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Background Intestinal barrier dysfunction has been implicated in necrotizing enterocolitis (NEC), but has not been directly measured in human NEC. Methods Small intestines removed during surgery were immediately mounted in an Ussing chamber. mRNA expression of tight junction (TJ) proteins was measured with RT-PCR. Results Fifteen infants were included, 5 with NEC and 10 with other diagnoses. Average transepithelial resistance (TER) was 11.61 ± 1.65 Ω/cm2 in NEC specimens, 23.36 ± 1.48 Ω/cm2 at resection margin, and 46.48 ± 5.65 Ω/cm2 in controls. Average flux of permeability marker mannitol was 0.23 ± 0.06 μMol/cm2 per h in NEC, 0.04 ± 0.01 μMol/cm2 per h at resection margin, and 0.017 ± 0.004 μMol/cm2 per h in control tissue (p < 0.05). RT-PCR analysis showed marked decrease in mRNA expression of a TJ protein occludin in NEC affected tissue (p < 0.03 vs. control). Additionally, mRNA expression of myosin light chain kinase (MLCK), an important regulator of TJ permeability, was increased in NEC specimens. Conclusion These studies show for the first time that NEC intestinal tissue have increased intestinal permeability, even at grossly healthy-appearing resection areas. The increase in intestinal permeability in NEC appeared to be related in part to a decrease in occludin and an increase in MLCK expression. Level of evidence Level 2.

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We propose the addition of CMV to the list of pathogens responsible for NEC. A review of neonatal CMV infection is provided.

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Background: The ability to effectively teach culturally and linguistically diverse students is critically important. Research has shown that providing teacher candidates educative experiences through critical service-learning can better prepare future teachers and can foster a social justice stance. Purpose: This study examines teacher candidates' perceptions of a critical service-learning experience in a literacy methods course where participants worked in community settings to support English language learners. Methodology/Approach: Using an interpretative framework, the authors collected and analyzed data from 18 participants including reflection portfolios, questionnaires, and interviews. Findings/Conclusions: This study found that the critical service-learning experience (a) cultivated an understanding of the identities, strengths, and motivations of learners; (b) nurtured their practice; and (c) fostered their understanding of the importance of community engagement, which all contribute to a social justice perspective. Implications: This study demonstrates how critical service-learning enriches understanding within our communities, which allows individuals to tackle issues to advance social justice and equity.

A dropped appendicolith is a well-known complication of laparoscopic appendectomy that may occur because of stone expulsion from the appendix, before or during surgery, and typically manifests as a focal, subcentimeter area of high attenuation with or without associated abscess. Dropped appendicoliths may act as niduses for infection and may result in the future development of abscess formation. We report the case of a 10-year-old pediatric patient who developed 2 perihepatic abscesses caused by 2 appendicoliths that were inadvertently dropped during laparoscopic surgery.