Feasibility and impact of three-dimensional (3D) printing technology in simulated teaching of congenital malformations.

AIMS: This study aimed to investigate the feasibility and effectiveness of utilizing three-dimensional (3D) printing technology in the simulation teaching of congenital malformations. METHODS: We conducted a comparative analysis between an experimental group that received traditional teaching supplemented with 3D printing model demonstrations and hands-on model operation, and a control group that received traditional teaching methods. Various parameters, including classroom interest, classroom interaction, learning enthusiasm, disease awareness, teaching satisfaction, and independent operation confidence, were assessed, along with theoretical and practical tests. RESULTS: The results showed no significant difference in theoretical test scores between the two groups (91.92 ± 15.04 vs. 89.44 ± 14.89), but the practical test revealed a significantly higher number of qualified trainees in the experimental group compared to the control group (23 vs. 8). In terms of classroom engagement, both groups exhibited similar levels of interest (8.08 ± 1.52 vs. 8.74 ± 0.984), classroom interaction (7.88 ± 1.97 vs. 8.7 ± 1.33), learning enthusiasm (8.81 ± 1.021 vs. 8.52 ± 1.189), and disease awareness (8.58 ± 0.99 vs. 8.58 ± 0.99). However, the experimental group demonstrated significantly higher teaching satisfaction (8.81 ± 1.06 vs. 9.19 ± 0.96) and greater operation confidence (7.67 ± 2.56 vs. 5.5 ± 2.79) than the control group. CONCLUSION: 3D printing technology can be effectively utilized to create surgical teaching models, enhancing the confidence of standardized training doctors and improving teaching outcomes.

Does prenatal diagnosis of meconium peritonitis have the better recovery? A single-center over 10 years of experience.

OBJECTIVE: To evaluate whether infants with prenatal diagnosis of meconium peritonitis (MP) have a poorer prognosis. METHODS: A retrospective analysis of data from infants treated with surgery from January 2008 to December 2020 was conducted. The patients were divided into prenatal diagnosis group and postnatal diagnosis group based on the timing of diagnosis. The intraoperative and postoperative parameters of the two groups of patients were compared. RESULTS: A total of 71 cases of MP were included in the study, with 48 cases in the prenatal diagnosis group and 23 cases in the postnatal diagnosis group. The comparison of preoperative indicators between the two groups of patients showed no statistically significant differences in baseline (p > 0.05). Intraoperative indicators, including blood loss, anastomosis, retained intestinal tube length and excised intestinal tube length, showed no statistically significant differences between the two groups (p > 0.05). However, the postnatal diagnosis group had a significantly shorter operation time than the prenatal diagnosis group (p < 0.05). Postoperative indicators, including fasting time, albumin usage, complications, and abandonment or mortality rates, show no difference (p > 0.05). Nevertheless, the postnatal diagnosis group exhibited significantly shorter hospital stay and time to first bowel movement compared to the prenatal diagnosis group (p < 0.05). CONCLUSION: Prenatal diagnosis of meconium peritonitis is associated with increased surgical complexity, prolonged hospital stay, and delayed recovery of intestinal function. However, there is no evidence of higher mortality or more complications compared to infants diagnosed postnatally, and there is no significant difference in long-term prognosis.

Case Report: Gas in the esophagus, stomach wall and portal vein with congenital hypertrophic pyloric stenosis.

Background: CHPS dramatically affects infant growth and development and can even cause aspiration resulting from esophageal reflux. There is potential danger. CHPS is common, while CHPS with gas in the stomach wall and portal vein is rare. Gas in the stomach wall and portal vein are often the key features of more serious disease. It can be easily mistaken as a serious disease when patients with CHPS have gas in the stomach wall and portal vein. Case presentation: A 56-day-old baby was hospitalized for aspiration pneumonia after vomiting without bile for 20 days. Compared with vomiting, which is the most common symptom, pneumonia tends to attract more attention. Because of pneumonia, a chest CT scan was performed and revealed massive gas accumulation in the walls of the esophagus, stomach, and portal vein. Therefore, NEC was considered first and was treated conservatively for one week. However, the vomiting continued, and CHPS was confirmed by ultrasound. The delay in CHPS diagnosis was due to insufficient recognition of the signs of gas accumulation. Because of inexperience and lack of knowledge about CHPS with gastrointestinal pneumatosis, physicians failed to make an early accurate diagnosis. Case 2 was a 29-day-old male who was admitted to the hospital with vomiting without bile. He was examined by ultrasound, which revealed gas in the stomach wall and portal vein after admission to the hospital. No peritonitis was found after a detailed and comprehensive physical examination. Emergency life-threatening diseases such as NEC were quickly ruled out. He received surgery as soon as possible and had an uneventful recovery with no complications. Conclusion: CHPS may present with gas in the gastric or esophageal wall and portal vein, which is not a contraindication to surgery.

Successful thoracoscopic resection of a giant mediastinal cyst in a newborn boy.

There are fewer reports of thoracoscopic surgical resection of mediastinal cysts in neonates. The aim of this article is to report on the feasibility of thoracoscopic resection of a large mediastinal cyst and the management of chylothorax after surgery in neonates.

Chylous ascites with lymphatic leakage localization: technical aspects and clinical applications.

BACKGROUND: Carbon nanoparticle suspension (CNS) was applied to locate the lymphatic leakage in chylous ascites (CA). However, the flow speed and distance of the CNS were particularly decreased in the following two cases (patient 5 and 6). This study aimed to investigate and improve the flow speed and distance of the CNS via a rat model. METHODS: Seven patients with CA were accepted for surgery in the past two years. Clinical data were recorded. Rats were divided into two groups to confirm the hypothesis regarding whether accepting milk or orally administered food before surgery was the key factor in CA surgery with CNS. The animals were divided into 2 groups: experimental group of 5 rats receiving fat emulsion injection (2 g/kg) 30 min before the operation and control group of 5 rats receiving saline. We analyzed flow speed and distance of the CNS in two groups of rats. The hypothesis established was that CNS movements pattern differ depending on the degree of capillary lymph duct filling. Finally, the late case reconfirmed the hypothesis again. RESULTS: In animal experiments, the CNS in the preoperative high-fat feeding group moved faster and over a longer distance than that in the control group (0.51 ± 0.09 cm vs. 0.19 ± 0.10 cm, respectively; p < 0.05). Based on this, the CNS was applied to the seventh patient, who had been given a diet with a slightly higher fat content 3 days before the operation, and marked improvement with a complete cure was recorded. CONCLUSIONS: The capillary lymph duct was beginning to swell after dietary intake. The dilation of the lymph vessel could make it easier for the CNS to move and reach the leakage.

Laparoscopic vs open Ladd's procedure for malrotation in neonates and infants: a propensity score matching analysis.

BACKGROUND: Laparoscopic Ladd's procedure for malrotation in children is still a controversial approach. Although some retrospective studies have compared the outcomes of the two types of procedure with inconsistency outcomes. Currently, there are few large-scale studies on laparoscopic treatment in malrotation with neonates and infants. We did a study based on propensity score matching to compare the effects of the two kinds of approach in neonates and infants. To investigate the therapeutic effect of laparoscopy and open Ladd's procedure by the propensity score-matching (PSM) to enhance the validity of the comparison. METHODS: A total series of 143 cases of intestinal malrotation without intestinal necrosis was included in the study during the 8 years from January 2012 to January 2020, including 68 cases of open Ladd's procedure and 75 cases of laparoscopic Ladd's procedure including five cases of transfer laparotomy. By a propensity score 1:1 matching, 62 patients were stratified for each group. RESULTS AND CONCLUSION: There was no significant difference in volvulus degree, weight and gender between the two groups (p > 0.05). Laparoscopic surgery took more time than open surgery (105.9 min vs 70.6 min, p < 0.05), but it had less hospital stay (12.4 days vs 14.6 days, p < 0.05) or less incision infection (0 vs 6, p < 0.05). There was no significant difference between the two groups at the time of first defecation, blood loss, time of full feeding and reoperation (p > 0.05). The cosmetic effect of laparoscopic surgery is better than that of open surgery. Laparoscopic Ladd's procedure is a safe approach. It can reduce the length of hospital stay and incision infection, but the operation time was extended, the other complications are similar compared with open procedure for intestinal malrotation in neonates and infants.

Knockdown of RREB1 inhibits cell proliferation via enhanced p16 expression in gastric cancer.

Gastric cancer (GC) is the most common gastrointestinal malignancy worldwide. However, the molecular mechanisms of the progression of GC are not fully understood. Ras-responsive element binding protein 1 (RREB1) is an oncogene in many types of cancer that is involved in various biological processes, such as DNA damage repair, cell growth and proliferation, cell differentiation, fat development, and fasting glucose balance. In this study, we demonstrate the role of RREB1 in gastric cancer. First, by immunohistochemistry staining (IHC) and bioinformatics analysis, we demonstrated the expression of RREB1 in gastric cancer and paired normal gastric tissues. Then, we established RREB1 overexpression and knockdown cell lines via lentiviral transfection and detected cell proliferation by using MTT, colony-forming, cell cycle and apoptosis assays in vitro. We demonstrated the effect of RREB1 on cell proliferation in vivo by using a subcutaneous xenograft tumor model in nude mice. Finally, by using Western blotting and IHC, we demonstrated the possible mechanism by which RREB1 affects cell proliferation. The IHC and bioinformatics analyses demonstrated that RREB1 was highly expressed in gastric cancer and showed that RREB1-expressing patients had a larger tumor size and more lymphovascular invasion than RREB1-negative patients. Knockdown of RREB1 inhibited cell proliferation in vivo and in vitro. Knockdown of RREB1 enhanced p16 expression in vivo and in vitro, and p16 expression was negatively related to RREB1 in gastric cancer tissue. RREB1 was highly expressed in gastric cancer, and knockdown of RREB1 inhibited cell proliferation via enhanced p16 expression.

A novel two-port single-site laparoscopic pyloromyotomy for infantile hypertrophic pyloric stenosis.

OBJECTIVE: The objective of the study is to explore a less invasive laparoscopic pyloromyotomy for treating infantile hypertrophic pyloric stenosis. PATIENTS AND METHODS: A series of 154 cases from January 2014 to January 2020 were retrospectively analysed. Seventy patients were treated with the method of transumbilical single-site laparoscopic pyloromyotomy (SSLP), and 84 patients were treated with two-site laparoscopic pyloromyotomy. There was no difference in the body weight, sex ratio or age between the two groups. The operation time, blood loss, post-operative feeding time and complications between the two groups were compared. RESULTS: The novel single-site method had better cosmetic effect than the two-site approach. There was no difference in the operation time, blood loss, post-operative feeding time or complications between the two groups. CONCLUSION: The novel SSLP method requires only two incisions through the umbilicus to complete the procedure, with barely visible scars and similar surgical complications to that of the two-site approach; thus, the novel method is worth promoting.

SIRT1 relieves Necrotizing Enterocolitis through inactivation of Hypoxia-inducible factor (HIF)-1a.

Necrotizing enterocolitis (NEC) is a major cause of mortality and morbidity in newborns, characterized by inflammatory intestinal necrosis. Sirtuin-1 (SIRT1), a NAD-dependent deacetylase, is involved in multiple biological functions. It has been reported that SIRT1 was downregulated in NEC tissues. However, the precise role of SIRT1 in NEC progress remains unknown. In this study, we found that SIRT1 was decreased in serum samples of NEC patients, associated with an inflammation response. an in vitro model was established by using LPS-induced NEC-like cell in this study. The results indicate that overexpression of SIRT1 inhibited the cell apoptosis induced by LPS. Besides, overexpression of SIRT1 suppressed the high expression of proinflammatory factors (IL-6, IL-8, and TNF-α), the decrease of transepithelial electrical resistance (TEER), and the decline expression of tight junction proteins (ZO-1, ZO-2, and Claudin-4) induced by LPS in Caco-2 cells. What is more, serum HIF-1α was increased in NEC patients. SIRT1 overexpression suppressed the expression and activity of HIF-1a, while knockdown of SIRT1 made the opposite effect. In summary, this study indicates that overexpression of SIRT1 alleviates the inflammation response and intestinal epithelial barrier dysfunction through regulating the expression and inactivation of HIF-1a.

Novel technique to manage refractory chylous ascites with carbon nanoparticle suspension in infants.

OBJECTIVE: Chylous ascites (CA) is a rare form of ascites that results from the leakage of lipid-rich lymph into the peritoneal cavity. In infants, CA is mostly caused by lymphatic malformation or unknown reasons. The creation of a shunt for the lymphorrhea is the last option for patients unresponsive to all other conservative treatments. Localization of the leakage is a critical problem during surgery. We applied a carbon nanoparticle suspension (CNS) in CA patients to locate the external lymphatic leakage and evaluated its utility during surgery. PATIENTS AND METHODS: Twelve infants with CA were treated in our center recently. Ten patients received laparotomy, one refused therapy, and one was cured after undergoing conservative treatment. Recently, two infants with CA received CNS in the visceral peritoneum during laparotomy. The results of the traditional procedure were compared to our innovative technique for CA to evaluate the use of CNS in treating CA. RESULTS: The features of the baseline data did not differ substantially. Location of the leakage with CNS was employed in 2 of the 10 patients whose lymphatic leakages were identified with the resolution of the refractory CA. Overall, in 5 patients, ascites was resolved successfully. The refractory CA was resolved more effectively in patients in whom the leakage site was identified with CNS than in patients in whom the leakage site could not be identified under conventional surgery. CONCLUSIONS: Injecting CNS improved the accuracy of lymphorrhagia leakage site identification and the outcomes of infants who underwent surgical treatment for refractory CA. LEVEL OF EVIDENCE: II-III.