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Pediatric health checkups have been mandatory for all citizens since 1966 based on the Maternal and Child Health Law in Japan, and cryptorchidism or undescended testis in adult males are rare. We report a case of an adult right inguinal hernia and cryptorchidism treated simultaneously with laparoscopic transabdominal preperitoneal repair and laparoscopic orchiectomy. A 35-year-old man came to our department with a chief complaint of bulging in the right inguinal region for several months. He was diagnosed with a right inguinal hernia and was scheduled for transabdominal preperitoneal repair. During intraoperative intraperitoneal observation, a white 30-mm mass was found in the hernia orifice. A diagnosis of right cryptorchidism was made, and transabdominal preperitoneal repair and laparoscopic orchiectomy were performed. Laparoscopic simultaneous surgery could be safely performed in an adult patient with a hernia complicated by a cryptorchidism. It can be recommended as a surgical option in such cases. [ABSTRACT FROM AUTHOR]

Extramedullary hematopoiesis (EMH) is the proliferation of hematopoietic stem cells outside the bone marrow and often observed in the liver, spleen in association with myeloproliferative disorders. On the other hand, EMH in the gastric wall is extremely rare. We report a rare case of EMH foci coexisting with early gastric cancer, which resulted in severe gastrointestinal bleeding. A 70-year-old male was diagnosed with myelofibrosis 4 years ago and visited our emergency room with a complaint of hematemesis and tarry stools. Upper gastrointestinal endoscopy revealed three early-stage gastric cancers in the lower gastric body and antrum, and biopsy was performed. Persistent bleeding at the biopsy site of the hypogastric lesion led to the consideration of surgical intervention. An open distal gastrectomy was performed. Postoperative histopathological examination revealed the tumor of the lower gastric body had EMH foci associated with myelofibrosis. [ABSTRACT FROM AUTHOR]

Objective A double-blind, randomized controlled trial showed that low-dose glucocorticoid therapy in pediatric ARDS patients is feasible and may improve both ventilation and oxygenation indices in these patients. However, the molecular mechanisms underlying potential changes in outcomes remain unclear. Based on these clinical findings, this study was designed to examine the effects of intravenous methylprednisolone on circulating inflammatory biomarkers in pediatric ARDS patients. Design Double-blind, placebo-controlled randomized trial with blood collection on study entry and day 7. Setting Tertiary care children’s hospital. Patients Children (0–18 years) with ARDS undergoing mechanical ventilation. Interventions 35 children were randomized within 72 h of mechanical ventilation. The glucocorticoid group received methylprednisolone 2 mg/kg loading dose followed by 1 mg/kg/day continuous infusion from days 1 to 7. Both groups were ventilated following the ARDSnet recommendations. WBC and differential cell counts, plasma cytokines and CRP levels, and coagulation parameters were analyzed on days 0 and 7. Results At study entry, the placebo group had higher IL-15 and basophil levels. On day 7, in comparison to study entry, the placebo group had lower IL-1α, IFN-γ and IL-10 levels. The glucocorticoid group had lower INF-α, IL-6, IL-10, MCP-1, G-CSF and GM-CSF levels, and higher IL-17α levels on day 7 in comparison to study entry. Total and differential cell counts remained unchanged within the placebo group between days 0 and 7, whereas in the glucocorticoid group total WBC and platelets counts were increased on day 7. Pearson’s correlation studies within the placebo and glucocorticoid groups revealed positive and negative correlations between cytokine levels, cell counts, coagulation parameters and relevant clinical parameters of disease severity identified in our previous study. Multiple regression models identified several cytokines as predictors for alterations in clinical parameters of disease severity. Conclusion This pilot study shows the feasibility of simultaneously measuring multiple inflammatory cytokines, cell counts and coagulation parameters in pediatric ARDS patients. We report statistical models that may be useful for future, larger trials to predict ARDS severity and outcomes. [ABSTRACT FROM AUTHOR]

We investigated the effects of (1,4)-α-D-glucan (α-DG), a novel immune stimulatory drug from Tinospora cordifolia, on the concentration of pro- and anti-inflammatory cytokines (interleukin [IL]-1β, IL-6, tumour necrosis factor-α [TNF-α], γ-interferon [IFN-γ] and IL-10) in the lung and spleen of endotoxin-stimulated juvenile rats. Experimental groups (n = 16/group) included controls with an intraperitoneal injection of saline, endotoxaemic rats with a non-lethal dose of 10 mg/kg Escherichia coli endotoxin, and endotoxaemic rats treated with two doses of 10 mg/kg α-DG, intraperitoneally, 2 and 4 hr after endotoxin injection. At 24 hr of treatment, rats were euthanized and lungs and spleen were removed for cytokines determination and lung injury. Endotoxaemia increased IL-1β concentration by fivefold in both organs, while creating a moderate pulmonary hypercellularity (demonstrated by about 11% increase in the alveolar-septal thickening and 11% decrease in the alveolar-interstitial space ratio). In the lung, α-DG treatment reduced concentrations of IL-1β by 30% ( p > 0.05), IL-6 by 43% ( p < 0.01), IFN-γ by 46% ( p < 0.01) and the anti-inflammatory cytokine, IL-10, by 31% ( p > 0.05) compared to endotoxaemia. In the spleen, α-DG treatment decreased the ratio of IL-1β to IL-10 by 55% ( p < 0.05), demonstrating an anti-inflammatory trend. These data suggest that α-DG differentially modulates cytokine response in the lung and spleen and modifies the pro- and anti-inflammatory balance during an early period of endotoxaemia in juvenile rats. [ABSTRACT FROM AUTHOR]

Therapeutic hypercapnia (TH), an intentional inhalation of CO2, has been shown to improve pulmonary function in certain models of lung injury. We tested the null hypothesis that TH does not improve hyperoxic lung injury in neonatal rats. The prospective, randomized study was set at Research laboratory in Children’s Hospital. Forty-five newborn rats were randomly assigned to three groups ( n = 15/group), and exposed to 96 h of normoxia (FiO2 = 0.21), hyperoxia (FiO2 > 0.98), and TH (FiO2 = 0.95, FiCO2 = 0.05). Lung histology, wet-weight to dry-weight ratio, and concentrations of pro- and anti-inflammatory cytokines (IL-1β, IL-6, TNF-α, and IL-10) were used to evaluate pulmonary damage. Using a scale of 0–4, the total scores for lungs hypercellularity, inflammation, and hemorrhage was significantly increased from a median value of 1.5 in normoxia to 2.5 in hyperoxia ( P < 0.05) and 3.0 with TH ( P < 0.001, nonparametric ANOVA). The interstitial space relative to the alveolar space, as a measure of hypercellularity, was increased by 18% during hyperoxia and by 44% with TH compared with normoxia. TH significantly increased the size of the interstitial space by 22% compared with hyperoxia ( P < 0.001). The lung wet-weight to dry-weight ratio was increased by 10% in both hyperoxic groups ( P < 0.001). Both hyperoxic groups showed significant reductions in the concentration of IL-1β compared with normoxia ( P < 0.001), whereas the ratio of IL-1β to IL-10 was significantly decreased, indicating an anti-inflammatory trend. TH does not prevent histological manifestations of hyperoxic lung injury in spontaneously breathing neonatal rats and may worsen the outcome. [ABSTRACT FROM AUTHOR]

We have established a method for in situ tissue engineering of the stomach in a canine model using an acellular collagen scaffold graft. The current study was conducted to evaluate the functional aspects of the tissue-engineered stomach wall. The anterior wall of the stomach in beagle dogs was replaced with a collagen sponge scaffold measuring 4 × 4 cm. At 16 weeks after implantation, the animals were sacrificed and the stomach specimens were evaluated immunohistochemically and physiologically. Regeneration of the proton pump and thin muscle layer, which are essential for mechanical and chemical digestion by the stomach, was observed in the tissue-engineered gastric tissue. However, acetylcholine-induced contraction was not observed in the tissue-engineered stomach wall. Although there is still room for improvement, the tissue-engineered stomach wall had a highly organized structure, and it is anticipated that this approach could eventually become an alternative for stomach reconstruction after gastrectomy. [ABSTRACT FROM AUTHOR]

Background. We have succeeded in regenerating the small intestine by the use of tissue engineering techniques. However, the regenerated intestine proved to lack the muscle layer, which is essential for functional peristalsis. To induce regeneration of the muscle layer, we focused on autologous mesenchymal stem cells (MSC) as a source of muscle tissue. The aim of this study was to investigate the effect of MSC seeding onto the collagen scaffold on induction of the muscle layer.Materials and methods. We used six female beagle dogs. The small intestine was resected over a length of 5 cm and reconstructed by a collagen sponge graft in the same way as in our previous study. Autologous MSC derived from bone marrow (107 cells) were seeded onto the collagen sponge just before implantation. Animals were sacrificed at 2, 4, and 16 weeks after surgery, and specimens were examined histologically.Results. All six dogs survived until the scheduled time of sacrifice. At 4 weeks, regeneration of the intestine was observed at the reconstructed site. Cells positive for α-smooth muscle actin appeared on the scaffold in the MSC-seeded group. However, they disappeared by 16 weeks and only a thin muscle layer regenerated beneath the mucosal layer, although the regenerated mucosal layer covered the luminal surface of the regenerated intestine.Conclusions. MSC seeding induced a transient distribution of cells positive for α-smooth muscle actin on the scaffold, but did not induce regeneration of the muscle layer. Further investigation is necessary to achieve this aim. [Copyright &y& Elsevier]

A case of bilateral spontaneous chylothorax with respiratory syncytial virus (RSV) bronchiolitis has never been reported. We report the case of a 7-month-old boy born at 33 weeks gestation with a history of Down syndrome, atrial septal defect, pulmonary hypertension, and chronic lung disease, hospitalized due to RSV bronchiolitis who developed bilateral spontaneous chylothorax with exacerbation of pulmonary hypertension (PH). The patient died after 9 weeks of mechanical ventilation and treatment for PH. The autopsy showed acute infectious signs, a chronic interstitial lung disease with pulmonary hypertensive changes and subpleural cysts with no evidence of congenital lymphangiectasia. The cause of chylothorax in this child could be multifactorial. However, worsening pulmonary hypertension with RSV infection might have partially contributed to the development of chylothorax through elevated superior venous cava pressure. Thoracentesis should be considered for patients with Down syndrome and PH associated with congenital heart disease who develop persistent pleural effusion during RSV bronchiolitis to rule out chylothorax. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to articles in a 2015 issue including "Corticosteroid Exposure in Pediatric Acute Respiratory Distress Syndrome," by N. Yehya and colleagues and "Corticosteroids for Paediatric ARDS: Unjustified--Even Unjustifiable?," by M. J. Peters and colleagues.

B Introduction: b Children with Trisomy 21 (T21) are known to have anatomic and physiologic abnormalities that may complicate tracheal intubation. We hypothesize the Adverse Airway Outcomes: AAOs (adverse TI associated events: TIAEs and/or peri-intubation hypoxemia: >20% decrease in SpO2) are higher in children with T21 as compared to those without T21. AAOs occurred similarly between those with T21 vs without (26% vs. 24%, p=0.669); adverse TIAEs occurred less in T21 (9% vs 14%, p=0.02), but hypoxemia occurred more frequently (23% vs 18%, p=0.046). [Extracted from the article]

Generation of carbon, silicon, and silver clusters by a laser- vaporization supersonic expansion cluster beam source was studied using a reflectron-type time-of-flight (TOF) mass spectrometer. The atomic cluster was generated by the laser vaporization of a solid sample disk, followed by cooling with supersonic expansion of pulsed helium gas. The neutral cluster, carried by helium gas, was ionized by a fourth harmonic Nd:YAG laser and accelerated by high voltage to the reflectron mass spectrometer. Positi ve-ion TOF mass spectra of carbon, silicon, and silver clusters were compared for se veral cluster source nozzle conditions. Helium gas pressure at the time of vaporization of solid material played the key role in cluster size range obtained. The effect of pressure was thoroughly examined for a relatively large carbon cluster, which was regarded as fullerene. [ABSTRACT FROM AUTHOR]