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86°, was null after arthrodesis (p < 0.0001). The tibial sesamoid position, according to the Hardy and Clapham classification, decreased from a mean value of 4.84 to 1.27 after surgery, within normality (p < 0.0001).

Correction of the deformity in a single plane is generally insufficient. It is necessary to act on the three planes of space to correct the deformity, obtain good outcomes, and avoid recurrence.

Radiographic outcomes of triplanar correction with the 3D Lapidus procedure are excellent, achieving statistically significant differences in all parameters studied.

Radiographic outcomes of triplanar correction with the 3D Lapidus procedure are excellent, achieving statistically significant differences in all parameters studied.

Anderson-Hynes dismembered pyeloplasty is considered the standard surgical treatment for ureteropelvic junction obstruction (UPJO). After pyeloplasty, stent drainage remains controversial. The commonly used stents are either an internal double-J (DJ) or an externalized pyeloureteral (PU) stents. We evaluated the outcome of using DJ versus PU stents following open pyeloplasty for UPJO in children.

We retrospectively evaluated 175 patients who underwent primary open pyeloplasty in two tertiary hospitals. A total of 110 patients underwent internal DJ stent insertion (63%) while 65 patients (37%) underwent placement of external PU stent. The type of stent used at the time of surgery was according to surgeon preference and experience. Operative time, postoperative hospital stay, overall complications and success rates were compared between the two groups.

The mean age was 3.8 years, and the mean follow-up was 4 years. Mean operative time was similar in the two groups (145min). Mean hospital stay was 3.7 and l pyeloplasty cases.

The two types of stents are comparable as regard overall complication and success rates after pyeloplasty. Although internal DJ stent insertion provides a relatively shorter hospital stay, a second operating room visit and anesthesia for removal remains unavoidable.

The two types of stents are comparable as regard overall complication and success rates after pyeloplasty. Although internal DJ stent insertion provides a relatively shorter hospital stay, a second operating room visit and anesthesia for removal remains unavoidable.The normal development of the glanular urethra is closely related to the normal development of the foreskin. A ventral deficit in the foreskin results with the failure to develop the septum glandis and frenulum, which also form the ventral wall of the glanular and subcoronal urethra. Here we present the anatomical modeling of the foreskin in order to obtain a mucosal collar for the reconstruction of the glanular hypospadias with the GFC technique (Glanular-Frenular-Collar), which can also be used for various purposes to reconstruct the urethra in hypospadias.

Pediatric surgery began with single-incision flank surgery and has evolved to multi-port laparoscopic and robotic approaches. Recent technological advances with the single-port (SP) robot have allowed for transition back to single-incision surgery.

A 14-year-old paraplegic male with T2 spinal injury presented with neurogenic bladder and increasing difficulty performing clean intermittent catheterization thus the decision was made to perform the first SP robotic Mitrofanoff procedure in a pediatric patient. The SP platform has one 2.5cm, 4-channel port, a 12×10mm articulating camera, and 6mm multi-wristed instruments.

The SP robotic Mitrofanoff was completed successfully without issues with space, triangulation or articulation. There is, however, loss of insufflation with use of laparoscopic instruments as the seal on the port is difficult to maintain. The single-port robot has been successfully utilized in seven patients six underwent dismembered pyeloplasty and one underwent Mitrofanoff with a median operative time of 120min and estimated blood loss of <25cc. Chk2 Inhibitor II Chk inhibitor Postoperatively, no patients required opioid pain medications, and all were discharged in <24h without complications.

Single-port robotic surgery is feasible in pediatric patients, but patient selection is key. Future development of the platform is needed to widen application to smaller patients.

Single-port robotic surgery is feasible in pediatric patients, but patient selection is key. Future development of the platform is needed to widen application to smaller patients.Despite long-standing interest in local adaptation of plants to their biotic and abiotic environment, existing theory, and many case studies, little work to date has addressed within-species evolution of concerted strategies and how these might contrast with patterns across species. Here we consider the interactions between pollinators, herbivores, and resource availability in shaping plant local adaptation, how these interactions impact plant phenotypes and gene flow, and the conditions where multiple traits align along major environmental gradients such as latitude and elevation. Continued work in emerging model systems will benefit from the melding of classic experimental approaches with novel population genetic analyses to reveal patterns and processes in plant local adaptation.In honour of the 25th anniversary of Trends in Plant Science, we wanted to take a look back over some of the milestones from recent decades. Here, we asked authors of the June 2021 special issue to reflect on the changes that have occurred within the field of plant breeding during the past 25 years, as well as to contemplate what the future might hold.Chemoresistance is a major hindrance in cancer chemotherapies, a leading cause of tumor recurrence and cancer-related deaths. Cancer cells develop numerous strategies to elude immune attacks and are regulated by immunological factors. Cancer cells can alter the expression of several immune modulators to upregulate the activities of immune checkpoint pathways. Targeting the immune checkpoint inhibitors is a part of the cancer immunotherapy altered during carcinogenesis. These immune modulators have the capability to reprogram the tumor microenvironment, thereby change the efficacy of chemotherapeutics. In general, the sensitivity of drugs is reduced in the immunosuppressive tumor microenvironment, resulting in chemoresistance and tumor relapse. The regulation of microRNAs (miRNAs) is well established in cancer initiation, progression, and therapy. Intriguingly, miRNA affects cancer immune surveillance and immune response by targeting immune checkpoint inhibitors in the tumor microenvironment. miRNAs alter the gene expression at the post-transcriptional level, which modulates both innate and adaptive immune systems.