Objective This study analyzes the risk factors for postoperative gastrointestinal dysfunction(POGD)in infants after intestinal surgery.Methods The perioperative clinical data of 220 infants who underwent intestinal surgery in Children's Hospital of Nanjing Medical University from March 2019 to March 2024 were retrospectively analyzed.Based on the criteria of postoperative"fasting time more than 5 d,vomiting bile fluid or bile fluid drainage from nasogastric tube,abdominal distension",the infants were divided into POGD group(78 cases)and non-POGD group(142 cases),and the clinical data of the two groups were analyzed by one-way analysis,and the independent factors with a P＜0.05 were included in the binary Logistic regression analysis to analyze the independent influencing factors affecting the recovery of gastrointestinal function after surgery.Results The time of the first defecation after surgery in the POGD group and the non-POGD group was(1.79±1.78)days and(1.44±0.71)days,respectively,and the time of parenteral nutrition was(9.73±4.64)days and(5.19±2.18)days,respectively,and the hospital stay was(13.31±5.70)days and(8.46±2.90)days,respectively.There was statistically significant difference between the two groups(P＜0.05).Multivariate regression analysis showed that a low preoperative weight for age Z(WAZ)score(P＜0.05,OR=0.705)and a long operation time(P＜0.05,OR=2.642)were risk factors for POGD.Conclusion Preoperative nutritional status and duration of surgery are risk factors for the development of postoperative gastrointestinal dysfunction in infants.

Objective This study analyzes the risk factors for postoperative gastrointestinal dysfunction(POGD)in infants after intestinal surgery.Methods The perioperative clinical data of 220 infants who underwent intestinal surgery in Children's Hospital of Nanjing Medical University from March 2019 to March 2024 were retrospectively analyzed.Based on the criteria of postoperative"fasting time more than 5 d,vomiting bile fluid or bile fluid drainage from nasogastric tube,abdominal distension",the infants were divided into POGD group(78 cases)and non-POGD group(142 cases),and the clinical data of the two groups were analyzed by one-way analysis,and the independent factors with a P＜0.05 were included in the binary Logistic regression analysis to analyze the independent influencing factors affecting the recovery of gastrointestinal function after surgery.Results The time of the first defecation after surgery in the POGD group and the non-POGD group was(1.79±1.78)days and(1.44±0.71)days,respectively,and the time of parenteral nutrition was(9.73±4.64)days and(5.19±2.18)days,respectively,and the hospital stay was(13.31±5.70)days and(8.46±2.90)days,respectively.There was statistically significant difference between the two groups(P＜0.05).Multivariate regression analysis showed that a low preoperative weight for age Z(WAZ)score(P＜0.05,OR=0.705)and a long operation time(P＜0.05,OR=2.642)were risk factors for POGD.Conclusion Preoperative nutritional status and duration of surgery are risk factors for the development of postoperative gastrointestinal dysfunction in infants.

Objective:To evaluate the safety and efficacy of enhanced recovery after surgery(ERAS) in the perioperative period of congenital choledochal cysts in children.Methods:This is a multicenter prospective randomized controlled study. The clinical data of 273 pediatric congenital choledochal cysts(CCC) patients who underwent surgery at 14 medical centers with complete follow-up data were collected through the medical data analysis platform. Among them, 123 cases in ERAS group were managed perioperatively in strict accordance with ERAS mode, and 150 cases in conventional group were managed according to traditional mode. The length of hospital stay,time to first farting, time to complete feeding, the incidence of complications, cost and readmission rate within 30 days,stress indexes and liver function were compared between the two groups.Results:Compared with the conventional group, median time to start farting (2.0 d vs. 3.0 d, P<0.001), median time to complete feeding (5.0 d vs. 7.0 d, P<0.001), median postoperative hospitalization time (6.0 d vs. 9.0 d, P<0.001),the median total length of stay(13.0 d vs. 15.0 d, P<0.001) were shorter,the median hospitalization cost (37,000 yuan vs.43,000 yuan P<0.001) was lower, and stress indexes recovered quickly. The incidence of postoperative hospital stay and readimission rate within 30 d were not statistically different between the two groups. Conclusion:It is safe and feasible to implement ERAS for children with CCC in the perioperative period, which can reduce stress response, speed up recovery,and save medical costs.

177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Background and objective Current studies suggest that for early-stage lung cancers with a component of ground-glass opacity measuring ≤2 cm,sublobar resection is suitable if it ensures adequate margins.However,lobectomy may be necessary for some cases to achieve this.The aim of this study was to explore the impact of size and depth on surgical techniques for wedge resection,segmentectomy,and lobectomy in early-stage lung cancer ≤2 cm,and to determine methods for ensuring a safe resection margin during sublobar resections.Methods Clinical data from 385 patients with early-stage lung can-cer ≤2 cm,who underwent lung resection in 2022,were subject to a retrospective analysis,covering three types of procedures:wedge resection,segmentectomy and lobectomy.The depth indicator as the OA value,which is the shortest distance from the inner edge of a pulmonary nodule to the opening of the corresponding bronchus,and the AB value,which is the distance from the inner edge of the nodule to the pleura,were measured.For cases undergoing lobectomy and segmentectomy,three-dimensional computed tomography bronchography and angiography(3D-CTBA)was performed to statistically determine the number of subsegments required for segmentectomy.The cutting margin width for wedge resection and segmentectomy was recorded,as well as the specific subsegments and their quantities removed during lung segmentectomy were documented.Results In wedge resection,segmentectomy,and lobectomy,the sizes of pulmonary nodules were(1.08±0.29)cm,(1.31±0.34)cm and(1.50±0.35)cm,respectively,while the depth of the nodules(OA values)was 6.05(5.26,6.85)cm,4.43(3.27,5.43)cm and 3.04(1.80,4.18)cm for each procedure,showing a progressive increasing trend(P＜0.001).The median resec-tion margin width obtained from segmentectomy was 2.50(1.50,3.00)cm,significantly greater than the 1.50(1.15,2.00)cm from wedge resection(P＜0.001).In wedge resections,cases where AB value＞2 cm demonstrated a higher proportion of cases with resection margins less than 2 cm compared to those with margins greater than 2 cm(29.03％vs 12.90％,P=0.019).When utilizing the size of the nodule as the criterion for resection margin,the instances with AB value＞2 cm continued to show a higher proportion in the ratio of margin distance to tumor size less than 1(37.50％vs 17.39％,P=0.009).The median number of subsegments for segmentectomy was three,whereas lobectomy cases requiring segmentectomy involved five subsegments(P＜0.001).Conclusion The selection of the surgical approach for lung resection is influenced by both the size and depth of pulmonary nodules.This study first confirms that larger portions of lung tissue must be removed for nodules that are deeper and larger to achieve a safe margin.A distance of ≤2 cm from the inner edge of the pulmonary nodule to the nearest pleura may be the ideal indication for performing wedge resection.

Children short bowel syndrome(SBS)is a malabsorption with acquired reduction in length of the small intestine or congenital bowel anomalies which cannot meet the needs of normal growth and development,and requires parenteral nutrition to support longer than 42 days.Due to the changes of intestinal structure and function,long-term intravenous nutrition,and antibiotic use,the intestinal flora of children with SBS is often disordered.Maintaining the diversity and stability of intestinal flora in children with SBS plays an important role in protecting the intestinal mucosal barrier,enhancing intestinal adaptation,withdrawing PN early,and reducing complications such as intestinal failure-related liver damage.Probiotics play an important role in maintaining the stability of intestinal flora,regulating metabolism and immunity.However,the role of probiotics in SBS is still controversial.This article summarizes the characteristics of intestinal flora in children with SBS and its effects on the body,and the role of probiotics in maintaining the homeostasis of intestinal flora in children with SBS,hoping to provide reference for the clinical treatment of children with SBS.

Children short bowel syndrome(SBS)is a malabsorption with acquired reduction in length of the small intestine or congenital bowel anomalies which cannot meet the needs of normal growth and development,and requires parenteral nutrition to support longer than 42 days.Due to the changes of intestinal structure and function,long-term intravenous nutrition,and antibiotic use,the intestinal flora of children with SBS is often disordered.Maintaining the diversity and stability of intestinal flora in children with SBS plays an important role in protecting the intestinal mucosal barrier,enhancing intestinal adaptation,withdrawing PN early,and reducing complications such as intestinal failure-related liver damage.Probiotics play an important role in maintaining the stability of intestinal flora,regulating metabolism and immunity.However,the role of probiotics in SBS is still controversial.This article summarizes the characteristics of intestinal flora in children with SBS and its effects on the body,and the role of probiotics in maintaining the homeostasis of intestinal flora in children with SBS,hoping to provide reference for the clinical treatment of children with SBS.

Objective To analyze the clinical characteristics and risk factors of ( acute myocardial infarction , AMI ) in elderly patients with ( hyperuricemia , HUA) in Suzhou, and to provide a theoretical basis for the prevention and treatment of AMI in patients with HUA. Methods Among of 356 patients with hyperuricemia aged ≥60 years who were admitted to Suzhou Jiulong Hospital from January 2016 to December 2021 were selected. The patients were divided into control group and AMI group according to whether they were complicated with AMI. The clinical data of the patients were collected from the medical record system, and the types of AMI and the lesions of the three main coronary vessels in patients with HUA were statistically analyzed. The serum BNP level and LVEF value of the two groups were compared. Univariate analysis and logistic regression analysis were conducted to analyze the risk factors of AMI in patients with HUA. Results Fifty-five cases (15.45%) of 356 patients with HUA developed AMI, including 31 males and 24 females. There were 26 patients (47.27%) with NSTEMI and 29 patients (52.73%) with STEMI. In addition, 30 cases (54.55%) had three-vessel lesions. Compared with the control group, the male ratio, average age, smoking history ratio, systolic blood pressure, FPG, LDL-C and Hcy levels in the AMI group were significantly increased (P<0.05), while LVEF values decreased (P<0.05). Smoking history (OR=2.987), high LDL-C (OR=3.439), high Hcy (OR=2.672) and high FPG (OR=3.874) were risk factors for AMI in patients with HUA (P<0.05). Conclusion HUA patients in Suzhou area have a high risk of AMI, and most of them are STEMI patients, with the characteristics of multi vessel branch lesions. For HUA patients with smoking history, poor control of Hcy, LDL-C and FPG, the risk of AMI is higher. Smoking cessation and control of LDL-C, Hcy and FPG levels should be actively adopted to reduce the risk of AMI.

Objective:To explore the clinical characteristics and medical nutritional therapy of 6 patients with late-onset ornithine transcarbamylase (OTC) deficiency.Methods:The clinical features, biochemical data, gene variations and treatment outcomes of 6 children with late-onset OTC deficiency admitted to the Department of Clinical Nutrition, Children′s Hospital of Nanjing Medical University from January 2020 to April 2022 were retrospectively analyzed.The 6 patients were all intervened by a long-term medical nutrition management.Results:Liver dysfunction and hyperammonemia (172.1-348.0 μmol/L) were found in all the 6 children with late-onset OTC deficiency.Serum citrulline decreased in 3 patients (3.95-5.43 μmol/L). Three patients showed increased urine orotic acid (123.48-342.60 mmol/mol Cr). Urine uracil increased in 4 patients (106.77-1 207.26 mmol/mol Cr). Variations of the OTC gene [c.364G>C p. (E122Q), c.1028C>G p. (T343R), c.664-2(IVS6)A>C, c.635G>T p. (G212V), c.929_c.931delAAG p. (E310del), c.829C>T p. (R277W)] were identified in all patients.The 6 children were all managed by individualized medical nutrition program and followed up for a long time.During the follow-up period, 3 cases developed hypoproteinemia, acute metabolic crisis and growth retardation, 3 cases had normal growth and laboratory indicators, and 1 case received liver transplantation after 3 months of nutritional management. Conclusions:The clinical manifestations of OTC deficiency are non-specific.Blood amino acids, urine organic acids and genetic tests are important for the diagnosis.Long-term regular medical nutrition management is helpful to improve the prognosis and quality of life of children.

Objective·To assess the effect of veno-arterial extracorporeal membrane oxygenation(VA-ECMO)treatment on the mortality rate of patients suffering from cardiogenic shock and cardiac arrest in hospital.Methods·A total of 19 patients with cardiogenic shock or cardiac arrest who were treated with VA-ECMO treatment in Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine from September 2017 to March 2022 were included in the retrospective study.Patients were divided into extracorporeal cardiopulmonary resuscitation(ECPR)group(n=9)and VA-ECMO for cardiogenic shock(E-CS)group(n=10)according to whether cardiac arrest had occurred.The general demographic data,clinical data,Sequential Organ Failure Assessment(SOFA)scores,postoperative complications and prognostic indicators of the two groups of patients were collected.Univariate and multivariate Cox proportional hazard regression analyses were used to evaluate the correlation between each covariate and hospital mortality.Results·Among the included patients,there were 15 males(78.9％),with an average age of 46.5(34.5,61.6)years.The incidence of postoperative complications was as follows:bleeding(47.4％),AKI(36.8％),infection(31.6％),limb ischemia(15.8％)and cerebrovascular accident(5.3％).The duration of VA-ECMO was 4.0(2.0,6.8)days,and the intensive care duration was 11.5(5.8,26.2)days;the ECMO withdrawal success rate was 63.2％,and the hospital mortality was 63.2％.The results of univariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were correlated with the hospital mortality of patients(all P＜0.05).The results of multivariate Cox proportional hazard regression analysis showed that AKI(prior to VA-ECMO initiation),postoperative complications of infection and limb ischemia were also independent risk factors for the hospital mortality of patients(all P＜0.05).Conclusion·For patients with cardiogenic shock and cardiac arrest treated with VA-ECMO,AKI(prior to VA-ECMO initiation),postoperative infection and limb ischemia are independently associated with higher hospital mortality.