Pediatric Surgery International最新文献

Purpose: The fertility potential of with 46,XY DSD individuals has remained poorly understood. This study aimed to assess testicular cytology and semen analysis findings in post-pubertal patients with 46,XY DSD.

Method: Following ethical approval, a cohort of post-pubertal (> 13 years) patients with 46,XY DSD assigned a male gender was evaluated through a personal interview, clinical examination, and hormonal assay. Prostatic and testicular volumes and echotexture were assessed. Semen analysis and testicular cytology were also performed.

Results: Of the 75 eligible patients, 17 responded. The mean age at the time of study was 17(± 3.33) years, with a follow-up of 160 (± 68.28) months. All patients reported comfort with male gender assignment. The median stretched penile length was 6 cm, and clinically assessed testicular volumes were within normal limits. However, prostate volumes were small, and prostate-specific antigen (PSA) levels were undetectable in one-third. Semen analysis revealed that 6 patients were unable to ejaculate, 4 had aspermia, 4 had oligospermia, and 3 had azoospermia. Testicular FNAC demonstrated normal spermatogenesis in only 6 patients. The median spermatogenic-to-Sertoli cell ratio was 0.84, markedly lower than the normal expected value. Notably, several patients with normal spermatogenesis on FNAC had abnormal semen analysis findings.

Conclusions: Despite overall comfort with male gender assignment and normal hormonal profiles, both semen analysis and testicular cytology revealed compromised fertility potential in post-pubertal patients with 46,XY DSD.

Purpose: Access to appropriate and clean toilet facilities is essential for children with Hirschsprung Disease (HD). This study aims to assess how parents of children with HD perceive school toilet facilities.

Method: A cross-sectional survey was spread among parents of children aged 4-13 years with HD. The questionnaire addressed the frequency of toilet use and reasons for positive or negative experiences, with open- and closed-ended questions, for quantitatively and qualitatively analyses, respectively.

Results: Forty-four parents completed the questionnaire. The median age of the children was 7 years (IQR 5.3-10.8). Five (11.4%) children never used the school toilet, 16 (36.6%) used it for urination only, and 23 (52.3%) used it for urination and defecation. Positive parental experiences (29, 65.9%) were associated with the possibility for the child to clean themselves at school, while negative experiences (15, 38.6%) were linked to the absence of child-specific toilet rules. Qualitative analysis revealed six influencing themes; assistance, possibilities, school rules, medical nature, toilet facilities, and information.

Conclusion: Toilet avoidance for defecation remains common among children with HD. Improvements in toilet facilities, support, and individualized toilet policies may enhance well-being in this population.

Purpose: To evaluate whether hemoglobin P₅₀, automatically calculated from routine blood gas analyses, can serve as a practical early biomarker for necrotizing enterocolitis (NEC) in preterm infants.

Methods: We retrospectively analyzed 117 preterm infants born at < 32 weeks' gestation who were admitted to a tertiary NICU between 2022 and 2024. Hemoglobin P₅₀ and serum lactate values were obtained from arterial blood gases on postnatal days 1-3. NEC was defined according to modified Bell's criteria (stage ≥ II). Discriminative performance was assessed using receiver operating characteristic (ROC) analysis, with a prespecified P₅₀ threshold of 21.0 mmHg.

Results: NEC developed in 27 infants (23%). Mean day-2 P₅₀ was significantly higher in the NEC group compared with controls (22.5 ± 6.8 vs. 18.9 ± 3.6 mmHg; p = 0.03). Day-2 P₅₀ predicted NEC with moderate accuracy (AUC 0.70, 95% CI 0.56-0.83), outperforming lactate (AUC 0.52, 95% CI 0.38-0.67). At the 21.0 mmHg cutoff, sensitivity was 67%, specificity 72%, positive predictive value 41.8%, and negative predictive value 87.9%.

Conclusion: Day-2 hemoglobin P₅₀ was elevated in infants who subsequently developed NEC. These preliminary findings indicate that P₅₀ may be a feasible, cost-effective biomarker for early NEC risk stratification; however, larger prospective studies are required to validate its predictive utility.

Purpose: Perineal morphometric alterations and functional outcomes in patients with hypospadias remain a subject of ongoing debate. This study aimed to evaluate the changes in anogenital distance (AGD)/anal position index (API) values and their intestinal functional impacts in relation to the severity of hypospadias in children.

Method: Fifty-one children who underwent hypospadias surgery (2014-2024) and 19 controls presenting for circumcision (June-September 2024) were assessed. Patients were classified as distal hypospadias (n = 31) or proximal hypospadias (n = 20). Posterior scrotal raphe-anus center (AGD), posterior scrotal raphe-coccyx distance, and API were measured. Constipation was evaluated using Rome IV criteria. Percentile values ​​were calculated.

Results: Patient ages (years): 7.42 ± 1.67/11.51 ± 2.79/8.8 ± 2.37 for control/distal/proximal hypospadias groups. Proximal hypospadias showed significantly lower AGD (33.39 ± 8.11 mm) and API (0.35 ± 0.07) compared to distal hypospadias (54.79 ± 15.65 mm; 0.53 ± 0.07) and controls (55.54 ± 15.57 mm; 0.59 ± 0.08) (p = 0.042), (p < 0.001). Constipation was strongly associated with proximal hypospadias (p < 0.001). AGD distribution varied significantly across percentiles (p < 0.001), whereas API distribution did not significantly (p = 0.587).

Conclusion: Changes in perineal morphometric parameters and their functional outcomes exhibit clinically meaningful distinctions in pediatric patients with proximal hypospadias. Furthermore, it is suggested that these perineal morphometric measurements should be taken into account in predicting and monitoring constipation status during postoperative follow-up in children with hypospadias.

Background: Mechanical bowel preparation (MBP) has traditionally been routine before pediatric intestinal surgery, based on the belief that it reduces the risk of infection. In adults, benefits are only observed when MBP is combined with oral antibiotics; however, evidence in pediatrics remains limited and inconsistent.

Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD420251133552) following PRISMA 2020 and Cochrane guidelines, searching databases up to August 2025. Eligible studies included Randomized controlled trials and comparative observational cohorts comparing MBP with no MBP in elective Pediatric intestinal surgery. The primary outcome was surgical site infection (SSI); secondary outcomes included anastomotic leak (AL), intra-abdominal abscess (IAA), ileus, bowel obstruction, and length of stay (LOS). Random-effects models produced pooled estimates, and certainty was assessed using the GRADE approach.

Results: Seventeen studies involving 3,036 children were included. MBP showed no reduction in SSI, AL, or IAA, with moderate certainty for SSI and low certainty for AL/IAA due to rare events. MBP was associated with longer LOS and possible non-significant increases in ileus and obstruction.

Conclusion: Current evidence suggests that MBP offers no significant benefits in pediatric elective intestinal surgery and may even delay recovery. Within the framework of ERAS protocols, routine use of MBP appears unnecessary. However, MBP might still be required for specific functional or reconstructive indications. Further high-quality multicentre trials are essential before any definitive conclusions can be drawn regarding its discontinuation.

Purpose: This study aimed to investigate the expression of cluster of differentiation 7 (CD7) in hepatoblastoma (HB) and its potential use as a novel biomarker of HB.

Methods: CD7 expression was investigated in human HB samples at the gene level by bulk, single-cell RNA sequencing, and spatial transcriptomic analyses, in addition to the protein level by immunohistochemical (IHC) staining. CD7 gene expression-based survival analysis was also conducted, along with gene set enrichment analysis (GSEA) of the CD7-SECTM1 receptor-ligand gene pair.

Results: CD7 was differentially expressed in human HB at both the gene level by various bioinformatics analyses, and the protein level by IHC, with remarkably higher expression levels in embryonal HB. Conversely, CD7 was not expressed in other primary adult liver tumors. CD7^high HB cases showed poorer 5-year event-free survival (P = 0.016), and GSEA demonstrated that CD7 is linked to the embryonal MYCN transcription factor, as were protumor kinases such as JAK3, and marginally MAPK14 and MAPK3.

Conclusion: CD7 is expressed in human HB, especially the embryonal histological subtype, and appears to be linked to tumor progression and poor clinical outcomes. Nevertheless, CD7-targeted chimeric antigen receptor T cells could be proposed as a promising immunotherapy for embryonal HB.

Purpose: To investigate vasoactive intestinal peptide (VIP) expression and distribution in fetal Sprague-Dawley (SD) rat lung with congenital diaphragmatic hernia (CDH). Assess the impact of VIP analog Aviptadil on CDH-associated lung hypoplasia.

Methods: CDH was induced in pregnant SD rats by nitrofen gavage on E9.5. The CDH + VIP group received Aviptadil via tail vein from E10.5. Lung development was assessed by hematoxylin and eosin (HE) staining. VIP, α-SMA, and CD31 were evaluated by immunofluorescence (IF). VIP mRNA and protein levels were quantified by RT-qPCR and Western blotting.

Results: The CDH group exhibited a significantly lower lung index compared to the control group (P < 0.001), with no significant difference observed between the CDH and CDH + VIP groups. Compared to controls, VIP expression in CDH lungs was significantly downregulated at both the mRNA (P = 0.049) and protein levels (P = 0.049). HE staining revealed mature alveolar structures in the control group, whereas the CDH group showed disrupted pulmonary architecture. Partial improvement was observed in the CDH + VIP group. IF analysis indicated that VIP was predominantly localized in the bronchi. VIP fluorescence intensity was significantly decreased in the CDH group compared to both the control group (P = 0.002) and the CDH + VIP group (P = 0.005), while no significant difference was found between the CDH + VIP and control groups. α-SMA fluorescence was primarily localized to pulmonary arterioles and bronchial smooth muscle. Compared to the control group, α-SMA expression was significantly upregulated in the CDH group (P < 0.001). The CDH + VIP group showed a significant reduction in α-SMA expression compared to the CDH group (P = 0.026), with no significant difference from the control group. CD31 was mainly localized to the vascular endothelium. CD31 fluorescence intensity was markedly increased in the CDH group compared to both the control (P < 0.001) and CDH + VIP groups (P < 0.001). The CDH + VIP group also had significantly higher CD31 levels than the control group (P = 0.005).

Conclusion: This study revealed that VIP is downregulated in CDH lungs. In this nitrofen-induced SD rat model, Aviptadil partially restored VIP levels and was associated with attenuation of vascular remodeling and alveolar dysplasia, suggesting a possible therapeutic role in CDH-related pulmonary hypoplasia that warrants further investigation.