BACKGROUND:This study evaluates age-specific patterns and factors influencing incomplete correction after the Nuss procedure, challenging the premise that younger age inherently increases recurrence. METHODS:A retrospective review was conducted on patients who underwent the Nuss procedure for pectus excavatum (2006-2021), with a minimum follow-up of 2 years after bar removal. Patients were stratified by operative age: Group A (3-6 years), Group B (7-10 years), Group C (11-14 years), and Group D (≥15 years). Perioperative parameters and outcomes were compared. RESULTS:Among 526 patients, the preoperative Haller index decreased with age (P < .001). Older groups demonstrated increased operative time, blood loss, bar use, and non-life-threatening complication rates (all P < .001). While the 6.3% (33/526) incomplete correction rate initially varied by age (P = .049), risk disparities became non-significant following adjustment for multiple comparisons. Presentation timing differed, with Group A showing delayed presentation within one year post-removal versus early detection within one month for Group D. Oblique bar placement, introduced in 2012, significantly reduced incomplete correction in the youngest group (12.2% to 3.3%, P = .020), without significant effect on other groups. CONCLUSIONS:No deterioration occurred in complete correction cases among all age groups. Younger age was associated with fewer postoperative complications. Incomplete correction rate was not age-dependent, but the underlying mechanisms varied among groups. Modifications in surgical technique and instrumentation significantly improved the complete correction rate.

Background This study investigates the tutor-postgraduate interaction among clinical medical graduates at Tongji Medical College using Peplau's interpersonal relationship theory. Through surveys from both student and supervisor perspectives, it assesses the current interaction status and analyzes influencing factors, aiming to provide insights for improving this critical educational dynamic. Methods Cross-sectional online survey was conducted among 78 postgraduates and 39 tutors at Tongji Medical College from October 1, 2024, to October 1, 2025. Data from self-developed questionnaires based on Peplau's theory in two versions were analyzed via descriptive statistics, chi-square tests, and multiple linear regression in SPSS 26. Results In this study, descriptive analysis revealed that students at Tongji Medical College generally expressed high satisfaction with their mentor-mentee relationships, though mentors demonstrated uneven performance across the stages of Peplau's interpersonal theory. Differential and correlation analyses of the 5-point Likert scale questionnaire revealed that all 16 variables significantly influenced student satisfaction. Among these, four variables showed a significant positive correlation with satisfaction: the mentor's initiative in understanding students, the mentor's willingness to adjust teaching plans during the process, students' ability to learn by analogy, and students' development of independent clinical reasoning. Additionally, two variables showed negative correlations with student satisfaction: whether mentors progressively increased students' clinical autonomy and whether students developed the ability to mentor junior students. Conclusion The current study proposes that Peplau's interpersonal relationship theory provides guidance for improving mentor-student relationships, and incorporating Peplau's Interpersonal Relationship Theory into the evaluation system can more objectively assess the teaching outcome of mentors.

Hepatoblastoma, a common extracranial malignant solid tumor in childhood, is often detected at an advanced stage and is difficult to treat surgically. Despite the availability of multiple comprehensive treatments that can be combined with surgery, hepatoblastoma treatment outcomes remain poor. Surgery is the main treatment strategy for hepatoblastoma, but it faces many challenges, including tumor attachment to surrounding tissues, tumor wrapping or invading of vital organs and tissues, the presence of giant or multiple tumors, distant metastasis, the formation of a tumor thrombus, and significant surgical trauma. In this review, we discuss recent research advances and propose potential strategies for overcoming these challenges. Such strategies may improve the rate of hepatoblastoma resection and local control in children, as well as reduce complications and trauma.

PDF file, 201KB, Scratch migration assay of NB cells.

PDF file, 84KB, Knockdown of miR-9 in NB cells in vitro.

PDF file, 23KB, MMP-14 expression in the NB tissues.

PDF file, 21KB, Primer sets used for RT-PCR and qPCR.

PDF file, 19KB, MMP-14 directly regulated the VEGF expression in NB cells.

BACKGROUND:To explore the clinical application of robotic-assisted surgery in paediatric solid tumours and to explore its feasibility.METHODS:From 2015 to 2022, 53 children with solid tumours underwent robotic-assisted surgery in our centre were retrospectively analysed.RESULTS:The mean weight of the patients was 27.7 kg, and the mean age was 6.7 years. The average tumour volume was 5.5*4.6*3.7 cm. Two procedures (3.8%) were converted. The mean total operative time was 198.5 min. The mean estimated blood loss was 27.1 ml, and no intraoperative complications occurred. Two (3.8%) patients had postoperative complications. At a median follow-up of 21.2 months, one (1.9%) patient with malignant tumours stopped treatment, and two (3.8%) patients developed tumour recurrence.CONCLUSIONS:Robotic-assisted tumour resection is feasible in highly selected cases of young age, light weight, huge tumour or malignant tumour.

PDF file, 60KB, Distribution of miR-9 in the NB tissues.

PDF file, 19KB, Sequences of pre-miRNAs and small interfering RNAs.

The objective of the study was to assess the validity of the NASA-TLX score in rating the workload of pediatric robotic operations. The workload of 230 pediatric gastrointestinal and thoracic robotic operations was rated using the NASA-TLX score. The difference between the high workload group and the low workload group in each subscale of the NASA-TLX score was analyzed. The correlation of each subscale with the total workload score in the high workload group and low workload group was also analyzed. A logistic regression analysis was subsequently conducted to assess the effects of different factors (sex, age, weight, procedure duration, procedure specialties, combined malformation and blood loss) on the workload. The average NASA-TLX score was 56.5 ± 5.1 for the total group, 56.9 ± 5.0 for the gastrointestinal group and 54.6 ± 4.8 for the thoracic group, p = 0.007. The score of the high workload group was 62.7 ± 3.2, while it was 50.6 ± 2.7 for the low workload group (p < 0.001). The score on each subscale was also significantly different between the high and low workload groups. In the high workload group, a stronger correlation was observed between the total score and TD and Fr and a lower correlation with MD and Pe. In the low workload group, all six subscales showed a moderate correlation with the total score. A multivariate logistic regression analysis revealed that the procedure duration was an independent influencing factor for a higher workload score. NASA-TLX is a valid tool to rate the surgeon’s workload in pediatric robotic surgery. A longer operative time contributes to a higher workload.

BACKGROUND:Circular RNAs (circRNAs) have been identified as key factors in the development of hepatocellular carcinoma (HCC). However, the role and potential molecular mechanism of circRNAs in HCC remain largely unclear. In addition, exosomes are known as important messengers of the cross-talk between tumor cells and immune cells, while the role of extracellular circRNAs in the cell-to-cell communication of tumor cells and immune cells remains not unclear.METHODS:The level of hsa_circ_0074854 in HCC cell lines and HCC cell-derived exosomes was assessed using RT-qPCR assay. In addition, CCK-8 and transwell assays were used to determine the viability, migration and invasion of HCC cells.RESULTS:Hsa_circ_0074854 expression was upregulated in HCC tissues and HCC cell lines. Additionally, hsa_circ_0074854 knockdown was found to inhibit HCC growth in vitro and in vivo. Mechanistically, hsa_circ_0074854 knockdown inhibited the migration and invasion of HCC cells via interacting with human antigen R (HuR) to reduce its stability. Furthermore, hsa_circ_0074854 can be transferred from HCC cells to macrophages via exosomes. Exosomes with downregulated hsa_circ_0074854 suppressed macrophage M2 polarization, which in turn suppressing migration and invasion of HCC cells both in vitro and in vivo.CONCLUSION:Downregulation of hsa_circ_0074854 suppresses the migration and invasion in hepatocellular carcinoma via interacting with HuR and via suppressing exosomes-mediated macrophage M2 polarization. Collectively, these findings may help to understand the diagnosis and treatment of HCC.

BACKGROUND:Runt-related transcription factor 1 (RUNX1) is a heterodimeric transcription factor that binds to the core element of many enhancers and promoters and can accelerate apoptosis in various tumors. However, the regulatory mechanisms underlying RUNX1 expression in neuroblastoma (NB), a highly malignant tumor in childhood, remain largely unclear. In this study, we aimed to assess the role of RUNX1 in NB and to reveal the underlying mechanisms that may contribute to finding a potential therapeutics strategy against NB. METHODS:Growth, invasion, metastasis and angiogenesis were assessed using Cell Counting Kit-8 (CCK-8) immunocytochemistry, and studies involving soft agar, cell invasion, tube formation and whole animals. The levels of expression were measured using real-time quantitative PCR for RNA, Western blot and immunostaining analyses for proteins. Luciferase reporter and chromatin immunoprecipitation assays indicated that RUNX1 directly binds within the BIRC5, CSF2RB and NFKBIA promoter regions to facilitate transcription. The level of apoptosis was assessed by determining mitochondrial membrane potential and flow cytometry. RESULTS:RUNX1 was highly expressed in ganglioneuroma (GN) and well-differentiated (WD) tissues relative to the poorly differentiated (PD) and undifferentiated (UD) ones. Moreover, RUNX1 effectively reduced cell viability, invasion, metastasis, angiogenesis, and promoted apoptosis in vitro and in vivo. RUNX1 reduced BIRC5 transcription and increased CSF2RB and NFKBIA transcription by directly binding BIRC5, CSF2RB and NFKBIA promoters. In addition, cytotoxic drugs, especially cisplatin, significantly increased RUNX1 expression in NB cells and promoted apoptosis. CONCLUSIONS:These data show that RUNX1 is an independent surrogate marker for the progression of NB and it can be used for monitoring NB prognosis during therapy.

目的 探讨腹腔镜辅助Malone手术治疗儿童完全性大便失禁的效果.方法 回顾性分析2017年5月～2018年11月腹腔镜辅助Malone手术治疗直肠肛门疾病矫治术后保守治疗无效的完全性大便失禁8例资料.平均年龄9.2岁(6～14岁).术后6个月以Schell评分评价手术效果,以大便失禁快速评价量表(Rapid Assessment Fecal Incontinence Score,RAFIS)评估排便功能.结果 8例均顺利完成手术.平均手术时间84 min(65～110 min).术后24 h开始流质饮食.随访时间6～24个月,平均16个月.1例术后2个月造瘘口狭窄,经间断扩张及放置支撑管后缓解,无造瘘口感染、出血、插管困难等并发症.术后1个月腹壁无明显瘢痕.每天灌肠1～2次,灌肠液200～500 ml,灌肠后30～45 min内可完成排便,两次排便期间无污粪.术后6个月Schell评分22～25分,(24.0±1.8)分;RAFIS量表从术前(19.0±1.0)分降至(4.3±0.7)分.结论 腹腔镜辅助Malone手术治疗儿童顽固性完全大便失禁近期效果确切,远期效果及并发症需要进一步观察评价.

The Notch signaling pathway is highly conserved, involved in cell-cell communication, and essential for multicellular organism development. The recombination signal binding protein for immunoglobulin kappa J region (RBPJ) transcriptional regulator plays a vital role in Notch signaling. When not complexed with Notch proteins, RBPJ acts as a transcriptional repressor. However, when bound to the Notch intracellular domain (NOTCH ICD) in the nucleus, RBPJ activates the transcription of Notch target genes. However, the role of RBPJ in the Notch signaling pathway in neuroblastoma (NB) remains unclear. In this study, we show that SNW domain containing 1 (SNW1) acts as a novel RBPJ partner and regulates the expression of Notch target genes. Additionally, we show that silencing RBPJ expression can prevent SNW1-mediated Notch gene expression. Public datasets and clinical NB tissues indicate that RBPJ and SNW1 are upregulated in NB, and are associated with unfavorable patient outcomes. Taken together, our results highlight that SNW1 interacts with RBPJ to regulate the Notch signaling pathway and presents a potential therapeutic target for NB.

Heparanase (HPSE) is the only endo-β-D-glucuronidase that is correlated with the progression of neuroblastoma (NB), the most common extracranial malignancy in childhood. However, the mechanisms underlying HPSE expression in NB still remain largely unknown. Herein, through analyzing cis -regulatory elements and mining public microarray datasets, we identified SMAD family member 4 (Smad4) as a crucial transcription regulator of HPSE in NB. We demonstrated that Smad4 repressed the HPSE expression at the transcriptional levels in NB cells. Mechanistically, Smad4 suppressed the HPSE expression through directly binding to its promoter and repressing the lymphoid enhancer binding factor 1 (LEF1)-facilitated transcription of HPSE via physical interaction. Gain- and loss-of-function studies demonstrated that Smad4 inhibited the growth, invasion, metastasis, and angiogenesis of NB cells in vitro and in vivo . Restoration of HPSE expression prevented the NB cells from changes in these biological features induced by Smad4. In clinical NB specimens, Smad4 was under-expressed and inversely correlated with HPSE levels, while LEF1 was highly expressed and positively correlated with HPSE expression. Patients with high Smad4 expression, low LEF1 or HPSE levels had greater survival probability. These results demonstrate that Smad4 suppresses the tumorigenesis and aggressiveness of NB through repressing the HPSE expression.

Objetive To evaluate the feasibility and safety of transumbilical laparoscopy for high ligating inguinal hernias in children using one para-umbilical microincision and intraperitoneal knot-ty-ing. Methods Between October 2013 and June 2014,a total of 102 children with inguinal hernias were re-cruited for the above technique.There were 86 boys and 16 girls with a mean age range of 2.4 years (25 days to 13.6 years).Their clinical data were retrospectively analyzed.The detailed approaches were as follows:One 5 mm trocar was inserted into abdomen through umbilicus.A needle holder was punctured into abdomen through 3 mm incisions on umbilical ring without trocars.And 2 -0 non-absorbable suture was introduced into peritoneal cavity through anterior abdominal wall near internal inguinal ring.The orifice of hernial sac was closed extraperitoneally with a purse-string suture around internal inguinal ring and intraperitoneal knot-tying performed. Results All operations were completed successfully.The mean operative duration was 18.7 min for single side and 23.5 min for two sides.There was no onset of postoperative hemorrhage,abdominal wall emphysema,abdominal viscera injury,scrotal edema,postoperative testicular atrophy or hypertrophy or hernia recurrence.And 99% of patients resumed appropriate activities on the first postsurgical day.The mean follow-up period was 11 (7 ~15)months.There was no recurrence,visible scars on abdominal wall or foreign body feelings on inguinal portion. Conclusions Transumbilical laparoscopy is both safe and efficient for inguinal hernia in children.And the cosmetic outcomes are excellent.

BACKGROUND:The most striking feature of pectus excavatum (PE) after previous congenital heart disease (CHD) surgery through a median sternotomy is the postsurgical adhesions between the sternum and heart. For patients with severe adhesions, passing the introducer can be difficult and hazardous when performing a Nuss repair. We describe a hybrid Nuss procedure using a small subxiphoid incision for blunt and sharp anterior mediastinal dissection and using a thoracoscope to ensure the whole process of dissection is under direct visualization.METHODS:A retrospective case review was conducted of PE patients (previous CHD operation) who had undergone the hybrid Nuss procedure between January 2012 and June 2015. Demographic, treatment, and outcome variables were recorded.RESULTS:Eleven patients were included. The mean age was 4.7 ± 1.7 years (range, 3.2 to 8.9). The mean Haller index based on computed tomography was 4.15 ± 0.78 (range, 3.2 to 5.8). All cases were the symmetric type. Mean operating time was 95.5 ± 8.4 minutes (range, 80 to 110); mean blood loss was 15 ± 2.3 mL; and mean length of hospitalization was 6.0 ± 1.4 days (range, 4 to 8). There was no pneumothorax, cardiac injury, wound infection, discomfort requiring removal, or bar rotation at the average 27-month (range, 9 to 50) follow-up. Two patients had the bars removed. No reoperations were performed owing to recurrence.CONCLUSIONS:The hybrid Nuss procedure is a safe, simple modification of the Nuss repair for patients with severe retrosternal adhesions. This procedure achieves dissection with direct visualization. Hence, the risk of death due to cardiac perforation can be prevented.