Objective:To explore the efficacy and safety of the Da Vinci robotic single-port-plus-one technique in common urological surgeries in children.Methods:The data of 59 children who underwent robot-assisted single-port-plus-one laparoscopic surgery from May 2022 to November 2023 in Fuzhou University Affiliated Provincial Hospital were retrospectively analyzed. There were 44 males and 15 females, aged 36 (6, 108)months. Among them, 27 cases had ureteropelvic junction obstruction, with a preoperative anterior-posterior diameter of the renal pelvis of (31.83±6.59) mm. The American Society of Fetal Urology (SFU) grading system revealed grade Ⅲ in 8 sides and grade Ⅳ in 19 sides. Bilateral renal function showed a difference of 13.50% (7.18%, 31.06%). Additionally, 17 cases presented with vesicoureteral reflux. Preoperative voiding cystourethrogram (VCUG) indicated reflux grades Ⅲ, Ⅳ, and Ⅴ in 8, 14, and 4 sides, respectively, with a difference in bilateral renal function of 18.58% (6.04%, 28.30%). Ten cases had obstructive megaureter, with a preoperative renal pelvis diameter of (22.17±7.64)mm and a maximum ureteral diameter of (19.51±3.71)mm. The preoperative bilateral renal function difference was 18.02% (5.23%, 49.42%).Five cases involved duplicated kidney and ureter. Magnetic resonance urography (MRU) confirmed unilateral duplicated kidneys with associated dilatation of the upper renal pelvis and calyces, hydroureter, thin renal cortex in all 5 patients. Among them, 2 cases had ectopic ureteral opening and 1 case had terminal ureteral cyst. Patients with ureteropelvic junction stenosis underwent pyeloplasty, those with vesicoureteral reflux and obstructive megaureter underwent ureteral reimplantation, and patients with duplicated ureters underwent nephrectomy. The Da Vinci robotic surgical system was employed for all procedures. The port placement technique involved a 2-3 cm incision around the navel to insert a single-port four-channel device, followed by the placement of an additional 8 mm operating channel in the left or right abdomen under direct visualization based on the surgical site. Preoperative and postoperative parameters were compared.Results:All operations were successfully completed without conversion to open or laparoscopic surgery. The operation time of the ureteropelvic junction obstruction children was (141.52±22.93) min. The postoperative renal pelvis diameter and bilateral renal function difference were (12.54±4.05) mm and 5.60%(2.14%, 14.48%), respectively, both of which showed significant improvement compared to preoperative levels ( P<0.01). Postoperative hydronephrosis grades were as follows: 13 sides with grade Ⅰ, 13 sides with grade Ⅱ, and 1 side with grade Ⅲ. The operation time of vesicoureteral reflux children was (125.00±11.75) min in the unilateral group and (153.22±14.39) min in the bilateral group. Postoperatively, 2 sides demonstrated reflux grade Ⅰ, 1 side grade Ⅱ, and 1 side grade Ⅲ, indicating improvement compared to preoperative levels. Bilateral renal function difference post-surgery was 13.34% (1.85%, 20.54%), which was more balanced than preoperatively ( P=0.011). Postoperative renal pelvis anterior-posterior diameter and maximum ureteral diameter were reduced to (10.31±3.86) mm and (6.62±2.44) mm, respectively, which were significantly smaller than preoperative measurements ( P<0.01). The bilateral renal function difference post-surgery was 12.04% (4.85%, 47.53%), showing improvement, though not statistically significant ( P=0.508). The operation time of the repeated nephrectomy children was (140.00±12.75) min. No recurrence of preoperative symptoms was noted, and renal cortical function remained generally normal during follow-up. In this study, only 3 cases of obstructive megaureter developed febrile urinary tract infection within 1 month after surgery, and no complications were observed in the remaining cases. Conclusions:This study preliminarily confirmed that the Da Vinci robotic single-port-plus one-port technology can be used in the treatment of common diseases of the urinary system in children. The patients' symptoms were significantly relieved after surgery, and the indicators of hydronephrosis improved compared with those before surgery. The incidence of postoperative complications was low, and aesthetic outcomes of postoperative scars were enhanced. Further studies are needed to assess its long-term efficacy.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:To evaluate the efficacy of transumbilical single-port robotic-assisted laparoscopic surgery for congenital choledochal cysts in children.Methods:Clinical data of 13 children with congenital choledochal cysts undergoing surgery at the Provincial Hospital of Fuzhou University from January 2024 to June 2024 were retrospectively analyzed, including 4 males and 9 females, aged 48 (24, 60) months. All children underwent transumbilical single-port robotic-assisted laparoscopic radical resection of congenital choledochal cyst with common hepatic duct jejunum Roun-en-Y anastomosis by the same surgeon. The efficacy of this technique was evaluated by surgical safety indicators such as operation time and intra-operative blood loss, as well as indicators of the postoperative scar assessment scale (OSAS).Results:All surgeries were successfully performed without conversion to open surgery. The operation time was (200±22) min. The blood loss was (8.07±2.56) ml without intraoperative blood transfusion. The time to start water feeding was (2.76±0.83) d and the time to start liquid diet was (3.92±1.12) d. The postoperative hospital stay was (7.00±3.37) d and the postoperative follow-up time was (5.38±2.06) months. No postoperative complications such as bile reflux gastritis and cholangitis were seen in patients. No dilatation of the common hepatic duct or intrahepatic bile ducts were observed at three months postoperatively. There were good indicators of satisfaction with the appearance of wounds as assessed by OSAS.Conclusion:Transumbilical single-port robotic-assisted laparoscopic surgery could be safe and effective for congenital choledochal cysts in children.

Objective:To explore the efficacy and safety of the Da Vinci robotic single-port-plus-one technique in common urological surgeries in children.Methods:The data of 59 children who underwent robot-assisted single-port-plus-one laparoscopic surgery from May 2022 to November 2023 in Fuzhou University Affiliated Provincial Hospital were retrospectively analyzed. There were 44 males and 15 females, aged 36 (6, 108)months. Among them, 27 cases had ureteropelvic junction obstruction, with a preoperative anterior-posterior diameter of the renal pelvis of (31.83±6.59) mm. The American Society of Fetal Urology (SFU) grading system revealed grade Ⅲ in 8 sides and grade Ⅳ in 19 sides. Bilateral renal function showed a difference of 13.50% (7.18%, 31.06%). Additionally, 17 cases presented with vesicoureteral reflux. Preoperative voiding cystourethrogram (VCUG) indicated reflux grades Ⅲ, Ⅳ, and Ⅴ in 8, 14, and 4 sides, respectively, with a difference in bilateral renal function of 18.58% (6.04%, 28.30%). Ten cases had obstructive megaureter, with a preoperative renal pelvis diameter of (22.17±7.64)mm and a maximum ureteral diameter of (19.51±3.71)mm. The preoperative bilateral renal function difference was 18.02% (5.23%, 49.42%).Five cases involved duplicated kidney and ureter. Magnetic resonance urography (MRU) confirmed unilateral duplicated kidneys with associated dilatation of the upper renal pelvis and calyces, hydroureter, thin renal cortex in all 5 patients. Among them, 2 cases had ectopic ureteral opening and 1 case had terminal ureteral cyst. Patients with ureteropelvic junction stenosis underwent pyeloplasty, those with vesicoureteral reflux and obstructive megaureter underwent ureteral reimplantation, and patients with duplicated ureters underwent nephrectomy. The Da Vinci robotic surgical system was employed for all procedures. The port placement technique involved a 2-3 cm incision around the navel to insert a single-port four-channel device, followed by the placement of an additional 8 mm operating channel in the left or right abdomen under direct visualization based on the surgical site. Preoperative and postoperative parameters were compared.Results:All operations were successfully completed without conversion to open or laparoscopic surgery. The operation time of the ureteropelvic junction obstruction children was (141.52±22.93) min. The postoperative renal pelvis diameter and bilateral renal function difference were (12.54±4.05) mm and 5.60%(2.14%, 14.48%), respectively, both of which showed significant improvement compared to preoperative levels ( P<0.01). Postoperative hydronephrosis grades were as follows: 13 sides with grade Ⅰ, 13 sides with grade Ⅱ, and 1 side with grade Ⅲ. The operation time of vesicoureteral reflux children was (125.00±11.75) min in the unilateral group and (153.22±14.39) min in the bilateral group. Postoperatively, 2 sides demonstrated reflux grade Ⅰ, 1 side grade Ⅱ, and 1 side grade Ⅲ, indicating improvement compared to preoperative levels. Bilateral renal function difference post-surgery was 13.34% (1.85%, 20.54%), which was more balanced than preoperatively ( P=0.011). Postoperative renal pelvis anterior-posterior diameter and maximum ureteral diameter were reduced to (10.31±3.86) mm and (6.62±2.44) mm, respectively, which were significantly smaller than preoperative measurements ( P<0.01). The bilateral renal function difference post-surgery was 12.04% (4.85%, 47.53%), showing improvement, though not statistically significant ( P=0.508). The operation time of the repeated nephrectomy children was (140.00±12.75) min. No recurrence of preoperative symptoms was noted, and renal cortical function remained generally normal during follow-up. In this study, only 3 cases of obstructive megaureter developed febrile urinary tract infection within 1 month after surgery, and no complications were observed in the remaining cases. Conclusions:This study preliminarily confirmed that the Da Vinci robotic single-port-plus one-port technology can be used in the treatment of common diseases of the urinary system in children. The patients' symptoms were significantly relieved after surgery, and the indicators of hydronephrosis improved compared with those before surgery. The incidence of postoperative complications was low, and aesthetic outcomes of postoperative scars were enhanced. Further studies are needed to assess its long-term efficacy.

Objective:To evaluate the clinical efficacy of botulinum toxin type A (BTX-A) injection in enhancing chin aesthetics.Methods:A retrospective analysis was conducted on patients with suboptimal chin aesthetics who underwent dual-plane BTX-A injection at Plastic Surgery Hospital, Chinese Academy of Medical Sciences between August 2023 and March 2024. Prior to injection, patients were instructed to repeatedly pucker their lips forward and upward to identify the most prominent points of the mentalis muscle for injection. A 13 mm 30 G needle was inserted perpendicularly into the muscle layer, and BTX-A was administered at a concentration of 20 U/ml, with 3 U per injection point. For the patients exhibiting significant orange peel signs at rest, intradermal deep-layer BTX-A injection was concurrently performed at a concentration of 5 U/ml, with 0.5 U per linear track. Postoperative follow-up was conducted, and third-party physicians assessed pre- and post-treatment photographs using the global aesthetic improvement scale (GAIS) (scores ranging from 5 to 1, representing worse, no improvement, mild improvement, moderate improvement, and significant improvement, respectively). Patient satisfaction was also surveyed [categorized as very satisfied, satisfied, dissatisfied, or very dissatisfied; satisfaction rate = (very satisfied + satisfied) cases/total cases × 100%], along with their willingness to undergo repeated injections and recommend the procedure to others. Descriptive statistical analysis was performed using SPSS 24.0 software. Normally distributed continuous data were expressed as Mean±SD, and categorical data were expressed as counts (%).Results:A total of 120 patients were included, comprising 11 males and 109 females, aged 22-39 years (mean age of 33.3 years). Follow-up ranged from 1 to 5 months (mean of 1.3 months). Postoperatively, 102 patients reported subjective improvement in chin appearance, characterized by enhanced fullness and roundness of the chin. Thirty-one patients noted a slight elevation of the submental fat pad and improved definition of the cervicomental angle. The mean GAIS score was 1.61±0.78, with 76 cases scoring 1, 24 cases scoring 2, 10 cases scoring 3, and 10 cases scoring 4. Improvement (scores 1-3) was achieved in 91.7% (110/120) of patients. The subjective satisfaction rate was 85.0% (102/120), and 94 patients (78.3%) expressed willingness to undergo repeated injections and recommend the procedure to family or friends. Early postoperative complications included localized bruising in 17 cases, which was resolved within 10 d, and transient fine motor dysfunction of the lower jaw in 23 cases, with normal chewing, swallowing, and facial expressions, all of which were resolved completely within 6 weeks. No cases of mouth deviation, facial paralysis, allergic reactions, or other complications were observed.Conclusion:The application of BTX-A via intramuscular mentalis injection combined with intradermal deep-layer injection significantly improves both dynamic and static chin aesthetics. However, some common complications also ask for the further attention of practitioners.

Objective:To evaluate the efficacy of transumbilical single-port robotic-assisted laparoscopic surgery for congenital choledochal cysts in children.Methods:Clinical data of 13 children with congenital choledochal cysts undergoing surgery at the Provincial Hospital of Fuzhou University from January 2024 to June 2024 were retrospectively analyzed, including 4 males and 9 females, aged 48 (24, 60) months. All children underwent transumbilical single-port robotic-assisted laparoscopic radical resection of congenital choledochal cyst with common hepatic duct jejunum Roun-en-Y anastomosis by the same surgeon. The efficacy of this technique was evaluated by surgical safety indicators such as operation time and intra-operative blood loss, as well as indicators of the postoperative scar assessment scale (OSAS).Results:All surgeries were successfully performed without conversion to open surgery. The operation time was (200±22) min. The blood loss was (8.07±2.56) ml without intraoperative blood transfusion. The time to start water feeding was (2.76±0.83) d and the time to start liquid diet was (3.92±1.12) d. The postoperative hospital stay was (7.00±3.37) d and the postoperative follow-up time was (5.38±2.06) months. No postoperative complications such as bile reflux gastritis and cholangitis were seen in patients. No dilatation of the common hepatic duct or intrahepatic bile ducts were observed at three months postoperatively. There were good indicators of satisfaction with the appearance of wounds as assessed by OSAS.Conclusion:Transumbilical single-port robotic-assisted laparoscopic surgery could be safe and effective for congenital choledochal cysts in children.

Objective To retrospectively analyze the clinical data of skin ulcer patients in Lingnan area,and to explore the distribution of traditional Chinese medicine(TCM)syndrome types and their related influencing factors.Methods The clinical data of 241 patients with skin ulcer who were hospitalized in the Department of Dermatology,Guangdong Provincial Hospital of Chinese Medicine from August 2012 to July 2022 were collected,and their clinical characteristics and distribution of TCM syndrome types were analyzed.Results(1)The analysis of clinical characteristics showed that the age of the 241 patients with skin ulcers ranged from 10 years old to 98 years old,and the patients aged 70-79 years had the high incidence;the course of disease ranged from one week to more than 20 years,and most of the patients had the course of disease being 1-5 year(s);most of the patients were male,and the ratio of male to female was 1.62∶1;a total of 200 cases(82.99%)suffered skin ulcers in the lower limbs,17 cases(7.05%)suffered skin ulcers in the trunk,13 cases(5.39%)suffered multiple skin ulcers in the whole body,9 cases(3.73%)suffered skin ulcers in the upper limbs,and 2 cases(0.83%)suffered skin ulcers in the head and face.There was no significant difference in the gender and foci of the patients(P＞0.05).(2)The distribution of TCM syndrome types showed that among the 241 patients with skin ulcers,damp-heat and stasis obstruction syndrome was the most common(46.89%),followed by spleen deficiency with predominant dampness syndrome(27.39%),qi deficiency and blood stasis syndrome(14.11%),and qi and yin deficiency syndrome(11.62%).There was no significant difference in the gender among the four TCM syndrome types(P＞0.05),but there was significant difference in the age of the patients(P＜0.05).Conclusion There were certain differences exert in the distribution of the age,gender,foci and course of disease in the patients with skin ulcers in Lingnan area,and the damp-heat and stasis obstruction syndrome is the most common type of the patients.

OBJECTIVE To establish the quality standard of Triadica cochinchinensis and to perform the acute toxicity study. METHODS Appearance properties, powder microscopic identification, and thin-layer chromatography(TLC) identification were researched. The specific chromatogram was established by HPLC. The content of cadmium(Cd), lead(Pb), arsenic(As), copper(Cu), and mercury(Hg) was determined by inductively coupled plasma-mass spectrometry(ICP-MS). Acute toxicity was studied by maximum dose. RESULTS The outer skin of herbs was dark brown, and the inner surface was light yellow brown and fibrous. Besides, crystal sheath fiber was common, and calcium oxalate clusters arranges in rows. In the TLC diagram of the test product, the fluorescent spots of the same color were displayed at the corresponding position of the control product(scopoletin, isofraxidin). Five common peaks were calibrated in the characteristic map and the three characteristic peaks(scopoletin, isofraxidin, dimethylfraxetin) were recognized. The content of the measured heavy metal elements was lower than the national limit standard. The linear correlation coefficient was R2 > 0.999. The precision, stability, repetitive RSD were < 10%. The average recovery rate of the added sample was 80%−120%, and the RSD was < 10%. The maximum dose of the acute toxicity test was 184.09 g·kg−1. The 14 d internal body mass, food intake, organ-body ratios, the serum glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, blood urea nitrogen, and creatinine were not significantly different by comparing with the normal controls. Therefore, no significant toxicity was observed. CONCLUSION The established standard can provide a reference for evaluating the quality of Triadica cochinchinensis. The heavy metal content of ten batches of medicinal materials is within the safe range. Acute toxicity test show that there is no obvious significant adverse teactions after oral administration, and the safe dose range is large, which can provide a reference for the subsequent development and utilization.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.

Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0％ were gram-positive and 71.0％ were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6％,81.9％ and 78.5％,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9％ of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4％ of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1％ in the isolates from children and and 95.9％ in the isolates from adults.The resistance rate to carbapenems was lower than 15.0％ for most Enterobacterales species except for Klebsiella,22.5％ and 23.6％ of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6％ to 10.0％.The resistance rate to imipenem and meropenem was 21.9％ and 17.4％ for Pseudomonas aeruginosa,respectively,and 67.5％ and 68.1％ for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.