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Graft-versus-host disease (GVHD) is a frequent complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), with high morbidity and mortality rates. Intestinal clinical signs are unspecific, which means differential diagnosis with infections and drug-related etiology should be carried out. Even though intestinal biopsy is widely considered as the gold standard technique, there is no consensus as to which sampling method is best.

To assess the results of the biopsy techniques used in patients with suspected intestinal GVHD.

A retrospective study of patients with suspected intestinal GVHD undergoing allo-HSCT from 2010 to 2019 was carried out. They were assessed through digestive biopsy - esophagogastroduodenal biopsy (upper GI endoscopy - UGIE) or rectal biopsy (colonoscopy or direct biopsy). Quantitative variables, expressed as median and interquartile range, and qualitative variables, expressed as absolute frequency and percentage, were collected.

23 patients were studied, 60.9% of whom were male. Median age at biopsy was 9 years (7-14 years). UGIE was used in 47.8% of patients (n=11), colonoscopy was used in 26.1% of patients (n=6), and direct biopsy was used in 34.8% of patients (n=8), with GVHD positive results in 2 (18.2%), 2 (33.3%), and 4 (50%) patients, respectively.

Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.

Samples taken through direct biopsy stand as an effective alternative in GVHD diagnosis.

The objective of this work was to compare excision with primary closure according to Karydakis technique (KT) with en bloc resection with secondary healing (EB) in the treatment of pilonidal sinus in adolescents.

An observational, retrospective, multi-center study was carried out in adolescent patients (11-18 years old) diagnosed with pilonidal sinus and undergoing surgery from 2011 to 2017. Patients were divided into 2 groups KT (pediatric surgeons) and EB (general surgeons).

Our sample consisted of 61 patients (KT 26 patients; EB 35 patients). Mean total recovery time (days) was significantly shorter in the KT group (37.77 KT vs. 107.76 EB, p< 0.001). In terms of postoperative complications, no differences were noted regarding overall complication rate (53.8% KT vs. 40% EB). However, differences were found in postoperative bleeding (0% KT vs. 25.7% EB, p=0.005), seroma occurrence (23.1% KT vs. 0% EB, p=0.003), and surgical wound dehiscence (42.3% KT vs. 8.6% EB, p=0.002). Recurrence rate was lower in the Karydakis group than in the en bloc resection group (4% vs. 28.6%, p=0.015).

Both surgical techniques (KT and EB) are acceptable and safe, but in our study, Karydakis technique demonstrated to be more effective than en bloc resection with secondary closure, since it allowed for shorter recovery times and lower recurrence rates. Therefore, Karydakis surgical technique can be an excellent alternative in the treatment of pilonidal sinus in the adolescent population.

Both surgical techniques (KT and EB) are acceptable and safe, but in our study, Karydakis technique demonstrated to be more effective than en bloc resection with secondary closure, since it allowed for shorter recovery times and lower recurrence rates. Therefore, Karydakis surgical technique can be an excellent alternative in the treatment of pilonidal sinus in the adolescent population.

Acute appendicitis (AA) is the most frequent surgical pathology in pediatrics. However, publications discussing the most adequate antibiotic therapy for AA prophylaxis and treatment in children are limited.

A retrospective analysis of patients under 14 years of age hospitalized as a result of AA was carried out. The periods pre- and post- implementation of an antimicrobial optimization program (AOPR) were compared. The pre-AOPR period went from September 2017 to March 2019, while the post-AOPR period went from April 2019 to September 2019.

206 patients were included, 139 in the pre-AOPR group, and 67 in the post-AOPR group. Dual therapy (ceftriaxone + metronidazole) and single therapy (cefoxitin) were more commonly used in the post-AOPR group (p=0.0001), with reduced use of amoxicillin + clavulanic acid and piperacillin + tazobactam as an empirical therapy (p=0.0001). To determine whether conversion to oral therapy was feasible or not, a number of clinical (no fever, sustained transit, adequate tolerance with satisfactory oral pain control) and blood test (a 20-50% CRP decrease from its highest level and a ≤12,000/mm3 leukocyte count) criteria were established. This allowed conversion to oral treatment to increase in the post-AOPR period (p=0.03). No differences in terms of hospital stay or complications were found between periods, but narrower spectrum oral antimicrobials were used earlier in the post-AOPR period.

Implementing an AOPR for surgical pathologies and establishing protocols adapted to the resistance and microbiological profile found at each unit is strongly recommended.

Implementing an AOPR for surgical pathologies and establishing protocols adapted to the resistance and microbiological profile found at each unit is strongly recommended.Normal spermatogenic processes require the scrotal temperature to be lower than that of the body as excessive heat affects spermatogenesis in the testes, reduces sperm quality and quantity, and even causes infertility. Endoplasmic reticulum stress (ERS) is a crucial factor in many pathologies. Although several studies have linked ERS to heat stress, researchers have not yet determined which ERS signaling pathways contribute to heat-induced testicular damage. Melatonin activates antioxidant enzymes, scavenges free radicals, and protects the testes from inflammation; however, few studies have reported on the influence of melatonin on heat-induced testicular damage. Using a murine model of testicular hyperthermia, we observed that heat stress causes both ERS and apoptosis in the testes, especially in the spermatocytes. These observations were confirmed using the mouse spermatocyte cell line GC2, where the Atf6 and Perk signaling pathways were activated during heat stress. Knockout of the above genes effectively reduced spermatocyte damage caused by heat stress. Pretreatment with melatonin alleviated heat-induced apoptosis by inhibiting the Atf6 and Perk signaling pathways. This mitigation was dependent on the melatonin receptors. In vivo experiments verified that melatonin treatment relieved heat-induced testicular damage. In conclusion, our results demonstrated that ATF6 and PERK are important mediators for heat-induced apoptosis, which can be prevented by melatonin treatment. Thus, our study highlights melatonin as a potential therapeutic agent in mammals for subfertility/infertility induced by testicular hyperthermia.Persistent uplift means the Qinghai-Tibet Plateau (QTP) is an ideal natural laboratory to investigate genome evolution and adaptation within highland environments. However, how paleogeographic and paleoclimatic events influence the genome and population of endemic fish species remains unclear. Glyptosternon maculatum is an ancient endemic fish found on the QTP and the only critically endangered species in the Sisoridae family. Here, we found that major transposons in the G. maculatum genome showed episodic bursts, consistent with contemporaneous geological and climatic events during the QTP formation. Notably, histone genes showed significant expansion in the G. maculatum genome, which may be mediated by long interspersed nuclear elements (LINE) repetitive element duplications. Population analysis showed that ancestral G. maculatum populations experienced two significant depressions 2.6 million years ago (Mya) and 10 000 years ago, exhibiting excellent synchronization with Quaternary glaciation and the Younger Dryas, respectively. Thus, we propose that paleogeography and paleoclimate were dominating driving forces for population dynamics in endemic fish on the QTP. Tectonic movements and temperature fluctuation likely destroyed the habitat and disrupted the drainage connectivity among populations. These factors may have caused severe bottlenecks and limited migration among ancestral G. maculatum populations, resulting in the low genetic diversity and endangered status of the species today.Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease and renal replacement therapy worldwide. A pathophysiological hallmark of DKD is glomerular basal membrane (GBM) thickening, whereas this feature is absent in minimal change disease (MCD). According to fundamental transport physiological principles, a thicker GBM will impede the diffusion of middle-molecules such as cystatin C, potentially leading to a lower estimated GFR (eGFR) from cystatin C compared to that of creatinine. Here we test the hypothesis that thickening of the glomerular filter leads to an increased diffusion length, and lower clearance, of cystatin C. Twenty-nine patients with a kidney biopsy diagnosis of either DKD (n = 17) or MCD (n = 12) were retrospectively included in the study. GBM thickness was measured at 20 separate locations in the biopsy specimen and plasma levels of cystatin C and creatinine were retrieved from health records. A modified two-pore model was used to simulate the effects of a thicker GBM on glomerular water and solute transport. The mean age of the patients was 52 years, and 38% were women. The mean eGFRcystatin C /eGFRcreatinine -ratio was 74% in DKD compared to 98% in MCD (p less then 0.001). Average GBM thickness was strongly inversely correlated to the eGFRcystatin C /eGFRcreatinine -ratio (Pearson's r = -0.61, p less then 0.01). Two-pore modeling predicted a eGFRcystatin C /eGFRcreatinine -ratio of 78% in DKD. We provide clinical and theoretical evidence suggesting that thickening of the glomerular filter, increasing the diffusion length of cystatin C, lowers the eGFRcystatin C /eGFRcreatinine -ratio in DKD.

Rhabdomyosarcoma (RMS) is the most common soft-tissue sarcoma of childhood, but occurs infrequently in infants (<1 year). Historically, infants with RMS have worse overall survival compared to other pediatric age groups.

This study aims to assess the clinical features and treatment factors associated with survival comparing infants to children aged 1-9 years diagnosed with RMS.

Children aged <10 years diagnosed with RMS between 2000 and 2016 were identified using the SEER database. Descriptive statistics were used to assess demographic, clinical, and treatment characteristics of infants and children with RMS. Kaplan-Meier estimates and Cox proportional hazards regression were performed to assess for factors associated with survival.

Age <1year was independently associated with an increased risk of mortality. Compared to children aged 1-9 years, fewer infants received standard of care therapy, that is, chemotherapy combined with local control (surgery and/or radiation; 86.8 vs. 75.7%; p=.009). the therapy associated with best survival in all age groups. Cell Cycle inhibitor Other factors contributing to differences in survival should be further explored.IgG4-related disease (IgG4-RD) is a fibroinflammatory disorder signified by aberrant infiltration of IgG4-restricted plasma cells into a variety of organs. Clinical presentation is heterogeneous, and pathophysiological mechanisms of IgG4-RD remain elusive. There are very few cases of IgG4-RD with isolated central nervous system manifestation. By leveraging single-cell sequencing of the cerebrospinal fluid (CSF) of a patient with an inflammatory intracranial pseudotumor, we provide novel insights into the immunopathophysiology of IgG4-RD. Our data illustrate an IgG4-RD-associated polyclonal T-cell response in the CSF and an oligoclonal T-cell response in the parenchymal lesions, the latter being the result of a multifaceted cell-cell interaction between immune cell subsets and pathogenic B cells. We demonstrate that CD8+ T effector memory cells might drive and sustain autoimmunity via macrophage migration inhibitory factor (MIF)-CD74 signaling to immature B cells and CC-chemokine ligand 5 (CCL5)-mediated recruitment of cytotoxic CD4+ T cells.