BACKGROUND AND OBJECTIVE

Pediatric post-operative congenital diaphragmatic hernia (CDH) patients have been shown to encounter reduced pulmonary function tests (PFT) potentially leading to respiratory symptoms. Strategies involving exercise have been used to improve PFT. This meta-analysis aims to determine the effectiveness of exercise in improving lung function in pediatric post-operative CDH patients.

An electronic search was done on May 2023 in MEDLINE via Pubmed, Cochrane Library, Embase, ClinicalKey, Scopus, Google Scholar, and Herdin Plus, using the search terms "exercise" and "congenital diaphragmatic hernia" and "children" or "pediatric" and "pulmonary function" or "lung function". The study included pediatric patients in whom CDH has been surgically corrected, and excluded patients who were unable to perform the test maneuvers, have cardiopulmonary instability, and have serious associated anomalies. Randomized controlled trials (RCT) were identified and independently assessed by two review authors. Each RCT was independently assessed for bias by two review authors using the Cochrane Handbook for Systematic Reviews of Interventions. The RevMan 5.4 software was used for statistical analysis.

A total of 124 participants from three studies were included in the meta-analysis. The pooled mean difference showed a significantly higher mean functional vital capacity (FVC) (MD=6.12, 95%CI=3.91 to 8.33, p-value < 0.00001) and forced expiratory volume in 1 second (FEV1 ) (MD=6.25, 95%CI=3.39 to 9.10, p-value < 0.0001) in the study group compared to the control group.

Exercise may be effective in improving lung function in children with pediatric post-operative CDH. However, the study is limited by its small sample size, the lack of assessment of long-term outcomes, and the difference in exercise regimens used in each RCT. Further studies are recommended to determine the most optimal exercise regimen and to measure its effect on the other outcomes for this population.

Incisional hernia is a type of iatrogenic disease, and its clinical treatment is complicated. In recent years, there have been new advances in the diagnosis, surgical methods, and materials science of incisional hernias. Based on the Guidelines for Diagnosis and Treatment of Abdominal Wall Incisional Hernia (2018 Edition), more than 70 domestic experts have evaluated related publications using standards of evidenced-based medicine. Issues such as complex abdominal wall status, loss of domain, principles of incisional hernia treatment, techniques of abdominal wall hernia defects closure, perioperative management, and follow-up have been modified in the 2025 edition for the reference of clinicians.
Humans ; Incisional Hernia/surgery* ; Abdominal Wall/surgery* ; Hernia, Abdominal/therapy* ; Herniorrhaphy ; Practice Guidelines as Topic

In recent years, the diagnosis and treatment of inguinal hernia have become mature, and personalized treatment plans for different inguinal hernias have become more standardized. Based on the Guidelines for Diagnosis and Treatment on the Adult Inguinal Hernia (2012 & 2014 Edition), more than 70 domestic experts have evaluated related publications using standards of evidenced-based medicine. Major modifications include diagnosis and treatment of inguinal hernia in children and adolescents, diagnosis and treatment of scrotal hernia, management of hernia related complications, and postoperative education and follow-up in this new edition, for the reference of clinicians.
Humans ; Hernia, Inguinal/surgery* ; Practice Guidelines as Topic

The incidence of hiatal hernia is on the rise due to population aging and improved awareness of the disease. Laparoscopic repair is the main treatment modality; however, there remains a lack of consensus on the selection of mesh materials and operative specifications. Based on high-level evidence, this expert consensus has formulated 11 recommendations regarding the indications for mesh application, material selection, and operative methods: For patients with giant hiatal hernias (defect area >10 cm², hiatal diameter ≥ 5 cm, or over 1/3 of the gastric body entering the thoracic cavity), complex hernias, recurrent hernias, or those with weak diaphragmatic crura, mesh-reinforced repair is recommended to reduce the risk of recurrence. Synthetic meshes are suitable for giant/complex hernias; biological meshes help reduce foreign body reactions; and bioabsorbable synthetic meshes combine mechanical strength with safety. The preferred shape of the mesh is U-shaped, and fixation methods (non-absorbable sutures, absorbable staplers, or medical adhesives) are selected based on hernia size and anatomical features. For suturing the diaphragmatic crura, non-absorbable sutures are recommended, with the choice between interrupted or continuous suturing techniques tailored to patient characteristics. The method of fundoplication is determined according to esophageal pH measurement and lower esophageal sphincter pressure, and non-absorbable sutures are recommended for plication.
Humans ; Hernia, Hiatal/surgery* ; Laparoscopy/methods* ; Surgical Mesh ; Herniorrhaphy/methods*

OBJECTIVE: To investigate the current status of kinesiophobia after lumbar fusion surgery in patients with lumbar disc herniation (LDH) and to analyze its influencing factors. METHODS: A total of 489 LDH patients who underwent lumbar fusion surgery in our hospital from January 2021 to December 2022 and effectively filled out the tampa scale for kinesiophobia (TSK) and other questionnaires on the first day after surgery were collected as the study subjects, the current status of kinesiophobia in LDH patients after lumbar fusion surgery were investigated using the TSK. The LDH patients were grouped into a kinesiophobia group (n=221) and a non kinesiophobia group (n=268) based on whether there was kinesiophobia after lumbar fusion surgery. The self-designed general data questionnaires were used to collect data, and Logistic regression was applied to analyze independent risk factors for kinesiophobia after lumbar fusion surgery in the LDH patients. RESULTS: In the study, 221 out of the 489 LDH patients (45.19%) had kinesiophobia after lumbar fusion surgery. Univariate analysis showed that there were statistically significant differences between the phobic group and the non phobic group in terms of gender, education level, course of disease, whether there was hypoproteinemia, pain level, self-efficacy, social support, whether there was anxiety, and whether there was depression (P < 0.05). There were no statistically significant differences in terms of age, body mass index, monthly family income, marital status, residence, medical expense payment form, whether there was hypertension, whether there was diabetes, whether there was cardiovascular and cerebrovascular disease, whether there was respiratory disease, whether there was surgery experience, whether there was anemia, work conditions, and responsibility segments (P>0.05). Male (95%CI: 3.289-10.586, P < 0.001), education level below undergraduate level (95%CI: 6.533-45.162, P < 0.001), severe pain (95%CI: 10.348-72.025, P < 0.001), moderate pain (95%CI: 6.247-37.787, P < 0.001), low self-efficacy (95%CI: 4.238-15.095, P < 0.001), and medium self-efficacy (95%CI: 2.804-8.643, P < 0.001) were influencing factors for kinesiophobia after lumbar fusion surgery in the patients with LDH (P < 0.05). CONCLUSION The incidence of kinesiophobia after lumbar fusion surgery in patients with LDH is high, and its influencing factors include gender, education level, pain level, and self-efficacy.
Humans ; Spinal Fusion/psychology* ; Intervertebral Disc Displacement/psychology* ; Lumbar Vertebrae/surgery* ; Male ; Female ; Middle Aged ; Phobic Disorders/etiology* ; Surveys and Questionnaires ; Adult ; Risk Factors ; Aged ; Fear ; Kinesiophobia

OBJECTIVE: To elucidate how spinal manipulative therapy (SMT) exerts its analgesic effects through regulating brain function in lumbar disc herniation (LDH) patients by utilizing resting-state functional magnetic resonance imaging (rs-fMRI). METHODS: From September 2021 to September 2023, we enrolled LDH patients (LDH group, n=31) and age- and sex-matched healthy controls (HCs, n=28). LDH group underwent rs-fMRI at 2 distinct time points (TPs): prior to the initiation of SMT (TP1) and subsequent to the completion of the SMT sessions (TP2). SMT was administered once every other day for 30 min per session, totally 14 treatment sessions over a span of 4 weeks. HCs did not receive SMT treatment and underwent only one fMRI scan. Additionally, participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale (VAS) and the Japanese Orthopedic Association (JOA) score, whereas HCs did not undergo clinical scale assessments. The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo). Correlation analyses were conducted between specific brain regions and clinical scales. RESULTS: Following SMT treatment, pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain. In comparison to TP1, TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L (voxelwise P<0.005; clusters >30; FDR correction). Additionally, the most substantial enhancement in ReHo values was observed for the Cuneus_R, while the most prominent reduction was noted for the Olfactory_R (voxelwise P<0.005; clusters >30; FDR correction). Moreover, a comparative analysis revealed that, in contrast to HCs, LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L (voxelwise P<0.005; clusters >30; FDR correction). Furthermore, the most significant enhancement in ReHo values was observed for Postcentral_L, while the most prominent reduction was identified for ParaHippocampal_L (voxelwise P<0.005; clusters >30; FDR correction). Notably, correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score (r=0.9333, P<0.0001). CONCLUSIONS Long-term chronic lower back pain in patients with LDH manifests significant activation of the "AUN-DMN-S1-SAN" neural circuitry. The visual network, represented by the Cuneus_R, is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients. (Trial registration No. NCT06277739).
Humans ; Magnetic Resonance Imaging ; Intervertebral Disc Displacement/diagnostic imaging* ; Male ; Female ; Brain/diagnostic imaging* ; Adult ; Manipulation, Spinal/methods* ; Middle Aged ; Lumbar Vertebrae/physiopathology* ; Pain Management ; Rest ; Case-Control Studies

OBJECTIVES: In the early stage of central cervical disc herniation, clinical symptoms may be mild. However, as the spinal cord becomes compressed by herniated nucleus pulposus tissue, progressive edema and degeneration may occur, resulting in more severe clinical manifestations, including limb weakness, bladder and bowel dysfunction, spastic paraplegia of the lower extremities, and even respiratory difficulty. The spinal endoscopic Key-hole technique is widely applied in treating radiculopathic cervical spondylosis and has demonstrated good clinical outcomes. This study aims to analyze and summarize the technical points and therapeutic efficacy of the far lateral Key-hole technique in the treatment of central cervical disc herniation, providing reference for clinical application. METHODS: Eight patients with central cervical disc herniation treated with the far lateral Key-hole technique were included as the experimental group. Another 8 patients who underwent single-level anterior cervical diskectomy and fusion (ACDF) during the same period were selected as the control group. Data collected included gender, age, intraoperative blood loss, incision length, and length of hospitalization. Pain severity was evaluated using the Visual Analogue Scale (VAS); cervical function was assessed using the Japanese Orthopaedic Association (JOA) score; and cervical disability was measured by the neck disability index (NDI). Radiological outcomes were assessed using disc height index (DHI), cervical Cobb angle, and operative segment Cobb angle. RESULTS: Compared with the control group, the experimental group had significantly less intraoperative blood loss, shorter incision length, and shorter hospital stay (all P<0.05), while there was no significant difference in operation time (P>0.05). Postoperative VAS and NDI scores in both groups were significantly lower than preoperative values, and JOA scores significantly improved (P<0.05). No significant differences were noted between the two groups preoperatively (P>0.05). Postoperatively, the experimental group showed significantly lower VAS and NDI scores and higher JOA scores than the control group (P<0.05). There was no statistical significance in DHI before and after surgery in the experimental group (P>0.05), while the DHI increased significantly postoperatively in the control group (P<0.05). Postoperative DHI in the experimental group was significantly lower than in the control group (P<0.05). No significant differences were observed in the cervical Cobb angle either within or between groups (all P>0.05). The operative segment Cobb angle increased significantly after surgery in the control group (P<0.05), while no other operative segment angle changes were statistically significant (all P>0.05). CONCLUSIONS The far lateral Key-hole technique offers advantages in treating central cervical disc herniation, including reduced intraoperative bleeding, smaller incision length, shorter hospitalization, and improved postoperative pain relief. Additionally, the technique does not affect cervical physiological curvature or stability in the short term, making it suitable for clinical application.
Humans ; Intervertebral Disc Displacement/surgery* ; Cervical Vertebrae/surgery* ; Male ; Female ; Middle Aged ; Adult ; Diskectomy/methods* ; Treatment Outcome ; Spinal Fusion/methods* ; Endoscopy/methods*

Pneumothorax during pediatric laparoscopic surgery is a potentially fatal complication that may not be promptly recognized. It can occur due to congenital anatomical abnormalities, pre-existing pulmonary disease, or operative factors during laparoscopy. Clinical presentation may range from asymptomatic to acute respiratory distress, pleuritic chest pain, and even life-threatening circulatory collapse. Here, we report a case of sudden intraoperative pneumothorax accompanied by extensive subcutaneous emphysema of the neck and chest wall during laparoscopic high ligation of the hernial sac in a child. The child presented with a reducible left lower abdominal mass and mild pain 3 days prior but did not seek medical attention. Symptoms worsened 1 day prior to admission, with difficulty reducing the mass. On April 8, 2021, the patient was admitted to the Department of Anesthesiology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine of Central South University, with a diagnosis of "left inguinal hernia." On the second day of hospitalization, laparoscopic high ligation of the left inguinal hernia sac was performed under general anesthesia. During the procedure, the patient developed a sudden increase in airway pressure, marked hemodynamic fluctuations, crepitus in the neck and right anterior chest regions, and significantly diminished breath sounds in the right lung. Emergent bedside chest X-ray confirmed a right-sided pneumothorax. Immediate intervention including thoracic needle decompression, closed thoracic drainage, the lung re-expansion was performed. The patient was discharged on the 7th postoperative day with full recovery. This case highlights the need for clinicians to remain vigilant for iatrogenic pneumothorax during pediatric laparoscopic surgery. Close intraoperative monitoring of vital signs is crucial for early detection, recognition, and timely management of pneumothorax to ensure patient safety during minimally invasive procedures.
Humans ; Laparoscopy/methods* ; Pneumothorax/etiology* ; Ligation/methods* ; Hernia, Inguinal/surgery* ; Male ; Intraoperative Complications/etiology* ; Child ; Herniorrhaphy/methods* ; Female ; Subcutaneous Emphysema/etiology*

Lumbar disc (LD) herniation and aging are prevalent conditions that can result in substantial morbidity. This study aimed to clarify the mechanisms connecting the LD aging and herniation, particularly focusing on cellular senescence and molecular alterations in the nucleus pulposus (NP). We performed a detailed analysis of NP samples from a diverse cohort, including individuals of varying ages and those with diagnosed LD herniation. Our methodology combined histological assessments with single-nucleus RNA sequencing to identify phenotypic and molecular changes related to NP aging and herniation. We discovered that cellular senescence and a decrease in nucleus pulposus progenitor cells (NPPCs) are central to both processes. Additionally, we found an age-related increase in NFAT1 expression that promotes NPPC senescence and contributes to both aging and herniation of LD. This research offers fresh insights into LD aging and its associated pathologies, potentially guiding the development of new therapeutic strategies to target the root causes of LD herniation and aging.
Intervertebral Disc Displacement/metabolism* ; Humans ; Aging/pathology* ; Nucleus Pulposus/pathology* ; Male ; Female ; Transcriptome ; Middle Aged ; Lumbar Vertebrae/pathology* ; Adult ; Cellular Senescence ; Stem Cells/pathology* ; Aged ; Intervertebral Disc Degeneration/metabolism*

OBJECTIVES: This study aimed to evaluate the effect of disc morphology and disc-condyle angle on the treatment of anterior repositioning splint (ARS) for anterior disc displacement with reduction (ADDwR). METHODS: On the basis of the inclusion and exclusion criteria, a total of 11 patients diagnosed with ADDwR were included. The effects of changes in disc length, thickness, and morphology classifications on the clinical symptoms, disc morphology parameters, and disc-condyle angles after ARS treatment were evaluated using magnetic resonance imaging and the Helkimo index. RESULTS: After ARS treatment, the Ai and Di of all patients with ADDwR decreased, the disc length increased, and the thickness decreased. The Ai of patients with slight ADDwR and those with type 1 joint discs was reduced to 0, with the most significant decrease observed in Di. The disc length of mild ADDwR (increased to 8.65 mm±1.79 mm) and type 5 disc (increased to 10.71 mm±2.62 mm) significantly increased the most. The disc thickness of slight ADDwR decreased to 3.08 mm±0.51 mm significantly. CONCLUSIONS The therapeutic effect of ARS is correlated with the displacement degree and morphological features of the disc, providing evidence for clinical treatment decisions.
Humans ; Magnetic Resonance Imaging ; Conservative Treatment ; Temporomandibular Joint Disc/diagnostic imaging* ; Male ; Adult ; Female ; Intervertebral Disc Displacement/pathology* ; Middle Aged