A comprehensive scoring system for the better prediction of bowel resection in pediatric intussusception.

BACKGROUND: Intussusception presents a significant emergency that often necessitates bowel resection, leading to severe complications and management challenges. This study aims to investigate and establish a scoring system to enhance the prediction of bowel resection necessity in pediatric intussusception patients. METHODS: This retrospective study analyzed 660 hospitalized patients with intussusception who underwent surgical management at a pediatric hospital in Southwest China from April 2008 to December 2020. The necessity of bowel resection was assessed and categorized in this cohort. Variables associated with bowel resection were examined using univariate and multivariate logistic regression analyses. Based on these analyses, a scoring system was developed, grounded on the summation of the coefficients (ß). RESULTS: Among the 660 patients meeting the inclusion criteria, 218 required bowel resection during surgery. Bowel resection occurrence was linked to an extended duration of symptoms (Odds Ratio [OR] = 2.14; 95% Confidence Interval [CI], 1.03-5.23; P = 0.0015), the presence of gross bloody stool (OR = 8.98; 95% CI, 1.76-48.75, P < 0.001), elevated C-reactive protein levels (OR = 4.79; 95% CI, 1.12-28.31, P = 0.0072), lactate clearance rate (LCR) (OR = 17.25; 95% CI, 2.36-80.35; P < 0.001), and the intussusception location (OR = 12.65; 95% CI, 1.46-62.67, P < 0.001), as determined by multivariate logistic regression analysis. A scoring system (totaling 14.02 points) was developed from the cumulative ß coefficients, with a threshold of 5.22 effectively differentiating infants requiring surgical intervention from others with necrotizing enterocolitis (NEC), exhibiting a sensitivity of 78.3% and a specificity of 71.9%. CONCLUSIONS: This study successfully identified multiple risk factors for bowel resection and effectively used a scoring system to identify patients for optimal clinical management.

Liberal surgical laparoscopy reduction for acute intussusception: experience from a tertiary pediatric institute.

The optimal treatment for acute intussusception has not yet been defined. In this study, we explored whether employing a liberal laparoscopic intervention for intussusception could lead to favorable outcomes. We performed a historical control analysis to evaluate the outcomes associated with this liberal surgical management protocol. This liberal surgical management protocol were revised to incorporate a new protocol centered around the laparoscopic approach. In some cases of acute intussusception, liberal laparoscopic exploration and intervention were undertaken without initial hydrostatic or pneumatic reduction. During the study interval, a retrospective review was conducted on a total of 3086 patients. These were categorized into two groups: 1338 cases before May 2019 (pre-protocol group) and 1748 cases after May 2019 (post-protocol group). Surgical intervention rates in the pre-protoco and post-protocol period were 10.2% and 27.4% respectively (odds ratio [OR] = 0.30 [95% CI 0.25-0.37]; p < 0.001). No significant differences were observed in baseline clinical characteristics or demographic features between the two groups. The duration from admission to operation was longer for the pre-protocol group (p = 0.008) than for the post-protocol group. The post-protocol group demonstrated decreases in both intestinal resection (OR = 1.50 [95% CI 0.96-2.35]; p = 0.048) and total recurrent events (OR = 1.27 [95% CI 1.04-1.55]; p = 0.012) compared to the pre-protocol group. Liberal laparoscopic intervention for intussusception may effectively reduce the risk of intestinal resection and total recurrent events, thereby exhibiting promising outcomes for patients with intussusception.

Risk Factors to Predict Post-Operative Organ/Space Infection After Appendectomy in the Pediatric Population: A Retrospective Case Control Analysis.

Background: Post-operative organ/space infection (OSI) is associated with prolonged hospital stay or re-admission. Here, we explore the predictors for OSI in pediatric patients after appendectomy. Patients and Methods: Among post-appendectomy pateints, the OSI was reviewed. A multicenter case control study was conducted to explore the risk factors for OSI among pediatric patients with appendicitis after appendectomy between January 2009 and December 2019. The potential risk factors associated with OSI were explored using multivariable logistic regression methods. Results: In the current cohort, 723 patients fulfilled the OSI criteria. According to multivariable logistic regression analysis, the occurrence of OSI was associated with complicated appendicitis (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.03-3.686; p = 0.016), the lower the level of pre-operative lymphocyte-C-reactive protein (LCR; OR, 14.42; 95% CI, 1.57-73.26; p < 0.001), pan-peritonitis (OR, 4.36; 95% CI, 1.34-21.66; p = 0.006), systemic inflammatory response syndrome (SIRS; OR, 8.22; 95% CI, 1.84-49.63; p < 0.001), and abscess presentation (OR, 11.32; 95% CI, 2.03-61.86; p < 0.001). The receiver operating characteristic (ROC) curve evaluation further confirmed the relatively high accuracy of the above factors to predict OSI. Conclusions: The identified potential risk factors in the current research can be used for OSI identification in patients after appendectomy. Recognition of the risk factors may allow the choice of the treatment process more reasonably.

Simple Scoring System that Predicts the Need for Surgical Intervention in Infants with Necrotizing Enterocolitis.

BACKGROUND AND AIMS: It is difficult to identify those preterm infants who require surgical intervention. This study examined the predictive factors for bowel resection in infants with definitive and advanced necrotizing enterocolitis (NEC). We then developed a scoring system to better predict the need for surgical intervention. METHODS: A total of 203 infants with modified Bell's stage 2 or higher NEC from January 2018-December 2020 were identified for this study. A retrospective study evaluated the association between several comprehensive variables and surgical intervention using a multiple logistic regression analysis, and then a scoring system was developed based on the sum of coefficients (ß). RESULTS: Of the 135 patients who met the inclusion criteria, 57 infants underwent a surgical intervention. The multivariable logistic regression analysis showed that birth weight (regression coefficient, ß = 1.30), PCT (ß = 2.33), not having received enteral nutrition before the diagnosis of NEC (ß = 2.13), acidosis (ß = 1.57), respiratory alkalosis (ß = 2.42), hypokalemia (ß = 2.14), peritonitis (ß = 2.87) and coagulation disorders (ß = 1.78) were associated with the occurrence of bowel resection. A scoring system ranging from 0-17 was developed based on the total coefficient obtained. It was found that a cut-off score of 5 may distinguish those infants needing surgical intervention from other infants with NEC. CONCLUSION: We successfully developed a clinical decision-making tool associated with the need for surgical intervention among infants with advanced NEC. The risk scoring system could accurately identify infants who would benefit from surgical intervention.

Value of abdominal ultrasonography in predicting intestinal resection for premature infants with necrotizing enterocolitis.

BACKGROUND: Abdominal ultrasonography (AUS) has been suggested to be valuable in the early detection of necrotizing enterocolitis (NEC). OBJECTIVE: Here, we intended to assess the efficiency of abdominal ultrasound in terms of predicting bowel resection in infants with NEC. METHODS: From January 2018 to March 2021, 164 hospitalized children with NEC who underwent surgical management were enrolled. The enrolled infants were separated into two groups according to whether they underwent bowel resection. We reviewed the clinical data, as well as dynamic sonographic and abdominal radiographic (AR) parameters. The potential performance of AUS parameters was identified and compared with that of AR using a logistic regression analysis and receiver operating characteristic (ROC) curve analysis. RESULTS: Several parameters were detected to be statistically significant in predicting the occurrence of bowel resection, including thick to thin transformation [p < 0.001, odds ratios (OR), 4.38; 95% confidence interval (CI) 2.26-8.52], absence of peristalsis certain areas (p = 0.001, OR, 2.99; 95% CI 1.53-5.86), absence of bowel wall perfusion (p < 0.001, OR 10.56; 95% CI 5.09-21.90), and portal venous gas (p = 0.016, OR, 2.21; 95% CI 1.12-4.37). Furthermore, the ROC curve analysis showed significant differences (p = 0.0021) in the area under the receiver operating curve (AUROC) for the logistic models of AUS (AUROC: 0.755, 95% CI 0.660-0.849) and AR (AUROC: 0.693, 95% CI 0.597-0.789) for the prediction of intestinal resection. CONCLUSIONS: A dynamic AUS examination play an important role to indicate the potential for bowel loss during the surgery.

Intermediate-Term Evaluation of Initial Non-Surgical Management of Pediatric Perianal Abscess and Fistula-In-Ano.

Background: Non-surgical intervention has been proposed for the management of perianal abscess (PA) and fistula-in-ano (FIA), with potential benefits in terms of quality of life, wound healing, and functional outcome, although this strategy remains rare and controversial. Here, we aimed to compare the intermediate-term outcomes of non-surgical management with those of surgical incision and/or drainage. Patients and Methods: A study of pediatric patients with first-time PA and/or FIA was conducted retrospectively from January 2010 to December 2020. The patient population was stratified by surgical and non-surgical management. The clinical outcomes, including PA recurrence, FIA formation, and wound healing time, were compared between the surgical and non-surgical management groups. Results: A total of 457 patients managed for first-time PA and/or FIA were eligible for the current study. Of these patients, 169 (50.9%) patients received non-surgical intervention. There were no differences in terms of age, gender distribution, wound healing course, or abscess size between the two groups. Furthermore, no difference was noted between the two groups in terms of PA recurrence and/or FIA development rates and revisits for additional treatment. Conclusions: Although PA/FIA management is still controversial, non-surgical intervention exhibited promising outcomes for most cases of first-time PA/FIA, with fewer hospital admissions and surgical procedures and similar recurrence and fistula formation incidences. Immediate surgical intervention might be avoided because PA/FIA has a chance for spontaneous resolution in children.

Hand-Assisted Laparoscopic Splenectomy with Temporary Splenic Artery Occlusion in Pediatric Patients: The Experience in a Chinese Tertiary Children's Hospital.

Background: The hand-assisted laparoscopic splenectomy (HALS) approach overcomes the difficulties experienced with conventional laparoscopic splenectomy (LS) with added advantages. In this study, we compared the HALS technique with standard LS based on the feasibility and intermediate postoperative outcomes in pediatric patients. Methods: We retrospectively investigated pediatric patients who underwent HALS or LS from October 2013 to May 2021 at the Children's Hospital, Chongqing Medical University. Potential parameters related to HALS or LS were explored, and the intermediate-term clinical outcomes were compared between the two groups. The quality of life and splenic regrowth data were followed up routinely for 12 months after the operation. Results: In total, 39 patients underwent splenectomy (11 for HALS and 28 for LS) and were eligible for this research. Patients who underwent HALS had a greater proportion of focal benign splenic lesions (P < .001) and partial splenectomy (P < .001). The HALS operative time was reduced compared with LS (P = .032). No operation conversion was noted in the HALS group, whereas 4 (14.3%) cases were converted to an open operation (P = .249). For partial splenectomies, favorable outcomes with HALS, including short operative time (P = .001) and reduced blood loss (P = .014), were noted compared with LS. No postoperative mortality was observed. During the follow-up period, a good quality of life and splenic regrowth were noted for most of the patients. Conclusions: Although another incision is necessary, HALS confers the advantages of a minimally invasive technique to manage the fragile spleen, especially in pediatric patients requiring partial splenectomy.

Postoperative organ space infection (OSI) following appendectomy: early term evaluation for pediatric population.

No consensus has been reached on the duration of antibiotic prophylaxis for postoperative organ space infection (OSI) following appendectomy. This study investigated the influence of antibiotic administration on postoperative OSIs in children with complex appendicitis. A multicenter, retrospective study was conducted in patients with OSI following complicated appendicitis between 2017 and 2019 at 3 hospitals in China. The qualified patients were dichotomized into a long-duration antibiotic group (> 5.5 days) and a short-duration antibiotic group (< 5.5 days) based on the median duration (5.5 days) of antibiotic administration. Potential biases in baseline characteristics were managed using propensity score matching for the two groups. Primary and secondary outcomes were compared between the two groups. Propensity-matched analysis of the entire cohort revealed no significant effects in terms of the time to OSI resolution (p = 0.16) or recurrence (p = 0.22) for the short-duration and long-duration antibiotic groups. A slightly lower complication rate, including the incidence of abdominal distention (p = 0.093) and antibiotic-associated diarrhea (p = 0.024), was noted in patients with short-duration antibiotic administration. Furthermore, no significant difference in readmission requirements (p = 0.14) or hospitalization duration (p = 0.102) was found between the two groups. For OSI following complicated appendicitis, long-term antibiotic administration did not provide a significant benefit.

Short- and intermediate-term evaluation of the initial definitive operation for perforated choledochal cysts compared to two-stage management.

BACKGROUND: Recently, single definitive hepaticojejunostomy has been proposed to replace two-stage procedures, including initial urgent biliary drainage and final biliary reconstruction, with a reduced hospitalization time and corresponding overall hospitalization cost. We aimed to investigate the safety and efficacy of the initial definitive operation compared with the two-stage approach. METHODS: The medical records of patients with perforated CDCs managed between 2010 and 2017 were retrospectively reviewed. The qualified samples were divided according to a single definitive operation or two-stage approach. We conducted a comparison of the clinical characteristics, including surgical parameters, length of stay, and short- and intermediate-term complications. RESULTS: A total of 117 patients with perforated CDCs were reviewed, with 48 cases of single-stage management and 69 cases of two-stage management. No differences in the baseline characteristics between the two groups were found, such as age, sex distribution, ultrasound presentation, or laboratory findings. The initial definitive operation was associated with a lower total duration of drainage, including abdominal drainage and biliary drainage (p < 0.001), and rate of unplanned readmission (OR, 0.056; 95% CI 0.007-0.435; p < 0.001) than those who underwent two-stage management. Furthermore, the initial definitive operation significantly reduced the postoperative hospital stay (p < 0.001), and the overall hospitalization cost was accordingly reduced compared with two-stage management (p < 0.001). CONCLUSIONS: The initial single definitive operation was safe and effective for most of the patients with perforated CDCs when expertise was available. Therefore, a single definitive operation should be considered the treatment of choice for perforated CDCs.

A promising new predictive factor for detecting bowel resection in childhood intussusception: the lymphocyte-C-reactive protein ratio.

BACKGROUND: The most critical concern for the management of childhood intussusception is bowel resection due to intestinal ischemia and necrosis. The early prediction of this problem is of great importance. We investigated the value of various combinations of inflammatory factors to predict intestinal necrosis and resection. METHODS: We retrospectively reviewed the medical records of pediatric patients with intussusception who underwent surgical management. During the research period, 47 patients who underwent intestinal resection due to intestinal necrosis and 68 patients who did not undergo intestinal resection were enrolled. We evaluated the diagnostic value of various combinations of inflammatory markers from preoperative laboratory analyses using the receiver operating characteristic (ROC) method. RESULTS: In the current cohort, 115 patients underwent operations for intussusception; among them, 47 patients (40.9%) underwent intestinal resections. In the patients with intestinal resection, the neutrophil count(p = 0.013), CRP level(p = 0.002), platelet-lymphocyte ratio (PLR, p = 0.008), NLR (neutrophil-lymphocyte ratio, p = 0.026), and LCR (lymphocyte-CRP ratio, p < 0.001) values were significantly higher than those in the patients without any resection. The receiver operating characteristic (ROC) analysis results showed that the combination of lymphocytic count along with C-reactive protein levels (LCR) demonstrated the highest correlation with intestinal resection due to intussusception compared with other parameters in the patients, with a sensitivity of 0.82 (0.73-0.86) and specificity of 0.80 (0.57-0.94) for the diagnosis of strangulation. CONCLUSION: The preoperative LCR level is a useful marker to predict the need for intestinal resection due to intestinal necrosis in patients with intussusception.

Risk factors and impact on bile leakage in patients with choledochal cysts: a retrospective case-control analysis.

Although bile leakage is a major postoperative complication after hepatobiliary surgery, the associated risk factors for pediatric patients remain poorly defined. Here, we intend to identify the perioperative risk factors for bile leakage in pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy. A multicenter case-control study investigating the risk factors for bile leakage was conducted among 1179 eligible pediatric patients with choledochal cysts following Roux-en-Y hepaticojejunostomy between January 2009 and December 2019. There were 267 cases with bile leakage, and approximately four control patients were identified for each case. Multivariable logistic regression was performed to identify the risk factors, including perioperative variables. According to univariable analysis, bile leakage was associated with severe cholangitis (p = 0.012), low albumin levels (p = 0.010), anemia (p = 0.002) and laparoscopic surgery (p = 0.004). Multivariable analysis showed that a low level of preoperative albumin (ALB) (odds ratio [OR] = 1.11; 95% CI 1.02-1.19; p = 0.016), worse symptoms (severe cholangitis) (OR = 1.16; 95% CI 1.01-1.26; p < 0.001), and a previous hepatobiliary procedure (OR = 1.32; 95% CI 1.09-1.63; p = 0.036) were independent factors that were associated with bile leakage. This study identified potential risk factors for bile leakage in patients following Roux-en-Y hepaticojejunostomy that should be targeted for interventions to reduce the occurrence of the condition.

Strict Surgical Repair for Bile Leakage Following the Roux-en-Y Hepaticojejunostomy.

Background: The optimal bile leakage management strategy in the pediatric population following the initial Roux-en-Y hepaticojejunostomy is still a matter of discussion today. Here, we assessed the roles of bile leakage management and surgical implementation on outcomes for patients with bile leakage. Materials and Methods: A revised protocol for bile leakage management with restricted surgical intervention was implemented at Chongqing Children's Hospital on March 15, 2013 and Sanxia Hospital on April 20, 2013. We performed a retrospective, historical control analysis for the protocol implementation to compare the short- and long-term outcomes using the corresponding statistical methods. Results: There was a total of 84 patients included in the analysis, including 46 patients in the pre-protocol group and 38 patients in the post-protocol group. No statistical differences for the demographic features were found between the two groups. There was a decrease in redo surgeries in the post-protocol cohort compared to those in the pre-protocol cohort (odds ratio [OR] = 4.48 [95% CI, 1.57-12.77]; p = 0.003). Furthermore, patients in the post-protocol group were less likely to be associated with intensive care unit (ICU) admission (OR = 3.72 [95% CI, 1.11-12.49]; p = 0.024) compared to patients in the pre-protocol group, respectively. There was no mortality between the two groups. Conclusions: A restrictive surgical intervention strategy can effectively reduce the rate of redo surgery and exhibited promising outcomes for bile leakage in terms of postoperative recovery and hospitalization costs.

Structure and magnetic properties of a novel heteroheptanuclear metal string complex [Ni3Ru2Ni2(µ7-teptra)4(NCS)2](PF6).

We report the synthesis of a novel heteroheptanuclear metal string complex (HMSC) [Ni3Ru2Ni2(µ7-teptra)4(NCS)2](PF6) 1 supported by tetra-pyridyl-tri-amine (H3teptra) ligands. We employed X-ray diffraction and other spectroscopic techniques to characterize the complex. The observed remarkably short Ru-Ru distance of 2.2499(3) Å for 1 is indicative of a unique metal-metal interaction in the mixed-valence [Ru2]5+ (S = 3/2) unit. The complex exhibits a relatively high magnetic moment value of 4.55 B.M. at 4 K, which increases rapidly to 6.00 B.M. at 30 K and remains at 6.11 B.M. from 50 to 300 K as shown by SQUID measurements, indicating a high spin (S≥ 3/2) system which is further supported by the analyses of EPR spectra at low temperatures. These magnetic behaviors can be ascribed to the result of spin-exchange interactions among multi-spin centers.

Distributional variations in trabecular architecture of the mandibular bone: an in vivo micro-CT analysis in rats.

PURPOSE: To evaluate the effect of trabecular thickness and trabecular separation on modulating the trabecular architecture of the mandibular bone in ovariectomized rats. MATERIALS AND METHODS: Fourteen 12-week-old adult female Wistar rats were divided into an ovariectomy group (OVX) and a sham-ovariectomy group (sham). Five months after the surgery, the mandibles from 14 rats (seven OVX and seven sham) were analyzed by micro-CT. Images of inter-radicular alveolar bone of the mandibular first molars underwent three-dimensional reconstruction and were analyzed. RESULTS: Compared to the sham group, trabecular thickness in OVX alveolar bone decreased by 27% (P = 0.012), but trabecular separation in OVX alveolar bone increased by 59% (P = 0.005). A thickness and separation map showed that trabeculae of less than 100 µm increased by 46%, whereas trabeculae of more than 200 µm decreased by more than 40% in the OVX group compared to those in the sham group. Furthermore, the OVX separation of those trabecular of more than 200 µm was 65% higher compared to the sham group. Bone mineral density (P = 0.028) and bone volume fraction (p = 0.001) were also significantly decreased in the OVX group compared to the sham group. CONCLUSIONS: Ovariectomy-induced bone loss in mandibular bone may be related to the distributional variations in trabecular thickness and separation which profoundly impact the modulation of the trabecular architecture.

[Expression and immunological activity of an anti-CD3×VEGFR2 bispecific single-chain antibody].

AIM: To construct and express an anti-VEGFR2/anti-CD3 bispecific single-chain antibody (bscVEGFR2×CD3)and to identify its binding specificities to CD3 and VEGFR2. METHODS: The gene encoding anti-VEGFR2/anti-CD3 bispecific single-chain antibody was designed and synthesized. Bispecific single-chain antibody (bsc-Ab) DNA was subcloned into a eukaryotic expression vector pcDNA3.1(+), then transfected into Chinese hamster ovary (CHO) cells and stable expression cell lines were selected. Expressed Bsc-Ab was purified by His-tag affinity chromatography and confirmed by 120 g/L SDS-PAGE and Western blotting. Antigen binding activity of the bsc-Ab was analyzed by FACS. RESULTS: The plasmid DNA containing bispecific single-chain fragments were confirmed. BscVEGFR2×CD3 was secreted by CHO into the supernatant. Six stable expression cell lines were established. The molecular weight of bsc-Ab was correct indicated by SDS-PAGE and Western blotting. The bsc-Ab could specifically bind to CD3(+); jurkat cells and VEGFR2(+); A375 cells. CONCLUSION: An anti-VEGFR2/anti-CD3 bispecific single-chain antibody is successfully constructed and expressed, and the antibody has specific binding capacity to CD3 and VEGFR2.