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Wieck MM. Response to: High-powered magnets still require high-powered vigilance: Next steps. J Pediatr Surg 2022; 57:1714. [PMID: 35321797 DOI: 10.1016/j.jpedsurg.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Minna M Wieck
- Division of Pediatric Surgery, UC Davis Children's Hospital, 2335 Stockton Blvd. NAOB 5th Floor, Sacramento, CA 95817 USA.
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2
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Wieck MM, Silva T, Kohler JE. Changing Patterns of Pediatric Trauma During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e286-e290. [PMID: 35858219 DOI: 10.3928/19382359-20220504-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The implementation of lockdown and social distancing policies at the beginning of the coronavirus disease 2019 (COVID-19) pandemic changed both the nature of pediatric traumatic injuries and how those injuries were managed by pediatric trauma centers. At the start of the pandemic, the number of injured children evaluated at trauma centers decreased. Trauma volumes have since rebounded, and a concerning increase in abuse-related injuries has been seen. Pediatric trauma systems responded to the pandemic with new approaches to protect health care providers, conserve critical resources, and assist adult trauma systems overburdened by patients with COVID-19. The widespread effect of COVID-19 continues to have significant repercussions on children's health, but the lessons learned and gaps exposed by the pandemic may be an opportunity to positively transform injury prevention and health care delivery. [Pediatr Ann. 2022;51(7):e286-e290.].
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3
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Affiliation(s)
- Minna M Wieck
- Division of Pediatric Surgery, Comer Children's Hospital, The University of Chicago, Chicago, Illinois
| | - Jessica J Kandel
- Division of Pediatric Surgery, Comer Children's Hospital, The University of Chicago, Chicago, Illinois
| | - Grace Z Mak
- Division of Pediatric Surgery, Comer Children's Hospital, The University of Chicago, Chicago, Illinois.
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Rao A, Wagner ES, Wieck MM, Raiji MT, Schulte JJ, Husain AN, Azzam R. An Unusual Lung Mass of Heterotopic Pancreatic Tissue in a Neonate With an Elevated Immunoreactive Trypsinogen on Newborn Screen. Pediatr Dev Pathol 2020; 23:163-166. [PMID: 31514577 DOI: 10.1177/1093526619876820] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a case of a neonate with tracheoesophageal fistula and esophageal atresia along with a suspicious lung mass who had a false-positive newborn screen for cystic fibrosis due to an elevated serum immunoreactive trypsinogen with an additionally elevated serum lipase. The infant's lung mass was found to contain heterotopic pancreatic tissue consisting of acini, ducts, and islet cells, without an associated gastrointestinal duplication cyst. This constellation of congenital abnormalities has not been described in previous literature. Also, this is the first reported case of a neonate with elevated serum pancreatic enzymes in which the underlying etiology was discovered to be heterotopic pancreas.
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Affiliation(s)
- Anita Rao
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The University of Chicago Medical Center, Chicago, Illinois
| | - Ellen S Wagner
- Department of Pediatrics, The University of Chicago Medical Center, Chicago, Illinois
| | - Minna M Wieck
- Department of Pediatric Surgery, The University of Chicago Medical Center, Chicago, Illinois
| | - Manish T Raiji
- Department of Pediatric Surgery, The University of Chicago Medical Center, Chicago, Illinois
| | - Jefree J Schulte
- Department of Thoracic, Head, and Neck Pathology, The University of Chicago Medical Center, Chicago, Illinois
| | - Aliya N Husain
- Department of Thoracic, Head, and Neck Pathology, The University of Chicago Medical Center, Chicago, Illinois
| | - Ruba Azzam
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, The University of Chicago Medical Center, Chicago, Illinois
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5
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McLaughlin C, Wieck MM, Barin E, Rake A, Burke RV, Roesly HB, Young LC, Chang TP, Cleek EA, Morton I, Goodhue CJ, Burd RS, Ford HR, Upperman JS, Jensen AR. Impact of Simulation-Based Training on Perceived Provider Confidence in Acute Multidisciplinary Pediatric Trauma Resuscitation. Pediatr Surg Int 2018; 34:1353-1362. [PMID: 30324569 PMCID: PMC6353611 DOI: 10.1007/s00383-018-4361-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients. METHODS An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children's hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation. RESULTS Survey response rate was 49% (n = 93/190) pre-simulation, 22% (n = 42/190) post-simulation, and 79% (n = 150/190) at 2-year follow-up. These providers reported more anxiety (p = 0.01) and less confidence (p = 0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p = 0.02) and greater confidence (p = 0.01), compared to untrained providers. CONCLUSIONS Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence. LEVEL OF EVIDENCE II, Prospective cohort.
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Affiliation(s)
- Cory McLaughlin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Minna M Wieck
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Erica Barin
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Alyssa Rake
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Rita V Burke
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Heather B Roesly
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - L. Caulette Young
- Division of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Todd P Chang
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Elizabeth A Cleek
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Inge Morton
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Catherine J Goodhue
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Randall S Burd
- Divisions of Trauma and Pediatric Surgery, Children’s National Medical Center, Washington, DC 20010
| | - Henri R Ford
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
| | - Aaron R Jensen
- Division of Pediatric Surgery, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027,Trauma Program, Children’s Hospital Los Angeles and the Keck School of Medicine of the University of Southern California, Los Angeles, CA 90027
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Fowler KL, Wieck MM, Hilton AE, Hou X, Schlieve CR, Grikscheit TC. Marked stem/progenitor cell expansion occurs early after murine ileostomy: a new model. J Surg Res 2017; 220:182-196. [PMID: 29180181 DOI: 10.1016/j.jss.2017.06.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 04/27/2017] [Revised: 06/09/2017] [Accepted: 06/28/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Improving treatment for short bowel syndrome requires a better understanding of how intestinal adaptation is affected by factors like mechanoluminal stimulation. We hypothesized that in mice, luminal diversion via an ileostomy would drive adaptive changes similar to those seen in human intestine after diversion while offering the opportunity to study the immediate events after resection that precede intestinal adaptation. MATERIALS AND METHODS With Institutional Animal Care and Use Committee approval, a distal ileostomy with a long distal Hartman's was created in 9- to 14-week-old C57/B6 mice (n = 8). Control mice only had a midline laparotomy without stoma formation (n = 5). A rim of tissue from the proximal stoma was resected as a historical control for the proximal segment. Postoperatively, mice received a high-protein liquid diet and water ad libitum. On day 3, tissue from both the proximal and distal limbs were collected for histologic and RNA analysis. Morphometric measures, immunofluorescent antigen detection, and RNA expression were compared with Student paired t-tests with a P value < 0.05 considered significant. RESULTS At 3 d, survival for mice with an ileostomy was 87% and average weight loss was 12.5% of initial weight compared to 6.05% for control mice. Compared to the distal limb, the proximal limb in mice with an ileostomy demonstrated significantly taller villi with deeper and wider crypts. The proximal limb also had decreased expression of intestinal stem cell markers lgr5, bmi1, sox9, and ascl2. Fewer goblet and enteroendocrine cells per hemivillus were also noted in the proximal limb. In control mice, none of these measures were significant between proximal and distal ileum except for villus height. CONCLUSIONS This new murine ileostomy model allows study of intestinal adaptation without intestinal anastomosis, which can be technically challenging and morbid.
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Affiliation(s)
- Kathryn L Fowler
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California
| | - Minna M Wieck
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley E Hilton
- Keck Medical School, University of Southern California, Los Angeles, California
| | - Xiaogang Hou
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California
| | - Christopher R Schlieve
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, The Saban Research Institute at Children's Hospital Los Angeles, Los Angeles, California; Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California; Keck Medical School, University of Southern California, Los Angeles, California.
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Wieck MM, Blake B, Sellick C, Kenron D, DeVries D, Terry S, Krishnaswami S. Utilizing technology to improve intraoperative family communication. Am J Surg 2017; 213:895-900. [PMID: 28372788 DOI: 10.1016/j.amjsurg.2017.03.014] [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: 01/10/2017] [Revised: 01/31/2017] [Accepted: 03/15/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To create and assess satisfaction with an electronic-medical-record (EMR) integrated communication system designed to optimize perioperative communication with families. METHODS We built a tool in the EMR's intraoperative nursing navigation screen for sending customized or standardized text pages to families in English or Spanish. Preoperatively, families were given text pagers with instructions and a hospital map to facilitate leaving the waiting area. After 6 months, Press-Ganey™ data and internal surveys from randomly selected families, and all nurses and surgeons were analyzed for satisfaction and effectiveness. RESULTS Press-Ganey™ data demonstrated 30% improvement in patient satisfaction (p < 0.05). Among families, > 90% indicated pagers were easy to use and provided the desired information during surgery. Of nurses, >90% found the system easy to use and believed it improved families' experience. All surgeons reported improved intraoperative communication and ease of finding families postoperatively. CONCLUSION Perioperative family communication via EMR-integrated text improves efficiency and family, nurse, and surgeon satisfaction.
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Affiliation(s)
- Minna M Wieck
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Blue Blake
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Chanda Sellick
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Daniel Kenron
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Daniel DeVries
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Susan Terry
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
| | - Sanjay Krishnaswami
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health Science University, Portland, OR, USA.
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Wieck MM, Nowicki D, Schall KA, Zeinati C, Howell LK, Anselmo DM. Management of pediatric intramuscular venous malformations. J Pediatr Surg 2017; 52:598-601. [PMID: 27622586 DOI: 10.1016/j.jpedsurg.2016.08.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/05/2016] [Accepted: 08/21/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intramuscular venous malformations (VMs) are rare, but can be highly symptomatic. There are few reports on outcomes, particularly pain, functional limitations, and muscle contractures. We aimed to compare results of medical management, sclerotherapy, and surgical resection. METHODS We retrospectively reviewed 45 patients with an extremity or truncal intramuscular VM between June 2005 and June 2015 at a single institution. Outcomes were compared between treatment modalities with ANOVA and χ2 tests. RESULTS Six patients (13%) were treated with medical management, 4 (9%) with surgical resection, 23 (51%) with sclerotherapy, and 12 (27%) with both surgery and sclerotherapy. Sclerotherapy alone decreased pain in 72%. Only 20% of patients presented with muscle contracture. For these patients, 33% resolved with sclerotherapy, physical therapy, and aspirin; 22% resolved with surgery, and 45% had persistent contracture. 40% of patients treated with sclerotherapy then surgery developed new muscle contractures, compared to 4% of sclerotherapy only patients and 0% of surgery only patients (p=0.04). CONCLUSIONS Medical management, surgery and sclerotherapy are effective treatments for intramuscular VMs. Observation and supportive care can be a primary treatment for patients with minimal symptomatology and no functional limitations. Sclerotherapy is more effective for treating pain than contractures and when used alone, rarely causes a new muscle contracture.
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Affiliation(s)
- Minna M Wieck
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Donna Nowicki
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Kathy A Schall
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Chadi Zeinati
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Lori K Howell
- Department of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
| | - Dean M Anselmo
- Department of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
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Wieck MM, Schlieve CR, Thornton ME, Fowler KL, Isani M, Grant CN, Hilton AE, Hou X, Grubbs BH, Frey MR, Grikscheit TC. Prolonged Absence of Mechanoluminal Stimulation in Human Intestine Alters the Transcriptome and Intestinal Stem Cell Niche. Cell Mol Gastroenterol Hepatol 2017; 3:367-388.e1. [PMID: 28462379 PMCID: PMC5403975 DOI: 10.1016/j.jcmgh.2016.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 06/08/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS For patients with short-bowel syndrome, intestinal adaptation is required to achieve enteral independence. Although adaptation has been studied extensively in animal models, little is known about this process in human intestine. We hypothesized that analysis of matched specimens with and without luminal flow could identify new potential therapeutic pathways. METHODS Fifteen paired human ileum samples were collected from children aged 2-20 months during ileostomy-reversal surgery after short-segment intestinal resection and diversion. The segment exposed to enteral feeding was denoted as fed, and the diverted segment was labeled as unfed. Morphometrics and cell differentiation were compared histologically. RNA Sequencing and Gene Ontology Enrichment Analysis identified over-represented and under-represented pathways. Immunofluorescence staining and Western blot evaluated proteins of interest. Paired data were compared with 1-tailed Wilcoxon rank-sum tests with a P value less than .05 considered significant. RESULTS Unfed ileum contained shorter villi, shallower crypts, and fewer Paneth cells. Genes up-regulated by the absence of mechanoluminal stimulation were involved in digestion, metabolism, and transport. Messenger RNA expression of LGR5 was significantly higher in unfed intestine, accompanied by increased levels of phosphorylated signal transducer and activator of transcription 3 protein, and CCND1 and C-MYC messenger RNA. However, decreased proliferation and fewer LGR5+, OLFM4+, and SOX9+ intestinal stem cells (ISCs) were observed in unfed ileum. CONCLUSIONS Even with sufficient systemic caloric intake, human ileum responds to the chronic absence of mechanoluminal stimulation by up-regulating brush-border enzymes, transporters, structural genes, and ISC genes LGR5 and ASCL2. These data suggest that unfed intestine is primed to replenish the ISC population upon re-introduction of enteral feeding. Therefore, the elucidation of pathways involved in these processes may provide therapeutic targets for patients with intestinal failure. RNA sequencing data are available at Gene Expression Omnibus series GSE82147.
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Affiliation(s)
- Minna M. Wieck
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Christopher R. Schlieve
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Matthew E. Thornton
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Kathryn L. Fowler
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California
| | - Mubina Isani
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Christa N. Grant
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Ashley E. Hilton
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Xiaogang Hou
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California
| | - Brendan H. Grubbs
- Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California
| | - Mark R. Frey
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatrics and Biochemistry, Department of Molecular Biology, University of Southern California, Los Angeles, California
| | - Tracy C. Grikscheit
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Los Angeles, California,Department of Pediatric Surgery, Children’s Hospital Los Angeles, Los Angeles, California,Keck School of Medicine, University of Southern California, Los Angeles, California,Correspondence Address correspondence to: Tracy C. Grikscheit, MD, The Saban Research Institute, Children’s Hospital Los Angeles, 4650 W Sunset Boulevard, MS#100, Los Angeles, California 90027. fax: (323) 361-1546.The Saban Research InstituteChildren’s Hospital Los Angeles4650 W Sunset BoulevardMS#100Los AngelesCalifornia 90027
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10
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Wieck MM, Debelius JW, Spurrier RG, Trecartin A, Knight R, Grikscheit TC. The pediatric intestinal mucosal microbiome remains altered after clinical resolution of inflammatory and ischemic disease. Surgery 2016; 160:350-8. [PMID: 27302104 DOI: 10.1016/j.surg.2016.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/15/2016] [Accepted: 05/05/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The pediatric intestinal microbiome is impacted by many factors, including age, diet, antibiotics, and environment. We hypothesized that in operative patients, alterations to antibiotics and mechanoluminal stimulation would demonstrate measurable changes in the intestinal microbiome and that microbial diversity would be reduced without normal mechanoluminal stimulation and with prolonged antibiotic treatment. METHODS Bacterial 16s rRNA was extracted from swabbed samples of 43 intestines from 29 patients, aged 5 days to 13 years old. Swabs were obtained during initial resection or later stoma closure. Samples were compared using phylogenetic diversity whole tree alpha diversity and unweighted UniFrac distance beta diversity and by comparing significantly different taxonomic groups. RESULTS Microbial community structure varied significantly between obstructive and inflammatory diseases (P = .001), with an effect size of 0.99 (0.97, 1.00). This difference persisted even 6 weeks after return to health. Family Enterobacter and Clostridiaceae predominated in patients with necrotizing enterocolitis or focal intestinal perforation; patients with an obstructive pathology had an abundance of Bacteroides. Comparison of UniFrac distance between paired proximal and distal intestines demonstrated that paired samples were significantly closer than any other comparison. CONCLUSION In infants, inflammatory and ischemic intestinal pathologies treated with prolonged courses of antibiotics durably alter the intestinal mucosal microbiome. Diversion of mechanoluminal stimulation, however, does not.
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Affiliation(s)
- Minna M Wieck
- Division of Pediatric Surgery, Children's Hospital Los Angeles and USC Keck School of Medicine, Los Angeles, CA
| | | | - Ryan G Spurrier
- Division of Pediatric Surgery, Children's Hospital Los Angeles and USC Keck School of Medicine, Los Angeles, CA
| | - Andrew Trecartin
- Division of Pediatric Surgery, Children's Hospital Los Angeles and USC Keck School of Medicine, Los Angeles, CA
| | - Rob Knight
- Department of Pediatrics, University of California, San Diego, CA; Department of Computer Science & Engineering, University of California, San Diego, CA
| | - Tracy C Grikscheit
- Division of Pediatric Surgery, Children's Hospital Los Angeles and USC Keck School of Medicine, Los Angeles, CA.
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11
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Wieck MM, El-Nachef WN, Hou X, Spurrier RG, Holoyda KA, Schall KA, Mojica SG, Collins MK, Trecartin A, Cheng Z, Frykman PK, Grikscheit TC. Human and Murine Tissue-Engineered Colon Exhibit Diverse Neuronal Subtypes and Can Be Populated by Enteric Nervous System Progenitor Cells When Donor Colon Is Aganglionic. Tissue Eng Part A 2015; 22:53-64. [PMID: 26414777 DOI: 10.1089/ten.tea.2015.0120] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Tissue-engineered colon (TEC) might potentially replace absent or injured large intestine, but the enteric nervous system (ENS), a key component, has not been investigated. In various enteric neuropathic diseases in which the TEC is derived from aganglionic donor colon, the resulting construct might also be aganglionic, limiting tissue engineering applications in conditions such as Hirschsprung disease (HD). We hypothesized that TEC might contain a diverse population of enteric neuronal subtypes, and that aganglionic TEC can be populated by neurons and glia when supplemented with ENS progenitor cells in the form of neurospheres. MATERIALS AND METHODS Human and murine organoid units (OU) and multicellular clusters containing epithelium and mesenchyme were isolated from both mouse and human donor tissues, including from normally innervated and aganglionic colon. The OU were seeded onto a biodegradable scaffold and implanted within a host mouse, resulting in the growth of TEC. Aganglionic murine and human OU were supplemented with cultured neurospheres to populate the absent ENS not provided by the OU to rescue the HD phenotype. RESULTS TEC demonstrated abundant smooth muscle and clusters of neurons and glia beneath the epithelium and deeper within the mesenchyme. Motor and afferent neuronal subtypes were identified in TEC. Aganglionic OU formed TEC with absent neural elements, but neurons and glia were abundant when aganglionic OU were supplemented with ENS progenitor cells. CONCLUSION Murine and human TEC contain key components of the ENS that were not previously identified, including glia, neurons, and fundamental neuronal subtypes. TEC derived from aganglionic colon can be populated with neurons and glia when supplemented with neurospheres. Combining tissue engineering and cellular replacement therapies represents a new strategy for treating enteric neuropathies, particularly HD.
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Affiliation(s)
- Minna M Wieck
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Wael N El-Nachef
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Xiaogang Hou
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Ryan G Spurrier
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Kathleen A Holoyda
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Kathy A Schall
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | | | - Malie K Collins
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Andrew Trecartin
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Zhi Cheng
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Philip K Frykman
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
| | - Tracy C Grikscheit
- Saban Research Institute, Children's Hospital Los Angeles , Los Angeles, California
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Finkbeiner SR, Freeman JJ, Wieck MM, El-Nachef W, Altheim CH, Tsai YH, Huang S, Dyal R, White ES, Grikscheit TC, Teitelbaum DH, Spence JR. Generation of tissue-engineered small intestine using embryonic stem cell-derived human intestinal organoids. Biol Open 2015; 4:1462-72. [PMID: 26459240 PMCID: PMC4728347 DOI: 10.1242/bio.013235] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [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] [Indexed: 12/13/2022] Open
Abstract
Short bowel syndrome (SBS) is characterized by poor nutrient absorption due to a deficit of healthy intestine. Current treatment practices rely on providing supportive medical therapy with parenteral nutrition; while life saving, such interventions are not curative and are still associated with significant co-morbidities. As approaches to lengthen remaining intestinal tissue have been met with only limited success and intestinal transplants have poor survival outcomes, new approaches to treating SBS are necessary. Human intestine derived from embryonic stem cells (hESCs) or induced pluripotent stem cells (iPSCs), called human intestinal organoids (HIOs), have the potential to offer a personalized and scalable source of intestine for regenerative therapies. However, given that HIOs are small three-dimensional structures grown in vitro, methods to generate usable HIO-derived constructs are needed. We investigated the ability of hESCs or HIOs to populate acellular porcine intestinal matrices and artificial polyglycolic/poly L lactic acid (PGA/PLLA) scaffolds, and examined the ability of matrix/scaffolds to thrive when transplanted in vivo. Our results demonstrate that the acellular matrix alone is not sufficient to instruct hESC differentiation towards an endodermal or intestinal fate. We observed that while HIOs reseed acellular porcine matrices in vitro, the HIO-reseeded matrices do not thrive when transplanted in vivo. In contrast, HIO-seeded PGA/PLLA scaffolds thrive in vivo and develop into tissue that looks nearly identical to adult human intestinal tissue. Our results suggest that HIO-seeded PGA/PLLA scaffolds are a promising avenue for developing the mucosal component of tissue engineered human small intestine, which need to be explored further to develop them into fully functional tissue. Summary: HIO-seeded PGA/PLLA scaffolds thrive in vivo and develop into tissue that looks nearly identical to adult human intestinal tissue. These scaffolds appear to be suitable for further tissue engineering approaches to develop functional intestine.
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Affiliation(s)
- Stacy R Finkbeiner
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA Center for Organogenesis, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jennifer J Freeman
- Center for Organogenesis, University of Michigan Medical School, Ann Arbor, MI 48109, USA Department of Surgery, Section of Pediatric Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Minna M Wieck
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital, Los Angeles, CA, USA
| | - Wael El-Nachef
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital, Los Angeles, CA, USA
| | - Christopher H Altheim
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Yu-Hwai Tsai
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Sha Huang
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Rachel Dyal
- Department of Internal Medicine, Section of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Eric S White
- Department of Internal Medicine, Section of Pulmonary and Critical Care, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Tracy C Grikscheit
- Developmental Biology and Regenerative Medicine Program, Saban Research Institute, Children's Hospital, Los Angeles, CA, USA
| | - Daniel H Teitelbaum
- Center for Organogenesis, University of Michigan Medical School, Ann Arbor, MI 48109, USA Department of Surgery, Section of Pediatric Surgery, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Jason R Spence
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, MI 48109, USA Center for Organogenesis, University of Michigan Medical School, Ann Arbor, MI 48109, USA Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Wieck MM, Spurrier RG, Debelius JW, Knight R, Grikscheit TC. The intestinal microbiota of children does not differ significantly after resolution of infectious disease compared to obstructive disease. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.204] [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: 11/29/2022]
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Wieck MM, Hou X, Grikscheit TC. Autologous Tissue-Engineered Small Intestine Forms in a New Porcine Preclinical Model. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.371] [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: 10/23/2022]
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