Objective:To summarize the clinical features of primary segmental volvulus (PSV) in neonates.Methods:A retrospective analysis was conducted on the clinical data of neonates with PSV who were admitted to the Department of Neonatal Surgery, Children's Hospital Affiliated to Capital Institute of Pediatrics from May 2014 to May 2023. The clinical manifestations, auxiliary examinations, treatment and prognosis of the neonates were summarized, and descriptive statistical analysis was performed on the collected data.Results:A total of 10 neonates with PSV were included, with a mean gestational age of (34.1±3.0) weeks and birth weight of (2 291±646) g. Eight cases had an onset age of 3 d or less, and 2 cases had an onset age of more than 3 d. Abdominal distension was observed as the main manifestation in all cases, while bilious vomiting occurred in seven cases and hematochezia in five cases. Imaging examinations mainly revealed low intestinal obstruction without specific manifestations. Laboratory tests showed metabolic acidosis and varing degrees of anaemia. Nine cases underwent diagnostic abdominal puncture, of which five had bloody ascites, two had clear ascites, one had bloody mixed with fecal-like ascites, and one had chylous ascites. All the cases underwent emergency exploratory laparotomy and segmental small bowel resections with either primary intestinal anastomosis or enterostomy. All cases were successfully cured and had been followed up to the age of 4 months to 9 years with good growth and development as normal children of the same age.Conclusions:Neonatal PSV is an independent abdominal emergency characterized by non-specific clinical manifestations and difficult preoperative diagnosis, but the overall prognosis is favorable after active surgical treatment.

Objective:To determine the pharmacodynamics of ciprofol for adjunctive sedation in elderly patients undergoing neuraxial anesthesia.Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification Ⅰ-Ⅲ patients of either sex, aged ≥65 yr, with a body mass index of 18-30 kg/m 2, scheduled for elective knee replacement under neuraxial anesthesia from June to September 2023 in the Second Hospital of Shanxi Medical University, were selected. After completion of neuraxial anesthesia, ciprofol was pumped intravenously at a loading dose of 0.05 mg/kg (administered for approximately 4 min). The maintenance dose was determined by the sequential method. The initial maintenance dose was 0.2 mg·kg -1·h -1, and the dose gradient was 0.02 mg·kg -1·h -1. If the patient was satisfactorily sedated, the dose of ciprofol was decreased by 0.02 mg·kg -1·h -1 in the next patient; if the sedation was unsatisfactory, the dose of ciprofol was increased by 0.02 mg·kg -1·h -1 in the next patient, and the trial was terminated after 8 transitions. The occurrence of adverse reactions was recorded during administration and emergence. The median effective dose (ED 50), 95% effective dose (ED 95) and the corresponding 95% confidence interval ( CI) of ciprofol were calculated using the probit regression analysis. Results:Thirty-five patients were finally included in this study.The ED 50 of ciprofol for adjunctive sedation was 0.246 mg·kg -1·h -1 (95% CI 0.217-0.300 mg·kg -1·h -1), and the ED 95 was 0.325 mg·kg -1·h -1 (95% CI 0.284-0.771 mg·kg -1·h -1) in elderly patients undergoing knee arthroplasty under neuraxial anesthesia. During the administration of ciprofol, bradycardia occurred in 4 cases (11%), hypotension in 2 cases (6%), and hypoxemia in 2 cases (6%), which improved after treatment. No injection pain, abnormal limb movements, agitation during emergence, dizziness, headache, nausea and vomiting and postoperative delirium developed in patients. Conclusions:The ED 50 of ciprofol for adjunctive sedation is 0.246 mg·kg -1·h -1 and the ED 95 is 0.325 mg·kg -1·h -1 in elderly patients undergoing neuraxial anesthesia.

Objective To explore the safety and feasibility of laparoscopic surgery for congenital annular pancreas in neonates.Methods From June 2015 to June 2023,a total of 61 neonates with congenital annular pancreas were treated with three-port laparoscopic surgery.Under the laparoscope,the proximal and distal segments of the duodenum around the annular pancreas were freed.The duodenum was then suspended,and a transverse incision was made in the dilated proximal duodenum while a longitudinal incision was made in the narrowed distal part.Continuous suturing of the anterior and posterior walls of the duodenum was performed with 5-0 PDS sutures.Results Three cases were converted to open surgery,while the remaining 58 cases were completed under laparoscope.The duration of surgery ranged 60-324 min,with an average of(163±57)min.The time to start oral feeding after surgery ranged 3-15 d,with an average of(6.8±2.9)d.The length of hospital stay varied 4-83 d,with a median of 17 d.One case experienced intestinal adhesive obstruction at 12 d after surgery,and underwent laparoscopic adhesion release.One case developed anastomotic leakage at 3 d after surgery and underwent laparoscopic repair.One case with prematurity and low birth weight developed severe infection,shock,and disseminated intravascular coagulation at 73 d after surgery,and died after the family decided to discontinue treatment.The remaining 60 cases were discharged after successful treatment.All the 60 patients were regularly followed up for 1-96 months,with a median of 37 months,having a good growth and development.Conclusions Laparoscopic surgery in the treatment of congenital annular pancreas in neonates is safe and feasible.Refined management is required during the perioperative period for premature and low birth weight infants.

Objective:To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia (CDH) and to share the experience.Methods:This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital, Capital Institute of Pediatrics from May 1, 2011, to March 31, 2022. Based on gestational age and birth weight, the infants were divided into the preterm and/or low birth weight group (gestational age < 37 weeks and/or birth weight less than 2 500 g, n=41) and the control group (gestational age ≥ 37 weeks and birth weight ≥ 2 500 g, n=76). Furthermore, the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup ( n=31) and the open surgery subgroup ( n=10) according to the surgical approach. Statistical analysis of the data was performed using two independent sample t-tests, rank sum tests, Chi-square test, or Fisher's exact probability test. Results:Preoperative data showed that the Apgar scores at 1 min [7.0 (6.0-8.0) vs 9.0 (8.0-9.8), Z=－4.03] and 5 min [9.0 (8.0-10.0) vs 9.0 (9.0-10.0), Z=－2.13] of the preterm and/or low birth weight infants were both lower than those in the control group (both P<0.05), while the proportion of infants with moderate to severe pulmonary hypertension was higher [68.3% (28/41) vs 38.2% (29/76), χ 2=9.68, P<0.05]. There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery, operation time, right diaphragmatic hernia, presence of hernia sac, grading of the defect, presence of liver herniation, and application of mesh (all P>0.05). Regarding the postoperative outcomes, the death rate in the preterm and/or low birth weiht group was higher compared to the control group [36.6% (15/41) vs 13.2% (10/76), χ 2=8.70, P<0.05]. Additionally, the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group [25 d (18-29 d) vs 16 d (10-25 d), Z=2.31, P<0.05]. The thoracoscopic subgroup had a lower mortality compared to the open surgery subgroup [25.8% (8/31) vs 7/10, P<0.05]. The thoracoscopic surgery subgroup had a higher Apgar score at 1 min after birth [(7.4±1.6) vs (6.0±2.2), t=2.20, P<0.05], later age at operation (hours after birth) [31.0 h (23.0-48.0 h) vs 17.0 h (4.7-24.5 h), Z=2.57, P<0.05], a lower proportion of infants operated within 24 hours after birth [32.3% (10/31) vs 8/10, P<0.05], and longer duration of operation [170.0 min (122.0-200.0 min) vs 110.0 min (87.3-120.0 min), Z=3.65, P<0.05]. Conclusions:In this study, a higher mortality in the preterm and/or low birth weight group compared to the control group was observed, which may be attributed to the higher proportion of neonates with moderate-severe pulmonary hypertension. The thoracoscopic diaphragmatic repair can be attempted for preterm and low birth weight infants who have relatively stable respiratory and circulatory functions.

Objective:To investigate the relationship between the CT images of a lateral condylar tibial plateau fractures and complete medial collateral ligament (MCL) injury.Methods:Data of 59 patients with lateral condylar fracture of tibial plateau complicated with MCL injury admitted to Tianjin Hospital from January 2020 to November 2021 were collected, including 32 males and 27 females, aged 42.4±12.3 years (range, 19-65 years), there were 26 cases of extension injury and 33 cases of flexion injury. The patients were separated into two groups: those with partial MCL injury and those with total rupture based on preoperative MR examination and intraoperative valgus stress test following fracture fixation. According to the ABC fracture classification of lateral condyle tibial plateau proposed by Sun et al., the fracture locations were determined on CT images, and the lateral plateau collapse depth (LPD) was measured. The relationship between LPD and MCL complete rupture was analyzed by receiver operating characteristic (ROC) curve.Results:Among 59 patients with lateral condylar tibial plateau fracture and MCL injury, 42 had partial injuries and 17 had complete ruptures. According to the ABC fracture classification, there were 26 cases of extension injury (involving area A), 21 cases of AB type, and 5 cases of ABC type; and 33 cases of flexion type injury, 19 cases of B type, 12 cases of BC type, and 2 cases of C type. All the 17 cases of MCL complete fracture occurred in extension injury, including type AB (14 cases) and type ABC (3 cases). The difference between the mean LPDs of the MCL full rupture group and the partial injury group was not statistically significant ( t=0.11, P=0.567), and the mean LPDs of both groups were 11.7±5.3 mm (range, 4.3-28.1 mm) and 11.5±4.8 mm (range, 3.8-23.6 mm), respectively. The area under the curve (AUC) of the ROC curve analysis was 0.504, and there was no statistical correlation between lateral platform collapse depth and MCL injury. Among the 26 patients with extensional injury area, MCL was completely ruptures in 17 cases and partially injury in 9 cases, LPD was 11.7±5.3 mm (range, 4.3-28.1 mm) and 6.6±1.8 mm (range, 3.8-9.4 mm), respectively, and the difference was statistically significant ( t=3.57, P=0.009). The best predictive cut-off value of LPD was 7.25 mm, the sensitivity was 88.2%, the specificity was 77.8%, and the AUC was 0.868. Conclusion:When the lateral condyle fracture of the tibial plateau is located in the extensional injury area (involving the A area in the ABC fracture classification) and the LPD measured on the CT image is greater than 7.25 mm, the complete rupture of the MCL should be considered. Clinical MCL repair is required after the fracture fixation surgery for improved surgical outcomes.

Circular RNAs (circRNAs) are endogenous non-coding RNAs with covalently closed structures, which have important functions in plants. However, their biogenesis, degradation, and function upon treatment with gibberellins (GAs) and auxins (1-naphthaleneacetic acid, NAA) remain unknown. Here, we systematically identified and characterized the expression patterns, evolutionary conservation, genomic features, and internal structures of circRNAs using RNase R-treated libraries from moso bamboo (Phyllostachys edulis) seedlings. Moreover, we investigated the biogenesis of circRNAs dependent on both cis- and trans-regulation. We explored the function of circRNAs, including their roles in regulating microRNA (miRNA)-related genes and modulating the alternative splicing of their linear counterparts. Importantly, we developed a customized degradome sequencing approach to detect miRNA-mediated cleavage of circRNAs. Finally, we presented a comprehensive view of the participation of circRNAs in the regulation of hormone metabolism upon treatment of bamboo seedlings with GA and NAA. Collectively, our study provides insights into the biogenesis, function, and miRNA-mediated degradation of circRNAs in moso bamboo.
RNA, Circular/metabolism* ; Multiomics ; Poaceae/metabolism* ; Seedlings/genetics* ; Hormones/metabolism* ; MicroRNAs/metabolism* ; Gene Expression Regulation, Plant

Objective:The aim of this study was to explore the associations of muscle size and density with handgrip strength(HGS)and the Timed Up and Go(TUG)test.Methods:Totally 301 participants living in the Xinjiekou community near Beijing Jishuitan Hospital were recruited for CT imaging of the hip and a 1-cm slice of the mid-thigh.The cross-sectional area and density of the gluteus maximus and the mid-thigh muscles were estimated by the Osirix viewer based on CT images.HGS and TUG were also performed in these subjects.Logistic regression analysis was used to evaluate the correlations of muscle density and size with TUG and grip strength.Results:In women, after adjustment for age and BMI, the density of the gluteus maximus was negatively correlated with TUG( P trend=0.0366), while the size of the gluteus maximus and the mid-thigh muscles was not correlated with TUG.In men, the density or size of these muscles was not correlated with TUG.After adjustment for age and BMI, the density of the gluteus maximus was positively correlated with grip strength( P trend=0.0334)and the size of the mid-thigh muscles was also positively correlated with grip strength( P trend=0.0155)in men, but they were not correlated with grip strength in women. Conclusions:There were sex differences in the relationship between muscle size or density and grip strength or timed up and go.The density of the gluteus maximus is associated with muscle strength and physical performance while the size of the mid-thigh muscles is correlated with muscle strength.

Objective:To analyze the risk factors of deep venous thrombosis (DVT) in patients with tibial plateau fracture during preoperative period.Methods:From July 2017 to October 2019, a total of 264 patients undergoing surgeries of tibial plateau fractures were enrolled. Duplex ultrasonography (DUS) during hospitalization was used to screen for DVT of the bilateral lower extremities. Patients were divided into DVT group and non-DVT group according to results of DUS. Data on demographics, comorbidities, injury-related data, fracture type, laboratory biomarkers were collected and compared between groups with and without DVT.Results:The incidence of preoperative DVT was 39.0% (103/264) among 264 patients with traumatic tibial plateau fractures, and distal thrombosis predominated in DVT group. There were 103 cases in DVT group. 55 were males and 48 were females. The average age was 54.00±11.12. According to the Schatzker classification of tibial plateau fractures, 7 cases belonged to type I, 37 to type II, 2 to type III, 11 to type IV, 29 to type V, and 17 to type VI. There were 161 cases in non-DVT group. 89 were males and 72 were females. The average age was 48.57±13.25. According to the Schatzker classification of tibial plateau fractures, 23 cases belonged to type I, 76 to type II, 2 to type III, 10 to type IV, 33 to type V, and 17 to type VI. Univariate analysis showed that age ( t=3.451, P=0.001), the type of tibial plateau fracture ( χ2=8.314, P=0.004), D-dimer ( χ2=18.552, P<0.001), APTT ( t=2.869, P=0.004), ALB ( t=2.292, P=0.023) and Hb ( t=1.983, P=0.048) were statistically different than those in non-DVT group. Multivariate analysis showed age ( OR=1.033, 95% CI: 1.009, 1.058; P=0.007), the type of tibial plateau fracture ( OR=1.829, 95% CI: 1.014, 3.299; P=0.045) and D-dimer ( OR=1.914, 95% CI: 1.057, 3.464; P=0.032) were independent risk factors. Conclusion:The incidence of DVT in patients with tibial plateau fractures during preoperative period is high, and distal thrombosis is the main part of venous thrombosis of lower extremity. The type of tibial plateau fracture, age and the level of D-dimer are independent risk factors of preoperative DVT in patients with tibial plateau fractures.

Objective: To investigate the clinical features of patients with hyperextension bicondylar tibial plateau fractures (HEBTPs), and assess surgical effectiveness of HEBTP and non-HEBTP fracture patients. Methods: From June 2014 to May 2017, 82 patients with bicondylar tibial plateau fracture were included in this study. There were 63 patients with 63 knees (76.8%) that had sustained non-HEBTPs, and 19 patients with 19 knees (23.2%) that had HEBTPs, including 49 males and 33 females with a mean age of 48.3 years (range, 22-76). Of the 19 HEBTPs patients, 4 cases were hyperextension valgus injury, 9 cases were hyperextension varus injury, and 6 cases were pure hyperextension injury. All patients were treated with open reduction internal fixation combined with bone grafting or non-bone grafting. All follow-up patients were evaluated clinically and radiographically, included the incidence of associated injuries, infection, posttraumatic osteoarthritis, range of motion (ROM) of knee, numeric rating scale (NRS) for assessment of pain, and Short Musculoskeletal Functional Assessment (SMFA) scores for assessment of knee function. The fracture healing and postoperative alignment were assessed with anteroposterior and lateral X-rays. Results: All patients were followed up for 12-22 months, the mean follow-up time was 15.4 months. Bone union was obtained in all patients, and the bone union time was 12.6 weeks (ranged: 12-16 weeks). At the last follow up, all patients had full range of motion. The incidence of significant associated injuries was 36.8% in the HEVBTP group compared with 15.8% in the non-HEBTP group. The incidence of popliteal artery injury, common peroneal nerve injury and ligament injury that needed repair in 19 HEBTPs patients was 21.1%, 26.3% and 31.6%, respectively, while the corresponding incidence of complications in 63 non-HEBTPs patients was 3.2%, 4.8%, and 9.5%, respectively. The NRS pain score of HEBTPs and non-HEBTPs at 12 months after surgery was 3.89±1.9 and 2.76±1.88, respectively. The value of HEBTPs patients was higher than that of non-HEBTPs patients, But the difference was not statistically significant. The SMFA scores of HEBTPs and non-HEBTPs patients at 12 months after surgery were 27.27±19.44 and 17.09±15.87, respectively. Patients with HEBTP had higher functional (SMFA) scores and a trend of higher pain scores than those with non-HEBTP, indicating associated soft-tissue damage and developed posttraumatic osteoarthritis. Conclusion The present showed that the HEBTP is a unique fracture. These injuries result in worse functional outcomes than non-HEBTP. Physicians must recognize the possible associated injuries (included ligaments, vessels and nerves), and the treatment effect of HEBTP is relatively poor.

Objective To assess the clinical value of cross raft screws technique in preventing postoperative collapse of tibial plateau fracture.Methods From September 2014 to November 2017,data of 14 patients with tibial plateau fracture who were treated by cross raft screws technique were retrospectively analyzed.There were 9 males and 5 females aged from 30-65 years old (average,44.4± 1.7 years).There were 8 patients that the thickness of subchondral cancellous bone measured preoperatively by CT data was less than 4 mm,and 6 patients that the thickness of subchondral cancellous bone measured intraoperatively was less than 4 mm.1/4 tubular plate was placed along the anterior rim of lateral tibial plateau,and the 3.5 mm cortical bone screws were fixed as bamboo raft from anterior to posterior through the plate.The collapse of tibial plateau after surgery were measured by CT scan after union of the fracture.The function of knee was evaluated by Rasmussen Anatomical and Functional Grading.Results The time of tubular plate procedure was 18 to 35 min (average,24.1±5.4 min).All 14 patients were successfully followed-up for 13.8±5.1 months.The height of collapse preoperatively by CT scan was 5-21 mm (average,8.00± 1.40 mm).3 days after the operation,the height between articular line and lateral articular surface was 0-2 mm (average,0.80±0.06 mm).Compared with CT data preoperatively,the collapse was corrected postoperatively that was proved by CT scan (P＜ 0.05).After the fracture was healed,according to CT data,the height between articular line and lateral articular surface was 0-2 mm (average,0.70±0.08 mm).Compared with CT data postoperatively,there was no postoperative collapse happened (P=0.466).The position and length of nails were placed appropriately.The average healing time of fracture was 3.6 months.There were no infection,nonunion and pain of tendon happened.The plate could be touched subcutaneously in 2 patients,who had no discomfort feelings.The patient's postoperative Rasmussen Anatomical Grading were 13-18 (average,16.7),including 8 cases excellent and 6 cases good.The postoperative Rasmussen Functional Grading was 18-28 (average,25.7),including 11 cases excellent and 3 cases good.Conclusion The cross raft screws technique is a good way to prevent the postoperative collapse of the lateral articular surface of tibial plateau.