OBJECTIVE To compare the efficacy and safety of levetiracetam versus valproic acid in the treatment of pediatric epilepsy， and to provide evidence-based reference. METHODS The databases including CNKI， VIP， China Biomedical Literature Database， Wanfang data， PubMed， Embase and Cochrane Library were searched for the RCTs about levetiracetam （trial group） and valproic acid （control group） were collected from the inception to October 1st， 2021. After literature screening and data extraction， the quality of included literature was evaluated using the bias risk assessment tool recommended by Cochrane system evaluator manual 5.1.0 and RevMan 5.3 software were used for meta-analysis， sensitivity analysis and bias risk analysis. RESULTS A total of 33 RCTs were included， involving 3 116 patients in total. The results of the meta-analysis showed that the effective rate of trial group was significantly higher than control group [RR＝1.06， 95%CI （1.02， 1.11）， P＝0.003]. The subgroup analysis according to different courses of treatment showed that there was no statistical significance in the effective rate between 2 groups after 1 and 3 months of treatment （P＞0.05）； after 6 months of treatment， the effective rate of trial group was significantly higher than that of control group （P＜0.05）. The incidence of adverse drug reaction in trial group was significantly lower than control group [RR＝0.50， 95%CI （0.41， 0.61）， P＜0.000 01]； among specific adverse drug reactions， the incidence of nausea and vomiting in trial group was significantly lower than control group （P＜0.05）； but there was no statistical significance in the incidence of rash， drowsiness， abnormal mood， loss of appetite， dizziness or headache （P＞0.05）. Results of sensitivity analysis showed that study results were stable and reliable. Results of publication bias analysis showed that there was little possibility of publication bias in this study. CONCLUSIONS The short-term efficacy （1， 3 months） of LEV is similar to that of VPA in the treatment of pediatric epilepsy， but long-term efficacy （6 months） of LEV is better than that of VPA； moreover， LEV shows better safety in digestive system.

Objective:To summarize the ideal strategy for the treatment of female hypospadias.Methods:The data of 12 female patients with hypospadias admitted to the Sixth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine from December 2011 to December 2019 were retrospectively analyzed. The patients was (31.0±16.6) years old (7-67 years old). Among them, 3 cases had a history of pelvic fracture trauma, 3 cases had a history of birth trauma, and the remaining 6 cases had no history of trauma and surgery. Among them, there were 6 cases of congenital hypospadias and 6 cases of acquired hypospadias. The clinical manifestations were urinary incontinence in 6 cases and dysuria in 6 cases. Examination of the normal position of the external opening of the genital urethra did not show the opening of the urethra, but moved down to different parts of the anterior wall of the vagina. All patients underwent urethral lengthening. For congenital hypospadias, the urethral plate is used to cut the coiled tube during the operation to prolong the urethra. For acquired hypospadias, the stenotic urethra was enlarged and lengthened with a labial pedicled flap coil. The subcutaneous fat pad of the labia majora was mobilized and transferred to the outside of the newly constructed urethra to prevent the occurrence of urethro-vaginal fistula and increase the pressure of the urethra. Five patients with significant urinary incontinence underwent bladder neck reconstruction at the same time. Anatomical success of the procedure was defined as the appearance of a normal-shaped external urethral opening beneath the clitoris. Functional success was defined as the absence of moderate to severe urinary incontinence after surgery, and the maximum urinary flow rate was >15ml/s during the 12-month follow-up period.Results:All operations were successfully completed. All patients had no perioperative complications, and were followed up for 18-96 months, with an average of 57.3±32.5 months. All patients were able to urinate spontaneously after operation, 4 cases of urinary incontinence disappeared, and 2 cases improved significantly; 4 cases of patients with strenuous urination urinated smoothly. The remaining 2 cases still complained of dysuria after operation, which was solved by subsequent urethral dilatation. The anatomical repair success rate was 100.0%(12/12) and the functional success rate was 83.3% (10/12).Conclusions:Urethral lengthening is an effective method for female hypospadias. The pedicled fat pad helps to increase urethral pressure and prevent fistulas. For female patients with hypospadias and severe urinary incontinence, bladder neck reconstruction is an ideal method. of the technique.

Objective:To investigate the effects of desloratadine combined with Tongqiao Biyan capsule on allergic rhinitis. Methods:100 patients with allergic rhinitis who received treatment in The Affiliated Hospital of Medical College of Ningbo University from February 2018 to February 2020 were included in this study. They were randomly assigned to receive treatment with either desloratadine tablets (control group, n = 50) or desloratadine tablets combined with Tongqiao Biyan capsule (observation group, n = 50) for 21 days. Improvement in clinical symptoms and changes in inflammatory factors were observed in each group. Results:Scores of nasal itch, nasal obstruction, runny nose, and sneezing in the observation group were (1.42 ± 0.10) points, (1.20 ± 0.13) points, (1.25 ± 0.13) points, and (1.33 ± 0.14) points, respectively, which were significantly lower than those in the control group [(1.80 ± 0.12) points, (1.68 ± 0.15) points, (1.68 ± 0.11) points, (1.68 ± 0.13) points, t = 17.20, 17.10, 17.85, 12.95, all P < 0.001]. After treatment, interleukin -4, -6, -8 levels in the observation group were (16.12 ± 5.05) ng/L, (5.33 ± 2.10) ng/L, (37.16 ± 9.80) ng/L, respectively, which were significantly lower than those in the control group [(21.52 ± 5.58) ng/L, (8.12 ± 2.15) ng/L, (48.55 ± 9.65) ng/L, t = 5.07, 6.56, 5.86, all P < 0.05]. Interferon-γ level was significantly higher in the observation group than in the control group [(26.58 ± 2.58) ng/L vs. (23.68 ± 2.69) ng/L, t = 5.50, P < 0.001]. After treatment, the total score of the quality of life questionnaire was significantly higher in the observation group than in the control group [(61.58 ± 8.57) points vs. (40.98 ± 8.35) points, t = 12.17, P < 0.001]. There was no significant difference in total incidence of adverse reactions between observation and control groups [10.00% (5/50) vs. 14.00% (7/50), χ2 = 0.38, P > 0.05]. Conclusion:Desloratadine combined with Tongqiao Biyan capsule can better improve the symptoms of allergic rhinitis and better reduce inflammation without increasing adverse drug reactions compared with desloratadine alone.

Objective:To identify the pathogens isolated in the subperiosteal abscesses from the pediatric patients with acute osteomyelitis and to investigate the characteristics of bacterial drug resistance.Methods:A retrospective study was conducted on children with acute septic osteomyelitis who were hospitalized in the Children's Hospital, Zhejiang University School of Medicine from January 1, 2011 to March 1, 2018. The results of bacterial cultures isolated from the subperiosteal abscesses or bone marrow fluid were collected. The Merier automatic bacterial identification system (i.e., Vitek) was used to identify the bacteria and to assess the drug sensitivity.Results:(1) A total of 104 pediatric patients were included and 60 (57.7%) were male. Sixty-six strains of pathogens were isolated from 65 patients (62.5%). Among them, 53 strains (51.0%) were Staphylococcus aureus; 3 strains were Escherichia coli; 2 strains (1.9%) were Pseudomonas aeruginosa; 2 strains (1.9%) were Streptococcus pneumoniae, 2 strains (1.9%) were Ochrobactrum anthropi, and 4 strains (3.8%) were other bacteria. Pathogens were not found in 39 patients (37.5%). (2) Staphylococcus aureus accounted for 81.5% (53/65) of the pathogen-positive cases. Among them, 23 strains (43.4%) were methicillin-resistant Staphylococcus aureus (MRSA). Aureus-positive children were statistically significantly older ( P=0.028), heavier ( P=0.040) and had higher C-reactive protein (CRP) level ( P=0.038) than the aureus-negative children. (3) All the 53 Staphylococcus aureus strains were resistant to penicillin and 56.6% of them were only sensitive to benzocillin. The resistance rates to compound sulfamethoxazole, tetracycline, clindamycin and erythromycin were 11.3%, 30.2%, 67.9% and 69.8%, respectively. The sensitivity rate of the strains to furantoin was 90.2%. All strains were sensitive to quinupristin/dalfopristin, linezolid, rifampicin, tigecycline, levofloxacin, moxifloxacin, ciprofloxacin and vancomycin. There was 69.8% of the strains resistant to three or more different types of antibiotics. Conclusions:Staphylococcus aureus is the most common pathogen that causes the acute septic osteomyelitis in children, and the resistance rate to Benzocillin is relatively high. Therefore, Benzocillin and Clindamycin, as the traditionally-used drugs, should not be considered as the first choice when empirically using intravenous antibiotics. In the present study, pathogens in 39 patients (37.5%) were not detected in their subperiosteal abscesses or bone marrow fluid, so further effort should be made to investigate the etiology of these patients.

Objective:To explore management experience for post-adolescent postoperative urethral stricture of hypospadias in a single center.Methods:The clinical data of 71 cases of postoperative urethral stricture of post-adolescent hypospadias from January 2015 to December 2019 were retrospectively analyzed. The average age was 27.7(12-65) years. The mean duration of urethral stricture was 33.4(1-240) months. The number of prior surgeries was 2.5(1-9). There were 32 cases of ectopic urethral orifice, including 22 on penile, 8 on scrotum and 2 on perineum. There were 17 cases of urethral stricture with penile curvature, 11 with urethra-cutaneous fistula, 9 with urethral diverticulum, 11 with urethral calculus and 25 with urethral infection. Ten patients kept suprapubic tubes; 61 patients were able to urinate on their own, but suffered from dysuria and weak steam. The average maximum uroflow rate of 71 cases was 4.7(0-11.2) ml/s. The primary urethral reconstruction procedures were performed on 33 cases, included 11 penile or scrotal septum flap urethroplasty, 2 urethral diverticulum wall flap urethroplasty, 12 oral mucosal urethroplasty and 8 urethrotomy. Thirty-three cases underwent two-staged surgery. For patients with penile curvature greater than 30 degrees, the penis was straightened with a urethrotomy in first stage. Besides, the dorsal skin of penis or oral mucosal graft were transferred to the ventral side of the penis to the preset urethral plate. In second-stage, Denis Brown urethroplasty was performed on 23 patients, tubularized incised plate (Snodgrass) urethroplasty on 6, and oral mucosa inlay urethral plate (Snodgraft) urethroplasty on 4. In 5 cases, preplacing of oral mucosa was done in the second stage with a third-staged urethroplasty. Penile curvature was relieved by ventral scar resection with the folding the dorsal tunica albuginea of corpus cavernosum when necessary.Results:The mean follow-up time was 30.5(4-59) months. Sixty-one patients got satisfying postoperative urination, with an average maximum uroflow rate of 22.7 ml/s (15.8-37.2 ml/s). Restenosis occurred in 10 cases, and urethral fistula in 7 cases. Re-stricture patients underwent urethrotomy in 5 cases, augmented urethroplasty with flap in 4 cases, and urethroplasty with oral mucosal graft in 1 case. Among the 7 patients with urethral fistula, 5 were cured by one fistula repair, and 1 cured by second repair; the rest one was left untreated. 2 patients still had penile curvature after operation.Conclusions:It is difficult to manage post-adolescent postoperative urethral stricture of hypospadias, especially for patients with residual penile curvature greater than 30 degrees and lack of penile skin. Performing correction of the curvature and reconstruction of the urethral plate in first stage and Denis Brown urethroplasty or Snodgrass urethroplasty in second or third stage could achieve good results.

Objective:To investigate the characteristics and the management of male genital lichen sclerosus (MGLSc)accompanied by urethral carcinoma.Methods:A retrospective analysis was performed on 16MGLSc accompanied by urethral carcinoma patients who were referred to Shanghai Sixth People’s Hospital between June 2000 and August 2019. The average age was 53.7 (45-69) years. All of the patients had a mean history of MGLSc 15(6-35) years, anterior urethral stricture received urethral dilatation and other inappropriate urethrotomy treatment for 10 (8-15) years. There were 5 cases of solid mass 4.5 (3-7) cm in scrotum, accompanied by obviously pain. There were 11 cases of infective masses 6(4-10)cm in the perineum, and the masses were ulcerated with purulent secretions and residue-like pus mixed with necrotic tissues draining from the wounds. Urethrocutaneous fistula developed in 9 cases, and the secretions in the fistula cannot heal. The diseased tissue was confirmed by pathology as the metastasis of invasive urothelial carcinoma in 12 patients and urethral squamous cell carcinoma in 4 patients. 9 cases of tumor invaded corpus spongiosum or corpus cavernosum, 5 cases invaded corpus spongiosum or corpus cavernosum, with enlarged firm one side inguinal node. 2 cases of tumor invaded corpus cavernosum, beyond prostatic capsule and bladder neck, bilateral palpable inguinal lymph nodes metastasis were found, one case found tumor involved the left testis. 9 cases were T 2-3N 0M 0, 5 cases T 2-3N 1M 0, 1 case T 3N 2M 0, 1 case T 4N 2M 1. 5 patients with substantial tumors located in the scrotum, penile-sparing scrotum tumor, urethral tumor resection and urethrostomy was performed in 2 patients. Partial phallectomy, urethral tumor resection and perineal urethrostomy were performed in 3 patients. 11 patients with urethral cancer complicated with perineal infectious mass, 2 patients underwent extensive resection of the tumor and suprapubic cystostomy. 8 cases with perineal tumor infection complicated with urethrocutaneous fistulas formation, of which 2 patients received perineal mass, urethral tumor, fistula resection and suprapubic cystostomy, 4 patients with unilateral inguinal lymph node metastasis and received perineal mass, urethral tumor, fistula, lymph node resection and suprapubic cystostomy. 2 patients with bilateral inguinal node metastasis underwent total phallectomy and urethrectomy, inguinal lymph node resection and suprapubic cystostomy. One case of perineal infectious mass with urethral cutaneous fistula and unilateral inguinal lymph node metastasis (T 2-3N 1M 0) gave up tumor resection. Results:The pathological examination of surgical resection of the glans and urethra showed typical MGLSc manifestations as epithelial keratinization, basal cell vacuoles degeneration, dermis lymphocyte infiltration. The pathological examination of the surgical excised diseased urethra and surrounding tumor tissue showed invasive urothelial carcinoma in 12 patients. Immunohistochemical staining showed positive expression of P53, Ki-67 and GATA3. 4 patients of urethral squamous carcinoma and immunohistochemical staining showed positive expression of Ki-67, P40 and GATA3. All patients received cisplatin combined with gemcitabine chemotherapy for an average of 4.8 (2-6)courses and received local radiotherapy (50-70Gy/5w). The mean postoperative survival time of the 16 patients was 26 (3-48) months, and the survival time of urethral transitional cell carcinoma and squamous cell carcinoma was 29 (18-48) months and 18 (3-24) months, respectively. All patients died of tumor metastasis, with 6 patients of lung metastsis, 2 patients of lumbar and bone metastasis, 3 patients of liver metastasis, 2 patients of brain metastasis and 3 patients of lung combined with bone metastasis.Conclusions:MGLSc can cause urethal stricture and urethral carcinoma. The clinical manifestations are dysuria, urinary tumor, repeated infection and urethral fistula. Tumor excision and urinary diversion are common surgical methods. Urethral transitional cell carcinoma and squamous cell carcinoma are common pathological types. Postoperative combined radiotherapy and chemotherapy can be used, but the overall prognosis is poor.

Objective:To explore the outcomes of urethra around corpora cavernosus anastomotic urethroplasty for the treatment of complex posterior urethral strictures.Methods:Between June 2008 and June 2020, 35 patients with complex posterior urethral strictures were treated using urethra rerouted under one corpora cavernosus anastomotic urethroplasty. The patients’ age was 3-54 years(mean 23.2 years), the urethral stricture or loss length was 4-7 cm(mean 5.2 cm), and 6 patients associated with urethrorectal fistula. The technique involved: ①The anterior urethra is dissected long more than 5 cm, separation of the proximal corporeal bodies, inferior pubectomy and the dissected proximal urethra.②A channel around the left crus of the penis through the inferior pubectomy is separated and urethra rerouted under left corpora cavernosus to allow a tension-free anastomosis to the proximal urethra.Results:Two patients lost follow-up; the remainder 33 patients were followed-up for 3 to 144 months(mean 37 months). Thirty-two patients could void normally(97%), The examination of maximal urinary flow rates(Q max) were taken in 21 patients, of whom Q max was 13.6-35.5 ml/s (mean 17.5 ml/s) in 7 children and 16.3-77.6 ml/s(mean 27.9 ml/s) in 14 adult patients. All 6 patients associated with urethrorectal fistula successful repaired, of these patients 1 had died of hemorrhage of brain 6 years postop. One patient developed urethral stenosis postoperatively. Continence was achieved in 29 patients, the remaining 3 patients had incontinence from mild to moderate. Conclusions:Urethra rerouted under left corpora cavernosus anastomotic urethroplasty is not only an effective surgical salvage option, with low recurrent rate for patients with complex posterior urethral strictures, but also do not cause curve and affect growth of corpora cavernosus.

Objective To explore the erectile function preservational mechanism of Non-transecting urethroplasty(NTU) for posterior urethral stricture.Methods From May 2012 to September 2016,62 patients with posterior urethral stricture,who were treated with NTU,were enrolled in this study.The mean age was 37.5 years old,ranging 18-48 years old.The causes were pelvic fracture urethral injury in 53 cases and iatrogenic injury in 9 cases.Preoperative urethrography and urethroscopy revealed the strictures located in posterior urethra,which was at the distal of verumontanum.The mean length of stricture was 2.1 cm,ranging 0.5-2.5 cm.The average period between trauma and surgery was 6.4 months,ranging 3 months-2 years.All patients had no previous history of urethroplasty.Their sexual hormones were in normal level.Among those patients,the IIEF-5 scores were more than 12 and number of events during NPT test were more than twice.Finally,43 cases were underwent NTU and 19 cases accepted inferior pubectomy (IP)+ NTU.All patients had a general anesthesia.The bulbar urethra was mobilized dorsally from the tunica albuginea of the corpora cavernosa and then extended proximally up toward the perineal membrane.Scar tissue surrounding the urethra was excised and inferior pubectomy (IP) was performed as a supplemental technique to keep the suturing position without tension.The ventral hemi-circumference was then sutured with interrupted 4-0 polyglycolic sutures with tension-free anastomosis.The 18-Fr indwelling catheter was inserted.Result Average follow-up was 20.2 months,ranged from 12 to 36 months.In NTU group,NPT test revealed no significant difference in number of events (2.7 ± 0.7 vs.3.0 ± 1.0,P ＞ 0.05),duration of best episode [(16.4 ± 3.5) min vs.(16.4 ± 3.8) min,P ＞ 0.05)] or tip rigidity [(31.2 ± 4.7) ％ vs.(30.8 ± 3.5) ％,P ＞ 0.05)] between pre-and post-operation,respectively.The IIEF-5 score (19.7 ± 1.9 vs.20.4±2.1,P＜0.05)and Qmax[(8.7 ±4.0)ml/s vs.(25.5 ±4.7)ml/s,P＜0.05)] increased significant pre-and post-operation,respectively.In IP + NTU group,Qmax [(8.4 ± 4.4) ml/s vs.(23.1 ± 3.5)ml/s,P ＜ 0.05)] increased significant pre and post operation.The NPT test revealed slight decrease in number of events(2.3 ± 0.6 vs.1.6 ± 1.0,P ＜ 0.05),duration of best episode [(15.6 ± 2.4) min vs.(14.5±2.4)min,P＜0.05)] or tip rigidity [(29.8±3.0)％ vs.(25.6 ±7.1)％,P＜0.05)] between pre-and post-operation,respectively.However,the IIEF-5 scores (17.3 ± 1.6 vs.16.5 ± 2.1,P ＜ 0.05) didn't show significant difference pre-and post-operation.Stricture recurrence occurred in 3 patients,the success rate was 95.2％ (59/62) during 12 months following.Conclusion NTU is not only a safe and promising procedure for posterior urethral stricture less than 2.5cm,but also a new minimally invasive approach to preserve erectile function.

Alterations of the lactoferrin gene are associated with an increased incidence of tumor,however,the exact mechanisms involved in the anti-tumor activity of lactoferrin are still unclear.Several studies suggest that lactoferrin can affect the initiation and development of tumors via different mechanisms such as damaging cell membranes,inducing apoptosis,blocking cell cycle,regulating cellular immune response and inhibiting angiogenesis in different cancer cell lines.Further study about the mechanism can provide new ideas for clinical prevention and treatment of tumors.

Objective To investigate the clinical effect of transverse island fasciocutaneous penile flap in the treatment of meatus and navicular fossa stricture.Methods Fifteen patients with urethral reconstruction with transverse island fasciocutaneous penile flap from October 2014 to December 2018 were enrolled.Six patients had a history of urethroscopic surgery,three had a history of lichensclerosus,three had a history of urethral dilation,and three had no obvious causes.All patients underwent transverse incision under the coronal sulcus,and after fully dissecting the urethra,the urethra was opened longitudinally ventrally.After measuring the actual length of stenosis,the irradiance fascia flap with the corresponding length of the incision was reconstructed.The patients were reviewed at 1 and 3 months after operation,and any complications such as recurrence or urinary fistula were recorded.The urine flow rate was tested 3 months after surgery.Results All 15 patients in this group underwent a successfully operation.The actual measurement of urethral stricture length was 0.5-4.0 cm during operation,with the average of 2.82 cm.Three months after the operation,the urine flow rate ranged from 13.5 ml/s to 23.7 ml/s,with an average of 18.5 ml/s.The overall successful rate was 93.3％ (14/15).The rate of post-operative fistula was 20.0％ (3/15).Two cases complained of needle-like fistula at the incision.One case healed after 3 months,and the other gave up further treatment.One patient developed urethral stricture and urethral skin spasm again 1 month later and was surgically repaired again.Conclusions The initial experience of pedicled island fascia flap for the treatment of urethral stenosis and scaphoid stenosis is safe,feasible and effective for the treatment of urethral stricture.