Treatment guidelines for persistent cloaca, cloacal exstrophy, and Mayer-Rokitansky-Küster-Häuser syndrome for the appropriate transitional care of patients.

We developed treatment guidelines (TGs) for appropriate transitional care of the genitourinary system in patients with persistent cloaca (PC), cloacal exstrophy (CE), or Mayer-Rokitansky-Küster-Häuser syndrome (MRKH). These TGs are in accordance with the Medical Information Network Distribution Service (Minds), published in 2014 in Japan. Clinical questions (CQs) concerning treatment outcomes of the genitourinary system, pregnancy and delivery, and quality of life in adulthood were prepared as six themes for PC and CE and five themes for MRKH. We were able to publish statements on chronic renal dysfunction, hydrometrocolpos, and pregnancy, based on four CQs about PC, four about CE, and two about MRKH, respectively. However, due to the paucity of proper manuscripts, we were unable to make conclusions about the correct timing and method of vaginoplasty for patients with PC, CE, and MRKH or the usefulness of early bladder closure for patients with CE. These TGs may help clarify the current treatments for PC, CE, and MRKH in childhood, which have been carried out on an institutional basis. To improve clinical outcomes, systematic clinical trials revealing comprehensive clinical data of the urinary and reproductive systems, especially the length of the common channel in PC, are essential.

Equilibrium surface tension, dynamic surface tension, and micellization properties of lactobionamide-type sugar-based gemini surfactants.

A sugar-based gemini surfactant N,N'-dialkyl-N,N'-dilactobionamideethylenediamine (2C(n)Lac, where n represents alkyl chain lengths of 8, 10, 12, and 14) was synthesized by reacting N,N'-dialkylethylenediamine with lactobionic acid. The adsorption properties of 2C(n)Lac were characterized by equilibrium and dynamic surface tension measurements. Their micellization properties were investigated by steady-state fluorescence using pyrene as a probe and dynamic light scattering (DLS) techniques. The dependence of these properties on the alkyl chain length and the number of sugars was determined through a comparison with the corresponding monomeric surfactants C(n)MLA and previously reported sugar-based gemini surfactants containing monosaccharide gluconamide or disaccharide lactobionamide groups with a hexanediamide spacer. The critical micelle concentration (cmc) and surface tension of 2C(n)Lac are both lower than those of C(n)MLA surfactants. These lower values indicate that the synthesized sugar-based gemini surfactants have excellent micelle-forming ability in solution and high adsorption ability at the air-water interface, which result from strong interactions of the hydrogen bonds between the hydroxyls in lactobionamide groups. When the alkyl chain length of 2C(n)Lac increases to 14, premicellar formation occurs in the solution along with adsorption at the air-water interface at concentrations below the cmc. Furthermore, 2C(n)Lac forms micelles measuring 4 to 12 nm in solution, with no dependence on the alkyl chain length, and their size slightly increases with increasing concentration.