BackgroundPreoperative complications of mesenteric lymphatic malformations (ML) in children are various and complex. We aim to analyze the incidences and risk factors of three major preoperative complications (hemorrhage of the cyst, infection of the cyst and intestinal volvulus) in ML patients, and explore their influence on the outcomes.MethodsThis retrospective cohort study enrolled ML patients undergoing surgery at Beijing Children's Hospital between June 2016 and June 2022 and classified them according to different preoperative complications, preoperative hemorrhage or infection, and preoperative intestinal volvulus. The groups were examined and compared according to sex, age at admission, presenting symptoms, laboratory examinations, imaging examinations, preoperative treatments, cyst characteristics, surgical details, perioperative clinical data, and follow-up. Logistic regression analysis was performed to identify the independent risk factors for preoperative hemorrhage or infection, and preoperative intestinal volvulus.ResultsOf the 104 enrolled ML patients, 27 (26.0%) had preoperative hemorrhage or infection, and 22 (21.2%) had preoperative intestinal volvulus. Univariate analysis showed that patients with preoperative hemorrhage or infection had a higher rate of ML in the mesocolon (44.4 vs. 23.4%, p < 0.038) and larger cysts (10 vs. 8 cm, p = 0.042) than patients without preoperative hemorrhage or infection. Multivariable logistic regression analysis found that the location (OR, 3.1; 95% CI, 1.1–8.6; p = 0.026) and size of the cyst (≥7.5 cm) (OR, 6.2; 95% CI, 1.6–23.4; p = 0.007) were independent risk factors for preoperative hemorrhage or infection. Preoperative intestinal volvulus was only found in ML at the intestinal mesentery. Further analysis showed that ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus (OR, 3.3; 95% CI, 1.1–10.0; p = 0.027). Patients with preoperative hemorrhage or infection spent more on hospitalization costs than patients without preoperative hemorrhage or infection (3,000 vs. 2,674 dollars, p = 0.038).ConclusionsML patients should be treated as soon as possible after diagnosis. The location and size of the cyst were independent risk factors for preoperative hemorrhage or infection. ML in the jejunal mesentery was an independent risk factor for preoperative intestinal volvulus.

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Background Preoperative diagnosis of total colonic aganglionosis is important for the rational choice of treatment. The present study aimed to evaluate the diagnostic performance of radiographic signs on preoperative barium enema in patients with total colonic aganglionosis. Methods Forty-four patients [41 (3-659) days] with total colonic aganglionosis, including 17 neonatal patients, who received preoperative barium enema at our center, from January 2007 to December 2019 were included. All radiographs were retrospectively restudied by 2 pediatric radiologists to ascertain radiographic signs including rectosigmoid index, transition zone, irregular contraction, gas-filled small bowel, microcolon, question-mark-shaped colon and ileocecal valve reflux. Kappa test was performed to assess the accuracy and consistency of the radiographic signs. Results The 2 radiologists showed slight agreement for gas-filled small bowel, microcolon and rectosigmoid index, fair agreement for transition zone and irregular contraction, and moderate agreement for question-mark-shaped colon and ileocecal valve reflux (Kappa values, 0.043, 0.075, 0.103, 0.244, 0.397, 0.458 and 0.545, respectively). In neonatal patients, the 2 radiologists showed moderate agreement for ileocecal valve reflux and substantial agreement for question-mark-shaped colon (Kappa values, 0.469 and 0.667, respectively). In non-neonatal patients, the 2 radiologists showed substantial agreement for ileocecal valve reflux (Kappa value, 0.628). In 36 patients with total colonic aganglionosis extending to the ileum, the accuracies of question-mark-shaped colon, ileocecal valve reflux and the combination of both were 47%, 53%, and 75%, respectively, in one radiologist and 53%, 50% and 72%, respectively, in the other. Conclusion Ileocecal valve reflux was a reliable radiographic sign for diagnosing total colonic aganglionosis and could improve the accuracy by combination with question-mark-shaped colon.

Background: The acceptance of wearable intelligent medical devices and the factors influencing behavioral intention to use them have been scarcely studied. This study aimed to increase the current understanding of wearable intelligent medical devices and investigate the factors influencing their acceptance.Methods: Integrating the unified theory of acceptance and use of technology and the theory of perceived risk, and based on the features of wearable intelligent medical devices, we proposed a modified unified theory of acceptance and use of technology model to identify factors influencing the acceptance of these devices.Using data collected from 2,192 respondents in China from an online survey, we used structural equation modeling to test the measurement and structural models. Results:The findings suggested that facilitating conditions (path coefficient =0.942, P<0.001) were critical to the use of wearable intelligent medical devices. Behavioral intention significantly mediated the effects of perceived risk, perceived cost, health expectation, perceived ease of use, and social influence on user behavior (path coefficient =0.210, P<0.001). Health expectation (path coefficient =0.860, P<0.001), perceived ease of use (path coefficient =0.289, P<0.001), and social influence (path coefficient =0.153, P<0.001) were found to play essential roles in predicting behavioral intention. Perceived cost (path coefficient =0.034, P<0.05) and perceived risk (path coefficient =−0.031, P<0.05) had no significant effect on behavioral intention. People with underlying diseases had lower health expectations and perceived costs. Conclusions:The modified unified theory of acceptance and use of technology model in our research is a reliable model to evaluate the user acceptance of wearable intelligent medical devices.