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 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 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 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 investigate the safety and efficacy of novel bioabsorbable vascular scaffold(BVS)in the treatment of patients with complex coronary artery disease.Methods This was a retrospective,matched,single-center observational study.45 patients with coronary atherosclerotic cardiopathy received BVS treatment in the cardiovascular medicine department Department of the Affiliated Hospital of Guangdong Medical University from June 2020 to June 2021(BVS),and 45 patients treated with drug-eluting stents(DES)group were selected according to matching study requirements during the same period.Baseline,surgical,and follow-up data were compared between the two groups to evaluate safety and efficacy.The main measures of safety were:surgical time,intraoperative adverse events,etc.,and the end point of efficacy was target lesion failure(TLF),including cardiac death,target vessel myocardial infarction,and ischa-driven target lesion revascularization.Results A total of 90 patients were enrolled in this study,all of whom were followed up for at least 3 years.There were 20 cases of bifurcation lesions and 25 cases of diffuse long lesions in the two groups,and 50 cases of imaging were reviewed among the 90 patients.The proportion of stable coronary heart disease,history of diabetes,history of hypertension,history of smoking,pre-dilated balloon pressure and postoperative diastolic blood pressure in BVS group was higher than that in DES group,and the proportion of family history was lower than that in DES group(all P＜0.05).There were no statistically significant differences in the rates of cardiac death,target vessel myocardial infarction,and ischemia-driven revascularization of target lesions between the two groups(all P＞0.05).Binary Logistic regression model analysis showed that the diameter stenosis ratio of target lesions was an independent risk factor for intrastent restenosis(OR 2.786,95％CI 1.096-7.081,P=0.031).Conclusions Compared with traditional DES,BVS implantation has consistent safety and efficacy in the treatment of complex coronary artery disease within 3 years.The diameter stenosis ratio of target lesions was an independent risk factor for intrastent restenosis.

Objective:To investigate the incidence of coronary artery tortuosity and its correlation with poor prognosis in patients with septal hypertrophic cardiomyopathy (HCM).Methods:This was a retrospective cohort study. Patients with septal HCM who were hospitalized in Fuwai Central China Cardiovascular Hospital and Zhengzhou University People′s Hospital between December 1, 2017 and June 10, 2021 were selected. Non-HCM patients were matched by gender, age, and hypertension as control group. Septal HCM was divided into two groups based on the presence or absence of coronary artery tortuosity. Clinical baseline data and coronary angiography findings were compared using a multifactorial logistic analysis of the risk factors for coronary artery tortuosity. Patients were followed up until July 1, 2022, with the primary outcome being the composite endpoint of malignant arrhythmia, ischemic stroke and all-cause death. Incidence densities were compared between the coronary artery tortuosity and non-coronary artery tortuosity groups of septal HCM patients. The Cox risk-ratio model was used to analyze risk factors for primary outcomes in septal HCM patients.Results:There were 156 patients in the septal HCM group and 156 patients in the control group, both aged (57.0±11.4) years, and 75 (48.1%) were female. The incidence of coronary artery tortuosity was significantly higher in the septal HCM group than in the control group (63.5% vs. 36.5%, P<0.01), and the coronary artery tortuosity score was also higher in the septal HCM group than in the control group ( P<0.01). Multiple logistic regression analysis showed that septal HCM was a risk factor for coronary artery tortuosity ( OR=3.27, 95% CI: 2.02-5.29, P<0.01). In the septal HCM patients, after (2.5±1.2) years of follow-up, the incidence density of primary outcome was significantly higher in the coronary artery tortuosity group than in the non-coronary artery tortuosity group ( P=0.02), while each on-point in coronary artery tortuosity score increased the risk of primary outcome by 53% for septal HCM patients ( HR=1.53, 95% CI: 1.26-1.86, P<0.01). Conclusions:Patients with septal HCM are more prone to suffer coronary artery tortuosity and suffer from it to a greater extent. Coronary artery tortuosity is an important risk factor for adverse events in patients with septal HCM.

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 understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.
Humans ; Male ; Female ; Adult ; Aged, 80 and over ; Antiviral Agents/therapeutic use* ; Hepatitis B, Chronic/epidemiology* ; Hepatitis B e Antigens ; Hepatitis B/drug therapy* ; Hepatitis B Surface Antigens ; Hepatitis A ; Liver Cirrhosis/drug therapy* ; China/epidemiology* ; Registries ; Hepatitis B virus/genetics* ; DNA, Viral

Professor YANG Jun's clinical experience of acupuncture and moxibustion for oculomotor paralysis is summarized. Professor YANG Jun pays attention to disease differentiation and syndrome differentiation in the treatment of this disease. According to the characteristics of oculomotor paralysis, "early diagnosis and seeking treatment from the source" is advocated. According to the etiology and pathogenesis, professor YANG divides oculomotor paralysis into three types: the syndrome of wind-evil attacking collaterals, the syndrome of spleen-stomach weakness and the syndrome of qi-deficiency and blood-stasis. As such, the acupoints are selected according to syndrome differentiation, and several different acupuncture methods (pricking needling at eyelids, penetrating needling and lifting eyelids and contralateral- balance needling on the healthy side) are adopted to improve the symptoms of oculomotor paralysis. It is also suggested to use the combination of scalp acupuncture and electroacupuncture to achieve the best dose-effect state. Moreover, local stimulation around the eyes is important to achieve the effects of "qi reaching affected area".
Acupuncture ; Acupuncture Points ; Acupuncture Therapy ; Humans ; Moxibustion ; Ophthalmoplegia ; Syndrome