Objective To explore the safety of the left anterior pararenal space approach in laparoscopic distal pancreatectomy with splenic preservation.Methods 30 patients operated between August 2008 and September 2013 were retrospectively reviewed.Results Of the 30 patients,28 underwent laparoscopic distal pancreatectomy with preservation of splenic artery and vein,2 underwent laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels.All the 30 patients had their operations carried out successfully with an average operative time of (55 ± 38) min,blood loss (100 ± 48) ml and duration of hospitalization 7.8 d.Pancreatic fistula occurred in 2 patients and it healed spontaneously on drainage.Partial splenic infarction occurred in 1 patient.The pathological lesions were serous cystadenoma in 6 patients,mucinous cystadenoma in 6 patients,insulinoma in 5 patients,solid pseudopapillary tumor in 6 patients,chronic pancreatitis presenting as a mass in 3 patients,and pancreatic cyst in 4 patients.Conclusions The left anterior pararenal space approach was safe and efficacious in distal pancreatectomy with splenic preservation.If the pancreatic lesion was big and compressed the splenic artery and vein,laparoscopic distal pancreatectomy with division of the splenic artery and vein and preservation of the short gastric vessels was the procedure of choice.

Objective To evaluate the common traditional Chinese medicine syndrome types, therapies and formulas of the wind of four fossae. This will provide reference for the formulation of the guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae. Methods Delphi method using questionnaires were developed based on literature about TCM syndromes and treatment of the wind of four fossae. The questionnaire were sent to 25 experts nationwide for 2 rounds. The database of the collected data was established. The mean, full score ratio, rank sum and coefficient of variation were described and by SAS 6.12 statistical software. Results A total of 21 valid questionnaires were recovered in the first round and 23 valid questionnaires in the second round. The active coefficient of the experts was 84% and 92%, respectively. The results showed that syndromes of newborn heat, damp heat retention, spleen deficiency and blood dryness, wind dampness accumulating skin, blood deficiency and wind dryness demonstrated high concensus. The consistency scores' mean of 5 syndromes were 1.67, 1.90, 1.83, 1.71 and 1.90. The sum of degrees of 5 syndromes were 37, 40, 42, 36 and 40. The ratio of full scores of 5 syndromes were 0.81, 0.90, 0.87, 0.71 and 0.90. The coefficient of variations of 5 syndromes were 0.32, 0.16, 0.27, 0.27 and 0.16. The therapy of syndrome of newborn heat was clearing away the heart-fire and inducing diuresis by the sanxin daochi decoction; The therapy of syndrome of damp heat retention was clearing heat and removing dampness by longdan xiegan decoction; The therapy of syndrome of wind dampness accumulating skin was dispelling wind and eliminating dampness by xiaofeng san; The therapy of syndrome of spleen deficiency and blood dryness was enriching blood and moistening dryness by danggui decoction; The therapy of syndrome of blood deficiency and wind dryness was replenishing qi to invigorate the spleen and enriching blood to calm endogenous wind by shenling baizhu power and danggui decoction. Conclusion Questionnaire survey could quantify the opinions of experts, and provide reference for the establishment of guideline for the diagnosis and treatment of traditional Chinese medicine in the wind of four fossae.

Objective:To investigate the clinical effect of Dynamic neutralization system applied to the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle.Methods:From Jan 2015 to Dec 2017, a total of 53 patients of lumbar degenerative diseases with multifidus fatty infiltration treated by Dynesys in our hospital were analyzed, included 21 males and 32 females, aged 66.2±7.4 (range 48-81) years. There were lumbar spinal stenosis in 37 casesand lumbar disc herniationin 16 cases; the index level included L 2-S 1 in 3 cases, L 3-S 1 in 13 cases, L 2-L 5 in 5 cases, L 4-S 1 in 17 cases, and L 3-L 5 in 15 cases. The pedicle screws were inserted at the point of intersection of the outer edge of superior articular process and the midline of transverse process. After discectomy of herniated disc and hyperplastic ligamentum flavum, the distance between the upper and lower pedicle screws was measured and then the spacer of the corresponding length was cut out. Finally, the spacer was placed and fixed between the upper and lower pedicle screws by the elastic rope. The degree of multifidus fat infiltration, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slop (SS), range of motion (ROM), intervertebral height (IH), Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), the MOS 36-item short-form health survey (SF-36) and visual analog scale (VAS) were evaluated postoperatively. Results:The operation was performed successfully in all the patients. The operation duration was 173.5±64.7 (range 125-240) min. Intraoperative blood loss was 469.5±118.2 (range 380-620) ml. The patients were followed up for 47.9±6.7 (range 38-62) months averagely. At the last follow-up, the degree of fatty infiltration of the multifidus muscle showed no further progress by MR scan. There was no significant difference in ROM and IH at different time points preoperativelyand postoperatively. The LL recovered from 37.6°±8.8° to 43.2°±9.1°, the PT decreased from 24.7°±9.3° to 20.5°±5.1°, and the SS increased from 22.1°±7.7°to 26.3°±8.0°. The JOA score increased from preoperative 6.4±1.2 to 20.6±2.8, ODI decreased from preoperative 50.6%±11.3% to 13.0%±3.4%, SF-36 increased from preoperative 81.5±3.6 to 95.5±4.2, and the VAS decreased from preoperative 4.2±1.0 to 1.1±0.6. One patient experienced loosening and displacement on the left side pedicle screw of the L2 vertebral body 3.5 years after operation, and herclinical symptom improved significantly after conservative treatment.Conclusion:Dynesysis is safe and effective for the treatment of lumbar degenerative diseases with fatty infiltration of multifidus muscle, and it can restore the complete structure and function of tension band at lower back and prevent the progress of multifidus muscle fat infiltration combined with postoperative rehabilitation training.

Objective To investigate the effects and mechanisms of Zhenxin Anshen Prescription(composed of Os Draconis,Ostreae Concha,Lophatheri Herba,Drynariae Rhizoma,Poria)on mice with atopic dermatitis(AD)based on the calcium channel regulator 1(ORAI1)/nuclear factor of T-cells(NFAT)signalling axis.Methods Thirty-six BALB/c mice were randomly divided into a blank control group,a model group,a Cetirizine group(1.3 mg·kg-1)and a Zhenxin Anshen Prescription group(36.36 g·kg-1),with nine mice in each group.AD mouse model was established using 1-chloro-2,4-dinitrobenzene(DNCB)induction.The drug was administered by gavage once a day for 2 weeks.At the end of drug administration,the area of skin lesions was measured and the severity of skin lesions was scored;spleen mass was measured and spleen index was calculated;pathological changes of skin lesion tissues were observed by HE staining;interleukin 4(IL-4),IL-13 and thymic stromal lymphopoietin(TSLP)in serum were detected by ELISA;and the protein expression levels of ORAI1,calmodulin phosphatase A(CaN)and nuclear factor of T cells 2(NFAT2)were detected by Western Blot.Results Compared with the blank control group,the skin lesion score of mice in the model group was significantly increased(P＜0.01),the skin lesion area was significantly enlarged(P＜0.01);the thickness of the epidermis and dermis were significantly increased(P＜0.01),hyperkeratosis of the epidermis,hypertrophy of the stratum spinosum,and infiltration of inflammatory cells such as eosinophils and lymphocytes can be seen in the dermis;the splenic index and serum IL-4,IL-13,TSLP levels were significantly increased(P＜0.01);protein expression levels of CaN,NFAT2,ORAI1 were significantly increased in the skin lesion tissues(P＜0.01).Compared with the model group,the dermatitis score of mice in the Zhenxin Anshen Prescription group was significantly decreased(P＜0.01),the lesion area was significantly reduced(P＜0.01),the epidermal and dermal thicknesses(P＜0.01),the hyperkeratosis of epidermis was alleviated,the spinous layer was slightly hypertrophic,and there was a small amount of inflammatory cell infiltration in the dermis;the splenic index and the levels of serum IL-4,IL-13,and TSLP were significantly decreased(P＜0.01);the protein expressions levels of CaN,NFAT2,and ORAI1 in the skin lesion tissues were significantly decreased(P＜0.01).Conclusion Zhenxin Anshen Prescription can ameliorate dermatopathological injury in DNCB-induced AD mice,and the mechanism may be related to its ability to inhibit the protein expressions of ORAI1,CaN and NFAT2,reduce the levels of serum type 2 inflammatory factors TSLP,IL-4 and IL-13,and ameliorate cutaneous inflammation and itching through immunomodulation.

Objective To explore the structure changes of white matter in the first-episode schizo-phrenic patients with never-medicated(FESZ)and the relationship between facial emotion perception and white matter(WM)integrity.Methods Sixty-three schizophrenic patients and thirty health control subjects underwent diffusion tensor imaging(DTI)scans.Voxel-based analysis was used to compared fractional ani-sotropy(FA)map between the two groups.Correlations were analyzed with pearson relative analysis between impaired facial emotion perception tested by facial emotion categorization(FEC)and severity of symptoms measured by the Positive and Negative Syndrome Scale(PANSS).Results (1)Compared with controls, FESZ patients showed overall decreased FA in WM of the body of left ventral frontal lobe((MNI(x,y,z):-18,26,-4;t=4.43)),right supramarginal gyrus((MNI(x,y,z):32,-50,26;t=4.27)),left middle oc-cipital gyral((MNI(x,y,z):-26,-60,0;t=4.89)),right middle occipital gyral((MNI(x,y,z):28,-70, 14;t=4.18)),left fusiform gyrus((MNI(x,y,z):-40,-50,0;t=3.92)),left cerebellum anterior lobe ((MNI(x,y,z):-32,-56,-28;t=4.57)),right parahippocampa gyrus1((MNI(x,y,z):32,-10,-14;t=4.16)),right parahippocampa gyrus2((MNI(x,y,z):16,-6,-14;t=4.56)),left anterior cingulate ((MNI(x,y,z):-2,4,-6;t=4.41)),left extra-nuclear((MNI(x,y,z):-2,-10,-6;t=4.44)),right thalamus((MNI(x,y,z):10,-10,2;t=4.20)),left thalamus((MNI(x,y,z):-22,-28,12;t=4.01)), and right caudate((MNI(x,y,z):14,12,8;t=4.87)).(2)Compared with controls,the patients with schizo-phrenia showed a higher shift point and a steeper slope than control subjects in FEC.Correlational analysis re-vealed that the negative correlations were found between the slope and negative factor(r=-0.298,P=0.036),between positive factor and the FA value in WM of the right middle occipital gyral(r=-0.322,P=0.023)and the left middle occipital gyral(r=-0.288,P=0.043),and between the FA value in the left cere-bellum anterior lobe and shift point(r=-0.393,P=0.005),but the positive correlation was found between disorganized/concrete factor and the FA value in the right parahippocampal gyrus(r=0.429,P=0.002).Con-clusions There are extensive microstructural abnormalities in WM of patients with FESZ.Disrupted WM in-tegrity in these regions may constitute a potential neural pathological basis for the facial emotion perception impairments in schizophrenia.

Based on the introduction of gut-brain-skin axis, this article discussed the relationship between psychological behavior, intestinal flora, and atopic dermatitis. By combing the literature on the treatment of atopic dermatitis with TCM, it is found that TCM therapy can regulate the relative abundance of intestinal flora, participate in immune metabolism and restore skin barrier function by intervening in the gut-brain-skin axis, so as to achieve the purpose of treating atopic dermatitis.

Objective:To investigate the therapeutic effect of dorsal skin-tightening technique on the correction of mild penile curvature in children with hypospadias.Methods:The clinical characteristics of hypospadias patients (95 cases) with mild penile curvature (<30°) after degloving penis during operation in our hospital from Jan 2017 to Sep 2020 were analyzed retrospectively. Group A: A new technique, reconstructing penile pubic angle at 12 o'clock position of penile dorsal side after degloving and suturing forskin outer and inner plate with tension at 12 o'clock position, was performed in dorsal skin-tightening group (43 cases). Gtoup B: while in dorsal midline tunica albuginea plication group (52 cases), Buck fascia was incised on dorsal midline area, following by tunica albuginea plication with one or two stitches. The patients in Group A were 0.4 to 1.5 years old, and the median age was 1.1 years, urethral orifice were located on distal shaft in 36 cases, proximal in 7 cases.The patients in Group B were 0.5 to 2.6 years old, and the median age was 1.5 years, urethral orifice were located on distal shaft in 41 cases, proximal in 11 cases. The penile ventral curvature degree was recorded during regular follow-up (postoperative 6 and 12 months), as well as postoperative complications.Results:Artificial erection test showed penile curvature was corrected during surgery by measuring with protractor. There was no chordee by measuring with the side photos in all patients during an average of 1.6 years follow-ups. There were 4 case of urethral fistula in Group B and 3 cases in Group A. No cases of urethrostenosis, diverticulum or concealed penis was recorded. The difference of postoperative complications had no statistical significance.Conclusion:Hypospadias with mild penile curvature could be effectively corrected by dorsal skin-tightening technique, which showed a good result of early follow-up.

Objective:To investigate abnormal urination and penile appearance satisfaction of preschool children (3-6 years old) after hypospadias repair.Methods:From January 2016 to December 2020, children with primary hypospadias, who had no postoperative complications for more than 1 year and were at pre-school age at the time of investigation (January 2022), were selected. The abnormal urination manifestations and satisfaction with penile appearance of the children after operation were investigated by questionnaires to their parents.The questionnaire was designed based on the reported abnormal urination after hypospadias surgery, including 4 items (urination spraying, urination dripping, deflection of urine line, small urine line). Another questionnaire was used to evaluate the penis appearance satisfaction according to the existing pediatric penile perception score (including 4 items: the position and shape of the external urethral orifice, the shape of glans, the appearance of the prepuce, and the overall appearance; items were scored according to the subjective satisfaction of the subjects: very satisfied 3 points, satisfied 2 points, dissatisfied 1 point, very dissatisfied 0 point). The patients were divided into two groups according to whether the penile curvature after degloving was more than 30°. In group Ⅰ (penile curvature≤30°), 28 patients without severe penile curvature underwent tubularized incised plate (TIP) surgery, with a median age of 3.2 years (ranged 1.1-5.4 years). In group Ⅱ (penile curvature>30°), there were 27 patients with severe penile curvature and they underwent staged flap operation. Their median age was 2.8 years (ranged 1.5-4.7 years). There was no significant difference in age at operation between the two groups ( P=0.82). The questionnaire content was analyzed and the differences between the two groups were compared. Results:Among the 55 children, 21(38%, 21/55) had abnormal urination, and there was a significant difference between group Ⅰ (25%, 7/28) and group Ⅱ (52%, 14/27)( P=0.04). All the items of penis appearance satisfaction were satisfactory (scores ≥2), and the total scores of group Ⅰ and group Ⅱ were respectively 10.3±2.2 and 9.0±2.9, with no significant difference between the two groups (P=0.63). Conclusions:In the postoperative follow-up of preschool children with hypospadias, parents were satisfied with the appearance of the penis.The abnormal urination was common. Compared with children without severe penile curvature treated by TIP surgery, abnormal urination was more common in children with severe penile curvature treated by staged flap operation.

OBJECTIVE：To systematically evaluate the therapeutic efficacy and safety of Chinese patent medicine compound preparation combined with conventional therapy for psoriasis vulgaris ，and to provide evidence-based reference for clinical drug use. METHODS ：Retrieved from CNKI ，Wanfang database ，VIP，CBM，PubMed，the Cochrane Library and Web of Science ， RCTs about Chinese patent medicine compound preparation combined with conventional therapy versus conventional therapy in the treatment of psoriasis vulgaris were collected during the inception to Feb. 2020. After literature retrieval and data extraction ，the quality of the included studies was evaluated with risk bias assessment tool recommended by the Cochrane evaluation manual handbook 5.1. Bayesian network Meta-analysis was perfor med by using Stata 15.0 software，Addis 1.16.6 software and Markov Chain Monte Carlo method. RESULTS ：A total of 41 RCTs were included ，involving 4 122 patients. 5 kinds of interven- tion measures included Compound qingdai capsule ，Xiaoyin SF-010） granule， Keyin pill ，Yujin yinxie tablet and conventional therapy. Results of network Meta-analysis showed that in terms of improving the total effective rate ， compared with conventional therapy ，4 kinds of Chinese patent medicine compound preparations combined with conventional therapy could significantly improve the total effective rate （P＜0.05）；the results of network Meta-analysis were as follows ：Keyin pill combined with conventional therapy ＞Compound qingdai capsule combined with conventional therapy ＞Xiaoyin granule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞conventional therapy. In terms of reducing psoriasis area and severity index （PASI）score after treatment ，compared with conventional therapy ，Keyin pill and Xiaoyin granule combined with conventional therapy could significantly reduce the PASI score （P＜0.05），while Compound qingdai capsule and Yujin yinxie tablet combined with conventional treatment had no significant difference （P＞0.05）；the results of network Meta-analysis showed that Xiaoyin granule combined with conventional therapy ＞Keyin pill combined with conventional therapy ＞ Compound qingdai capsule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞ conventional therapy. In terms of reducing serum inflammatory factor level ，compared with conventional therapy ，Compound qingdai capsule and Xiaoyin granule combined with conventional therapy could significantly reduce the level of IL- 17（P＜0.05）， but Keyin pill and Yujin yinxie tablet combined with conventional therapy had no significant difference （P＞0.05）；the results of network Meta-analysis showed that Xiaoyin granule combined with conventional therapy ＞Compound qingdai capsule combined with conventional therapy ＞Yujin yinxie tablet combined with conventional therapy ＞Keyin pill combined with conventional therapy＞conventional therapy. In terms of safety ，there was no statistical significance in the incidence of ADR between 4 kinds of Chinese patent medicine combined with conventional therapy and conventional therapy （P＞0.05）；the results of network Meta-analysis showed that Compound qingdai capsule combined with conventional therapy ＞Xiaoyin granule combined with conventional therapy ＞Keyin pill combined with conventional therapy ＞conventional therapy ＞Yujin yinxie tablet combined with conventional therapy . CONCLUSIONS ：Compared with conventional therapy ，additional use of 4 kinds of Chinese patent medicine compound preparations can improve the curative effect of psoriasis vulgaris patients with blood heat syndrome ，and Keyin pill is the best ；Xiaoyin granule is the best in reducing the degree of skin lesions and serum inflammatory factors ；additional use of 4 kinds of Chinese patent medicine compound preparations show good safety ，and Compound qingdai capsule is the best.

BACKGROUND:The traditional view is that proximal fibular fractures do not require fixation.Others and our research suggest that the proximal fibular structure plays an important role in the stability of the posterolateral structure of the knee joint,and its mechanism of action is worth studying. OBJECTIVE:To investigate the biomechanical effects of proximal fibular fractures on various structures of the knee joint in an extended state. METHODS:Finite element method was used to conduct simulated biomechanical experiments.A healthy young male volunteer was selected to establish a finite element model of the knee joint in an extended state using MRI and CT image data,and four proximal fibular shapes were simulated(Model A:intact,Model B:1 cm fracture below the fibular head,Model C:1 cm tip defect fracture from the proximal end of the fibula to the distal end,and Model D:2 cm bone defect from the proximal end of the fibula).A longitudinal concentrated load of 1 500 N was applied to the femoral shaft to compare and analyze the distribution and changing trend of the maximum equivalent stress and maximum first principal stress of each structure of the knee joint in an extended state under four working conditions. RESULTS AND CONCLUSION:(1)In Model A,the maximum equivalent stress in the tibial cartilage and lateral compartment of the meniscus was greater than that in the medial compartment,while the maximum first principal stress in the tibial plateau and medial compartment of the meniscus was greater than that in the lateral compartment.The maximum equivalent stress of the medial condyle of the femoral cartilage was greater than that of the lateral condyle,and the maximum first principal stress of the medial condyle of the femoral cartilage was greater than that of the medial condyle.(2)Compared to Model A,there was no significant difference in the magnitude and distribution of the maximum equivalent stress and maximum first principal stress in the cartilage and meniscus of Model C.(3)Compared to Model A,the maximum equivalent stress increase amplitude of Model B was in the order of medial tibial cartilage(14.9％),medial condyle of femoral cartilage(13.6％),and medial meniscus(6.6％).The maximum first principal stress increase amplitude was the medial meniscus(11.06％),the medial tibial cartilage(8.65％),and the medial condyle of the femoral cartilage(7.46％).The maximum equivalent stress increase amplitude of the ligament was as follows:popliteal arch ligament(33.2％)>anterior cruciate ligament(21.3％)>fibular collateral ligament(17％)>posterior cruciate ligament(14.3％)>anterior lateral collateral ligament(13.2％)>medial collateral ligament(10.1％).(4)Compared to Model A,the maximum equivalent stress increasing trend of Model D followed the medial tibial cartilage(19.5％),femoral cartilage medial condyle(17.9％),and medial meniscus(9.9％).The maximum first principal stress in sequence was the medial meniscus(14.04％),the medial tibial cartilage(13.03％),and the medial condyle of the femoral cartilage(11.37％).The increasing trend of maximum equivalent stress in ligaments was as follows:anterior cruciate ligament(25.2％)>posterior cruciate ligament(18.9％)>medial collateral ligament(18.5％)>anterior lateral collateral ligament(12.7％).(5)It is suggested that when the knee joint is extended,a 1 cm fracture below the fibular head and a 2 cm fibular tip bone defect have a significant impact on the structure of the medial ventricular cartilage,anterior cruciate ligament,and posterior lateral ligament complex.