Two Novel, Nonoperative Methods of Stoma Prolapse in Newborns: 3 Case Reports.

BACKGROUND: Prolapse is a common complication following enterostomy; the defect and consequences of a prolapse significantly affect health-related quality of life. Creative techniques must be employed to manage the prolapse. CASES: This article describes management of 3 neonates with stoma prolapse. CONCLUSION: Management of stoma prolapse should be individualized, employing successful nonoperative techniques rather than more difficult operative procedures to prevent recurrent prolapse.

New sonographic feature (C-sign) to improve the prenatal accuracy of jejunal atresia.

OBJECTIVES: To describe a new sonographic feature of the C-sign for prenatal diagnosis of jejunal atresia and evaluate its role in prenatal jejunal atresia, particularly preceding bowel dilatation and polyhydramnios. METHODS: This was a retrospective study from a tertiary maternal hospital. Patients with prenatal sonographic examination and confirmed small bowel atresia postdelivery were included. All sonographic images were reviewed by two senior sonographers. Comparison of sonographic images between prenatal jejunal and ileal atresia using the C-sign resembles the shape of the entire duodenum and other traditional sonographic features. The control group without bowel atresia was assessed for the presence of the C-sign. RESULTS: The C-sign and combined bowel dilatation with polyhydramnios were more frequent in jejunal atresia than ileal atresia, but the C-sign can be used to detect jejunal atresia earlier. The C-sign can be more likely to diagnose jejunal atresia in persisting bowel dilatation and polyhydramnios. The C-sign was not reported in any of the control fetuses. CONCLUSION: The C-sign is a new sonographic feature that can be used to improve the prenatal accuracy and early detection of jejunal atresia. However, further prospective validation is needed.

Interleukin-6-mediated CCR9+ interleukin-17-producing regulatory T cells polarization increases the severity of necrotizing enterocolitis.

BACKGROUND: Increased frequency of CCR9+ CD4+ T cells in peripheral blood is linked to several gastrointestinal inflammatory diseases; however, its relationship with necrotizing enterocolitis (NEC) is not understood. We investigated whether the frequencies of CCR9+ CD4+ T cells and related subsets were increased in peripheral blood of both patients and mice with NEC. METHODS: CCR9+ CD4+ T cells and related subsets were evaluated by flow cytometry in peripheral blood collected from both patients and mice with NEC and controls. The suppressive function of CCR9+ regulatory T (Treg) cells in NEC was assessed via in vitro suppression assay. An in vitro T cell polarization assay was performed to investigate the role of proinflammatory cytokines in Treg cell polarization. In vivo Treg cell polarization analysis was performed using NEC mice treated with anti-interleukin-6 (IL-6) receptor antibody. FINDINGS: A higher proportion of CCR9+ CD4+ T cells occurred in peripheral blood of both patients and mice with NEC than in controls. Elevated CCR9+ CD4+ T cells were primarily CCR9+ IL-17-producing Treg cells, possessing features of conventional Treg cells, but their suppressive activity was seriously impaired and negatively correlated with the severity of intestinal tissue injury. IL-6 promoted polarization of CCR9+ Treg cells to CCR9+ IL-17-producing Treg cells, and blocking IL-6 signalling inhibited this conversion in vitro and ameliorated experimental NEC in vivo. INTERPRETATION: Collectively, these data suggested that CCR9+ IL-17-producing Treg cells may be a biomarker of severity and highlight the possibility that antibodies targeting IL-6R could ameliorate NEC by modulating lymphocyte balance. FUND: This work was supported by the Science and Technology Planning Project of Guangdong Province, China (2017A020215100), the Science and Technology Foundation of Guangzhou, China (201704020086 and 201604020154), the Medical Scientific Research Foundation of Guangdong Province, China (A2017304 and A2014704), and the Social Science and Technology Development Foundation of Dongguan, China (2016108101037).

[Timing investigation of single-stage definitive surgery for newborn with Hirschsprung's disease].

OBJECTIVE: To investigate the operation timing of newborns with rectosigmoid Hirschsprung's disease (HD). METHODS: From March 2013 to September 2015, 35 newborns diagnosed as rectosigmoid HD in our department were prospectively and randomly divided into 2 groups: less than 3 months treatment group (18 cases) and more than 3 months treatment group (17 cases, conservative treatment for 3 months). They all underwent laparoscopic-assisted transanal endorectal pull-through (LATEP) (modified Soave) procedure. Clinical data, perioperative conditions, postoperative complication, postoperative anal function evaluated by Wingspread score and barium enema were compared between two groups. RESULTS: The baseline data of two groups were comparable (all P>0.05). All the cases completed single-stage LATEP procedure successfully without conversion to open operation. Compared with more than 3 months treatment group, preoperative bowel preparation time and operation time were significantly shorter [(6.2±3.3) vs. (9.3±4.1) days, P=0.042; (95±15) vs.(121±23) minutes, P=0.029, respectively], intra-operative blood loss was significantly less [(13±3) ml vs. (22±5) ml, P=0.036], length of resected bowel was significantly shorter [(16±5) cm vs.(23±8) cm, P=0.033], and bowel movement recovery time, parenteral nutrition time, hospital stay were also significantly shorter [(2.3±0.5) vs. (2.9±0.6) days, P=0.046; (5.1±2.1) vs. (5.9±2.3) days, P=0.048; (12.9±3.3) vs. (15.8±4.3) days, P=0.049, respectively] in less than 3 months treatment group. No short-term complications, such as anastomotic leak, interlayer infection and abdominal infection occurred in both groups. The follow-up period ranged from 2 months to 24 months. Only the incidence of perianal excoriation was significantly higher in less than 3 months treatment group compared with more than 3 months treatment group [50.0%(9/18) vs. 23.5%(4/17), P=0.045]. Wingspread score results at 6 and 12 months after operation showed excellent rate of postoperative anal function, which was not significantly different between two groups[ <3 months group : 81.3%(13/16) and 92.9%(13/14); >3 months group: 85.7%(12/14) and 92.3%(12/13), all P>0.05]. Postoperative barium enema results at 6 and 12 months after operation all showed normal shape of colon without residue of barium. CONCLUSIONS: For newborns with rectosigmoid HD, single-stage definitive operation performed at the age less than 3 months has the advantages of shorter preoperative preparation time, less operating injury, shorter resected bowel, and faster postoperative recovery as compared to the age more than 3 months. If rectosigmoid HD is definitively diagnosed, early operation is suggested to perform at the age less than 3 months.