Objective To report our laparoscopic and laparoscopic assisted urologic cases. Methods There were 33 laparoscopy cases,in 24 male and 9 female patients.The mean age were 4.6 years.Hypoplastic kidney were 5 cases,impalpable testis 14 cases,hydronephrosis 11 cases,duplicated kidney and duplicated kidney with ureterocole 1 case respectively,and pelvis stone 1 case.Retroperitoneal laparoscopic nephrectomy,heminephrectomy and pyelolithotomy ( 7 cases ),retroperitoneal laparoscopic assisted dismembered pyeloplasty ( 11 cases),laparoscopic orchiedopexy or orchiedectomy (14 cases),and laparoscopic pnuemovesical Cohens operation(1 cases) were conducted. Results 33 laparoscopic operations were completed successfully without conversion. Oral intake started on postoperative day 1.No serious complications occurred. Conclusions Laparoscopic techniques could be used for common pediatric urologic operations like hydronephrosis,impalpable testis ect.The surgical trauma and pain could be reduced and cosmetic effect improved.

Objective To investigate the effect of di-2-ethylhexyl phthalate (DEHP) on the proliferation of SK-N-SH human neuroblastoma cells and its underlying mechanism. Methods Cells were cultured in estrogen-free improved Dulbecco's Modified Eagle's Medium and then divided into 5 groups: no treatment (control group); treated with 17β-estradiol (E_2 group); treated with DEHP (DEHP group); treated with both E_2 and phosphatidylinositol-3-kinases (PI3K) inhibitor LY294002 (E_2 + LY294002 group); treated with both DEHP and LY294002 (DEHP + LY294002 group). The absorbance value (AV) was measured on day 0, 2, and 5. DNA proliferation index (PI) and apoptotic index (AI) were determined by flow cytometry on day 5. Caspase-3 protein, protein-serine-threonine kinase (Akt) and phosphor-Akt (Ser473) protein expression were analyzed by Western blot on day 5. Results The AV of All groups increased on day 2, and 5. The AV of E_2 and DEHP groups were higher than that of the control group (P<0. 001), but the AV of E_2 + LY294002 and DEHP + LY294002 groups were lower than those of E_2 and DEHP groups (P<0.01) on day 2 and 5. On day 5, PI of E_2 and DEHP groups were also higher than that of control (P<0.01). However, PI of E_2 + LY294002 and DEHP + LY294002 groups were lower than those of E_2 and DEHP group (P<0.01) on day 5. There was no significant difference in AI and caspase-3 protein expression among the groups. At the same time, phosphor-Akt (Ser473) protein expression of E_2 and DEHP groups increased obviously, compared with the control group. Compared with E_2 and DEHP groups, E_2 + LY294002 and DEHP + LY294002 groups decreased significantly. However, Akt protein expression was equal among those groups. Conclusions DEHP can promote the growth of SK-N-SH cells to a level similar to that of E_2, with activation of the PI3K/Akt signaling pathway.

Objective To explore the factors which are related to the reoperation and relapse hiatus hernia in children.Methods Between Jan.2002 and May 2013,64 patients who suffered from hiatus hernia in Children's Hospital of Fudan University were divided into uneventful group (U group,n =49) and reoperation group (R group,n =15).The ages at operation,barium swallow examinations,operative procedures,findings during the operation and the followup of these two groups were reviewed.Results The average ages at operation in U group and R group were (14.70 ± 0.79) months and (13.60 ± 0.59) months,respectively.The major symptoms before the second operation in R group was vomiting(6 cases),pneumonia (4 cases) and dysphagia (2 cases).Asymptomatic recurrence was found in 3 patients.Through barium swallow examination,short esophagus was found in 10 cases in U group,while 3 cases were reported in R group.However,during the operation,the length of intra-abdominal esophagus without tension could be obtained with average (3.33 ± 0.86) cm in these short esophagus patients,which was only (3.18 ± 1.14) cm in those normal esophagus patients.There was no significant difference between the U group and R group in the width of the hiatus and the ratio of stomach above the hiatus.The length of esophagus which mobilized during operation was shorter in R group than that in U group(P =0.003).The difference of operative methods and the ratio of large hernia between these two groups could not be found.The common cause of failure in R group was herniated fundoplication (9 cases),which was followed by disputed fundoplication (4 cases),twisted fundoplication (1 case) and rupture of esophagus (1 case).The average follow up time was (8.3 ± 4.2) months in R group.Vomiting was found in 3 patients,and pneumonia was found in one case in R group after the second operation.The symptoms of these four patients were relieved half year later postoperatively.Conclusions The age,symptoms,size of the hiatus,short esophagus,and the operative methods are not related to the reoperation in hiatus hernia.But if the length of intra-abdominal esophagus without tension was not obtained enough,it may contribute to the recurrence of hiatus hernia.Wrap herniation has now become the most common mechanism of failure requiring reoperation.

Objective To report experience of minimally invasive surgery of urinary calculi caused by melamine in infants. Methods Retrospectively reviewed the treatments and outcomes of 36 cases with urinary calculi caused by melamine from November 2007 to October 2008. 13 girls and 23 boys aged 8 to 36 months after daily consumption for six month or more of milk products tainted with melamine. These infants underwent MPCNL, ureteroscopic lithotripsy and placement of ureteral stent, respectively. Results The operations were performed successfully in all patients. Five cases underwent MPCNL. Ureteroscopic lithotripsy were performed in fourteen cases. Seventeen cases were placed of ureteral stents. No major complications like hemorrhea, perforation and organic injury were noted. The postoperative hospital stays were 3 to 10 days. All cases were followed up for 1 to 12 months. Calculus had no recurrence. Hydronephrosis and hydroureterosis disappeared or lightened. Growth and development were normal. Conclusions Various kinds of minimally invasive surgical procedures is safe and effective treatments for urinary calculi caused by melamine in infants, applicable in calculi with urinary obstruction especially.

Objective To evaluate the treatment of current status and prognosis in childhood APL with APL2008 ,which was administrated since 2008 in our center .Methods A total of 43 children with newly diagnosed APL between 2008 to 2014 were studied retrospectively .Treatment options and current status were summarized from 28 patients who received APL2008 therapy . Results Studied 43 patients were at median age of 8 years and 4 months ,with 28 boys and 15 girls .The main clinical manifestations were infection ,anemia ,bleeding ,fever ,hepatomegaly ,splenomegaly and lymphadenopathy .The proportions of low ,intermediate and high risk groups were 27 .9% ,48 .8% and 23 .3% ,respectively .Eleven cases could be diagnosed as DIC .Bone marrow morphology showed abnormal elevation of promyelocyte .37 patients had distinctive immunophenotype such as frequent expression of CD33 , CD117 and MPO .PML/RARαfusion gene positive rate was 100% in 43 children and cytogenetic analysis were positive in 37 cases , of which specific genetic lesion in APL cells with t (15 ;17)(q22 ;q12) was found in 28 cases ,and karyotypes was found in 9 cases as infrequent chromosomal abnormalities .In 43 patients ,4 cases were early dead from intracranial hemorrhage at early stage ,and 11 cases were given up early .There were only 2 cases dead ,2 cases relapsed and 1 case lost among 28 APL children ,which enabled ef‐ficacy analysis possible .96 .4% of these 28 cases achieved HCR .The 2 year Kaplan Meier estimates of OS and EFS were 85 .9% ± 7 .6% and 80 .4% ± 8 .8% .But OS and EFS would be 94 .7% ± 5 .1% and 88 .9% ± 7 .4% if 3 patients who had non standard treat‐ment were excluded .Conclusion Childhood APL were characterized by anemia ,bleeding ,fever and infiltration .APL′s coincidence rate between PML/RARa fusion gene and morphology ,immunology and cytogenetics were 95 .3% ,90 .2% and 86 .5% ,respective‐ly .APL2008 significantly improved the prognosis of APL .

Objective To summarize the experience of multidisciplinary consultation for prenatal fetal deformity, and to explore the mode suitable for China. Methods The Obstetrics and Gynecology Hospital of Fudan University and Children's Hospital of Fudan University established a joint multidisciplinary consultation center, including obstetrics, pediatrics, pediatric surgery, ultrasound and other departments. A total of 3 378 pregnant women visited the consultation center from July 31, 2003 to August 1, 2013. After consultation, treatment was divided into three classes:pregnancy termination, pregnancy continuation and perinatal treatment. Follow-up was made through correspondence and telephone communication. Retrospective analysis on reasons for consultation, fetal structural abnormalities of the classification system, chronological order of abnormalities, gestational weeks of diagnosis, maternal-related factors, treatment and prognosis was performed. Results (1) Reasons for consultation:Among 3 378 women undertaking prenatal multidisciplinary consultation, 3 243 (96.00%) were due to fetal factors, and 135 (4.00%) were due to maternal factors. (2) Classification of fetal structural abnormalities:Among the 3 243 cases undertaking consultation with fetal factors, fetal abnormality was found in 80.85%(2 622/3 243). The most common were neurological abnormalities(23.19%, 608/2 622), followed by urinary tract malformation (20.25%, 531/2 622) and cardiovascular malformation (15.48%, 406/2 622). These were followed by digestive system malformation, limb deformities and space-occupying lesions. There were 156 cases of multiple malformations. (3) Average gestational weeks for diagnosis of fetal deformity:The 2 622 cases of fetal deformity were diagnosed at a mean (26.7± 2.1) of gestational weeks (21.1–30.4 weeks). Urinary tract malformations were detected at (24.0±0.7) weeks, whereas digestive system malformations were detected at (28.3±2.6) weeks. (4) Induced labor:Induced labor cases accounted for 35.66% (935/2 622), among which, 92 cases were fetal intrauterine death and 843 cases were active choice. The several highest induced labor rates resulted from multiple malformations (75.64%, 118/156), abdominal wall defects (62.22%, 28/45), diaphragmatic hernia (61.54%, 24/39), cleft lip and palate (55.32%, 26/47) and cardiovascular malformations (49.51%, 201/406). For nervous system (27.80%, 169/608), urinary tract (25.80%, 137/531) and digestive system malformations (26.94%, 66/245), induced labor rates were <30%. For abdominal lesions (14.04%, 25/178) and sacrococcygeal teratoma (13.64%, 3/22), induced labor rates were<15%. (5) Continuation of pregnancy in 1 687 cases:Cesarean section was conducted in 1 046(61.94%). Neonatal death occurred in 117(6.94%).(6) Perinatal treatment:Twenty-one cases were treated during pregnancy, including thirteen cases with fetal ascites and hydrothorax treated by drainage, five cases with fetal anemia treated by intrauterine transfusion and three cases with fetal tachycardia treated by digoxin. Ten cases were treated by ex-utero intrapartum treatment. After birth, 297 newborns immediately underwent neonatal surgery. Among these, 259 cases underwent radical surgery, eleven palliative surgery, and sixteen elective surgery after follow-up. Conclusions Prenatal multidisciplinary consultation can make comprehensive multidisciplinary assessment of fetal prognosis and improve the diagnosis and treatment of structural malformations.

Objective To explore the risk factors of Schistosoma japonicum infection in the residents in Xingzi County,Ji?angxi Province. Methods Six administrative villages from different areas were randomly selected by the cluster sampling meth?od as the study sites in Xingzi Country in 2013,and all the residents aged 5 years or above were investigated epidemiologically, and the schistosome infection was surveyed by Kato?Katz technique. The risk factors of schistosomiasis were analyzed by using the Chi?square test analysis and multivariate Logistic regression model. Results In 2013,there were 2 050 residents received the stool examination and 146 persons were positive,the schistosome infection rate was 7.1%. The Chi?square test showed that gender,age,occupation and education level were associated with the population infection rate(χ2=26.485、16.836、25.700、90.805,all P<0.05). The multivariate Logistic regression mode showed that the probability of schistosomiasis for the male was 3.041 times as much as that for the female;the probability of schistosomiasis for the illiteracy and primary education level crowd was 8.870 times as much as that for the college degree or above crowed;the probability of schistosomiasis for the junior middle school education level crowd was 5.598 times as much as that for the college degree or above crowed;the probability of schistoso?miasis for the high school education level crowd was 2.995 times as much as that for the college degree or above crowed;the probability of infection of fishermen was the highest,which was 3.053 times as much as that for the other professional crowds. Conclusions The risk factors of schistosome infection mainly include gender,occupation and the education level. We should strengthen the health education of schistosomiasis control,protection against the infested water contact,and so on.

Objective Radiological grade of splenic injury was seldomly used in China trauma center now,though it had been established in 1994 by American Association for Surgery of Trauma (AAST) and widely used.The present study is aimed to analyze the imaging grade and clinical characteristics of traumatic splenic rupture in children,discuss the feasibility of conservative treatment,and the role of radiographic grading during clinical treatment.Methods Information (including age,gender,severity based on radiological findings,treatment strategies,and clinical outcome) regarding 59 hospitalized splenic injury patients whose injuries occurred between 2008 and 2014 was retrospectively analyzed.Results Between 2008 and 2014,59 pediatric patients with splenic injury were treated in our institution.Median age was 9.5 years (range,3 months to 16 years).Of all patients,41 (69.5%) were male.The injuries were primarily caused by traffic crash (45.7%),stumbling/falling from a height (38.9%).According to AAST,5 cases were grade Ⅰ,26 patients grade Ⅱ (44.1%),and 21 cases grade Ⅲ (35.6%),6 over grade Ⅳ,and only one was unclear.Of all patients,25 cases were with the other organs complications.All patients underwent fasting,bed rest,and antibiotics.Only 1 case was transferred to operation during the conservative treatment.Forty-nine patients underwent with CT scan over 2 times.Conclusion Imaging classification helps guide clinical treatment.Conservative treatment is feasible for traumatic splenic injury in children.Early imaging classification of splenic injury may be helpful in clinical judgment,and reduce children radiation exposure.

Objective To investigate the relationship between EVI1 gene expression and clinical features and prognosis of children with acute myeloid leukemia (AML). Methods EVI1 gene was detected in AML children, correlation of clinical and lab features, prognosis of AML children with EVI1 gene were analyzed. Results EVI1 expression is positive in 38 of 145 children with AML. There were no significant differences in age, gender, hemoglobin concentration, leukocytes and platelet count, subtype of morphology, ratio of chromosomal anomaly and complex karyotypes between EVI1 positive and EVI1 negative group (P>0.05); coexist genes were detected in 9 cases (23.68%) of EVI1 positive group. Rate of complete remission (CR) was 91.67% in 24 cases of EVI1 positive patients received chemotherapy. Relapse rate was 64.29% and 14.29% in EVI1 positive patients who received chemotherapy and allo-hematopoietic stem cell transplantation (allo-HSCT), retrospectively and significant differences were found (P<0.05). There was no significant difference in CR but significant difference was found in event free survival (P<0.05) for EVI1 positive and EVI1 negative patients who received chemotherapy. EVI1 gene kept negative when bone marrow relapse occurred in two patients with EVI1 positive at diagnosis. Conclusion EVI1 gene may play adverse role in pediatric AML; prognosis of EVI1 positive AML patients can be improved by allo-HSCT; follow-up of EVI1 transcript levels is insufficient to monitoring of minimal residual disease.

Objective In order to explore the effects of rehabilitation training and acupuncture on the neural function deficit and motor function in patients with ischemic streke.Methods Eighty patients with ischemic stroke were randomly divided into rehabilitation and acupuncture groups.According to different recovery stages,the rehabilitation group received purposeful rehabilitation training for 28 days while the acupuncture group received scalp needling combined with body acuptmcture.The neural deficit scores(NDS)and motor fimction comprehensive assessment(FCA) were evaluated at the recruitment(M_0),the 28~(th)(M_1)and 56~(th)(M_2)days after treatment.Results No significant difierences were found in the NDS and motor FCA between the rehabilitation and the acurluncture groups at the recruitment.The significant differences appeared at the 28~(th) and the 56~(th) days comparing with baseline assessments in each group.There was no significant difference in the changes of NDS and motor FCA between the two groups at 28~(th) day,however,the NDS and motor FCA in rehabilitation group revealed better outcome than the acupuncture group at the 56~(th) day.Conclusion The study indicated that both rehabilitation training and acupuncture could improve the neural function and enhance the motor function in patients with ischemic stroke.