Causes of recurrence of paediatric inguinal hernia after single-port laparoscopic closure.

PURPOSE: This paper explores the causes of paediatric inguinal hernia (PIH) recurrence after single-port laparoscopic percutaneous extraperitoneal closure (SPLPEC). METHOD: From January 2015 to December 2020, the clinical data of 3480 children with PIHs who underwent SPLPEC were retrospectively reviewed, including 644 children who underwent SPLPEC with a homemade single-hook hernia needle from January 2015 to December 2016 and 2836 children who underwent the SPLPEC with a double-hook hernia needle and hydrodissection from January 2017 to December 2020. There were 39 recurrences (including communicating hydrocele) during the 2-5 years of follow-up. The findings of redo-laparoscopy were recorded and correlated with the revised video of the first operation to analyse the causes of recurrence. RESULT: Thirty-three males and 6 females experienced recurrence, and 8 patients had a unilateral communicating hydrocele. The median time to recurrence was 7.1 months (0-38). There were 20 cases (3.11%) in the single-hook group and 19 cases (0.67%) in the double-hook group. Based on laparoscopic findings, recurrence most probably resulted from multiple factors, including uneven tension of the ligation (10 cases), missing part of the peritoneum (14 cases), loose ligation (8 cases), broken knot (5 cases), and knot reaction (2 cases). All children who underwent repeat SPLPEC were cured by double ligations or reinforcement with medial umbilical ligament. CONCLUSION: The main cause of recurrence is improper ligation. Tension-free and complete PIH ligation are critical to the success of surgery, which requires avoiding the peritoneum skip area and the subcutaneous and muscular tissues. Redo-laparoscopic surgery was suitable for the treatment of recurrent inguinal hernia (RIH). For giant hernias, direct ligation of the internal ring incorporating the medial umbilical ligament (DIRIM) may be needed.

[Anti-arthritic-related metal bioavailability for optimal compatibility ratio of Aconiti Radix Cocta and Paeoniae Radix Alba].

Trace metals deficiency or excess are associated with the etiology and pathogenesis of rheumatoid arthritis(RA). Aconiti Radix Cocta(A) and Paeoniae Radix Alba(B) are commonly used together for the treatment of RA. In this study, we aim to determine anti-arthritic-related metal bioavailability in the compatibility of herb A and B for avoiding metal deficiency or excess, and optimize the combination ratio of herb A and B, accordingly. Anti-arthritic-related metal bioaccessibility were evaluated by in vitro simulator of all gastrointestinal tract(including mouth, stomach, small and large intestines), and the roles of gastrointestinal digestive enzymes and intestinal microflora were investigated. Anti-arthritic-related metal bioavailability was assessed by the affinity adsorption with liposomes. The results indicated that compatibility proportion of corresponding herbal plants, gastrointestinal digestion and microbial metabolic, which could affect metal digestion and absorption. The optimal compatibility proportion of 1 A∶1 B is recommended, according to the dose of anti-arthritic-related metal bioavailability, which is often chosen for clinical practice of RA therapy. Thus, anti-arthritic-related metal bioavailability might be the key active substances for RA treatment.

[Epidemiological survey of asthma among children aged 0-14 years in 2010 in urban Zhongshan, China].

OBJECTIVE: To investigate the prevalence, current treatment, and clinical characteristics of asthma, as well as the risk factors for this disease, among children aged 0-14 years in 2010 in urban Zhongshan, China. METHODS: A total of 10 336 children aged 0-14 years were selected from urban Zhongshan by cluster random sampling. The Third National Childhood Asthma Epidemiological Questionnaire 2010 was used to analyze the prevalence, current treatment, and clinical characteristics of childhood asthma, as well as the risk factors for this disease. RESULTS: Asthma was diagnosed in 179 cases (1.73%). The prevalence of asthma in male children was significantly higher than that in female children (2.25% vs 1.16%; P<0.01). Of the 179 patients, severe attacks were common in 104 cases (58.1%), 110 cases (61.5%) had slow onset, 102 cases (57.0%) had gradually relieved conditions, 61 cases (34.1%) suffered from asthma during seasonal transition, and 150 cases (83.8%) developed asthma due to respiratory tract infection. Among all asthmatic children, 71.5% had been treated with inhaled corticosteroids, and 71.5% had been treated with bronchodilator. The multivariate logistic regression analysis showed that a history of penicillin allergy, a family history of allergy, food allergy, eczema, allergic rhinitis, cesarean delivery, family mould, and perinatal passive smoking were independent risk factors for childhood asthma. CONCLUSIONS: The prevalence of childhood asthma in urban Zhongshan is on a high level, and is associated with gender. The treatment of asthma has been standardized, but still needs further improvement. The onset of asthma attack is influenced by various factors.

Hyperleptinemia directly affects testicular maturation at different sexual stages in mice, and suppressor of cytokine signaling 3 is involved in this process.

BACKGROUND: Leptin plays an important role in reproductive function, and the mechanism of this phenomenon primarily focuses on the hypothalamic-pituitary-gonadal axis. However, until now, the direct effects of leptin on the testes during development from infancy to adulthood remained unclear. The aim of the present study was to explore the effects and molecular mechanisms that underlie leptin's action in the testes during sexual maturation. METHODS: We used a monosodium glutamate (MSG)-treated mouse model to assess the effects of endogenous hyperleptinemia on the development of the testes from infancy to adulthood. Then, a variety of reproductive parameters were measured, including the concentration of testosterone, the weight and volume of the testicles, the diameter of the seminiferous tubules, and numbers of spermatogonia, spermatocytes, sperm, Leydig cells and offspring. In addition, we assessed the direct role of leptin and suppressor of cytokine signalling 3 (SOCS3)/phosphorylated signal transducer and activator of transcription 3 (pSTAT3) on the testes in vitro. RESULTS: Testosterone secretion exhibited a diverse response: a low concentration of leptin induced testosterone secretion, and a high concentration inhibited testosterone secretion both in vivo and in vitro. A variety of reproductive parameters decreased in hyperleptinemic mice, including the weight and volume of the testicles, the diameter of the seminiferous tubules, and the numbers of spermatocytes, sperm, Leydig cells and offspring. The amount of spermatogonia was also elevated. The development of the testes was partially recovered after hyperleptinemia withdrawal. A high concentration of leptin induced SOCS3 expression and inhibited pSTAT3 expression in the testes. CONCLUSIONS: The results indicated that MSG-induced hyperleptinemia directly affects testicular structure and function and that SOCS3/pSTAT3 played an important role in this process. These results also indicated the importance of monitoring and controlling leptin levels in obese male children. SOCS3 is a potential therapeutic target for leptin-induced dysgenesis.

Foetal endoscopic tracheal occlusion for severe congenital diaphragmatic hernia--a systemic review and meta-analysis of randomized controlled trials.

To evaluate and analyze the effect of foetal endocsopic tracheal occlusion (FETO) therapy on survival rates of neonatal with congenital diaphragmatic hernia and maternal complications. We performed a systemic review and meta-analysis of three randomized controlled trials (RCTs). The combined data on neonatal survival rates, length of gestational age and rates of premature rupture of membrane from these studies were retrieved and analysed. Pooled data of these three RCTs revealed that FETO provided neonates with severe congenital diaphragmatic hernia a significantly higher survival rate: 27/48 VS 12/52. The odds ratio was 5.95 (95% CI: 2.11 - 16.79, p < 0.0008). The gestational age (week) of FETO group was shorter than postnatal standard therapy group. The mean difference was -3.43 (95% CI: -6.82 - -0.04, p < 0.05). FETO group also had a significantly greater rate of premature rupture of membranes than control group with the odds ratio of 3.35 (95% CI: 2.11 - 16.79, p < 0.0008). Foetal endoscopic tracheal occlusion improved neonatal survival rate but also increased major maternal complications including preterm delivery and premature rupture of membranes.

[Incidence of wheezing and chronic cough in children aged 3-14 years in rural and urban areas of Zhongshan, China: a questionnaire survey].

OBJECTIVE: To investigate the incidence of wheezing and chronic cough in children aged 3-14 years in different living areas of Zhongshan, China. METHODS: According to the unified program of the 2010 national epidemiological survey of asthmatic children aged 0-14 years, a questionnaire survey of the children aged 3-14 years in rural and urban areas of Zhongshan was conducted. RESULTS: A total of 15 763 children were included in the survey. Among all participants, 8 248 were from the urban area, and 7 515 from the rual area; 8 306 were boys, and 7 457 were girls. The percentage of children with a history of wheezing was significantly higher in the urban group than in the rural group (6.6% vs 3.2%; P<0.05), and it was significantly higher in boys than in girls for each group (P<0.05). The urban group had a significantly higher percentage of individuals who had wheezing in the past one year than the rural group (2.8% vs 1.5%; P<0.05), and this percentage was significantly higher in boys than in girls for each group (P<0.05). Compared with the rural group, the urban group had a significantly higher percentage of individuals who had chronic cough (duration 1 year) (7.9% vs 3.1%; P<0.05). The above indices were relatively high in children under 6 years of age, and all but the percentage of girls who had wheezing in the past one year in both rural and urban areas showed significant differences between all age groups. CONCLUSIONS: The incidence of wheezing and chronic cough varies with age, sex, and living area for children aged 3-14 years in Zhongshan, and it is relatively high under 6 years of age, in the urban area, and among boys.

Desmoplastic small round cell tumor of the kidney: a case report and discussion.

A 13-year-old boy was admitted to the hospital with 1-month history of neck pain and a 2-week history of bilateral hip joint pain accompanied by low fever. Positron emission tomography-computed tomography (PET-CT) revealed the presence of a malignant tumor in the left kidney with metastases to the left renal hilum, retroperitoneum, para-aortic lymph nodes, and multiple bone sites throughout the body. Given that the patient's left kidney capsule was intact and the boundary with surrounding tissues was clear, left nephrectomy was performed. Postoperative pathological diagnosis showed desmoplastic small round cell tumor (DSRCT) of the left kidney. CAV-VIP alternating chemotherapy was given 20 days after the first stage surgery. After the end of the 6th cycle, the patient underwent surgery again. The tumor in front of the aorta and postcava, the greater omentum, the retroperitoneal lymph nodes and the hepatic hilum lymph nodes, and the visible tumors in the abdomen were removed. CAV-VIP alternating chemotherapy was continued after the second stage surgery. At the end of the 4th cycle of post operation chemotherapy, radiotherapy was started. An abdominal CT scan conducted 11 months after second-stage surgery did not reveal any recurrence of abdominal tumors; however bone metastases persisted. The patient is currently receiving oral targeted therapy with anlotinib while ongoing follow-up continues.

Laparoscopic surgery for stage III neuroblastoma: A case report.

Laparoscopic surgery for malignant solid tumors is still in the stage of clinical exploration. Neuroblastoma is a common solid tumor in children. The present study discussed significance and feasibility of complete resection of stage III neuroblastoma by laparoscopic surgery and its safety and effectiveness was compared with traditional surgery. For children suffering from neuroblastoma with large tumor volume and vascular invasion, preoperative chemotherapy can be given and minimally invasive laparoscopic surgery can be one option to be considered when the tumor volume is <6 cm. During the operation, the tumor tissue can be removed by segmental resection and the removal of as much tumor tissue as possible is an important factor in improving the prognosis. Laparoscopic minimally invasive surgery is associated with minimal surgical trauma and quick recovery of patients, and children can receive postoperative chemotherapy as early as possible, which is conducive to good recovery. Basically, the prerequisite and requirements for performing this operation are professional laparoscopic skills and an experienced team.

Natural green-peel orange essential oil enhanced the deposition, absorption and permeation of prochloraz in cucumber.

Pesticides have long been used in agricultural production and will continue to be used long into the future. Enhancing their efficient use in agricultural production is an effective method to avoid their loss to non-target areas, such as soil, water and air. Here natural green-peel orange essential oil (GOEO) was used as a spray adjuvant to improve the efficient use of pesticides. A comparative study between a conventional formulation and a conventional formulation with GOEO was conducted. Conventional formulations of prochloraz were chosen as control groups. It was obvious that the concentrations of prochloraz and its metabolite in cucumber leaves treated by conventional formulations with GOEO were much higher than those treated without GOEO. The data also showed, for both emulsifiable concentrate (EC) and suspension concentrate (SC), that the spreading and penetration performance were improved when GOEO was used as a spray adjuvant, but with SC the impact was more significant. GOEO improved the deposition, absorption and degradation performance of prochloraz on cucumber leaves. It was more applicable to those pesticide formulations without a good wetting and spreading effect, such as SC. As a plant source extract, GOEO is much safer for crops and more friendly to the environment than other synthetic adjuvants. The application of GOEO as a spray adjuvant has great potential to increase the pesticide utilization rate.

Continuous-type splenogonadal fusion: A case report.

Splenogonadal fusion (SGF) is a rare congenital malformation. Since it lacks characteristic features, very few cases of SGF have been diagnosed preoperatively. Laparoscopy was effective in both diagnosing and surgically treating this condition. Herein, we reported left side SGF in a male patient who was diagnosed during laparoscopic exploration, and Fowler-Stephens orchidopexy was implemented at the same time. The patient was followed up for one year. At a 6-month follow-up, the left scrotum demonstrated swelling and the internal contents were hard. An ultrasound of this testicle indicated non-uniform, splenic-like organization. However, at the one-year follow-up, the volume of splenic-like organization was reduced but the testicular size did not exhibit further atrophy.

[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.

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.

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.

[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.

[Longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo type IV].

OBJECTIVE: To investigate the effectiveness of longitudinal preputial pedicled flap urethroplasty for chordee of Donnahoo IV type. METHODS: Between June 1994 and October 2011, 30 patients with chordee (Donnahoo type IV) underwent longitudinal preputial pedicled flap urethroplasty. The patients' age ranged from 2 to 16 years (mean, 5.8 years). The morphology of the balanus-navicular fossa-external urethral orifice ranged normal; the penis length was 2.5-6.8 cm (mean, 4.3 cm); the penis bending angle was 35-70 degrees (mean, 40.1 degrees). Primary and secondary operation was 27 cases and 3 cases, respectively. The size of flap ranged from 1.5 cm x 1.3 cm to 4.0 cm x 2.0 cm. RESULTS: After correction, the penis length was 3.0-8.5 cm (mean, 6.6 cm); the penis bending angle was 0-10 degrees (mean, 1.2 degrees). All patients were followed up 6 months to 12 years (mean, 33 months). No recurrence, stabbing pain of the balanus, or foreign body sensation occurred during follow-up. Of them, 4 patients (13.33%) had urinary fistular, they had satisfactory results after the second operation; 2 patients (6.67%) had urethral stricture 1 month after operation, they also had satisfactory results after arethral dilatation. The other patients showed no scattering urinary flow and good direction without complication. Six patients had satisfactory sexual function after puberty without erection disorder, pain, or dyspareunia. CONCLUSION: Longitudinal preputial pedicled flap urethroplasty can achieve maximum utilization of prepuce and aesthetic and functional improvement with less complication, so it is a relatively ideal mean for treating chordee of Donnahoo type IV.