Objective To observe the stereoscopic vision in ametropic amblyopia and normal children.Methods The stereoscopic vision in 57 ametropia children with normal corrected vision(≥ 0.9)and 50 normal children were measured and statistically evaluated by usingRandom stereoscopic examination diagramwritten by Yan Shaoming,synoptophone of random-dot stereopsis and synoptophore.Results(1) Compared with normal children,the zero disparity,crossed disparity,uncrossed disparity and far stereopsis in ametropic amblyopia children were all significantly worse(P 0.01 or P 0.05);the distance fusion range had no obvious difference.(2) There were no significant difference of the indexes excluding crossed disparity between mild group and moderate group in ametropic amblyopia children before correction of the vision.Conclusion Ametropic amblyopia affects the formation of children's stereoscopic vision badly.Thereby,Ametropic amblyopia should be prevented,detected early and corrected effectively.
Double-J (DJ) stent placement is an important procedure during laparoscopic pyeloplasty (LP). Failing to insert the DJ stent may indicate the patient was also complicated with uretero-vesical junction obstruction (UVJO), and surgeons have to change to another alternative drainage method. In the present study, we analyzed the risk factors of failure of DJ stent placement during the LP and reviewed the clinical outcomes of these challenging pyeloplasties.We retrospectively analyzed the clinical data of patients with ureteropelvic junction obstruction (UPJO) who underwent LP in our department from January 2016 to September 2020. For patients who developed a difficult process of inserting the DJ stent, the externalized uretero-pyelostomy (EUP) stent was indwelled. Patients were finally divided into two groups: DJ group and EUP group. The primary outcomes were recurrent UPJO, postoperative uretero-vesical junction obstruction (UVJO) and complications.A total of 535 patients were included in the study, of which 37 patients (6.9%) failed to insert the DJ stent. Age was younger, and weight was lower (P < 0.05) in the EUP group. Within follow-up, recurrent UPJO occurred in ten (1.87%) patients, nine in the DJ group and one in the EUP group (P > 0.05). The incidence of postoperative UVJO in the EUP group was significantly higher than in the DJ group (10.8% vs. 0.2%, P < 0.01). 74 patients (13.8%) developed complications after surgery, 12 patients (32.4%) in the EUP group, significantly higher than that in the DJ group (32.4% vs. 12.4%, P < 0.01). Compared with the DJ group, the larger APD were observed in the EUP group at three months postoperatively (3.50 [3.02;4.58] vs. 2.20 [1.50;2.88], P < 0.05), but the difference vanished in further follow-up.The failure of DJ stent placement tends to occur in patients with younger age, lower weight, and larger preoperative APD. Failure may not increase the recurrent UPJO rate, but may indicate a higher probability of postoperative UVJO and may develop more postoperative complications and slower recovery.
Abstract Central precocious puberty secondary to Leydig cell tumors is rare in children. We retrospectively analyzed the mid- to long-term follow-up data of patients with Leydig cell tumors. The clinical data of 12 consecutive patients who were treated at Beijing Children’s Hospital, Capital Medical University (Beijing, China), between January 2016 and October 2023 were retrospectively reviewed. Clinical evaluations, including physical examination, hormone examination, serum tumor marker analysis, abdominal and scrotal ultrasound, chest X-ray, and bone age measurement, were conducted before surgery and at follow-up time points. Surgical approaches were selected according to the individual conditions. Patients with an abnormal hormonal status and suspected of having central precocious puberty were referred to endocrinologists to confirm the diagnosis. Subsequently, gonadotropin-releasing hormone analog therapy was proposed. The mean patient age was 81.3 (range: 40–140) months at the time of the operation. Ten patients had peripheral precocious puberty at admission. All patients had elevated preoperative testosterone levels, whereas tumor marker levels were normal. Testis-sparing surgery was performed in eleven patients, and radical orchiectomy was performed in one patient. The follow-up duration (mean ± standard deviation) was 36.2 ± 25.3 months. Five patients had central precocious puberty, with a mean duration of 3.4 (range: 1–6) months postoperatively. Three patients were receiving gonadotropin-releasing hormone analog therapy, and good suppression of puberty was observed. No risk factors were found for secondary central precocious puberty. There was a high prevalence of central precocious puberty secondary to Leydig cell tumors in our study. Gonadotropin-releasing hormone analog therapy has satisfactory treatment effects. Larger sample sizes and long-term follow-up are needed in future studies.
Background: Urethral plate transection (UPT) is crucial in hypospadias surgery. This study aims to develop a nomogram to predict UPT and assess the severity of hypospadias, to assist in choosing surgical techniques and improving preoperative parental counseling.Methods: We retrospectively reviewed the clinical data of hypospadias patients who underwent urethroplasty from 2018 to 2020 at the National Center for Children's Health (NCCH) and sixteen tertiary institutions in China. Data from NCCH were used to develop the prediction nomogram. The nomogram was internally validated by 10-fold cross-validation and externally validated by the multicenter cohort.Findings: A total of 584 patients in the NCCH cohort and 511 patients in the multicenter cohort were included. The UP width (odds ratio [OR]: 0·49; 95% confidence interval [CI]: 0·42–0·57), preoperative meatus position (OR: 2·65; 95% CI: 2·25–3·13), and preoperative curvature (OR: 1·08; 95% CI: 1·07–1·10) were selected to fit the nomogram (Plate-Meatus-Curvature, PMC model). The nomogram was well-calibrated. The receiver operating characteristic analysis illustrated that the area under the curve was 0·924 (95% CI: 0·845–0·998) in the NCCH cohort and 0·879 (95% CI: 0·845–0·998) in the multicenter cohort. Decision curve analyses revealed great clinical utility. Furthermore, we identified 120·0 as a cut-off value of nomogram points to discriminate patients between severe and non-severe groups. The UPT and postoperative complication rates in the severe group were significantly higher than those in the non-severe group (P < 0·001).Interpretation: The PMC model showed good performance for predicting UPT in hypospadias surgery. Furthermore, we identified a cut-off point for describing the severity of hypospadias, which correlate with postoperative outcomes.Funding: This work was supported by grants from the National Key R&D Program of China (2016YFC 1000807).Declaration of Interest: None to declare. Ethical Approval: The study was approved by the ethics committee of Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (IEC-C-006-A04-V.06, [2022]-E-030-R).
Abstract Purpose To find the cut-off value of urethral defect length (UDL) to guide the choice of single‑stage or two‑stage transverse preputial island flap urethroplasty (TPIFU). Methods We prospectively collected the data of patients with severe hypospadias underwent single-stage and two-stage TPIFU at fifteen tertiary referral institutions from 2019 to 2020. The receiver operating characteristic (ROC) analyzed the cut-off value of UDL to predict postoperative complications with single-stage TPIFU. We extracted patients with long UDL (longer than the cut-off value) in the single-stage and two-stage TPIFU, comparing the postoperative complications. Results A total of 536 patients included 483 underwent single-stage TPIFU and 53 underwent two-stage TPIFU were collected. The ROC analyzed the cut-off value of UDL was 3.5 cm. 169 patients with long UDL (longer than 3.5 cm) were extracted from all 536 patients, with 126 underwent single-stage TPIFU (single-stage group) and 43 underwent two-stage TPIFU (two-stage group). In the single-stage group, complications occurred in 62 (49.2%) patients, including 34 (27.0%) with urethrocutaneous fistula, 21 (16.7%) with urethral stricture, and 25 (19.8%) with diverticulum. In the two-stage group, total complications occurred in four (9.3%), there were both two (4.7%) with urethral stricture and diverticulum, and no urethrocutaneous fistula was recorded. Conclusion Our results show that two-stage TPIFU can significantly reduce the incidence of postoperative complications for hypospadias with UDL longer than 3.5 cm, especially urethrocutaneous fistula and diverticulum.
Background Hypospadias repair is a complex surgical procedure that involves correcting penile ventral curvature (VC) and performing urethroplasty. This study aims to evaluate the effectiveness of different strategies for VC correction and analyse the trends in hypospadias repair at a national centre in China. Methods Prospective data collection was conducted from 2019 to 2020 for patients undergoing hypospadias repair. The effectiveness of VC correction was assessed based on the degree of VC change with different strategies. Furthermore, the choice of surgical techniques for different types of hypospadias repair was analysed. Results A total of 434 patients were included, with a median preoperative VC degree of 50° (35°, 70°). All patients achieved a straight penis postoperatively, with 15.2% undergoing degloving, 28.6% undergoing degloving and dorsal plication (DP), 13.1% undergoing degloving and urethral plate transection (UPT), and 43.1% undergoing degloving, UPT and DP. Degloving alone was effective in correcting VC in 57.6% of patients with VC less than 30°. In our analysis, DP after UPT resulted in a higher degree of correction (25°) compared with DP after degloving alone (20°) (p<0.001). The study identified the current trends in hypospadias repair, with tubularised incised plate urethroplasty (TIP) being the most common technique used in distal hypospadias repair (70.6% of patients) and transverse preputial island flap urethroplasty (TPIFU) being preferred for proximal hypospadias repair (63.0%). Conclusions Degloving alone is effective for correcting VC less than 30°. The majority of patients in our centre underwent UPT, and DP after UPT yielded better results compared with DP after degloving alone. Distal hypospadias repair commonly used TIP, while TPIFU was favoured for proximal hypospadias repair. Trial registration number ChiCTR1900023055.
Bilateral Wilms tumor (BWT) is a relatively rare malignant renal tumor in children. Nephron-sparing surgery (NSS) is the preferred surgical approach for treating BWT, but lacks uniform surgical indications worldwide. This study aimed to summarize the clinical and imaging features of BWT children, establish a radiomics nomogram, and predict the feasibility of NSS for improving outcomes.A 12-year retrospective single-center review was conducted on clinical data and preoperative imaging features of BWT patients. The tumor kidneys were divided into NSS and non-NSS groups. Logistic regression analysis was performed to identify independent predictors and develop a prediction model of the feasibility of NSS in BWT patients. A radiomics nomogram was constructed and internally validated by the parametric bootstrapping method.A total of 58 BWT patients (115 renal units) were included in this study. After evaluations based on preoperative imaging and clinical data, 94 renal units underwent NSS with negative resection margins and were included in the NSS group, whereas 16 renal units with positive resection margins, macroscopic residual, or total nephrectomies were included in the non-NSS group. Tumor size [odds ratio (OR): 0.540, 95% confidence interval (CI): 0.308-0.945], relationship with the collecting system (OR: 0.013, 95% CI: 0.0004-0.370), and remaining renal parenchyma (RRP) proportion (OR: 71.23, 95% CI: 1.632-3108.8) were identified as independent predictors for NSS. A nomogram was constructed based on these factors, which demonstrated great consistency between the predicted and observed feasibility of NSS. The model presented with good discriminative ability [area under the curve (AUC), 0.982]. The decision curve analysis (DCA) revealed the clinical usefulness of the model.This study analyzed the clinical and preoperative imaging data of BWT patients and identified three independent predictors for the feasibility of NSS, including tumor size, relationship with the collecting system, and residual renal parenchyma proportion. The radiomics nomogram established in this study can provide individualized predictions to assist clinicians in making better decisions and improving patient outcomes.
Objective To analyze the macular thickness measured in myopic eyes by spectral domain optical coherence tomography (OCT).Methods The macular thicknesses of 268 eyes of 137 participants with 47 emmetropic,70 low myopic,102 moderate myopic and 49 highly myopic eyes were measured by the Topcon 3D OCT 1000.The macular thicknesses were compared between emmetropic and low myopic,moderate myopic and highly myopic eyes.Results The Central subfield thickness of emmetropic and low myopic,moderate myopic and highly myopic eyes were (226.36±21.68),(231.36±19.28),(227.06±17.41) and (231.51±19.17)μm.Average thickness of emmetropic and low myopic,moderate myopic and highly myopic eyes were (281.45± 11.49),(277.70± 12.03),(269.93±12.05) and (268.38±10.97)μtm.Center thickness and central subfield thickness were not significantly thinner in myopic eyes than in emmetropic eyes.Macular thickness in outer and inner region (Infra-inner except,P=0.18) of moderate myopic eyes was significantly thinner than that of emmetropic eyes and low myopic eyes.Conclusions The center macular thickness is not becomes thinner in young myopic eyes.Retina thickness in outer and inner macular region of myopic is thinner than that of emmetropic eyes.The amount of macular thinner gradually increases from outer region to inner region with the increase of the degree of myopia.
Key words:
Optical coherence tomography (OCT); Macular thickness; Myopic eyes
Purpose Review the experience of redo laparoscopic pyeloplasty (RLP) in patients with recurrent ureteropelvic junction obstruction (UPJO) in comparison to primary laparoscopic pyeloplasty (PLP) and redo open pyeloplasty (ROP), and determine the feasibility and effectiveness of RLP for recurrent UPJO in children. Methods We retrospectively reviewed the clinical data of patients treated with transperitoneal PLP, RLP, and ROP for UPJO from December 2015 to December 2022. The Propensity score matching (PSM) was used to balance confounding variables. RLP patients were 1:4 matched with PLP and 1:3 matched with ROP. The primary outcomes were failure and post-operative complications. Complications were classified according to the Clavien-Dindo grading system. Results The study included ten patients who underwent RLP, 43 patients who underwent ROP, and 412 patients who underwent PLP. The follow-up time ranged from 6 to 36 months in the RLP group, 12 to 60 months in the PLP group, and 24 to 54 months in the ROP group. In the RLP group, no failure but three post-operative complications (Clavien grade II) were observed during the follow-up. Compared with the PLP group, the older age, higher weight, larger pre-operative anteroposterior diameter (APD) and APD/cortical thickness (P/C ratio), longer operation time, and post-operative length of stay (LOS) in the RLP group ( P < 0.05). After PSM, longer operation time and post-operative LOS were observed in the RLP group ( P < 0.05). Compared with the ROP group, the older age, higher weight, and longer post-operative LOS in the RLP group ( P < 0.05). After PSM, longer post-operative LOS was observed in the ROP group ( P < 0.05). The failure and complication rates were comparable between RLP and PLP or RLP and ROP ( P > 0.05). Conclusions Our result demonstrated that RLP performed as well as PLP except for a longer operation time. Compared with ROP, RLP has the advantages of a clearer surgical view, sufficient exposure, clearer anatomical landmark position, and minor trauma with a comparable clinical outcome. On experienced hands, RLP for recurrent UPJO after is a safe and effective procedure and should be considered an excellent alternative to the more commonly recommended ROP in select patients.
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