Objective:To explore the clinical characteristics and outcomes of pediatric kidney transplantations at a single center and discuss the related clinical issues.Methods:From January 1990 to October 2019, clinical data were analyzed retrospectively for 244 pediatric renal transplants. The youngest recipient was aged 1.8 years and the median age of pediatric recipients was 12.2 years. The major disease was primary or hereditary glomerulonephritis ( n=160, 69.0%), congenital anomalies of kidney and urinary tract (CAKUT), cystic renopathy and other hereditary nephropathies ( n=55, 23.7%). The donor sources included traditional deceased donor ( n=42, 17.2%), living-related donor ( n=19, 7.8%) and organ donation ( n=183, 75.0%). The median age of donors was 2 years (0-51) and the median weight 12.0(2.7-72.0) kg. From January 2013 to October 2019, 170 cases), the major induction immunosuppression regimen was anti-thymocyte globulin (ATG) ( n=110, 64.7%) or basiliximab ( n=58, 34.1%). The maintenance regimen was tacrolimus + mycophenolic acid (MPA) + glucocorticosteroids. Finally the outcomes and the complications were analyzed. Results:The survival rates of 244 kidney allograft recipients were 98.1%, 94.5% and 93.4% and the graft survival rates 92.6%, 84.2% and 82.0% at 1/3/5 years respectively. Ten recipients died of accident ( n=2, 20.0%), pneumonia after transplantation ( n=2, 20.0%) and intracranial hemorrhage ( n=2, 20.0%). Thirty-three recipients lost their allografts mainly due to intravascular thrombosis in graft ( n=5, 14.3%), acute rejection ( n=5, 14.3%) and death ( n=9, 25.7%). Besides, among 109 deceased donor allograft recipients, the postoperative outcomes were delayed graft function recovery (DGF) ( n=27, 24.8%), arterial thrombosis ( n=6, 5.5%), venous thrombosis ( n=1, 0.9%), graft perirenal hematoma ( n=6, 5.5%), raft artery stenosis ( n=10, 9.2%) and graft ureteral fistula ( n=1, 0.9%). The incidence of acute rejection was 17.5% and 23.2% at 1/3 year respectively. The recurrent rate of primary disease was 6.9%, including primary FSGS ( n=3, 42.9%) and IgA nephropathy ( n=2, 28.6%). At 1/3 year post-operation, the incidence of pulmonary infection was 16.9% and 22.4% and the incidence of urinary tract infection 26.9% and 31.7%. Excluding recipients with graft failure, the estimated glomerular filtration rate (eGFR) at 1/2/3 year postoperatively was (80.3±25.2), (81.4±27.8) and (71.8±27.6) ml/(min·1.73 m 2)respectively. Conclusions:The outcomes of pediatric renal transplantations are excellent at our center. Future efforts shall be devoted to optimizing the strategies of donor kidney selection and strengthening preoperative evaluations, perioperative and postoperative managements for improving the long-term outcomes of pediatric renal transplantations.

Objective:To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly, and to discuss the corresponding method for repair.Methods:Clinical data of 25 children with postoperative deformities after simple syndactyly releasing were reviewed retrospectively in the past 5 years, including 13 males and 12 females, with an average age of 3 years and 2 months. The possible causes leaded to postoperative deformity were analyzed by investigating the data of the first operation, including the age of the first operation, whether there was skin graft and whether there was postoperative infection. The common types of postoperative deformities were summarized through morphological observation, and the main methods of reoperation repair were reviewed. During follow-up, the improvement of postoperative deformities after repair was evaluated from the four aspects of webbed shape, finger shape, fingernail shape and skin color difference, so as to propose an effective repair plan for such postoperative deformities.Results:The average age of the first operation was 1 year and 5 months, 15 cases had no skin graft with tense skin, and 4 cases had a history of wound infection. The postoperative deformities of simple syndactyly can be summarized in four main categories: web deformity in 27 webs, finger deformity in 53 fingers, nail deformity in 46 nails and skin color difference in 15 fingers. During the revision surgery, for web deformity, Z-plasty technique were used to widen narrow webs, the flaps were used to reconstruct the recurred webs and the double wing flap were used in 13 webs. For finger deformity, in all cases, most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers, while full-thickness skin grafting was employed if lacking of enough skin to close wound. For nail deformity, using the adjacent flap pushed forward to wrap the nail margin in 14 crooked nail cuticles and others remained untreated. For skin color difference, using z-plasty incision to break the large piece of dark skin into small one and remove the overly dark skin as much as possible. The average follow-up time after reoperation was 33 months, and all webs reached the normal depth and width. Except for the incomplete correction of the lateral deviation in 1 finger, the deformity of the other fingers hand was corrected completely. There was no improvement in other nail deformity except for 10 skew nail cuticle being improved. The skin color difference were improved in all cases.Conclusions:The occurrence of postoperative deformity of simple syndactyly may be related to the tight stitching (should have skin grafting) and the wound infection during primary surgery. The reconstructive operation should be performed about one year after the initial operation when the scar is softened. The flaps for construction of web space, especially double wing flap, can be used widely in all kinds of web deformities, which could result in excellent web shape. The area of skin grafting can be reduced dramatically by reserving softened scar skin. Multiple Z-plasty technique can make use of the transverse excess skin to extend the longitudinal skin and corrected enlarged finger bodies. When should be used to reduce the color difference. But the repair of most of nail deformity were too difficult to improve.

Objective:To evaluate the clinical performance of postoperative deformity after the release of simple syndactyly, and to discuss the corresponding method for repair.Methods:Clinical data of 25 children with postoperative deformities after simple syndactyly releasing were reviewed retrospectively in the past 5 years, including 13 males and 12 females, with an average age of 3 years and 2 months. The possible causes leaded to postoperative deformity were analyzed by investigating the data of the first operation, including the age of the first operation, whether there was skin graft and whether there was postoperative infection. The common types of postoperative deformities were summarized through morphological observation, and the main methods of reoperation repair were reviewed. During follow-up, the improvement of postoperative deformities after repair was evaluated from the four aspects of webbed shape, finger shape, fingernail shape and skin color difference, so as to propose an effective repair plan for such postoperative deformities.Results:The average age of the first operation was 1 year and 5 months, 15 cases had no skin graft with tense skin, and 4 cases had a history of wound infection. The postoperative deformities of simple syndactyly can be summarized in four main categories: web deformity in 27 webs, finger deformity in 53 fingers, nail deformity in 46 nails and skin color difference in 15 fingers. During the revision surgery, for web deformity, Z-plasty technique were used to widen narrow webs, the flaps were used to reconstruct the recurred webs and the double wing flap were used in 13 webs. For finger deformity, in all cases, most of scar skin was reserved and released by multiple Z-plasty incisions to extend and straighten the fingers, while full-thickness skin grafting was employed if lacking of enough skin to close wound. For nail deformity, using the adjacent flap pushed forward to wrap the nail margin in 14 crooked nail cuticles and others remained untreated. For skin color difference, using z-plasty incision to break the large piece of dark skin into small one and remove the overly dark skin as much as possible. The average follow-up time after reoperation was 33 months, and all webs reached the normal depth and width. Except for the incomplete correction of the lateral deviation in 1 finger, the deformity of the other fingers hand was corrected completely. There was no improvement in other nail deformity except for 10 skew nail cuticle being improved. The skin color difference were improved in all cases.Conclusions:The occurrence of postoperative deformity of simple syndactyly may be related to the tight stitching (should have skin grafting) and the wound infection during primary surgery. The reconstructive operation should be performed about one year after the initial operation when the scar is softened. The flaps for construction of web space, especially double wing flap, can be used widely in all kinds of web deformities, which could result in excellent web shape. The area of skin grafting can be reduced dramatically by reserving softened scar skin. Multiple Z-plasty technique can make use of the transverse excess skin to extend the longitudinal skin and corrected enlarged finger bodies. When should be used to reduce the color difference. But the repair of most of nail deformity were too difficult to improve.

Lymphatic metastasis is the main metastatic route for colorectal cancer, which increases the risk of cancer recurrence and distant metastasis. The properties of the lymph node metastatic colorectal cancer (LNM-CRC) cells are poorly understood, and effective therapies are still lacking. Here, we found that hypoxia-induced fibroblast activation protein alpha (FAPα) expression in LNM-CRC cells. Gain- or loss-function experiments demonstrated that FAPα enhanced tumor cell migration, invasion, epithelial-mesenchymal transition, stemness, and lymphangiogenesis via activation of the STAT3 pathway. In addition, FAPα in tumor cells induced extracellular matrix remodeling and established an immunosuppressive environment via recruiting regulatory T cells, to promote colorectal cancer lymph node metastasis (CRCLNM). Z-GP-DAVLBH, a FAPα-activated prodrug, inhibited CRCLNM by targeting FAPα-positive LNM-CRC cells. Our study highlights the role of FAPα in tumor cells in CRCLNM and provides a potential therapeutic target and promising strategy for CRCLNM.