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.

[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.