1.Eupatilin Inhibits Proliferation, Invasion, and Metastasis of Non-small Cell Lung Cancer via EZH2/H3K27me3 Signaling Pathway
Bo XU ; Yihan YU ; Linling HU ; Bo JIANG ; Yu QI ; Shasha YUAN ; Yiling FAN ; Jixian ZHANG ; Qing MIAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):58-69
ObjectiveTo investigate the mechanisms by which eupatilin (Eup) inhibits proliferation, invasion, and metastasis of non-small cell lung cancer (NSCLC) through the enhancer of zeste homolog 2/histone H3 lysine 27 trimethylation (EZH2/H3K27me3) signaling pathway. MethodsIn vivo, a subcutaneous xenograft tumor model was established in nude mice using H1299 cells to evaluate the anti-NSCLC effects of Eup. Immunohistochemistry (IHC-P) was used to detect the expression of proliferation- and invasion/metastasis-related proteins, including proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor A (VEGFA). In vitro, cell counting kit-8 (CCK-8) assays were performed to determine the viability of H1299 cells treated with different concentrations of Eup (0-200 μmol·L-1) and to select appropriate concentrations. Colony formation and 5-ethynyl-2′-deoxyuridine (EdU) assays were used to evaluate cell proliferation. Wound healing and invasion assays were conducted to assess cell migration and invasion. Human umbilical vein endothelial cell (HUVEC) angiogenesis assays were used to evaluate the effects of Eup on angiogenesis. Transcriptomic analysis was performed to identify the targets of Eup in H1299 cells and to explore its major functions. Molecular docking and molecular dynamics simulations were conducted to predict the binding affinity and interaction stability between Eup and its target proteins. Western blot was used to detect the effects of Eup on the expression levels of EZH2/H3K27me3 pathway-related proteins and proliferation- and invasion/metastasis-related proteins, including PCNA, MMP-2, MMP-9, and VEGFA. ResultsIn the subcutaneous xenograft model, compared with the model group, Eup treatment dose-dependently inhibited the growth of H1299 xenograft tumors, and the tumor inhibition rate was significantly increased (P<0.05). IHC-P results showed that, compared with the model group, high-dose Eup significantly reduced the expression levels of PCNA, MMP-2, MMP-9, and VEGFA in vivo (P<0.05). In vitro, compared with the control group, Eup inhibited the proliferation, invasion, and metastasis of NSCLC cells in a concentration-dependent manner. Transcriptomic analysis further showed that, compared with the control group, Eup significantly downregulated EZH2 expression, and its functional effects were associated with inhibition of tumor metastasis. Molecular docking and molecular dynamics simulations indicated that Eup exhibited strong binding affinity with EZH2 and stable interactions. Western blot results demonstrated that, compared with the model group, Eup significantly inhibited, in a dose-dependent manner, the expression levels of EZH2, H3K27me3, and proliferation- and invasion/metastasis-related proteins (PCNA, MMP-2, MMP-9, and VEGFA) in both in vivo and in vitro experiments (P<0.05). In vitro, compared with the control group, overexpression of EZH2 via plasmid transfection partially reversed the inhibitory effects of Eup on the expression of key proteins involved in proliferation and invasion/metastasis in H1299 cells. ConclusionEup effectively inhibits the proliferation, migration, and invasion of H1299 cells both in vivo and in vitro. The underlying mechanism may be related to inhibition of the EZH2/H3K27me3 signaling pathway and downregulation of proliferation- and invasion/metastasis-related proteins, including PCNA, MMP-2, MMP-9, and VEGFA. Eup may serve as a potential therapeutic agent for suppressing proliferation and invasion/metastasis in NSCLC.
2.Anti-lung Cancer Mechanisms of Yang-warming Herbs and Formulas: A Review
Bo XU ; Yu QI ; Jixian ZHANG ; Linling HU ; Bo JIANG ; Yilong ZOU ; Cunyu FAN ; Yiling FAN ; Qing MIAO ; Yihan YU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):70-79
Lung cancer, particularly non-small cell lung cancer (NSCLC), is the malignant tumor with the highest incidence and mortality in China and worldwide. In 2022, the global number of deaths reached 1.8 million, accounting for 18.7% of all cancer-related deaths, seriously threatening human health and life, and posing a severe challenge for prevention and treatment. Although treatment strategies for lung cancer have been continuously enriched in recent years, and progress has been made in targeted therapy and immunotherapy, long-term survival benefits remain limited due to primary or acquired drug resistance, low immune responsiveness, and chemotherapy-related toxicities. Therefore, there is an urgent need to explore safe and effective adjunctive therapeutic strategies. Traditional Chinese medicine (TCM), with its advantages of holistic regulation and individualized syndrome differentiation, has played an increasingly prominent role in comprehensive cancer treatment. TCM holds that "Yang deficiency leads to accumulation" is a key pathogenesis of tumors. Based on the theory that "Yang transforms Qi, while Yin forms substance", deficiency of Yang Qi results in impaired warming and transformation functions, leading to internal accumulation of Yin-cold. This is closely related to dysregulation of the immune microenvironment, "cold tumor" characteristics, and dysfunction of the neuroendocrine system in modern medicine. Accordingly, the therapeutic strategy of "warming Yang, supporting healthy Qi, and combating cancer" has gained increasing attention. In recent years, commonly used Yang-warming Chinese herbs, including Aconiti Lateralis Radix Praeparata, Zingiberis Rhizoma, Cinnamomi Cortex, Epimedii Folium, and Psoraleae Fructus, as well as their active constituents, have achieved notable progress in anti-lung cancer research by regulating multiple signaling pathways, inducing apoptosis, inhibiting metastasis, and reversing drug resistance. In addition, Yang-warming formulae such as Sini Tang and Yanghe Tang have shown promising effects in alleviating myelosuppression, improving cancer-related fatigue, managing malignant pleural effusion, and relieving cancer pain. These therapies exhibit toxicity-reducing and efficacy-enhancing effects, significantly improving patients' quality of life and survival benefits. To systematically summarize the roles and mechanisms of Yang-warming Chinese herbal medicines and compound formulae in lung cancer, this paper provides a comprehensive review of recent advances, aiming to offer insights for the clinical practice of TCM in the prevention and treatment of lung cancer.
3.Eupatilin Inhibits Proliferation, Invasion, and Metastasis of Non-small Cell Lung Cancer via EZH2/H3K27me3 Signaling Pathway
Bo XU ; Yihan YU ; Linling HU ; Bo JIANG ; Yu QI ; Shasha YUAN ; Yiling FAN ; Jixian ZHANG ; Qing MIAO
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):58-69
ObjectiveTo investigate the mechanisms by which eupatilin (Eup) inhibits proliferation, invasion, and metastasis of non-small cell lung cancer (NSCLC) through the enhancer of zeste homolog 2/histone H3 lysine 27 trimethylation (EZH2/H3K27me3) signaling pathway. MethodsIn vivo, a subcutaneous xenograft tumor model was established in nude mice using H1299 cells to evaluate the anti-NSCLC effects of Eup. Immunohistochemistry (IHC-P) was used to detect the expression of proliferation- and invasion/metastasis-related proteins, including proliferating cell nuclear antigen (PCNA), matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9), and vascular endothelial growth factor A (VEGFA). In vitro, cell counting kit-8 (CCK-8) assays were performed to determine the viability of H1299 cells treated with different concentrations of Eup (0-200 μmol·L-1) and to select appropriate concentrations. Colony formation and 5-ethynyl-2′-deoxyuridine (EdU) assays were used to evaluate cell proliferation. Wound healing and invasion assays were conducted to assess cell migration and invasion. Human umbilical vein endothelial cell (HUVEC) angiogenesis assays were used to evaluate the effects of Eup on angiogenesis. Transcriptomic analysis was performed to identify the targets of Eup in H1299 cells and to explore its major functions. Molecular docking and molecular dynamics simulations were conducted to predict the binding affinity and interaction stability between Eup and its target proteins. Western blot was used to detect the effects of Eup on the expression levels of EZH2/H3K27me3 pathway-related proteins and proliferation- and invasion/metastasis-related proteins, including PCNA, MMP-2, MMP-9, and VEGFA. ResultsIn the subcutaneous xenograft model, compared with the model group, Eup treatment dose-dependently inhibited the growth of H1299 xenograft tumors, and the tumor inhibition rate was significantly increased (P<0.05). IHC-P results showed that, compared with the model group, high-dose Eup significantly reduced the expression levels of PCNA, MMP-2, MMP-9, and VEGFA in vivo (P<0.05). In vitro, compared with the control group, Eup inhibited the proliferation, invasion, and metastasis of NSCLC cells in a concentration-dependent manner. Transcriptomic analysis further showed that, compared with the control group, Eup significantly downregulated EZH2 expression, and its functional effects were associated with inhibition of tumor metastasis. Molecular docking and molecular dynamics simulations indicated that Eup exhibited strong binding affinity with EZH2 and stable interactions. Western blot results demonstrated that, compared with the model group, Eup significantly inhibited, in a dose-dependent manner, the expression levels of EZH2, H3K27me3, and proliferation- and invasion/metastasis-related proteins (PCNA, MMP-2, MMP-9, and VEGFA) in both in vivo and in vitro experiments (P<0.05). In vitro, compared with the control group, overexpression of EZH2 via plasmid transfection partially reversed the inhibitory effects of Eup on the expression of key proteins involved in proliferation and invasion/metastasis in H1299 cells. ConclusionEup effectively inhibits the proliferation, migration, and invasion of H1299 cells both in vivo and in vitro. The underlying mechanism may be related to inhibition of the EZH2/H3K27me3 signaling pathway and downregulation of proliferation- and invasion/metastasis-related proteins, including PCNA, MMP-2, MMP-9, and VEGFA. Eup may serve as a potential therapeutic agent for suppressing proliferation and invasion/metastasis in NSCLC.
4.Anti-lung Cancer Mechanisms of Yang-warming Herbs and Formulas: A Review
Bo XU ; Yu QI ; Jixian ZHANG ; Linling HU ; Bo JIANG ; Yilong ZOU ; Cunyu FAN ; Yiling FAN ; Qing MIAO ; Yihan YU
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(10):70-79
Lung cancer, particularly non-small cell lung cancer (NSCLC), is the malignant tumor with the highest incidence and mortality in China and worldwide. In 2022, the global number of deaths reached 1.8 million, accounting for 18.7% of all cancer-related deaths, seriously threatening human health and life, and posing a severe challenge for prevention and treatment. Although treatment strategies for lung cancer have been continuously enriched in recent years, and progress has been made in targeted therapy and immunotherapy, long-term survival benefits remain limited due to primary or acquired drug resistance, low immune responsiveness, and chemotherapy-related toxicities. Therefore, there is an urgent need to explore safe and effective adjunctive therapeutic strategies. Traditional Chinese medicine (TCM), with its advantages of holistic regulation and individualized syndrome differentiation, has played an increasingly prominent role in comprehensive cancer treatment. TCM holds that "Yang deficiency leads to accumulation" is a key pathogenesis of tumors. Based on the theory that "Yang transforms Qi, while Yin forms substance", deficiency of Yang Qi results in impaired warming and transformation functions, leading to internal accumulation of Yin-cold. This is closely related to dysregulation of the immune microenvironment, "cold tumor" characteristics, and dysfunction of the neuroendocrine system in modern medicine. Accordingly, the therapeutic strategy of "warming Yang, supporting healthy Qi, and combating cancer" has gained increasing attention. In recent years, commonly used Yang-warming Chinese herbs, including Aconiti Lateralis Radix Praeparata, Zingiberis Rhizoma, Cinnamomi Cortex, Epimedii Folium, and Psoraleae Fructus, as well as their active constituents, have achieved notable progress in anti-lung cancer research by regulating multiple signaling pathways, inducing apoptosis, inhibiting metastasis, and reversing drug resistance. In addition, Yang-warming formulae such as Sini Tang and Yanghe Tang have shown promising effects in alleviating myelosuppression, improving cancer-related fatigue, managing malignant pleural effusion, and relieving cancer pain. These therapies exhibit toxicity-reducing and efficacy-enhancing effects, significantly improving patients' quality of life and survival benefits. To systematically summarize the roles and mechanisms of Yang-warming Chinese herbal medicines and compound formulae in lung cancer, this paper provides a comprehensive review of recent advances, aiming to offer insights for the clinical practice of TCM in the prevention and treatment of lung cancer.
5.Clinical manifestations and disease severity of multi-respiratory infectious pathogens.
Mingyue JIANG ; Yuping DUAN ; Jia LI ; Mengmeng JIA ; Qing WANG ; Tingting LI ; Hua RAN ; Yuhua REN ; Jiang LONG ; Yunshao XU ; Yanlin CAO ; Yongming JIANG ; Boer QI ; Yuxi LIU ; Weizhong YANG ; Li QI ; Luzhao FENG
Chinese Medical Journal 2025;138(20):2675-2677
6.Medication rules of Astragali Radix in ancient Chinese medical books based on "disease-medicine-dose" pattern.
Jia-Lei CAO ; Lü-Yuan LIANG ; Yi-Hang LIU ; Zi-Ming XU ; Xuan WANG ; Wen-Xi WEI ; He-Jia WAN ; Xing-Hang LYU ; Wei-Xiao LI ; Yu-Xin ZHANG ; Bing-Qi WEI ; Xian-Qing REN
China Journal of Chinese Materia Medica 2025;50(3):798-811
This study employed the "disease-medicine-dose" pattern to mine the medication rules of traditional Chinese medicine(TCM) prescriptions containing Astragali Radix in ancient Chinese medical books, aiming to provide a scientific basis for the clinical application of Astragali Radix and the development of new medicines. The TCM prescriptions containing Astragali Radix were retrieved from databases such as Chinese Medical Dictionary and imported into Excel 2020 to construct the prescription library. Statical analysis were performed for the prescriptions regarding the indications, syndromes, medicine use frequency, herb effects, nature and taste, meridian tropism, dosage forms, and dose. SPSS statistics 26.0 and IBM SPSS Modeler 18.0 were used for association rules analysis and cluster analysis. A total of 2 297 prescriptions containing Astragali Radix were collected, involving 233 indications, among which sore and ulcer, consumptive disease, sweating disorder, and apoplexy had high frequency(>25), and their syndromes were mainly Qi and blood deficiency, Qi and blood deficiency, Yin and Yang deficiency, and Qi deficiency and collateral obstruction, respectively. In the prescriptions, 98 medicines were used with the frequency >25 and they mainly included Qi-tonifying medicines and blood-tonifying medicines. Glycyrrhizae Radix et Rhizoma, Angelicae Sinensis Radix, Ginseng Radix et Rhizoma, Atractylodis Macrocephalae Rhizoma, and Citri Reticulatae Pericarpium were frequently used. The medicines with high frequency mainly have warm or cold nature, and sweet, pungent, or bitter taste, with tropism to spleen, lung, heart, liver, and kidney meridians. In the treatment of sore and ulcer, Astragali Radix was mainly used with the dose of 3.73 g and combined with Glycyrrhizae Radix et Rhizoma to promote granulation and heal up sores. In the treatment of consumptive disease, Astragali Radix was mainly used with the dose of 37.30 g and combined with Ginseng Radix et Rhizoma to tonify deficiency and replenish Qi. In the treatment of sweating disorder, Astragali Radix was mainly used with the dose of 3.73 g and combined with Glycyrrhizae Radix et Rhizoma to consolidate exterior and stop sweating. In the treatment of apoplexy, Astragali Radix was mainly used with the dose of 7.46 g and combined with Glycyrrhizae Radix et Rhizoma to dispell wind and stop convulsions. Astragali Radix can be used in the treatment of multiple system diseases, with the effects of tonifying Qi and ascending Yang, consolidating exterior and stopping sweating, and expressing toxin and promoting granulation. According to the manifestations of different diseases, when combined with other medicines, Astragali Radix was endowed with the effects of promoting granulation and healing up sores, tonifying deficiency and Qi, consolidating exterior and stopping sweating, and dispelling wind and replenishing Qi. The findings provide a theoretical reference and a scientific basis for the clinical application of Astragali Radix and the development of new medicines.
Drugs, Chinese Herbal/history*
;
Humans
;
Medicine, Chinese Traditional/history*
;
History, Ancient
;
Astragalus Plant/chemistry*
;
China
;
Astragalus propinquus
7.Multifaceted mechanisms of Danggui Shaoyao San in ameliorating Alzheimer's disease based on transcriptomics and metabolomics.
Min-Hao YAN ; Han CAI ; Hai-Xia DING ; Shi-Jie SU ; Xu-Nuo LI ; Zi-Qiao XU ; Wei-Cheng FENG ; Qi-Qing WU ; Jia-Xin CHEN ; Hong WANG ; Qi WANG
China Journal of Chinese Materia Medica 2025;50(8):2229-2236
This study explored the potential therapeutic targets and mechanisms of Danggui Shaoyao San(DSS) in the prevention and treatment of Alzheimer's disease(AD) through transcriptomics and metabolomics, combined with animal experiments. Fifty male C57BL/6J mice, aged seven weeks, were randomly divided into the following five groups: control, model, positive drug, low-dose DSS, and high-dose DSS groups. After the intervention, the Morris water maze was used to assess learning and memory abilities of mice, and Nissl staining and hematoxylin-eosin(HE) staining were performed to observe pathological changes in the hippocampal tissue. Transcriptomics and metabolomics were employed to sequence brain tissue and identify differential metabolites, analyzing key genes and metabolites related to disease progression. Reverse transcription-quantitative polymerase chain reaction(RT-qPCR) was employed to validate the expression of key genes. The Morris water maze results indicated that DSS significantly improved learning and cognitive function in scopolamine(SCOP)-induced model mice, with the high-dose DSS group showing the best results. Pathological staining showed that DSS effectively reduced hippocampal neuronal damage, increased Nissl body numbers, and reduced nuclear pyknosis and neuronal loss. Transcriptomics identified seven key genes, including neurexin 1(Nrxn1) and sodium voltage-gated channel α subunit 1(Scn1a), and metabolomics revealed 113 differential metabolites, all of which were closely associated with synaptic function, oxidative stress, and metabolic regulation. RT-qPCR experiments confirmed that the expression of these seven key genes was consistent with the transcriptomics results. This study suggests that DSS significantly improves learning and memory in SCOP model mice and alleviates hippocampal neuronal pathological damage. The mechanisms likely involve the modulation of synaptic function, reduction of oxidative stress, and metabolic balance, with these seven key genes serving as important targets for DSS in the treatment of AD.
Animals
;
Alzheimer Disease/genetics*
;
Male
;
Drugs, Chinese Herbal/administration & dosage*
;
Mice
;
Mice, Inbred C57BL
;
Metabolomics
;
Transcriptome/drug effects*
;
Maze Learning/drug effects*
;
Hippocampus/metabolism*
;
Humans
;
Disease Models, Animal
;
Memory/drug effects*
8.Scientific analysis and usage reassessment of suspected medicinal cinnabar unearthed from Mawangdui Tomb No.3 of the Han Dynasty.
Ning-Ning XU ; Ting-Yan REN ; Ming-Jie LI ; Pan XIAO ; Guo-Hui SHEN ; Ji-Qing BAI ; Qi LIU
China Journal of Chinese Materia Medica 2025;50(11):2915-2923
Cinnabar(HgS) was widely used in ancient times for medicinal purposes, religious rituals, and pigments. A group of bright red powdery clumps was excavated from Mawangdui Tomb No.3 of the Han Dynasty. Early studies considered the clumps as evidence of cinnabar's medicinal use during the Qin-Han period. This study employed a range of archaeometric techniques, including extended-depth-of-field stereo imaging, micro-CT, scanning electron microscopy-energy dispersive spectroscopy, Raman spectroscopy, and Fourier transform infrared spectrometry FTIR, to systematically analyze the material composition and structural characteristics of these remains. The results revealed that the cinnabar particles were granular, finely ground, and tightly bound to silk matrix, with no detectable excipients typically associated with medicinal formulations. Micro-CT imaging indicated a well-preserved textile structure, with clear signs of sedimentary accumulation and mechanical damage. Based on historical and archaeological studies, this study suggested that these remains were more likely degraded accumulations of cinnabar-colored silk textiles rather than medicinal cinnabar. By clarifying the diversity of ancient cinnabar applications and preservation states, this study provides new insights for the archaeological identification of mineral medicinal materials and contributes to the standardized study of Chinese medicinal materials and understanding of the historical use of cinnabar.
History, Ancient
;
China
;
Humans
;
Medicine, Chinese Traditional/history*
;
Archaeology
;
Drugs, Chinese Herbal/history*
;
Spectroscopy, Fourier Transform Infrared
;
Spectrum Analysis, Raman
;
Mercury Compounds
9.Comparative experimental study on the biomechanical properties of retrograde tibial nailing and distal tibia L-shaped plate in distal tibia fracture.
Xu-Ping LIN ; Qing-Jun LIU ; Sheng-Gui XU ; Cong ZHANG ; Ming-Ming GAO ; Zhen-Qi DING ; Bin LIN
China Journal of Orthopaedics and Traumatology 2025;38(7):737-742
OBJECTIVE:
To investigate the biomechanical characteristics of retrograde tibial nailing (RTN) and distal tibial L-shaped plating in the internal fixation of distal tibial fractures.
METHODS:
Fourteen fresh adult tibia specimens were selected, comprising 7 males and 7 females aged from 34 to 55 years old. The specimens were randomly divided into experimental group and control group by numerical table method with 7 specimens in each group. RTN was used for internal fixation of distal tibial fractures in the experimental group, and L-shaped plate was used for internal fixation of distal tibial fractures in the control group. The axial compression properties of the two groups of specimens were tested under the pressure of 100, 200, 300, 400, and 500 N after operation, and torsional resistance at torque levels of 1.0, 2.0, 3.0, 4.0, 5.0 N·m. The anti-fatigue performance of the specimens was tested at 500 N pressure for 3 000 and 10 000 cycles. X-ray fluoroscopy was performed to observe whether the the internal fixator was deformed and whether the screw was loosened or broken.
RESULTS:
When the pressure was 400 N and 500 N, the axial compression displacement of the experimental group was (1.11±0.06) mm and (1.24±0.05) mm, which were smaller than those of the control group (1.21±0.08) mm and (1.37±0.11) mm, and the differences were statistically signific (P<0.05). Under the pressure of 500 N, the axial compression stiffness of the experimental group was (389.24±17.79) N·mm-1, which was significantly higher than that of the control group (362.37±14.44) N·mm-1(P<0.05). When the torque was 4 and 5 N·m, the torsion angles of the experimental group were (2.97±0.23) ° and (3.41±0.17) °, which were smaller than those of the control group (3.31±0.28) ° and (3.76±0.20) °, and the differences were statistically significant (P<0.05). When the torque was 5 N·m, the torsional stiffness of the experimental group was (1.48±0.07) N·m per degree, which was higher than that of the control group (1.36±0.06) N·m per degree, and the difference was statistically significant (P<0.05). For the intragroup comparison of fatigue resistance, the differences in axial compression displacement between the two groups were not statistically significant at 3 000 and 10 000 cycles (all P>0.05). When 3 000 times and 10 000 times of compression, the axial compression displacement of the experimental group was (1.38±0.08), (1.43±0.07) mm, which was smaller than that of the control group (1.51±0.10), (1.54±0.08) mm, the differences were statistically significant (P<0.05). In the experimental group, no screw loosening, fracture or internal fixation deformation was found, while in the control group, locking screw loosening occurred in 2 models after 10 000 pressures.
CONCLUSION
The biomechanical performance of RTN is obviously better than that of the distal tibial L-shaped plate, which provides biomechanical data support for the clinical application of RTN.
Humans
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Female
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Male
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Adult
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Tibial Fractures/physiopathology*
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Middle Aged
;
Biomechanical Phenomena
;
Bone Plates
;
Fracture Fixation, Internal/instrumentation*
;
Bone Nails
;
Tibia/surgery*
10.Application of the modified Byars staged procedure for severe hypospadias repair.
Qi-Gen XIE ; Ting-Ting XUE ; Xu-Ren CHEN ; Zhao-Ying LI ; Zhe XU ; Zuo-Qing LI ; Peng LUO
Asian Journal of Andrology 2025;27(1):65-71
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias. We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between October 2012 and October 2022. In total, 31 patients underwent the conventional Byars procedure (conventional group), and 45 patients underwent the modified Byars staged procedure (modified group). Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage. Notably, there were no statistically significant differences in the preoperative baseline characteristics, duration of surgery, amount of blood loss, or occurrence of postoperative complications, including urethral fistula, stricture and diverticulum, or penile curvature, between the conventional and modified groups. However, there was a significantly lower incidence of coronal sulcus fistula (0 vs 16.1%, P = 0.02) and glans dehiscence (0 vs 12.9%, P = 0.02) in the surgical group than that in the conventional group. In addition, the modified group exhibited a notably greater rate of normotopic urethral opening (100.0% vs 83.9%, P = 0.01) and a higher mean score on the Hypospadias Objective Penile Evaluation (HOPE; mean ± standard error of mean: 8.6 ± 0.2 vs 7.9 ± 0.3, P = 0.02) than did the conventional group. In conclusion, the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula. Consequently, it offers a promising approach for achieving favorable penile esthetics, thereby providing a reliable therapeutic option for severe hypospadias.
Humans
;
Hypospadias/surgery*
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Male
;
Retrospective Studies
;
Urologic Surgical Procedures, Male/methods*
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Child, Preschool
;
Child
;
Postoperative Complications/etiology*
;
Urethra/surgery*
;
Plastic Surgery Procedures/methods*
;
Surgical Flaps
;
Penis/surgery*
;
Treatment Outcome
;
Infant

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