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.

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.

Objective To compare the efficacy of vacuum sealing drainage(VSD)and traditional dressing on sup-purative infection at abdominal incisions.Methods A retrospective analysis was performed using data from 32 patients who were admitted into our hospital from February 2015 to October 2016 due to suppurative infection at abdominal inci-sions.The patients were divided into an experimental group and a control group, according to their different treatment methods.The two groups were compared for age, gender, the number of emergency operations, preoperative complica-tions and incision length.The incision suture time,the time of antibiotics use and the number of dressing changes were also compared.Results There were no significant differences between the two groups in terms of age,gender,the num-ber of emergent operations,preoperative complications and incision length(P>0.05).The experimental group showed remarkable differences in the incision suture time,the time of antibiotics use and the number of dressing changes,com-pared with the control group(P<0.05).Conclusions VSD is useful to treat suppurative infection on abdominal inci-sions,which can significantly shorten the time of incision healing,reduce the number of dressing changes and the time of antibiotics use.

Introduction Uterine rupture during pregnancy caused by uterine dysplasia, such as the double uterus, is very rare and easily overlooked by the surgeon. Case A 25-year-old woman, at 17 weeks of gestation presented to our emergency center with acute right lower abdominal pain for more than 10 h. The initial diagnosis is acute appendicitis, but during the exploration, we found about 2500 mL of intraperitoneal hemorrhage, appendix was normal, pregnancy in one of the double uterine and ruptured at the right bottom. The pregnancy was removed and the uterine defect was repaired. Conclusion Uterine rupture caused by double uterus is very rare and easily Ignored by the surgeon. The survival of patients suffered from uterine rupture depends on the time interval between rupture and intervention.

Objective To compare the difference in the expressions of forkhead box protein 3 (FoxP3) and adenosine 2a receptor (A2aR) in gastric cancer tissues and its adjacent tissues,and to investigate the relationship between the elevated expression of FoxP3/A2aR and clinicopathologica] features in gastric cancer.Methods Gastric cancer tissues and their adjacent tissues from 52 patients with gastric cancer were collected,who underwent surgery in the Affiliated Hospital of Xuzhou Medical University from July 2015 to November 2016,immunohistochemical staining was used to detect the expressions of FoxP3 and A2aR.Results ① The high-expression rate of FoxP3 in gastric cancer tissues was 69.2％ (36/52),which was higher than that of adjacent tissues (11.5％,6/52),P＜0.001.The high-expression rate of A2aR in gastric cancer tissues was 69.2％ (36/52),which was higher than that of adjacent tissues (25.0％,13/52),P＜0.001.② The expression of FoxP3 was positively correlated with the expression of A2aR in gastric cancer tissues (r=0.76,P＜0.05).③ In gastric cancer tissues,high-expressions of FoxP3 and A2aR were not related to gender,age,diameter of tumor,tumor location,degree of differentiation,gross type,and histological type (P＞0.05),but both associated with TNM stage,T stage,number of lymph node metastasis,and distant metastasis (P＜0.05),the high-expression rates of FoxP3 and A2aR in patients with stage Ⅲ+Ⅳ were higher than those of patients with stage Ⅰ + Ⅱ,the high-expression rates of FoxP3 and A2aR in patients with stage T3+T4 were higher than those of patients with stage T1+T2,the high-expression rates of FoxP3 and A2aR in patients with distant metastasis were higher than those of patients without distant metastasis,and the high-expression rates of FoxP3 and A2aR increased gradually with the increase in the number of lymph node metastasis.Conclusion There are high expressions of FoxP3 and A2aR in gastric cancer tissues,and both of them may play important role in promoting the occurrence and development of gastric cancer.

肿瘤免疫治疗是一种有效的手段.调节性T细胞(Treg)可通过细胞表面外核苷酸酶(CD39,CD73)降解ATP生成腺苷(ADO),ADO和细胞表面A2aR结合后可激活细胞内腺苷酸环化酶合成cAMP,从而进一步抑制效应T细胞(Teff)的免疫活性.胃癌作为常见的消化道恶性肿瘤之一,其免疫治疗尚处于临床前期或起步阶段.近年来,关于腺苷在调节性T细胞对胃癌免疫调控中的作用日益受到重视,作者对腺苷、T细胞与胃癌的研究进展进行了综述.