The timing of minimally invasive surgery for prenatally diagnosed choledochal cysts.

OBJECTIVE: There are no clear evidence-based recommendations concerning when patients with prenatally diagnosed choledochal cysts (CCs) should undergo surgery. This study was primarily designed to explore the proper timing of minimally invasive surgery for prenatally diagnosed CC patients. METHODS: Seventy-three patients with prenatally diagnosed CC were enrolled in this study and divided into 4 subgroups according to age at surgery (15 patients in the < 1 month group, 27 in the 1-2 months group, 14 in the 2-3 months group and 17 in the > 3 months group). Eighty-five healthy infants were recruited and divided into 4 age groups (29 in the < 1 month group, 20 in the 1-2 month group, 19 in the 2-3 month group and 17 in the > 3 month group). Preoperative data were collected and compared between CC patients and healthy controls in 4 age groups. Additionally, 73 patients were divided into laparoscopic and open groups to compare postoperative recovery indices and the occurrence of complications to determine the safety and feasibility of laparoscopic CC application in neonates and young infants. RESULTS: Twenty-one of 73 (28.8%) patients who were prenatally diagnosed with CCs experienced various clinical symptoms, and 15 of 21 (71.4%) patients experienced clinical symptoms less than 2 months after birth. No differences were found in alanine transaminase (ALT), aspartate transaminase (AST) or aspartate transaminase (APRI) levels between CC patients and controls at ≤ 1 month or 1-2 months of age (all p > 0.05), while higher levels were found in CC patients at 2-3 months or > 3 months of age (all p < 0.05). ALT, AST and DBIL levels 1 week after surgery were significantly lower than those before surgery in CC patients who underwent laparoscopic CC excision at > 2 months of age, while DBIL levels 1 week after surgery were also significantly lower than those before surgery in patients who underwent CC excision at ≤ 2 months of age. The initial oral feeding time in the laparoscopic surgery group was significantly earlier than that in the open surgery group for both CC patients who underwent CC excision at ≤ 2 months of age and those > 2 months of age (all p < 0.05). No differences were found in the rates of anastomotic leakage or stricture formation between the laparoscopic and open surgery groups at ≤ 2 months or > 2 months of age. CONCLUSION: Most clinical symptoms attributed to CC occur less than 2 months after birth, while liver function and liver fibrosis may deteriorate after 2 months of age in patients with prenatally diagnosed CC. Laparoscopic surgery for CC in newborns and young infants (either less than or more than 2 months old) is safe and feasible and can shorten the initial oral feeding time without increasing complications such as postoperative anastomotic leakage or stricture. Thus, performing laparoscopic CC excisions within 2 months after birth in patients with prenatally diagnosed CC may be appropriate.

Correlation between congenital pelvic floor muscle development assessed by magnetic resonance imaging and postoperative defecation.

OBJECTIVE: Children with congenital anorectal malformation (CAM) experience challenges with defecation. This study aims to assess defecation in preschool-age children with CAM and to evaluate the correlation between pelvic floor muscle developed assessed by magnetic resonance imaging (MRI) and postoperative defecation. METHODS: We collected clinical data and MRI results from 89 male children with CAM. The bowel function scores for children with Perineal (cutaneous) fistula, Rectourethral fistula(Prostatic or Bulbar), and Rectovesical fistula were computed. MRI scans were subjected to image analysis of the striated muscle complex (SMC). The association between pelvic floor muscle score and bowel function score was examined using the Cochran-Armitage Trend Test. RESULTS: We observed that 77.4% of the SMC scores by MRI for Perineal fistula were good. The Rectourethral fistula SMC score was 40.6% for moderate and 59.4% for poor. The SMC score for Rectovesical fistula was 100% for moderate. Furthermore, 77.4% of patients with Perineal fistula had bowel function scores (BFS) ≥ 17 points. Among those with Rectourethral fistula and Rectovesical fistula, 12.5% and 0 had BFS ≥ 17 points, respectively. An analysis of muscle development and bowel function in patients with Rectovesical fistula, Rectourethral fistula, and Perineal fistula revealed a correlation between SMC development and BFS. Subgroup analysis showed that the Perineal fistula had statistical significance; however, the Rectourethral fistula and Rectovesical fistula were not statistically significant. CONCLUSION: A correlation exists between pelvic floor muscle development and postoperative defecation in children with Perineal fistula.

A convenient nomogram for predicting early death or liver transplantation after the Kasai procedure in patients with biliary atresia.

PURPOSE: Many patients with biliary atresia (BA) after the Kasai procedure (KP) progress to death or require liver transplantation to achieve long-term survival; however, most cases of death/liver transplantation (D/LT) occur in the early period after KP (usually within 1 year). This study was designed to construct a convenient nomogram for predicting early D/LT in patients with BA after KP. METHODS: A BA cohort was established in May 2017, and up to May 2023, 112 patients with 1-5 years of follow-up were enrolled in the study and randomly (ratio, 3:1) divided into a training cohort for constructing a nomogram (n = 84) and a validation cohort (n = 28) for externally validating the discrimination and calibration. The training cohort was divided into two groups: the early D/LT group (patients who died or had undergone LT within 1 year after KP [n = 35]) and the control group (patients who survived through the native liver more than 1 year after KP [n = 49]). Multivariate logistic regression and stepwise regression were applied to detect variables with the best predictive ability for the construction of the nomogram. The discrimination and calibration of the nomogram were internally and externally validated. RESULTS: The Kaplan-Meier (K-M) curve showed an actual 1-year native liver transplantation (NLS) rate of 57.1% and an estimated 2-year NLS rate of 55.2%. By multivariate regression and stepwise regression, age at KP, jaundice clearance (JC) speed 1 month after KP, early-onset PC (initial time < 36.5 days) after KP, sex, aspartate aminotransferase-to-platelet ratio index (APRI), and weight at KP were identified as the independent variables with the best ability to predict early D/LT and were used to construct a nomogram. The developed nomogram based on these independent variables showed relatively good discrimination and calibration according to internal and external validation. CONCLUSION: Most D/LTs were early D/LTs that occurred within 1 year after KP. The established nomogram based on predictors, including sex, weight at the KP, the APRI, age at the KP, JC speed 1 month after the KP, and early PC, may be useful for predicting early D/LT and may be helpful for counseling BA patients about patient prognosis after KP. This study was retrospectively registered at ClinicalTrials.gov (NCT05909033) in June 2023.

Bowel function and features of bowel dysfunction in preschool children with anorectal malformation type rectoperineal and rectovestibular fistula.

Anorectal malformations (ARMs) of the rectoperineal and rectovestibular fistula type (RPF/RVF) generally have a good prognosis but may be accompanied by bowel dysfunction, especially constipation. Bowel dysfunction in preschoolers may persist into adolescence and adulthood, exerting a negative effect on their quality of life. This study was designed to evaluate bowel function and identify the features of bowel dysfunction in preschoolers with RPF/RVF across type and sex differences. A total of 159 preschoolers with RPF/RVF (male RPF group, n = 95; female RPF group, n = 26; RVF, n = 38) and 128 normal control preschoolers (control group, n = 128; female control group, n = 35), according to the bowel function score (BFS) obtained through a questionnaire survey, the BFS items in the questionnaire, and the clinical characteristics of patients were compared among groups. The rates of bowel dysfunction (BFS < 17) were 27.2% and 50.0% in the RPF and RVF groups, respectively. Normal rates of BFS items, namely, ability to hold back defecation, feels/reports of the urge to defecate, frequency of defecation, and constipation, in the RPF and RVF groups were significantly lower than those in the control and female control groups (all p < 0.05). After subgroup analysis among the male RPF, female RPF, and RVF groups, higher rates of normal bowel function and ability to hold back defecation were found in the male RPF group than in the female RPF and RVF groups (p < 0.05). Normal rates of feels/reports of the urge to defecate were higher in the male and female RPF groups than in the RVF group (all p < 0.05). The rate of never soiling in the male RPF group was significantly higher than that in the RVF group (p < 0.05).  Conclusions: In patients with RPF/RVF, bowel dysfunction is still prevalent, characterized by inadequate ability to hold back defecation, inability to feel/report the urge to defecate, soil, less frequent defecation, and constipation. However, male RPF patients had better overall bowel function than female RPF or RVF patients, including more adequate ability to hold back defecation and feels/reports of the urge to defecate and slighter soiling, which may be linked to early age at surgery, low occurrences of low sacral ratio, and tethered cord in male RPF.  Trial registration: This study was retrospectively registered in ClinicalTrials.gov on 09/01/2023 (NCT05716230). What is Known: • Rectoperineal and rectovestibular fistula (RPF/RVF) of the anorectal malformation (ARM) type has a good prognosis but may cause bowel dysfunction, especially constipation. • Bowel dysfunction at preschool age may lead to social and psychological disorders that undermine the quality of life in adolescence and adulthood. What is New: • Bowel function in preschoolers with RPF/RVF was deeply evaluated in a relatively large number of patients and normal control children. • Features of bowel dysfunction in RPF/RVF preschoolers across type and gender differences were identified in this study.

A Novel Ion Species- and Ion Concentration-Dependent Anti-Counterfeiting Based on Ratiometric Fluorescence Sensing of CDs@MOF-Nanofibrous Films.

Traditional fluorescent anti-counterfeiting labels based on "on-off" fluorescence can be easily cloned. It is important to explore advanced anti-counterfeiting fluorescent labels with high-level security. Here, a pioneering ion species- and ion concentration-dependent anti-counterfeiting technique is developed. By successive loading Cu2+ -sensitive yellow emitted carbon dots (Y-CDs) and Cu2+ non-sensitive blue emitted carbon dots (B-CDs) into metal-organic frameworks (MOFs) and followed by electrospinning, the B&Y-CDs@MOF-nanofibrous films are prepared. The results show that the use of MOF not only avoids the fluorescence quenching of CDs but also improves the fluorescence stability. The fluorescence Cu2+ -sensitivity of the CDs@MOF-nanofibrous films can be regulated by polymer coating or lamination. The fluorescent label consisting of different Cu2+ -sensitivity films will show Cu2+ concentration-dependent decryption information. Only at a specific ion species and concentration (Cu2+ solution of 40-90 µm), the true information can be read out. Less or more concentration (<40 or >90 µm) will lead to false information. The identification of the real information depends on both the species and the concentration. After Cu2+ treatment, the fluorescence of the label can be recovered by ethylenediaminetetraacetic acid disodium (EDTA-2Na) for further recycling. This work will open up a new door for designing high-level fluorescent anti-counterfeiting labels.

Compact plasmon modulator based on the spatial control of carrier density in indium tin oxide.

To keep pace with the demands of semiconductor integration technology, a semiconductor device should offer a small footprint. Here, we demonstrate a compact electro-optic modulator by controlling the spatial distribution of carrier density in indium tin oxide (ITO). The proposed structure is mainly composed of a symmetrical metal electrode layer, calcium fluoride dielectric layer, and an ITO propagating layer. The carrier density on the surface of the ITO exhibits a periodical distribution when the voltage is applied on the electrode, which greatly enhances the interaction between the surface plasmon polaritons (SPPs) and the ITO. This structure can not only effectively improve the modulation depth of the modulator, but also can further reduce the device size. The numerical results indicate that when the length, width, and height of the device are 14 µm, 5 µm, and 8 µm, respectively, the modulation depth can reach 37.1 dB at a wavelength of 3.66 µm. The structure can realize a broadband modulation in theory only if we select a different period of the electrode corresponding to the propagating wavelength of SPPs because the modulator is based on the scattering effect principle. This structure could potentially have high applicability for optoelectronic integration, optical communications, and optical sensors in the future.

Early oral feeding following intestinal anastomosis surgery in infants: a multicenter real world study.

Background: To prevent postoperative complications, delayed oral feeding (DOF) remains a common model of care following pediatric intestinal anastomosis surgery; however, early oral feeding (EOF) has been shown to be safe and effective in reducing the incidence of complications and fast recovery after pediatric surgery. Unfortunately, the evidence in support of EOF after intestinal anastomosis (IA) in infants is insufficient. Therefore, this study was primarily designed to evaluate the safety and efficacy of EOF. In addition, the current status of EOF application and associated factors that favor or deter EOF implementation were also assessed. Methods: A total of 898 infants were divided into two groups (EOF group, n = 182; DOF group, n = 716), and the clinical characteristics were collected to identify the factors associated with EOF in infants. Complications and recovery were also compared to define the safety and efficacy after balancing the baseline data by propensity score matching (PSM) (EOF group, n = 179; DOF group, n = 319). Results: The total EOF rate in infants with IA was 20.3%. Multivariate logistic regression revealed significant differences in the EOF rates based on IA site and weight at the time of surgery (OR = 0.652, 95% CI: 0.542-0.784, p < 0.001) and (OR = 1.188, 95% CI: 1.036-1.362, p = 0.013), respectively. The duration of total parenteral nutrition (TPN), parenteral nutrition (PN), and postoperative hospital stay were significantly shorter in the EOF group than the DOF group [2.0 (1.0, 2.0) d vs. 5.0 (3.0, 6.0) d; 6.0 (5.0, 8.0) d vs. 8.0 (6.0, 11.0) d; 10.0 (7.0, 14.0) d vs. 12.0 (9.0, 15.0) d, all p < 0.001]. The rates of abdominal distension and vomiting in the EOF group were significantly higher than the DOF group (17.9% vs. 7.2%, p < 0.001; 7.8% vs. 2.5%, p = 0.006); however, no differences were found in failure to initial OF, diarrhea, hematochezia, and anastomotic leakage between the two groups (p > 0.05). Conclusion: The overall rate of EOF in infants following IA was low, and the sites of anastomosis and weight at surgery were two factors associated with EOF. Nevertheless, performing EOF in infants after IA was safe and effective, reduced PN usage, shortened the hospital stay, and did not increase the rate of severe complications.Clinical Trial Registration: ClinicalTrails.gov, identifier NCT04464057.

A multi-parameter tunable plasmon modulator.

Multi-parameter control of light is a key functionality to modulate optical signals in photonic integrated circuits for various applications. However, the traditional optical modulators can only control one or two properties of light at the same time. Herein, we propose a hybrid structure which can modulate the amplitude, wavelength and phase of surface plasmon polaritons (SPPs) simultaneously to overcome these limitations. The numerical results show that when the Fermi level of graphene changes from 0.3 to 0.9 eV, the variation of optical transmission, wavelength and phase are 32.7 dB, 428 nm and 306°, respectively. The demonstrated structure triggers an approach for the realization of ultracompact modulation and has potential applications in the fields of optical switches, communications and photo-detection.

Heating-free synthesis of red emissive carbon dots through separated processes of polymerization and carbonization.

Polymerization and carbonization are believed as two basic processes for the bottom-up synthesis of carbon dots (CDs). Since these two processes usually occur simultaneously due to the high reaction temperature and fast reaction rate, it is still a challenge to separate and control these two processes. In the present work, we reported a new room temperature method, which achieved the separated and controlled polymerization and carbonization processes. The polymerization process is realized by dissolving o-phenylenediamine (OPD) in ethanol at room temperature, and finally obtained polymer dots (PDs) without any lattice with a sphere size of 29.6 nm. The carbonization process begins in a manual way by adding concentrated sulfuric acid. After carbonization, CDs (noted as CPDs in this work) with a size of 3.6 nm and a clear lattice can be obtained. Importantly, the separated polymerization and carbonization make us possible to adjust the composition or interactions of intermediate products during the synthesis process. As a prototype, we added acetic acid (AA) additives into OPD precursors during the polymerization stage. Due to the crosslink enhanced emission (CEE) effect via hydrogen bonds which are produced by the amide groups from AA reaction products with H in the -NH3+ or aromatic ring, the resulted CPDs show improved PLQY from an initial 6.87% (without AA) to 16.47%. The current work realized the separated and controllable polymerization and carbonization processes, opening up the door for tuning the composition and interactions of intermediate products before carbonization.

Post-synthetic regulation of the fluorescence of CDs: insights into the fluorescence mechanism.

Exploring the origin of emission is fundamental in the field of carbon dots (CDs). Due to the lack of suitable in situ probing techniques, it is necessary to explore effective alternative methods that can accurately reflect the relationship between the emission and the composition of the functional groups of CDs. Herein, we propose a new method of post-synthetic treatment of CDs by photo-oxidation to investigate the origin of emission for CDs. After the addition of a photo-oxidant into pre-prepared CDs under UV irradiation, the fluorescence of CDs can be regulated from the original orange emission to the final green emission due to the damage of original functional groups and the formation of new functional groups on CDs during the post-treatment process. The abundant dynamic information about the functional groups and emissions of CDs during the visible and ready-to-monitor post-treatment process makes it possible to quantitatively analyze the origin of the emission of CDs. Our results suggest that the emission sub-peaks at 560 nm and 600 nm relate to the CD surface-state-associated -NH3+ groups, while the emission sub-peak at 537 nm or 494 nm is associated with the CD surface-state-associated -OH groups or the CD surface-state-associated carbonyl groups (CO). Under UV irradiation, the CD surface-state-associated -NH3+ groups can be continuously converted into the CD surface-state-associated -OH groups and the CD surface-state-associated carbonyl groups (CO), leading to the changed emission color of CDs.

Bowel function at preschool and early childhood age in children with long-segment Hirschsprung disease.

Bowel dysfunction has been proven to be the most typical complication of long-segment Hirschsprung disease (LSHD). Additionally, bowel dysfunction in preschool and early childhood should be properly assessed, because it may result in persistent bowel dysfunction, social issues, and depression in adolescence and adulthood. This study evaluated bowel function during preschool and early childhood in patients with LSHD. A cross-sectional bowel function score (BFS) questionnaire survey was conducted on 270 infants with short-segment Hirschsprung disease (SSHD) and LSHD who underwent pull-through (PT) between January 2014 and December 2019 at the Children's Hospital of Nanjing Medical University. One hundred ninety patients who consented to the survey were asked to complete the questionnaire and were divided into two groups: the LSHD group (n = 42) and the SSHD group (n = 148). Bowel function outcomes were assessed by using a questionnaire. The total BFS score in the LSHD group was significantly lower than that in the SSHD group (15.0 [14.0, 17.0] vs. 18.0 [16.0, 19.0], p < 0.05) and did not improve with age (p > 0.05). Independent BFS items with lower scores were discovered in LSHD than in SSHD, including the capacity to hold back defecation, feeling/reporting the urge to defecate, frequency, soiling, and accidents (all p < 0.05). After subgroup analysis of follow-up age (3-5 years, 5 ~ 7 years, and > 7 years), there was no difference between the score of ability to hold back defecation over 7 years old and feeling/reporting the urge to defecate over 5 years old (all p > 0.05). The frequency and soiling scores were lower in the LSHD group than in the SSHD group over 5 years of age (all p < 0.05). Fortunately, there was no difference in constipation scores and social problems between the LSHD and SSHD groups in every sub-follow-up group (all p > 0.05).  Conclusion: Overall, bowel function at preschool and early childhood age was poorer in LSHD than in SSHD and did not improve with age. However, the ability to hold back defecation and feeling/reporting the urge to defecate with age in LSHD may be similar to those in SSHD. Simultaneously, the frequency, soiling, and number of accidents were consistently worse in the LSHD group.  Trial registration: This study was retrospectively registered in the ClinicalTrials database.gov (NCT05461924) in August 2022. What is Known: • Bowel function in SSHD is satisfactory or near-normal, and the general consensus is that the longer the aganglionic segment, the worse the bowel function after surgery. • Bowel functional outcomes of LSHD were not defined, and the limited reports of bowel functional outcomes compared with SSHD were extensively varied. Bowel dysfunction at preschool and early childhood may lead to persistent bowel dysfunction, social problems, and depression in adolescence or adulthood. What is New: • Bowel function in preschool and early childhood in patients with LSHD has not been defined and should be thoroughly assessed in a larger group of patients with precise definitions of incontinence or soiling. • The present study was primarily designed to evaluate bowel function at preschool and early childhood age in LSHD compared with SSHD in a relatively large number of HD cases using BFS.

Compact plasmon modulator with a high extinction ratio.

To keep pace with the demands in optical communications, electro-optic modulators should feature a high extinction ratio, offer a small footprint, and allow for practical detection. Herein, we demonstrate a compact plasmon modulator with a high extinction ratio where a compact modulation region composed of indium tin oxide (ITO) is embedded to the arms of the Mach-Zehnder (M-Z) interferometer. The modulator has a footprint of 20µm×12µm with a modulation region of 4µm×0.5µm. The numerical results show that the extinction ratio is 15.2 dB when the electron concentration of ITO is changed 4×1020cm-3. This type of modulator paves the way for future compact optoelectronic integration and has potential application in the fields of optical communication, photodetection, and sensing.

Congenital hepatic cyst: Eleven case reports.

BACKGROUND: Liver cysts in infants are uncommon. With modern diagnostic imaging, we can achieve an early diagnosis of congenital hepatic cysts. Our purpose was to investigate the clinical features, surgical treatment methods and prognosis of infants with congenital hepatic cysts. Herein, we report a case series of congenital hepatic cysts. CASE SUMMARY: Eleven infants with hepatic cysts were retrospectively analysed. Ten of them had simple hepatic cysts, and a girl with a large hepatic mass was diagnosed with a solitary intrahepatic biliary cyst accompanied by a choledochal cyst. Among the ten simple hepatic cysts, eight were solitary and two were multiple. A total of 87.5% (7 of 8) of infants with solitary hepatic cysts were detected before delivery, and 86% (6 of 7) of those cysts were located in the right lobe of the liver. Surgical intervention was required for symptomatic hepatic cysts. Cyst resection or unroofing with fulguration of the cyst bed was employed. No recurrence of cysts was observed in these infants. CONCLUSION: Congenital hepatic cyst is a condition with a narrow differential diagnosis. Accurate diagnosis is essential for appropriate management. Unroofing is the favoured treatment in infants with symptomatic cysts. Most infants with congenital hepatic cysts have a good prognosis.

Ultralow Threshold Room Temperature Polariton Condensation in Colloidal CdSe/CdS Core/Shell Nanoplatelets.

Room-temperature exciton-polariton Bose-Einstein condensation (BEC), a phase transition to single quantum state with strong nonlinearity, provides a new strategy for coherent light sources and ultralow threshold optic switches. In this work, colloidal CdSe/CdS 2D nanoplatelets are embedded into a microcavity, and exciton-polariton BEC is realized with an ultralow threshold of 0.5 µJ cm-2 at room temperature. The superlinear power-dependent emission, macroscopic occupation of the ground state, strong blueshift and broadening of the emission peak, and long-range coherence strongly confirm the realization of the polariton laser. This work suggests considerable prospects for colloidal nanoplatelets in low-cost, high-performance polariton devices, and coherent light sources.

A plasmon modulator by directly controlling the couple of photon and electron.

The manipulation of surface plasmon polaritons plays a pivotal role in plasmonic science and technology, however, the modulation efficiency of the traditional method suffers from the weak light-matter interaction. Herein, we propose a new method to overcome this obstacle by directly controlling the couple of photon and electron. In this paper, a hybrid graphene-dielectric- interdigital electrode structure is numerically and experimentally investigated. The plasmon is excited due to the confined carrier which is regulated by the potential wells. The frequency of plasmon can be tuned over a range of ~ 33 cm-1, and the obtained maximum extinction ratio is 8% via changing the confined area and the density of carrier. These findings may open up a new path to design the high efficiency all-optical modulator because the electrons can also be driven optically.

The effect of solvent on preparation of CH3 NH3 PbI3 photodetectors via an antisolvent-free method.

During the fabrication of lateral-structured photodetectors based on CH3 NH3 PbI3 film, antisolvents represented by toluene are usually used to accelerate the crystallization of perovskite. Using antisolvent not only leads to the formation of shrinkage holes at the bottom of the perovskite layer, but the toxicity of antisolvents would also hinder the industrial preparation of perovskite devices. An antisolvent-free method is a possible solution to avoid these problems. Here, we report a lateral-structured photodetector based on an antisolvent-free method. The lateral photodetector exhibited a high responsivity of 1.75 A⋅W-1 and specific detectivity (D*) of 3.54 × 1012 Jones. In particular, the results indicated that the solvent had an influence on perovskite film morphology, crystallization, and device performance. The prepared CH3 NH3 PbI3 film presented needle-like crystals and low performance with single precursor solvent N,N-dimethylformamide (DMF). In comparison, appropriate mixing of dimethyl sulfoxide (DMSO) could improve the morphology, crystallization, and performance of the film. In addition, the solvent volume ratio of the precursor had a profound effect on the performance of the as-prepared photodetectors. At a DMSO:DMF volume ratio of 5:5, the as-prepared film had massive perovskite crystals and fewer defects, resulting in optimal device performance, which can be explained by Urbach energy.

Optimal timing for Soave primary pull-through in short-segment Hirschsprung disease: A meta-analysis.

BACKGROUND: The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease. METHODS: The NCBI PubMed database was searched for English-language manuscripts published between 2000 and 2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis. RESULTS: A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0-31.7%, soiling 1.3-26.0%, anastomotic stricture 0.0-14.6%, and anastomotic leak 0.0-3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients <2.5 months at their initial corrective surgery had higher rates of soiling (25.9% vs. 11.4%, p<0.01), as well as stricture (10.0% vs 1.7%, p<0.01) and leak (5.5% vs 1.3%, p<0.01). CONCLUSION: While age at Soave endorectal pull-through for short-segment Hirschsprung disease has decreased over time, functional outcomes associated with this trend have only recently been examined. Our findings suggest that patients <2.5 months old at the time of endorectal pull-through may have worse functional outcomes, emphasizing the need to consider further study of the timing of surgery in this population.

Risk factors for the occurrence and recurrence of acute cerebellar ataxia: a retrospective observational study.

OBJECTIVE: There is little evidence to support a correlation between abdominal surgery and acute cerebellar ataxia (ACA). We reviewed the records of children with ACA treated at our institution to analyze risk factors for ACA. METHODS: Clinical data of 442 children with ACA treated at Children's Hospital of Nanjing Medical University between November 2015 and June 2019 were retrospectively analyzed. Univariate and multivariate analyses were performed to determine risk factors for the occurrence and recurrence of ACA. RESULTS: In total, 442 children with ACA were included in this study. Multivariate logistic regression analysis showed age (p = 0.009), infection (p < 0.001), vaccination (p < 0.001), head trauma (p < 0.001), intussusception surgery (IS) (p < 0.001), operation for indirect inguinal hernia (p < 0.001), and operation for congenital gastrointestinal malformation (p < 0.001) were independent risk factors for ACA occurrence. Univariate analysis showed that only IS (p < 0.001) was associated with ACA recurrence. CONCLUSIONS: Surgeons should be aware that age, infection, vaccination, head trauma, and history of abdominal surgery are associated with ACA, while IS is a risk factor for ACA recurrence.

Nano-particle transport and the prediction of a valid area to be trapped based on a plasmonic antenna array.

Optical antennas are promising for optical trapping and particle manipulation, when converting light between localized energy and freely propagating radiation. In this paper, we proposed a numerical method for the transport of nanoparticles using the optical force field over a plasmonic Au antenna array. The plasmonic Au antenna array is designed to produce strong near-field hot spots when illuminated by a plane wave. The hot spots function as optical traps, separately addressable by their resonant wavelengths. By changing the traps sequentially, the nanoparticles can be handed off between adjacent traps. We also demonstrated a valid area in which the nanoparticles could be trapped and transferred stably by discussing the trapping potential that particles encountered. The simulated and calculated results showed that this method had promising applications in the field of biochemical diagnoses and high-accuracy optical manipulation.

Silicon-assisted surface enhanced fluorescence toward improved assay performances.

A novel scheme of silicon-assisted surface enhanced fluorescence (SEF) is presented for SEF-based assays, where the blank signal suppression and the fluorescence signal enhancement is combined. The P-doped, (100) oriented silicon substrate is used to quench the fluorescence of Rose Bengal (RB) molecules attached to it, resulting in an effectively suppressed background signal, which is useful for a lower limit of detection (LOD). When a proper quantity of silver nanoparticles (AgNPs) is deposited on the RB-attached silicon substrate, a significant fluorescence enhancement of up to around 290 fold is obtained, which helps to improve the sensitivity in fluorescence-based assays. Besides, conventional gold nanoparticles (AuNPs) have also been demonstrated to exhibit excellent SEF effect using the presented scheme, providing improved stability and biocompatibility. The mechanism of the observed SEF effect has been investigated, and both the decreased apparent quantum yield and the silicon-induced electric field redistribution are considered to play important roles. The experimental results suggest that the presented scheme holds great potential in the SEF-based assays aiming at higher sensitivity and lower LOD.