Publications by authors named "Xuewu Jiang"

23 Publications

  • Page 1 of 1

Risk factors and predictive model for abdominal wound dehiscence in neonates: a retrospective cohort study.

Ann Med 2021 12;53(1):900-907

Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China.

Background: Abdominal wound dehiscence (AWD) is a major complication of abdominal surgery, and 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 and construct a predictive model.

Methods: The clinical data of 453 cases that underwent neonatal laparotomy from June 2009 to June 2020 were retrospectively analyzed, among which 27 cases of AWD were identified. Nine factors, including gender, age at admission, weight at admission, preterm delivery, level of preoperative anaemia, 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), among which partial wound dehiscence accounted for 4.9% (22/453) and complete wound dehiscence accounted for 1.1% (5/453). Hypoproteinemia and incision type were the independent risk factors for neonatal AWD, and weight at admission was a protective factor for AWD in the multivariate models. All these factors were incorporated to construct a nomogram, and a calibration curve was plotted. The result indicated that the actual risk was close to the predicted risk when the predicted risk rate was greater than about 35%.

Conclusions: Neonatal AWD is closely related to hypoproteinemia and incision contamination. Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery.Key messagesNeonatal abdominal wound dehiscence (AWD) has a serious consequence and the incidence of neonatal AWD was about 6.0% and the complete AWD morbidity is 1.1%.Hypoproteinemia and incision type were the independent risk factors for neonatal AWD.Our predictive model showed the potential to provide an individualized risk estimate of AWD for neonatal patients undergoing abdominal surgery.
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http://dx.doi.org/10.1080/07853890.2021.1938661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8204998PMC
December 2021

RXFP2 as novel potential biomarker for abnormal differentiation induced by diethylstilbestrol in the gubernaculum of fetal mice.

Am J Transl Res 2020 15;12(7):3715-3727. Epub 2020 Jul 15.

Department of Radiology, The First Affiliated Hospital of Shantou University Medical College No. 57 Changping Road, Shantou 515041, Guangdong, China.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7407749PMC
July 2020

Diagnosis and Treatment of Hypospadias With Megameatus Intact Prepuce.

Front Pediatr 2020 31;8:128. Epub 2020 Mar 31.

Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.

To evaluate the diagnosis and treatment methods of hypospadias with megameatus intact prepuce (MIP). A retrospective analysis was performed in 27 MIP children, 13 of whom underwent tubularized incised plate urethroplasty (TIP procedure), 7 underwent the Duplay procedure, 5 underwent the Mathieu procedure, 1 underwent meatal advancement and glanuloplasty (MAGPI procedure), and 1 underwent the glans approximation procedure (GAP). The patients were followed for 6-36 months to evaluate the surgical outcomes by the Pediatric Penile Perception Score (PPPS). A total of 27 patients with a mean age of 8.12 ± 3.0 years were enrolled in this study, and 25 cases (25/27, 92.6%) were accidentally discovered during the first visit for phimosis. The patients had a formed urethra of 0.5 to 1.5 cm. Complications occurred in 4 of the 27 patients (14.81%): 2 patients with urethral fistula and 2 patients with meatal stenosis. One patient had a case of self-healed urethral fistula, and the remaining 3 patients underwent reoperation. The post-operative effect was satisfactory in all patients, and the urinary flow and stream during urination were normal. The overall average PPPS score of non-operative surgeons and parents was satisfactory. There were no significant differences in meatus appearance, glans appearance, skin appearance, and general appearance PPPS score among the Mathieu, TIP, and Duplay surgical procedures. MIP clinical manifestations are concealed and usually noted when circumcision is attempted. The suitable procedure for each patient should be tailored according to the anatomic features, and several techniques can be used with good functional and cosmetic results.
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http://dx.doi.org/10.3389/fped.2020.00128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136419PMC
March 2020

Megameatus intact prepuce treated with urethral plate-preserving surgery: a retrospective study of an unusual hypospadias variant.

Transl Androl Urol 2019 Dec;8(6):583-590

Department of Radiology, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, China.

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.
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http://dx.doi.org/10.21037/tau.2019.10.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987599PMC
December 2019

Children with Cryptorchidism Complicated by Testicular Torsion: A Case Series.

Urol Int 2019 26;102(1):113-117. Epub 2018 Oct 26.

Department of Pediatric Surgery, Woman's and Children's Hospital, Shenzhen University and Pingshan District, Shenzhen, China.

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.
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http://dx.doi.org/10.1159/000493766DOI Listing
March 2019

Diethylstilbestrol Regulates the Expression of LGR8 in Mouse Gubernaculum Testis Cells.

Med Sci Monit 2016 Feb 8;22:416-21. Epub 2016 Feb 8.

Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China (mainland).

BACKGROUND Hormonal effects on the gubernaculum can affect testicular descent. Diethylstilbestrol (DES) is a nonsteroidal synthetic estrogen that disrupts the outgrowth of gubernaculums, leading to testis maldescent. However, the underlying mechanisms remain elusive. MATERIAL AND METHODS The gubernaculum were removed from 3-day-old mice and cultured. The subcultured cells were randomly divided into a normal control group and experimental groups. The DES groups were administered 10 μg/ml, 1 μg/ml, 0.1 μg/ml, 0.01 μg/ml of diethylstilbestrol dissolved in dimethyl sulfoxide (DMSO) respectively. The cell morphology was observed under an inverted microscope, and leucine-rich repeat-containing G protein-coupled receptor 8 (LGR8) was localized by immunofluorescence. The expressions of LGR8 gene and protein in gubernaculum cells were quantified by RT-PCR and Flow Cytometer respectively. RESULTS DES treatment converted cells from a normal fibroblast-like morphology into a more refractile, spindle-shaped morphology or irregular elliptical shapes along with cytoplasmic shrinkage. LGR8 was expressed in the cytoplasmic membrane, DES dose-dependently downregulated LGR8 expression at low doses (≤1.0 μg/ml), but upregulated LGR8 at high doses (10 μg/ml) at both the mRNA and protein levels. CONCLUSIONS These results suggest that DES causes testicular maldescent by altering the LGR8 pathway in mouse gubernaculum testis cells.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750751PMC
http://dx.doi.org/10.12659/msm.895089DOI Listing
February 2016

An insight into insulin-like factor 3 regulate its receptor RXFP2 in mouse gubernaculum testis cells.

Int J Clin Exp Pathol 2015 1;8(11):14806-11. Epub 2015 Nov 1.

Department of Pediatric Surgery, The Second Affiliated Hospital of Shantou University Medical College Shantou, Guangdong, China.

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.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4713594PMC
October 2016

Altered Levels of Zinc and N-methyl-D-aspartic Acid Receptor Underlying Multiple Organ Dysfunctions After Severe Trauma.

Med Sci Monit 2015 Sep 3;21:2613-20. Epub 2015 Sep 3.

Department of Pediatric surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China (mainland).

Background: Severe trauma can cause secondary multiple organ dysfunction syndrome (MODS) and death. Oxidative stress and/or excitatory neurotoxicity are considered as the final common pathway in nerve cell injuries. Zinc is the cofactor of the redox enzyme, and the effect of the excitatory neurotoxicity is related to N-methyl-D-aspartic acid receptor (NMDAR).

Material And Methods: We investigated the levels of zinc and brainstem NMDAR in a rabbit model of severe trauma. Zinc and serum biochemical profiles were determined. Immunohistochemistry was used to detect brainstem N-methyl-D-aspartic acid receptor 1 (NR1), N-methyl-D-aspartic acid receptor 2A (NR2A), and N-methyl-D-aspartic acid receptor 2B (NR2B) expression.

Results: Brain and brainstem Zn levels increased at 12 h, but serum Zn decreased dramatically after the trauma. NR1 in the brainstem dorsal regions increased at 6 h after injury and then decreased. NR2A in the dorsal regions decreased to a plateau at 12 h after trauma. The levels of NR2B were lowest in the death group in the brainstem. Serum zinc was positively correlated with NR2A and 2B and negatively correlated with zinc in the brain. Correlations were also found between the brainstem NR2A and that of the dorsal brainstem, as well as between brainstem NR2A and changes in NR2B. There was a negative correlation between zinc and NR2A.

Conclusions: Severe trauma led to an acute reduction of zinc enhancing oxidative stress and the changes of NMDAR causing the neurotoxicity of the nerve cells. This may be a mechanism for the occurrence of MODS or death after trauma.
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http://dx.doi.org/10.12659/MSM.895075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4571529PMC
September 2015

Computer-aided three-dimensional reconstruction of main vessels in hemangiomas.

Int J Clin Exp Med 2015 15;8(2):1747-54. Epub 2015 Feb 15.

Department of Pediatric Surgery, Shantou University Medical College Shantou 515041, Guangdong Province, P.R China.

This study aimed to investigate three-dimensional (3-D) morphological features of the main vessel architecture of human hemangioma. Serial sections of specimens from three cases of children hemangioma were stained with hematoxylin and eosin (HE) to visualize the vessels. Serial images were taken and processed with computer-assisted 3-D reconstruction. Partial 3-D structure reconstruction of vessel morphology in hemangioma revealed strange distribution and branching, which were different from normal vessels of the human skin. The 3-5 microvascular was most common in hemangioma. We observed respective characteristics of three cases: 1 case showed uniform artery vein distribution accompanied by running trend; 1 case showed main artery distribution and less vein distribution, and there were many blood sinus in the shallow surface close to the skin; another case showed vein distribution in the middle of antrum. In conclusion, digital vascular model of 3-D structure of main vessel hemangioma provides a new way for the diagnosis and treatment of hemangioma of children.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402750PMC
May 2015

Blood zinc, iron, and copper levels in critically ill neonates.

Biol Trace Elem Res 2015 Mar 4;164(1):8-11. Epub 2014 Dec 4.

The Second Affiliated Hospital, Shantou University Medical College, Shantou City, 515041, Guangdong Province, People's Republic of China.

The aim of this study is to explore the prognostic value of blood zinc, iron, and copper levels in critically ill neonates by comparing blood metal levels with the score for neonatal acute physiology (SNAP). Forty-six neonates (26 boys, 20 girls; ages ranging from 10 min to 23 days) who had been admitted to the neonatal intensive care unit of hospital and who were critically ill according to SNAP were included. Another 15 neonates (12 boys, 8 girls; ages ranging from 30 min to 24 days) who were brought to the hospital for a health checkup were included as controls. Clinical data, time in the intensive care unit, prognosis, and SNAP for critically ill neonates were recorded. Blood Cu, Zn, and Fe values were measured by inductively coupled plasma atomic emission spectrophotometry. Ill neonates were divided into extremely critical (SNAP ≥ 10) and critical groups (1 ≤ SNAP < 9). Zn levels were lower in patients than in controls (p <0.05). Cu levels did not differ between patients and controls (p >0.05). Fe levels were not significantly between the critical and control groups (p >0.05). In ill neonates, blood Zn and Fe concentrations in the extremely critical group were lower than in the critical group (p <0.05). Serious illness in neonates may lead to decreased Zn and Fe blood concentrations. Zn and Fe supplements may be beneficial for critically ill children.
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http://dx.doi.org/10.1007/s12011-014-0193-3DOI Listing
March 2015

The composition of surgical teams in the operating room and its impact on surgical team performance in China.

Surg Endosc 2014 May 6;28(5):1473-8. Epub 2013 Dec 6.

Department of Minimally Invasive Surgery, Second Affiliated Hospital of Shantou University Medical College, Dongxia North Road (Zhu-Xia Block), Shantou, 515041, Guangdong, China.

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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.
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http://dx.doi.org/10.1007/s00464-013-3318-4DOI Listing
May 2014

What is the optimal surgical strategy for bulbous urethral stricture in boys?

J Urol 2009 Oct 18;182(4 Suppl):1755-8. Epub 2009 Aug 18.

Department of Urology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

Purpose: Optimal management for bulbous urethral stricture in children is poorly defined. We compared our long-term experience with direct vision internal urethrotomy and open repair to define the optimal surgical strategy.

Materials And Methods: We reviewed the records of 63 patients who underwent direct vision internal urethrotomy or open repair. A total of 46 patients (73%) were treated with 1 or more urethrotomies. Of the patients 17 (27%) underwent urethroplasty, 13 underwent end-to-end repair and 4 received a patch graft or tube. Eight of 17 cases required urethroplasty only, whereas in 9 combined open repair and urethrotomy were done. Mean patient age was 14.1 years (range 5 months to 21 years). Followup included voiding cystourethrogram, retrograde urethrogram and/or cystoscopy, or flow rate. Mean followup was 30 months for urethrotomy and 16 months for open urethroplasty.

Results: When direct vision internal urethrotomy was the initial approach, 1 procedure was successful in 28 of 53 cases (53%). Multiple urethrotomies increased the success rate to 59% (43 of 73 cases). The 53 patients with urethrotomy required a total of 84 procedures (mean 1.6 each). When open repair was the initial approach, 1 procedure was successful in 8 of 10 cases (80%). A total of 12 procedures (mean 1.2 each) were required in those 10 cases. A combined urethrotomy/open approach with 2 procedures was successful in 78% of cases (7 of 9).

Conclusions: Open reconstruction is more successful than direct vision internal urethrotomy as the initial approach to bulbous urethral strictures. Although aggressive, end-to-end repair usually provides a definitive solution. Initial direct vision internal urethrotomy is successful in half of the cases and repeat urethrotomy adds little to success. The success of the combined urethrotomy/open approach approximates that of initial open reconstruction. If initial direct vision internal urethrotomy is elected, we advocate only 1 attempt, followed by open end-to-end urethroplasty if necessary.
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http://dx.doi.org/10.1016/j.juro.2009.02.082DOI Listing
October 2009

Varicocele surgery: a decade's experience at a children's hospital.

BJU Int 2009 Jul 19;104(2):246-9. Epub 2008 Dec 19.

Department of Urology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.

Objectives: To review our experience at a children's hospital over a 10-year period with the Palomo, Ivanissevich, subinguinal and laparoscopic techniques for varicocele, assessing the success and complication rates according to specific procedure, and the added effect that the modifications of microsurgery and artery-sparing has had on these rates. A second objective was to assess the rate of testicular compensatory growth after surgery for testicular hypotrophy.

Patients And Methods: Ninety-two patients with >1 year of follow-up between 1996 and 2006 were assessed retrospectively. The median (range) age at surgery was 15 (8-21) years. Patients were stratified based on the surgical technique used by eight different urology faculty members. Microsurgery and attempted artery-sparing were applied to some Palomo, Ivannisevich, and subinguinal cases but not to laparoscopic procedures.

Results: The laparoscopic (100%) and Palomo (93%) techniques had significantly higher success rates than the Ivanissevich approach (69%). The success rate with the subinguinal technique (88%) was intermediate between the more successful supra-inguinal and less successful inguinal approaches. There was a higher hydrocele rate (32%) in the laparoscopic approach. Artery sparing significantly lowered hydrocele rates but had no effect on success rates. Incorporating microsurgery also had no effect on success rates but resulted in no hydrocele formation. One case of testicular atrophy occurred in a patient undergoing microsurgical artery-sparing subinguinal spermatic vein ligation. There was compensatory growth in 68% of patients operated on for testicular hypotrophy.

Conclusions: During our 10-year experience the laparoscopic and Palomo approaches were the most successful. The subinguinal approach (usually incorporating microsurgery and artery sparing) had an intermediate success rate. The Ivanissevich approach was least successful. Hydroceles did not occur when microsurgery was used, and were significantly less common with artery sparing. The only case of testicular atrophy was with a microsurgical artery-sparing subinguinal approach. When the spermatic vein was ligated for testicular hypotrophy there was compensatory growth in two-thirds of testes.
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http://dx.doi.org/10.1111/j.1464-410X.2008.08288.xDOI Listing
July 2009

In utero treatment for bladder outlet obstruction using robot assisted laparoscopic techniques.

J Urol 2008 Oct 21;180(4 Suppl):1790-4; discussion 1794. Epub 2008 Aug 21.

Department of Urology (Robotic Research and Training Center), Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts 02115, USA.

Purpose: Bladder outlet obstruction can have devastating consequences. Given the poor outcome, intervention in utero has been advocated in an attempt to salvage pulmonary and renal function. We evaluated whether laparoscopic decompression of the obstructed bladder could be performed efficiently by adapting current robot assisted laparoscopic techniques to access the fetus in utero.

Materials And Methods: At 95 days of gestation 20 fetal sheep underwent ligation of the urethra and urachus. Two to 5 days later robot assisted laparoscopic vesicostomy was performed. Ultrasound of the kidneys and bladder was performed before each procedure. At 135 days of gestation the urinary tract was evaluated to assess the adequacy of bladder decompression and a patent vesicostomy.

Results: After 48 hours of undergoing ligation all fetuses had bilateral moderate hydronephrosis and a markedly distended bladder. In the first 10 fetuses vesicostomy could not be completed laparoscopically due to limited visualization. Additional modifications in trocar placement and gas infusion allowed vesicostomy to be completed laparoscopically in the last 8 fetuses in 2.5 to 4 hours. Urinary tract decompression and a patent vesicostomy were observed in all of these fetuses postoperatively.

Conclusions: We developed specific modifications in current robot assisted laparoscopic techniques and instrumentation to allow the treatment of bladder outlet obstruction in utero. This procedure may be performed efficiently and it may provide advantages over conventional surgery for fetal intervention.
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http://dx.doi.org/10.1016/j.juro.2008.03.085DOI Listing
October 2008

Surgical treatment of jugular vein phlebectasia in children.

Am J Surg 2006 Sep;192(3):286-90

Department of Pediatric Surgery, Second University Hospital of Shantou University Medical College, Dongxia Bei Rd., Shantou City, Guangdong Province, People's Republic of China, 515041.

Background: Jugular vein phlebectasia (JVP) is a cervical mass that occurs relatively infrequently and usually presents in children as a soft cystic swelling in the neck during straining. It is liable to be misdiagnosed or managed inappropriately. This report elucidates the clinical presentation, diagnosis, treatment choices, and postoperative complications of JVP, and diagnostic methods and treatment choices are recommended.

Methods: Fifty-one cases of JVP were reviewed (right vein in 38 patients, left in 7 patients, and bilateral in 6 patients). The internal jugular vein was involved the most frequently. The main complaint was a soft and compressible mass in the neck, becoming more prominent with the Valsalva maneuver. All of the children except 2 had an ultrasound or color Doppler flow imaging (CDFI) performed in combination with the Valsalva's breathing test. Surgical intervention was performed in 46 patients and the other 5 patients were followed-up conservatively for 2 to 15 years.

Results: Ultrasound or CDFI showed local dilatation of unilateral or bilateral veins in all patients except 2, and confirmed the diagnosis in combination with the Valsalva's breathing test. Surgical intervention included ligation of the involved jugular vein in 32 patients, and longitudinal constriction suture venoplasty plus encapsulation with medical Dacron cloth or PTFE in 14 patients. All of the children who had surgery recovered uneventfully, except 3 patients undergoing ligation of the right internal jugular vein.

Conclusions: The Valsalva maneuver was most important for establishing the diagnosis. Ultrasound or CDFI, or in combination with the Valsalva's breathing test, was the diagnostic procedure of choice to confirm the diagnosis of JVP because of its clarity, safety, and low cost. Surgical intervention was recommended for cosmetic and psychologic purposes. Ligation or excision of the involved jugular vein was very safe, simple, and effective for most patients. However, in cases of lesions of the right and bilateral internal jugular veins, longitudinal constriction suture venoplasty plus encapsulation might be more preferable and safer, and should be recommended. Otherwise, treatment should be conservative (follow-up evaluation).
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http://dx.doi.org/10.1016/j.amjsurg.2006.02.025DOI Listing
September 2006

Combined treatment of hepatoblastoma with transcatheter arterial chemoembolization and surgery.

Pediatr Hematol Oncol 2006 Jan-Feb;23(1):1-9

Department of Pediatric Surgery, The Second Hospital of Shantou University Medical College, Shantou, China.

Hepatoblastoma (HB) frequently presents at an advanced and unresectable stage. Transcatheter arterial chemoembolization (TACE) had been attempted to improve the feasibility of removing the bulky tumor in the authors' hospital and the results were presented here to evaluate the effectiveness and therapeutic role of TACE in the HB infants. Eight patients (6 boys, 2 girls), ranging in age from 2 months to 12 months, had unresectable HB based on clinical manifestation, B-ultrasound (B-US), chest X-ray film, computed tomography (CT), blood chemistry, and serum alpha-fetoprotein (AFP), and were subjected to TACE 1-3 times. On each TACE, Adriamycin (ADR, 20 mg/m2), vincristine (VCR, 1.5 mg/m2), and cisplatin (CDDP, 40 mg/m2) dispersed in 5-10 mL lipiodol were infused into the tumor, and stainless-steel embolization coils were released into the main feeding artery until completely embolized. Then, all the patients were reexamined once a month. Digital subtractive angiography was performed and the therapeutic strategy of further TACE or surgery was individualized in terms of the changes of tumor stain and the newly forming feeding artery. Six children (75%) had a marked response after the first TACE and were judged as being surgically resectable, but one boy died of pneumonia just before the scheduled operation and another boy preferred further TACE. The other 2 patients had only a partial response and required further TACE before the operation. Thus 6 children eventually underwent complete surgical resection and 1 boy achieved successful disappearance of tumor after 3 episodes of TACE alone. Seven children had an excellent recovery and remained tumor-free for 15-49 months. The results indicate that TACE is an effective and useful preoperative therapeutic choice for unresectable hepatoblastoma, and can improve the resectablity of the bulky tumor and the survival rate of HB patients. Multiple TACE could enhance the therapeutic effect and should be considered if indicated.
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http://dx.doi.org/10.1080/08880010500313256DOI Listing
July 2006

Transcatheter arterial embolization in the treatment of extensive maxillofacial hemangioma in children.

World J Surg 2005 Dec;29(12):1550-6

Department of Pediatric Surgery, Second Affiliated Hospital, Shantou University Medical college, Shantou, Guangdong Province, 515041, Peoples Republic of China.

Infantile hemangioma frequently occurs in the maxillofacial region as an extensive mass involving many vital structures. As such, many children are found to have an unresectable hemangioma at the initial diagnosis. In the present study transcatheter arterial embolization (TAE) alone or in combination with surgery and local injection of bleomycin A has been attempted to improve the treatment of these lesions. The results of evaluating the effectiveness and therapeutic role of TAE in these extensive maxillofacial hemangiomas in children are presented. We retrospectively analyzed the records of 17 children with maxillofacial hemangioma treated between 1997 and 2004. Altogether, 17 patients (11 boys, 6 girls) were diagnosed as having an extensive maxillofacial hemangioma based on its clinical manifestation, color Doppler ultrasonography, and sometimes computed tomography. They underwent selective TAE alone or TAE followed by surgical excision. For the children with Kasabach-Merritt syndrome, systemic corticosteroid therapy was administered first. All the children had an excellent response after TAE treatment without obvious complications, and the size of the hemangioma body markedly decreased. Local injection of bleomycin A was then undertaken in four children and surgical removal in five. All the children achieved successful disappearance of the hemangioma, with no recurrence during the follow-up period of 5 to 86 months. TAE is thus a reliable and effective therapeutic choice for extensive maxillofacial hemangioma in children, alone or as a preoperative adjunctive measure. It improves the feasibility of complete resection and effects the disappearance of these potentially dangerous bulky tumors with little bleeding and few complications.
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http://dx.doi.org/10.1007/s00268-005-7872-3DOI Listing
December 2005

Congenital jugular vein phlebectasia.

Am J Otolaryngol 2005 May-Jun;26(3):172-4

Department of Pediatric Surgery, Medical College of Shantou University, Shantou City, Guangdong Province, China.

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).
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http://dx.doi.org/10.1016/j.amjoto.2005.02.009DOI Listing
September 2005

An exceptional combined malformation: duplication of the urinary and intestinal tracts and the vulva (04-80CR).

J Pediatr Surg 2005 Mar;40(3):E5-9

Department of Pediatric Surgery, Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, China.

The authors reported the surgical treatment of a 2-year-old girl with complete duplication of the kidney, ureter, bladder, urethra, and the vulva, associated with intestinal duplication and complete duplication of the appendix and colon. Congenital intestinal malrotation also concurred. After a series of preoperative examinations, exploratory operation including reduction of intestinal malrotation, fusion of bladder and colon, obliteration of the duplicated urethra, resection of the intestinal and appendiceal duplications, and cosmetic repair of the vulva was performed. Incontinence of urine and stool disappeared, and she had been followed up for 10 months until this report. Repeat voiding cystourethrography performed recently demonstrated a fused bladder and the disappearance of the duplicated urethra.
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http://dx.doi.org/10.1016/j.jpedsurg.2004.11.003DOI Listing
March 2005

Cure of hepatoblastoma with transcatheter arterial chemoembolization.

J Pediatr Hematol Oncol 2004 Jan;26(1):60-3

Second University Hospital of Shantou University, Department of Pediatric Surgery, Dongxia Bei Road, Shantou City, Guangdong Province 515031, China.

Until now surgical resection was still considered as the only choice of successful treatment of hepatoblastoma. Therefore, successful use of transcatheter arterial chemoembolization (TACE) alone to cure the unresectable hepatoblastoma in an infant was firstly reported. A 6-month-old boy presented with a huge abdominal mass and was found to have a hepatoblastoma of 17.5 cm x 11.5 cm x 10 cm on computed tomography (CT) scan. The serum alpha-fetoprotein (AFP) was elevated to 6250 ng/mL. On the first TACE the main feeding arteries were completely occluded by stainless steel embolization coils. After one month tumor shrinkage was 75%, but a newly formed feeding artery was found and embolized on second TACE. Since the third TACE no newly formed feeding artery was found and 6 courses of intravenous chemotherapy were consolidated. On the last DSA and CT the tumor was completely disappeared and AFP returned to normal. During the follow-up he remained disease-free for 33 months until the present report. TACE may provide an additional promising choice in the treatment of hepatoblastoma.
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http://dx.doi.org/10.1097/00043426-200401000-00018DOI Listing
January 2004

Effect of epidermal growth factor on pulmonary hypoplasia in experimental diaphragmatic hernia.

J Pediatr Surg 2004 Jan;39(1):37-42

Department of Pediatric Surgery, the Second University Hospital of Shantou University, Shantou City, Guangdong Province, China.

Background/purpose: 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.

Methods: 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.

Results: 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, P < 0.01).

Conclusions: 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.
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http://dx.doi.org/10.1016/j.jpedsurg.2003.09.014DOI Listing
January 2004

Isolated renal mucormycosis in children.

J Urol 2004 Jan;171(1):387-8

Department ofPediatric Surgery, Second University Hospital of Medical College, Shantou University, Guangdong Province, China.

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http://dx.doi.org/10.1097/01.ju.0000100842.96636.a0DOI Listing
January 2004

Single ureteral ectopia with congenital renal dysplasia.

J Urol 2003 Aug;170(2 Pt 1):558-9

Department of Pediatric Surgery, Second University Hospital of Shantou University, Shantou City, Guangdong Province, China.

Purpose: We reviewed the clinicopathological features and surgical management of 16 cases of single ureteral ectopia with congenital renal dysplasia.

Materials And Methods: 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.

Results: 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.

Conclusions: 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.
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http://dx.doi.org/10.1097/01.ju.0000076000.82388.80DOI Listing
August 2003
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