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Background Abdominal Wound Dehiscence (AWD), occupying a large proportion of neonatal surgery is an essential complication of abdominal surgery, which can leads to severe consequences, including life-threatening. This study aims at exploring prediction value for AWD with potential joint factors of hypoproteinemia and incision type. Method The Cox proportional-hazards model (the Cox model) was applied to analyze clinical data came from 453 patients underwent neonatal laparotomy from June 2009 to June 2020. According to application of the random numbers, 453 cases were divided into two separate models randomly involving training set with 318 observations (70%) and validation set with 135 observations (30%), and then the models trained were validated based on the validation set. Investigation in the connection between hypoproteinemia, incision type, combined factors and AWD, were used for comparing those prediction values for AWD. Results With a median follow-up of 15 months, the incidence of neonatal AWD was 6.0% (27/453). Based on the univariate and multivariate Analysis using the Cox Regression Analysis, hypoproteinemia(HR = 7.005, P = 0.001) and joint factor༈HR = 6.901, P

Background: Abdominal wound dehiscence (AWD) is a major complication of abdominal surgery, neonates are a group with a high risk of AWD, which has serious consequences or can even result in death. The purpose of this study is to explore the risk factors for neonatal AWD.Methods: The clinical data for 453 cases of neonatal laparotomy from June 2009 to June 2020 were retrospectively analyzed, among which 27 cases of AWD were found. Nine factors, including gender, age at admission, weight at admission, preterm delivery, level of preoperative anemia, hypoalbuminemia, operation time, incision length, and incision type, were analyzed to explore their correlation with neonatal AWD.Results: The incidence of neonatal AWD was 6.0% (27/453), of which partial wound dehiscence 4.9% (22/453) and complete wound dehiscence 1.1% (5/453). Anemia, hypoproteinemia, and wound contamination were the main risk factors for neonatal AWD. The AWD-free survival rates for infants with severe anemia and mild to moderate anemia were 83.3% and 91.2%, respectively. The AWD-free survival rates for those with hypoproteinemia, type II and type III incision were 88.0%, 95.1% and 87.1%, respectively.Conclusion: Neonatal AWD is closely related to anemia, hypoproteinemia, and incision contamination. It is of great significance for the prevention of neonatal AWD to strengthen nutritional support, correct preoperative anemia, and control infection.Trial registration: Research Registry, researchregistry5350. Registered 01 February 2020 - Retrospectively registered, https://www.researchregistry.com/browse-the-registry#home/registrationdetails/5e359028eef79c001577fa18/

Objective: To investigate the clinical features, diagnosis, treatment and prognosis of children with cryptorchidism complicated by testicular torsion. Methods: The clinical data of 6 children with cryptorchidism complicated by testicular torsion admitted to our hospital from December 2000 to December 2016 were analyzed retrospectively. Results: All 6 children were diagnosed with cryptorchidism by surgery, their age was from 12 days up to 11 years, and the average time between onset of symptoms and diagnosis was 20.5 h. Torsion testis was located in the groin area and the rate of left to right was about 2:1. Twist was 600° on average. All children were admitted because of the inconsolable cry, abdominal pain, and the swelling of the groin. Three patients underwent orchidectomy, while the other 3 patients underwent detorsion and cryptorchidopexy. Color Doppler ultrasound examination showed normal testes at 6 months after operation. Only 1 case was diagnosed with cryptorchidism after birth. Conclusions: Cryptorchidism is an emergency in pediatric urology and often leads to a low testicular salvage rate, especially in infants, due to lack of knowledge, delayed diagnosis, and late treatment. Neonatal genital examination is important for the early diagnosis and management of cryptorchidism.

Environmental estrogens (EEs) have been correlated with abnormalities in the male urogenital system. However, the mechanism underlying the effect of these molecules remains unclear. In vitro and in vivo experiments were performed to examine the expression level and mechanism of relaxin family peptide receptor 2 (RXFP2) in the gubernaculum of fetal mice following diethylstilbestrol (DES) treatment. The in vivo results demonstrate that DES treatment increased the stillbirth rate gradually, decreased the gubernacular cone volume significantly, and disrupted the tissue structure, leading to incomplete testicular descent. In vitro experiments reveal that DES administration resulted in abnormal cellular morphology and structural disorder of gubernacular cells, which lost their original morphology in a dose-dependent manner. Moreover, DES-induced F-actin rearrangement and stress fiber formation in cultured cells. Protein quantitative analysis showed that the RXFP2 level in each experimental group was significantly lower than that of the normal group. In conclusion, DES affects the morphology and alters the gubernaculum structure, as well as the expression of RXFP2 protein. These data demonstrate that DES is toxic to gubernaculum in fetal mice, and that RXFP2 is associated with the abnormal gubernaculum morphology induced by DES. Taken together, these data suggest that RXFP2 may be a novel potential biomarker for abnormal differentiation of the gubernaculum.

Background: Megameatus intact prepuce (MIP) is a unique variant of hypospadias and is a clinically rare condition. Due to the anatomical characteristics of the MIP hypospadias variant presenting a unique challenge to surgeons, no single urethroplasty method provides a universal solution for all patients. The purpose of this study was to evaluate the outcomes of hypospadias after MIP repair by urethral plate- preserving urethroplasty. Methods: A retrospective study was performed on 25 coronal or distal MIP patients, with a median age of 8, with most deficiencies being discovered during their first hospital visit for phimosis. Correction with urethroplasty was performed for all patients; 5 underwent the Mathieu procedure, 13 underwent the tubularized incised plate (TIP) procedure, and 7 underwent the Duplay procedure. The 25 patients were followed up for 6 to 36 months to evaluate the surgical outcomes. Results: There were no significant differences in intraoperative bleeding, hospital stays, postoperative analgesia rate, and cure rate among the three surgical procedures. The operative time for the Mathieu procedure was longer than that for the TIP and Duplay procedures, which did not differ. Complications occurred in 4 of the 25 patients (16.0%), and the overall complication-free survival rate at 1 year after surgery was 80.5%. The age at the time of surgery, urethral plate width, urethroplasty length, surgical procedures, or meatal location (coronal or distal penis) were not independently predictive of complications. Conclusions: The clinical manifestations of MIP are often concealed and then accidentally discovered during hospital visits for phimosis; thus, the actual incidence of MIP might be higher. The urethral plate should be preserved during MIP-correcting treatment, especially for coronal or distal MIP. The same satisfactory outcomes can be obtained with Mathieu, TIP, or Duplay urethroplasty.

The etiology of testicular dysgenesis syndrome is multifactorial and involves abnormalities in the anatomical structures and endocrine factors. Several studies have shown that the abnormal development of the gubernaculum may affect testicular descent, and the insulin-like factor 3 (INSL3) appears to play an important role in development of the gubernaculum have been proved. INSL3 binds its specific receptor (Relaxin family peptide 2, RXFP2), which was highly expressed in gubernaculum, to produce a crucial effect in the first transabdominal descent stage, but its mechanism still remain unclear. In this study, in order to explore how does INSL3 regulate its receptor RXFP2, we cultured mouse gubernaculum testis cells in vitro, which was treated by INSL3, and examined the expression of RXFP2 in mouse gubernaculum testis cells. The results displayed that INSL3 changed RXFP2 expression, and we found that low dose INSL3 can increase RXFP2 expression, the mechanism of above-mentioned might be related with the hormesis of INSL3.

Currently, tracheal occlusion (TO) is a potent stimulus for fetal lung growth but also a rather invasive and high-risk procedure. The aim of this study was to investigate a new and much less invasive therapeutic strategy, namely the maternal intraperitoneal administration of epidermal growth factor (EGF) and its effect on pulmonary hypoplasia in the nitrofen-induced congenital diaphragmatic hernia (CDH) rat model, especially its effect on type II pneumocytes.CDH was induced by maternal administration of a single oral dose (100 mg) of nitrofen on day 8.5 of pregnancy. Four groups of pregnant rats were designed on day 18.5: normal control (n = 4), CDH (n = 4), CDH plus Dex (n = 4), CDH plus EGF (n = 8). All fetuses were delivered by cesarean section on day 21. Accordingly, there were 4 groups of fetuses: normal controls (n = 33), nitrofen-induced CDH (n = 19), CDH plus Dex treatment (n = 15), and CDH plus EGF treatment (n = 24). Lung tissue weight (LW) and body weight (BW) of each fetus were recorded, lung histologic and morphometric evaluations were performed, and image analysis was combined after lung processing. Transmission electron microscopy was used for ultrastructural observation, especially type II pneumocytes.CDH was observed in 58 of the 94 rat fetuses (61.7%). Lw/Bw of CDH group was significantly lower than those of Dex and EGF (P.05). The lungs of CDH fetuses showed marked hypoplasia, in contrast to improved mesenchymal differentiation in that of Dex and EGF fetuses. Statistical differences of these morphologic parameters (RAC, MTBD, interstitial%, and alveoli%) were found (P.05). As to ultrastructural features, type II cells of CDH lungs had few if any lamellar bodies and cytoplasmic organelles, and showed evidence of abundant glycogen granules. The sparse type II cells also showed cytoplasmic degenerative changes. By contrast, type II cells of EGF lungs showed numerous mitochondria, abundant lamellar bodies (surfactant) and deficiency of glycogen granules, and displayed prominent microvillous projections and pitlike depressions. The density of type II pneumocyte were 65 +/- 4.5, 31 +/- 3.1, and 8 +/- 1.5 for EGF, Dex, and CDH, respectively (EGF v Dex, P.05; EGF v CDH, P0.01).Compared with TO, prenatal EGF administration as a much less-invasive therapeutic strategy had shown marked improvement in pulmonary hypoplasia and promotion of type II pneumocyte differentiation in the nitrofen-induced CDH rat model. Thus, EGF could improve the prognosis of CDH by means of promoting pulmonary hypoplasia and improving the surfactant deficiency, which suggested a potential role in the clinical treatment of CDH.

Background/purpose: The purpose of the present study was to elucidate the clinical presentation, diagnosis, treatment, and postoperative complications of jugular vein phlebectasia (JVP), and to recommend diagnostic methods and treatment choices. Materials and methods: Thirty-six cases of JVP were reviewed (right vein in 27, left in 6, and bilateral in 3). The internal jugular veins were the most commonly involved. The main complaint was the soft and compressible mass in the neck. Ultrasound or color Doppler flow imaging (CDFI) was performed on all the children. Surgical intervention was performed in 32 cases, and the other 4 cases were conservatively followed up for 4 to 6 years. Results: Ultrasound or CDFI demonstrated local dilatation of the unilateral or bilateral veins in all the patients. Surgical intervention included ligation of the involved jugular vein in 31 cases and draping with medical Dacron cloth in 1 case. All of the operated children recovered uneventfully, except 3 for cases who underwent ligation of the right internal jugular vein. Conclusions: Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI was the diagnostic procedure of choice to confirm the diagnosis of JVP. Surgical ligation or excision of unilateral jugular vein was recommended for cosmetic and psychological purposes. However, special attention must be paid to prevent postoperative complications in case of ligation of right internal jugular vein. Or else, treatment should be conservative (follow-up).

Previous studies on surgical team composition have shown that surgical team size had an independent impact on surgical performance in US and Canadian hospitals. We aimed to investigate the impact of team composition on surgical performance in two Chinese hospitals.General surgery procedures performed from April 2011 to June 2012 were retrospectively reviewed to record the number of attendees in the operating room (OR) and the procedure time (PT).A total of 1,900 valid procedures, mostly laparoscopic, were performed during the study period. The mean PT was 90.5 min. On average, there were a total of 6 (range = 3-8) team members per procedure: 3 (range = 1-5) surgeons, 2 nurses, and 1 anesthesiologist. Unlike the data reported for the US and Canada, the number of nurses and anesthesiologists remained stable in most cases, whereas the number of surgeons differed by procedure. Multiple-regression analysis revealed that both the complexity of the operation and the team size significantly affected PT. When procedure complexity and patient condition were kept constant, adding one team member in our data analysis predicted an increase of 34.7 min in the PT.The surgical team size has a measurable effect on PT. Aside from surgical complexity, the team composition and member stability affected PT in the OR. Optimizing surgical teams and developing a strategy to maintain team stability are of great importance for improving OR efficiency.

Commercial gas chromatography quadrupole ion-trap mass spectrometer (GC/ITMS) instruments have been used in a novel way for the study of negative ions formed from perfluorotributyl-amine and polychlorinated biphenyl compounds. Negative ions, formed during a normal electron impact ionization period in which 70 eV electrons were used, were isolated in an ion trap by the application of a negative DC voltage to the ring electrode that caused all positive ions to be ejected from the ion trap; in the subsequent analytical scan, negatives ions were detected with an electron multiplier biased normally so as to detect positive ions. The major negative-ion species detected from FC-43 were m/z 252 to m/z 633; 34 other negative-ion species were detected also, though in low abundance. The observed negative-ion mass range extended from m/z 252 to m/z 633. The signal-to-noise ratio of negative-ion mass spectra was enhanced by operation of the GC/MS instrument in GC mode and averaging the mass spectra acquired. In an examination of 3 hexachlorobiphenyl compounds, the molecular anion cluster around m/z 360 for the non-ortho-substituted congener 169 was observed with a signal-to-noise ratio of ca. 20 for 90 pg injected on column: the response for congener 169 was greater than that for congener 156 (mono-ortho-substituted) which, in turn, was greater than that for congener 153 (di-ortho-substituted).

We reviewed the clinicopathological features and surgical management of 16 cases of single ureteral ectopia with congenital renal dysplasia.Excretory urography, retrograde ureterography, computerized tomography, diuretic B-mode ultrasound (B-US) and color Doppler imaging (CDI) were performed in 16 females. Explorative operations were performed in all 16 patients and renal dysplasia was further confirmed by pathological examination.The 16 female patients were 1.5 to 12 years old. The main clinical signs were urinary incontinence accompanied by regular voiding since birth. Vaginal ectopic ureters were observed in 6 patients and vestibular ureters in 10. Excretory urography did not show dysplastic kidney except some indirect signs of renal dysplasia. Computerized tomography clearly revealed renal dysplasia in 4 of 9 cases performed without contrast medium. Dysplastic kidneys were precisely located and diagnosed by diuretic B-US in 6 of 8 cases, and by CDI in 7 of 7 cases. Nephrectomy was performed in all 16 patients with satisfactory results.Single ureteral ectopia with congenital renal dysplasia is exceedingly rare. B-US, especially CDI, is the recommended procedure for preoperative localization and diagnosis. Nephrectomy of dysplastic kidney is the treatment of choice.