A study on evaluation of laparoscopic surgical approach for pediatric appendix abscess.

BACKGROUND: The main objective of this study was to investigate and compare chosen time laparoscopic surgery to traditional open surgery and to analyze whether laparoscopic surgery is safe and feasible for pediatric appendix abscess in emergency. METHODS: This retrospective study consisted of three groups of patients designated as group A, group B, group C and the preoperative and postoperative clinical characteristics were analyzed and compared. Group A comprised of 63 patients of appendix abscess which has been treated by laparoscopic surgery from January 2011 to December 2014. Group B comprised of 60 patients who had undergone pediatric appendix abscess laparotomy and group C comprised of 35 cases who had undergone time-selective laparoscopic appendix ablation surgery after receiving anti-inflammatory treatment. RESULTS: The average operation time during which all the appendix ablated successfully between group A and group B patients was not significantly different (P>0.05), meanwhile, operation time was significantly less for group C patients in comparison with group A patients (P<0.05). The incidence of postoperative complications among patients of group A was significantly lower than that of group B (P<0.05), while, these complications were similarly distributed between group A and group C (P>0.05). The duration of hospitalization among patients of group B (P<0.05) and group C (P<0.05) was significantly higher in comparison with group A patients. CONCLUSIONS: As long as preoperative and perioperative periods are appropriately dealt with, laparoscopic surgery is safe and feasible to pediatric appendix abscess in emergency.

Analysis of difficulties and influencing factors in treatment of appendiceal abscess in children with laparoscopic surgery.

BACKGROUND: The purpose of this study was to investigate and analyze the difficulties and the influencing factors in the laparoscopic surgery for appendiceal abscess in children. METHODS: Forty-six patients with appendiceal abscess receiving laparoscopic surgery (laparoscopic surgery group) in Xuzhou Children's Hospital from January 2012 to March 2017 were retrospectively analyzed. The surgery was performed using the 3-hole method, the 30° lens was placed in umbilical region, and the left lower abdomen and superior pubis were the operating holes. If the appendix was thick and big, 10 mm trocar was replaced on the superior pubis and the appendix was removed, followed by pelvic or lower abdominal drainage via the superior pubis incision. RESULTS: The laparoscopic surgery group was compared with 45 cases of laparotomy (traditional surgery group) for appendiceal abscess performed by the same group of operators in the past, and the perioperative period and postoperative complications between the two groups were compared. The child patients' age, history of abdominal pain and prediagnosis treatment were compared within the laparoscopic surgery group. Compared with those in traditional surgery group, the surgery time in laparoscopic surgery group had no statistically significant difference (P>0.05), the incidence rate of complications was lower, and the difference was statistically significant (P<0.05). In laparoscopic surgery group, the surgery time of child patients aged ≥6 years old with the medical history for more than 5 days and unreasonable preoperative treatment was longer than that of child patients aged <6 years old with the medical history for less than or equal to 5 days and reasonable preoperative treatment, and the difference was statistically significant (P<0.05). CONCLUSIONS: Compared with the traditional surgery, laparoscopic surgery for appendiceal abscess in children can significantly reduce the postoperative complications; at the same time, the history of abdominal pain and preoperative treatment are the influencing factors of surgery.

Expressions of Fib, IL-12 in Serum of Neonatal Necrotizing Enterocolitis and Their Correlation with Clinicopathological Features.

BACKGROUND: To investigate the expressions of fibrinogen (Fib) and Interleukin-12 (IL-12) in serum of neonatal necrotizing enterocolitis (NEC), and to analyze the correlation between the two and their relationship with clinicopathological features. METHODS: Forty two children with NEC treated in Xuzhou Children's Hospital, Xuzhou Medical University Xuzhou, China from 2016-2019 were selected as an observation group and 40 children who underwent physical examination at the same period as a control group. The expression levels of Fib and IL-12 in the serum of two groups were detected by ELISA. The correlation between Fib and IL-12 in the observation group and the correlation among the expressions of Fib, IL-12, the clinicopathological features and common examination indexes of the children with NEC were investigated by Pearson correlation analysis. RESULTS: The levels of Fib and IL-12 in the serum of the children in observation group were significantly higher than those in the control group were (P<0.05). There was a significant positive correlation between the levels of Fib and IL-12 in the serum of the children in observation group (P<0.05). The expression levels of Fib, IL-12 were not significantly correlated with sex and age of NEC children, but correlated with vomiting, diarrhea, bloody stool and bradycardia in NEC children (P<0.05). Fib and IL-12 were positively correlated with erythrocyte level (P<0.05) and negatively correlated with platelet level. CONCLUSION: The expressions of Fib and IL-12 in the serum of NEC children can objectively predict the severity of NEC.

Curcumin improves necrotising microscopic colitis and cell pyroptosis by activating SIRT1/NRF2 and inhibiting the TLR4 signalling pathway in newborn rats.

This study aimed to explore comprehensively the biological function of curcumin, and its underlying mechanism, in protecting from necrotising microscopic colitis in newborn rats. A total of 20 normal healthy rats were selected, and a necrotising enterocolitis (NEC) model was established. After hypoxia and hypothermia stimulation, these rats were treated with different doses of curcumin (control group, NEC model group, NEC+20 mg/kg curcumin and NEC+50 mg/kg curcumin). Inflammation was identified using hematoxylin and eosin staining, and inflammatory factors were detected via ELISA. The mRNA and protein levels of SIRT1, NRF2, TLR4, NLRP3 and caspase-1 were determined by quantitative RT-PCR and Western blotting, respectively. Curcumin improved the inflammatory condition of NEC and inhibited the expression of inflammatory factors in NEC newborn rat intestinal tissue. Furthermore, the SIRT1/NRF2 pathway was inhibited in the intestinal tissue of NEC newborn rats, whereas curcumin treatment induced the activation of the SIRT1/NRF2 pathway and inhibited TLR4 expression in these animals. In addition, curcumin could also inhibit the expression of inflammatory factors and alleviate the LPS/ATP-induced focal death pathway in intestinal epithelial cells through the SIRT1 pathway. Curcumin can improve necrotising microscopic colitis and cell pyroptosis by attenuating NEC-induced inhibition of SIRT1/NRF2 and inhibiting the TLR4 signalling pathway in newborn rats.

Overexpressed FOXO3 improves inflammatory status in mice by affecting NLRP3-mediated cell coronation in necrotizing colitis mice.

OBJECTIVE: To investigate the relationship between FOXO3 overexpression and NLRP3 and explore the effect of FOXO3 on necrotizing colitis. METHODS: 100 clean grade newborn SD (Sprague Dawley) rats were randomly divided into 4 groups: NEC group, NEC + FOXO3a group, NEC + NC group and control group. NEC rat model was established by hypoxia + hypothermia stimulation; HE staining was used for detection of the inflammation of intestinal tissue. The histological scores of intestinal tissues were histologically scored, generally, there were three types of inflammatory scoring systems including anatomically based systems, severity-based systems and quality of life systems (Lim et al., 2015) and in this study we utilized severity-based systems by HE staining. Human intestinal epithelial cell line was transfected with recombinant plasmid overexpressing FOXO3a and recombinant plasmid overexpressing NLRP3, and divided into control group, LPS group, LPS + NC group, LPS + FOXO3a group and LPS + FOXO3a + NLRP3 group; Caspase-1 was used for the detection of pyroptosis. The expressions of FOXO3a, NLRP3, cleaved Caspase-1 and the expression of TLR4 in TLR4 signaling pathway were detected by RT-qPCR and WB. IL-1ß, IL-6, IL-18 and TNF-α were detected by ELISA. RESULTS: (1) FOXO3a is under-expressed and NLRP3 is highly expressed in NEC neonatal rat intestinal tissue. (2) The inflammatory condition of intestinal tissue in NEC + FOXO3a group was improved compared with NEC group (P < 0.05). (3) FOXO3a was highly expressed in NEC + FOXO3a group. The expression of IL-1ß, IL-6, IL-18, SOD and MDA in NEC + FOXO3a group was lower than that in NEC group. (4) The expression of IL-1ß, IL-6, IL-18, SOD and MDA in intestinal epithelial cells of LPS + FOXO3a group was lower than other groups. (5) Overexpression of FOXO3a inhibits LPS-induced pyroptotic cell death in intestinal epithelial cells by inhibiting NLRP3. CONCLUSION: Overexpression of FOXO3 in mice with necrotizing colitis can improve inflammatory conditions in mice by affecting NLRP3-mediated cell caking.

Inhibition of miR-124 improves neonatal necrotizing enterocolitis via an MYPT1 and TLR9 signal regulation mechanism.

BACKGROUNDS: Necrotizing enterocolitis (NEC) was one of the main causes of morbidity and mortality in neonates. Our objective was to detect the mechanism of miR-124 in small bowel tissues of NEC. METHODS: Hematoxylin and eosin (H&E) staining was used to detect the repair of the damaged tissues in rat NEC model. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was used to evaluate the cell apoptosis level in intestinal tissue. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect the messenger RNA (mRNA) expression level of miR-124, Rho-associated coiled-coil-containing protein kinase 1 (ROCK1), myosin phosphatase target subunit 1 (MYPT1), and Toll-like receptor 9 (TLR9) in NEC tissues and IEC-6 cells. Luciferase reporter assay was used to verify whether ROCK1 is a direct target of miR-124. RESULTS: miR-124 was overexpressed in the NEC tissues, while ROCK1 and MYPT1 was downregulated in the NEC tissues. Inhibition of miR-124, suppressed the intestinal cell apoptosis and promoted the expression of ROCK1 and MYPT1. What is more, overexpression of miR-124 could inhibit the expression of ROCK1, TLR9, and MYPT1. Luciferase assay confirmed that miR-124 can regulate the transcriptional activity of ROCK1 through binding its 3'-UTR region. CONCLUSION: miR-124 was a promoter of NEC, which promotes the intestine cell apoptosis and inflammatory cell infiltration through the inhibition of TLR9 expression by targeting ROCK1.

Analysis of the clinical diagnosis data of four experimental detection methods for pediatric syphilis.

BACKGROUND: The aim of this study was to analyze the clinical testing data of syphilis suspected children, to give more comprehensive detection information and offer experimental basis for the clinical diagnosis of syphilis. METHODS: From April 2010 to December 2012, 141 suspected syphilis children, 0-3 years old in XuZhou Children's Hospital were selected and divided into two groups: infants group (0-1 years old, 119 cases) and children group (1-3 years old, 22 cases). Blood samples were collected from these children and following experimental detection methods were used: the rapid plasma reagin (RPR) test, the colloidal gold test (SYP), the enzyme-linked immuno-sorbent assay (ELISA) and the Treponema pallidum particle agglutination (TPPA) test. The relevant experimental data were analyzed by SPSS 13.0 software. RESULTS: The positive rate of ELISA was the highest, RPR was the lowest; the positive rate of SYP and TPPA were higher than RPR, the positive rate of SYP and TPPA were lower than ELISA, and the differences were statistically significant. Among the 86 false positives, the rate for ELISA was the highest, and no TPPA false positive was found. False positive were higher in the children group than the infant group. CONCLUSIONS: High false positive rate of ELISA could be caused by hemolysis. RPR had low sensitivity in suspected syphilis neonates, and SYP was suitable for emergency treatment. TPPA was fit for the diagnosis of syphilis. Thus a combination of all these methods would be the best choice to cure syphilis infection in children. Final diagnosis can only be confirmed after periodically reexamining samples of suspected syphilis children.

Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children.

We aimed to explore the feasibility and the safety of the laparoscopic surgery for incarcerated indirect inguinal hernia (IIH) in children. From January 2012 to December 2014, 64 children were enrolled into this study. All 64 patients received laparoscopic surgery and we reviewed their perioperative and postoperative follow-up studies. In addition, we enrolled 60 cases of children who received traditional surgery of IIH administered through minimally invasive surgery as the control group. Results from the present study showed that the mean operation time for the laparoscopic group was 41.5 min (range, 15-80 min) which was significantly shorter than the control group. Nine cases developed incarcerated intestine necrosis, expanded umbilical incision and parallel resection anastomosis. They received laparoscopic hernia sac high ligation. Only 5 cases developed scrotum edema after the surgery. The postoperative length of the stay ranged from 2 to 7 days (average, 3.2). The postoperative follow-up was from 6 months to 1 year and no relapse or secondary testicular atrophy was observed in the laparoscopic group. The operation time, incidence of postoperative complications and length of stay in the laparoscopic group were decreased compared to the control group, and differences were statistically significant (P<0.05). In conclusion, laparoscopic surgery treatment for incarcerated inguinal hernia is safe and feasible and produced better results compared with the alternative.

[Rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn].

OBJECTIVE: To explore the value of rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch in the treatment of congenital high anal atresia in the newborn. METHODS: Clinical data of 232 newborns diagnosed as congenital high anal atresia undergoing operation from January 2001 to December 2010 were retrospectively analyzed. Among these patients, 168 underwent rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch through the previous of sagittal approach (intrathecal pull-through group), and 64 cases underwent the Pena procedure (Pena group). Patients were followed up for two years. Kelly score was used to estimate postoperative anorectal function. Defecography was used to examine the morphology of anorectum. Rectal pressure was measured as well. RESULTS: Two years after operation, Kelly score revealed that 126 (75.0%) cases in the intrathecal pull-through group and 54 cases (84.4%) in the Pena group had good control defecation (P>0.05), while constipation rate was significantly lower in intrathecal pull-through group [8.3% (14/168) vs. 21.9% (14/64), P<0.05]. Postoperative barium defecography showed that defecation rectum maximum diameter was (2.2±0.3) cm in intrathecal pull-through group and (2.3±0.8) cm in the Pena group (P>0.05). Anorectal manometry showed rectal maximum capacity threshold value was (91.4±15.2) ml in the intrathecal pull-through group and (95.1±18.6) ml in the Pena group (P>0.05). There were no significant differences in defecography, anal bowel function and anorectal manometry between the two groups postoperatively (all P>0.05). CONCLUSIONS: Rectal mucosa stripping and pull-through from rectal muscle sheath of blind pouch through the former sagittal can be completed with one-stage operation in newborn for the treatment of congenital high anal atresia, the efficacy of which is similar to the classic Pena operation. This procedure can avoid other operations, ameliorate the pains of newborns, decrease the burden of family, and has lower constipation rate, therefore it is a valid surgical option.