Rapunzel syndrome in children: a retrospective review of ten cases combined with literature review in a tertiary referral center.

PURPOSE: Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. METHODS: A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. RESULTS: Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. CONCLUSION: The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention.

Exploration of pathogenic microorganism within the small intestine of necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) is the most common severe gastrointestinal emergency in neonates. We designed this study to identify the pathogenic microorganisms of NEC in the microbiota of the small intestine of neonates. METHODS: Using the 16S ribosomal DNA (rDNA) sequencing method, we compared and analyzed the structure and diversity of microbiotas in the intestinal feces of different groups of neonates: patients undergoing jejunostomy to treat NEC (NP group), neonates undergoing jejunostomy to treat other conditions (NN group), and neonates with NEC undergoing conservative treatment (NC group). We took intestinal feces and saliva samples from patients at different time points. RESULTS: The beta diversities of the NP, NN, and NC groups were all similar. When comparing the beta diversities between different time points in the NP group, we found similar beta diversities at time points E1 to E3 but significant differences between the E2-E3 and E4 time points: the abundances of Klebsiella and Enterococcus (Proteobacteria) were higher at the E1-E3 time points; the abundance of Escherichia-Shigella (Proteobacteria) increased at the E2 time point, and the abundance of Klebsiella decreased significantly, whereas that of Streptococcus increased significantly at the E4 time point. CONCLUSIONS: Our results suggest that the pathological changes of intestinal necrosis in the small intestine of infants with NEC are not directly caused by excessive proliferation of pathogenic bacteria in the small intestine. The sources of microbiota in the small intestine of neonates, especially in premature infants, may be affected by multiple factors.

Personal Exposure to Source-Specific Particulate Polycyclic Aromatic Hydrocarbons and Systemic Inflammation: A Cross-Sectional Study of Urban-Dwelling Older Adults in China.

Environmental exposure to ambient polycyclic aromatic hydrocarbons (PAHs) can disturb the immune response. However, the evidence on adverse health effects caused by exposure to PAHs emitted from specific sources among different vulnerable subpopulations is limited. In this cross-sectional study, we aimed to evaluate whether exposure to source-specific PAHs could increase systemic inflammation in older adults. The present study included community-dwelling older adults and collected filter samples of personal exposure to PM2.5 during the winter of 2011. Blood samples were collected after the PM2.5 sample collection. We analyzed PM2.5 bound PAHs and serum inflammatory cytokines (interleukin (IL)1ß, IL6, and tumor necrosis factor alpha levels. The Positive Matrix Factorization model was used to identify PAH sources. We used a linear regression model to assess the relative effects of source-specific PM2.5 bound PAHs on the levels of measured inflammatory cytokines. After controlling for confounders, exposure to PAHs emitted from biomass burning or diesel vehicle emission was significantly associated with increased serum inflammatory cytokines and systemic inflammation. These findings highlight the importance of considering exposure sources in epidemiological studies and controlling exposures to organic materials from specific sources.

The role of preserved bowel and mesentery fixation in apple-peel intestinal atresia.

OBJECTIVE: This study explored the feasibility of mesoplasty with end-to-side anastomosis in the treatment of different apple-peel mesenteric defects with high jejunal atresia. METHODS: A retrospective analysis was performed on 42 premature infants admitted to the hospital between 2014 and 2021. Prenatal ultrasound scans revealed bowel dilatation. The patients experienced vomiting after birth and produced white or no meconium. Plain radiography showed double or triple bubble signs and the patients underwent emergency laparotomy. High jejunal atresia with different apple-peel atresia appearance was discovered intraoperatively, involving mobilization of the ileocecal region. Patients received end-to-side anastomosis between the enlarged blind pouch and atretic bowel, as well as mesoplasty. A jejunal feeding tube was placed trans-nasally. Patients were discharged after achieving full enteral feeding. We also reviewed the literature on the subject. RESULTS: Three patients died and 39 survived. The discharged patients were followed up for 12 months, and none showed post-operative complications such as intestinal obstruction, malnutrition, or chronic diarrhea. All surviving patients reached the expected height and weight for children of the same age. CONCLUSION: For cases of high jejunal atresia with apple-peel intestinal atresia, mesoplasty may be a good option to avoid postoperative volvulus.

Analysis of Factors Influencing Outcomes in Preterm Infants With Necrotizing Enterocolitis.

Background: To explore the surgical outcomes between patients with perforated and non-perforated neonatal necrotizing enterocolitis (NEC) and identify indications for surgical intervention. Methods: The surgical outcomes of 271 children with NEC admitted to the Seventh Medical Center of Chinese PLA General Hospital between August 2009 and August 2020 were retrospectively analyzed. The patients were divided into the non-perforated and perforated groups. The preoperative factors, including gestational age, birth weight, intrauterine infection, cholestasis, platelet change, white blood cell count, and C-reactive protein level were compared between the two groups, along with postoperative factors including infection status, complications, enteral and parenteral nutrition time, ICU time, ventilator use time, and intestinal necrosis length. Bell staging was performed for the two groups and the mortality of different Bell stages was explored. The risk of death and predisposing factors of patients with NEC were analyzed. Results: In total, 271 children undergoing surgery were included in this study. A total of 188 children were observed without perforation, including 57 deaths (30.3%), and 83 children with perforation, including 24 deaths (28.9%). Preoperative cholestasis and time from NEC diagnosis to surgery were significantly different between the two groups (P < 0.05). Postoperative factors, including parenteral nutrition time (32 [3-94] days vs. 23 [1-53] days), enteral nutrition time (27 [0-86] days vs. 18 [0-81] days), NICU time (44 [5-125] days vs. 29 [1-92] days), and length of intestinal necrosis (15 [0-92] cm vs. 10 [2-70] cm), were significant. The mortality rate of patients with Bell stage IIIA was higher than that of patients with Bell stage IIIB. A total of 81 patients had 30-day postoperative mortality (57 non-perforated cases). Multivariate Cox regression analysis showed that non-perforation was a poor prognostic factor for survival outcome (hazard ratio 2.288, 95% confidence interval [1.329-3.940], P = 0.003). Conclusions: Preterm infants in the non-perforated group had more serious complications and had a longer recovery time after surgery. Bell staging is not accurate in diagnosing severe NEC that needs surgical intervention.

Characteristics, Source Contributions, and Source-Specific Health Risks of PM2.5-Bound Polycyclic Aromatic Hydrocarbons for Senior Citizens during the Heating Season in Tianjin, China.

Polycyclic aromatic hydrocarbons (PAHs) have carcinogenic impacts on human health. However, limited studies are available on the characteristics, sources, and source-specific health risks of PM2.5-bound PAHs based on personal exposure data, and comparisons of the contributions of indoor and outdoor sources are also lacking. We recruited 101 senior citizens in the winter of 2011 for personal PM2.5 sample collection. Fourteen PAHs were analyzed, potential sources were apportioned using positive matrix factorization (PMF), and inhalational carcinogenic risks of each source were estimated. Six emission sources were identified, including coal combustion, gasoline emission, diesel emission, biomass burning, cooking, and environmental tobacco smoking (ETS). The contribution to carcinogenic risk of each source occurred in the following sequence: biomass burning > diesel emission > gasoline emission > ETS > coal combustion > cooking. Moreover, the contributions of biomass burning, diesel emission, ETS, and indoor sources (sum of cooking and ETS) to PAH-induced carcinogenic risk were higher than those to the PAH mass concentration, suggesting severe carcinogenic risk per unit contribution. This study revealed the contribution of indoor and outdoor sources to mass concentration and carcinogenic risk of PM2.5-bound PAHs, which could act as a guide to mitigate the exposure level and risk of PM2.5-bound PAHs.

Associations of Exposure to Fine Particulate Matter Mass and Constituents with Systemic Inflammation: A Cross-Sectional Study of Urban Older Adults in China.

Systemic inflammation is a key mechanism in the development of cardiovascular diseases induced by exposure to fine particles (particles with aerodynamic diameter ≤2.5 µm [PM2.5]). However, little is known about the effects of chemical constituents of PM2.5 on systemic inflammation. In this cross-sectional study, filter samples of personal exposure to PM2.5 were collected from community-dwelling older adults in Tianjin, China, and the chemical constituents of PM2.5 were analyzed. Blood samples were collected immediately after the PM2.5 sample collection. Seventeen cytokines were measured as targets. A linear regression model was applied to estimate the relative effects of PM2.5 and its chemical constituents on the measured cytokines. A positive matrix factorization model was employed to distinguish the sources of PM2.5. The calculated source contributions were used to estimate their effects on cytokines. After adjusting for other covariates, higher PM2.5-bound copper was significantly associated with increased levels of interleukin (IL)1ß, IL6, IL10, and IL17 levels. Source analysis showed that an increase in PM2.5 concentration that originated from tire/brake wear and cooking emissions was significantly associated with enhanced levels of IL1ß, IL6, tumor necrosis factor alpha (TNFα), and IL17. In summary, personal exposure to some PM2.5 constituents and specific sources could increase systemic inflammation in older adults. These findings may explain the cardiopulmonary effects of specific particulate chemical constituents of urban air pollution.

Fine particle-bound PAHs derivatives at mountain background site (Mount Tai) of the North China: Concentration, source diagnosis and health risk assessment.

Ten nitrated polycyclic aromatic hydrocarbons (nPAHs) and 4 oxygenated polycyclic aromatic hydrocarbons (oPAHs) in fine particulate matter (PM2.5) samples from Mount Tai were analyzed during summer (June to August), 2015. During the observation campaign, the mean concentration of total nPAHs and oPAHs was 31.62 pg/m3 and 0.15 ng/m3, respectively. Two of the monitored compounds, namely 9-nitro-anthracene (9N-ANT) (6.86 pg/m3) and 9-fluorenone (9FO) (0.05 ng/m3) were the predominant compounds of nPAHs and oPAHs, respectively. The potential source and long-range transportation of nPAHs and oPAHs were investigated by the positive matrix factorization (PMF) method and the potential source contribution function (PSCF) methods. The results revealed that biomass/coal burning, gasoline vehicle emission, diesel vehicle emission and secondary formation were the dominant sources of nPAHs and oPAHs, which were mainly from Henan province and Beijing-Tianjin-Hebei region and Bohai sea. The incremental life cancer risk (ILCR) values were calculated to evaluate the exposure risk of nPAHs and oPAHs for three group people (infant, children and adult), and the values of ILCR were 7.02 × 10-10, 3.49 × 10-9 and 1.41 × 10-8 for infant, children and adults, respectively. All these values were lower than the standard of EPA (Environmental Protection Agency) (<10-6), indicating acceptable health risk of nPAHs and oPAHs.

[Reconstruction of forefoot skin defect with island flap pedicled with lateral tarsal artery].

OBJECTIVE: To investigate the therapeutic effect of island flap pedicled with lateral tarsal artery for forefoot skin defect. METHODS: From March 2007 to January 2009, 12 cases with forefoot skin defects were treated by reversed island flap pedicled with lateral tarsal artery. RESULTS: All the flaps survived completely with a followed-up period of 8-22 months, 13 months in average. The flaps and skin grafts had soft texture and a similar color as the surrounding skin. The flaps had a suitable thickness with deep pain sensation. Shallow touch and pain sensation recovered in the skin graft and within 1-2 cm of the flap edge, which was graded as S1-S2. There was no problem in shoes-wearing and walking. No flap ulcer happened. CONCLUSION: Island flap pedicled with lateral tarsal artery is suitable for forefoot skin defect, leaving less morbidity to donor site.

[Application of AO miniplate and screw in the treatment of metacarpophalangeal joint periarticular fractures].

OBJECTIVE: To evaluate the clinical efficacies for open reduction and internal fixation of unstable periarticular fractures of metacarpophalangeal joint (MCP) with the AO miniature plate system. METHODS: A total of 265 patients (172 males and 93 females) with 302 MCP periarticular fractures were retrospectively reviewed. Their mean age was 32.5 years old (range: 17 - 59). The standard internal fixation treatment method was established on the basis of the AO/ASIF Comprehensive Classification of Fractures. A "T" shape plate, double-row-plate or a condylar plate was used for A2, A3, C1, C2 type fractures. Screws alone were used for B type fractures. Active and passive flexion and extension exercises at Day 3 post-operation within the limits of patient pain tolerance. All patients were evaluated regarding the total active motion (TAM) score, average PROM, quick-DASH score, the power of gripping, pinching and Kapandji score. RESULTS: The patients were followed up for an average of 4.6 months (range: 4 - 24). Radiological examinations showed that the fracture line disappeared in an average of 8.2 weeks (average: 8.2). According to TAM rating criteria, the functions of hands were as follows: excellent (n = 113), good (n = 136) and poor (n = 53). The fair rate was 82.8%. The average PROM of MP joint was 82.3° ± 4.7° and the average quick-DASH score 17.4. Contrast to the health side, the power of gripping recovered for 94.5% and pinching for 88.6%. The Kapandji score was 90%. A total of 103 MCP (34.1%) completely recovered. Contrasting between the head of metacarpal fracture combined the base of proximal phalangeal fracture and alone the head of metacarpal fracture or the base of proximal phalangeal fracture, the post-operative rates of complications and tendon adhesion were higher. As compared with traditional methods, each of the above parameters had statistic significances (P < 0.01). CONCLUSION: Because of complex anatomic structures, the MCP periarticular fractures have such complications as tendon adhesion, joint stiffness and post-traumatic arthritis, etc. The traditional treatment method is less effective. The AO miniplate and screw system provides rigid and stable fixation so that it is a preferred technique in the treatment of MCP periarticular fractures.

[Effects of decimeter wave and sodium hyaluronate product on postoperative adhesions in flexor tendon].

OBJECTIVE: To compare the effect of decimeter wave with sodium hyaluronate product (SHP) on preventing and treating peritendinous adhesion and promoting tendon healing. METHODS: Totally 96 healthy male white 6-month-old Leghorn chickens weighing (2.24 +/- 0.07) kg were randomized into group A (decimeter wave therapy group, n = 32), in which decimeter wave therapy was applied 1 to 21 days after operation at a frequency of 915 MHz, a power of 8 W, radiation distance of 10 cm, for 10 minutes once per day; group B (SHP group, n = 32), in which 5 mL and 1.2% SHP was applied; and group C (control group, n = 32), in which injury received no treatment. The III and IV toes of left feet of all chickens were made into tendon injury model. The general condition of animal was observed after operation; gross and histological observations were made 7, 10, 14, 18, 21 and 28 days after operation, and the biomechanical analysis was done 14 and 28 days after operation. RESULTS: Operative incision healed well, no infection and death occurred. Peritendinous adhesions in groups A, B were looser, and tendon healing was better than that of group C 14 and 28 days after operation. More fibroblasts with active metabolism and more collagen formation in groups A, B than that in group C. The Pmax of group A was better than that of group B 14 and 28 days after operation (P < 0.05); the delta max of group A was better than that of group B 18 and 21 days after operation (P < 0.05), and the W0 of group A was better than that of group B 18, 21 and 28 days after operation (P < 0.05). There was no significant difference between group A and group B at the other time points. CONCLUSION: Topical decimeter wave therapy and application of SHP after flexor tendon repair can promote intrinsic healing, meanwhile they can prevent the adhesion of tendon and reduce extrinsic healing. Decimeter wave therapy can improve the qualities of tendon's wound healing.

[Clinical application of groin skin and iliac bone composite graft in contracture of first web space and reconstruction of pollicis opponens function].

OBJECTIVE: To investigate the therapeutic effects of the groin skin and iliac bone composite graft on the repair of severe contracture of the first web space and one-stage reconstruction of the pollicis opponens function under the condition of no ideal muscle or tendon used. METHODS: From July 2003 to February 2006, 5 patients (4 males, 1 females; age range, 20-38 years) with severe contracture of the first web space with loss of the pollicis opponens function were treated by the groin skin and iliac bone composite graft, with the clinical observation performed. The defect was caused by a crush injury in 3 patients, by an explosion injury in 1 patient, and by a wrist joint mutilation injury in 1 patient. They all had been treated by operation at least once with a disease course of 6-24 months. The width and the angle of the first web space was 18 mm and 20 degrees on average. RESULTS: The followed-up for 6-12 moths revealed that all the flaps had a success. The pedicle of the groin skin and iliac bone composite graft was cut off after 3 weeks, and 8 weeks later there was a bone union between the imbedded bone block and the first and second metacarpal bones. There was no evidence that the imbedded bone block was deformed or absorbed. The width of the first web space was augmented by an average of 32 mm, the angle of the first web space was augmented by an average of 60 degrees. The pollicis opponens function recovered. CONCLUSION: It is relatively simple and reliable to repair the contracture of the first web space and reconstruct the pollicis opponens function in one-stage using the groin skin and iliac bone composite graft.

[A probe to the treatment of Madelung deformity].

OBJECTIVE: To explore a method of treating Madelung deformity. METHODS: Seven cases of Madelung deformity had been treated with the excision of ulnar carpi ulnaris segment and distal osteotomy of radius and tight constrict of extensor carpi ulnaris from Mar. 2000 to Nov. 2003. The angle of ulnar tilting was 37-70 degrees and the angle of volar tilting was over 16 degrees. A longitudinal incision on each side of the radius and ulnar was made, the ulna was excised about 2-3 cm segment. Then the fracture of ulna was fixed by double across vertical steel wire and the radius was fixed with medullary wire. Lastly the extensor carpi ulnaris was shortened and sutured after the wrist was located rest-position. RESULTS: After surgery, the deformity of wrist was improved and pain-free in the seven cases. The angle of ulnar tilting was reduced to 22-24 degrees. The angle of volar tilting was reduced to 15 degrees below. Follow-ups were conducted in the 7 patients for 2 years in average. The activity of wrist joint and the rotation of forearm recovered from those before operation. The wrist joint could stretch fully. CONCLUSION: This method of treating Madelung proves to be effective in recovering deformity, releasing pain, improving function, and reducing traumatic osteoarthritics of the distal radioulnar joint.