Crohn's disease in children. Preliminary experience with a laparoscopic approach.

BACKGROUND: Laparoscopic surgery in patients with Crohn's disease (CD) has been demonstrated to have advantages over a conventional approach in children. The aim of this study was to review the children treated for CD with a laparoscopic approach, to report our indications, the surgical procedure, the complications, and to compare the children with pancolitis or ileocaecal (segmental) Crohn's disease. PATIENTS AND METHOD: We reviewed the files of 11 children treated for CD in a single institution between 1999 and 2004 for a retrospective study of clinical and surgical data. Mann-Whitney U-test was used for statistical analysis of nonparametric data. RESULTS: Eleven children were operated. The average age when initial clinical symptoms became apparent was 12.1 years (range 6.6 - 15), and surgery was performed after an average of 3.4 years of disease (range 1 - 7.6). The surgical indications were stenosis in 6 cases, failure to thrive in 1 case (segmental CD, SCD group) and pancolitis refractory to medical treatment in 4 cases (pancolitis group, PCD group). Mean operative time was 207 minutes (range 140 - 270) for the SCD group and 285 minutes (range 260 - 300) for the PCD group (p < 0.05). Three cases needed a conversion to open surgery (2 in PCD group, one in SCD group), mainly in relation to anastomosis performed with an EEA stapler. The average length of surgical unit stay was 6.5 days (range 4 - 8) for the PCD group and 6.4 days (range 4 - 8) for the SCD group; average follow-up was 16 months (range 3 - 38). Two patients had a relapse of CD (stenosis of the anastomosis in one, skin fistula in the other). CONCLUSION: A laparoscopic approach for ileocolic resection in Crohn's disease is a feasible procedure, even in cases of pancolitis. We recommend an extra-corporeal anastomosis because, in relation to the inflammatory bowel, the mechanical anastomosis is not a safe procedure in cases of pancolitis.     

Divergence influences triggering of both vertical and horizontal saccades.

PURPOSE: In real life, divergence is frequently combined with vertical saccades. The purpose of this study was to examine the initiation of vertical and horizontal saccades, pure or combined with divergence. METHODS: We used a gap paradigm to elicit vertical or horizontal saccades (10 degrees), pure or combined with a predictable divergence (10 degrees). Eye movements from 12 subjects were recorded with EyeLink II. RESULTS: The major results were (i) when combined with divergence, the latency of horizontal saccades increased but not the latency of vertical saccades; (ii) for both vertical and horizontal saccades, a tight correlation between the latency of saccade and divergence was found; (iii) when the divergence was anticipated, the saccade was delayed. CONCLUSION: We conclude that the initiation of both components of combined movements is interdependent.     

OBSERVATIONS AND EXPERIMENTS ON THE SO-CALLED THYROID CARCINOMA OF BROOK TROUT (SALVELINUS FONTINALIS) AND ITS RELATION TO ORDINARY GOITRE

Is this thyroid hyperplasia true carcinoma? In view of the facts that young fish are more affected than old fish, that iodin stops the hyperplasia and causes it to return to the colloid state, that removal of the fish from the ponds to the open brook also affects a cure, that the clinical incidence of tumors is directly related to the water supply, and that the severity of the disease as determined by histological examination is likewise directly related to the water supply, we cannot accept the prevailing opinion that the disease is true cancer. On the other hand, we believe that the disease as studied by us is an extreme illustration of endemic goitre, the end stage of which is cretinism. The opinion that it is cancer is based purely on anatomical studies—the essential fact being that the growing thyroid invades bone, muscle, etc. Such findings in mammalian tissues are strong evidence of malignancy, but this standard cannot be applied to fish thyroids for the reason that any growth of a widely and loosely distributed nonencapsulated gland would give the histological appearance of invasion of the surrounding tissues. The general views as to the cause of the disease may be divided into two groups: (I) infectious and (2) metabolic. Taking up the infectious theory, there are abundant grounds for such a view when one considers the flora of the tank. The very careful histological examinations by Hofer, Bonnet and Pick have yielded uniformly negative results. Direct infection cannot be excluded, but the fact that fish placed in the tail-race recover spontaneously, although living in the theoretically most polluted water, is not in harmony with our present conception of water-borne infection. Taking up the metabolic theory, the three factors of overfeeding, overcrowding and limited proportional water supply together with the many possibilities into which they are divisible seem to us to be in some way, still obscure, directly concerned with the development of the disease. It is not probable that a single substance, whether the result of food decomposition or of excretory products, excites the thyroid to its activity but rather that the thyroid reaction is the result of the activity of a great variety of these products.     

Enthesopathy in rheumatoid arthritis and spondyloarthritis: An ultrasound study

Objective

We aimed to compare the prevalence of enthesopathy seen on ultrasonography (US) in spondyloarthritis (SpA) and rheumatoid arthritis (RA) and compared it to healthy controls.

Cardiac function and exercise adaptation in 8 children with LPIN1 mutations

Introduction

Lipin-1 deficiency is a major cause of rhabdomyolysis that are precipitated by febrile illness. The prognosis is poor, with one-third of patients dying from cardiac arrest during a crisis episode. Apart from acute rhabdomyolysis, most patients are healthy, showing normal clinical and cardiac ultrasound parameters.

Acquisition of Broad-Spectrum Cephalosporin Resistance Leading to Colistin Resistance in Klebsiella pneumoniae

An extended-spectrum β-lactamase (ESBL)-producing and colistin-resistant Klebsiella pneumoniae clinical isolate was recovered from a patient who was treated with cefotaxime. This isolate harbored a bla_CTX-M-15 ESBL gene that was associated with an ISEcp1 insertion sequence. Transposition of that tandem occurred within the chromosomal mgrB gene, leading to inactivation of the mgrB gene and consequently to acquired resistance to colistin. We showed here a coselection of colistin resistance as a result of a broad-spectrum cephalosporin selective pressure.     

Skeletal Stem/Progenitor Cells in Periosteum and Skeletal Muscle Share a Common Molecular Response to Bone Injury

Bone regeneration involves skeletal stem/progenitor cells (SSPCs) recruited from bone marrow, periosteum, and adjacent skeletal muscle. To achieve bone reconstitution after injury, a coordinated cellular and molecular response is required from these cell populations. Here, we show that SSPCs from periosteum and skeletal muscle are enriched in osteochondral progenitors, and more efficiently contribute to endochondral ossification during fracture repair as compared to bone-marrow stromal cells. Single-cell RNA sequencing (RNAseq) analyses of periosteal cells reveal the cellular heterogeneity of periosteum at steady state and in response to bone fracture. Upon fracture, both periosteal and skeletal muscle SSPCs transition from a stem/progenitor to a fibrogenic state prior to chondrogenesis. This common activation pattern in periosteum and skeletal muscle SSPCs is mediated by bone morphogenetic protein (BMP) signaling. Functionally, Bmpr1a gene inactivation in platelet-derived growth factor receptor alpha (Pdgfra)-derived SSPCs impairs bone healing and decreases SSPC proliferation, migration, and osteochondral differentiation. These results uncover a coordinated molecular program driving SSPC activation in periosteum and skeletal muscle toward endochondral ossification during bone regeneration. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).