Juvenile Polyps Research Articles

Pattern of Colorectal Polyps among Sudanese Patients: a Single Centre Experience

Background: Polyps are masses projecting into the bowel lumen beyond the surface of the epithelium with or without a pedicle/stalk and it can be taken to mean a protuberant growth which can be either benign or malignant. The objective of the study was to study the pattern of colorectal polyps among Sudanese patients at Soba university hospital. Patients and methods: The study was a prospective, descriptive, cross sectional hospital based study. Conducted at Soba University Hospital department of endoscopy, in a period from Oct 2017 to August 2018.The study was conducted on Patients with colorectal polyps finding in colonoscopy or flexible Sigmoidoscopy. All the patients have been followed for duration not less than 3 months to assess the outcome. The main objective was to study the pattern of colorectal polyps among Sudanese population. Results: A total of (120) patients with colorectal polyps out of (626) patients underwent lower GI endoscopy during the period of the study, with male to female ratio of 1.8:1.0.The age ranged between (4) to (94) years. The incidence of polyp at the study was (19%). Thirty nine patient (32.5%) are smoker, while (6.7%) of the patients were alcohol consumers. NSAIDs consumptions were found in (40%) of the patients. Considering the consumption of fiber diet the study showed most of the patients were using the moderate fiber diet (53%). Schistosomasis found in 4 patients (3.3%) and these patients had polyps showing inflammatory polyps of schistosomasis origin. Presenting complains includes bleeding per rectum, altered bowel habit, mucus per rectum, abdominal pain, weight loss, abdominal distension, anorexia and anaemic symptoms. The most common co-morbidities were DM in (17.5%), IBD in (11.7%), FAP (6.7.4%) and diverticular diseases in (1.7%). The mode of the diagnosis was either through sigmoidoscopy or colonoscopy, and the NBI was used in (7.5%). The most common type was sessile polyps (67.5%) followed by pedunclated polyps (29.2%). Most of the polyps are within the left side, mainly at the rectum, anal canal and sigmoid colon. The size of the polyps lies between (1 mm to 50mm).The most common modes intervention was snare polypectomy (66.7%), followed by excision via biopsy forceps (62.7), while other treatment options are less frequent. Histopathology showed that most of the polyps were benign polyps (74.2%). (10.8%) were of high degree dysplasia and the rest was less frequent. Thirty three patients showed inflammatory polyps (27.5%) followed by tubulovilous adenomatous polyps (20.8% ), tubuloadenomatus polyp (11.7), juvenile polyp (10.8),hyperplastic polyps (9.2%), villous adenomatus polyp (5%), tubularadenomatus polyp (4.2%), schistosomal polyp (3.3%), hamratomatous polyp (2.5%) , fibroepithelial polyp (2.5%), invasive adenocarcinoma (1.7%) and granulomatus polyp (8%). Conclusion: The pattern of Colorectal polyps among Sudanese patients at our study was in line with international pattern in age, gender, common presentation, risk factors, types, shape and histopathology and most of them were of benign nature..

20-year experience of treating esophageal polyps in children

Introduction. Gastrointestinal polyps are rare in newborn children, at the same time they are most common in children aged 2 to 10 years. Many aspects of endoscopic surgical treatment of polyps in children remain controversial, since they are not sufficiently covered in domestic and foreign literature.The aim was to conduct a retrospective analysis of surgical treatment of abdominal polyps of the esophagus in 52 children in the surgical and endoscopic department of the Regional Children's Clinical Hospital of Rostov-on-Don.Material and methods. For a 20-year period (2001-2020) and presentation of own material for the treatment of children with esophageal polyps based on modern pathogenetic views on the occurrence and development of this pathology. The main symptom of the disease in patients was dysphagia, which occurred in 79% of patients. Under anesthesia in the operating unit, patients underwent endoscopic polypectomy using diathermocoagulation, followed by covering the defect of the esophageal wall by clipping the edges of the mucous membrane.Results. The authors found that it is sufficient to perform polyp removal within the unaffected areas and continue antireflux therapy in order to get a full recovery of patients. Polyps of the transition zone between the esophagus and the stomach seem to have, among other things, also a morphological cause of their origin and development.The contact of two types of mucous membranes (esophagus and stomach) suggests, under certain conditions, the possibility of the development of polyps at the junction of two different morphological structure of mucous membranes. The benign nature of the polyps was confirmed histologically.Conclusion. The authors found that in the treatment of juvenile esophageal polyps, the suppression of gastroesophageal reflux disease should be considered mandatory both before and after surgery. There were no relapses of the disease.

Smooth Muscle Proliferation in Hamartomatous Polyps Mimicking Prolapse in Pediatric Patients with PTEN Hamartoma Tumor Syndrome

Abstract Introduction/Objective In the field of pediatric pathology, it is vital to find recognize cases that could be associated with cancer predisposition syndromes. PTEN hamartoma tumor syndrome (PHTS) is an inherited set of disorders caused by germline inactivating mutations of the PTEN tumor suppressor gene. In the GI tract, PHTS is associated with hamartomatous polyps that can display smooth muscle overgrowth. We therefore present a series of three cases of colonic polyps with smooth muscle overgrowth, mimicking prolapse, in pediatric patients with PTEN mutations. Methods/Case Report The first case is a 19-year-old male with PHTS who underwent colonoscopy due to hematochezia. Two pedunculated polyps were removed from the transverse and descending colon. Both polyps showed prominent smooth muscle and ganglion cells in the lamina propria. In the second case, a 9-year-old male with PHTS also underwent colonoscopy due to hematochezia. At least 20 sessile 2-4mm polyps were present in the colon. Histology showed smooth muscle proliferation and ganglion cells in the lamina propria. The third case is a 13-year-old male with undiagnosed PHTS, but a history of Chron’s disease, trichilemmoma, and plantar wart like lesions. He underwent upper and lower endoscopy for Chron’s disease assessment. Three polyps were removed from the descending colon. One was a juvenile polyp while the other two showed prominent smooth muscle proliferation and ganglion cells in the lamina propria. Results (if a Case Study enter NA) NA Conclusion Histologically, all hamartomatous polyps had smooth muscle overgrowth, confirmed by SMA immunostain, which could easily be confused with prolapse type changes such as in solitary rectal ulcer syndrome. The key in distinguishing between the two is by recognizing ganglion cells within the lamina propria, confirmed by S100 immunostain. Additional clues include identifying mucosal ganglion cells, disarray of crypt architecture, and fibromuscular proliferation as well as considering the location and number of polyps. It is vital for pathologists to recognize the differential diagnosis of polyps with smooth muscle proliferation, especially in pediatric populations where a diagnosis of cancer predisposition syndromes may not be established. Furthermore, is important to discuss pursuing PTEN genetic testing with clinical colleagues as it has immense medical implications and requires a thorough future medical following.

Risk factors of post-polypectomy bleeding and recurrence in children with colorectal polyps after endoscopic mucosal resection: a retrospective cohort study.

The incidence rate of colorectal polyps in children has gradually increased in recent years. It is still unclear whether endoscopic mucosal resection (EMR) can be performed in children with colorectal polyps as well as their incidences of post-polypectomy bleeding and recurrence. This retrospective study was performed to explore the feasible of EMR in children with colorectal polyps and analyze the risk factors of post-polypectomy bleeding and recurrence. Patients aged younger than 18 years diagnosed with colorectal polyps and received EMR for polypectomy between January 2017 and December 2021 were included in this study. The baseline data of included patients were retrospectively collected. All complications related to polypectomy were recorded during follow up via telephone, internet, or outpatient department, including post-polypectomy bleeding, perforation and polyp recurrence. Patients with and without post-polypectomy complications were divided into 2 groups. The risk factors of post-polypectomy bleeding and polyp recurrence were analyzed using multivariable logistic regression models after adjusting potential risk factors using univariable regression models. A total of 589 patients were included in this retrospective study. There were 333 male patients and 256 female patients, and their average age was 4.4±1.9 years old. The average diameter of their polyps was 8.4±2.8 mm, and 542 (92.0%) polyps presented as pedunculated lesions. A total of 540 (91.7%) polyps were diagnosed as juvenile polyps and 509 (86.4%) patients had only 1 polyp. There were a total of 75 cases of post-polypectomy complications (12.7%). The most common complication was early post-polypectomy bleeding (5.3%), followed by polyp recurrence (3.7%). Post-polypectomy bleeding occurred the most on the third and fourth day after EMR polypectomy. Larger polyps (OR =1.742, P<0.001), sessile lesions (OR =3.150, P=0.019), and multiple polyps (OR =4.372, P=0.003) were identified to be related to the incidence of post-polypectomy bleeding. Besides, sessile lesions (OR =3.887, P=0.026) were identified as the main risk factor and older patients (OR =0.606, P=0.004) had lower potential for post-polypectomy recurrence. More attention should be paid to large, sessile, and multiple polyps during the procedure of EMR in children. The small number of patients in this study limits further analysis of results and a large sample study should be performed.

Coral larvae suppress heat stress response during the onset of symbiosis decreasing their odds of survival.

The endosymbiosis between most corals and their photosynthetic dinoflagellate partners begins early in the host life history, when corals are larvae or juvenile polyps. The capacity of coral larvae to buffer climate-induced stress while in the process of symbiont acquisition could come with physiological trade-offs that alter behaviour, development, settlement and survivorship. Here we examined the joint effects of thermal stress and symbiosis onset on colonization dynamics, survival, metamorphosis and host gene expression of Acropora digitifera larvae. We found that thermal stress decreased symbiont colonization of hosts by 50% and symbiont density by 98.5% over 2 weeks. Temperature and colonization also influenced larval survival and metamorphosis in an additive manner, where colonized larvae fared worse or prematurely metamorphosed more often than noncolonized larvae under thermal stress. Transcriptomic responses to colonization and thermal stress treatments were largely independent, while the interaction of these treatments revealed contrasting expression profiles of genes that function in the stress response, immunity, inflammation and cell cycle regulation. The combined treatment either cancelled or lowered the magnitude of expression of heat-stress responsive genes in the presence of symbionts, revealing a physiological cost to acquiring symbionts at the larval stage with elevated temperatures. In addition, host immune suppression, a hallmark of symbiosis onset under ambient temperature, turned to immune activation under heat stress. Thus, by integrating the physical environment and biotic pressures that mediate presettlement event in corals, our results suggest that colonization may hinder larval survival and recruitment under projected climate scenarios.

S2024 Elderly Patient, Youthful Pathology: Solitary Colonic Juvenile Polyp Found in a 75-Year-Old Male

Introduction: Colonic juvenile polyps are generally found in the pediatric population. Classically, juvenile polyps (JP) are the most common polyp subtype seen in pediatric gastroenterology, accounting for approximately 80-90% of polyps in children. Generally, JP are diagnosed within the first decade of life and most common presentation is painless rectal bleeding. Other terminology used are juvenile hamartomatous polyp or retention polyps. There is no malignant potential for solitary JP and they tend to not recur. Case Description/Methods: We present a 75-year-old male with past medical history of hypertension, diabetes and hyperlipidemia referred to gastroenterology for surveillance colonoscopy due to a history of tubular adenomas. At the pre-procedure visit, the patient was well without GI complaints such as overt bleeding, change in bowel habits or unintentional weight loss. No family history of colon cancer or polyps was reported. Physical exam and vitals were normal at the time of procedure. Colonoscopy revealed a 40mm pedunculated sigmoid colon polyp which was excised using an endoloop at the stalk base followed by hot snare polypectomy ((Figure A). Three other sub-centimeter sessile polyps in the rectosigmoid area were removed by cold snare polypectomy. Histopathological examination of the large pedunculated polyp was consistent with a JP(Figure B). Other polyps were tubular adenomas. Discussion: Our current patient is the oldest reported case of isolated colonic JP. These polyps tend to have a common phenotypical appearance measuring around 10-30mm and roughly 90% of them are considered pedunculated. JP are ultimately defined by their distinctive histopathological features such as edematous lamina propria with inflammatory cells, cystically dilated glands that are bordered by cuboidal or columnar epithelium with reactive changes, and mucus filled glands. Fortunately for our patient, the presence of only a solitary colonic JP generally carries no known malignant potential. Juvenile polyposis syndrome (JPS) on the other hand is a hereditary condition characterized by the presence of hamartomatous polyps in the digestive tract and is known to have an increased risk of digestive tract malignancies. JPS is suspected when a patient has 5 or more juvenile polyps in the gastrointestinal tract or a juvenile polyp and a family history of juvenile polyps. A DNA test to check SMAD4 or BMPR1A gene is helpful.Figure 1.: (a) A 40mm polyp (Paris 0-Ip) located in the in the sigmoid colon. (b) Hamartomatous polyp has ulcerated surface with benign dilated glands.

Analysis of clinical and endoscopic characteristics of colorectal polyps in children

To analyze the clinical and endoscopic characteristics of colorectal polyps in children, and to explore the detection rate, age and gender distribution characteristics, endoscopic treatment effect and follow-up monitoring of colorectal polyps in children, so as to provide reference for disease management of colorectal polyps in children. The clinical and endoscopic characteristics of children with colorectal polyps in Xi 'an Children's Hospital from January 2019 to December 2019 were retrospectively analyzed. The patients were divided into 5 groups according to age (y): 0<y<1 years, 1≤ y<4 years, 4≤ y<7 years, 7≤ y<12 years, and 12≤ y ≤18 years. Independent sample t test, Pearson Chi-square test (χ2) were used to compare groups' differences. The results showed that a total of 724 colonoscopies were completed in 2019, and 160 colorectal polyps were diagnosed, with a detection rate of 22.10%. Among the children with colorectal polyps, 105 were males, accounting for 65.62%, and 55 were females, accounting for 34.38%. The detection rate of male colorectal polyps was 22.68%, and the detection rate of female colorectal polyps was 21.08%. There was no significant difference in the detection rate of colorectal polyps between males and females (χ2 = 0.25, P =0.617). Children with colorectal polyps were most common in the age group of 1≤ y<4 years, 72 cases, accounting for 41.14%(72/175). The detection rate of colorectal polyps in different age groups was statistically significant (χ2=73.929, P<0.05). The main symptom of children with colorectal polyps was hematochezia, accounting for 87.5% (140/160). Colorectal polyps were mainly single polyps in 140 patients, accounting for 87.50%, 15 patients had 2-4 polyps, accounting for 9.38%, and 5 patients had 5 or more polyps, accounting for 3.12%. A total of 210 polyps were removed, and the most common site of polyps was rectum, 123 polyps, accounting for 58.57% (123/210). 111 (52.86%, 111/210) of them were 1 cm to 2 cm in diameter. The Yamada classification was mainly type Ⅲ, 114 pieces, accounting for 54.29% (114/210). Among the 210 polyps with diameter ≥0.5 cm, 165 were removed by endoscopic mucosal resection, accounting for 78.57% (165/210). There were 23 patients with postoperative complications, including hematochezia, abdominal pain, fever, vomiting, diarrhea, dizziness, and no gastrointestinal perforation. Juvenile polyps were the main pathological type, accounting for 88.13% (141/160). The children with juvenile polyps were followed up for 3-30 months, and recurrence was considered in 2 of them. In conclusion, the detection rate of colorectal polyps in children aged 1≤ y<4 years is high, and hematochezia is the main clinical manifestation. Standardized endoscopic treatment and follow-up monitoring are very important for children with colorectal polyps.

A rare case of a juvenile polyp of patient with Peutz-Jeghers syndrome, complicated with intussusception of the small intestine

We report a rare case of Peutz-Jeghers syndrome (PJS) in a 35-year-old female. The patient was diagnosed with PJS when she was 11 years old. She has remained under observation since then. We strongly believe that PJS is a very rare diagnosis. However, it can have serious complications such as the intussusception we observed in our patient. Her condition (recurrent abdominal pain and vomiting) in childhood required further diagnostic procedures. Although the diagnosis of PJS was made, among many resected polyps, one of them appeared to be a juvenile polyp. The diagnosis was confirmed in the histopathology report, which was incredibly unique. Genetic testing revealed LKB1/STK11 gene mutation. Clinicians should be aware of the malignant potential in the course of PJS. Hence, these patients require tailor-made management, long-term follow-up, and our particular attention.

The Heteromorphic Receptacle–Juvenile Polyp

Juvenile polyp is a common paediatric intestinal polyp constituted of prominent, cystic glandular dilatation circumscribed by an inflamed stroma.

Causes and Outcome of Children with Lower Gastrointestinal Bleeding (LGIB) Presenting at Tertiary Care Hospital

Background: One of the most potentially fatal pediatric events is gastrointestinal (GI) bleeding. Lower gastrointestinal bleeding children often have anemia, but determining the cause of the bleeding is crucial in developing a management plan. Objective: To assess the causes and outcome of children presenting with lower gastrointestinal bleeding. Methodology: The current study was prospective cross sectional study carried out at the pediatrics department of Fauji Foundation Hospital, Peshawar Cantt for duration of one year from June 2021 to July 2022. A total of 250 children with lower GI bleeding were enrolled in the current study. All the data was analyzed by IBM SPSS version 23. Results: In the current study, male children were 140 (56%) while female children were 110 (44%) with the mean age of 6.80 (± 1.50) years. The commonest complaint was abdominal pain in 105 (42%) patients whereas the commonest clinical observation was pallor observed amongst 115 (46%) patients. Juvenile colonic or rectal polyps were observed in 91 (36.4%) patients based on colonoscopy. Based on histo-pathological findings, polyps were observed in 93 (37.2%) patients, amongst whom 90 (96.77%) cases were Juvenile polyps and 3 (3.33%) cases were familial adenomatous polyposis. Conclusion: There are several underlying causes of lower gastrointestinal bleeding (LGIB). Abdominal pain was a common symptom in children with LGIB while the most typical cause of LGIB in children was a juvenile polyp in our study. Colonoscopy is a safe and effective diagnostic and therapeutic technique for children with LGIB. Keywords: Children; Lower gastrointestinal bleeding; Causes; Outcomes

Clinical and functional characterisation of the SMAD4 germline variant c.1035C > A in a family with juvenile polyposis syndrome by whole-exome sequencing.

Juvenile polyposis syndrome (JPS) is a rare autosomal dominant inherited disease characterised by multiple juvenile polyps. Genes with JPS-associated mutations and their correlation with the phenotype are currently unknown. Gastrointestinal endoscopy results of a 31-year-old female patient showed multiple polyps in the digestive tract, and the presence of juvenile polyps was confirmed by pathological examination. During follow-up, the patient underwent total gastrectomy and polypectomy several times. Five members of this family were diagnosed with JPS, of which two died and three survived. Full exon gene sequencing of eight members of this family revealed a SMAD4 (NM-005359.3) c.1035C > A (p.Cys345*) mutation. This mutation leads to premature codon termination, causing protein truncation. SMAD4 is a pathogenic gene associated with JPS. This is the first report of an association between the c.1035C > A mutation and JPS pathogenesis. Detection of JPS-related mutations in family members with a genetic predisposition for JPS is very important for genetic counselling, surgical intervention, long-term monitoring and follow-up, and drug treatment.

Analysis of clinical characteristics of 126 children with recurrent intussusception

Objective: To analyze and summarize the clinical features in children with recurrent intussusception. Methods: This retrospective cohort study collected the clinical data of 126 children with recurrent intussusception who were admitted to the Children's Hospital of Zhejiang University School of Medicine due to "abdominal pain, paroxysmal crying, vomiting, bloody stools" from January 1, 2015 to November 30, 2019. The clinical manifestations of recurrent intussusception between ≤3 years old group and >3 years old group were compared, the etiology and age characteristics of pathologic lead points (PLP) were analyzed, and the clinical characteristics of PLP group and non-PLP group were also compared. The χ2 test and Mann-Whitney U test were used to compare the differences between groups. Results: A total of 126 children with recurrent intussusception were included, of whom 76 were males and 50 were females, with the age of 2.9 (1.7, 5.1) years. The proportion of children aged more than 1 year was 87.3% (110/126), and 48.4% (61/126) more than 3 years. Clinical manifestations mostly lacked the typical triad of symptoms. The percentage of paroxysmal crying in ≤ 3 years old group was significantly higher than that in >3 years old group (52.3% (34/65) vs. 24.6% (15/61), χ2=10.17, P=0.001), while the percentage of abdominal pain was significantly lower than that in the >3 years old group (46.1% (30/65) vs. 75.4% (46/61), χ2=11.25, P=0.001). The rate of positive ultrasound examination was 17.5% (22/126), and 63.6% (14/22) of them were diagnosed. The positive rate of CT examination was 4/13, of which 2 cases were diagnosed. In this study, 37 children were diagnosed with PLP by colonoscopy, laparoscopy or laparotomy, and 89 children were found without PLP. The positive rate of PLP in >3 years old group was significantly higher than that in ≤3 years old group (37.7% (23/61) vs. 21.5% (14/65), χ2=3.96, P=0.046). Meckel's diverticulum and juvenile polyp were the main contributors of PLP in ≤3 years old group, accounting for 7/14 and 3/14 respectively, while lymphoma and juvenile polyp accounted for 34.8% (8/23) and 26.1% (6/23), respectively in >3 years old group. Compared with non-PLP group, PLP group had higher age (5.2 (1.6, 6.7) vs. 2.7 (1.8, 4.2) years, Z=-2.26, P=0.01). However, there were no significant differences in gender and recurrence frequency between the two groups (both P>0.05). Conclusions: Recurrent intussusception is more common in children more than 1 year old, and has a wide spectrum of non-specific clinical presentations. Imaging examinations can be used to identify PLP. The most recurrent intussusception is idiopathic, but the presence of PLP should be alerted for, such as Meckel's diverticulum, lymphoma and juvenile polyp. Colonoscopy sometimes is necessary, surgical exploration and treatment should be carried out in time.

Recurrent Recto-Sigmoid Intussusception due to Juvenile Polyp: A Case Report

Recurrent Recto-Sigmoid Intussusception due to Juvenile Polyp: A Case Report

A Case Series of Pediatric Intestinal Ganglioneuromatosis With Novel Phenotypic and Genotypic Profile.

IntroductionIntestinal ganglioneuromatosis (IGN) is a rare condition with enteric involvement. Herein, we report a case series of pediatric IGN with a novel phenotypic and genotypic profile.MethodsThe clinical presentation, histopathology, immunochemistry, molecular features, treatment, and prognosis of 3 cases of IGN were assessed.ResultsThe cases involved 3 boys with an age range of 1 year and 4 months to 8 years, mimicking juvenile polyps or pseudomembranous enteritis. One patient carried a novel germline mutation in RTEL1 (c.296C > T/p.Pro99Leu) along with variants in F11 (c.1489C > T/p.Arg497Xaa), NBAS (c.1514delC/p.Pro505Hisfs*15), and FECH (c.315-48T > C/splicing), who died due to intractable inflammation. The other two patients underwent recurrence without significant signs of systemic syndrome or malignant progression.ConclusionThis case series added to the phenotypic and genotypic spectrum of pediatric IGN, which requires the accumulation of more cases and research for in-depth understanding.

Colonoscopic Evaluation of Per Rectal Bleeding in Children : Our Experience

Background: Most patients with Per Rectal Bleeding (PRB) warrant endoscopic examination of the lower GI tract. This study was done to determine the demographic profile and find out the etiology of bleeding per rectum under colonoscipic evaluation.&#x0D; Meterials and methods : In this study, we did a retrospective review of the clinical data of children between 0 and 18 years of age who presented with per rectalbleeding and underwent diagnostic and therapeutic colonoscopy in the Department of Pediatric Gastroenterology &amp; Nutrition, Chattagram Maa-O-Shishu Hospital, Chattagram from July 2014 to July 2021.Patient demographics, clinical features and endoscopic and histopathological findings were recorded.&#x0D; Results: Overall, we included 111 patients with mean age 9.6±5.1 years. There were 69 (62.2%) male, 42(37.80%) female and with a male to female ratio of 1.64:1.0 The highest incidence was the age group of 11 to 18 years, 46 (41.40%). The most common colonoscopy finding were juvenile colorectal polyp 46 (41.44% ) which include rectal polyps 21 ( 18.9%), Sigmoid polyp 17 (15.3), recto sigmoid polyp 4 (3.6%), colonic polyp 4(3.6%), followed by internal hemorrhoids (20 cases, 18%) rectal ulcers (5 cases, 4.5%) colitis (4 cases, 3.60%) and findings suggestive of koach’s infection (2 cases, 1.8 %). All polyps were removed by colonoscopic polypectomy (47 cases 42.30%), 64 cases (57.65%) were given conservative treatment.&#x0D; Conclusion :We found that Juvenile colorectal polyps constitute the most common cause of per rectal bleeding in pediatric age group followed by hemorrhoids and colitis . Colonoscopy remains a useful and safe procedure in children for evaluation of lower GI bleeding and it’s good for both diagnostic and therapeutic procedure.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.21 (1); January 2022; Page 66-69

Cnidarian-Symbiodiniaceae symbiosis establishment is independent of photosynthesis

Photosynthesis shapes the symbiotic relationships between cnidarians and Symbiodiniaceae algae-with many cnidarian hosts requiring symbiont photosynthate for survival-but little is known about how photosynthesis impacts symbiosis establishment. Here, we show that during symbiosis establishment, infection, proliferation, and maintenance can proceed without photosynthesis, but the ability to do so is dependent on specific cnidarian-Symbiodiniaceae relationships. The evaluation of 31 pairs of symbiotic relationships (five species of Symbiodiniaceae in sea anemone, coral, and jellyfish hosts) revealed that infection can occur without photosynthesis. A UV mutagenesis method for Symbiodiniaceae was established and used to generate six photosynthetic mutants that can infect these hosts. Without photosynthesis, Symbiodiniaceae cannot proliferate in the sea anemone Aiptasia or jellyfish Cassiopea but can proliferate in the juvenile polyps of the coral Acropora. After 6months of darkness, Breviolum minutum is maintained within Aiptasia, indicating that Symbiodiniaceae maintenance can be independent of photosynthesis. Manipulating photosynthesis provides insights into cnidarian-Symbiodiniaceae symbiosis.

Colorectal filling contrast ultrasonography for close inspection of pediatric juvenile polyps.

Colorectal filling contrast ultrasonography for close inspection of pediatric juvenile polyps.

Clinical features of children with colorectal polyps and the efficacy of endoscopic treatment: an analysis of 1 351 cases

To study the clinical features of children with colorectal polyps and the efficacy of endoscopic treatment. A retrospective analysis was performed on the medical data of 1 351 children with colorectal polyps who were admitted and received colonoscopy and treatment in the past 8 years, including clinical features and the pattern and outcomes of endoscopic treatment. Among the 1 351 children, 893 (66.10%) were boys and 981 (72.61%) had an age of 2-<7 years, and hematochezia (1 307, 96.74%) was the most common clinical manifestation. Of all the children, 89.27% (1 206/1 351) had solitary polyps, and 95.77% (1 290/1 347) had juvenile polyps. The polyps were removed by electric cauterization with hot biopsy forceps (6 cases) or high-frequency electrotomy and electrocoagulation after snare ligation (1 345 cases). A total of 1 758 polyps were resected, among which 1 593 (90.61%) were pedunculated and 1 349 (76.73%) had a diameter of <2 cm. Postoperative complications included bleeding in 51 children (3.77%), vomiting in 87 children (6.44%), abdominal pain in 14 children (1.04%), and fever in 39 children (2.89%), while no perforation was observed. The children aged <3 years had the highest incidence rates of postoperative bleeding and fever (P<0.0125), and the children with a polyp diameter of ≥2 cm had significantly higher incidence rates of postoperative bleeding, vomiting, and fever (P<0.05). Solitary polyps, pedunculated polyps, and juvenile polyps are common types of pediatric colorectal polyps. Electric cauterization with hot biopsy forceps or high-frequency electrotomy and electrocoagulation after snare ligation can effectively remove colorectal polyps in children, with good efficacy and few complications. Younger age and larger polyp diameter are associated with a higher risk of postoperative bleeding.

Colocolic Intussusception in Children: A Case Series and Review of the Literature.

BackgroundColocolic intussusception is a rare subtype of intussusception mostly caused by juvenile polyps. The treatment of colocolic intussusception caused by other pathologic lead points in children remains poorly understood.MethodA systematic literature review was performed between January 2000 and June 2021 to characterize the comprehensive treatment of colocolic intussusception in children. This report also included patients admitted to our center between January 2010 and June 2021 who were not previously reported in the literature.ResultsWe identified 27 patients in 20 studies in addition to 17 patients from our center for a total of 44 patients (median age, 4.4 years; 52.3% male). The lead point was identified in 40 patients (40/44, 90.9%). The most common lead point was juvenile polyps (19/44, 43.2%). A therapeutic enema was performed in 15 patients with colocolic intussusception caused by juvenile polyps and was successful in 9 patients (9/15, 60.0%). Colonoscopic polypectomy was subsequently performed in 8 patients and was successful in 7 patients (7/8, 87.5%). The other patient had undergone laparoscopic exploration, and no abnormality was found. Subsequently, the patient underwent open surgery. The patients with colocolic intussusception caused by other pathologic lead points almost underwent surgical treatment (15/21, 71.4%), including 13 open surgeries and 2 laparoscopic surgeries.ConclusionA therapeutic enema followed by colonoscopic polypectomy is feasible to treat colocolic intussusception caused by juvenile polyps unless the patient has bowel perforation; however, surgery is sometimes needed. For patients with colocolic intussusception caused by other pathologic lead points, open surgery remains the primary treatment.

Eosinophilia and Platelet Derived Growth Factor Receptor A Overexpression in Juvenile Polyps

Eosinophilia and Platelet Derived Growth Factor Receptor A Overexpression in Juvenile Polyps