Objective:To investigate the application effect of the compound flap transfer in tubularized incised plate (TIP) urethroplasty.Methods:Children with hypospadias who received TIP in the Department of Pediatric Urology, the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University from January 2018 to March 2022 were prospectively divided into compound flap transfer group (group A) and traditional TIP group (group B) by random number method. Group A was treated with TIP modified by compound flap transfer, and group B was treated with traditional TIP covered with fascia.The improvement of the compound flap transfer for TIP operation is mainly reflected in the multi-layer cover of the new urethra and the free skin embedded in the incision of the penile head. According to the intention-to-treat (ITT) principle, the final full analysis set (FAS) includes both group A and group B. Some patients were excluded from the analysis of the primary endpoint events due to reasons such as loss to follow-up or treatment group switch. Additionally, the final per-protocol set (PPS) consisting of group A and group B, which adheres to the study protocol, is subjected to statistical analysis.Independent sample t-test or Wilcoxon rank sum test was used for average age, the width of the penile head, degree of chordee, length of neourethra, and operative time. The classification of hypospadias, proportion of dorsal tunica albuginea plication, and incidence of postoperative complications were compared using the Chi-square test or Fisher’s exact test, P < 0.05 was considered statistically significant. Results:According to ITT principles, 50 children were included in FAS group A, ranging in age from 8 months to 15 years and 2 months, with an average age of 4 years. Group B included 50 children, ranging in age from 10 months to 14 years and 9 months, with an average age of 4 years and 1 month. Thirty-seven children in PPS group A were included, ranging in age from 1 year 2 months to 12 years 1 month, with an average age of 4 years. Group B consisted of 41 children, ranging in age from 1 year 2 months to 11 years 9 months, with an average age of 4 years 2 months. Statistical analysis showed that no matter FAS set or PPS, there were no statistically significant differences in the mean age, hypospadias type, average penile head width, average penile subcurvature number, number of dorsal tunica albuginea plication, and the average length of plastic neourethra between group A and group B ( P > 0.05). The average operative time of group A was higher than that of group B. The difference was statistically significant ( P < 0.05). The postoperative follow-up was 3 to 48 months, with an average follow-up of 2 years and 3 months. The complication rate of group A was lower than that of group B [10.81% (4/37) vs 29.27% (12/41)], and the difference was statistically significant ( P< 0.05). Urethral fistula occurred in 3 cases (8.11%), respectively and 6 cases (14.63%) in the two groups, the difference was not statistically significant ( P>0.05); urethral stricture occurred in 1 case (2.70%) and 5 cases (12.20%) respectively, the difference was not statistically significant ( P>0.05), There were 0 case and 1 case (2.44%) of urethral orifice descending or urethral dehiscence respectively, and the difference was not statistically significant ( P> 0.05). Conclusion:TIP with an improved compound flap transfer can reduce the overall postoperative complication rate and is worthy of promotion.

Objective:To introduce the application of a modified scrotoplasty for children with webbed penis.Methods:Retrospective study was carried out.The treatment results of 58 children with webbed penis in Department of Urology, the Affiliated Xuzhou Children′s Hospital of Xuzhou Medical University from June 2012 to April 2018 were analyzed.A total of 26 children with webbed penis and phimosis were treated with circumcision combined with modified scrotoplasty as modified scrotoplasty group, and 32 children with webbed penis and phimosis were treated with V-Y scrotoplasty as V-Y scrotoplasty group.The curative effect of webbed penis was compared between the two groups.Results:The operation time of V-Y scrotoplasty group and modified scrotoplasty group were (26.0±2.4) min and (28.0±3.2) min; the increased penis length in the horizontal position in the two groups were (0.30±0.06) cm and (0.40±0.06) cm; the score of parents′ satisfaction were (3.80±0.47) scores and (4.70±0.56) scores, there were significant differences in the average operation time, the increased penis length in the horizontal position and the score of parents′ satisfaction between the two groups ( t=2.703, 6.061, 6.652; all P<0.05). There was no significant difference in postoperative complications between the two groups ( P>0.05). Conclusions:Circumcision combined with modified scrotoplasty is used to repair webbed penis, which results in a good postoperative appearance, high parent satisfaction and easy clinical implementation.

To compare a novel modified W-incision scrotoplasty (MWS) operation method with the conventional V-Y scrotoplasty for treatment of severe penoscrotal webbing (PSW) in children a retrospective study was conducted on 26 children. Circumcision combined with modified scrotoplasty was used to repair the webbed penis and phimosis of children and another 32 patients undergoing V-Y scrotoplasty served as the control group. There was a statistically significant difference of angle improvements of penis and scrotum in a horizontal position (-66 ± 10; -57 ± 6, P < 0.001) and the parent satisfaction score (Five Likert Scale) (4.7 ± 0.56; 3.8 ± 0.47, P < 0.001) between the two groups. All 26 children who underwent MWS presented with no serious postoperative complications, and there was no significant difference in surgical complications compared to children treated with V-Y scrotoplasty.

Background: Concealed penis is an anomaly in infants and adolescents, accurate diagnosis of different types of which requires extensive experience. In general, an experienced physician can diagnose the type of abnormal penis by careful observation and then provide the corresponding treatment. The appearance of trapped penis and webbed penis is easier to distinguish than that of other abnormal penises. However, congenital concealed penis is easily confused with phimosis and obesity concealed penis, and it is not easy to distinguish clinically, especially for inexperienced physician. Objectives: This study aims to provide an auxiliary measurement method to assist diagnosis of concealed penis types. Methods: This study enrolled 105 children diagnosed as phimosis, 88 as congenital concealed penis, and 78 as obesity concealed penis. Multifunctional protractor was used to measure the foreskin angle and penis-scrotum angle. The foreskin angle was defined as the angle between the ventral and dorsal sides of the penis body and the line extending to the foreskin, which was the sagittal position of the natural state of the penis when the child lies down. The penis-scrotum angle was defined as the angle between the ventral side of penis and the scrotum. All measured data were recorded by professional physicians, and the differences between different groups were compared using t-test. Results: The average foreskin angle in the phimosis, congenital concealed penis, and obesity concealed penis groups were 10.05°, 74.34°, and 8.86°, respectively. The average penis-scrotum angle in the three groups were 6.98°, 118.65°, and 85.59°, respectively. Annular wrinkle numbers in the three groups were 0.26, 0.32, and 2.68, respectively. The difference of the groups was statistically significant (P < 0.05). These results indicated that congenital concealed penis had greater foreskin and penis-scrotum angle. Obesity concealed penis had moderately large penis-scrotum angle and higher number of annular wrinkles. On contrary, the three indicators in phimosis were the lowest. Conclusions: This evaluation system can provide an auxiliary way to help the diagnosis of different types of concealed penis in children and provide a basis for subsequent treatment. In addition, Experienced physicians teaching new physicians/students, can also use this as an auxiliary explanation.

目的 探讨自身免疫性脑炎(AE)患儿的细胞免疫及体液免疫功能,以证实该病免疫特征.方法 选取徐州市儿童医院神经内科收治的84例AE患儿作为研究组,另选取80例健康幼儿作为对照组.采集两组的空腹静脉血,使用全自动生化分析仪进行血清免疫球蛋白(IgA、IgG、IgM)水平检测,使用流式细胞仪测定血清CD3、CD4、CD8、CD54水平.所有人组对象还要采集血液标本的上清液测定抗谷氨酸脱羧酶(GAD)抗体与抗N-甲基-M-天冬氨酸受体(NMDAR)抗体水平,研究组患儿还需采集脑脊液测定抗GAD抗体及抗NMDAR抗体水平.对比、分析两组的各项指标检测结果.结果 研究组患儿的血清及脑脊液抗GAD抗体、抗NMDAR抗体检测结果均为阴性,对照组儿童的血清抗GAD抗体、抗NMDAR抗体检测结果也为阴性.研究组的IgM、IgA、IgG水平均显著高于对照组(P＜0.05).研究组的CD3、CD4水平均显著低于对照组(P＜0.05);两组的CD8、CD54水平接近(P＞0.05).结论 AE患儿普遍存在细胞免疫及体液免疫功能紊乱,抗GAD抗体与抗NMDAR抗体并非AE致病的主要因素,临床观察患儿细胞及体液免疫指标的变化,可为AE的诊断与治疗提供一定的参考依据.

Objective: To summarize the application experience of Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat in pediatric urology. Methods: A retrospective study of 1 481 cases of pediatric urology using a disposable oval circumcision anastomat at Xuzhou Children's Hospital from October 2014 to December 2017 was performed. The average age at the time of surgery was 5.2 (2-14 years) years. Among them, there were 1 226 cases of phimosis, 32 cases of scar phimosis in chronic infection, 23 cases of phimosis or redundant prepuce with urethral duplication, 29 cases of foreskin trauma, 35 cases of phimosis or redundant prepuce with urethral cyst, 3 cases of phimosis or redundant prepuce with urethral stricture, 108 cases of phimosis or redundant prepuce with webbed penis, 6 cases of phimosis with penile downward bending, 4 cases of phimosis with short frenulum preputii, and 15 cases of relatively normal foreskin development, I° and II° hypospadias with unapparent penile downward bending, and megalourethra with complete foreskin hypospadias. Results: All operations were completed successfully. The postoperative circumcision time was less than 5 days on 2 cases(0.1%), and was longer than 25 days on 9 cases(0.6%). The average postoperative circumcision time was 13.2 days. During a follow-up period of 3 months, except for 2 cases (0.1%) of frenulum preputii edema, all other cases had a satisfactory foreskin appearance. They had no obvious foreskin scar hyperplasia, the foreskin cutting edge was neat, the foreskin ligament was intact, the foreskin was left and right symmetrical, and the foreskin was preserved in the absence of erection to cover the coronary sulcus to 1/3 of the glans. All children with hypospadias had no urethral stricture and urethral fistula, and the penis was satisfactory. Conclusions: Ai Tong (Chinese Shang Ring) disposable oval circumcision anastomat is satisfactory in the treatment of various diseases of pediatric urology. With a low incidence of postoperative complications, it may be easy to carry out this procedure at grass-roots hospital.

Objective To summarize the experiences of hypospadias repair using prolonged and broadened plate plus Onlay flap urethroplasty.Methods A retrospective review of prolonged and broadened plate plus Onlay flap urethroplasty was performed from October 2015 to April 2016.Among 37 patients with primary hypospadias,the clinical types were penile (n =27) and penoscrotal (n =10).Urethral plate was resected for straightening out corpora cavernosa.All urethral plates measured ≥8 mm and all glans ≥14 mm in diameter.Urethral plate was preserved and penile skin degloved until root of penis.After fully straightening out,lengthway incision was made in the middle of urethral plate for broadening.Then sideling in the most obvious place of penis was bent for prolonging urethral plate.After indwelling catheter,partial urethra formed.Then a foreskin pedicel island flap was chipped and onlaid with urethral plate.Ventral superficial fascia was used as a second layer vascular cover over neourethra.Glansplasty was performed with suturing glans wings to obtain the esthetics of glans and meatus.Results All operations were performed successfully.The average operative duration was 77 (65-95) min.The postoperative complications included urethral fistula (n =4,10.8％)and urethral stricture (n=5,13.5％).All 5 patients stayed in remission after 1-3 urethra dilatation.After a 3-month follow-up period,3 cases (8.1％) were complicated by urethral fistula.There was no occurrence of urethral stricture or recurrent penile curvature.All of them had entopic and slitlike urinary meatus.Conclusions Prolonged and broadened plate plus Onlay flap urethroplasty is effective for severe hypospadias.With a low incidence of postoperative complications,this procedure may be easily performed.It is indicated when transecting urethral plate is required for penile straightening.

Objective To summarize the experience of hypospadias repair with tubularized incision and prolonged plate urethroplasty.Methods From June 2015 to November 2015,a retrospective review of tubularized incision and prolonged plate urethroplasty was performed for 21 primary hypospadias patients.The clinical types were penile (n =17) and penoscrotal (n =4).After reserving urethral plate and degloving penile skin to penile root,full straightening out was performed.Incision of middle urethral plate was intended for broadening urethral plate.And sideway incision in the most obvious bent place of penis was made to prolong urethral plate.After indwelling catheter,urethra was formed.Results The average operative duration was 78 (65-100) min.Postoperative complications included urethral fistula (n =3,14.3％) and urethral stricture (n =4,19.0％).All of them stayed in remission after 1-3 sessions of urethra dilatation.During a follow-up period of 3 months,2 cases (9.5％) were complicated by urethral fistula.There was no instance of urethral stricture or recurrent penile curvature.Conclusions Tubularized incision and prolonged plate urethroplasty are effective for hypospadias.With a low incidence of postoperative complications,this procedure may be easily popularized at grass-roots.

Objective: To investigate the prevalence of depression in patients with Parkinson's disease and its correlated factors.Methods: For the diagnosed PD patients,evaluated with the Hamilton Depression Rating Scale(HAMD),the mini-mental state examination(MMSE) and the Webster rating scale,analysis of the incidence of depression and related factors.Results: 32 PD patients were associated with depression,and the frequency of depression was 49.2%.There were significant differences in duration of disease,educational level,webster score and MMSE score(P<0.05).There were no statistical relationships between age,gender,marital status and economic situation(P>0.05).Logistic regression analysis demonstrated that the most important predictive factors for depression were duration of disease and severity of disease.Conclusion: The prevalence of depression was high in PD patients,and may be occur for social psychology,neurobiology result of many factors.