Individualized treatment of pediatric inguinal hernia reduces adolescent recurrence rate: an analysis of 3006 cases.

PURPOSE: We implemented the individualized treatment (IT) regimen for children with inguinal hernia and the Lichtenstein hernioplasty using an acellular tissue matrix patch (LHAP) for those with high risks. This retrospective study compares the complications of conventional laparoscopic high hernia sac ligation (LHSL) with those of the IT regimen for the management of pediatric inguinal hernia and investigates whether the recurrence rate of inguinal hernias in children treated by IT is lower than that of those treated by LHSL. METHODS: The subjects of this retrospective study were 3006 children who underwent LHSL or IT for inguinal hernia between February, 2008 and February, 2016 at the Beijing Chao-Yang Hospital (Beijing, China). They comprised 1516 (50.4%) children who underwent LHSL between February, 2008 and December, 2012, and 1490 (49.6%) who underwent IT between January, 2013 and June, 2016. We analyzed the patients' data, including clinical characteristics and postoperative complications. The mean follow-up was 85.31 months for the LHSL group and 43.34 months for the IT group (P < 0.01). Given the difference in the follow-up periods, the log-rank test was used to analyze the recurrence rate. RESULTS: The mean age, weight, and height of these children at the time of surgery were 6 years old, 24.17 kg, and 114.48 cm in the LHSL group and 6 years old, 24.57 kg, and 115.18 cm in the IT group, respectively (P = 0.647, P = 0.393, P = 0.505). The mean age, body weight, and height for adolescents at the time of surgery were 14.7 years old, 57.19 kg, and 168.37 cm in the LHSL group and 14.9 years old, 57.96 kg and 169.21 cm in the IT group, respectively (P = 0.099, P = 0.061, P = 0.059). The male/female ratio was 5.1:1 (1268/248) in the LHSL group and 4.9:1 (1241/249) in the IT group (P = 0.795). The side ratio of inguinal hernia (right/left/bilateral) was about 10:7:8 (602/430/484) in the LHSL group and 3.8:2.8:3.4 (567/422/501) in the IT group (P = 0.551). The comorbidities of the male patients included hydrocele (206), cryptorchidism (15), umbilical hernia (12), congenital heart disease (16), and other congenital diseases (25). The comorbidities in the female patients included round ligament cysts (11). There was no significant difference between the groups in postoperative complications including hydrocele (P = 0.687), hematoma (P = 0.061), surgical site infection (P = 0.742), testicular atrophy (not found), and umbilical trocar hernia (P = 0.585). There were two cases of recurrence in the IT group and eight in the LHSL group (P = 0.07). The frequency of postoperative recurrence of adolescent inguinal hernia was 3.16% (7/221) in the LHSL group, 0 (0/223) in the IT group (P = 0.008), and 0 (0/128) in the LHSL subgroup in the IT group (P = 0.045). CONCLUSION: The favorable outcomes of IT, which had a lower recurrence rate than LHSL for adolescent inguinal hernia, demonstrate that this is a reasonable treatment regimen for pediatric inguinal hernia.

[Seasonal dynamics and vertical distribution pattern of bud bank in different erosion environments on hilly-gully Loess Plateau of Northwest China].

This paper studied the vegetation composition, bud composition, and the seasonal dynamics and vertical distribution pattern of bud bank in five erosion environments (sunny gully slope, sunny hilly slope, hilltop, shady hilly slope, and shady gully slope) on the hilly-gully Loess Plateau of North Shaanxi. In the study area, the perennial species with perennial bud bank accounted for 80.3% of the total species, while the annual species with seasonal bud bank took up 19.7% of the total. In vegetation turning-green season, there was a relatively large perennial bud bank stock on the sunny hilly-gully slope where serious erosion occurred, while seasonal bud bank showed a higher bud bank density in blossom and fruit-setting season on the hilltop and two shady slopes where soil erosion intensity was relatively gentle. The proportion of underground bud bank to total perennial bud bank in different erosion environments was relatively stable. On the land surface, the perennial bud bank stock was larger on the sunny slope where the soil disturbance often occurred, whereas the seasonal bud bank stock was larger on the shady slope and hilltop. Due to the different species composition of plant communities in different erosion environments, in addition to the disturbance of soil erosion and the seasonal plant regeneration, the seasonal dynamics and vertical distribution pattern of bud bank changed. It was suggested that bud bank played an important role in the vegetation regeneration after the disturbance of soil erosion on the hilly-gully Loess Plateau of North Shaanxi.

[Ecological adaptability of leaf epidermis of erosion-resistant plants in hilly-gully area of Loess Plateau, Northwest China].

By the temporary slide method of leaf epidermis, an observation was made on the morphological characteristics of the leaf epidermis of six erosion-resistant plant species in different soil erosion environments (gully, inter-gully, and inter-gully artificial Robinia pseudoacacia forest land) in hilly-gully area of Loess Plateau. Compared with those in the gully, the stomata aperture, stomata density, stomata index, stomata apparatus length/width plasticity, stomata apparatus area plasticity, epidermal hair density, and epidermal cell density of the leaf upper and lower epidermis of the plants in the inter-gully were 93.8% and 90.4%, 66.8% and 76.6%, 17.9% and 9.8%, 36.4% and 47.1%, 42.3% and 43.9%, 199.4% and 98.2%, and 46.5% and 50.1% higher, respectively; while in the inter-gully artificial R. pseudoacacia forest land, the same morphological indices of the leaf upper and lower epidermis of the plants were 66.7% and 106.7%, 20.5% and 45.8%, 11.9% and 11.9%, 37.9% and 41.3%, 19.8% and 21.2%, 113.1% and 52.2%, and 10.8% and 28.1% higher than those in the gully, respectively. The epidermal hair length and epidermal cell area of the leaf upper and lower epidermis of the plants in the inter-gully were 58.8% and 29.7%, and 40.3% and 37.0% lower than those in the gully, and the same morphological indices of the leaf upper and lower epidermis of the plants in the intergully artificial R. pseudoacacia forest land were respectively 25.0% and 23.6%, and 22.2% and 19.2% lower than those in the gully, respectively. The results suggested that the erosion-resistant plants in the study area were able to adapt to various soil erosion environments by increasing their leaf stomata aperture, stomata density, stomata index, stomata apparatus length/width plasticity, stomata apparatus area plasticity, epidermal hair density, and epidermal cell density, and by reducing their epidermal hair length and epidermal cell area.