Engineering Enhanced Antimicrobial Properties in α-Conotoxin RgIA through D-Type Amino Acid Substitution and Incorporation of Lysine and Leucine Residues.

Antimicrobial peptides (AMPs), acknowledged as host defense peptides, constitute a category of predominant cationic peptides prevalent in diverse life forms. This study explored the antibacterial activity of α-conotoxin RgIA, and to enhance its stability and efficacy, D-amino acid substitution was employed, resulting in the synthesis of nine RgIA mutant analogs. Results revealed that several modified RgIA mutants displayed inhibitory efficacy against various pathogenic bacteria and fungi, including Candida tropicalis and Escherichia coli. Mechanistic investigations elucidated that these polypeptides achieved antibacterial effects through the disruption of bacterial cell membranes. The study further assessed the designed peptides' hemolytic activity, cytotoxicity, and safety. Mutants with antibacterial activity exhibited lower hemolytic activity and cytotoxicity, with Pep 8 demonstrating favorable safety in mice. RgIA mutants incorporating D-amino acids exhibited notable stability and adaptability, sustaining antibacterial properties across diverse environmental conditions. This research underscores the potential of the peptide to advance innovative oral antibiotics, offering a novel approach to address bacterial infections.

Whole-exome sequencing reveals mutational profiles of anorectal and gynecological melanoma.

Mucosal melanoma is a rare and highly malignant type of melanoma. Among the sites that mucosal melanoma arises, anorectal and gynecological melanoma has more aggressive behavior and worse prognosis. There was no effective therapy for mucosal melanoma at present. Only a small number of mucosal melanoma patients which harbor mutations in BRAF or KIT benefit from targeted therapy. So it's an urgent need to identify more actionable mutations in mucosal melanoma. To identify more potential therapeutic targets in mucosal melanoma, 48 samples were collected from 44 patients with anorectal or gynecological melanoma and subjected to whole-exome sequencing. The tumor mutation burden was low with a median of 1.75 mutations per Mb. In chromosomal level, 1q, 6p and 8q of mucosal melanoma were significantly amplified while 9p, 10p, 10q, 16p and 16q were significantly deleted. Muc16 was the most frequently mutated oncogene in our samples(25%). The mutation frequency of KIT(20%) was comparable to the "triple-wild" genes-NRAS(20%), NF1(20%), and BRAF(11%). KMT2D mutation was found in 18.18% patients, which is previously unidentified. MAPK signaling pathway and lysine degradation were the most frequently mutated pathways. Moreover, patients with TP53 mutations tend to have worse clinical outcome (median survival time 19 vs. 50 months, log-rank P = 0.006). 2000 ore mutated genes involved in MAPK signaling pathway were identified, which expand the patients potentially benefit from ample MAPK inhibitors. KMT2D could be a potential therapeutic target. Moreover, TP53 could be a potential prognosis marker for mucosal melanoma.

Long-term outcomes in a retrospective cohort of patients with rectal cancer with complete response after total neoadjuvant therapy: a propensity-score weighted analysis.

Background: The watch-and-wait (W&W) strategy is a novel treatment option for patients with rectal cancer who have a strong desire for organ preservation. The study aimed to explore the long-term outcomes of the W&W strategy in a large cohort of rectal cancer patients who achieved a clinical complete response (cCR) after consolidation total neoadjuvant therapy (TNT), and to compare with patients who achieved a pathological complete response (pCR) after radical surgery. Methods: The W&W group comprised patients who were assessed as having a cCR after consolidation TNT and adopted the W&W strategy. Patients who underwent standard resection and achieved a pCR were compared as a reference. Inverse probability of treatment weighting (IPTW)-adjusted Kaplan-Meier analysis with log-rank test was used to compare survival outcomes. Results: We included 89 and 171 patients in the W&W and pCR groups, respectively. The median follow-up period was 45 and 58 months for the W&W and pCR groups, respectively. After IPTW adjustment, the 2-year local regrowth/recurrence rate for the W&W and pCR groups were 9.9% and 2.0%, respectively (p < 0.001). The W&W and pCR groups had similar 5-year outcomes, including overall survival, disease-free survival, and distant metastasis-free survival (all p > 0.05). No significant difference was observed in the rates of distant metastasis between patients in the W&W group with local regrowth and those without local regrowth (25% versus 6.2%, p = 0.119). Conclusion: Patients who were managed with a W&W strategy after consolidation TNT had favorable survival outcomes, which were similar to those of patients with a pCR. The rate of local regrowth in W&W patients was lower in our study than in other studies as a result of the implementation of consolidation TNT.

Comprehensive Review of Phytochemical Profiles and Health-Promoting Effects of Different Portions of Wampee (Clausena lansium).

Clausena lansium, commonly known as wampee, is a subtropical fruit from the Rutaceae family characterized by its high nutrient content and numerous bioactive substances. This low-fat fruit is abundant in fiber, vitamins, minerals, and essential amino acids. Wampee has been found to contain several bioactive compounds, including essential oils, phenolic compounds, and alkaloids. These bioactive constituents provide numerous health-enhancing properties, such as antioxidant, neuroprotective, anticarcinogenic, anti-inflammatory, hepatoprotective, antidiabetic, and antimicrobial effects. The relationship between these compounds and their impacts on health has been explored in various studies. While the disease-prevention efficacy of C. lansium has been established, additional research is necessary to elucidate the precise mechanisms and metabolic pathways involved. This paper presents a comprehensive review of wampee, focusing on its bioactive compounds, the beneficial effects derived from its consumption, and the evidence supporting the development of wampee-based functional foods in future studies.

GLP-1 Receptor Agonists: Beyond Their Pancreatic Effects.

Glucagon like peptide-1 (GLP-1) is an incretin secretory molecule. GLP-1 receptor agonists (GLP-1RAs) are widely used in the treatment of type 2 diabetes (T2DM) due to their attributes such as body weight loss, protection of islet ß cells, promotion of islet ß cell proliferation and minimal side effects. Studies have found that GLP-1R is widely distributed on pancreatic and other tissues and has multiple biological effects, such as reducing neuroinflammation, promoting nerve growth, improving heart function, suppressing appetite, delaying gastric emptying, regulating blood lipid metabolism and reducing fat deposition. Moreover, GLP-1RAs have neuroprotective, anti-infectious, cardiovascular protective, and metabolic regulatory effects, exhibiting good application prospects. Growing attention has been paid to the relationship between GLP-1RAs and tumorigenesis, development and prognosis in patient with T2DM. Here, we reviewed the therapeutic effects and possible mechanisms of action of GLP-1RAs in the nervous, cardiovascular, and endocrine systems and their correlation with metabolism, tumours and other diseases.

Association Between Three-Dimensional Transrectal Ultrasound Findings and Tumor Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: An Observational Study.

BACKGROUND: There is a significant demand for the development of non-surgical methods for the evaluation of complete response to tumor therapy. Predicting ability and image quality of routine imaging has not been satisfactory. To avoid the deficiencies, we assessed the capability of three-dimensional transrectal ultrasound in predicting the response to neoadjuvant chemoradiotherapy in rectal cancer patients. METHODS: The inclusion criteria were patients with locally advanced rectal adenocarcinoma, receiving capecitabine-based neoadjuvant chemoradiotherapy, distance from anal verge (≤6 cm), clinical stage T3-4 and/or N+ without evidence of distant metastasis, and restaging ycT0-3a (T3a <5 mm) after the end of neoadjuvant chemoradiotherapy. Three-dimensional transrectal ultrasound was performed 7 weeks after neoadjuvant chemoradiotherapy to discern the patients with complete response from the others. Eight main parameters were obtained from three-dimensional transrectal ultrasound: thickness of muscularis on the residual side, thickness of contralateral muscularis, angle of residual arc, regularity of the shape, integrity of the mucosal layer, blurring of the margin, internal echo, and posterior echo. The association between tumor response and three-dimensional transrectal ultrasound parameters was analyzed, and a model was developed by logistic regression. RESULTS: Between 2014 and 2019, 101 patients were recruited; 72 cases received total mesorectal excision, and 29 cases underwent watch-and-wait. Among the three-dimensional transrectal ultrasound parameters, the adjusted-thickness of the muscularis (P<0.01), angle of the residual arc (P<0.01), and regularity of the residual shape (P<0.01) were strongly associated with tumor response. In the dataset with total mesorectal excision cases (TME dataset), the residual adjusted-thickness (odds ratio [OR]=4.88, 95% confidence interval [CI]=1.44-16.6, P=0.01) and regularity of the residual shape (OR=5.00, 95% CI=1.13-22.2, P=0.03) were kept in the final logistic model. The area under the curve of the logistic model was 0.84. Among these parameters, residual adjusted-thickness correlated significantly with tumor response. Additionally, we observed similar results in the whole population of 101 cases (whole dataset) and in the cross-validation. CONCLUSION: Three-dimensional transrectal ultrasound model is a valuable method for predicting tumor response in rectal cancer patients undergoing neoadjuvant chemoradiotherapy, which should be included as a factor for evaluating clinical complete response. TRIAL REGISTRATION: This trial was registered with ClinicalTrials.gov, number NCT02605265. Registered 9 November 2015 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT02605265.

Grade G2 Rectal Neuroendocrine Tumor Is Much More Invasive Compared With G1 Tumor.

BACKGROUND: To compare clinicopathologic feature of rectal neuroendocrine tumor (NET) grade G1 with G2 NET. METHODS: Six hundred-one cases of rectal G1 and G2 NETs diagnosed in our center were analyzed. RESULTS: Of 601 cases of rectal NET, 515 cases were with grade G1 and 86 cases were with grade G2. Median tumor size was 0.7 cm. Compared with G1 NET, G2 tumors were with significantly larger tumor size (0.8 vs 2.2 cm, p < 0.001), less percentages of patients with tumors confined to submucosa (92.6 vs 42.8%, p < 0.001), more frequent presence of microvascular invasion (MVI) (3.6 vs 16.9%, p < 0.001) or peri-neural invasion (PNI) (2.0 vs 24.1%, p < 0.001). Incidence of lymph node and distant metastasis was 5.2 and 2.1% in G1 NET compared with 44.2 and 31.4% in G2 tumor, respectively (p < 0.001). For tumors sized 1-2 cm and confined to submucosa, incidence of lymph node metastasis was 6.1% for G1 NET compared with 21.1% for G2 NET. Status of MVI/PNI was predictive of lymph node metastasis for G2 tumor rather than G1 NET in this subgroup. CONCLUSIONS: Rectal G2 NET was much more invasive with significantly elevated prevalence of lymph node metastasis compared with G1 tumor.

Very Early Colorectal Anastomotic Leakage within 5 Post-operative Days: a More Severe Subtype Needs Relaparatomy.

Early anastomotic leakage (AL), usually defined as leakage within 30 post-operative days, represents a severe entity. However, mounting evidence has indicated that majorities of leakage occur within one week after surgery, making late AL rarity. Here we analyzed 101 consecutive colorectal AL, all of which occurred within 30 post-operative days, during Jan 2013 and Dec 2015 in cancer hospital of Fudan University. AL occurring within 5 post-operative days was defined as very early AL (vE-AL). We evaluated risk factors of vE-AL compared with non-vEAL and correlated with post-leakage peritonitis and need of relaparatomy. We found that AL occurred at median time of 7 days after surgery. 23 cases were vE-AL. Reconstruction of post-peritoneum for mid-low rectal carcinoma significantly reduced incidence of vE-AL compared with non-vE-AL (p = 0.042). Patients with vE-AL was associated with presence of peritonitis (p = 0.031), the latter significantly correlated with increased re-operation rate (p = 6.8E-13). Besides, patients with vE-AL trended to correlate with increased re-operation rate after leakage (p = 0.088). In concludsion, vE-AL occurring within 5 post-operative days represents a severe subtype associated with general peritonitis and need of relaparatomy.

The Prognostic Value of Preoperative Serum CEA and CA19-9 Values in Stage I-III Colorectal Cancer.

BACKGROUND/AIMS: There is disagreement about the prognostic value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients who have stage I-III colorectal cancer. Therefore, we investigated the relationship between preoperative serum CEA and CA19-9 levels and clinical outcome in patients with this disease. METHODOLOGY: The study included 724 patients who had received radical resection for stage I-III colorectal cancer in Fudan University Shanghai Cancer Center. We retrospectively investigated the relationship between patients' characteristics and survival, using univariate and multivariate analyses. In multivariate analysis, factors found significant in the univariate analysis were compared with patients' outcomes. RESULTS: In univariate analysis, differentiation (P < 0.001), depth of invasion (P < 0.001), number of lymph node metastases (P < 0.001), and elevated levels of CEA (P < 0.001) and CA19-9 (P < 0.001) were closely correlated with patients' survival. In multivariate analysis, the number of lymph node metastases (P < 0.001), preoperative CA19-9 (P = 0.015) and CEA (P = 0.028) values, differentiation (p = 0.040) and depth of invasion (p = 0.039) were independent prognostic factors for survival. CONCLUSIONS: Preoperative CA19-9 and CEA have independent prognostic values in stage I-III colorectal cancer. Elevation of and both CEA and CA19-9 values predicted the worst outcome.

[Prognosis of patients with early enteral nutrition after gastrointestinal operation: a meta-analysis].

OBJECTIVE: To systematically assess the effect of early enteral nutrition support after gastrointestinal operation on prognosis. METHODS: The Cochrane Library, PubMed, CBM, CNKI, Wanfang, and VIP databases were retrieved via computer system for randomized controlled trails(RCTs) with early enteral nutrition support to patients undergoing gastrointestinal operation. Quality of studies was evaluated by the Cochrane Jadad rating scale. Nutrition indexes, bowel function indices, postoperative complications, health-economics indices were collected. Meta-analysis was conducted with RevMan 5.2. RESULTS: Eleven relevant RCTs studies with 1087 cases were enrolled, including 541 patients in the study group(early enteral nutrition) and 546 in the control group. Meta-analysis showed that patients in the study group had significantly higher levels of plasma albumin and prealbumin than those in the control group(WMD=2.87, 95%CI:1.03-4.71; WMD=0.04, 95%CI:0.02-0.05). The time of postoperative bowel ventilation in the study group was significantly shorter than that in the control group(WMD=4.10, 95%CI:-5.38--2.82). The postoperative complication rate in the study group was significantly lower as compared to the control group(RR=0.64, 95%CI:0.44-0.93). CONCLUSION: Early enteral nutrition support after gastrointestinal operation is safe and effective, which can improve the nutritional status, promote bowel function return, and reduce postoperative complication rate.

Phase II trial of first-line chemoradiotherapy with intensity-modulated radiation therapy followed by chemotherapy for synchronous unresectable distant metastases rectal adenocarcinoma.

AIMS: Based on the hypothesis that first-line chemoradiation followed by chemotherapy was superior for primary tumor and non-inferior for distant lesions compared to chemotherapy alone in synchronous unresectable distant metastases rectal adenocarcinoma, this study was designed to assess the efficacy and safety of this strategy. MATERIALS AND METHODS: Thirty two eligible patients received intensity modulated radiation therapy (45 Gy to the pelvis and a concomitant 10 Gy boost to the gross tumor), along with concurrent weekly capecitabine and oxaliplatin. Patients underwent radical surgery if all lesions were visually evaluated as resectable and received chemotherapy for a total of 6 months, whether pre- or post-operatively (definitive therapy group). The remaining patients received 6 months of consolidation chemotherapy followed by maintenance chemotherapy (non-definitive therapy group). RESULTS: The toxicities were acceptable, with radiation-induced dermatitis around the anal verge being the most common (18.8%). Fourteen patients underwent surgical resection of the rectal tumor, with 5 (35.7%) experiencing a pathological complete response. Nine out of 14 received definitive treatment, defined as R0 resections of all visible tumors. At a median follow-up of 12 months (range, 4-23 months), 2 cases were evaluated as local failure, and the median overall survival (OS) and progression free survival (PFS) for all 32 patients were 17.5 and 12 months, respectively. OS differed significantly in the definitive and non-definitive therapy groups (p=0.045), and PFS tended to differ (p=0.274). CONCLUSION: It was demonstrated that the strategy of first-line chemoradiation followed by chemotherapy was effective and tolerable, especially for local control. OS and PFS were superior in patients who did than did not undergo curative therapy.

Retrospective analysis of perianal Paget's disease with underlying anorectal carcinoma.

AIM: To analyze clinical and pathological characteristics of an aggressive subtype of perianal Paget's disease (PPD) and explore its rational treatment modalities. METHODS: PPD patients were retrospectively collected in the institutional colorectal database of the Fudan University Shanghai Cancer Center. Detailed patient histories of past medical condition, diagnosis, treatment, and pathological findings were reviewed. Surgical specimen from diagnosis and surgery were reviewed by two independent pathologists for confirmation of diagnoses. Follow up was accomplished by clinical interview by cellphone. RESULTS: In total, eight cases of PPD were analyzed. All patients had underlying anorectal adenocarcinoma, including seven with synchronous lesions and one with metachronous lesions. Moreover, all anorectal lesions had a mucin-producing component. The median age at diagnosis was 65 (range 29-81 years), and the male/female ratio was 7:1. The Median follow-up time of all patients was 61.5 mo (range 10-204 mo). One patient treated with abdominoperineal resection (APR) died from lung metastases 10 mo after the APR operation. The other patients are still free of disease at the time of this analysis. CONCLUSION: PPD is a rare malignancy and is easily misdiagnosed. Underlying anorectal cancer was not unusual and was a significant prognostic factor. Rational treatment of both anorectal cancer and PPD lesion is essential for long-term survival.

Standardized pelvic drainage of anastomotic leaks following anterior resection without diversional stomas.

BACKGROUND: Anastomotic leakage is a serious complication in rectal cancer surgery. More than one third of rectal cancer patients with low anterior resection (LAR) will receive defunctional stomas during primary operation. METHODS: Six hundred thirty-nine consecutive rectal cancer patients, whose tumors were located 5 to 12 cm from the anal verge, were treated with LAR. A standardized pelvic drainage for all these patients and selective irrigation for patients with leakage were conducted, and defunctional stoma was used as a salvage modality. All the anastomoses were all extraperitonealized during primary operations. RESULTS: The anastomotic leakage rate was 7.04%. Male gender and location of tumor were found to be risk factors for leakage in patients with LAR. The overall stoma rate was 1.88%. Nearly 75% of leakage could be cured by irrigation-suction without surgical intervention. Severe complications, such as peritonitis, fistula, and obstruction, were strong predictors of irrigation failure. CONCLUSIONS: Extraperitonealized anastomosis and pelvic drainage obtained a very low rate of defunctional stoma for LAR. Pelvic irrigation-suction was an effective modality to resolve anastomotic leakage.

[Surgical correction of concealed penis].

OBJECTIVE: To discuss the severity grading and procedure design of concealed penis. METHODS: Between June 2004 and April 2008, 196 cases of concealed penis were surgically corrected. The age ranged from 1 year and 4 months to 44 years, with a median of 9 years. They presented with inconspicuous penis and abnormal cavernosa development. Four cases complicated by glanular hypospadias and 3 cases by penile epispadias. They were classified as mild in 49 cases, moderate in 109, and severe in 38 according to severity. Surgical procedures were selected based on varied anatomical changes in different categories. RESULTS: All the patients got satisfactory appearance immediately after surgery. No voiding problem, wound infection, and skin necrosis were found. With 6 months to 48 months (mean 16 months) follow-up, most patients achieved good results and the penile appearance resembled that after circumcision. Mild penile retraction was noted in 1 moderate case and 1 severe case; and recurrence occurred in another one, the result was satisfactory after reoperation. CONCLUSION: Various surgical procedures can be adopted for concealed penis. The key point is to design procedures according to the anatomical abnormalities.

Prognostic significance of the metastatic lymph node ratio in node-positive rectal cancer.

BACKGROUND: The purpose of the study was to evaluate the prognostic value of metastatic lymph node ratio (LNR) in node-positive rectal cancer. METHODS: A retrospective review was performed in 318 rectal cancer patients who received curative anterior resection in a single institution. Clinicopathological variables including LNR were studied in univariate and multivariate analyses by Cox regression. LNR was further studied when stratified by quartiles. Survival analyses were performed using the Kaplan-Meier method and log-rank test. RESULTS: With median follow-up of 41 months, the 5-year disease-free survival (DFS) rate, overall survival (OS) rate, and local recurrence (LR) rate were 56.82%, 59.8%, and 11%, respectively. Multivariate analysis revealed that LNR as a continuous variable was the most significant prognostic factor for DFS, OS, and LR. On quartiles, LNR was stratified into three groups: <0.14, 0.14-0.49, and 0.5-1. The 5-year DFS rate was 72.57%, 58.54%, and 34.75% (P = 0.0001) and the 5-year OS rate was 72.19%, 61.92%, and 38.47% (P = 0.002) in the three groups, respectively. Five-year LR rate was significantly higher with LNR between 0.14 and 1 (3.6% in LNR<0.14 versus 15.6% in LNR 0.14-1, P = 0.019). CONCLUSIONS: LNR is an important prognostic factor for node-positive rectal cancers. With a cutoff of 0.14 and 0.5, node-positive rectal cancer patients could be categorized into three subsets with significant different outcomes.

[Ventral urethroplasty for postoperative urethral stricture in patients with hypospadias].

OBJECTIVE: To investigate the effect of ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias. METHODS: From August 2000 to December 2005, 20 patients with anastomotic stricture after hypospadias repair were treated with ventral urethroplasty. The age ranged from 2 to 27 years with an average of 6.4 years. All patients showed dysuria after operation. Main clinical manifestation included dysuria and acraturesis. Interruption of urinary stream occurred in 17 cases; of them, 3 cases had urinary stasis and 4 cases had frequent micturition, urgent micturition and pain in urination. Urethrography and cystourethrography showed 0. 5-1. 0 cm stricture with proximal dilation of urethra in 16 cases and obvious diverticularization in 9 cases. Urine routine examination showed that white blood cell was ++ to ++++ in 16 cases and pus cell was +/+ to ++ in 13 cases. RESULTS: Twenty cases were followed up 2 months to 4 years (mean 2.3 years). All the cases achieved good results in urination with normosthenuria and normal force of urinary stream. No recurrent stricture, urethrocutaneous fistula, or penile curvature occurred. The cosmesis was satisfactory, and the results of urine routine examination was normal. CONCLUSION: Ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias is a simple and effective procedure.

Predicting prognosis of rectal cancer patients with total mesorectal excision using molecular markers.

AIM: To explore the prognostic variables in rectal cancer patients undergoing curative total mesorectal excision and the effect of postoperative chemotherapy in advanced rectal cancer. METHODS: A total of 259 consecutive rectal cancer patients treated with curative total mesorectal excision between 1999 and 2004 were collected. p53, p21, PCNA, and CD44v6 were examined using immunohistochemistry (IHC). The correlation between clinicopathological or molecular variables and clinical outcomes, including local recurrence, metastasis, disease-free survival and overall survival, was analyzed. RESULTS: The median follow-up was 44 mo. Five-year survival rates and 5-year disease free survival rates were 75.43% and 70.32%, respectively. Multi-analysis revealed TNM staging, preoperative CEA, and CD44v6 level were independent risk factors predicting overall survival or disease free survival. The hazard ratio of peroperative CEA was 2.65 (95% CI 1.4-5) and 3.10 (95% CI 1.37-6.54) for disease free survival and overall survival, respectively. The hazard ratio of CD44v6 was 1.93 (95% CI 1.04-3.61) and 2.21 (95% CI 1.01-4.88) for disease free survival and overall survival, respectively. TNM staging was the only risk factor predicting local recurrence. Postoperative chemotherapy without radiotherapy did not improve patients' outcome. CONCLUSION: TNM staging, preoperative CEA and CD44v6 were independent prognostic factors for rectal cancer patients with total mesorectal excision. Postoperative chemotherapy may be only used together with radiotherapy for rectal cancer patients.

Chordee without hypospadias: report of 79 Chinese prepubertal patients.

A series of Chinese prepubertal patients with congenital chordee without hypospadias is presented and the clinical data described. From July 1999 to September 2006, 79 boys with congenital chordee without hypospadias were treated in the Department of Pediatric Surgery, West China Hospital of Sichuan University, China. The ages ranged from 21 months to 14 years, with a mean of 76.8 months (6.4 years). The patients were categorized according to structural defect into 4 groups, with the aid of intraoperative artificial erection. Group I included those with skin tethering (28 cases, 35.4%); group II, fascial chordee (22, 27.8%); group III, corporal disproportion (10, 12.7%); and group IV, urethral tethering (19, 24.1%). Chordee-related structural defect was considered the only criterion for classification, and urethral dysgenesis influenced the choice of surgical procedure. The chordee in group I patients was corrected with penile degloving; group II, release of dense fibrous tissue in addition; group III, dorsal-midline-plication-based correction; and group IV, longitudinal-island-flap-urethroplasty-based repair. At a mean follow-up of 14.8 months (range, 2 to 63), all patients had penile straightening except 1 group III patient with residual curvature that was managed upon reoperation. Glans dehiscence occurred in 1 group II patient who underwent a tubularized incised plate urethroplasty. Urethrocutaneous fistula and urethral stricture were found in 2 group IV patients who underwent island flap urethroplasty. With the categorization based on structural defect, chordee without hypospadias may be managed well with minimized complications.

[Anatomical features of congenital chordee without hypospadias in children and implication for diagnosis and treatment].

OBJECTIVE: To investigate the anatomical features of congenital chordee without hypospadias in children and to discuss the diagnosis and treatment. METHODS: From August 1984 to December 2004, 94 children with chordee without hypospadias treated in the West China Hospital of Sichuan University were classified and analyzed for anatomical alterations. Their ages ranged from 18 months to 13 years (mean 6. 9 years). Ninety-four patients were divided into four groups. With intraoperation artificial erection, the patients with penis straightened after degloving were classified as type I patients (skin-tethering), those with penis straightened after fibrotic tissue in Buck's fascia released as type II patients (dysgenetic fascia), those with normal urethra and orthoplasty failed after degloving and removing fibrotic tissue as type III patients (corporal disproportion), and those with dysgenetic urethra tethering the corpora cavernosa as type lV patients (short urethra). RESULTS: In type I (n = 31, 32.9%) patients, the ventral skin and dartos fascia were contracted while Buck's fascia and the urethra was normal, in some (7 cases) scrotal skin extended to the ventral portion of penis (webbed penis). In type II (n = 45, 47.9%), contracture of Buck's fascia was evident and the thickening fibrotic tissue constituted the chief obstacle to orthoplasty, though in some skin was shortened. In type III (n = 6), the dorsal and ventral sides of the corpora cavernosa were disproportionated, and the morphologically normal urethra tightly adhered to the ventral aspect of corpora cavernosa. In some cases ventral skin and fascia were contracted, but orthoplasty could not be achieved through releasing these layers. In type IV (n = 12, 12.8%), the distal urethra was paper-thin and lacking corpus spongiosum, or dense fibrotic bands were found to be deep to the urethra. The urethra tethered the corpora cavernosa and formed a bow-to-string relation. The overlying skin and fascia were contracted in varying degrees while none had significance in straightening the penis. After operation, the length of penis increased to 6.9 cm from 5.2 cm on average and the chordee was corrected to 1.6 degrees from 42.6 degrees before operation on average. The patients were followed up 1 months to 15 years. The results were satisfactory. Chordee remained in 2 cases, fistula and urethral stricture occurred in 2 cases respectively, fistula in association with urethral stricture and diverticulum in 1 case; the operation was given again and the results was satisfactory. CONCLUSION: Patients with chordee without hypospadias may be divided into four types depending on which layer of the ventral penis constitutes the chief contribution to chordee. A systematic approach with repeated artificial erection tests is needed in determining the classification and surgical correction.

[Tubularized incised plate urethroplasty for hypospadias in children].

OBJECTIVE: To present the experience of hypospadias repair using the tubularized incised plate urethroplasty (Snodgrass procedure). METHODS: From May 2001 to November 2004, 82 patients with hypospadias underwent the Snodgrass procedure and the clinical data were analysed retrospectively. The mean age was 5 years (1.5 to 16 years). These cases were divided into: the earlier stage group (34 cases) and the later stage group (48 cases); the proximal group (19 cases) and the distal and middle group (63 cases); the primary operational group (49 cases) and the preoperational group (33 cases). RESULTS: Fistulas occurred in 12 patients (14.6%), complete glans dehiscence in 1 case. Fistula were as follows: 11 cases in the earlier stage group (32.4%) and 1 case in the later stage group (2.1%); 2 cases in the proximal group (10.5%) and 10 cases in the group of distal and middle group (15.9%); 8 cases in the primary operational group (16.1%) and 4 cases in the preoperational group (12.1%). There was statistically significant difference in the incidence of fistula between the earlier stage group and the later stage group (P < 0.01). There was no statistically significant difference between the proximal group and the distal and middle group, between the primary operational group and the preoperational group (P > 0.05). All patients were followed up more than one month. The neo-meatus was in normal position. The results of penile cosmetic and urethral function were satisfactory. Of these cases, 15 were followed up 1.5-6.0 months. The average flow rate was 7.8 ml/s (6.8-10.5 ml/s). The mean of maximum flow rate was 10. 5 ml/s (8.8-14.5 ml/s). CONCLUSION: Excellent neourethral functional and superior cosmetic results with low rate of complication can be gained by using tubularized incised plate urethroplasty for the cases of hypospadias without chordee or with mild chordee. But the preputial flap procedure should be chosen in condition that the hypospadias was association with obvious chordee.