Objective: To investigate the feasibility and safety of modified interposed jejunal anastomosis following total laparoscopic proximal gastrectomy. Methods: The modification in the digestive tract reconstruction involves transecting the small intestine 2-3 cm below the gastrojejunostomy site and relocating the enteroenterostomy cranially, based on the double-tract anastomosis technique. Specifically, the jejunum and its mesenteric vessels are transected 20-25 cm from the ligament of Treitz. An overlap anastomosis is performed between the esophagus and the distal jejunum, with the common opening closed using a 15 cm barbed suture in a buried manner. A side-to-side gastrojejunostomy is completed under natural anatomical alignment, and the common opening is closed similarly. A side-to-side anastomosis is then created between the small intestine approximately 10 cm below the gastrojejunal anastomosis and the small intestine distal to the ligament of Treitz. Finally, the small intestine is transected 2-3 cm below the gastrojejunal anastomosis without dividing the mesenteric vessels. Results: From April to December 2024, a total of five patients with adenocarcinoma of the esophagogastric junction underwent modified interposed jejunum anastomosis following totally laparoscopic proximal gastrectomy at the Affiliated Tumor Hospital of Xinjiang Medical University. The median age of the group was 56 (53-74) years, including four males and one female, with a median body mass index of 24 (21-29) kg/m². Three cases were classified as Siewert type II and two as type III. All five patients successfully completed the totally laparoscopic proximal gastrectomy with modified interposed jejunum anastomosis. The median operative time was 215 (165-240) minutes, the digestive tract reconstruction time was 75 (65-93) minutes, and the intraoperative blood loss was 50 (30-100) ml. The median time to postoperative flatus was 71 (68-88) hours, with no severe complications occurring in any case. The median postoperative hospital stay was 8 (8-9) days. Within three months after surgery, none of the patients reported reflux symptoms such as acid regurgitation or heartburn. Conclusions: Total laparoscopic modified interposed jejunal anastomosis is safe and feasible, with relatively simple operative steps. It effectively prevents reflux while ensuring the passage of food through the remnant stomach and duodenal loop.
Humans ; Gastrectomy/methods* ; Jejunum/surgery* ; Laparoscopy/methods* ; Anastomosis, Surgical/methods* ; Male ; Female ; Middle Aged ; Aged ; Stomach Neoplasms/surgery* ; Plastic Surgery Procedures/methods*

Otitis media is an infection of the middle ear mainly caused by bacteria, and current treatments rely heavily on antibiotics. However, the emergence of antibiotic-resistant bacterial strains seriously affects their efficacy. In our study, we found that extracellular vesicles (EVs) derived from human natural killer cells (NKs) inhibit the proliferation of both standard and levofloxacin (LVX)-resistant strains of Staphylococcus aureus in a dose-dependent manner. Moreover, compared to LVX, EVs were more effective at reducing effusion and rescuing hearing thresholds in animal models. For LVX-sensitive strains, EVs were significantly more effective in terms of curative time but not curative rate. For LVX-resistant strains, EVs were significantly more effective in terms of both curative rate and curative time when applied alone or applied jointly with LVX. In summary, we found that NK EVs are highly effective in treating otitis media, providing an alternative approach for treating this common disease.
Killer Cells, Natural/metabolism* ; Exosomes/metabolism* ; Animals ; Humans ; Otitis Media/therapy* ; Staphylococcus aureus/drug effects* ; Disease Models, Animal ; Anti-Bacterial Agents/pharmacology* ; Levofloxacin/pharmacology*

Objective: To explore the method and effect of endoscopic assisted functional rhinoplasty for patients with deviated nose and deviated nasal septum, which achieve correction of nasal morphology and ventilation dysfunction. Methods: The clinical data of 226 patients with deviated nose and deviated nasal septum from June 2009 to February 2022 who were treated by endoscopic assisted functional rhinoplasty in the Affiliated Hospital of Qingdao University were analyzed retrospectively. There were 174 males and 52 females, with the age ranging from 7 to 67 years old. The effect was evaluated by subjective and objective evaluation methods. SPSS 27.0 software was used for statistical analysis. Results: All patients were followed up for 6 to 24 months, 174 cases were cured (174/226, 76.99%), 52 cases were effective (52/226, 23.01%), and the total effective rate was 100% (226/226). The difference between preoperative and postoperative facial appearance deviation was statistically significant ((6.84±2.25)mm vs (1.82±1.05)mm, t=38.94, P<0.001), and the nasal ventilation function of all patients was improved. Conclusions: Endoscopic assisted functional rhinoplasty for the patients with deviated nose combined with deviated nasal septum has the advantages of clear surgical field, fewer complications, and good result. It can achieve the purpose of simultaneous correction of nasal and ventilation dysfunction, which is recommended for popularizing in clinical application.

Child ; Humans ; Singapore ; Health Personnel ; Delivery of Health Care

Aim To investigate the pharmacological effects of paeonol as a formyl peptide receptor activator on rheumatoid arthritis (HA).Methods The target rlataset was obtained from the high throughput Gene Expression Database ( GEO) , and multiple data sets were combined by USING R language to explore three groups of macrophage differentially expressed genes ( DEGs) in untreated,lipopolysaccharide (LPS) treat¬ment and paeonol and LPS treatment, and their enrich-ment pathway was analyzed.Protein-protein interaction (PPI) networks were constructed in the STRING data¬base anrl visualized in Cytoscape software.The inhibi¬tor}' effect of Hub gene formyl peptide receptor ( FPR) on RA inflammation was validated by TNF-cx stimula¬tion of fibroblast synovial cells ( FLS).Results Through bioinformatics analysis, 169 differential genes ( DEGs) related to inflammation and 275 DEGs related to the mechanism of paeonol action were obtained.Combined analysis of the two groups of DEGs showed that FPR played a key role in the anti-inflammatory mechanism of paeonol.Further studies on the mecha¬nism of paeonol showed that paeonol activated FPR, and the inhibitory effect of paeonol on FLS inflamma¬tion was rescued by TRP-ARg-TRP-TRP-TRP-TRP- TRP-TRP-NH2 (WRW4).Conclusion Paeonol can inhibit the inflammatory development of RA through the FPR pathway.

INTRODUCTION: Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA. METHODS: Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old. RESULTS: There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, CONCLUSION The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.
Adolescent ; Child ; Child Abuse ; Child Abuse, Sexual ; Child, Preschool ; Emergency Service, Hospital ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Parents ; Retrospective Studies

INTRODUCTION: Paediatric patients presenting to the general emergency departments (EDs) differ from those presenting to paediatric EDs. General EDs vary in preparedness to manage paediatric patients, which may affect delivery of emergency care with varying clinical outcomes. We aimed to elucidate the differences in utilisation patterns of paediatric and general EDs by paediatric patients. METHODS: This study was conducted in a public healthcare cluster in Singapore consisting of 4 hospitals. A retrospective review of the medical records of paediatric patients, defined as age younger than 16 years old, who attended the EDs from 1 January 2015 to 31 December 2018, was performed. Data were collected using a standardised form and analysed. RESULTS: Of the 704,582 attendances, 686,546 (97.4%) were seen at the paediatric ED. General EDs saw greater number of paediatric patients in the emergent (P1) category (921 [5.1%] versus 14,829 [2.2%]; CONCLUSION General EDs need to build their capabilities and enhance their preparedness according to the paediatric population they serve so that optimal paediatric emergency care can be delivered, especially for critically ill patients who are most in need of life-saving and timely treatment.

INTRODUCTION: In this study, we described paediatric sports injuries seen in the paediatric emergency department of a large, tertiary paediatric hospital in Singapore and evaluated risk factors for severe sports injuries. METHODS: This is a retrospective review of a paediatric trauma surveillance registry from February 2012 to October 2017, including patient demographics, type of sports, circumstances, type of injuries, and clinical management in the hospital. Patients 5 to 17 years old with a sports-related injury were included. We performed logistic regression to identify predictors of severe sports injuries (defined by Injury Severity Score of ≥9), injuries requiring hospitalisation, trauma team activation, resuscitation, or those that resulted in death. RESULTS: Among 10,951 patients analysed, the most common injuries sustained were fractures (4,819, 44.0%), sprains and contusions (3,334, 30.4%). For patients with severe injuries, the median length of hospital stay was 2 days (IQR 1-3 days), and time away from sports was 162 days (IQR 104-182 days). Predictors for severe injuries include transportation by emergency medical service (aOR 6.346, 95% CI 5.147-7.823), involvement in rugby (aOR 2.067, 95% CI 1.446-2.957), neurological injuries (aOR 4.585, 95% CI 2.393-4.365), dislocations (aOR 2.779, 95% CI 1.744-4.427), fractures (aOR 1.438, 95% CI 1.039-1.990), injuries to the head and neck (aOR 2.274, 95% CI 1.184-4.365), and injuries to the abdomen and pelvis (aOR 5.273, 95% CI 3.225-8.623). CONCLUSION Predictors for severe sports injuries identified may aid in risk stratification and resource allocation.

OBJECTIVETo investigate the differences between the Test of Infant Motor Performance (TIMP) data from the infants at 38-58 weeks of postconceptual age in three hospitals in Chongqing, China and the America norms, and to provide a reference for the introduction and application of TIMP in China.

METHODSTIMP was used to assess 642 infants with 38-58 weeks of postconceptual age who visited the departments of preterm infants or child healthcare in the Second Affiliated Hospital of Army Medical University, Shapingba Maternal and Child Health Hospital in Chongqing, and Chongqing Maternal and Child Health Hospital between January and December, 2016. The assessment scores were analyzed and compared with the America norms.

RESULTSThe TIMP scores increased with the increasing postconceptual age, with 37±5 points in the 38-39week group and 83±12 points in the 56-57week group. All age groups had a significantly lower mean score than the America norms (P<0.001).

CONCLUSIONSTIMP scores can reflect the motor performance in infants with various postconceptual ages. The TIMP scores from the infants with a postconceptual age of 38-58 weeks in three hospitals in Chongqing are significantly different from the America norms, suggesting that it is very necessary in China to establish the Chinese norms for assessing motor performance in infants using TIMP.

INTRODUCTIONPaediatric sepsis is a global health problem. It is the leading cause of mortality in infants and children worldwide. Appropriate and timely initial management in the first hours, often termed as the "golden hours", has great impact on survival. The aim of this paper is to summarise the current literature and updates on the initial management of paediatric sepsis.

MATERIALS AND METHODSA comprehensive literature search was performed via PubMed using the search terms: 'sepsis', 'septic shock', 'paediatric' and 'early goal-directed therapy'. Original and review articles were identified and selected based on relevance to this review.

RESULTSEarly recognition, prompt fluid resuscitation and timely administration of antibiotics remain key in the resuscitation of the septic child. Use of steroids and tight glycaemic control in this setting remain controversial.

CONCLUSIONThe use of early goal-directed therapy has had significant impact on patient outcomes and protocolised resuscitation of children in septic shock is recommended.