Objective:To study the value of ultrasound-guided endoscopic retrograde appendicitis therapy in children with uncomplicated appendicitis.Methods:This study was a single center, retrospective study, including all electronic cases of appendicitis diagnosed clinically in Department of Pediatrics, the Second Affiliated Hospital of Air Force Military Medical University from October 2018 to October 2020 and received ultrasound-guided endoscopic retrograde appendicitis therapy.The clinical features, treatment and prognosis of the children were retrospectively analyzed.Results:A total of 152 electronic cases were included, there were 77 males and 75 females, aged(6.84±3.09) years.All the 152 children were treated with ultrasound-guided endoscopic retrograde appendicitis therapy.Intubation success rate and clinical success rate was 98.03%(149/152 cases)and 97.99%(146/149 cases), respectively.The median time of endoscopic therapy was 42.50 (31.00, 56.00) minutes.Mean postoperative hospital stay was (2.81 ±1.41) days, and the mean total hospital stay was (4.19 ±1.71) days.A total of 139 patients were followed up with a median follow-up time of 5 (1, 26) months.During the follow-up, the recurrence rate was 7.19%(10/139 cases), and the median time of recurrence was 2 (1, 3) months.Conclusions:Ultrasound-guided endoscopic retrograde appendicitis therapy had high effective rate and low recurrence rate in children with uncomplicated appendicitis, preserved the physiological function of appendix and avoided radiation damage.It can be used as a safe and effective treatment for acute and chronic uncomplicated appendicitis in children.

Objective To investigate the effect of antibiotic-induced microbiota dysbiosis on colonic barrier and immune response in juvenile mice.Methods Twenty Balb/c mice were randomly divided into experimental group and control group.Broad spectrum antibiotic mixture were administered by means of gavage to the experimental group every 12 hours for 14 days to induce intestinal microbiota dysbiosis.The mice of control group were given an equal amount of physiological saline.On the 15th day,all mice were intraperitoneally injected with lipopolysaccharide(LPS) to induce intestinal inflammatory reaction.The structure of intestinal flora was analyzed by way of 16SrRNA sequencing,and the morphology of colonic mucosa was observed by means of HE staining.The infiltration of colonic mucosa was observed through toluidine blue staining and immunohistochemistry.The levels of inflammatory cytokines in colon tissue were measured by real-time PCR and intestinal permeability-related parameters were measured by enzyme-linked immunosorbent assay.Results The intestinal microbial composition of the experimental group was significantly changed,and the expression levels of inflammatory cytokines interleukin (IL)-1β,IL-6,IL-8,IL-10,tumor necrosis factor (TNF)-α mRNA in the antibiotic group (0.765 ± 0.062,0.082 ± 0.040,0.442 ± 0.059,0.469 ±0.079,0.736 ± 0.063) were all lower than those in the control group (1.738 ± 0.243,1.090 ± 0.104,1.151 ±0.136,1.066 ± 0.102,1.539 ± 0.218),and the differences were statistically significant (all P ＜ 0.05).The expressions of intestinal barrier related gene of mice ZO-1 and Occludin decreased (0.639 ± 0.071 vs.1.347 ± 0.224,0.770 ±0.067 vs.1.487 ± 0.148) but the level of fecal albumin increased [(6.419 ± 0.552) mg/L vs.(6.079 ± 0.011) mg/L] after antibiotic exposure,and the differences were statistically significant (all P ＜ 0.05).Conclusions Antibiotic exposure leads to changes of enteric microbiota,which adversely affects local mucosal immunity and intestinal barrier function of colon in juvenile mice.

To investigate the efficacy and safety of modified endoscopic retrograde appendicitis therapy (ERAT) in children with acute uncomplicated appendicitis complicated with intussusception. Data of 6 patients with acute uncomplicated appendicitis complicated with intussusception who received modified ERAT were collected from October 2018 to February 2020 in Pediatrics Department of Tangdu Hospital. The reduction rate of intussusception, the success rate of ERAT appendiceal intubation and endoscopic treatment, the remission time of clinical symptoms, the time of white blood cells return to normal, the length of hospital stay, complications and recurrence were summarized. All the 6 patients were confirmed to be acute uncomplicated appendicitis combined with ileocecal intussusceptions under colonoscopy. Endoscopic intussusception reduction and ERAT were performed successfully. The mean time of disappearance of abdominal tenderness was 1.3 days after the therapy, and the time of white blood cells return to normal was 1 day after surgery. The endoscopic treatment were all successful and the length of hospital stay was 3-6 days. No complications or recurrence of intussusception and appendicitis occurred during the follow-up period of 6-12 months. Modified ERAT can effectively, safely and minimally invitingly treat acute uncomplicated appendicitis with intussusception in children on the basis of definite diagnosis.

Objective:To investigate the epidemiology, characteristics and risk factors of functional constipation (FC) in children aged 0-4 years in Xi′an.Methods:From October, 2020 to June, 2021, a prevalence survey was conducted among 2 615 children aged 0-4 years in Xi′an by group sampling. The related factors of FC were investigated by questionnaire designed based on Rome Ⅳ diagnostic criteria.The children were divided into FC group and non-FC group. The prevalence, symptoms and signs of FC were analyzed, and its risk factors were analyzed by multivariate Logistic regression.Results:A total of 2 985 valid questionnaires were handed out, and 2 711 (90.8%) were received back. A total of 2 615 questionnaires were valid, with an effective rate of 96.5%. There were 1 338 males (51.2%) and 1 277 females (48.8%). There were 260 cases in FC group and 2 355 cases in non-FC group. The prevalence of FC in children aged 0-4 years in Xi ′an was 10.6%.There were significant differences in FC prevalence among children of different ages and sex (χ 2=14.58,4.39, both P<0.05), but not in urban or rural residence (χ 2=3.29, P=0.070). The main symptoms of FC group in the last month were large-diameter feces (73.5%, 191/260), painful defecation or dry and hard defecation (65.8%, 171/260). In the last month, FC group had higher incidences of the Bristol type 1, 2 and 3 stool, fecal retention, prolonged defecation, abdominal pain and incomplete defecation compared with non-FC group, with statistical significance (all P<0.05). Parental history of childhood constipation ( OR=2.13, 95% CI 1.55-2.92), fever in the last month ( OR=1.86, 95% CI 1.32-2.63), history of constipation ( OR=3.24, 95% CI 2.46-4.26) and taking probiotics in the last month ( OR=1.45, 95% CI 1.11-1.91) were risk factors of FC in children aged 0-4 years. Stratified with age, the results showed that complementary feeding earlier than 5 months of age or later than 6 months of age ( OR=2.42, 95% CI 1.13-5.20), dry stools during the complementary feeding ( OR=11.27, 95% CI 5.15-24.66), history of constipation ( OR=2.29, 95% CI 1.23-4.29) and taking probiotics in the last month ( OR=1.88, 95% CI 1.10-3.23) were risk factors of FC in children aged 0-<1 year, and breastfeeding ( OR=0.53, 95% CI 0.29-0.94) was a protective factor of FC in children aged 0-<1 year. Family members′ recent constipation history ( OR=2.02, 95% CI 1.06-3.85) and past history of constipation ( OR=3.06, 95% CI 1.74-5.38) were FC risk factors for children aged 1-<2 years. Parental history of childhood constipation ( OR=3.12, 95% CI 2.00-4.85), frequency of eating vegetables less than 3 times per week ( OR=3.28, 95% CI 2.00-5.38), history of constipation ( OR=3.66, 95% CI 2.42-5.53) and taking antibiotics in the last month ( OR=1.65, 95% CI 1.06-2.55) were risk factors for FC in children aged 2-4 years. Conclusions:FC in children aged 0-4 years in Xi′an is mainly manifested with large-diameter feces and painful defecation or dry and hard defecation in the last month. It is associated with a variety of risk factors, which are different in different age groups.