Metabolic-associated fatty liver disease in relation to site-specific and multiple-site subclinical atherosclerosis.

BACKGROUND & AIMS: Non-alcoholic fatty liver disease (NAFLD) and the newly proposed metabolic-associated fatty liver disease (MAFLD) were each associated with subclinical atherosclerosis. However, there is limited evidence on risk of atherosclerosis in individuals who meet the criteria for one but not the other. We aimed to investigate the associations of MAFLD or NAFLD status with site-specific and multiple-site atherosclerosis. METHODS: This is a prospective cohort study involving 4524 adults within the MJ health check-up cohort. Logistic regression model was used to estimate odds ratios (ORs) and confidence intervals (CIs) for subclinical atherosclerosis (elevated carotid intima-media thickness [CIMT], carotid plaque [CP], coronary artery calcification [CAC] and retinal atherosclerosis [RA]) associated with MAFLD or NAFLD status, MAFLD subtypes and fibrosis status. RESULTS: MAFLD was associated with higher risks of elevated CIMT, CP, CAC and RA (OR: 1.41 [95% CI 1.18-1.68], 1.23 [1.02-1.48], 1.60 [1.24-2.08], and 1.79 [1.28-2.52], respectively), whereas NAFLD per se did not increase risk of atherosclerosis except for elevated CIMT. Individuals who met both definitions or the definition for MAFLD but not NAFLD had higher risk of subclinical atherosclerosis. Among MAFLD subtypes, MAFLD with diabetes had the highest risk of subclinical atherosclerosis, but the associations did not differ by fibrosis status. Stronger positive associations were observed of MAFLD with multiple-site than single-site atherosclerosis. CONCLUSIONS: In Chinese adults, MAFLD was associated with subclinical atherosclerosis, with stronger associations for multiple-site atherosclerosis. More attention should be paid to MAFLD with diabetes, and MAFLD might be a better predictor for atherosclerotic disease than NAFLD.

Long-term, single-center study comparing open and laparoscopic procedures for congenital midureteral obstruction in children.

PURPOSE: To compare the safety and outcomes of open and laparoscopic procedures in the management of congenital midureteral obstruction in children (CMO). METHODS: Between February 2008 and February 2022, a total of 18 patients underwent open ureteroureterostomy (OU group), and 26 underwent laparoscopic ureteroureterostomy (LU group). The operative time, postoperative hospital stay, hospital costs, postoperative complications, and success rates of the two groups were compared. RESULTS: The median age of the patients was 59 months, with 29 patients presenting with asymptomatic hydronephrosis, 12 with intermittent abdominal pain, and 3 with flank mass. The median follow-up time was 42 months, and all patients were successfully treated surgically. The operative time and postoperative hospital stay in the LU group were shorter than those in the OU group (106.3 ± 21.4 vs. 85.8 ± 16.5 min, 11.6 ± 1.9 vs. 8.3 ± 1.7 days, respectively; p < 0.05). The OU group had two postoperative complications, both of which were classified as Clavien-Dindo grade II based on the Clavien-Dindo classification. One case of postoperative complication occurred in the LU group, which was classified as Clavien-Dindo Grade II. There was no significant statistical difference in complications between the two groups (P > 0.05). CONCLUSIONS: Our data showed that laparoscopic ureteroureterostomy is a safe and effective treatment for congenital midureteral obstruction in children, and provides several advantages, including fewer postoperative complications, shorter postoperative hospital stay, and a shorter operative time. Laparoscopic procedures should be the first choice for treating children with congenital midureteral obstructions.

Single-stage versus staged interposition urethroplasty for glandular hypospadias with severe penile curvature: 15-year experience.

PURPOSE: Our study examined the benefit of an alternative interposition urethroplasty (IU) procedure for glandular hypospadias (GH) with severe penile curvature (SPC). The technique involved transecting and reconstructing the urethra to preserve the distal glandular and coronal urethra and correct the curvature. We compared procedural characteristics, outcomes, and surgical complications for the single-stage and staged IU techniques. METHODS: We retrospectively studied 44 patients with GH with SPC who underwent single-stage or staged IU between March 2005 and June 2020. Demographics, operative details, complications, and uroflometry findings were analyzed. RESULTS: The median age at initial surgery was 37.5 months. Ten patients underwent single-stage IU repair, and 34 patients underwent staged IU repair. The median length of the interposition neourethra was 3.2 cm (2.2-4.3). The median follow-up duration was 58 months, and the overall complication rate was 13.6%. Complications were noted in 30% (3/10) and 8.8% (3/34) of patients in the single-stage and staged IU groups, respectively (p > 0.05). Fistula formation was noted in one and three patients in the single-stage and staged groups, respectively (8.8% vs. 10%, p > 0.05). Two cases of urethral stricture were documented in the single-stage group only. No chordee recurrence or urethral diverticula was noted in any of the patients. CONCLUSION: IU is a reliable and durable technique for GH with SPC. It avoided penile shortening, preserved the distal urethra, and reduced the risk of chordee recurrence. The staged IU technique had more superior outcomes compared to the single-stage IU technique.

Dietary pattern derived by reduced-rank regression and cardiovascular disease: A cross-sectional study.

BACKGROUND AND AIMS: Diet can affect cardiovascular health by changing lipid profiles or obesity levels. However, the association of dietary patterns reflecting lipid metabolism and adiposity measures with cardiovascular disease (CVD) is unclear. This study aimed to derive dietary patterns that explained variation in blood lipids and adiposity and investigate their associations with prevalent CVD. METHODS AND RESULTS: A cross-sectional study was constructed in Beijing MJ Health Screening Center from 2008 to 2018. A dietary pattern was derived using reduced-rank regression among 75,159 participants without CVD. The dietary pattern explained the largest in predicting lipid profiles and adiposity measures. The dietary pattern was associated with a higher level of LDL-cholesterol and triglyceride, and high body mass index and waist circumference, but lower HDL-cholesterol. The dietary pattern was characterized by high intakes of staple food, red meat, processed food, fried food, edible offal, and less intakes of jam or honey, fruits, milk, and dairy products. Among 89,633 participants, we evaluated its association with prevalent CVD using multivariate logistic regression with adjustment for age, sex, annual income, education attainment, marital status, family history of CVD, smoking status, alcohol use, physical activity, and daily energy intake. Individuals with the highest quintile of dietary pattern score were 1%-38% more likely to have prevalent CVD than the lowest quintile (OR = 1.18, 95% CI = 1.01-1.38). CONCLUSION: A diet pattern reflecting lipid profiles and obesity level was positively related to prevalent CVD, which could provide new insights in optimizing blood lipids and body shape for the prevention of CVD through dietary approaches among the Chinese population.

Risk factors for postoperative complications in children with proximal hypospadias with severe chordee who underwent urethral plate transection.

OBJECTIVES: To identify the risk factors associated with developing complications after transection of the urethral plate for proximal hypospadias with severe chordee. METHODS: We used a prospective database to identify patients with proximal hypospadias and severe chordee who underwent transection of the urethral plate and primary hypospadias repair in 2011 and 2021. All patients underwent urethroplasty with a follow-up period of >12 months. The association between variables (age, surgical technique, length of urethral defect, and surgeon volume) and postoperative complications (fistulas, urethral strictures, diverticula and glans dehiscence) was analyzed. RESULTS: Altogether, 493 patients were included, of whom 133 (26.9%) had postoperative complications. Univariate and multivariate analyses revealed that the preoperative proximal meatal position, one-stage repair, longer urethral defect length, and low surgeon volume were significant risk factors for postoperative complications with proximal hypospadias with severe chordee who underwent transection of the urethral plate. A urethral defect length of ≥4.55 cm was considered the best cutoff value for predicting postoperative complications. CONCLUSIONS: Preoperative proximal meatal location, one-stage repair, longer urethral defect length, and low surgeon volume were associated with postoperative complications in patients with proximal hypospadias with severe chordee who underwent transection of the urethral plate. A urethral defect length of ≥4.55 cm was significantly associated with the development of complications.

Efficacy of one- and two-stage segment urethroplasty for severe chordee with congenital short urethra.

OBJECTIVES: The aim of this study was to analyze the efficacy of segment urethroplasty to treat severe chordee with congenital short urethra and compared one-stage and two-stage segment urethroplasty. This procedure involved urethral transection to correct the chordee, and urethroplasty was performed to restore natural penile length. METHODS: We retrospectively studied a cohort of patients with severe chordee and congenital short urethra who underwent one- or two-stage segment urethroplasty at our institution between February 2006 and May 2020. We evaluated the efficacy of the procedures based on the incidence of complications. RESULTS: A total of 37 children were included in this study: 25 were treated with two-stage segment urethroplasty and 12 were treated with one-stage segment urethroplasty. The median length of neourethra in the one-stage repair group (3.21 cm) was similar to that in the two-stage repair group (3.23 cm; P > 0.05). Of the 37 patients, 32 (86.5%) were cured after urethroplasty. There were three patients with complications in the one-stage repair group (one urethral fistula and two urethral strictures) and two patients with fistula in the two-stage repair group. Among the five patients with complications, the three fistulas were successfully repaired through reoperation and the two urethral strictures were cured after urethral dilatation. No patient had diverticulum or recurrent chordee. CONCLUSIONS: Segment urethroplasty achieved satisfactory outcomes in the treatment of severe chordee with congenital short urethra. This can restore natural penile length, and the recurrence rate of severe chordee is low. The overall success rate of the two-stage procedure tends to be better than that of the one-stage procedure.

Urethroplasty for chordee with a paper-thin hypoplastic urethra: A long-term study.

OBJECTIVES: To establish a standard surgical procedure for children with chordee with a paper-thin hypoplastic urethra, which was based on the degree of curvature and urethral plate quality. To guidelines for the management of this disorder. METHODS: We reviewed 58 cases of chordee with a paper-thin hypoplastic urethra, managed between March 2006 and September 2020. The age of the patients ranged from 23 to 89 months. Operative details and postoperative complications were analyzed. RESULTS: Mild-moderate chordee with a paper-thin hypoplastic urethra correction was performed using a tubularized incised plate (13 cases) or onlay island flap (five cases) technique after penile degloving. Severe chordee with a paper-thin hypoplastic urethra required transection of the urethra and underwent a Duckett (11 cases) or staged (29 cases) urethroplasty. Complications in the tubularized incised plate and onlay island flap groups were 7.7% and 20%, respectively. The overall complication rate was 10.3% in the staged group and 27.3% in the Duckett group. CONCLUSIONS: Reconstruction of the entire hypoplastic urethra should be recommended in the management of chordee with a paper-thin hypoplastic urethra. We propose an algorithm based on the degree of curvature and urethral plate quality. The tubularized incised plate or onlay island flap technique can be used for mild to moderate chordee with a paper-thin hypoplastic urethra, and the outcome of the tubularized incised plate technique tends to be better than that of the onlay island flap technique. Duckett or staged urethroplasty is suitable for severe chordee with a paper-thin hypoplastic urethra, and the staged technique can improve the overall success rate.

[Ultrasound measurement of the testis volume of 0－14 years old Chinese boys].

OBJECTIVE: To obtain the normative values of the testis volume of 0－14 years old Chinese boys by ultrasound measurement. METHODS: We collected the testicular ultrasound data on 1607 Chinese boys with normal testes between January 2016 and June 2019. The boys were aged 0－14 years and divided into 14 age groups, with at least 100 cases in each group. We compared the mean, standard deviation and median of the testis volume among different age groups. RESULTS: The testis grew slowly in volume before 8 years old (0.372－0.678 ml), faster after 9 years old (1.040－4.600 ml), (1.040 ± 0.970) ml at 9－10 years, (1.876 ± 1.631) ml at 10－11 years, (2.831 ± 2.155) ml at 11－12 years, (3.640 ± 2.376) ml at 12－13 years, and (4.600 ± 3.559) ml at 13－14 years, larger in the 0－1 than in the 1－2 years group (ï¼»0.403 ± 0.130ï¼½ vs ï¼»0.372 ± 0.110ï¼½ ml, P = 0.04), negatively correlated in age between the two groups. CONCLUSIONS: Ultrasonography is an effective method for the measurement of the testis volume, which can provide the normative values of the testis volume of the 0－14 years old Chinese boys and some evidence for clinical diagnosis and consultation.

The advantages of transumbilical single-site laparoscopic percutaneous extraperitoneal closure for inguinal hernia in 1583 children.

BACKGROUND: There have been numerous surgical procedures for inguinal hernia in children, and recently the novel technique of single-site laparoscopic procedure was introduced. This study aimed to analyze the safety and efficacy of single-site laparoscopic hernia repair in a large number of children, while compared with the traditional open surgery. METHODS: From January 2012 to June 2015, we performed transumbilical single-site laparoscopic percutaneous extraperitoneal closure (TSLPEC) in 1583 patients, including bilateral hernia in 135 cases, and unilateral hernia in 1448 cases (left side in 582, right side in 866). From January 2007 to January 2010, we performed open inguinal hernia repair in 355 patients, including bilateral hernia in 52 cases, and unilateral hernia in 303 cases. Operating time, recurrence rate, incidence of contralateral hernia, and prevalence of contralateral patent processus vaginalis (cPPV) were recorded and compared. RESULTS: A total of 1583 patients underwent TSLPEC, without conversion to open surgery. For unilateral repair, the average operating time in TSLPEC group was shorter than open repair group (19.3 ± 6.1 vs. 28.0 ± 8.9, p < 0.05), and it was much shorter than open repair group for bilateral repair (26.2 ± 9.5 vs. 49.8 ± 12.9, P p < 0). The left hernia had higher prevalence of cPPV than right hernia (48.1% vs. 38.5%, p < 0.05). The wound recovered well with good cosmetic appearance in TSLPEC group. Hernia recurrence occurred in seven cases (0.4%) of TSLPEC group, and six cases (1.7%) of open repair group ( p < 00.05). No contralateral hernia developed in TSLPEC group, while 17 cased (5.6%) had contralateral hernia in open repair group ( p < 00.05). CONCLUSIONS: TSLPEC is an effective and safe procedure for inguinal hernias with lots of advantages, including short operating time, simultaneous management of cPPV, excellent cosmetic appearance, low incidence of contralateral hernia, and low recurrence rate. This procedure could be recommended as a routine treatment for inguinal hernias in children.

Yoga Aids Blood Pressure Recovery After Exposure of Forehead to Cold: A Pilot Study.

Context: Hypotension that occurs after a single bout of aerobic exercise also attenuates the vascular response to discrete stressors, an effect that can last for hours. It is unknown whether the hypotensive benefits of traditional exercise extend to alternative forms of mindful exercise, such as yoga, to confer transient protection against neurovascular challenges that increase blood pressure (BP). Objectives: The study intended to examine the effects of acute exercise on neurovascular responses to exposure of the forehead of female yoga practitioners to vasoconstrictive cold (ie, to cold pressor stress). Design: The research team designed a study with 3 conditions (ie, with participants' participation in 3 activities on separate days in a repeated-measures design). Participants were randomly assigned to perform the activities in 1 of 3 orders across successive visits. Participants: Participants were 9 females, 20 to 33 y old, who had regularly practiced Hatha yoga from 6 mo to 12 y before the start of the study. All participants were normotensive at entry to the study and had normal body weights for their heights. Interventions: All participants performed 3 activities: (1) self-directed yoga practice, the intervention; (2) cycling exercise at a self-selected intensity, a positive control; and (3) quiet rest, a negative control. Outcome Measures: Postintervention, participants' foreheads were exposed to cold. Their systolic blood pressures (SBPs), diastolic blood pressures (DBPs), pulse rates, and forearm oxygenation were assessed using near-infrared spectroscopy. Results: Participants' SBPs and DBPs increased during cold pressor stress under all conditions, concurrent with decreased forearm oxygenation. During recovery from the cold, participants' BPs declined to near precold pressor baseline levels after yoga and cycling but remained elevated after quiet rest. Conclusions: The enhanced recovery of BP from cold applied to the forehead after yoga practice or cycling exercise suggests that both types of exercise promote a hypotensive response, which could indicate lowered cardiovascular risk.

PRAMEF12, a novel cancer/testis gene, regulates proliferation and apoptosis to promote progression of glioma.

Aim: To evaluate whether PRAMEF12 can serve as a diagnostic biomarker for glioma. Methods: We examined PRAMEF12 expression in multiple normal and glioma tissues. The diagnostic value of PRAMEF12 was evaluated using receiver operating characteristic curve analysis. The effect of PRAMEF12 ablation on proliferation, cell cycle and apoptosis was investigated. Database analyses were utilized for functional enrichment analysis. Results: PRAMEF12 expression in normal tissue was restricted to the human testis. PRAMEF12 displayed significant diagnostic value in glioma. PRAMEF12 knockdown inhibited cell proliferation, induced apoptosis and resulted in induction of S-phase cell cycle arrest. Pathway enrichment analysis indicated that PRAMEF12 may participate in cancer. Conclusion: PRAMEF12, a novel cancer/testis gene, may be a potential new diagnostic biomarker for glioma.

[Box: see text].

The effect of Tai Chi/Qigong on depression and anxiety symptoms in adults with Cancer: A systematic review and meta-regression.

OBJECTIVE: We expand on prior systematic reviews of Tai chi/Qigong (TCQ) practice on depression or anxiety symptoms in adults with cancer to estimate the mean effect of TCQ on depression and anxiety in randomized controlled trials. Additionally, we perform moderator analysis to examine whether effects vary based on patient features, TCQ stimuli properties, or characteristics of research design. METHODS: Guided by PRISMA guidelines, we located articles published before August 31, 2023 using a combination of electronic database search and a complementary manual search through reference lists of articles and published reviews. Two separate multilevel meta-analyses with random-effects model were employed to estimate the overall effect of TCQ on depression and anxiety respectively. Further, multilevel meta-regression analysis was utilized to examine moderating effects based on moderators derived from patient features, TCQ stimuli properties, or characteristics associated with research design. Meta-analyses were performed in R4.0.0 and certainty of evidence with GRADEpro software. RESULTS: The TCQ intervention yielded a standardized mean effect size of 0.29 (95% CI, 0.18 to 0.40) for anxiety, indicating homogeneity among the included studies. Conversely, for depression, the standardized mean effect size was 0.35 (95% CI, 0.14 to 0.55), signifying heterogeneity: reductions were larger when the trial primary outcome, predominantly function-related outcomes, changed significantly between the TCQ and control group. CONCLUSIONS: TCQ practice exhibits small-to-moderate efficacy in alleviating depression and anxiety symptoms among cancer patients and survivors. Moreover, patients with depressive symptoms for whom TCQ intervention coupled with improvements in function-related outcomes manifested greater antidepressant effect.

Cumulative sum learning curve analysis of tubularized incised plate repair for hypospadias: a study of a single surgeon with a single surgical procedure.

Purpose: To ascertain the quantity of instances by which a single surgeon achieves competency and proficiency in using tubularized incised plate (TIP) technique for the repair of distal and mid-shaft hypospadias using the cumulative sum (CUSUM) analysis. Methods: We retrospectively evaluated patients with distal and mid-shaft hypospadias who were treated by a single surgeon between 2015 and 2021, using a single primary TIP technique with a de-epithelialized Byars flap. Data including type of hypospadias, age at surgery, curvature, operation time (OT), length of the reconstructed urethra, and postoperative outcomes were collected and assessed. CUSUM was used to assess the trends in OT and complication rate (CR) in order to generate the learning curve. The evolution of OT and CR can be divided into three phases: learning, competence, and proficiency. Results: CUSUM identified three phases in the learning curves of all TIP repairs. The median OT decreased from 135 min [interquartile range (IQR) = 125-155] to 92 min (IQR = 80-100) (P < 0.001), CR decreased from 28 (28%) to 8 (5.3%) (P < 0.001), and reoperations decreased from 15 (15.2%) to 4 (2.6%) (P < 0.001). According to the CUSUM learning curve, technical competency plateaued after the 99th case, and both OT and CR entered a significantly declining proficiency phase after the 231st case. Further, when the neourethral length exceeded the total average, total complications, urethrocutaneous fistula, and reoperations increased (P = 0.013, P = 0.006, and P = 0.028, respectively). Conclusions: Our study suggests that surgeons performing TIP repair may reach technical competency and achieve proficiency after operating on 99,231 cases, respectively. Moreover, the longer the neourethral length, the higher is the CR.

The comparative effects of Tai chi versus non-mindful exercise on measures of anxiety, depression and general mental health: A systematic review and meta-analysis.

BACKGROUND: Tai chi has been commonly used as an allied health strategy that can support the improvement of mental health for individuals, yet the comparative effects of Tai chi versus non-mindful exercise on measures of anxiety, depression and general mental health are unknown. This study aims to quantitatively estimate the comparative effects between Tai chi and non-mindful exercise on measures of anxiety, depression, and general mental health and examine whether selected moderators of theoretical or practical importance moderate the effects. METHODS: Consistent with PRISMA guidelines for conduct and reporting, we located articles published before 31 Dec 2021 using Google Scholar, Pubmed, Web of Science, EBSCO (PsycArticles, PsycExtra, PsycInfo, Academic Search Premier, ERIC, MEDLINE). To be included in the analysis, studies were required to have (1) a design that randomly assigned participants to Tai chi and non-mindful exercise comparison condition or group. (2) anxiety, depression, or general mental health outcome measured at baseline and during or after Tai chi and exercise intervention. Study quality was judged using the tool for assessing study quality and reporting in exercise (TESTEX) for randomized controlled trials (RCTs). Three separate multilevel meta-analyses with random effects were performed to estimate the comparative effects of Tai chi versus non-mindful exercise on psychometric measures of anxiety, depression, and general mental health respectively. In addition, possible moderators were assessed accordingly for each meta-analysis. RESULTS: Twenty-three studies that included measures of anxiety (10), depression (14), and general mental health (11) involved 4370 participants (anxiety, 950; depression, 1959; general mental health,1461) and yielded 30 effects on anxiety, 48 on depression, and 27 on general mental health outcomes. Tai Chi training consisted of 1-5 sessions per week, 20-83 min per session, and 6-48 weeks. After adjusting for nesting effects, the results showed significant small-to-moderate effects of Tai chi versus non-mindful exercise on the measure of anxiety (d = 0.28, 95 % CI, 0.08 to 0.48), depression (d = 0.20, 95 % CI, 0.04 to 0.36), and general mental health (d = 0.40, 95 % CI, 0.08 to 0.73). Further moderator analyses showed that baseline general mental health T-score and study quality influenced the effects of Tai chi versus non-mindful exercise on measure of general mental health. CONCLUSION: Compared to non-mindful exercise, the small body of studies reviewed here tentatively supports that Tai chi is more effective in reducing anxiety and depression and improving general mental health than non-mindful exercise. Higher-quality trials are needed to standardize Tai chi and non-mindful exercise exposure, quantify mindfulness elements in Tai chi practice, and control expectations on conditions to better determine the psychological effects of both exercise properties.

Effect of Prolonging the Duration of Stenting on Urethral Stricture in Proximal Hypospadias with Severe Curvature Repair: A Prospective Cohort Study.

INTRODUCTION: The aim of this study was to evaluate whether prolonged stenting reduces the risk of urethral stricture after proximal hypospadias (PH) with severe curvature (SC) repair. MATERIALS AND METHODS: We prospectively studied a cohort of patients with PH with SC repair who underwent urethral plate transection and urethroplasty between January 2010 and December 2020. According to the duration of stenting, the patients were divided into 2-, 4-, and 6-week groups. Postoperative complications and time of urethral stricture occurrence were analyzed. RESULTS: In total, 665 patients were included in the analysis. The overall incidence of complications was 26.6% (n = 177), including 42 cases of urethral strictures: 27 (64.3%) cases of urethral stricture occurred between 4 and 6 weeks after urethroplasty, 7 cases occurred between 7 weeks and 6 months after urethroplasty, 7 cases occurred more than 6 months after urethroplasty, and 1 case occurred at 3 weeks after urethroplasty. The incidence of urethral stricture in the 6-week group (1.8%) was significantly lower than that in the 4- (5.8%) and 2-week groups (10.9%) (p < 0.05). CONCLUSION: Prolonged stenting reduces the risk of urethral stricture in PH with SC repair. Four to six weeks after PH with SC repair may be the key period for the formation of early urethral strictures.

Comparison of Polidocanol Sclerotherapy with Laparoscopic Deroofing in the Management of Pediatric Symptomatic Simple Renal Cysts: A Long-Term Study.

Objective: To compare the efficacy and safety of percutaneous polidocanol sclerotherapy and laparoscopic deroofing in the management of pediatric symptomatic simple renal cysts (SRCs). Methods: Forty-six patients with symptomatic SRCs (cyst size ≥4 cm) were treated either with polidocanol sclerotherapy (group A) or by laparoscopic deroofing (group B) between December 2009 and October 2019. The patients were reevaluated at 1, 6, and 12 months and annually thereafter. Results: Twenty-one patients were treated with polidocanol sclerotherapy (group A) and 25 patients with laparoscopic deroofing (group B). The mean follow-up period was 58.7 months (14-107) in group A and 57.2 months (12-118) in group B. Complete regression was seen in 19 (90.5%) and 24 (96%) patients in groups A and B, respectively (p < 0.05). Partial regression was documented in one patient each in group A (4.8%) and B (4%). In one group A patient, a laparoscopic deroofing was performed due to sclerotherapy failure after 27 months. The operation time, postoperative hospital stay, and cost were significantly less in group A than in group B (36.3 ± 8.4 vs 96.9 ± 19.1, 19.7 ± 2.4 vs 56.0 ± 8.6, and ¥8173 ± 1343 vs ¥14,119 ± 2021, respectively; p < 0.05). Conclusion: Polidocanol sclerotherapy and laparoscopic deroofing were found to be equally effective interventions associated with minimal complications for pediatric symptomatic SRCs. We recommend polidocanol sclerotherapy as the first option for children with symptomatic SRCs and laparoscopic deroofing in cases of failed polidocanol sclerotherapy.

Open Versus Laparoscopic Gubernaculum-Sparing Second-Stage Fowler-Stephens Orchiopexy for Intra-Abdominal Testis: A Long-Term Study.

Background: The benefits of performing open versus laparoscopic gubernaculum-sparing second-stage Fowler-Stephens orchiopexy (FSO) remain unclear. We compared the two techniques to answer this question. Methods: We retrospectively studied a cohort of patients who underwent laparoscopic first-stage FSO and open versus laparoscopic gubernaculum-sparing second-stage FSO at our institution between September 2004 and June 2020 (all patients underwent surgery by a single surgeon). We evaluated both procedures based on the incidence of testicular atrophy, testicular ascent, and other complications. Results: The age at initial surgery was 45.7 ± 28.2 months (median, 39). One hundred nine cases were treated with open second-stage gubernaculum-sparing FSO (OFSO), and 96 cases were treated with laparoscopic second-stage gubernaculum-sparing FSO (LFSO). The mean follow-up period was 59.8 months (median, 54; standard deviation, +35). The overall testicular atrophy rate was 1.5%. Atrophy was observed in 2 and 1 patient in the OFSO and LFSO groups, respectively (1.8% versus 1.0%, P > .05). There was no significant difference in the incidence of testicular ascent between both groups (2.8% versus 3.1%). Five and four complications were noted in the OFSO and LFSO groups, respectively (P > .05). Conclusions: Second-stage gubernaculum-sparing FSO achieved high testicular survival rates and satisfactory testicular positions. Neither the open nor laparoscopic approach appeared superior, because the overall testicular survival rates and incidence of testicular ascent and other complications were equivalent between both groups.

Hypospadias With Severe Chordee: Effect of Urethral Plate Transection on Penile Length.

OBJECTIVE: To present our experience with urethral plate (UP) transection to treat hypospadias with severe chordee and examined the effects of this procedure on penile length. The technique involved transecting the UP to correct curvature, facilitating elongation of penile length and reconstruction of the urethra. METHODS: We prospectively studied a cohort of patients with hypospadias with severe chordee who underwent UP transection and urethroplasty at our institution between February 2012 and March 2020. The length of the UP defect (length of penile elongation), complications, and patient and urologist satisfaction with penile length were analyzed. RESULTS: A total of 510 children were included in our study: 78 cases of distal hypospadias and 432 cases of proximal hypospadias. The mean age at initial surgery was 34.84 ± 20.10 months. The length of the UP defect after transection was 2.51 ± 0.92 cm (1.6-8.0 cm). The length of the UP defect gradually increased with age (P < .05). Seven patients were "poorly satisfied" with their penile length after urethroplasty. The median follow-up duration was 32 months. Of the 510 patients, 108 (21.1%) had complications after urethroplasty, including urethral fistulas in 86 cases, urethral strictures in 9 cases, urethral diverticulum in 8 cases and glans dehiscence in 5 cases. During the follow-up period, 7 patients had mild chordee. CONCLUSION: Transecting the UP for hypospadias with severe chordee can elongate penile length, reduce the recurrence of curvature, and improve patient satisfaction.

The efficacy of topical 0.1% mometasone furoate for treating symptomatic severe phimosis: A comparison of two treatment regimens.

Background: Twice daily 0.1% mometasone furoate is an effective treatment for phimosis in children. However, mometasone furoate has an important therapeutic advantage because it is effective in once-daily applications. This study was to compare the efficacy of two different topical 0.1% mometasone furoate regimens for the treatment of symptomatic severe phimosis in pediatric patients. Methods: A total of 1,689 patients with symptomatic severe phimosis classified by the Kikiros system were prospectively enrolled in the study from March 2018 to February 2021. A total of 855 patients received 0.1% mometasone furoate twice-daily (BID group) and 834 patients received 0.1% mometasone furoate once-daily (QD group) for 4 weeks. Results: A total of 1,595 boys completed the treatment (798 and 797 in the BID and QD groups, respectively). The success rate of the BID group was higher than that of the QD group at the end of week 2 (44.8% vs. 33.3%, P < 0.05), while there was no difference in the success rate at 4 weeks and 3 months between the two groups (70.7% vs. 69.7%, and 66.8% vs. 64.9%, respectively) (P > 0.05). In both treatment groups, the success rate of grade 5 phimosis was lower than that of grade 4 at 2 weeks, 4 weeks, and 3 months. A total of 83 patients experienced recurrence of phimosis. Only fifteen patients had local mild adverse drug reactions. Conclusion: Topical application of 0.1% mometasone furoate once-daily or twice-daily for 4 weeks had comparable efficacy in children with symptomatic severe phimosis. A once a day regimen may be more suitable for children. Topical steroid application is more effective in children with low-grade phimosis than those with high-grade phimosis.

Metabolically healthy obesity was significantly associated with increased risk of gallstones.

OBJECTIVE: The risk of gallstones among metabolically healthy obesity (MHO) individuals is largely unexplored. Therefore, the present study investigated the association between MHO and gallstones in a health check-up cohort of Chinese adults. DESIGN: A prospective cohort study. METHODS: Participants included 58 862 individuals from the MJ health check-up cohort aged ≥ 18 years without a history of gallstones at baseline. Gallstones were diagnosed using abdominal B-type ultrasound. Metabolically healthy was defined as not having any one of the components of metabolic syndrome. Obesity was identified by BMI and waist circumference (WC). Participants were cross-classified at baseline by metabolic health and obesity. Adjusted hazard ratios (HRs) and 95% CIs of gallstones across BMI or WC categories were estimated with Cox proportional hazard regression models. RESULTS: During a median follow-up of 3.0 years (interquartile range, 1.6-6.1), 1269 participants developed gallstones. Individuals with MHO (HR: 1.95, 95% CI: 1.23, 3.09 for BMI criteria; HR: 1.74, 95% CI: 1.37, 2.21 for WC criteria) had a significantly higher risk of gallstones than those with metabolically healthy normal weight. In metabolically healthy individuals, BMI and WC both displayed linear dose-response relationships with gallstones (P for non-linearity >0.05). The association between MHO and gallstones remained unchanged when using different criteria for metabolic health and obesity. CONCLUSIONS: MHO was significantly associated with gallstones, suggesting that obesity can independently contribute to gallstones development, even among metabolically healthy individuals. These findings emphasize that metabolically healthy individuals may still benefit from maintaining normal body weight to prevent gallstones.