Objective To explore application effect of modified three-port robotic-assisted single-port multi-channel laparoscopic surgery in radical operation for choledochal cysts in children.Methods From March 2022 to June 2024,20 children with congenital choledochal cysts in our department underwent modified three-port robotic-assisted radical resection of choledochal cysts combined with Roux-en-Y anastomosis of the hepatic duct and jejunum.A single-port multi-channel laparoscopic device was inserted through an umbilical incision,and 8 mm trocars were respectively inserted under the right and left costal margins for robotic arm operation.Before the robot docking,the jejunum-jejunum anastomosis was completed outside the body through the umbilical single-port device.After docking,operations of cyst resection and anastomosis and reconstruction of the hepatic duct and jejunum were completed under the robotic laparoscope.Results The operations of 20 children were successfully completed without conversion to open surgery or intraoperative blood transfusion.The operation time was(269.8±23.3)min,the robotic operation time was(123.8±11.1)min,and the intraoperative blood loss was(8.3±3.9)ml.The postoperative exhaust time was(30.8±9.8)h,the abdominal drainage tube was removed at 5-6 d after operation,and the postoperative hospital stay was 7-8 d.On the 7th day after surgery,10 out of 11 children with elevated preoperative liver function transaminase(ALT and AST)levels decreased to normal,while 4 out of 6 children with elevated preoperative bilirubin(TBIL,DBIL,and IBIL)levels returned to normal.Abdominal ultrasound showed no anastomotic stenosis,cholangitis,or other serious complications during follow-ups for 3-6 months in the 20 children.Conclusion The robotic-assisted single-port multi-channel laparoscopic surgery(modified three-port method)is safe and feasible for the treatment of choledochal cysts in children.

Objective To explore application effect of modified three-port robotic-assisted single-port multi-channel laparoscopic surgery in radical operation for choledochal cysts in children.Methods From March 2022 to June 2024,20 children with congenital choledochal cysts in our department underwent modified three-port robotic-assisted radical resection of choledochal cysts combined with Roux-en-Y anastomosis of the hepatic duct and jejunum.A single-port multi-channel laparoscopic device was inserted through an umbilical incision,and 8 mm trocars were respectively inserted under the right and left costal margins for robotic arm operation.Before the robot docking,the jejunum-jejunum anastomosis was completed outside the body through the umbilical single-port device.After docking,operations of cyst resection and anastomosis and reconstruction of the hepatic duct and jejunum were completed under the robotic laparoscope.Results The operations of 20 children were successfully completed without conversion to open surgery or intraoperative blood transfusion.The operation time was(269.8±23.3)min,the robotic operation time was(123.8±11.1)min,and the intraoperative blood loss was(8.3±3.9)ml.The postoperative exhaust time was(30.8±9.8)h,the abdominal drainage tube was removed at 5-6 d after operation,and the postoperative hospital stay was 7-8 d.On the 7th day after surgery,10 out of 11 children with elevated preoperative liver function transaminase(ALT and AST)levels decreased to normal,while 4 out of 6 children with elevated preoperative bilirubin(TBIL,DBIL,and IBIL)levels returned to normal.Abdominal ultrasound showed no anastomotic stenosis,cholangitis,or other serious complications during follow-ups for 3-6 months in the 20 children.Conclusion The robotic-assisted single-port multi-channel laparoscopic surgery(modified three-port method)is safe and feasible for the treatment of choledochal cysts in children.

Objective:To investigate the dynamic brain function changes in adolescent depression patients with or without suicidal ideation, and to explore the characteristics and the hypothalamus-pituitary-adrenal axis of adrenocorticotropic hormone (ACTH) and the potential correlation between levels of the hormone cortisol.Methods:From March 2018 to January 2021, the First Affiliated Hospital of Jinan University conducted a study involving 48 adolescent patients with major depressive disorder (MDD) who have suicidal ideation(MDD+SI), 38 MDD patients without suicidal ideation(MDD-SI), and 41 healthy control participants(HC). The study utilized resting state functional magnetic resonance imaging (fMRI) to analyze the brain activity of these individuals. The dynamic local consistency (dReHo) and dynamic functional connection (dFC) values for the three groups were computed utilizing a sliding time window analysis technique. Blood samples were obtained within 24 hours following the completion of the MRI scan to quantify ACTH and cortisol levels via direct chemiluminescence. A one-way analysis of covariance was employed to compare the dReHo and dFC values among the three groups, while a one-way analysis of variance was utilized to compare the hormone levels across the three groups. Significant differences in dReHo values among the three groups were identified in specific regions, as well as in dFC values, using the least significant differences method correction following inspection ( P<0.05). Additionally, a partial correlation analysis was conducted to investigate the relationship between these dynamic indexes and hormone levels. Results:The difference of dReHo values among the three groups was found in the right posterior cerebellum (mainly Crus Ⅱ and Crus I) ( F=9.44, P<0.001), and the left precuneus ( F=10.93, P<0.05). There were significant differences in dFC values between the three groups in the left precuneus and left middle temporal gyrus ( F=9.60, P<0.001), and the left precuneus with bilateral precuneus ( F=9.66, P<0.001). The correlation analysis revealed a positive relationship between the decreased dReHo ( r=0.350, P=0.018) variability in the left precuneus, the decreased dFC( r=0.362, P=0.015) variability between the left precuneus and the left middle temporal gyrus (MTG), and the decreased cortisol level( P=0.013, 0.039) in the group of MDD+SI. Conclusion:Adolescents diagnosed with MDD, both with and without suicidal ideation, exhibit dynamic functional alterations in the precuneus and middle temporal gyrus. The cerebellar function changes appear to be unique to those with suicidal ideation. Furthermore, the aberrant dynamic brain function observed in the precuneus and middle temporal gyrus is associated with abnormal cortisol levels in individuals with suicidal ideation.

Objective: To assess the nutritional status of primary and secondary school students in Beijing City and to analyze the related factors, so as to provide a scientific basis for improving the nutritional status of primary and secondary school students in a targeted manner. Methods: Based on the 2021 Beijing Student Common Diseases and Health Influencing Factors Surveillance Project, a stratified random cluster sampling method was used to conduct a physical examination and questionnaire survey on 25 487 primary and secondary school students from September to November 2021. The Chi square test was used for comparison of nutritional status detection rates, and disordered multi classification Logistic regression analysis was used to explore the factors associated with students nutritional status. Results: The detection rates of malnutrition, overweight and obesity among primary and secondary school students in Beijing City were 4.7%, 18.0% and 23.8% respectively. The detection rates of malnutrition, overweight and obesity were higher among male students (5.1%, 20.4%, 29.7%) than female students (4.2%, 15.5%, 17.4%) ( χ 2= 12.23, 101.71, 526.99, P <0.01). The detection rate of obesity was higher in the suburbs than urban areas(26.6%, 19.8%), and the detection rate of malnutrition was lower in the suburbs than urban areas (4.2%,5.5%)( χ 2=157.25, 23.61, P <0.01). The results of disordered multi classification Logistic regression showed that the related factors for malnutrition, overweight and obesity were gender, residence, moderate to vigorous exercise ≥60 min per day and lack of sleep( OR =1.70, 1.88,2.48; 1.14, 0.87, 0.67; 0.85, 0.92, 0.81 ; 0.83, 1.08, 1.07); frequency of fried food intake daily was a related factor for overweight ( OR =0.70); whether eating breakfast daily or not was a related factor for overweight and obesity ( OR =0.91, 0.84); academic level (middle and high school) was a related factor for malnutrition and obesity ( OR =1.38, 1.37; 0.77, 1.40)( P <0.05). Conclusions The problem of overweight and obesity among primary and secondary school students in Beijing City continues to be serious, especially among boys and suburban areas. It is recommended that society, schools, families and individuals should work together to improve the nutritional status of primary and secondary school students by adopting a graded and classified approach.

Objective: To understand the trend of changes of hygiene status in the teaching environment among primary and secondary schools in Beijing City during 2016-2020, so as to provide basis for further improving the teaching environment and campus hygiene conditions in primary and secondary schools. Methods: A proportional systematic sampling method covered over 50% of schools selected annually in Beijing from 2016 to 2019, and 34% were selected in 2020. Two representative classrooms were selected from each selected school for testing based on their structure and other factors, with 6 196 classrooms supervised, from 2016 to 2020,1 330,1 312,1 384,1 322,848 classrooms were monitored for each year. Results: From 2016 to 2020, the overall lighting qualification rate of classrooms (lighting coefficient 72.8%, window to floor area ratio 41.8%, rear wall reflectance ratio 42.2%, blackboard reflection ratio 37.4%), the overall qualification rate of average blackboard illumination and uniformity (50.6%, 34.9 %), and the overall qualification rate of desk and chair allocation (58.6%) were all below 80%. The overall qualification rate of per capita classroom area (87.5%), blackboard size (83.2%), average desk illumination ( 80.1% ), average desk illumination and uniformity (82.9%), the distance between lamp and desk (99.1%), carbon dioxide ( 86.6% ), temperature (84.9%), and noise (96.6%) were all above 80%. The following indicators, blackboard size, the distance between lamp and desk, average blackboard illumination, lighting coefficient, blackboard reflectance, rear wall reflectance, carbon dioxide, temperature, and noise ( χ 2=78.38, 9.71, 11.76, 320.59, 37.63, 58.45, 236.45, 1 347.56, 101.97), had statistically significance between years. Among those indicators, the qualified rates of blackboard size, blackboard reflectance, lighting coefficient, and noise had been increasing year by year ( χ 2 trend =69.98, 15.82, 240.02, 5.77) ( P <0.05). The qualified rates of per capita classroom area, window to floor area ratio, and blackboard reflection ratio in primary schools (81.6%, 39.8%, 36.3%) were all lower than those in secondary schools (94.9%, 44.5%, 40.3%) ( χ 2=246.32, 12.03, 10.51, P <0.05). The qualified rates of blackboard size, average blackboard illumination, average blackboard illumination and uniformity, and desk and chair allocation (89.3%, 55.6% , 36.0%, and 60.2%) were all higher than those in secondary schools (75.4%, 44.1%, 33.3%, and 56.5%) ( χ 2=209.33, 78.41, 4.44, 8.22) ( P <0.05). The qualified rates of average desk illumination and uniformity, average blackboard illumination, rear wall reflectance ratio, desk and chair allocation, carbon dioxide, temperature, and noise indicators in urban area (82.9%, 84.1% , 51.9%, 45.0%, 60.9%, 91.2%, 89.5%, 97.8%) were all higher than those in suburban area (77.3%, 81.7%, 49.2%, 39.5%, 56.3%, 82.3%, 80.4%, 95.5%) ( χ 2=31.16, 6.28, 4.36, 16.40, 13.39, 105.29, 98.23, 24.66， P <0.05). The qualified rates of the distance between lamp and desk, lighting coefficient, window to floor area ratio, blackboard size, blackboard reflection ratio, average blackboard illumination and uniformity, and per capita classroom area in urban areas (98.8%, 65.2%, 34.3%, 76.7%, 35.9%, 30.1%, 84.6%) were all lower than those in suburban areas (99.4%, 81.4%, 49.8%, 89.7%, 40.2%, 39.6%, 90.3%) ( χ 2=6.80, 171.67, 132.43, 188.46 , 12.45, 60.28, 44.82) ( P <0.05). Conclusions The main problems in the teaching environment of schools in Beijing are classroom lighting, as well as desk and chair allocation. The findings suggest technical rationality and operability of relevant standard should be considered when under revision, and standard training and supervision management should be strengthened, with the aim of teaching environment improvement.

BACKGROUND:Tissue engineering is considered an ideal treatment for growth plate regeneration.However,most of the current research on regenerative tissue engineering is the traditional scaffold-based strategy.As the limitations of traditional scaffolds are gradually revealed,the research direction is gradually diversifying. OBJECTIVE:To summarize the application of scaffold-based and scaffold-free strategies in the treatment of growth plate cartilage regeneration and their respective advantages and disadvantages. METHODS:The relevant articles were searched from PubMed,Wiley,and Elsevier.The search terms were"growth plate injury,regeneration,tissue engineering,scaffold,scaffold-free,biomimetic,cartilage"in English.The time was limited from 1990 to 2023.Finally,104 articles were included for review. RESULTS AND CONCLUSION:The biomimetic strategy is to reduce the cell composition,biological signals and unique mechanical properties of each region to the greatest extent by simulating the unique organizational structure of the growth plate,so as to build a biomimetic microenvironment that can promote tissue regeneration.Therefore,the design of a biomimetic scaffold is to simulate the original growth plate as far as possible in terms of composition,structure and mechanical properties.Although some results have been achieved,there is still the problem of the unstable regeneration effect.The scaffold-free strategy believes that the limitations of scaffolds will have adverse effects on regenerative therapy.Therefore,the design of scaffold-free constructs relies as much as possible on the ability of cells to generate and maintain extracellular matrix without interfering with cell-cell signals or introducing exogenous substances.However,there are some problems,such as poor stability,low mechanical strength and greater difficulty in operation.Biomimetic strategy and scaffold-free strategy have different emphases,advantages and disadvantages,but they both have positive effects on growth plate cartilage regeneration.Therefore,subsequent studies,whether adopting a biomimetic strategy or a scaffold-free strategy,will focus on the continuous optimization of existing technologies in order to achieve effective growth plate cartilage regeneration therapy.

Objective: To analyze the current status and related factors of comorbidity of myopia, obesity, and depression symptoms among middle school students in Beijing, so as to provide a basis for comprehensive public health interventions for common diseases. Methods: Through stratified cluster random sampling in October 2022, a total of 11 262 junior high school, senior high school, and vocational high school students in 16 districts of Beijing were surveyed with self administered questionnaires, physical examinations and visual acuity examinations. The χ 2 test and binary Logistic regression model were used to analyze group differences in the comorbidity of myopia, obesity and depression symptoms and factors influencing the comorbidity. Stratified analysis was applied to analyze the associations between health risk behaviors and the comorbidity. Results: The detection rate of comorbidity of myopia, obesity, and depression symptoms among middle school students in Beijing was 3.35%, the comorbidity rate among vocational high school students (4.61%) was higher than that in junior high school students (2.80%) and senior high school students (3.41%). The comorbidity rate was higher among students in suburban areas (3.66%) than that in urban areas (2.92%), and the differences was statistically significant ( χ 2=15.02, 4.63, P <0.05). Binary Logistic regression analyses indicated that middle school students with poor dietary behaviors ( OR =1.59) and excessive screen time ( OR =1.70) were associated with elevated risk of comorbidity of myopia, obesity, and depression symptoms. Both boys and girls with poor dietary behaviors ( OR =1.63, 1.69) and excessive screen time ( OR =1.45, 2.23) had elevated likelihood of comorbidity of myopia, obesity and depression symptoms. Students in junior high school and senior high school with poor dietary behaviors ( OR =2.16, 1.47) and excessive screen time ( OR =2.20, 1.63 ) had elevated likelihood of comorbidity of myopia, obesity, and depression symptoms ( P <0.05). Conclusions The current status of comorbidity of myopia, obesity, and depression symptoms among middle school students in Beijing is concerning. Schools and parents should work together to guide students to develop healthy behaviors such as balanced diet and moderate video, in order to achieve the goal of controlling myopia, obesity and depression symptoms.

Objective:To investigate the dynamic brain function changes in adolescent depression patients with or without suicidal ideation, and to explore the characteristics and the hypothalamus-pituitary-adrenal axis of adrenocorticotropic hormone (ACTH) and the potential correlation between levels of the hormone cortisol.Methods:From March 2018 to January 2021, the First Affiliated Hospital of Jinan University conducted a study involving 48 adolescent patients with major depressive disorder (MDD) who have suicidal ideation(MDD+SI), 38 MDD patients without suicidal ideation(MDD-SI), and 41 healthy control participants(HC). The study utilized resting state functional magnetic resonance imaging (fMRI) to analyze the brain activity of these individuals. The dynamic local consistency (dReHo) and dynamic functional connection (dFC) values for the three groups were computed utilizing a sliding time window analysis technique. Blood samples were obtained within 24 hours following the completion of the MRI scan to quantify ACTH and cortisol levels via direct chemiluminescence. A one-way analysis of covariance was employed to compare the dReHo and dFC values among the three groups, while a one-way analysis of variance was utilized to compare the hormone levels across the three groups. Significant differences in dReHo values among the three groups were identified in specific regions, as well as in dFC values, using the least significant differences method correction following inspection ( P<0.05). Additionally, a partial correlation analysis was conducted to investigate the relationship between these dynamic indexes and hormone levels. Results:The difference of dReHo values among the three groups was found in the right posterior cerebellum (mainly Crus Ⅱ and Crus I) ( F=9.44, P<0.001), and the left precuneus ( F=10.93, P<0.05). There were significant differences in dFC values between the three groups in the left precuneus and left middle temporal gyrus ( F=9.60, P<0.001), and the left precuneus with bilateral precuneus ( F=9.66, P<0.001). The correlation analysis revealed a positive relationship between the decreased dReHo ( r=0.350, P=0.018) variability in the left precuneus, the decreased dFC( r=0.362, P=0.015) variability between the left precuneus and the left middle temporal gyrus (MTG), and the decreased cortisol level( P=0.013, 0.039) in the group of MDD+SI. Conclusion:Adolescents diagnosed with MDD, both with and without suicidal ideation, exhibit dynamic functional alterations in the precuneus and middle temporal gyrus. The cerebellar function changes appear to be unique to those with suicidal ideation. Furthermore, the aberrant dynamic brain function observed in the precuneus and middle temporal gyrus is associated with abnormal cortisol levels in individuals with suicidal ideation.

Objective:To explore the teaching experience of clinical teaching teachers in master of integrated traditional Chinese and western medicine nursing, so as to provide a reference for improving the training quality of master of integrated Chinese and western medicine nursing.Methods:From March to May 2022, a total of 14 clinical teaching teachers of integrated traditional Chinese and western medicine nursing in the First Affiliated Hospital of Hunan University of were enrolled using the objective sampling method and investigated by the semi-structured face-to-face interview. Content analysis was used to analyze the interview results.Results:Five themes were extracted, namely, the practice ability of nursing graduate students needs to be improved, the evaluation methods of clinical practice ability of graduate students need to be more diversified, teaching benefits teachers as well as students; difficulties of teaching (conflicts between teachers' clinical work and teaching, unclear orientation of postgraduate clinical practice learning) , hope to get support (improve scientific research ability, improve theoretical knowledge of traditional Chinese medicine, guarantee the clinical practice and study time of graduate students) .Conclusions:A variety of practice approaches should be provided for the training in master of integrated traditional Chinese and western medicine nursing graduate students, to improve students' clinical practice ability and professional identity, strengthen clinical teacher training, improve teachers' ability, and continuously improve the clinical practice training model and the quality of talent training for nursing graduate students.

Objective:To investigate the clinical features of neonatal testicular torsion and to evaluate the effect and necessity of early intervention.Methods:A retrospective analysis was performed on 11 neonates admitted to the Second Hospital of Shandong University with neonatal testicular torsion from June 2017 to June 2022. Clinical data of these cases including clinical manifestations, ultrasonography findings, surgical management and outcomes were reviewed and analyzed with descriptive statistical methods.Results:The median age of the 11 patients on admission was 2.6 d (1-5 d). The median time from finding abnormal scrotum to admission was 12 h (1-120 h). Various degrees of scrotal swelling or scleroma were found in the patients. Among them, seven patients presented with acute inflammatory signs of cyano sis or skin redness, and testis-like tissue induration could be touched. Ultrasound scan showed abnormal blood flow in the affected testicle in all cases. Emergency scrotal exploration under general anesthesia was performed successfully in all cases and ten of them underwent orchiectomy of the affected testicle plus contralateral orchiopexy. The rest one who was admitted within 1 h after birth only underwent orchiopexy of the affected testicle as the parents refused contralateral testicular exploration. During the operation, 12 twisted testis were observed, including seven with extravaginal torsion, three with intravaginal torsion and two adhering to the surrounding tissue without normal testicular tissue or distinguishable torsion direction or degree. In this study, ten patients had unilateral testicular torsion, which affected the left side in seven cases and the right side in three cases, and one had bilateral testicular torsion, which was diagnosed as left testicle torsion before surgery. During scrotal exploration, the left testicle of this bilateral case was resected due to necrosis, while the right testicle twisted about 180 degrees with good blood flow and was subjected to orchidopexy after reduction. In one case, the unaffected testicle was unfixed and dysplastic during contralateral exploration, which was also subjected to orchidopexy. In the 12 testis with torsion, one testicle of the patient admitted within 1 h after birth and the right testicle of the bilateral case were preserved with a salvage rate of 2/12. Pathological examination showed necrosis in the ten excised testis, and fibrosis and calcification foci in two of them. None of the patients had any perioperative complications and the scrotal incision healed well in all neonates. The patients were followed up for 6-12 months with regular ultrasound. The two preserved testis and the contralateral testis subjected to orchidopexy were located in the scrotum with good blood supply, and no torsion, atrophy or other abnormalities occurred.Conclusions:Neonatal testicular torsion is rarely seen in clinical practice and has no specific manifestations. It has a high excision rate due to testicular necrosis. Early diagnosis and bilateral scrotal exploration are crucial to the prognosis and the keys to save the affected testis and avoid anorchidism.