Objective To investigate the safety and feasibility of two-port laparoscopic full layer circular closure of the hernia ring for direct inguinal hernia.Methods Between September 2019 and February 2024,9 cases of pediatric indirect inguinal hernia were found to be accompanied by an occult direct inguinal hernia on the right side during two-port laparoscopic inner ring closure.After completing the high ligation of the indirect hernia under laparoscopic monitoring,the bottom of the direct hernia sac was investigated.The needle was held and inserted sequentially from the 4 o'clock direction,crossing the abdominal wall muscle layer through the peritoneum to the subcutaneous layer,and exited at the 8 o'clock direction.The same method was conducted from the 8 o'clock direction in and at the 12 o'clock direction out,and afterwards from the 12 o'clock direction in and at the 16 o'clock direction out(near the previous 4 o'clock insertion point),followed by knotting and closure of the hernia ring.Results Postoperative diagnosis indicated 3 cases of Pantalon hernia(right indirect hernia+right direct hernia)and 6 cases of left indirect hernia+right direct hernia.No extraperitoneal lipoma was found outside the hernia sac.Two-port laparoscopic high ligation of the indirect hernia and laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring was carried out.The operation time was(32.5±3.5)min,and blood loss was less than 1 ml.No intraoperative complications were seen.All the patients were discharged within 6 h after surgery and followed up for 5-13 months(mean,8 months),with 3 cases followed up for more than 12 months.No complications such as incision infection,recurrent hernia,hydrocele,iatrogenic cryptorchidism or testicular atrophy was found.Ultrasound examination of the direct hernia triangular area showed uniform thickness of the abdominal wall and no localized defects observed.Conclusions Laparoscopic circular closure through muscle layer to subcutaneous layer of abdominal wall around the hernia ring is safe and feasible.This procedure supplements the pediatric direct inguinal hernia repair procedure by suturing and closing both peritoneum and abdominal wall muscle layer of direct hernia defect without changing the normal anatomical position of the umbilical fold.

Objective To explore the safety and feasibility of extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure in the treatment of pediatric ovarian sliding hernia.Methods From September 2019 to September 2024,57 children with ovarian sliding hernia underwent extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure.Under the guidance of single-port umbilical laparoscopic monitoring,a 2-0 suturing needle with thread was inserted through the opposite internal ring and used to suture the round ligament of the uterus at the affected side's internal ring.The needle was passed through and exited near the entry point,and the extracorporeal suture traction was used to pull the ovary(and part of the fallopian tube)back into the abdominal cavity from the inguinal canal,maintaining the suture tension to prevent the ovary and fallopian tube from re-entering the internal ring.The internal ring was fully exposed.A 2-0 suturing needle with thread was inserted at the affected side(2-3 cm from the internal ring)to perform a circular suture of the peritoneum at the internal ring.The internal ring was closed at the level of internal ring orifice.Results All the 57 cases of ovarian sliding hernia were confirmed to be unilateral,with 18 cases on the right side(including 12 cases of pure ovarian sliding hernia and 6 cases of ovarian and fallopian tube sliding hernia)and 39 cases on the left side(including 22 cases of pure ovarian sliding hernia and 17 cases of ovarian and fallopian tube sliding hernia).The average surgery time was(22.5±2.5)min.All the patients were discharged within 6 h postoperatively and no complications were noted.A total of 49 patients were followed up for6-20 months(mean 9.5 months),with 21 cases followed for more than 12 months.No complications such as incision infection,recurrence of hernia,or Nuck's cyst were observed.Ultrasonic examinations showed normal bilateral ovarian blood flow.Conclusion For pediatric ovarian sliding hernia,extracorporeal suture traction of round ligament of the uterus assisted two-port laparoscopic internal ring closure can effectively retract the ovary(and part of the fallopian tube)from the inguinal canal back into the abdominal cavity,fully exposing the normal anatomical form of the internal ring,with the characteristics of safety and feasibility.

In order to explore the effects of lipopolysaccharide(LPS)on the repair of bovine endo-metrial stromal cells(BESCs)during inflammatory response,BESCs were treated by LPS in this study.Cell apoptosis rate was detected using flow cytometry,cell viability was measured using the CCK-8 assay,cell migration ability was observed using a scratch assay,and the expression of con-nective tissue growth factor(CTGF),transforming growth factor-beta 3(TGF-β3)and vascular endothelial growth factor(VEGF)mRNA was measured using qRT-PCR.Additionally,the expression of key proteins in the PI3K/AKT and Wnt/β-catenin signaling pathways was assessed using Western blot analysis.The results showed that cell viability of BESCs significantly decreased(P＜0.01),cell migration ability decreased(P＜0.05),apoptosis rate of BESCs increased(P＜0.01),CTGF and TGF-β3 mRNA expression levels decreased(P＜0.01),while VEGF mRNA ex-pression increased after treatment with LPS(P＜0.01).The phosphorylation levels of PI3K,AKT and GSK-3β proteins decreased(P＜0.05),as well as the expression levels of c-Myc and Cyclin-D1 proteins also decreased(P＜0.01).These results indicated that LPS can inhibit the proliferation of BESCs and promote cell apoptosis possibly through the inhibition of the PI3K/AKT and Wnt/β-catenin signaling pathways.

Objective To investigate the safety and feasibility of emergency transumbilical single-site laparoscopy for persistent intestinal intussusception in children.Methods From September 2019 to January 2025,32 children with persistent intestinal intussusception caused by small intestinal polyps underwent emergency transumbilical single-site laparoscopic exploration,intestinal intussusception reduction,and polypectomy.A 5-mm longitudinal incision was respectively made at the umbilical midline and the inferior edge of the umbilical ring for trocar placement.Under laparoscopic guidance,grasping forceps were used to explore the intestine from the ileocecal region to locate the intussuscepted bowel,followed by trying the laparoscopic instrumental reduction.The incision was further extended between the umbilical midline and the inferior edge of the umbilical ring to 3-4 cm length,and the intussuscepted bowel was externalized through the incision.Manual reduction was performed if the laparoscopic reduction failed.The intestinal segment containing the polyp was identified,and a longitudinal incision was made at the polyp site by using an electrocautery knife.The polyp was resected near the mucosal margin followed by closure of intestinal wall.Results Laparoscopic reduction was successful in 5 cases,while 27 cases required external manual reduction.Complete small bowel polyp screening was performed in all the cases.Polyp identification,localization,and resection were completed extracorporeally.Isolated polyps were found in 31 patients,and two polyps were identified in one patient.The mean operative time for all the 32 patients was(72.5±12.5)min,with no intraoperative complications.Pathological examination confirmed juvenile polyps in all the cases.All the 27 cases were followed up for 3-18 months(mean,6.5 months),of which 13 cases were followed up for more than 12 months.Ultrasound follow-up revealed no abnormalities,including intestinal leakage,wound infection,recurrence of intussusception,or polyp reoccurrence.Conclusion Emergency transumbilical single-site laparoscopy is a safe and feasible approach for persistent intestinal intussusception in children.

Objective:To evaluate the safety and efficacy of accelerator-based boron neutron capture therapy (AB-BNCT) in the treatment of recurrent and refractory malignant tumors.Methods:The data of 14 patients admitted to Xiamen Humanity Hospital from September 2022 to April 2023 were prospectively collected, including 7 patients with primary brain malignancies and 7 patients with locally recurrent inoperable head and neck malignancies. All patients received intravenous infusion of boron drug (NBB-001, p-dihydroxyborylphe nylalanine, a patented freeze-dried formulation) at a total nominal dosage of 500 mg/kg (11 patients) or 750 mg/kg (3 patients), and were irradiated with neutrons (operating with NeuPex system). Adverse events after treatment were recorded and assessed. The primary efficacy endpoint was the 90 d objective response rate (ORR), while the secondary endpoints included progression-free survival (PFS) and complete response rate (CRR). Data were compiled and analyzed by SAS 9.4 software. The rate and 95% CI were calculated using Clopper-Pearson method. Results:The median dose delivered to 80% of the target volume (D 80%) was 16.80 GyE (range: 8.93-23.79 GyE). The most common adverse reactions were hyperamylasemia, alopecia, and hyperprolactinemia. Five patients experienced 8 cases of grade 3 or above adverse events, including 1 case of grade 4 acute kidney injury and 7 cases of grade 3 adverse events. All adverse events were recovered after observation or treatment. At 90 d after treatment, the ORR of all patients was 9/14 (64%, 95% CI: 35%-87%), disease control rate (DCR) was 10/14 (71%, 95% CI: 42%-92%), CRR was 2/14 (14%, 95% CI: 2%-42%); and the best overall response during the entire course included an ORR of 10/14 (71% ,95% CI: 42%-92%), DCR of 13/14 (93%, 95% CI: 66%-100%), and CRR of 3/14 (21% ,95% CI: 5%-51%). The 1-year survival rate for head and neck malignancies was 71.4%, and the 2-year survival rate was 42.8%. The 1-year survival rate for recurrent brain malignancies was 42.8%. Conclusion:AB-BNCT demonstrates favorable safety and promising efficacy in treating primary brain malignancies and recurrent/refractory head and neck malignancies, representing a potential therapeutic option.

Objective To explore the safety and feasibility of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing for the treatment of inguinal indirect hernia in children≤3 months old.Methods From January 2020 to September 2024,49 children ≤ 3 months old with indirect hernia underwent external silk thread traction-assisted two-port laparoscopic internal ring suturing.All the patients were found to complicated with redundant peritoneum around internal ring.Under transumbilical single-port laparoscopic monitoring,the 3-mm laparoscopic needle holder holing the 3-0 needle-thread nylon was inserted through the inferior edge of the internal ring,entering the peritoneum and traveling through the retroperitoneal space.The external nylon thread was advanced to drag the redundant peritoneum,allowing the suture needle cross the surface of the spermatic cord vessels,the Doom's triangle,and the vas deferens(boys)or the uterine round ligament(girls)in the retroperitoneal space,followed by circular suturing and closure of the internal ring.Results The surgery time was(13.5±2.5)min for the 35 cases of unilateral hernia and(24.5±3.5)min for the 14 cases of bilateral hernia.No intraoperative complications occurred,and all the patients were discharged within 6 h post-operation.Except for 3 children of lost to follow-up,46 children were followed up for 6-26 months(mean,9.5 months),with 19 cases followed for＞12 months.No complications such as recurrence,wound infection,hydrocele,iatrogenic undescended testicle,or testicular atrophy were observed during the follow-ups.Conclusion For children ≤ 3 months old with indirect hernia,the use of 3-mm laparoscopic needle holder combined with 3-0 needle-thread nylon in external silk thread traction-assisted two-port laparoscopic internal ring suturing enhances the flexibility and convenience of the procedure,being safety and feasibility.

Objective:To explore the in vitro radiation levels and in vivo neutron activation after patients receiving boron neutron capture therapy (BNCT). Methods:Totally 29 BNCT treatments were performed for 21 patients with head and neck and brain cancer using the NeuPex accelerator-based boron neutron capture therapy (AB-BNCT) system in Xiamen Humanity Hospital from October, 2022 to April, 2024. The ambient dose equivalent rate around the patients was measured with an X/gamma dose rate survey meter. The gamma radiation dose rates were measured at 0, 0.5, 1.0, and 2.0 m from the irradiation position, at 0, 0.5, 1.0, and 2.0 m from the opposite side of the irradiation position, and at the navel and the affected knee, respectively. Meanwhile, a portable high-purity germanium gamma spectrometer was used to measure the spectrum of activated nuclides in the bodies of patients who had underwent the treatment, and the types of radionuclides generated by neutron activation during each BNCT treatment were analyzed.Results:The radionuclides 24Na, 38Cl, and 49Ca were mainly produced in the bodies of patients treated with BNCT. 20 minutes after BNCT treatment, the ambient dose equivalent rate at a distance of 1.0 m from the irradiation position was lower than 2.5 μSv/h. Conclusions:The dose delivered to the staff and family members by the patients undergoing BNCT is relatively low, and the resulting radiation risk is low. According to the ALARA principle, it is recommended that certain control actions be taken for patients having received BNCT treatment to minimize the exposure doses of both patients and staff as much as possible.

Objective:To explore the in vitro radiation levels and in vivo neutron activation after patients receiving boron neutron capture therapy (BNCT). Methods:Totally 29 BNCT treatments were performed for 21 patients with head and neck and brain cancer using the NeuPex accelerator-based boron neutron capture therapy (AB-BNCT) system in Xiamen Humanity Hospital from October, 2022 to April, 2024. The ambient dose equivalent rate around the patients was measured with an X/gamma dose rate survey meter. The gamma radiation dose rates were measured at 0, 0.5, 1.0, and 2.0 m from the irradiation position, at 0, 0.5, 1.0, and 2.0 m from the opposite side of the irradiation position, and at the navel and the affected knee, respectively. Meanwhile, a portable high-purity germanium gamma spectrometer was used to measure the spectrum of activated nuclides in the bodies of patients who had underwent the treatment, and the types of radionuclides generated by neutron activation during each BNCT treatment were analyzed.Results:The radionuclides 24Na, 38Cl, and 49Ca were mainly produced in the bodies of patients treated with BNCT. 20 minutes after BNCT treatment, the ambient dose equivalent rate at a distance of 1.0 m from the irradiation position was lower than 2.5 μSv/h. Conclusions:The dose delivered to the staff and family members by the patients undergoing BNCT is relatively low, and the resulting radiation risk is low. According to the ALARA principle, it is recommended that certain control actions be taken for patients having received BNCT treatment to minimize the exposure doses of both patients and staff as much as possible.

Objective To investigate the safety and feasibility of emergency transumbilical single-site laparoscopy for persistent intestinal intussusception in children.Methods From September 2019 to January 2025,32 children with persistent intestinal intussusception caused by small intestinal polyps underwent emergency transumbilical single-site laparoscopic exploration,intestinal intussusception reduction,and polypectomy.A 5-mm longitudinal incision was respectively made at the umbilical midline and the inferior edge of the umbilical ring for trocar placement.Under laparoscopic guidance,grasping forceps were used to explore the intestine from the ileocecal region to locate the intussuscepted bowel,followed by trying the laparoscopic instrumental reduction.The incision was further extended between the umbilical midline and the inferior edge of the umbilical ring to 3-4 cm length,and the intussuscepted bowel was externalized through the incision.Manual reduction was performed if the laparoscopic reduction failed.The intestinal segment containing the polyp was identified,and a longitudinal incision was made at the polyp site by using an electrocautery knife.The polyp was resected near the mucosal margin followed by closure of intestinal wall.Results Laparoscopic reduction was successful in 5 cases,while 27 cases required external manual reduction.Complete small bowel polyp screening was performed in all the cases.Polyp identification,localization,and resection were completed extracorporeally.Isolated polyps were found in 31 patients,and two polyps were identified in one patient.The mean operative time for all the 32 patients was(72.5±12.5)min,with no intraoperative complications.Pathological examination confirmed juvenile polyps in all the cases.All the 27 cases were followed up for 3-18 months(mean,6.5 months),of which 13 cases were followed up for more than 12 months.Ultrasound follow-up revealed no abnormalities,including intestinal leakage,wound infection,recurrence of intussusception,or polyp reoccurrence.Conclusion Emergency transumbilical single-site laparoscopy is a safe and feasible approach for persistent intestinal intussusception in children.

In order to explore the effects of lipopolysaccharide(LPS)on the repair of bovine endo-metrial stromal cells(BESCs)during inflammatory response,BESCs were treated by LPS in this study.Cell apoptosis rate was detected using flow cytometry,cell viability was measured using the CCK-8 assay,cell migration ability was observed using a scratch assay,and the expression of con-nective tissue growth factor(CTGF),transforming growth factor-beta 3(TGF-β3)and vascular endothelial growth factor(VEGF)mRNA was measured using qRT-PCR.Additionally,the expression of key proteins in the PI3K/AKT and Wnt/β-catenin signaling pathways was assessed using Western blot analysis.The results showed that cell viability of BESCs significantly decreased(P＜0.01),cell migration ability decreased(P＜0.05),apoptosis rate of BESCs increased(P＜0.01),CTGF and TGF-β3 mRNA expression levels decreased(P＜0.01),while VEGF mRNA ex-pression increased after treatment with LPS(P＜0.01).The phosphorylation levels of PI3K,AKT and GSK-3β proteins decreased(P＜0.05),as well as the expression levels of c-Myc and Cyclin-D1 proteins also decreased(P＜0.01).These results indicated that LPS can inhibit the proliferation of BESCs and promote cell apoptosis possibly through the inhibition of the PI3K/AKT and Wnt/β-catenin signaling pathways.