Objective To observe the therapeutic effects of Reduning combined with montmorillonite powder for infantile viral enteritis. Methods A total of 136 patients with infantile viral enteritis in Shanxi Tongchuan Mining Bureau Central Hospital pediatric clinic from August 2010 to October 2013 were selected and divided into two group by random number table method, a Reduning group (65 cases) and a combined treatment group (71 cases). The Reduning group was treated with Reduning injection and the combined treatment group was treated with Reduning injection plus oral montmorillonite powder. The total efficiency, improvement of symptoms and staying hospital time were compared between the two groups. Results The total effective rate in the combined treatment group was significantly higher than that in the Reduning group (97.1% vs. 59.9%, χ2=28.696, P<0.05). The fever clearance time (2.96 ± 1.32 d vs. 3.84 ± 1.94 d; t=2.587, P=0.011), the time to stop diarrhea (3.12 ± 1.44 d vs. 3.95 ± 1.97 d;t=2.340, P=0.022) and staying hospital time (4.60 ± 1.62 d vs. 5.86 ± 2.35 d;t=3.044, P=0.003) in the combined treatment group were all shorter than those in the Reduning group. Conclusions Reduning combined with montmorillonite powder is more effective in the treatment of infantile viral enteritis than Reduning alone, which shortens the course and staying hospital time.

Objective:To explore the therapeutic effect and safety of oral ibuprofen (INN)on patent ductus arterio-sus (PDA)in neonates.Methods:A total of 160 neonates,who hospitalized in our hospital and were diagnosed as PDA by color echocardiography from Feb 2011 to Dec 2013,were enrolled.According to number table method, they were randomly and equally divided into high dose group (received INN 10mg/kg on the first day,then 5mg/kg on the second and third day)and low dose group (received INN 5mg/kg for 3d).PDA closure was observed,com-pared and analyzed between two groups after INN therapy.Results:After INN therapy,PDA closed in 57 cases (71.3%)in high dose group,it was significantly higher than that of low dose group (48.8%,39/80),P <0.01;there were no significant difference in incidence rates of adverse reactions between two groups (P >0.05 all).Con-clusion:High-dose ibuprofen possesses better therapeutic effect on patent ductus arteriosus in neonates;its adverse reactions are few;which can avoid postoperative pain in partial children.

Objective To study the clinical and imaging features of chlamydial pneumonia in newborns.Methods Medical records,chest X-Ray and CT findings of 17 neonates with chlamydia pneumonia were reviewed.The age was ranged from 9.0 to 28.0 days with mean of ( 16.8 ± 5.8 ) days.There were 11males and 6 females.Sixteen were full term infants and one was born post term.All babies were examined with chest X-ray film,and 13 patients also underwent chest CT scan.Serologic test using immunofluorescence method for Chlamydia IgG and IgM antibodies were performed in all patients.Results All newborns presented with cough but without fever.Positive results of the serologic tests were demonstrated.Chest films showed bilateral hyperventilation in 10 patients,diffuse reticular nodules in 10 patients including nodules mimicking military tuberculosis in 7 patients,and accompanying consolidation in 9 patients.CT features included interstitial reticular nodules in 13 patients with size,density,and distribution varied.Subpleurul nodules ( 11patients) and fusion of nodules ( 10 patients ) predominated.Bilateral hyperinflation was found in 10 patients,which combined with infiltration in 12 patients,thickening of bronchovascular bundles in 10 patients,and ground glass sign in 5 patients.No pleural effusion and lymphadenopathy was detected in any patient.Conclusions Bilateral hyperinflation and diffuse interstitial reticular nodules were the most common imaging features of neonatal chlamydial pneumonia.The main clinical characteristic of neonatal chlamydial pneumonia is respiratory symptoms without fever,which is helpful to its diagnosis.

Yttrium vanadate:europium nanoprobes (YVO4∶Eu NPs) with good fluorescence properties and water solubility were synthesized by solvent thermal method.Due to the overlapping of the excitation spectrum of YVO4∶Eu NPs and the absorption spectrum of tryptophan, fluorescent internal filter effect (IFE) occurred, in which YVO4∶Eu NPs were the fluorophore and tryptophan was the absorber, leading the fluorescence of YVO4∶Eu NPs was quenched.Therefore, a new method for the determination of tryptophan was established by using fluorescent YVO4∶Eu as nanoprobes based on IFE.Some experimental parameters, such as the adding amount of YVO4∶Eu NPs, pH value of the reacting solution, and reacting time, were investigated.Under the optimum reaction conditions, the linear range of the method was 4.0×10-6-4.0×104 mol/L and the detection limit was 1.0×10-6 mol/L (3σ).The content of tryptophan in the soy sauce was determined with the recovery of 95.2% and 97.3%.This method is simple, rapid, sensitive and accurate.

BACKGROUND: Recently, the survival rate of premature infants increases year by year, but the cerebral growth of premature infants is immature, so the intellectual development of premature infants is slower than that of normal infants.OBJECTIVE: To explore the effect of family-oriented early intervention,which took material nutrition, information stimulation and petting as main interventional content, on level of intellectual development in premature infants in infantile age.DESIGN: Randomized sampling controlled observation.SETTING: Department of Pediatrics, Clinical Medical College of ShanPARTICIPANTS: Totally 35 premature infants of 31-36 weeks (18 males and 17 females) were enrolled as early interventional subjects, who were born at Jinan Municipal Central Hospital between May 2000 and July 2002. Meanwhile, 33 premature infants of 31-36 weeks (18 males and 15females) born in the same period and 49 mature neonates (26 males and 23females) were enrolled in control group.METHODS: The family-oriented early intervention, which considered nutrition, information stimulation and petting as chief interventional content,were performed in premature infants, and health archives was established.Taction and point massage were conducted. Home visit was done twice in one month. One routine health examination was determined at 3, 6 and 10months in the two control groups. The level of intellectual development was assessed in infants of 10-month old of each group with Gesell Developmental Schedules (GDS) and Japanese S-M Social Living Ability Scale.MAIN OUTCOME MEASURES: Evaluation of level of intellectual development in infants of each group.RESULTS: In the premature interventional group, 1 premature infant died, 2 withdrew from the study, and 32 eligible cases with the eligible rate of 91.4%; Among the 33 premature infants in the premature control group, there were 3 withdrawing from the study, and 30 eligible cases with the eligible rate of 90.9%. Among the 49 infants in the term infant control group, there were 3 withdrawing from the study and 46 eligible cases with the eligible rate of 93.9%. ①Developmental quotient (DQ) at each area of Gesell and evaluation of Japanese S-M Social Living Ability Scale were significantly higher in the premature interventional group than those in the premature control group at 10 months old. There were extremely significant differences in suitability, fine activity, language and individual social behavior. ②DQ at each area of Gesell and evaluation result of Japanese S-M Social Living Ability Scale were lower in the premature interventional group than those in the term infant control group at 10 months old, which had obvious difference. ③Evaluation in premature infants aged oyer 35 weeks of the interventional group was lower than that in the term infant control group, but there was insignificant difference (P ＞ 0.05).CONCLUSION: Early intervention has a marked effect in improving the intellectual developme nt of premature infants, and some premature infants can recover to the level of term infants in intelligence development after intervention.

Objective:To investigate the role of blood ammonia in the evaluation of the prognosis of septic patients in the emergency department and to compare its value with mortality in emergency department sepsis (MEDS) score.Methods:A retrospective clinical study was conducted to septic patients who were diagnosed in the Emergency Department of West China Hospital of Sichuan University from June 2017 to May 2018, and met the diagnostic criteria established by the diagnostic criteria of the American College of Chest Physicians/Society of Critical Care Medicine in 2001. The subjects who had other diseases that affected blood ammonia level and were lost to follow-up were excluded. MEDS scores were collected, and the survival status of patients was followed up by telephone. The independent samples t test was used to compare the differences between the two groups, receiver operating characteristic (ROC) curve was used to assess the accuracy of the prediction of sepsis mortality, and the logistic regression model was used to explore the value of the combined use of blood ammonia and MEDS score.Results:Eighty subjects were finally included in the study and divided into the 1-week survival group ( n=52), 1-week death group ( n=28); 4-week survival group ( n=37), 4-week death group ( n=43); 12-week survival group ( n=33), 12-week death group ( n=47); 1-year survival group ( n=32), and 1-year death group ( n=48). There was no statistical difference in the demographic characteristics of subjects between the groups. The average blood ammonia level of all the subjects who died was higher than that of the patients who survived in the same period [(116.57 ± 85.33) μmol/L vs (77.63 ± 35.82) μmol/L, (108.53 ± 73.00) μmol/L vs (71.19 ± 32.53) μmol/L, (106.74 ± 71.59) μmol/L vs (69.21 ± 28.84) μmol/L, (105.77 ± 71.14) μmol/L vs (69.50 ± 29.25) μmol/L, P<0.05]. Based on death after one week, four weeks, twelve weeks and one year, the area under ROC curve (AUC) of blood ammonia was 0.668 (95% CI: 0.542-0.793, P=0.014), 0.706 (95% CI: 0.593-0.819, P=0.002), 0.705 (95% CI: 0.592-0.818, P=0.002), and 0.697 (95% CI: 0.582-0.811, P=0.003), respectively. Compared with the use of blood ammonia, lactic acid or MEDS score alone, the combined use of blood ammonia and MEDS score increased the accuracy of prognosis evaluation in sepstic patients ( P<0.05). Conclusions:Blood ammonia has a high value in predicting the short-term and 1-year prognosis of septic patients in the emergency department. The combined use of blood ammonia and MEDS score can further improve its predictive value.

Objective:To investigate the morphological characteristics and operative methods of mixed total anomalous pulmonary venous connection (TAPVC), and to analyze the risk factors of postoperative death.Methods:From January 2011 to January 2019, 17 cases of mixed TAPVC were operated in Department of Cardiovascular Surgery, Beijing Children′s Hospital, Capital Medical University, with 10 males and 7 females.The average age was (4.4±3.8) months (1-15 months) and the average body mass was (5.6±1.7) kg (3.5-10.0 kg), including 1 case of ventricular septal defect, 17 cases of atrial septal defect and 15 cases of ductus arteriosus.Preoperative pulmonary vein stenosis was discovered in 4 cases and severe pulmonary hypertension was in 10 cases.A total of 5 cases needed ventilator support before operation, and 2 cases needed emergency operation.The diagnosis was confirmed by color Doppler ultrasound and CT before operation.There were 2 cases of type Ⅰ (type 2+ 2), 13 cases of type Ⅱ (type 3+ 1), and 2 cases of type Ⅲ (anatomic variant).Results:All the patients were treated through operation.The principle of operation was to correct all pulmonary veins to the left atrium.The cardiopulmonary bypass time was (182.3±122.8) min, the aortic occlusion time was (84.3±15.9) min, the postoperative ventilator support time was (92.9±70.0) h, and the monitoring room time was (6.9±4.9) d. In this group, 3 cases died in hospital (17.6%) and 1 case died out of hospital (5.9%).Conclusions:The mortality of mixed TAPVC type Ⅲ was high, while preoperative pulmonary vein stenosis, severe pulmonary hypertension and the combination of sub-cardiac type were the important risk factors of death.The operation mode depends on the anatomic drainage mode, so individualized operation is recommended.

Objective:To investigate the diagnosis, surgical methods, perioperative treatment and surgical results of Kommerell's diverticulum with double aortic arch in infants.Methods:From December 2014 to December 2019, 22 cases of double aortic arch combined with Kommerell diverticulum were operated in our hospital, 14 males and 8 females, with an average age of (13.7±11.6) months (1-36 months) and mean body mass of (9.8±3.4)kg (5-20 kg). The children had respiratory symptoms such as asthmatic suffocation, shortness of breath, repeated respiratory tract infection and chronic cough before operation. All patients underwent cardiac CT examination. The average diverticulum was 8 mm×9 mm, in the trachea The average compression degree of the lower segment was 56%±16% (30%-80%). The distal part of the left arch was atresia and Kommerell's diverticulum was found in all patients. The operation methods were left aortic arch separation, ligament separation and diverticulectomy. In one case, tracheal stent was placed simultaneously during the operation because of severe tracheal malacia.Results:The average time in the ward was(1.4±0.8)days (1-4)days, and the average time in hospital was (6.7±2.8)days (4-13 days). The average follow-up period was (25.5±16.9) months (2-60 months). During the follow-up period, 18 children had no persistent respiratory symptoms, and 4 children had only slight respiratory symptoms.Conclusion:Kommerell's diverticulum can also be combined with double aortic arch. The operation method is to separate the aortic arch and ligament at the atresia end and resect the diverticulum at the same time. It has a good early prognosis and may eliminate the residual symptoms and late complications.

Objective: To investigate the clinical efficacy of laparoscopic subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) in the treatment of senile slow transit constipation. Methods: A retrospective cohort study was performed. Clinical data of 30 colonic slow transit constipation patients aged ≥70 years old undergoing laparoscopic SCBCAC from July 2012 to October 2016 (bypass plus colostomy group), and 28 patients undergoing laparoscopic subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) from February 2009 to June 2012 (bypass group) at our institute were collected. Efficacy was compared between the two procedures. Inclusion criteria: (1) meeting the Rome III diagnosis criteria for constipation; (2) confirmed diagnosis of slow transit constipation; (3) age ≥ 70 years old; (4) receiving non-surgical treatment for more than 5 years, and Wexner constipation score > 15; (5) follow-up for more than 2 years. Those with psychiatric symptoms or previous psychiatric history, obvious signs of outlet obstructive constipation, organic diseases of the colon and life-threatening cardiovascular diseases or cancer were excluded. In the bypass plus colostomy group, laparoscopy was performed via five trocars. The ileocecal junction and the ascending colon were mobilized and the ileocecal junction was pulled down to the pelvic inlet. The ascending colon was transected and the appendix was excised. The lateral peritoneum of the sigmoid colon and the rectal mesentery were dissected and the upper rectum was transected. The avil of a circular stapler was placed in the bottom of the cecum. The shaft of the stapler was placed in the rectum via the anal canal to complete end-to-side anastomosis (end rectum to lateral cecum). The end of the rectal-sigmoid colon was used for colostomy via an extraperitoneal approach to complete the operation. The following efficacy indexes were collected before surgery and 3, 6, 12, and 24 months after surgery: the number of daily bowel movements, the Wexner incontinence scale (WIS, 0-20, the lower the better), the Wexner constipation scale (WCS, 0-30, the lower the better), the gastrointestinal quality of life index (GIQLI, 0-144, the higher score, the better), abdominal pain intensity indicated by the numerical rating scale (NRS, 0-10, the lower score, the better), and the abdominal bloating score (ABS, 0-4, the lower score, the better). The complications defined as Clavien-Dindo class II or above were observed and recorded. Results: No significant differences in preoperative WCS, WIS, GIQLI, NRS, and ABS were observed between bypass plus colostomy group and bypass group (all P>0.05). All the patients successfully underwent laparoscopic surgery and no patient in either group experienced postoperative fecal incontinence. WCS and GIQLI were significantly improved (all P<0.001) at 3, 6, 12, and 24 months after surgery in both groups. At 12 months after surgery, the number of bowel movements was significantly less in bypass plus colostomy group than that in bypass group [(2.4±0.7) times vs. (3.4±1.2) times, t=4.048, P<0.001]. At 3, 6, 12 and 24 months after surgery, the improvement of GIQLI in bypass plus colostomy group was significantly better than that in bypass group (all P<0.001). At 24 months after surgery, GIQLI in bypass plus colostomy group and bypass group was 122.3±5.3 and 92.8±16.6, respectively, with a significant difference (t=9.276, P<0.001). At 12 and 24 months after surgery, NRS in bypass plus colostomy group was significantly better than that in bypass group (both P<0.001). At 24 months after surgery, NRS in bypass plus colostomy group was 0.9±0.7, while that in bypass group was 3.7±2.7. There was a significant difference between two groups (t=5.585, P<0.001). At 6, 12 and 24 months after surgery, the improvement of ABS in bypass plus colostomy group was also significantly better than that in bypass group. At 24 months after surgery, ABS in bypass plus colostomy group was 0.6±0.6, while that in bypass group was 2.5±1.0, with a significant difference between two groups (t=8.797, P<0.001). At 1 year after surgery, barium enema examination was performed in all the patients of both groups. The barium emptying time was (21.2±3.8) hours and (95.8±86.2) hours in bypass plus colostomy group and bypass group respectively. The former group was significantly better than the latter group (t=4.740, P<0.001). Conclusions Laparoscopic SCBCAC is an effective and safe procedure for the treatment of senile slow transit constipation and can significantly improve prognosis. Its clinical efficacy is better than laparoscopic SCBAC.

OBJECTIVETo investigate the influence of length of preserved ileocecum on the efficacy of laparoscopic subtotal colectomy antiperistaltic cecorectal anastomosis (LSCACRA) in treating slow transit constipation (STC).

METHODSClinical data of 81 STC patients who received LSCACRA between April 2007 And December 2011 in the 150th Center Hospital of PLA were continuously collected. Patients were divided into two groups: 10 cm to 15 cm ascending colon preserved above ileocecal junction(10-15 cm group, n=41), and 2 cm to 3 cm ascending colon preserved above ileocecal junction (2-3 cm group, n=40). The Wexner constipation scale (WCS), Wexner incontinence scale(WIS), gastrointestinal quality of life index(GIQLI), abdominal pain intensity scale(NRS), abdominal pain frequency scale and abdominal bloating frequency scale in the two groups were determined and compared before and 6, 12, 24 months after operation.

RESULTSNo postoperative incontinence was found in all the patients. There were no significant differences in evacuation frequency between two groups at 6th and 12th month after surgery (all P>0.05). Two years after operation, barium enema emptying time examination revealed 2-3 cm group was (17.7±9.5) h, which was remarkably shorter than (21.2±20.7) h in 10-15 cm group (P=0.011). The WCS, GIQLI, NRS and abdominal pain frequency scale of two groups were improved obviously at 6th, 12th and 24th month after surgery (all P<0.01). Above parameters in 2-3 cm group were superior to 10-15 cm group (all P<0.01), but abdominal bloating frequency scale was not significantly different between the two groups (P>0.05). As compared with before operation, NRS in 2-3 cm group 6, 12, 24 months after operation reduced remarkably (all P<0.01), but did not improve obviously in 10-15 cm group (P>0.05).

CONCLUSIONThe shorter length of ascending colon preserved above ileocecal junction can improve the efficacy of LSCACRA in the treatment of STC and the prognosis of patients. Two to three cm length of ascending colon preserved above the ileocecal junction should be recommended.

Abdominal Pain ; Anastomosis, Surgical ; Antidiarrheals ; Cecum ; Colectomy ; Constipation ; Enema ; Humans ; Ileum ; Laparoscopy ; Postoperative Period ; Prognosis ; Quality of Life ; Rectum ; Treatment Outcome