Efficacy of laparoscopic low anterior resection for colorectal cancer patients with 3D-vascular reconstruction for left coronary artery preservation

BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation.However,the effect of surgery on patients'left coronary artery and its vascular reconstruction have not been deeply discussed.With the development of medical imaging technology,3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery(LCA)preserved.METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital.All patients underwent LLAR of rectal cancer with the LCA preserved,and the intraoperative and postoperative data were complete.The patients were divided into a reconstruction group(72 patients)and a nonreconstruction group(74 patients)according to whether 3D vascular reconstruction was performed before surgery.The clinical features,operation conditions,complications,pathological results and postoperative recovery of the two groups were collected and compared.RESULTS A total of 146 patients with rectal cancer were included in the study,including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group.There were 47 males and 25 females in the reconstruction group,aged(59.75±6.2)years,with a body mass index(BMI)(24.1±2.2)kg/m^(2),and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m^(2).There was no significant difference in the baseline data between the two groups(P>0.05).In the submesenteric artery reconstruction group,35 patients were type Ⅰ,25 patients were type Ⅱ,11 patients were type Ⅲ,and 1 patient was type Ⅳ.There were 37 type Ⅰ patients,24 type Ⅱ patients,12 type Ⅲ patients,and 1 type Ⅳ patient in the nonreconstruction group.There was no significant difference in arterial typing between the two groups(P>0.05).The operation time of the reconstruction group was 162.2±10.8 min,and that of the nonreconstruction group was 197.9±19.1 min.Compared with that of the reconstruction group,the operation time of the two groups was shorter,and the difference was statistically significant(t=13.840,P<0.05).The amount of intraoperative blood loss was 30.4±20.0 mL in the reconstruction group and 61.2±26.4 mL in the nonreconstruction group.The amount of blood loss in the reconstruction group was less than that in the control group,and the difference was statistically significant(t=-7.930,P<0.05).The rates of anastomotic leakage(1.4%vs 1.4%,P=0.984),anastomotic hemorrhage(2.8%vs 4.1%,P=0.672),and postoperative hospital stay(6.8±0.7 d vs 7.0±0.7 d,P=0.141)were not significantly different between the two groups.CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss.Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.

阿立哌唑治疗抽动障碍的药动学研究进展

抽动障碍是儿童期常见的以运动抽动和(或)发声抽动为主要特征的神经精神疾病,其发病机制与脑内局部多巴胺水平增高有关。阿立哌唑是新型的第3代非典型抗精神病药,是治疗抽动障碍的有效治疗药物之一。但目前阿立哌唑用于抽动障碍的治疗属于超说明书用药,且治疗窗尚不明确,药动学存在较大个体差异。为提高阿立哌唑治疗儿童抽动障碍的有效性和安全性,考察阿立哌唑在抽动障碍儿童群体中的药动学作用规律,探明其个体差异的产生机制意义重大。本文就目前阿立哌唑治疗儿童抽动障碍的药动学研究现状及意义作一综述。

Clinical Characteristics of Children with Coronavirus Disease 2019 in Hubei, China

Since December 2019,COVID-19 has occurred unexpectedly and emerged as a health problem worldw ide.Despite the rapidly increasing number of cases in subsequent weeks,the clinical characteristics of pediatric cases are rarely described.A cross-sectional multicenter study was carried out in 10 hospitals across Hubei province.A total of 25 confirmed pediatric cases of COVID-19 were collected.The demographic data,epidemiological history,underlying discascs,clinical mani festations,laboratory and radiological data,treatments,and outcomes were analyzcd.Of 25 hospitalized patients with COVID-19,the boy to girl ratio was 1.27:1.The median age was 3 years.COVID-19 cases in children aged<3 years,3-6 years,and≥6-years patients were 10(40%),6(24%),and 9(36%),respectively.The most common symptoms at onset of ilness were fever(13[52%]),and dry cough(11[44%]).Chest CT images showed essential normal in 8 cases(33.3%),unilateral involvement of lungs in 5 cases(20.8%),and bilateral involvement in 11 cases(45.8%).Clinical diagnoses included upper respiratory tract infection(n=8),mild pneumonia(n=15),and critical cases(n=2).Two critical cases(8%)were given invasive mechanical ventilation,corticosteroids,and immunoglobulin.The symptoms in 24(96%)of 25 patients were alleviated and one patient had been discharged.It was concluded that children were susceptible to COVID-19 like adults,while the clinical presentations and outcomes were more favorable in children.However,children less than 3 years old accounted for majority cases and critical cases lied in this age group,which demanded extra attentions during home caring and hospitalization treatment.

Molecular mechanism for the unusual enhancement of the second-step chemiluminescence production from the carcinogenic tetrabromohydroquinone and H2O_(2)

We have found recently that two-step intrinsic hydroxyl radical(·OH)-dependent chemiluminescence(CL)could be produced by carcinogenic tetrahaloquinone and H_(2)O_(2).However,the first-step CL was too fast to clearly detect the stepwise generation of·OH and CL,and to distinguish the exact dividing point between the first-step and second-step CL.Here we found that,extremely clear two-step intrinsic CL could be produced by the relative slow reaction of tetrabromohydroquinone(TBHQ)with H_(2)O_(2),which was directly dependent on the two-step·OH generation.Interestingly,the second-step,but not the first-step CL production of TBHQ/H_(2)O_(2)(CRET donor)was markedly enhanced by fluorescein(a typical xanthene dye,CRET acceptor)through a unique chemiluminescence resonance energy transfer(CRET)process.The novel CRET system of TBHQ/H_(2)O_(2)/fluorescein was successfully applied for the sensitive detection of TBHQ with the detection limit as low as 2.5μmol/L.These findings will help to develop more sensitive and highly efficient CL or CRET systems and specific CL sensor to detect the carcinogenic haloquinones,which may have broad environmental applications.

Diagnosis,treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children:experts'consensus statement updatedforthe Omicron variant

It has been more than 3 years since the novel coronavirus(SARS-CoV-2)pandemic raged globally.The coronavirus disease 2019(COVID-19)has greatly influenced human society.According to data from the World Health Organization(WHO),there were over 656 million confirmed cases of COVID-19 in the world as of January 1,2023,including over 6.6 million deaths[1].

Diagnosis,treatment,and prevention of monkeypox in children:an experts'consensus statement

Monkeypox is a zoonotic disease.Since the first human monkeypox case was detected in 1970,it has been prevalent in some countries in central and western Africa.Since May 2022,monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide.As of September 14,2022,there have been more than 58,200 human monkeypox cases,and there is community transmission.The cessation of smallpox vaccination in 1980,which had some cross-protection with monkeypox,resulted in a general lack of immunity to monkeypox,which caused global concern and vigilance.As of Sep-tember 14,2022,there are four monkeypox cases in China,including three in Taiwan province and one in Hong Kong city.Previous foreign studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians'understanding of monkeypox and achieve early detection,early diagno-sis,early treatment,and early disposal,we have organized national authoritative experts in pediatric infection,respiratory,dermatology,critical care medicine,infectious diseases,and public health and others to formulate this expert consensus,on the basis of the latest"Clinical management and infection prevention and control for monkeypox"released by The World Health Organization,the"guidelines for diagnosis and treatment of monkeypox(version 2022)"issued by National Health Commission of the People's Republic of China and other relevant documents.During the development of this consensus,multidisciplinary experts have repeatedly demonstrated the etiology,epidemiology,transmission,clinical manifestations,laboratory examinations,diagnosis,differential diagnosis,treatment,discharge criteria,prevention,disposal process,and key points of prevention and control of suspected and confirmed cases.

Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

Background An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan,Hubei,China.People of all ages are susceptible to SARS-CoV-2 infection.No information on severe pediatric patients with COVID-19 has been reported.We aimed to describe the clinical features of severe pediatric patients with COVID-19.Methods We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU),Wuhan Children's Hospital from January 24 to February 24.We collected information including demographic data,symptoms,imaging data,laboratory findings,treatments and clinical outcomes of the patients with severe COVID-19.Results The onset age of the eight patients ranged from 2 months to 15 years;six were boys.The most common symptoms were polypnea (8/8),followed by fever (6/8) and cough (6/8).Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six.Laboratory findings revealed normal or increased whole blood counts (7/8),increased C-reactive protein,procalcitonin and lactate dehydrogenase (6/8),and abnormal liver function (4/8).Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8),increased CD3 (2/8),CD4 (4/8) and CD8 (1/8),IL-6 (2/8),IL-10 (5/8) and IFN-γ (2/8).Treatment modalities were focused on symptomatic and respiratory support.Two critically ill patients underwent invasive mechanical ventilation.Up to February 24,2020,three patients remained under treatment in ICU,the other five recovered and were discharged home.Conclusions In this series of severe pediatric patients in Wuhan,polypnea was the most common symptom,followed by fever and cough.Common imaging changes included multiple patch-like shadows and ground-glass opacity;and a cytokine storm was found in these patients,which appeared more serious in critically ill patients.

Updated diagnosis, treatment and prevention of COVID-19 in children: experts' consensus statement (condensed version of the second edition)

In the early February,2020,we called up an experts' committee with more than 30 Chinese experts from 11 national medical academic organizations to formulate the first edition of consensus statement on diagnosis,treatment and prevention of coronavirus disease 2019 (COVID-19) in children,which has been published in this journal.With accumulated experiences in the diagnosis and treatment of COVID-19 in children,we have updated the consensus statement and released the second edition recently.The current version in English is a condensed version of the second edition of consensus statement on diagnosis,treatment and prevention of COVID-19 in children.In the current version,diagnosis and treatement criteria have been optimized,and early identification of severe and critical cases is highlighted.The early warning indicators for severe pediatric cases have been summarized which is utmost important for clinical practice.This version of experts consensus will be valuable for better prevention,diagnosis and treatment of COVID-19 in children worldwide.

SARS-CoV-2 infection in infants under 1 year of age in Wuhan City, China

Background The clinical characteristics and outcome of COVID-19 in children are different from those in adults.We aimed to describe the characteristics of infants under 1 year of age (excluding newborns) with COVID-19.Methods We retrospectively retrieved data of 36 infants with SARS-CoV-2 infection in Wuhan Children's Hospital from January 26 to March 22,2020.Clinical features,chest imaging findings,laboratory tests results,treatments and clinical outcomes were analyzed.Results The mean age of the infected infants was 6.43 months,with a range of 2-12 months.61.11% of the patients were males and 38.89% females.86.11% of the infants were infected due to family clustering.Cough (77.78%) and fever (47.22%) were the most common clinical manifestations.Chest CT scan revealed 61.11% bilateral pneumonia and 36.11% unilateral pneumonia.47.22% of the infants developed complications.Increased leucocytes,neutrophils,lymphocytes,and thrombocytes were observed in 11.11,8.33,36.11 and 44.44% of infants,respectively.Decreased leucocytes,neutrophils,thrombocyte and hemoglobin were observed in 8.33,19.44,2.78 and 36.11% of infants,respectively.Increased C-reactive protein,procalcitonin,lactate dehydrogenase,alanine aminotransferase,creatine kinase and D-dimer were observed in 19.44,67.74,47.22,19.44,22.22 and 20.69% of infants,respectively.Only one infant had a high level of creatinine.Co-infections with other respiratory pathogens were observed in 62.86% of infants.CD3 (20.69%),CD4 (68.97%),CD19 (31.03%) and Th/Ts (44.83%) were elevated;CD8 (6.9%) and CD16+CD56 (48.28%) was reduced.IL-4 (7.69%),IL-6 (19.23%),IL-10 (50%),TNF-α (11.54%) and IFN-γ (19.23%) were elevated.Up to March 22,97.22% of infants recovered,while a critical ill infant died.When the infant's condition deteriorates rapidly,lymphocytopenia was discovered.Meanwhile,C-reactive protein,D-dimer,alanine aminotransferase,creatine kinase,creatinine,IL-6 and IL-10 increased significantly.Conclusions In the cohort,we discovered that lymphocytosis,elevated CD4 and IL-10,and co-infections were common in infants with COVID-19,which were different from adults with COVID-19.Most infants with COVID-19 have mild clinical symptoms and good prognosis.

Response to "Myocardial dysfunction in SARS-CoV-2 infection in infants under 1 year of age"

First of all,we want to thank the author for the approval of our article,focusing on SARS-CoV-2 infection in infants.Our article was aimed to describe the characteristics of infants under 1 year of age(excluding newborns)with COVID-19.Clinical features,chest imaging findings,laboratory tests results,treatments and clinical outcomes were analyzed.Our replies to the questions mentioned in author's letter are as follows.

Expert consensus on COVID-19 vaccination in children

Coronavirus disease 2019(COVID-19)is a public health disaster that has not been encountered for a hundred years.On January 12,2020,the World Health Organization(WHO)confirmed and named the coronavirus which caused unexplained pneumonia as 2019 novel coronavirus(2019-nCoV).Since then,the disease caused by this virus had been named as coronavirus disease 2019(COVID-19).On February 11,2020,the International Committee on Taxonomy of Viruses announced that the English name of the novel coronavirus was severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)[1].At present,SARS-CoV-2 infection is still rampant worldwide.As of September 10,2021,there were about 222 million confirmed cases of COVID-19 and more than 4.5 million deaths worldwide[2].According to the American Centers for Disease Control and Prevention,by July 29,2021,4.19 million pediatric COVID-19 cases had been reported in the United States。