BackgroundNecrotizing enterocolitis (NEC) is the most frequent life-threatening gastrointestinal disease experienced by premature infants in neonatal intensive care units. The challenge for neonatologists is to detect early clinical manifestations of NEC. One strategy would be to identify specific markers that could be used as early diagnostic tools to identify preterm infants most at risk of developing NEC or in the event of a diagnostic dilemma of suspected disease. As a first step in this direction, we sought to determine the specific gene expression profile of NEC.MethodsDeep sequencing (RNA-Seq) was used to establish the gene expression profiles in ileal samples obtained from preterm infants diagnosed with NEC and non-NEC conditions. Data were analyzed with Ingenuity Pathway Analysis and ToppCluster softwares.ResultsData analysis indicated that the most significant functional pathways over-represented in NEC neonates were associated with immune functions, such as altered T and B cell signaling, B cell development, and the role of pattern recognition receptors for bacteria and viruses. Among the genes that were strongly modulated in neonates with NEC, we observed a significant degree of similarity when compared with those reported in Crohn’s disease, a chronic inflammatory bowel disease.ConclusionsGene expression profile analysis revealed a predominantly altered immune response in the intestine of NEC neonates. Moreover, comparative analysis between NEC and Crohn’s disease gene expression repertoires revealed a surprisingly high degree of similarity between these two conditions suggesting a new avenue for identifying NEC biomarkers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12920-016-0166-9) contains supplementary material, which is available to authorized users.

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ObjectivesVasopressors are not recommended by current trauma guidelines, but recent reports indicate that they are commonly used. We aimed to describe the early hemodynamic management of trauma patients outside densely populated urban centers.MethodsWe conducted a single-center retrospective cohort study in a Canadian regional trauma center. All adult patients treated for traumatic injury in 2013 who died within 24 hours of admission or were transferred to the intensive care unit were included. A systolic blood pressure <90 mmHg, a mean arterial pressure <60 mmHg, the use of vasopressors or ≥2 L of intravenous fluids defined hemodynamic instability. Main outcome measures were use of intravenous fluids and vasopressors prior to surgical or endovascular management.ResultsOf 111 eligible patients, 63 met our criteria for hemodynamic instability. Of these, 60 (95%) had sustained blunt injury and 22 (35%) had concomitant severe traumatic brain injury. The subgroup of patients referred from a primary or secondary hospital (20 of 63, 32%) had significantly longer transport times (243 vs. 61 min, p<0.01). Vasopressors, used in 26 patients (41%), were independently associated with severe traumatic brain injury (odds ratio 10.2, 95% CI 2.7–38.5).ConclusionsIn this cohort, most trauma patients had suffered multiple blunt injuries. Patients were likely to receive vasopressors during the early phase of trauma care, particularly if they exhibited signs of neurologic injury. While these results may be context-specific, determining the risk-benefit trade-offs of fluid resuscitation, vasopressors and permissive hypotension in specific patients subgroups constitutes a priority for trauma research going forwards.

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BackgroundCollaboration is an important competence to be acquired by residents. Although improving residents’ collaboration via interprofessional education has been investigated in many studies, little is known about the residents’ spontaneous collaborative behavior. The purpose of this exploratory study was to describe how residents spontaneously collaborate.MethodsSeven first-year residents (postgraduate year 1; three from family medicine and one each from ear, nose, and throat, obstetrics/gynecology, general surgery, and orthopedic surgery) participated in two collaborative meetings with actors performing the part of other health professionals (ie, occupational therapist, physiotherapist, nurse, or social worker). Both meetings were built around an issue or conflict with the patients’ families reported by one professional. The residents were required to lead the meeting to collect proper information to reach a joint decision. Two team members analyzed the video recordings of the meetings using an emerging-theme qualitative methodology.ResultsAlthough the residents spontaneously knew how to successfully communicate with other professionals, they seemed to struggle with the patient-centered approach and the shared decision-making process.DiscussionEven if the residents performed communication-wise in their collaborative role, they seemed to have perceived themselves as decision makers instead of collaborators in the joint decision process. The results of this study can inform future studies on learning strategies to improve behaviors that would more likely need attention in interprofessional education.

Several techniques for decompression of portal hypertension have been described. The spleno-caval shunt is an easy and safe technique described in adult patients. However, the procedures described in adults are not adapted to children. We report an adaptation of this technique in a child, using the internal jugular vein as an interposition graft for relief of portal hypertension.