A multicenter study on surgical procedure selection and risk factor analysis of postoperative complications after TIP and Duckett hypospadias repair.

BACKGROUND: Hypospadias is a common congenital malformation in pediatric urology with surgery being the only curative treatment. Although there are hundreds of surgical methods for hypospadias, no single method can treat all types, and there are still high rates of postoperative complications. We performed this study to investigate surgical procedure selection and perform risk factor analysis of postoperative complications in hypospadias repair. METHODS: Retrospective analysis was performed of complete clinical and follow-up data of children with hypospadias who were treated and followed up at 15 children's clinical centers in Mainland China from December 2018 to December 2019. Children were divided into groups according to Barcat classification and surgical methods in order to analyze the surgical choice for different types of hypospadias and the influencing factors of different surgical methods for complications. RESULTS: In total, 1011 patients were followed up for 26 months. According to Barcat classification, there were 248 cases of distal type hypospadias, 214 of intermediate, and 549 of proximal type. Transverse preputial island flap urethroplasty (Duckett) and tubularized incised plate urethroplasty (TIP) were performed in 375 (37.1%) and 336 cases (33.2%), respectively. The postoperative complication rate of distal hypospadias was 23.4% (15.8-57.1%), mid shaft 29.0% (22.7-40.0%), and proximal 43.7% (30.2-52.9%). Among the 375 patients in Duckett group, 192 had complications. Multivariate logistic analysis showed that the length of prepuce island flap (OR = 3.506, 95% CI: 2.258-5.442) was an independent risk factor for complications after Duckett operation (P < 0.001). In TIP group, there were 336 cases with 84 complications. Multivariate logistic analysis showed that the width of urethral plate after longitudinal resection (OR = 0.836, 95% CI: 0.742-0.942) and glans width (OR = 0.851, 95% CI: 0.749-0.965) were independent risk factors for postoperative complications after TIP (P = 0.003, P = 0.012). CONCLUSION: Several anatomical features play a role during the selection process among the different surgical approaches, including glans size, urethral plate width, and the meatal position. The width of the urethral plate and glans width were risk factors for postoperative complications after TIP. The length of prepuce island flap was a risk factor for complications after Duckett operation.

Emergency Management of Acute Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.

OBJECTIVES: Acute late-presenting congenital diaphragmatic hernia (CDH) might result in mediastinal shift away from the lesion and even sudden cardiopulmonary arrest. This study aimed to discuss the prompt and effective emergency management of acute late-presenting CDH. METHODS: A retrospective review of acute late-presenting CDH cases in West China Hospital of Sichuan University and Guizhou Provincial People's Hospital from October 2010 to June 2016 was conducted. RESULTS: A total of 22 patients were included in this study. All the patients presented with respiratory symptoms. Chest x-ray revealed swollen stomach and mediastinal shift. After nasogastric tube placement, fluid infusion, and nasal oxygen breathing, the symptoms in 8 patients ameliorated, and 14 patients had no signs of obvious relief. Three patients underwent the bedside percutaneous puncture of distensible stomach, and 1 patient died in the process of emergent management for critical condition. The remaining 21 patients underwent emergency surgery. Five thoracotomies and 16 thoracoscopies were performed. Five thoracoscopies that were converted to thoracotomies were required for the difficult reduction of herniated stomach. At follow-up, all patients improved their condition. CONCLUSIONS: Acute late-presenting CDH is a clinical emergency that can be fatal. The sudden and progressive expansion of the stomach is mainly responsible for this emergent condition. The prompt and effective management is key to decrease the mortality and achieve favorable prognosis.

[Comparison of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in treatment of complete concealed penis].

OBJECTIVE: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. METHODS: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. RESULTS: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation ( P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ 2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ 2=5.13, P=0.03; χ 2=7.53, P=0.01). CONCLUSION: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.

CXCR4-SF1 bifunctional adipose-derived stem cells benefit for the treatment of Leydig cell dysfunction-related diseases.

Stem cell transplantation is a candidate method for the treatment of Leydig cell dysfunction-related diseases. However, there are still many problems that limit its clinical application. Here, we report the establishment of CXCR4-SF1 bifunctional adipose-derived stem cells (CXCR4-SF1-ADSCs) and their reparative effect on Leydig cell dysfunction. CD29+ CD44+ CD34- CD45- ADSCs were isolated from adipose tissue and purified by fluorescence-activated cell sorting (FACS). Infection with lentiviruses carrying the CXCR4 and SF1 genes was applied to construct CXCR4-SF1-ADSCs. The CXCR4-SF1-ADSCs exhibited enhanced migration and had the ability to differentiate into Leydig-like cells in vitro. Furthermore, the bifunctional ADSCs were injected into BPA-mediated Leydig cell damage model mice via the tail vein. We found that the CXCR4-SF1-ADSCs were capable of homing to the injured testes, differentiating into Leydig-like cells and repairing the deficiency in reproductive function caused by Leydig cell dysfunction. Moreover, we investigated the mechanism underlying SF1-mediated differentiation and testosterone synthesis in Leydig cells, and the B-box and SPRY Domain Containing Protein (BSPRY) gene was proposed to be involved in this process. This study provides insight into the treatment of Leydig cell dysfunction-related diseases.

Thoracoscopic Treatment of Late-Presenting Congenital Diaphragmatic Hernia in Infants and Children.

PURPOSE: Given that the application of thoracoscopic surgery to late-presenting congenital diaphragmatic hernia (CDH) in infants and children is controversial, we summarized our experiences with patients at two medical centers and aimed to discuss the safety and feasibility of thoracoscopic repair. MATERIALS AND METHODS: A retrospective review of late-presenting CDH cases involving patients who underwent thoracoscopic repair from October 2010 to June 2017 was performed. Data, including patients' demographic characteristics, manipulative details, and postoperative complications, were extracted and analyzed. RESULTS: A total of 59 cases were included in this study. Patients ranged in age from 2 months to 8 years (mean: 18 months). Twenty-five patients presented with shortness of breath and dyspnea. Furthermore, 34 cases were found occasionally. Forty-six left-sided hernias and 13 right-sided hernias were found. Operating time ranged from 30 to 100 minutes (mean: 55 minutes), and the amount of blood loss was 3-5 mL (mean: 3.8 mL). The size of the diaphragmatic defect ranged from 2 × 2 cm to 5 × 8 cm. The chest tubes were taken out within 24 hours. The average length of postoperative hospital stay was 5.2 ± 0.4 days (range: 4-6 days). The length of the follow-up period ranged from 3 months to 3 years (mean: 18 months), with no recurrences. CONCLUSION: Thoracoscopic repair of late-presenting CDH is a safe and efficacious technique. It can facilitate the procedure and decrease the recurrence rate by shifting the focus to operative details. The prognosis is excellent once the correct operative details are achieved.

ZNF32 induces anoikis resistance through maintaining redox homeostasis and activating Src/FAK signaling in hepatocellular carcinoma.

Tumor cells need to attain anoikis resistance to survive prior to metastasis making it a vital trait of malignancy. The molecular mechanism by which hepatocellular carcinoma (HCC) cells resist anoikis remains not fully understood. Here, we report that ZNF32 expression is markedly upregulated in HCC cells upon detachment. Enforced ZNF32 expression significantly promotes the anchorage-independent growth capability of HepG2 and Huh7 cells, whereas knockdown of ZNF32 results in increased apoptosis of HCC cells after detachment. Mechanistically, we demonstrate that ZNF32 overexpression suppresses the reactive oxygen species (ROS) accumulation and maintains mitochondrial membrane potential, leading to ATP, GSH and NADPH elevation and promoting HCC cell survival in response to suspension. Moreover, ZNF32 enhances the phosphorylation and activation of Src/FAK signaling. Src and FAK inhibitors effectively reverse ZNF32-induced anoikis resistance in HCC cells. Collectively, our findings not only reveal a novel and important mechanism by which ZNF32 contributes to anoikis resistance through maintaining redox homeostasis and activating Src/FAK signaling, but also suggest the potential therapeutic value of ZNF32 in HCC patients.

The tumor suppressor role of microRNA-338-3p in renal cell carcinoma.

Human renal cell carcinoma (RCC) is the most common type of kidney malignancy in adults accounting for 2-3% of all adult malignancies. In China, RCC accounts for ~0.5% of all cancer-associated mortalities, ranking 16th among all cancer types. For early-stage RCC, surgery is the recommended treatment. Molecularly targeted therapy is the preferred first-line treatment for clear-cell RCC. However, more potential targets are required. MicroRNA-338-3p (miR-338-3p) functions as a tumor suppressor in various cancers, but has not been studied in RCC. Accordingly, the present study investigated the role of miR-338-3p of RCC. It was demonstrated that miR-338-3p was present at low levels in RCC tissues. Also, overexpression of miR-338-3p inhibited cell proliferation and promoted cell apoptosis, and downregulation of miR-338-3p promoted cell proliferation. The 3' untranslated region of AKT serine/threonine kinase 3 was targeted by miR-338-3p. In conclusion, the data of the present study revealed the inhibitory function of miR-338-3p in RCC and suggested that miR-338-3p is novel therapeutic target for RCC, but further investigation is needed.

A high-fat diet impairs reproduction by decreasing the IL1ß level in mice treated at immature stage.

Obesity causes low-grade inflammation that is involved in male infertility. Interleukin 1 beta (IL1ß) plays an important role in this process. A high-fat diet (HFD) is the most common cause of obesity. However, the effect of a HFD on IL1ß and its consequence in reproduction remain unclear. We established a HFD model in mice treated at immature stage (mice-TIS) and mice treated at mature stage (mice-TMS). Surprisingly, we found that a HFD decreased IL1ß levels and was accompanied by an increase in testosterone in mice-TIS, while the reverse results were observed in mice-TMS. In addition, a HFD caused a reduction in testis macrophages and in the expression of inflammasome-related genes and proteins in mice-TIS. Furthermore, we found that IL1ß inhibited testosterone secretion through down-regulating the gene expression of P450SCC and P450c17. However, the influence on mice-TIS that were induced by a HFD was recovered by stopping the HFD. In this study, we are the first to report that a HFD impairs the reproductive system by decreasing IL1ß and enhancing testosterone levels in mice-TIS, which are different from the effects in mice-TMS. This provides new ideas for the treatment of obesity-induced infertility.

DDX17 nucleocytoplasmic shuttling promotes acquired gefitinib resistance in non-small cell lung cancer cells via activation of ß-catenin.

Although epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are effective for non-small cell lung cancer (NSCLC) patients with EGFR mutations, almost all these patients will eventually develop acquired resistance to EGFR-TKI. However, the molecular mechanisms responsible for gefitinib resistance remain still not fully understood. Here, we report that elevated DDX17 levels are observed in gefitinib-resistant NSCLC cells than gefitinib-sensitive cells. Upregulation of DDX17 enhances the gefitinib resistance, whereas DDX17-silenced cells partially restore gefitinib sensitivity. Mechanistically, we demonstrate that DDX17 disassociates the E-cadherin/ß-catenin complex, resulting in ß-catenin nuclear translocation and subsequently augmenting the transcription of ß-catenin target genes. Moreover, we identify two nuclear localization signal (NLS) and four nuclear export signal (NES) sequences mediated DDX17 nucleocytoplasmic shuttling via an exportin/importin-dependent pathways. Interruption of dynamic nucleocytoplasmic shuttling of DDX17 impairs DDX17-mediating the activation of ß-catenin and acquired resistance in NSCLC cells. In conclusion, our findings reveal a novel and important mechanism by which DDX17 contributes to acquired gefitinib resistance through exportin/importin-dependent cytoplasmic shuttling and followed by activation of ß-catenin, and DDX17 inhibition may be a promising strategy to overcome acquired resistance of gefitinib in NSCLC patients.

ZNF32 contributes to the induction of multidrug resistance by regulating TGF-ß receptor 2 signaling in lung adenocarcinoma.

Multidrug resistance (MDR) is one of the most important contributors to the high mortality of cancer and remains a major concern. We previously found that zinc finger protein 32 (ZNF32), an important transcription factor associated with cancer in Homo sapiens, protects tumor cells against cell death induced by oxidative stress and other stimuli. We thus hypothesized that ZNF32 might enable the tolerance of cancer cells to anti-tumor drugs because higher ZNF32 expression has been found in cancer tissues and in drug-resistant lung adenocarcinoma (AC) cells. In this study, we found that ZNF32 is upregulated by Sp1 (specificity protein 1) in response to drug treatment and that ZNF32 promotes drug resistance and protects AC cells against cisplatin or gefitinib treatment. ZNF32 overexpression in AC cells conferred resistance to EGFR (epidermal growth factor receptor) inhibitors by enhancing MEK/ERK activation. Moreover, ZNF32 was found to directly bind to the TGF-ßR2 (transforming growth factor-beta receptor 2) promoter to promote its expression, and ZNF32-induced resistance was mediated by enhancing TGF-ßR2 expression and activating the TGF-ßR2/SMAD2 pathway. In both a mouse model and ex vivo cultured patient samples, a high level of ZNF32 expression was closely associated with worse overall survival and cisplatin resistance. ZNF32 appears to be a potential inducer of drug resistance that could increase the expression of the drug resistance-associated gene TGF-ßR2 and subsequently facilitate the induction of drug resistance during both conventional chemotherapy and novel target therapy. Thus, ZNF32-associated target therapy is a potential novel adjuvant therapy that might effectively prevent the occurrence of multidrug resistance (MDR) during chemotherapy and improve the survival of patients with AC.

IL-6 mediates differentiation disorder during spermatogenesis in obesity-associated inflammation by affecting the expression of Zfp637 through the SOCS3/STAT3 pathway.

Zfp637 is a recently identified zinc finger protein, and its functions remain largely unknown. Here, we innovatively demonstrate the effects of Zfp637 on the differentiation of mouse spermatogonia and on its downstream target gene SOX2 in vitro. Obesity has been recognized as a chronic inflammatory disease that leads to decreased sexual function and sexual development disorders. We observed higher levels of IL-6 in serum and testis homogenates from obese mice compared with control mice. We also demonstrated that high levels of IL-6 inhibited Zfp637 expression, and we elucidated the underlying mechanisms. SOCS3 overexpression and STAT3 phosphorylation inhibitor (AG490) were used to investigate the function of the SOCS3/STAT3 pathway during this process. Our results showed that exposure of mouse spermatogonial cells to high levels of IL-6 inhibited Zfp637 expression by increasing SOCS3 expression and inhibiting the phosphorylation of STAT3, further reducing cellular differentiation. Consistent with the in vitro results, we observed increasing expression levels of SOCS3 and SOX2, but a reduction of Zfp637 expression, in obese mouse testes. In conclusion, Zfp637 plays a crucial role in spermatogenesis by downregulating SOX2 expression, and IL-6 can decrease the expression of Zfp637 through the SOCS3/STAT3 signaling pathway.

A New Modification of the Koyanagi Technique for the One-stage Repair of Severe Hypospadias.

OBJECTIVE: To describe a new modification of the Koyanagi technique for the one-stage repair of severe hypospadias and its short-term outcomes. PATIENTS AND METHODS: Our modified Koyanagi technique was performed in 24 patients with severe hypospadias between February 2012 and January 2015. The age of the patients ranged from 1.9 to 11.9 years (mean = 3.5 years). The flap design was similar to the Koyanagi technique, but our modified technique highlighted the following points: after the chordee was completely corrected, the urethral plate was recreated using foreskin, and then a U-shaped incision was made on the original and recreated urethral plate (as in the Duplay technique); a pedicled flap of the tunica vaginalis or scrotal dartos was used for additional coverage of the neourethra. RESULTS: The operation time lasted from 120 to 150 minutes (mean = 140 minutes). There were 5 patients (20.8%) who developed complications: 4 patients (16.7%) developed a fistula and 1 patient (4.2%) developed dehiscence of the urethra. There were no reported urethral strictures, meatal stenosis, or urethral diverticula. The complications in the 5 patients were successfully addressed with secondary repair, and all patients achieved satisfactory cosmetic and urethral functional results. CONCLUSION: The modified Koyanagi technique simplified the operation and better preserved the blood supply to the flap. The additional coverage of the neourethra using a pedicled flap of the tunica vaginalis or scrotal dartos significantly decreased the rate of fistula formation. This technique is highly suitable for the one-stage repair of severe hypospadias with penoscrotal transposition.

[OBSERVATION OF EFFECTIVENESS OF THORACOSCOPIC SURGERY FOR LATEPRESENTING CONGENITAL DIAPHRAGMATIC HERNIA].

OBJECTIVE: To explore the effectiveness of thoracoscopic surgery for treating late-presenting congenital diaphragmatic hernias and summarize the experience. METHODS: Between October 2012 and February 2015, 21 children with late-presenting congenital diaphragmatic hernias underwent thoracoscopic surgery. Of the 21 cases, 12 were girls and 9 were boys with a median age of 1 year and 3 months (range, 2 months to 8 years). Eight patients had obvious symptom in the initial stage:shortness of breath and dyspnea; 13 cases were found occasionally through chest radiography. Of 21 cases, 17 had left diaphragmatic hernias and 4 had right diaphragmatic hernias. The emergency surgery was performed in 5 cases because oppressed obviously and selective operation in 16 cases. Hernial sac existed in 5 cases; there were 19 cases of Bochdalek's hernia and 2 cases of Morgagni's hernia. The size of diaphragmatic defect ranged from 3 cm×2 cm to 5 cm×5 cm. RESULTS: The operation time was 35-80 minutes (mean, 50 minutes), and intraoperative blood loss was 3-5 mL (mean, 3.8 mL). Primary healing of incision was obtained. Postoperative abdominal distension and pneumothorax occurred in 12 and 2 cases respectively. The follow-up time was 1-3 years (mean, 20 months). All the cases had a good recovery and satisfactory appearance of the thoracic incision. The symptoms and signs of shortness of breath and dyspnea disappeared. There was no recurrence and chest infection. CONCLUSIONS: Under the conditions of mastering operative indications strictly, thoracoscopic repair for late-presenting congenital diaphragmatic hernia is safe and feasible. It can facilitate the procedure and decrease the recurrence rate relying on intraoperative application of hernia repair needle, knot pusher-assistant, and reasonable processing defect periphery.

[CLITOROPLASTY FOR GENITAL VIRILIZATION IN GIRLS WITH CONGENITAL ADRENAL HYPERPLASIA].

OBJECTIVE: To investigate the effectiveness of clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate for genital virilization in girls with congenital adrenal hyperplasia (CAH). METHODS: Between June 2000 and October 2015, 27 girls with genital virilization were treated with clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate. The chromosomal karyotype was 46, XX in all patients, whose age ranged from 3 to 11 years (mean, 3.9 years). According to Parder's virilization scale, 5 cases were classified as stage Ⅱ, 18 cases as stage Ⅲ, and 4 cases as stage Ⅳ. The hormone tests showed decreased cortisol level and increased testosterone and 17-hydroxyprogesterone levels. They were diagnosed with non-salt-wasting CAH. RESULTS: All of the patients underwent clitoroplasty successfully. The mean operation time was 74 minutes (range, 58-95 minutes). Incision healed primarily. The patients were followed up 6 months to 10 years (median, 19 months). The external genitalia had good appearance, without necrosis of flap and the glans clitoris, abnormal sensation of the glans clitoris, or clitorism recurrence. Five girls had breast development and normal menstrual cycle during adolescence, and 1 patient who was followed up for 10 years gave birth to a son. CONCLUSIONS: Clitoroplasty of reserving the clitoris dorsal neurovascular bundle and the ventral complete urethral plate is a relatively ideal method for treating genital virilization in girls. It has less complications, good aesthetic and functional results. There are satisfactory outcomes when combining with the endocrine treatment.

[PREPUTIAL PEDICLED FLAP PHALLOPLASTY FOR REPAIR OF SEVERE WEBBED PENIS].

OBJECTIVE: To evaluate the effectiveness of preputial pedicled flap phalloplasty for repair of severe webbed penis. METHODS: Between May 2011 and May 2015, 23 boys with severe webbed penis were treated. The age ranged from 2 years and 8 months to 8 years and 3 months (mean, 4 years and 8 months). According to El-Koutby & El Gohary classification, 14 cases were rated as grade 3 simple webbed penis and 9 cases as compound webbed penis (2 cases of type 1, 2 cases of type 2, and 5 cases of type 3). The penis length was 2.1-5.4 cm (mean, 3.4 cm), and the penoscrotal angle was 130-160° (mean, 144°). All the glans could not be exposed. No other urinary system diseases and no history of penile surgery were found in children. All cases underwent one stage preputial pedicled flap phalloplasty. RESULTS: After successful correction, the penis length was 3.6-6.4 cm (mean, 4.7 cm); the penoscrotal angle was 90-110° (mean, 97°). Clear skin boundaries were observed at penile and scrotal parts. No web skin or scrotal skin was left on the penis. Primary healing of incision was obtained, with no necrosis of the flap or infection. All cases were followed up 12 to 41 months (mean, 25 months). No penile curvature, abnormal sensation of glans, or recurrence of the penoscrotal angle occurred, and the patients had normal urination. CONCLUSIONS: Preputial pedicled flap phalloplasty can be used as one stage repair for severe webbed penis. The penis is close to natural state and had satisfactory appearance, avoiding the possibility of long-term edema and penile curvature.

ZNF32 protects against oxidative stress-induced apoptosis by modulating C1QBP transcription.

Reactive oxygen species (ROS)-driven oxidative stress has been recognized as a critical inducer of cancer cell death in response to therapeutic agents. Our previous studies have demonstrated that zinc finger protein (ZNF)32 is key to cell survival upon oxidant stimulation. However, the mechanisms by which ZNF32 mediates cell death remain unclear. Here, we show that at moderate levels of ROS, Sp1 directly binds to two GC boxes within the ZNF32 promoter to activate ZNF32 transcription. Alternatively, at cytotoxic ROS concentrations, ZNF32 expression is repressed due to decreased binding activity of Sp1. ZNF32 overexpression maintains mitochondrial membrane potential and enhances the antioxidant capacity of cells to detoxify ROS, and these effects promote cell survival upon pro-oxidant agent treatment. Alternatively, ZNF32-deficient cells are more sensitive and vulnerable to oxidative stress-induced cell injury. Mechanistically, we demonstrate that complement 1q-binding protein (C1QBP) is a direct target gene of ZNF32 that inactivates the p38 MAPK pathway, thereby exerting the protective effects of ZNF32 on oxidative stress-induced apoptosis. Taken together, our findings indicate a novel mechanism by which the Sp1-ZNF32-C1QBP axis protects against oxidative stress and implicate a promising strategy that ZNF32 inhibition combined with pro-oxidant anticancer agents for hepatocellular carcinoma treatment.

[CLINICAL EXPERIENCE IN DIAGNOSIS AND MANAGEMENT OF COMPLETE DUPLICATION OF KIDNEY AND URETER IN 106 CHILDREN].

OBJECTIVE: To discuss the clinical classification and treatment protocols of complete duplication of kidney and ureter in children. METHODS: Between March 2000 and February 2015, 106 children with complete duplication of kidney and ureter were treated, and the clinical data were retrospectively analyzed. Of them, there were 11 boys and 95 girls, aged from 1 month to 11 years (mean, 3.5 years); one side was involved in 88 cases and two sides in 18 cases. They were divided into 4 types according to image examinations and clinical presentations: 14 patients who needed no special treatment were classified into the first type, 15 patients who underwent reconstruction into the second type, 74 patients who underwent segment removal of renal dysplasia and subtotal excision of abnormal duplicated ureter into the third type, and 3 patients who underwent removal of the whole affected kidney and subtotal excision of whole ureter into the forth type. RESULTS: The patients were followed up 2 months to 14 years (median, 23 months). There was no deteriorating case in the first type. There was no complication such as leakage of urine, discomfort over the back and loins, ureterocele, reproductive tract infection, or hematuresis in the other types. The results of white blood cell count, renal function, and electrolyte presented no abnormality. One patient in the second type and 6 patients in the third type had ureteral stump syndrome; 1 patient in the second type and 3 patients in the third type had urinary tract infection; and 3 patients in the second type had mild hydronephrosis after operation. CONCLUSION: It can obtain good clinical outcome to choose individualized treatment according to clinical classification of complete duplication of kidney and ureter, which can reserve effective renal units as much as possible and improves the patients' quality of life.

[MODIFIED Politano-Leadbetter REIMPLANTATION FOR TREATMENT OF CONGENITAL MALFORMATION OF VESICOURETERAL JUNCTION IN CHILDREN].

UNLABELLED: Corresponding author: HUANG Lugang, E-mail: lugang992001@aliyun.com OBJECTIVE: To explore the effectiveness of modified Politano-Leadbetter reimplantation for the treatment of congenital malformation of the vesicoureteral junction in children. METHODS: A retrospective analysis was made on the clinical data of 53 patients with congenital malformation of the vesicoureteral junction treated with modified Politano-Leadbetter reimplantation between June 2000 and October 2014. Of 53 cases, there were 24 boys and 29 girls, aged from 8 months to 7 years (mean, 2.1 years); 23 had congenital vesicoureteral junction obstruction (14 left, 5 right, and 4 bilateral), and 30 had vesicoureteral reflux (12 unilateral, 18 bilateral), which were verified by voiding cystourethrography. The disease duration was from 1 month to 1 year (mean, 5 months). RESULTS: All of the patients underwent modified Politano-Leadbetter reimplantation successfully. The mean operation time was 74 minutes (range, 65-85 minutes) for unilateral cases and 105 minutes (range, 98-130 minutes) for bilateral cases. There was no dysuria, infection of incision, or incision dehiscence after urinary catheter removal. The follow-up time was 6 months to 14 years (median, 28 months); all patients were free from complications of fistula, vesicoureteral reflux, vesicoureteral junction obstruction, or hypertension. The new ureteral orifices had good appearance at 1 month after operation. Urologic ultrasound showed that hydronephrosis relieved at 3 months after operation. Urinary tract infection rate was 13.2% (7/53) during 6 months after operation, which was cured by antibiotics. Voiding cystourethrography showed no vesicoureteral reflux in 32 cases at 6 months after operation. CONCLUSION: The modified Politano-Leadbetter reimplantation simplifies he operation course, which has the longitudinal ureter after operation and is similar to physiological state. It is a safe and effective option for congenital malformation of vesicoureteral junction in children with few complications, especially for patients with unilateral megaloureter.