Purpose: To compare the reliability and performance of Supersonic shear wave elastography (S-SWE) and Toshiba shear wave elastography (T-SWE) in the diagnosis of biliary atresia (BA) and assessment of liver fibrosis among jaundiced infants suspected of BA. Material and Methods: A total of 35 patients with suspected BA who underwent both S-SWE and T-SWE examinations were prospectively included. Diagnostic performances of S-SWE and T-SWE in identifying BA were evaluated. The correlation between two types of SWE values and histological liver fibrosis stages by Metavir scores were investigated in 21 patients with pathology results. The intraclass correlation coefficients (ICCs) were calculated in 16 patients for inter- and intra-observer agreement. The area under the receiver operating characteristic curve (AUC) analysis was compared using a DeLong test. Results: There were 22 patients with BA and 13 patients without BA. The diagnostic performance of S-SWE was comparable to that of T-SWE (AUC 0.895 vs. 0.822, p = 0.071) in diagnosing BA. The AUCs of S-SWE in predicting liver fibrosis stages were from 0.676 to 1.000 and showed no statistical differences from that of T-SWE (from 0.704 to 1.000, all p > 0.05). T-SWE provided higher inter-operator agreement (ICC 0.990) and intra-operator agreement (ICCs 0.966–0.993), compared with that of S-SWE in a previous study (ICC 0.980 for inter-operator and 0.930–0.960 for intra-operator). Conclusions: For infants suspected of BA, T-SWE had good performances in the diagnosis of BA and the assessment of liver fibrosis compared with S-SWE. Furthermore, T-SWE showed higher measurement reproducibility than S-SWE.

Purpose: Comprehension of the anatomical characteristics of pediatric kidney tumors is crucial for making surgical decisions. Previous kidney tumor nephrometry systems failed to incorporate two significant factors: tumor thrombus and multifocality. We develop a refined nephrometry system based on a comprehensive understanding of the characteristics exhibited by pediatric kidney tumors.Methods: The TUMORS nephrometry scoring system comprises 6 indicators, including tumor (T)hrombus, (U)rinary collecting system involvement, (M)ultiple tumors, (O)utward property, (R)adius, and (S)ite relative to the polar lines. Each renal unit was assessed and scored independently. The complexity characteristics of kidney tumors were summarized, and the correlation was compared with RENAL nephrometry system. Furthermore, the complexity of kidney tumors was compared across different surgical procedures.Results: A total of 43 patients were enrolled, involving 70 kidney units. Radical nephrectomy (RN) was performed on 13 kidneys, while the remaining 57 kidneys underwent nephron sparing surgery. In the NSS group, tumors in 37 kidneys were resected in vivo, whereas 20 kidneys underwent tumor resection ex vivo followed by kidney autotransplantation. According to the TUMORS nephrometry scoring system, there were 13, 34 and 23 kidney units classified as low, moderate and high complexity, respectively. Tumors that underwent RN or ex vivo removal exhibited higher complexity. The complications and positive margins of NSS were not statistically significant in relation to tumor complexity.Conclusion: The TUMORS nephrometry scoring system holds significant guidance for the decision of surgical protocol and can be applied to the preoperative evaluation.

Introduction This study aimed to evaluate the non-neoplastic renal parenchyma in Wilms tumor (WT) and investigate its impact on nephron-sparing surgery (NSS). Materials and Methods The non-neoplastic renal parenchyma of WT patients was prospectively collected for pathological examination. The histology of non-neoplastic renal parenchyma was assessed from two perspectives: nephrogenic rests (NRs) and nephrons. Results A total of 46 non-neoplastic renal parenchyma specimens were collected from 42 WT patients. The surgeons assessed the median proportion of non-neoplastic renal parenchyma as 30%, whereas using ellipsoid volume, it was calculated to be 27%. The Youden index of surgeons' assessment peaked at a 15% proportion of non-neoplastic renal parenchyma. The bilateral WT (BWT) group and NSS group exhibited significant differences compared with the unilateral WT group and radical nephrectomy group, respectively, with the BWT group showing a tendency toward thickened basement membrane. Conclusion The presence of NRs and endogenous nephron alternations should be given due attention in WT. The probability of abnormalities is low when the proportion of non-neoplastic renal parenchyma exceeds 15%, providing pathological support for expanding the adaptation of NSS. ^* These authors have contributed equally to this work and share first authorship. ^# Shicong Yang, Changxi Wang and Pengfei Gao serve as co-corresponding authors. The first corresponding author is Pengfei Gao. Received: 21 May 2024 Accepted: 25 September 2024 Article published online: 18 October 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Introduction: This study aims to present our experience with totally transaxillary endoscopic surgical release (TTESR) for the treatment of patients diagnosed with congenital muscular torticollis (CMT), as well as to compare the efficacy of this minimally invasive approach with that of conventional open surgical release (OSR). Materials and methods: A retrospective analysis was conducted on patients diagnosed with CMT who underwent either TTESR or OSR between January 2014 and December 2020. Herein, we provide a detailed description of the TTESR procedure. A total of 24 children were enrolled, with 6 patients undergoing TTESR and the remaining 18 undergoing OSR. The latter group was matched based on age and lesion location. Clinical data, including length of hospital stay, operative duration, intraoperative blood loss, and range of cervical rotation, were meticulously recorded. Comparative analysis was performed between the TTESR and OSR groups. Results: In our series, all 24 patients exhibited a marked improvement in cervical range of motion. No statistically significant differences were observed between the TTESR and OSR groups with respect to gender distribution, length of hospital stay, operative duration, or intraoperative blood loss. However, a significant difference was noted in the combined scores of scar evaluation and subjective assessments. No severe postoperative complications were reported. Additionally, with the accumulation of surgical experience, the average operative time for TTESR decreased to 40–50 min. Conclusion: This study demonstrates that TTESR serves an effective alternative to conventional OSR for correcting CMT, with the additional advantage of eliminating the aesthetically undesirable neck scar.