Abdominal injuries involving bicycle handlebars in 219 children: results of 8-year follow-up.

OBJECTIVES: Handlebar injuries are one of the most common causes of abdominal injuries in children. We aim to investigate the epidemiology of bicycle handlebar injuries and to emphasize the severity of the injuries. METHODS: A retrospective analysis of children admitted to our hospital with abdominal injury related to bicycle handlebars was performed. RESULTS: A total of 219 children (187 males and 32 females) younger than 17 years were hospitalized for abdominal handlebar injuries between 2005 and 2013. The age range of the patients was 4-17 (mean 10.93 ± 3.68) years. Most patients had an imprint of the handlebar edge on their abdomen. The most common abdominal organ injury was liver laceration. 33 patients had pancreas injury and 13 patients had hollow organ injury. Most patients were treated conservatively. Surgery was performed in 24 patients. Hospital stay was 4-60 (mean 9.63 ± 13.37) days. CONCLUSIONS: Trend of bicycle handlebar trauma over this time period was related to the local floating population and economy. The most common abdominal organ injury was liver. Hollow organ injury required emergency exploratory laparotomy and the Roux-y anastomosis applied well in cases whose gastrointestinal tract damaged seriously. Pancreatic injury usually led to secondary pseudocyst. The percutaneous ultrasound-guided drainage of pancreatic pseudocyst was really an effective way. The trend in the amylase and lipase levels could reflect the pancreatic injury condition and predict prognosis. Early diagnosis and optimal care without delay may help to reduce the morbidity of injuries to the internal organs. Children with abdominal handlebar injuries should be treated with great care.

Retroperitoneal laparoscopy management for ureteral fibroepithelial polyps causing hydronephrosis in children: a report of five cases.

INTRODUCTION: Hydronephrosis is a common disease in children and may be caused by ureteral fibroepithelial polyps (UFP). Ureteral fibroepithelial polyps are rare in children and are difficult to precisely diagnose before surgery. Surgical treatment for symptomatic UFP is recommended. At the present institution, retroperitoneal laparoscopy has been used to treat five boys with UFP since 2006. OBJECTIVE: To highlight the significance of UFP as an etiological factor of hydronephrosis in children and evaluate the applicative value of retroperitoneal laparoscopy in the treatment of children with UFP. METHODS: Between 2006 and 2013 five boys underwent retroperitoneal laparoscopy at the present institution. They were identified with UFP by review of the clinical database. Detailed data were collected, including: radiographic studies, gross anatomical pathology, and pathology and radiology reports. All boys had been followed up at least every 6 months. RESULTS: All of the boys were aged between 7 and 16 years (mean 9.8 years). The main symptoms were flank pain (all five) and hematuria (three). Radiographic examination showed that all of the boys presented with incomplete ureteral obstruction and hydronephrosis. The ureteral fibroepithelial polyps were located near the left UPJ or the left proximal ureter. All of the boys had the UFP removed: three underwent retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty and polypectomy, and two had retroperitoneal laparoscopic ureteral anastomosis. These polyps were all on the left side and between 15 and 35 mm in length (mean 22 mm) (Figure). All of the boys recovered well and were discharged from hospital. The postoperative histological report confirmed that the specimens were UFP. Hydronephrosis was periodically assessed by ultrasonography (using the same method as pre-surgical ultrasonography) after surgery. Mean follow-up was 33 months (range 6-58 months) and no complications were found afterwards. CONCLUSIONS: Ureteral fibroepithelial polyps are rare but rather important as they can cause UPJ obstruction, which often manifests as hydronephrosis. It is most important to confirm the site of ureteral obstruction before surgery as this may have an effect on the surgical management. It is recommended that UFP be successfully managed in children with retroperitoneal laparoscopy.

VEGF gene silencing by cytomegalovirus promoter driven shRNA expression vector results in vascular development defects in zebrafish.

Zebrafish has been generally considered as an excellent model in case of drug screening, disease model establishment, and vertebrate embryonic development study. In this work, the ability of human cytomegalovirus immediate early promoter (CMV promoter)-driven short hairpin RNA (shRNA) expression vector to induce shRNA against VEGF gene in zebrafish was tested, and its effect on vascular development was assed, too. Using RT-qPCR, blood vessel staining, and in situ hybridization, we confirmed certain transcriptional activity and down regulation of gene expression by the vector. In situ hybridization analysis indicated selective inhibition of NRP1 expression in the VEGF gene loss of function model, which might imply in turn that VEGF could not only activate endothelial cells directly but also could contribute to stimulating angiogenesis in vivo by a mechanism that involved up-regulation of its cognate receptor expression in zebrafish. This contributed to a better understanding of molecular mechanisms of cardiovascular development. The system improved the success rate in making inducible knockdown and widened the possibilities for better therapeutic targets in zebrafish.