Liver Regeneration after Partial Hepatectomy Is Not Impaired in Mice with Double Deficiency of Myd88 and IFNAR Genes

Liver regeneration is known to occur in mice lacking one or more Toll-like receptors (TLRs) or the adaptor protein MyD88. Though MyD88 is required for signaling by many TLRs, others signal via MyD88-independent pathways, leading to the induction of type I interferons (IFNs). Here, we assessed liver regeneration after partial hepatectomy (PH) in mice lacking both MyD88 and the type I IFN receptor (Myd88-IFNAR double-KO). Approximately 28% of Myd88-IFNAR double-KO mice had gross liver lesions prior to surgery. In mice without lesions, Myd88-IFNAR deficiency abrogated the increase in circulating IL-6 after PH but did not impair hepatocyte BrdU incorporation, mitotic figure counts, or recovery of liver-to-body weight ratios. These results indicate that type I IFNs are not responsible for the preservation of liver regeneration in Myd88-deficient mice, and they also cast doubt on the idea of microbial products being essential triggers of liver regeneration in mice undergoing PH

Fatal Clostridial necrotizing enterocolitis in a term infant with gastroschisis

AbstractNecrotizing enterocolitis (NEC) is most often a disease of preterm infants, but can develop in full term infants with gastroschisis. The latter cases typically present later and have a milder clinical course; we present the first case of fatal Clostridium perfringes-associated NEC in a full term infant with gastroschisis. Our case highlights the need for a high index of clinical suspicion for Clostridial NEC when there is rapid progression of disease and/or evidence of hemolysis. When Clostridial NEC is suspected, we recommend treatment with penicillin G and clindamycin, as well as prompt, aggressive surgical intervention

Tumor slice culture as a biologic surrogate of human cancer.

Background: The tumor microenvironment (TME) is critical to every aspect of cancer biology. Organotypic tumor slice cultures (TSCs) preserve the original TME and have demonstrated utility in predicting drug sensitivity, but the association between clinicopathologic parameters and Methods: One hundred and eight fresh tumor specimens from liver resections at a tertiary academic center were procured and precisely cut with a Vibratome to create 250 μm × 6 mm slices. These fixed-dimension TSCs were grown on polytetrafluoroethylene inserts, and their metabolic activities were determined by a colorimetric assay. Correlation between baseline activities and clinicopathologic parameters was assessed. Tissue CEA mRNA expression was determined by RNAseq. Results: By standardizing the dimensions of a slice, we found that adjacent tumor slices have equivalent metabolic activities, while those derived from different tumors exhibit \u3e30-fold range in baseline MTS absorbances, which correlated significantly with the percentage of tumor necrosis based on histologic assessment. Extending this to individual cancers, we were able to detect intra-tumoral heterogeneity over a span of a few millimeters, which reflects differences in tumor cell density and Ki-67 positivity. For colorectal cancers, tissue CEA expression based on RNAseq of tumor slices was found to correlate with clinical response to chemotherapies. Conclusions: We report a standardized method to assess and compare human cancer growth ex vivo across a wide spectrum of tumor samples. TSC reflects the state of tumor behavior and heterogeneity, thus providing a simple approach to study of human cancers with an intact TME

Pulmonary interstitial glycogenosis within a discrete pulmonary lesion mimicking congenital pulmonary airway malformation

Interstitial lung diseases (ILD) are a heterogeneous group of pulmonary disorders that are relatively rare in the pediatric population. These diseases are characterized by impaired gas exchange and typically manifest with diffuse infiltrates on radiographs. Pulmonary interstitial glycogenosis (PIG) has recently been identified as an ILD affecting neonates and infants that manifests diffusely throughout the lungs by imaging, has non-specific clinical features, and usually has a favorable outcome in the absence of significant comorbid conditions. We report two cases of PIG that presented with focal radiographic abnormalities, leading to erroneous diagnoses of congenital pulmonary airway malformations and pulmonary resection

A Prospective Study of a Focused, Surgeon-Performed Ultrasound Examination for the Detection of Occult Common Femoral Vein Thrombosis in Critically Ill Patients

Hypothesis A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. Design A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies. Setting Surgical intensive care unit. Patients All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis. Main Outcome Measure Presence of deep vein thrombosis in the common femoral veins. Results During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy. Conclusion A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected. The development of deep vein thrombosis (DVT) with its potential complications significantly increases morbidity and mortality for critically ill surgical patients. Although prophylactic agents and regimens have been shown to prevent DVT in most patients, they are not completely effective.1- 5 Therefore, additional measures such as sequential compression devices for prevention and serial duplex imaging of the lower extremities for early detection are used in select patients. Although sequential compression devices are widely available, serial duplex imaging, especially in a busy surgical intensive care unit (SICU), may be difficult to do routinely because of limited resources. Furthermore, the frequency with which such a study should be done to detect occult DVT is unknown. Considering the successful use of surgeon-performed, focused ultrasound examinations in patients with multiple acute conditions, it seems reasonable to use this technology as a screening tool for the detection of occult DVT in critically ill patients.6- 9 We hypothesized that serial focused ultrasound examinations performed by surgeons could accurately detect common femoral vein (CFV) thrombosis in critically ill surgical patients. The purpose of this study was to evaluate the efficacy of a limited ultrasound examination for the detection of occult CFV thrombosis

A Prospective Study of a Focused, Surgeon-Performed Ultrasound Examination for the Detection of Occult Common Femoral Vein Thrombosis in Critically Ill Patients

Hypothesis A focused, surgeon-performed ultrasound examination of the common femoral veins is an accurate screening tool for the detection of common femoral vein thrombosis in high-risk, critically ill patients. Design A prospective study using a focused ultrasound examination for findings consistent with deep vein thrombosis of the common femoral veins. The results of these examinations were compared with those of duplex imaging or computed tomographic venography studies. Setting Surgical intensive care unit. Patients All critically ill patients who were admitted to the surgical intensive care unit and considered to be at high risk for the development of deep vein thrombosis. Main Outcome Measure Presence of deep vein thrombosis in the common femoral veins. Results During a 16-month period, surgeons performed 306 ultrasound examinations on 220 critically ill surgical patients. The results included 295 true negative, 9 true positive, 1 false negative, and 1 false positive, yielding a 90.0% sensitivity, 99.6% specificity, and 99.3% accuracy. Conclusion A focused, surgeon-performed ultrasound examination is a rapid and accurate screening method to detect common femoral vein thrombosis in critically ill patients as well as to examine those patients in whom pulmonary embolism is strongly suspected. The development of deep vein thrombosis (DVT) with its potential complications significantly increases morbidity and mortality for critically ill surgical patients. Although prophylactic agents and regimens have been shown to prevent DVT in most patients, they are not completely effective.1- 5 Therefore, additional measures such as sequential compression devices for prevention and serial duplex imaging of the lower extremities for early detection are used in select patients. Although sequential compression devices are widely available, serial duplex imaging, especially in a busy surgical intensive care unit (SICU), may be difficult to do routinely because of limited resources. Furthermore, the frequency with which such a study should be done to detect occult DVT is unknown. Considering the successful use of surgeon-performed, focused ultrasound examinations in patients with multiple acute conditions, it seems reasonable to use this technology as a screening tool for the detection of occult DVT in critically ill patients.6- 9 We hypothesized that serial focused ultrasound examinations performed by surgeons could accurately detect common femoral vein (CFV) thrombosis in critically ill surgical patients. The purpose of this study was to evaluate the efficacy of a limited ultrasound examination for the detection of occult CFV thrombosis