Pediatric Surgery International最新文献

Purpose: Neonatal enterostomies often cause high-output losses of intestinal contents, leading to malabsorption, growth failure, and dependence on parenteral nutrition. Conventional refeeding relies on intermittent or continuous reinfusion and may entail contamination risk and technical difficulties.

Methods: This study introduces an indwelling tube refeeding approach that connects the proximal and distal bowel through a single continuous tube, enabling uninterrupted physiological flow. Using a bench-top in vitro model simulating a neonatal high-output stoma, nine three-dimensional -printed tubes (three diameters × three configurations) were tested at two infusion rates (100 and 50 mL/h).

Results: All 90 trials achieved continuous distal outflow without occlusion, confirming technical feasibility. Flow efficiency increased with tube diameter: at 100 mL/h, efficiencies were 95.2 ± 5.2% (9 mm), 62.5 ± 12.3% (7 mm), and 55.5 ± 8.6% (5 mm); a similar pattern was observed at 50 mL/h. Tube configuration and infusion rate had minimal effects on flow efficiency.

Conclusion: This bench-top study demonstrates the feasibility of an indwelling bridging tube for continuous proximal-to-distal transfer in vitro. Although larger diameters achieved higher flow efficiency, smaller-caliber tubes occupying approximately 40% of the lumen still achieved > 56% efficiency in this model; however, clinical safety and efficacy require further biomechanical and in vivo validation.

Background: Hepatoblastoma (HB) is the most common malignant liver tumor in pediatric patients. Even though the 5-year survival rate of HB patients has reached 80%, the prognosis in patients with high-risk features remain poor. This study aimed to establish the proteomic signature of HB to discover novel biomarkers and therapeutic targets.

Methods: HPLC-MS/MS coupled with bioinformatic analyses were performed to identify the differentially expressed proteins and related GO/KEGG pathways in HB tumor tissues. Molecular biology experiments in HepG2 and Huh6 cells were conducted to validate findings of proteomic results.

Results: Comparison of protein abundance profiles between HB tumors and normal adjacent liver tissues revealed high expression of HMGA2, IGFBP1, and LIN28B in HBs. GO/KEGG enrichment and protein-protein interaction analyses showed activation of RNA processing and the LIN28B/HMGA2 axis in HB tissue samples. Cellular and biochemical experiments confirmed that LIN28B expression was positively correlated with that of HMGA2, and that both promoted cell proliferation and tumor progression in the HB cell lines HepG2 and HUH6.

Conclusions: In this study, we mapped the protein abundance profile of HB, identified a possible regulatory role and therapeutic potential of the LIN28B/HMGA2 axis, and provided database and foundation for future studies.

Background: Hepatic cystic echinococcosis (HCE) imposes a significant health burden on children in endemic regions. This meta-analysis compares perioperative outcomes between laparoscopic (LS) and open surgery (OS) for pediatric HCE to inform surgical management strategies.

Methods: Following PRISMA guidelines, we systematically searched PubMed, CNKI, Wanfang, and VIP for studies (February 2019-April 2024) comparing LS and OS in children with HCE. Two reviewers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale. Pooled analysis was performed for operative time, blood loss, hospital stay, biliary complications, residual cavity effusion, and recurrence.

Results: Eleven studies involving 556 children (LS = 210, OS = 346) were included. LS was associated with significantly reduced intraoperative blood loss (SMD = -1.11, 95% CI: -1.36 to -0.86, P < 0.001) and shorter hospital stay (SMD = -1.12, 95% CI: -1.81 to -0.42, P = 0.002) compared to OS. Operative time was also shorter in the LS group (SMD = -0.36, 95% CI: -0.85 to 0.14, P < 0.001). There were no significant differences in rates of biliary complications (OR = 1.17, 95%CI 0.26-5.35, P = 0.083), residual cavity effusion (OR = 0.34, 95%CI 0.08-1.47, P = 0.149), or recurrence (OR = 0.57, 95%CI 0.21-1.56, P = 0.277).

Conclusion: For selected pediatric HCE patients, laparoscopic surgery offers faster recovery with less surgical trauma and a comparable safety profile to open surgery. These findings support integrating minimally invasive techniques into pediatric surgical practice in endemic, resource-limited settings.

Purpose: Necrotizing enterocolitis (NEC) is a life-threatening gastrointestinal disease of prematurity characterized by inflammation, necrosis, and high morbidity. Current therapies are limited, necessitating the development of novel treatments. Mesenchymal stromal cells (MSCs) have shown promise in murine NEC models. Given the anatomical and physiological similarities between premature piglets and human infants, we employed a preterm piglet model to evaluate MSC efficacy. We hypothesized that intraperitoneal MSC administration would reduce intestinal injury in NEC.

Methods: Preterm piglets were delivered via cesarean section. NEC was induced on day 3 through hypertonic enteral feeding. MSCs were administered intraperitoneally at low, medium, or high doses. Piglets were monitored and euthanized based on clinical criteria. Clinical scores, weight change, gross and histologic intestinal injuries were assessed. Cytokine levels in serum and ileum were quantified via ELISA, and intestinal tissue was analyzed by RNA sequencing. Statistical significance was set at p < 0.05.

Results: Medium-dose MSCs significantly improved clinical scores and reduced both gross and histologic intestinal injury (p < 0.05). A corresponding decrease in pro-inflammatory cytokines was observed.

Conclusion: This is the first study to demonstrate therapeutic benefit of MSCs in a preterm piglet NEC model, supporting their potential use in translational NEC therapies.

Purpose: We aim to present a single-center experience using this combined technique for phallic reconstruction.

Methods: Complicated circumcision cases referred to our department from June 2015 to May 2024 were reviewed. We identified consecutive cases who had been presented with grade III to V penile injury and subjected to phallic reconstruction by release of the subcutaneous corporal remnant and covering the exteriorized corporal remnant with a full-thickness skin graft and resurfacing of the glans penis by oral mucosa graft.

Results: 37 male children were identified. Age at surgery ranged from 9 months to 7 years, with a mean operative time of 150 min and follow-up of 3 months-5.5 years. Uneventful graft incorporation occurred in 29 patients, with all donor sites healing without morbidity. At 6 months, urethral patency and satisfactory cosmetic outcomes were achieved in all patients. Complications included total skin graft loss in 4 patients, partial skin graft loss in 3, and buccal mucosa graft eschar in 2.

Conclusion: Fenestrated full-thickness skin grafts for the shaft combined with fenestrated oral mucosa grafts for the glans provide a reliable approach to reconstructing severe post-circumcision penile injuries. This technique provides an encouraging aesthetic and functional result.

Purpose: Cryptorchidism is the most common congenital anomaly requiring pediatric surgical correction. Although surgical repositioning of the undescended testis (orchidopexy) is effective anatomically, the molecular and cellular mechanisms underlying ongoing testicular damage after surgery remain poorly understood.

Methods: We established a surgically induced unilateral cryptorchidism model in adult mice, collected testicular tissues at day 0, 3, 7, 10, and 14 after induction, and performed bulk RNA sequencing on samples collected at day 0, 3, and 7. Differentially expressed genes (DEGs) were analyzed for pathway enrichment and protein-protein interactions. Cell-type-specific gene expression patterns were evaluated using publicly available single-cell RNA-seq data. Histological evaluation was performed to validate tissue-level changes.

Results: Transcriptomic profiling revealed rapid upregulation of extracellular matrix remodeling and inflammatory signaling by day 3, primarily in somatic cells such as Sertoli and peritubular myoid cells. By day 7, we observed activation of pro-apoptotic and TGF-β signaling pathways. Key genes including Ddr1, Ltbp1, and Spp1 were enriched in somatic compartments. Histology confirmed progressive seminiferous tubule disorganization and germ cell depletion, consistent with somatic cell-driven structural deterioration.

Conclusions: This study provides hypothesis-generating evidence that somatic cell dysfunction may be an early feature of cryptorchidism-associated testicular injury in this adult mouse model. These findings identify candidate genes and pathways for further investigation. Validation in developmental cryptorchidism models and human tissue will be required to establish clinical relevance.

Background: We compared two types of gastro-jejunal (GJ) tubes used in children: Freka^® percutaneous endoscopic GJ tube (FPEGJ) with solid internal bumpers and balloon gastro-jejunal tubes (BGJ). Despite differences in design, comparative data on safety, durability, and complications remain limited.

Methods: A retrospective review was performed of 69 children with active GJ tubes as of August 2024. Each tube episode lasted until replacement to a different tube type under general anaesthesia. Demographic data, complications, and frequency of elective and unplanned tube changes were analysed.

Results: Forty-one children(59%) had an initial FPEGJ, and their median weight was significantly lower than those who had an initial BGJ (7.9 vs. 21.4 kg, p < 0.001). In total, 56 FPEGJ and 48 BGJ tube episodes were reviewed. Over a median of 14.5 months for FPEGJ and 37 months for BGJ (p < 0.001), BGJ required more routine changes (0.12 vs. 0.0 changes/month). However, acute change rates were similar (0.05 vs. 0.06 changes/month, p = 0.61), with Poisson regression adjusting for duration showing no significant difference (incidence rate ratio 0.97, p = 0.82). The most common cause for acute replacement was jejunal limb displacement (32% FPEGJ, 34% BGJ), followed by FPEGJ distal migration (19%) and BGJ balloon rupture (18%). Significant complications occurred exclusively with FPEGJ, including one gastrocolic fistula and 10 buried bumpers.

Conclusion: FPEGJ was the preferred primary tube for smaller infants, requires fewer routine changes but had significant complications. Primary BGJ insertion may reduce morbidity without increasing tube displacement risk. Innovation is needed to improve BGJ longevity and suitability for infants.