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Sbragia L, Nassr ACC, Gonçalves FLL, Schmidt AF, Zuliani CC, Garcia PV, Gallindo RM, Pereira LAV. VEGF receptor expression decreases during lung development in congenital diaphragmatic hernia induced by nitrofen. Braz J Med Biol Res 2014; 47:171-8. [PMID: 24519134 PMCID: PMC4051183 DOI: 10.1590/1414-431x20133221] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 08/21/2013] [Indexed: 11/22/2022] Open
Abstract
Changes in vascular endothelial growth factor (VEGF) in pulmonary vessels have
been described in congenital diaphragmatic hernia (CDH) and may contribute to
the development of pulmonary hypoplasia and hypertension; however, how the
expression of VEGF receptors changes during fetal lung development in CDH is not
understood. The aim of this study was to compare morphological evolution with
expression of VEGF receptors, VEGFR1 (Flt-1) and VEGFR2 (Flk-1), in
pseudoglandular, canalicular, and saccular stages of lung development in normal
rat fetuses and in fetuses with CDH. Pregnant rats were divided into four groups
(n=20 fetuses each) of four different gestational days (GD) 18.5, 19.5, 20.5,
21.5: external control (EC), exposed to olive oil (OO), exposed to 100 mg
nitrofen, by gavage, without CDH (N-), and exposed to nitrofen with CDH (CDH) on
GD 9.5 (term=22 days). The morphological variables studied were: body weight
(BW), total lung weight (TLW), left lung weight, TLW/BW ratio, total lung
volume, and left lung volume. The histometric variables studied were: left lung
parenchymal area density and left lung parenchymal volume. VEGFR1 and VEGFR2
expression were determined by Western blotting. The data were analyzed using
analysis of variance with the Tukey-Kramer post hoc test. CDH
frequency was 37% (80/216). All the morphological and histometric variables were
reduced in the N- and CDH groups compared with the controls, and reductions were
more pronounced in the CDH group (P<0.05) and more evident on GD 20.5 and GD
21.5. Similar results were observed for VEGFR1 and VEGFR2 expression. We
conclude that N- and CDH fetuses showed primary pulmonary hypoplasia, with a
decrease in VEGFR1 and VEGFR2 expression.
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Affiliation(s)
- L Sbragia
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A C C Nassr
- Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São CarlosSP, Brasil, Departamento de Hidrobiologia do Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F L L Gonçalves
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A F Schmidt
- Pediatrics House Office, Cincinnati Children's Hospital Medical Center, CincinnatiOH, USA, Pediatrics House Office, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - C C Zuliani
- Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, CampinasSP, Brasil, Departamento de Clínica Médica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brasil
| | - P V Garcia
- Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, CampinasSP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil
| | - R M Gallindo
- Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brasil, Divisão de Cirurgia Pediátrica, Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L A V Pereira
- Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, CampinasSP, Brasil, Departamento de Histologia e Embriologia, Instituto de Biologia, Universidade Estadual de Campinas, UNICAMP, Campinas, SP, Brasil
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15
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Gonçalves FLL, de Souza GFP, Schmidt AF, Regis AC, de Oliveira MG, Sbragia L. Evaluation of nitric oxide (NO) and nitric oxide synthases (NOS) in the amniotic fluid in an experimental gastroschisis rat model. Eur J Pediatr Surg 2011; 21:362-5. [PMID: 21960425 DOI: 10.1055/s-0031-1285872] [Citation(s) in RCA: 3] [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] [Indexed: 10/17/2022]
Abstract
UNLABELLED Intestinal damage due to gastroschisis (G), an anomaly found with increasing incidence by pediatric surgeons, is intimately associated with endogenous nitric oxide (NO) production and NO synthase (NOS) expression. AIM Aim of the study was to evaluate NO production and NOS isoforms in the intestine and amniotic fluid (AF) using a rat model of gastroschisis. METHODS A gastroschisis rat model was surgically created at 18.5 days of gestation (term=22 days). 3 groups of 12 fetuses each were studied: control (C), sham (S) and (G). Morphometric data of body weight (BW), intestinal weight (IW) and the IW/BW ratio were evaluated and compared. Indirect quantification of NO (nitrite and nitrate - NOx) was analyzed by chemiluminescence, and the expression of the 3 isoforms was analyzed by Western blotting. RESULTS Group G showed an increase in IW and IW/BW compared with groups C and S. IW: G=0.27 ± 0.06, C=0.20 ± 0.02, S=0.20 ± 0.02 (p<0.01); IW/BW: G=4.11 ± 0.57, C=5.21 ± 1.04, S=5.18 ± 1.23 (p<0.05). NO in the G group was lower in the intestine and higher in AF, as opposed to C and S, where it had increased in the intestine and decreased in AF. Intestinal NOx: G=0.85 ± 0.28, C=1.86 ± 0.82, S=1.80 ± 0.69 (p<0.05); NOx in AF: G=161.87 ± 52.11, C=6.99 ± 5.45, S=48.73 ± 13.183 (p<0.001). CONCLUSION The intestinal inflammation in gastroschisis promotes the release of nitric oxide to the environment (AF). Perhaps NO in the AF may be an inflammatory marker for G.
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Affiliation(s)
- F L L Gonçalves
- Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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16
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Schmidt AF, Gonçalves A, Bustorff-Silva JM, Oliveira Filho AG, Marba ST, Sbragia L. Does staged closure have a worse prognosis in gastroschisis? Clinics (Sao Paulo) 2011; 66:563-6. [PMID: 21655747 PMCID: PMC3093785 DOI: 10.1590/s1807-59322011000400007] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 12/21/2010] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Correction of gastroschisis can be accomplished by primary or staged closure. There is, however, no consensus regarding the best approach or criteria to favor one method over the other has been established. OBJECTIVE To compare the outcome of primary and staged closure in newborns with gastroschisis using intravesical pressure (IVP) as the decision criterion. PATIENTS & METHODS We prospectively analyzed 45 newborns with gastroschisis. An IVP with a threshold of 20 cm H(2)O was used to indicate primary or staged closure, and the outcomes between the two methods were compared. RESULTS AND DISCUSSION Newborns in whom primary closure was feasible were born at a lower gestational age. There was no significant difference in the frequency of complications, time to begin oral feeding, length of parenteral nutrition or length of hospital stay. Compared with previous reports, our data showed higher rates of prenatal diagnosis and cesarean delivery, a lower average birth weight, a higher rate of small gestational age babies and a more frequent association with intestinal atresia. Conversely, our data showed a lower rate of postoperative necrotizing enterocolitis and a lower average length of hospital stay. CONCLUSION No significant difference was observed in the outcome of newborns who underwent primary closure or staged closure of gastroschisis when using an IVP below 20 cm H(2)O as the criterion for primary closure.
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Affiliation(s)
- Augusto Frederico Schmidt
- Discipline of Pediatric Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas, Brazil
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17
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Sbragia L, Schmidt AF, Moraes S, Bittencourt DG, Gonçalves FLL, Pereira LAVD, Velloso LA. Inflammatory response in a rat model of gastroschisis is associated with an increase of NF-kappaB. ACTA ACUST UNITED AC 2010; 43:160-5. [PMID: 20098844 DOI: 10.1590/s0100-879x2010005000005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 12/17/2009] [Indexed: 11/22/2022]
Abstract
Babies with gastroschisis have high morbidity, which is associated with inflammatory bowel injury caused by exposure to amniotic fluid. The objective of this study was to identify components of the inflammatory response in the intestine and liver in an experimental model of gastroschisis in rats. The model was surgically created at 18.5 days of gestation. The fetuses were exposed through a hysterotomy and an incision at the right of the umbilicus was made, exposing the fetal bowel. Then, the fetus was placed back into the uterus until term. The bowel in this model had macro- and microscopic characteristics similar to those observed in gastroschisis. The study was conducted on three groups of 20 fetuses each: gastroschisis, control, and sham fetuses. Fetal body, intestine and liver weights and intestine length were measured. IL-1beta, IL-6, IL-10, TNF-alpha, IFN-gamma and NF-kappaB levels were assessed by ELISA. Data were analyzed statistically by ANOVA followed by the Tukey post-test. Gastroschisis fetuses had a decreased intestine length (means +/- SD, 125 +/- 25 vs 216 +/- 13.9; P < 0.005) and increased intestine weight (0.29 +/- 0.05 vs 0.24 +/- 0.04; P < 0.005). Intestine length correlated with liver weight only in gastroschisis fetuses (Pearson's correlation coefficient, r = 0.518, P = 0.019). There were no significant differences in the concentrations of IL-1beta, TNF-alpha or IFN-gamma in the intestine, whereas the concentration of NF-kappaB was increased in both the intestine and liver of fetuses with gastroschisis. These results show that the inflammatory response in the liver and intestine of the rat model of gastroschisis is accompanied by an increase in the amount of NF-kappaB in the intestine and liver.
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Affiliation(s)
- L Sbragia
- Disciplina de Cirurgia Pediátrica, Departamento de Cirurgia, Universidade Estadual de Campinas, SP, Brasil.
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18
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Klaritsch P, Mayer S, Sbragia L, Toelen J, Roubliova X, Lewi P, Lang U, Deprest J. Albumin als Zusatz zur Trachealokklusion bei fetalen Ratten mit Nitrofen-induzierter Zwerchfellhernie – eine placebokontrollierte Studie. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1238978] [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: 10/20/2022] Open
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19
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Klaritsch P, Mayer S, Toelen J, Sbragia L, Beck V, Petersen S, Carmeliet P, Debyser Z, Lang U, Deprest J. 439: Intra-amniotic VEGF administration in fetal rats with nitrofen induced lung hypoplasia – A placebo controlled study. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.468] [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: 10/21/2022]
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20
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Klaritsch P, Mayer S, Sbragia L, Toelen J, Debyser Z, Haeusler M, Roubliova X, Deprest J. 241: Effects of tracheal occlusion and albumin on proliferation in fetal rats with nitrofen induced congenital diaphragmatic hernia – A placebo controlled molecular study. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.269] [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: 11/25/2022]
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21
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Carlon M, Toelen J, Mayer S, Gijsbers R, Sbragia L, Deprest J, Debyser Z. 653: Evaluation of different screening models for optimal pulmonary transduction with lentiviral vectors. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.683] [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: 10/21/2022]
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22
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Sbragia L, Oliveira-Filho AG, Vassallo J, Pinto GA, Guerra-Junior G, Bustorff-Silva J. Adrenocortical Tumors in Brazilian Children: Immunohistochemical Markers and Prognostic Factors. Arch Pathol Lab Med 2005; 129:1127-31. [PMID: 16119984 DOI: 10.5858/2005-129-1127-atibci] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—The behavior of adrenocortical tumors (ACTs) is usually difficult to establish in childhood, and the role of immunomarkers in predicting outcome has not yet been elucidated.
Objective.—To investigate the relationship between clinical, pathologic, and immunohistochemical findings and prognosis in a series of children with ACTs.
Patients and Methods.—Clinical data were evaluated retrospectively in 33 children with ACTs, including age at diagnosis, sex, time between first symptoms and diagnosis, clinical signs and symptoms, tumor position, and follow-up. Histologic sections were reviewed, each tumor was classified, and staging was performed according to previously published criteria. Immunohistochemical analysis of p53, Ki-67, c-Erb-B2, and Bcl-2 was performed according to previously published techniques.
Results.—Sixty-four percent (n = 21) of the patients were female, and the age at diagnosis in the cohort ranged from 2 to 96 months. Virilization alone affected 70% (n = 23) of the patients, and 18 patients had stage 1 disease, 9 had stage 2 disease, and 3 each had stage 3 and stage 4 disease. Female sex and stage 1 and stage 2 disease were associated with good outcome. None of the histopathologic criteria evaluated correctly predicted outcome. Only tumors with a volume exceeding 200 mL were associated with malignant behavior. Because only a small number of tumors expressed the antigens, results of these immunohistochemical tests were considered inconclusive.
Conclusion.—In this sample of pediatric ACTs, the clinical and surgical parameters are the most important prognostic factors, while the immunohistochemical markers evaluated were not predictive of outcome.
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Affiliation(s)
- Lourenco Sbragia
- Division of Pediatric Surgery, Department of Surgery, School of Medical Sciences, State University of Campinas, UNICAMP, Campinas, Sao Paulo, Brazil.
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Chapin CJ, Ertsey R, Yoshizawa J, Hara A, Sbragia L, Greer JJ, Kitterman JA. Congenital diaphragmatic hernia, tracheal occlusion, thyroid transcription factor-1, and fetal pulmonary epithelial maturation. Am J Physiol Lung Cell Mol Physiol 2005; 289:L44-52. [PMID: 15764645 DOI: 10.1152/ajplung.00342.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Congenital diaphragmatic hernia (CDH) occurs in ∼1:2,500 human births and has high morbidity and mortality rates, primarily due to pulmonary hypoplasia and pulmonary hypertension. Tracheal occlusion (TO), in experimental animals, distends lungs and increases lung growth and alveolar type I cell maturation but decreases surfactant components and reduces alveolar type II cell density. We examined effects of CDH and CDH+TO on lung growth and maturation in fetal rats. To induce CDH, we administered nitrofen (100 mg) to dams at 9.5 days of gestation. We compared lungs from fetuses with CDH, CDH+TO, and those exposed to nitrofen without CDH. CDH decreased lung wet weight bilaterally ( P < 0.0001) and DNA content in lung ipsilateral to CDH ( P < 0.05). CDH+TO significantly increased lung wet weights bilaterally; DNA content was intermediate between CDH and NC. To evaluate effects on the distal pulmonary epithelium, we examined surfactant mRNA and protein levels, type I and II cell-specific markers (RTI40 and RTII70, respectively), and transcriptional regulator thyroid transcription factor-1 (TTF-1). Decreased lung distension (due to CDH) increased SP-C mRNA and TTF-1 protein expression and reduced RTI40 ( P < 0.05 for all). Increased lung distension (due to CDH+TO) reduced expression of SP mRNAs and pro-SP-C and TTF-1 proteins and enhanced expression of RTI40 (mRNA and protein; P < 0.05 for all). We conclude that CDH+TO partially reverses effects of CDH; it corrects the pulmonary hypoplasia and restores type I cell differentiation but adversely affects SP expression in type II cells. These effects may be mediated through changes in TTF-1 expression.
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Affiliation(s)
- Cheryl J Chapin
- Cardiovascular Research Institute, University of California, San Francisco, 94143, USA.
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Bakonyi Neto A, Takegawa B, Ortolan E, Galvão F, Mendonça F, Sbragia L, Crepaldi N, Vicente Y, Chaves H, Guimarães J. Demographic of short gut syndrome: increasing demand is not followed by referral of potential candidates for small bowel transplantation. Transplant Proc 2004; 36:259-60. [PMID: 15050127 DOI: 10.1016/j.transproceed.2004.01.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite improvements in small bowel transplantation (SBTx), early referral of patients with irreversible intestinal failure (IF) remains a major obstacle. In this study we evaluated the demand for SBTx among seven surgical pediatric centers located at least 200 km from our center. METHODS From 1997 to 2001, 640 patients have been treated for neonatal diseases, including 248 who underwent a minor or major intestinal resection. Twenty-four patients with major resections presented with short gut syndrome, requiring total parenteral nutrition (TPN). The greatest demand was in postsurgical neonates with necrotizing enterocolitis, gastroschiesis, onphalocoeles, or midgut volvulus, and in three adults with postradiotherapy arteritis (n = 2) and mesenteric vein thromboses (n = 1). The median length of residual bowel after resection was 20 to 30 cm, without an ileocecal valve. Four patients were referred for SBTx evaluation; three died while awaiting a donor; 20 were not referred, among whom 14 died of TPN complications. RESULTS Approximately 62 children per year require nutritional support for IF, most of whom develop complications related to TPN. Because many patients who are TPN-dependent develop complications, we believe that early referral would reduce mortality. CONCLUSIONS Greater medical awareness about the feasibility of SBTx procedures and earlier referral may improve results and quality of life after transplant.
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Affiliation(s)
- A Bakonyi Neto
- Department of Surgery, Botucatu Faculty of Medicine, UNESP, São Paulo, Brazil.
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Yoshizawa J, Sbragia L, Paek BW, Sydorak RM, Yamazaki Y, Harrison MR, Farmer DL. Fetal surgery for repair of myelomeningocele allows normal development of anal sphincter muscles in sheep. Pediatr Surg Int 2004; 20:14-8. [PMID: 14689212 DOI: 10.1007/s00383-003-1073-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
One major problem for patients with myelomeningocele (MMC) is fecal incontinence. To prevent this problem, fetal surgery for repair of MMC has been recently undertaken. The strategy behind this surgery is to allow normal development of anal sphincter muscles. The purpose of this study was to determine whether fetal surgery for repair of MMC allows normal development of anal sphincter muscles. Myelomeningocele was surgically created in fetal sheep at 75 days of gestation. At 100 days of gestation, fetal surgery for repair of the MMC lesion was performed. Three repair methods were used: standard neurosurgical repair (4 fetal sheep), covering the MMC lesion with Alloderm (2 fetal sheep), and covering the MMC lesion with Gore-Tex (2 fetal sheep). After the sheep were delivered (140 days of gestation), external and internal anal sphincter muscles were analyzed histopathologically. In control fetal sheep (not repaired) anal sphincter muscles did not develop normally. In contrast, in fetal sheep that underwent repair of the MMC, the external and internal anal sphincter muscles developed normally. Histopathologically, in the external sphincter muscles, muscle fibers were dense. In the internal sphincter muscles, endomysial spaces were small, myofibrils were numerous, and fascicular units were larger than those in unrepaired fetal sheep. There was no difference in muscle development for the repair methods. Fetal surgery for repair of MMC allows normal development of anal sphincter muscles.
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Affiliation(s)
- Jyoji Yoshizawa
- Division of Pediatric Surgery and Fetal Treatment Center, Department of Surgery, University of California, San Francisco, CA, USA.
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Yoshizawa J, Chapin CJ, Sbragia L, Ertsey R, Gutierrez JA, Albanese CT, Kitterman JA. Tracheal occlusion stimulates cell cycle progression and type I cell differentiation in lungs of fetal rats. Am J Physiol Lung Cell Mol Physiol 2003; 285:L344-53. [PMID: 12679321 DOI: 10.1152/ajplung.00281.2002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fetal tracheal occlusion (TO) has been reported to stimulate lung growth but decreases number and maturation of type II cells, effects that vary with gestational age and duration of TO. We examined effects of a novel method of TO (unipolar microcautery to seal the trachea) produced at 19.5-20 days (d) of gestation in fetal rats; fetuses were delivered at term, 22 d. Controls were sham operated and unoperated littermates. TO increased wet lung weight but not dry lung weight or lung DNA and protein. To evaluate further the effects of TO, we examined the cell cycle regulators, cyclins D1 and A, in fetal lungs. Cyclin D1 increased with TO (P < 0.005). TO also increased expression of the type I epithelial cell marker RTI40 (mRNA and protein). TO decreased mRNA for surfactant proteins (SP)-A and -C but did not affect protein levels of SP-A and -B and of RTII70, a type II epithelial cell marker. We conclude that TO by microcautery, even of short duration, has diverse pulmonary effects including stimulating increased levels of cyclin D1 with probable cell cycle progression, type I cell differentiation, and possibly inhibiting type II cell function.
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Affiliation(s)
- Jyoji Yoshizawa
- Department of Veteran Affairs, University of California, San Francisco, CA 94118, USA
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Yoshizawa J, Sbragia L, Paek BW, Sydorak RM, Yamazaki Y, Harrison MR, Farmer DL. Fetal surgery for repair of myelomeningocele allows normal development of the rectum in sheep. Pediatr Surg Int 2003; 19:162-6. [PMID: 12811478 DOI: 10.1007/s00383-002-0910-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2002] [Indexed: 10/25/2022]
Abstract
To determine whether fetal surgery in a fetus with myelomeningocele (MMC) allows normal development of rectal muscles and nerves, we analyzed the rectum after fetal surgery in a sheep model. An MMC lesion was surgically created in 13 fetal sheep at 75 days of gestation. One fetal sheep died after the lesion was created. Eight fetal sheep were repaired at 100 days of gestation; the others were not repaired, as a control (n=4). Three methods were used for fetal surgery of MMC: standard neurosurgical repair (4 fetal sheep), covering of the MMC lesion by Alloderm (2 fetal sheep), and covering of the MMC lesion by Gore-Tex (2 fetal sheep). At 140 days of gestation, fetal sheep were harvested and histo-pathological analysis was performed on the rectum using hematoxylin and eosin staining for muscles and S-100 protein staining for nerves. One fetal sheep treated by standard neurosurgical repair died before harvesting. The four untreated fetal sheep had hypoplastic longitudinal muscles of the rectum but well developed-circular muscles. In addition, the untreated fetuses had a hypoplastic submucosal nerve plexus but a well-developed intermuscular nerve plexus. In contrast, treated fetal sheep had well-developed longitudinal and circular muscles except for one sheep treated with standard neurosurgical repair. In addition, except for the same fetal sheep, treated fetal sheep had well-developed nerve plexuses. There was no difference in muscle and nerve development of the rectum among the three repair methods. Fetal surgery for repair of MMC allows normal development of rectal muscles and nerves.
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Affiliation(s)
- Jyoji Yoshizawa
- Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California San Francisco, San Francisco, California, USA.
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Sydorak RM, Nijagal A, Sbragia L, Hirose S, Tsao K, Phibbs RH, Schmitt SK, Lee H, Farmer DL, Harrison MR, Albanese CT. Gastroschisis: small hole, big cost. J Pediatr Surg 2002; 37:1669-72. [PMID: 12483626 DOI: 10.1053/jpsu.2002.36689] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE This study was designed to assess the outcome and financial costs incurred for the treatment of gastroschisis. METHODS A retrospective analysis was conducted of all patients with gastroschisis at a single institution over the past decade (n = 69). Hospital costs were determined and standardized to December 2001 dollars. RESULTS Of the 69 patients, average gestational age at delivery was 35.9 weeks. Thirty-six patients had a primary fascial closure; 33 had a silo placed. The mean time to first feeding was 22 days and full feeding, 33 days. Average length of stay was 47 days. There were 3 deaths (2 shortly after birth, and one 131 days later owing to sepsis). The average cost of hospitalization and physician fees for patients with gastroschisis was $123,200. Using multivariate regression analysis, significant variables (P <.05) associated with cost of hospitalization were number of operative procedures, ventilatory days, male gender, and length of stay. Room expenses (43%), physician fees (15%), respiratory and pulmonary care (10%), and supply and devices (10%) made up the majority of costs. CONCLUSIONS Cost of care associated with treatment for gastroschisis is high. Strategies designed to reduce cost must limit gastrointestinal, respiratory, and operative complications and reduce length of stay.
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Affiliation(s)
- R M Sydorak
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA, USA
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Abstract
BACKGROUND/PURPOSE In the last 10 years, the ability to diagnose fetal tumors in the prenatal period has improved greatly because of technical advances in imaging. Early diagnosis and determination of tumor may affect prognosis. METHODS The authors retrospectively reviewed the records of 1316 fetuses who underwent sonographic evaluation for congenital defects at University of California-San Francisco over a 6-year period. Of these, 16 had fetal tumors and were followed up at our institution. There were solid or predominantely solid with small cystic component masses in one of 3 locations: cervical, mediastinal, or abdominal. Excluded from our study were those fetuses with either sacrococcygeal teratoma, congenital cystic adenomatoid malformation of the lung, or ovarian cyst, because these defects have been extensively reviewed elsewhere. In addition, masses that were primarily cystic also were excluded. Data collected included diagnosis, gestational age at diagnosis and at delivery, mode of delivery, fetal and neonatal survival, and disease confirmation. RESULTS Of the 16 fetuses, 4 had mediastinal tumors: 2 with pericardial teratomas (both of whom died in utero) and 2 with cardiac rhabdomyomas (1 died; the other presented tuberous sclerosis and is alive at 2 years of age). Four patients had cervical tumors (3 died; 1 survived and is alive and well), and 8 had abdominal tumors (3 with liver tumors, 4 with a left adrenal mass, and 1 with retroperitoneal teratoma). All eight patients with an abdominal tumor are alive and well. CONCLUSIONS Fetal tumors are rare, and the prognosis seems to depend on their location and size. Although easier to detect, cervical and mediastinal tumors have a worse prognosis. Abdominal masses are more difficult to detect but have a better prognosis.
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Affiliation(s)
- L Sbragia
- Fetal Treatment Center and the Department of Surgery, University of California San Francisco, CA 94143-0570, USA
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Sbragia L, Paek BW, Filly RA, Harrison MR, Farrell JA, Farmer DL, Albanese CT. Congenital diaphragmatic hernia without herniation of the liver: does the lung-to-head ratio predict survival? J Ultrasound Med 2000; 19:845-848. [PMID: 11127009 DOI: 10.7863/jum.2000.19.12.845] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of the present study was to determine the ability of lung-to-head ratio to predict survival and need for extracorporeal membrane oxygenation support in fetuses with left congenital diaphragmatic hernia without herniation of the liver into the chest. The perinatal records of 20 fetuses with isolated left congenital diaphragmatic hernia without herniation of the left lobe of the liver into the chest were reviewed. Fetuses were stratified into two groups depending on lung-to-head ratio: those with a ratio of less than 1.4 (historically a poor prognosis group) and those with a ratio of greater than 1.4. The outcome of both groups was compared with chi-square analysis. Eight of 11 fetuses with a lung-to-head ratio greater than 1.4 survived, whereas 8 of 9 fetuses with a ratio of less than 1.4 survived. No differences were noted in the need for extracorporeal membrane oxygenation support or survival between the two groups. Fetuses with a prenatally diagnosed left congenital diaphragmatic hernia without herniation of liver into the chest have a favorable prognosis even in the presence of a low lung-to-head ratio.
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Affiliation(s)
- L Sbragia
- The Fetal Treatment Center, Department of Surgery, University of California, San Francisco 94143-0570, USA
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