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Article ; Online: Seropositivity for cytomegalovirus and PCR-EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant.

Éboli, Lígia Patrícia de Carvalho Batista / Tannuri, Ana Cristina Aoun / Tannuri, Uenis

2022 Volume 26, Issue 4, Page(s) e14226

Abstract: Background: PTLD is a clinical condition with high mortality. Monitoring EBV replication can be a useful tool to avoid the development of PTLD.: Materials and methods: This was a retrospective analysis of 428 pediatric patients who underwent liver ... ...

Abstract	Background: PTLD is a clinical condition with high mortality. Monitoring EBV replication can be a useful tool to avoid the development of PTLD. Materials and methods: This was a retrospective analysis of 428 pediatric patients who underwent liver transplantation between 1989 and 2016. The patients were divided into 2 groups (transplanted before 2006, when PCR-EBV was not monitored, and after 2006, when PCR-EBV monitoring was started). Patients with continuous PCR measurements for EBV were evaluated for the impact of a reduction in immunosuppression or a change in immunosuppressants on the number of viral copies. A logistic regression model was applied to evaluate factors related to PTLD. Results: The prevalence of PTLD was 4.2%. After monitoring patients with PCR for EBV levels, a predominance of the most severe, monomorphic form of lymphoproliferative disorder was observed (p = .009). The PTLD mortality was 5%. There was a change in the PCR level after tacrolimus reduction (p = .002) and after tacrolimus exchange for mTOR (p = .008). The number of EBV copies was significantly higher (p = .029) in patients who developed PTLD. In the multiple regression model, seropositivity for CMV was an independent protective factor for lymphoproliferative disorder (OR=0.09; 95% CI 0.02-0.42), reducing the chance of having PTLD adjusted by serology for EBV by 91%. Conclusions: Monitoring the EBV viral load by PCR seems to prevent the emergence of milder forms of lymphoproliferative disorder. Pretransplant seropositivity for CMV is a protective factor for PTLD.
MeSH term(s)	Child ; Cytomegalovirus/genetics ; Cytomegalovirus Infections/complications ; Cytomegalovirus Infections/diagnosis ; DNA, Viral ; Epstein-Barr Virus Infections/complications ; Epstein-Barr Virus Infections/diagnosis ; Herpesvirus 4, Human/genetics ; Humans ; Liver Transplantation ; Lymphoproliferative Disorders/diagnosis ; Lymphoproliferative Disorders/epidemiology ; Lymphoproliferative Disorders/etiology ; Polymerase Chain Reaction ; Protective Factors ; Retrospective Studies ; Tacrolimus/therapeutic use ; Viral Load
Chemical Substances	DNA, Viral ; Tacrolimus (WM0HAQ4WNM)
Language	English
Publishing date	2022-01-17
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	1390284-2
ISSN	1399-3046 ; 1397-3142
ISSN (online)	1399-3046
ISSN	1397-3142
DOI	10.1111/petr.14226
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Article ; Online: Development of a prognostic model for pediatric acute liver failure in a Brazilian center.

Colleti Junior, José / Tannuri, Ana Cristina Aoun / Tannuri, Uenis / Delgado, Artur Figueiredo / de Carvalho, Werther Brunow

Jornal de pediatria

2022 Volume 98, Issue 6, Page(s) 607–613

Abstract: Objective: Pediatric acute liver failure (PALF) is a heterogeneous, rare, and severe condition, which outcome is survival due to liver spontaneous recovery or death. The patients who do not recover may be allocated to liver transplantation, which is the ...

Abstract	Objective: Pediatric acute liver failure (PALF) is a heterogeneous, rare, and severe condition, which outcome is survival due to liver spontaneous recovery or death. The patients who do not recover may be allocated to liver transplantation, which is the standard treatment. This study aimed to build a prognostic model to support the clinical decision to indicate liver transplantation for patients with PALF in a Brazilian center. Methods: The authors retrospectively analyzed the clinical variables of 120 patients in the liver transplantation program of the 'Children's Institute of the University of São Paulo, Brazil. The authors conducted a univariate analysis of variables associated with survival in PALF. Logistic multivariate analysis was performed to find a prognostic model for the outcome of patients with pediatric acute liver failure. Results: Risk factors were analyzed using univariate analysis. Two prognostic models were built using multiple logistic regression, which resulted in 2 models: model 1(INR/ALT) and model 2 (INR/Total bilirubin). Both models showed a high sensitivity (97.9%/96.9%), good positive predictive value (89.5%/90.4%), and accuracy (88.4%/88.5%), respectively. The receiver operating characteristic was calculated for both models, and the area under the curve was 0.87 for model 1 and 0.88 for model 2. The Hosmer-Lemeshow test showed that model 1 was good. Conclusion: The authors built a prognostic model for PALF using INR and ALT that can contribute to the clinical decision to allocate patients to liver transplantation.
MeSH term(s)	Child ; Humans ; Prognosis ; Brazil ; Retrospective Studies ; Liver Failure, Acute/surgery ; Liver Transplantation/methods ; ROC Curve
Language	English
Publishing date	2022-04-09
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	731324-x
ISSN	1678-4782 ; 0021-7557
ISSN (online)	1678-4782
ISSN	0021-7557
DOI	10.1016/j.jped.2022.03.002
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Article ; Online: Effects of local and remote ischemic postconditioning methods on ischemiareperfusion injury in a young animal model of acute mesenteric ischemia.

Abreu, Mateus Souza / Tannuri, Ana Cristina Aoun / Rodrigues, Rafael Felipe Gonçalves / Silva, Rafael José da / Gonçalves, Josiane de Oliveira / Serafini, Suellen / Tannuri, Uenis

Acta cirurgica brasileira

2023 Volume 38, Page(s) e381323

Abstract: Purpose: Acute mesenteric ischemia (AMI) is a condition in pediatric surgery that ranges from intestine necrosis to death. Ischemic postconditioning (IPoC) methods were developed to reduce the damage caused by revascularization. This study aimed to ... ...

Abstract	Purpose: Acute mesenteric ischemia (AMI) is a condition in pediatric surgery that ranges from intestine necrosis to death. Ischemic postconditioning (IPoC) methods were developed to reduce the damage caused by revascularization. This study aimed to evaluate the efficacy of these methods in an experimental weaning rat model. Methods: Thirty-two 21-day-old Wistar rats were allocated into four groups according to the surgical procedure performed: control, ischemia-reperfusion injury (IRI), local (LIPoC) and remote IPoC (RIPoC). At euthanasia, fragments of the intestine, liver, lungs, and kidneys were submitted to histological, histomorphometric, and molecular analyses. Results: In the duodenum, intestines, and kidneys histological alterations promoted by IRI were reversed by remote postconditioning method. In the distal ileum, the histomorphometric alterations could be reversed by the postconditioning methods with more evident effects promoted by the remote method. The molecular analysis found that the levels of expression of Bax (proapoptotic) and Bcl-XL (antiapoptotic) genes in the intestine were increased by IRI. These alterations were equally reversed by the postconditioning methods, with more evident effects of the remote method. Conclusions: IPoC methods positively reduced the damage caused by IRI in weaning rats.
MeSH term(s)	Rats ; Animals ; Ischemic Postconditioning/methods ; Rats, Wistar ; Mesenteric Ischemia ; Models, Animal ; Reperfusion Injury/prevention & control ; Reperfusion Injury/pathology
Language	English
Publishing date	2023-06-01
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2012156-8
ISSN	1678-2674 ; 1678-2674
ISSN (online)	1678-2674
ISSN	1678-2674
DOI	10.1590/acb381323
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Article ; Online: A new systematization of histological analysis for the diagnosis of Hirschsprung's disease.

Serafini, Suellen / Santos, Maria Mercês / Tannuri, Ana Cristina Aoun / Di Loreto, Celso / Gonçalves, Josiane de Oliveira / Tannuri, Uenis

Clinics (Sao Paulo, Brazil)

2023 Volume 78, Page(s) 100198

Abstract: Background: Hirschsprung's Disease (HD) is characterized by intestinal sub-occlusion and the absence of enteric ganglion cells. A rectal biopsy examination is performed to confirm the diagnosis. In a recent study, we demonstrated that the analysis of 60 ...

Abstract	Background: Hirschsprung's Disease (HD) is characterized by intestinal sub-occlusion and the absence of enteric ganglion cells. A rectal biopsy examination is performed to confirm the diagnosis. In a recent study, we demonstrated that the analysis of 60 sections of rectal mucosa and submucosa stained by H&E may ensure a 90% diagnostic accuracy. Although the need to analyze so many sections makes the process of reading the slides more time-consuming, this encouraged us to study their distribution in the healthy rectal submucosa, to simplify the diagnosis. Objectives: To develop a method that facilitates HD diagnosis by studying the distribution of ganglion cells in the submucosal plexus. Methods: Using the calretinin technique, we studied the distribution of plexuses in 60 fragments of rectal submucosa from 19 cadavers. After the study, the reading method created was used for diagnosis in 47 cases of suspected HD, using H&E staining. The accuracy was verified by comparing the results obtained with H&E to those obtained with the acetylcholinesterase technique, the golden standard in our laboratory. Results: The study of submucosal plexus distribution showed that just by examining the submucosal region every 20 µm, approximately, it is possible to locate a ganglionic plexus, and we have already been able to diagnose HD with 93% accuracy. Conclusion: The study of ganglion cell distribution enabled the creation of a simplified method for reading the slides. The method applied achieved good accuracy and it can be used as an alternative method in HD diagnosis.
MeSH term(s)	Humans ; Infant ; Hirschsprung Disease/diagnosis ; Hirschsprung Disease/pathology ; Acetylcholinesterase/analysis ; Rectum/chemistry ; Rectum/pathology ; Biopsy/methods
Chemical Substances	Acetylcholinesterase (EC 3.1.1.7)
Language	English
Publishing date	2023-04-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.1016/j.clinsp.2023.100198
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Article ; Online: Effects of serum sodium and chloride levels in the outcome of critically ill pediatric patients in the post-operative period of liver transplantation.

Luglio, Michele / de Carvalho, Werther B / Tannuri, Uenis / Tannuri, Ana Cristina A / Matsura, Rodrigo Hideki / Morais França, Gardenia / Delgado, Artur F

BMC nephrology

2023 Volume 24, Issue 1, Page(s) 141

Abstract: Background: Sodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric ... ...

Abstract	Background: Sodium and chloride disturbances have attracted increasing attention in recent years. Many pathophysiological effects are associated with hyperchloremia, including reduction in mean arterial pressure and acute renal disease. Pediatric patients undergoing liver transplantation are at risk of developing various electrolyte and biochemical abnormalities, with an impact on their postoperative outcomes. Objective: To analyze the impacts of serum sodium and chloride levels on prognosis of Pediatric Liver Transplant receptors. Methods: This was a retrospective analytical observational study performed in a single transplant reference center in Sao Paulo, Brazil. Included patients were pediatric patients who underwent liver transplantation between January 2015 and July 2019. Statistical regression analysis and General Estimating Equations analysis were performed to evaluate the impacts of sodium and chloride disturbances on the development of acute renal failure and mortality. Results: A total of 143 patients were included in this study. The main diagnosis was Biliary Atresia (62.9%). Twenty-seven patients died (18.9%), and graft dysfunction was the main cause of death (29.6%). The only variable individually associated with 28-days mortality was PIM-3 score (HR 1.59, CI 95% 1.165-2.177, p = 0.004). Forty-one patients (28.6%) developed moderate or severe AKI. PIM-3 score (OR 3.052, 95% CI 1.56-5.97, p = 0.001), hypernatremia (OR 3.49, 95% CI 1.32-9.23, p = 0.012), and hyponatremia (OR 4.24, 95% CI 1.52-11.85, p = 0.006) were independently associated with the development of moderate/severe AKI. Conclusions: In pediatric patients after liver transplantation, PIM-3 score, and abnormal serum sodium levels were correlated with AKI development.
MeSH term(s)	Child ; Humans ; Acute Kidney Injury/diagnosis ; Acute Kidney Injury/etiology ; Brazil/epidemiology ; Chlorides/blood ; Critical Illness ; Liver Transplantation ; Retrospective Studies ; Risk Factors ; Sodium/blood ; Postoperative Period
Chemical Substances	Chlorides ; Sodium (9NEZ333N27)
Language	English
Publishing date	2023-05-22
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2041348-8
ISSN	1471-2369 ; 1471-2369
ISSN (online)	1471-2369
ISSN	1471-2369
DOI	10.1186/s12882-023-03195-1
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Article ; Online: Total esophageal substitution for combined hypopharyngeal and esophageal strictures after corrosive injury in children.

Tannuri, Ana Cristina Aoun / Tannuri, Uenis

Journal of pediatric surgery

2017 Volume 52, Issue 11, Page(s) 1742–1746

Abstract: Background/purpose: The treatment of children with esophageal strictures and involvement of the hypopharynx caused by caustic substance ingestion continues to be challenging. The aims of the present study are to describe the peculiarities of the ... ...

Abstract	Background/purpose: The treatment of children with esophageal strictures and involvement of the hypopharynx caused by caustic substance ingestion continues to be challenging. The aims of the present study are to describe the peculiarities of the technique of complete esophageal substitution for the treatment of children with severe caustic strictures (pharyngocoloplasties) and to compare the results to those of classical esophagocoloplasty with thoracic and abdominal esophageal substitution in another group of children. Methods: A total of 258 children underwent colon interposition for esophageal replacement. Among these patients, 19 had complex esophageal caustic strictures involving the high level of the esophagus and hypopharynx without response to endoscopic dilatations. This group was compared with another group who required partial esophagocoloplasty with intact hypopharynx and high esophagus (239 patients). For the pharyngocoloplasty procedure, the transverse and great parts of the right colon were the segments selected for interposition and were maintained by a double vascular pedicle based on the left colic vessels and the marginal paracolic arcade via the sigmoid vessels. Results: In the pharyngocoloplasty group, 9 patients (47.4%) presented with cervical anastomosis stenosis with episodes of aspiration pneumonia, although good responses to endoscopic dilatation treatments were observed. All patients survived. In the esophagocoloplasty group, the main complications were cervical leaking (18.0%) and stenosis (16.7%). Statistical comparisons revealed that the pharyngocoloplasty patients exhibited a lower incidence of cervical leakage and increased incidences of cervical stenosis and aspiration pneumonia, although all patients could swallow normally. Conclusion: Pharyngocoloplasty with complete esophageal substitution is a safe and effective procedure for the treatment of esophageal caustic strictures with severe stenoses reaching the hypopharynx that are refractory to previous endoscopic treatment. Level of evidence: II.
Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2017.02.003
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Article ; Online: Pediatric Liver Transplantation Program at the Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo.

Tannuri, Ana Cristina Aoun / Tannuri, Uenis

Clinics (Sao Paulo, Brazil)

2016 Volume 71, Issue 4, Page(s) 185–186

MeSH term(s)	Brazil ; Child ; Graft Rejection ; Humans ; Liver Diseases/surgery ; Liver Transplantation ; Living Donors ; Tissue and Organ Procurement/organization & administration ; Waiting Lists/mortality
Language	English
Publishing date	2016-02-02
Publishing country	United States
Document type	Editorial
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.6061/clinics/2016(04)01
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Article ; Online: Microsurgical arterial anastomosis in young and adult rats: an evolutive and comparative study.

Santos, Maria Mercês / Tannuri, Ana Cristina Aoun / Lacerda, Adriana Vasconcelos / Gonçalves, Josiane de Oliveira / Ricardi, Luiz Roberto Schlaich / Tannuri, Uenis

Acta cirurgica brasileira

2022 Volume 37, Issue 6, Page(s) e370604

Abstract: Purpose: To evaluate the caliber of an arterial micro-anastomosis in the young growing animal using a continuous suture technique. Additionally, late morphological changes and blood flows distal to the anastomosis were evaluated.: Methods: Seventy- ... ...

Abstract	Purpose: To evaluate the caliber of an arterial micro-anastomosis in the young growing animal using a continuous suture technique. Additionally, late morphological changes and blood flows distal to the anastomosis were evaluated. Methods: Seventy-four Wistar rats were submitted to laparotomy to access the aorta for blood flow measurement. The aorta was sectioned using microsurgery technique and an end-to-end anastomosis with continuous suture. After a period of six months to one year, the anastomosis was checked. Results: Regarding the size of the aortas, comparing the pre- and postoperative values, there was an increase of 13.33% in adult animals and 25% in young animals, without any difference in the blood flows. Conclusions: The arteries of young rats show signs of growth at the site of the anastomosis performed with continuous suture.
MeSH term(s)	Anastomosis, Surgical/methods ; Animals ; Arteries/surgery ; Microsurgery/methods ; Rats ; Rats, Wistar ; Suture Techniques ; Vascular Surgical Procedures
Language	English
Publishing date	2022-09-05
Publishing country	Brazil
Document type	Journal Article
ZDB-ID	2012156-8
ISSN	1678-2674 ; 1678-2674
ISSN (online)	1678-2674
ISSN	1678-2674
DOI	10.1590/acb370604
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Article ; Online: Adaptation Processes of the Remaining Jejunum or Ileum after Extensive Intestinal Resection.

Mussolino, Affonso Flávio Jorge / Tannuri, Ana Cristina Aoun / Gonçalves, Josiane de Oliveira / Serafini, Suellen / Tannuri, Uenis

Journal of investigative surgery : the official journal of the Academy of Surgical Research

2021 Volume 35, Issue 4, Page(s) 793–800

Abstract: Purpose: To compare the adaptation processes of the remaining jejunum or ileum after extensive intestinal resection in a growing animal model.: Materials and methods: Forty 21-day old rats were divided into four groups: JG: remaining jejunum group - ... ...

Abstract	Purpose: To compare the adaptation processes of the remaining jejunum or ileum after extensive intestinal resection in a growing animal model. Materials and methods: Forty 21-day old rats were divided into four groups: JG: remaining jejunum group - ileal enterectomy; IG: ileum remaining group - jejunum enterectomy; SHAM: sham-operated group - open-and-close laparotomy; and NO: non-operated animals. Results: After 3 weeks, JG and IG animals had decreased weights comparing to SHAM and NO animals (p = 0.017 and p = 0.005, respectively). The histomorphometric analysis showed that in JG animals the villi were higher than in SHAM, NO, and IG animals (p = 0.007, p = 0.008, and p = 0.01), the depth of crypts in JG and IG animals was greater than in NO and SHAM animals (p = 0.03, p = 0.002, and p = 0.003 respectively), and muscle layer thickness of the jejunum of JG animals had values greater than SHAM and NO animals (p = 0.01 and p = 0.02, respectively). The Ki-67 expression in the ileum was higher in comparison with the jejunum (p = 0.014). The pro-apoptotic gene (Bax) expression was decreased in JG animals compared to IG, SHAM, and NO animals (p = 0.013, p = 0.024, and p = 0.021). The anti-apoptotic gene (Bcl-XL) expression was decreased in JG animals in comparison to IG and NO animals (p = 0.002 and p = 0.046) although it was increased in the colon of IG animals in comparison to JG, SHAM, and NO animals (p = 0.002, p = 0.001, and p = 0.001, respectively). The Bax/Bcl-XL ratio was higher in JG than in IG animals (p = 0.011). Conclusion: Adaptive responses seemed to be more effective in the ileum than in the jejunum.
MeSH term(s)	Adaptation, Physiological/physiology ; Animals ; Ileum/metabolism ; Ileum/surgery ; Intestinal Mucosa ; Intestines ; Jejunum/surgery ; Rats
Language	English
Publishing date	2021-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	639444-9
ISSN	1521-0553 ; 0894-1939
ISSN (online)	1521-0553
ISSN	0894-1939
DOI	10.1080/08941939.2021.1963355
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Article ; Online: Post-natal prognostic factors in CDH: experience of 11 years in a referral center in Brazil.

Nam, Camila Pinho Brasileiro Martins / Campos, Carolina Vieira / Leal, Gabriela Nunes / Tannuri, Uenis / Ceccon, Maria Esther Jurfest Rivero / Carvalho, Werther Brunow de

Clinics (Sao Paulo, Brazil)

2023 Volume 78, Page(s) 100217

Abstract: Objective: To describe post-natal risk factors associated with death in Newborns (NB) with Congenital Diaphragmatic Hernia (CDH) in a Brazilian reference center.: Methods: In this retrospective cohort study, post-natal clinical factors of all NB ... ...

Abstract	Objective: To describe post-natal risk factors associated with death in Newborns (NB) with Congenital Diaphragmatic Hernia (CDH) in a Brazilian reference center. Methods: In this retrospective cohort study, post-natal clinical factors of all NB diagnosed with CDH were reviewed in an 11-year period (2007‒2018). The primary outcome was death. Secondary outcomes included clinical features, prognostic indexes, type of mechanical ventilation, complications during hospitalization and surgical repair. Results: After applying the exclusion criteria, the authors analyzed 137 charts. Overall mortality was 59% (81/137), and the highest rates were observed for low-birth-weight NB (87%), syndromic phenotype (92%), and those with major malformations (100%). Prognostic indexes such as Apgar, SNAPPE-II and 24hOI (best oxygenation index in 24 hours) were all associated with poor evolution. In a multivariate analysis, only birth weight and 24hOI were statistically significant risk factors for mortality, with a reduction in mortality risk of 17.1% (OR = 0.829, 95% IC 0.72‒0.955, p = 0.009) for each additional 100g at birth and an increase by 26.5% (OR = 1.265, 95% IC 1.113‒1.436, p = 0.0003) for each unitary increase at the 24hOI. Conclusion: Prognostic indexes are an important tool for predicting outcomes and improving resource allocation. Post-natal risk factors may be more suitable for settings where antenatal diagnosis is not universal. Classical risk factors, such as prematurity, low birth weight, higher need for supportive care, and poorer prognostic indexes were associated with mortality in our CDH population.
MeSH term(s)	Humans ; Infant, Newborn ; Female ; Pregnancy ; Hernias, Diaphragmatic, Congenital/surgery ; Brazil/epidemiology ; Prognosis ; Retrospective Studies ; Birth Weight
Language	English
Publishing date	2023-05-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2182801-5
ISSN	1980-5322 ; 1807-5932
ISSN (online)	1980-5322
ISSN	1807-5932
DOI	10.1016/j.clinsp.2023.100217
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