Objective:To evaluate the short-term and long-term efficacy of Heidelberg triangle dissection in surgical treatment for pancreatic head cancer.Methods:The clinicopathological data of 97 patients with pancreatic head cancer who underwent pancreaticoduodenectomy at Cangzhou Central Hospital from Jan 2017 to Jan 2020 were retrospectively analyzed. After propensity score matching, 33 patients were included into the Heidelberg group and 36 patients in the control group.Results:There were no significant difference between Heidelberg group and control group in preoperative general conditions and postoperative major complications, while there were more cases with safe surgical margin > 1 mm (81.8% vs. 58.3%, P=0.034) and a significantly higher total number of lymph node dissection (11.24±2.35 vs. 9.50±2.76, P=0.006). In the survival analysis, the cumulative recurrence rate at 12 months (0.182±0.067 vs. 0.444±0.083, P=0.023) and 18 months (0.424±0.086 vs. 0.667±0.079, P=0.024) were better off in the Heidelberg group, and the local recurrence rate in the Heidelberg group was significantly lower than that in the control group (15.3 % vs. 36.1 %, P=0.037). However, there was no statistical difference in the overall survival time between the two groups. Conclusion:Dissection of Heidelberg triangle in radical resection of pancreatic head cancer reduces tumor local recurrence ,while fails to provide survival benefit.

Objective To study the efficacy of breathing training in the patients with chronic non-spe-cific low back pain (CNLBP).Methods The databases of Pubmed,Embase,Web of Science,Cochrane Librar-y,CNKI,China Biomedical Literature Database,Wanfang Database and VIP Database were searched for obtai-ning relevant trials of respiratory-related training for treating CNLBP.The retrieval time limit was from the database establishment to October 2022.The quality assessment was performed by using the Cochrane Manual for Systematic Reviews,and the data analysis was performed by using StataSE15.1 software.Results Nine-teen articles were finally obtained,involving in 1011 cases.The meta analysis showed that the visual analogue scale (VAS) score or pain numerical scale (NRS) score in the experiment group were lower than those in the control group (MD=-1.19,95％CI:-1.51 to-0.87,P<0.05),and the Oswestry dysfunction index (ODI) score was lower than that in the control group (MD=-0.64,95％CI:-0.91 to-0.38,P<0.05). For different types of the patients,the improvement effects of VAS score for different types of patients with CNLBP from high to low were in turn postpartum patients (MD=-1.89,95％CI:-2.51 to-1.27,P<0.05),athletes (MD=-1.46,95％CI:-1.79 to-1.13,P<0.05) and general population (MD=-1.01,95％CI:-1.40 to-0.61,P<0.05).Conclusion Thebreathing training has the improvement effect for pain,dysfunction,proprioception and posture control in various populations with CNLBP.

Objective To explore the clinical significance of sortilin 1(SORT1)gene as a new diagnostic biomarker for pediatric sep-sis.Methods Three pediatric sepsis-related microarray datasets,including GSE13904,GSE26378,and GSE26440,were obtained from the gene expression omnibus(GEO)database to analyze the expression difference of SORT1 gene between normal and sepsis sam-ples.Then,65 clinical samples were used to validate the difference through qRT-PCR.The molecular mechanism and biological process associated with SORT1 gene were explored by the gene set enrichment analysis(GSEA).Results The expression levels of SORT1 gene in the sepsis samples of GSE13904,GSE26378,and GSE26440 datasets and clinical samples were higher than that in normal samples.Compared with commonly used inflammatory markers such as procalcitonin(PCT),C-reactive protein(CRP),white blood cell(WBC),and the percentage of neutrophils(Neu％),SORT1 gene showed better diagnostic ability for pediatric sepsis and the area under the receiver operating characteristic(ROC)curve(AUCROC)was 0.863.SORT1 gene may be involved in the occurrence and de-velopment of pediatric sepsis through the TNF-α/NF-κB signaling pathway.Conclusion SORT1 gene may have certain diagnostic val-ue for pediatric sepsis,which needs to be further confirmed in clinical practice.

Objective To explore the value of fractional order calculus(FROC)model diffusion weighted imaging(DWI)for evaluating pathological classification and differentiation degree of cervical cancer(CCA).Methods Totally 74 CCA patients were enrolled and divided into squamous cell carcinoma(SCC)group(n=54)and adenocarcinoma(ACA)group(n=20)based on pathological classification,also low differentiation group(n=33)and medium-high differentiation group(n=41)based on differentiation degree.Conventional MR examination and DWI with 12 b-values were performed,FROC model parameters(D,β,and p value)and the apparent diffusion coefficient(ADC)of mono-exponential model were obtained via software analysis.The parameters were compared between groups,and receiver operating characteristic curve of those being significantly different between groups were drawn,the area under the curves(AUC)were calculated to evaluate the diagnostic efficacy.Results Significant differences of ADC,D,and β values were found between SCC group and ACA group(all P＜0.05),and D value had the highest AUC(0.726)for distinguishing pathological classification CCA.Meanwhile,significant differences of D,β,p values and ADC were observed between low differentiation group and medium-high differentiation group(all P＜0.05),D value also had the highest AUC(0.865).AUC of the combined model constructed based on significant variables β and p values in logistic regression was 0.926,higher than that of each parameter alone(all P＜0.05).Conclusion FROC model DWI could be used to evaluate pathological classification and differentiation degree of CCA.

【Objective】 To explore critical regulatory genes in the hemoglobin switch process by analyzing transcriptomic data from the GSE6236, GSE17639 and GSE35102 datasets. 【Methods】 The mRNA expression profiles of the three datasets were downloaded from the GEO database and gene annotation was performed using the AnnoProbe package.The remove-BatchEffect function of the Limma package was used to remove batch effects. Weighted gene co-expression network analysis (WGCNA) was used to explore the most relevant modular genes in reticulocytes. The receiver operating characteristic curve (ROC) was used to assess the value of differential genes in differentiating between cord blood and adult peripheral blood reticulocytes. The GSE35102 dataset was used to validate changes in differential gene expression during hemoglobin transformation. Finally, real-time quantitative PCR was used to verify differential gene expression in cord blood and adult peripheral blood reticulocytes. 【Results】 Twelve genes showed differential expression in reticulocytes from cord blood and adult peripheral blood ( |logFC|≥1.5, P<0.05). WGCNA found that genes in the blue module were most strongly associated with reticulocytes (R² =0.76,P<0.001). Of the five genes that overlapped between the two, only CDC42 showed differential expression in the combined dataset (t =3.776, P<0.001) and was able to better differentiate between reticulocytes in cord blood and adult peripheral blood. The expression of CDC42 varied significantly during the hemoglobin transformation process (Z = -2.908, P<0.01), and was significantly lower in adult reticulocytes compared to reticulocytes from cord blood (t =7.824, P <0.001). 【Conclusion】 The CDC42 gene is involved in the hemoglobin switching of reticulocytes and could be a potential therapeutic target for sickle cell disease.

Objective:To observe the application effect of self-made anti-pressure sore cotton cover on the prevention of facial pressure injury in patients with non-invasive ventilation, and to explore the effective method of preventing facial pressure injury.Methods:A prospective study was conducted. Patients with mild to moderate respiratory failure and non-invasive ventilation admitted to the department of intensive care medicine of Harisen International Peace Hospital Affiliated to Hebei Medical University from March 2020 to August 2021 were enrolled, and they were divided into gauze pad group, foam dressing group and self-made anti-pressure ulcer cotton cover group by random number table method. Before wearing the ventilator mask, the gauze pad group and the foam auxiliary dressing group should fold or cut out the auxiliary dressing with the corresponding size and suitable for the patient's facial contour. In the self-made anti-pressure sore cotton cover group, the ventilator cotton cover could be worn only by selecting the cotton cover suitable for the patient's face shape, aligning the vent to the mouth and nose, and tying the fixed belt behind the ear. The incidence of facial pressure sore, the time required to connect man-machine interface (from the preparation of auxiliary dressing for pressure sores to the connection of ventilator) and the cost of dressing were compared among the three groups.Results:A total of 150 patients with non-invasive ventilation were enrolled, with 50 patients in each group. Compared with the gauze pad group and the foam dressing group, the incidence of facial pressure sore in the self-made anti-pressure sore cotton cover group was significantly reduced [6.0% (3/50) vs. 44.0% (22/50), 12.0% (6/50), both P < 0.05], and the time required to connect the man-machine interface was significantly shortened (minutes: 5.0±1.5 vs. 10.0±1.5, 8.0±2.0, both P < 0.05), dressing cost was significantly reduced (yuan: 30±10 vs. 150±20, 118±29, both P < 0.05). Conclusion:Compared with the gauze pad and the foam dressing, the incidence of facial pressure sore in non-invasive ventilation patients with self-made anti-pressure sore cotton cover is lower, the time required to connect man-machine interface is shorter, and the cost of pressure sore prevention dressing is less, which is suitable for the prevention of facial pressure injury in non-invasive ventilation patients.

Objective:To investigate the application effect of the compound flap transfer in tubularized incised plate (TIP) urethroplasty.Methods:Children with hypospadias who received TIP in the Department of Pediatric Urology, the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University from January 2018 to March 2022 were prospectively divided into compound flap transfer group (group A) and traditional TIP group (group B) by random number method. Group A was treated with TIP modified by compound flap transfer, and group B was treated with traditional TIP covered with fascia.The improvement of the compound flap transfer for TIP operation is mainly reflected in the multi-layer cover of the new urethra and the free skin embedded in the incision of the penile head. According to the intention-to-treat (ITT) principle, the final full analysis set (FAS) includes both group A and group B. Some patients were excluded from the analysis of the primary endpoint events due to reasons such as loss to follow-up or treatment group switch. Additionally, the final per-protocol set (PPS) consisting of group A and group B, which adheres to the study protocol, is subjected to statistical analysis.Independent sample t-test or Wilcoxon rank sum test was used for average age, the width of the penile head, degree of chordee, length of neourethra, and operative time. The classification of hypospadias, proportion of dorsal tunica albuginea plication, and incidence of postoperative complications were compared using the Chi-square test or Fisher’s exact test, P < 0.05 was considered statistically significant. Results:According to ITT principles, 50 children were included in FAS group A, ranging in age from 8 months to 15 years and 2 months, with an average age of 4 years. Group B included 50 children, ranging in age from 10 months to 14 years and 9 months, with an average age of 4 years and 1 month. Thirty-seven children in PPS group A were included, ranging in age from 1 year 2 months to 12 years 1 month, with an average age of 4 years. Group B consisted of 41 children, ranging in age from 1 year 2 months to 11 years 9 months, with an average age of 4 years 2 months. Statistical analysis showed that no matter FAS set or PPS, there were no statistically significant differences in the mean age, hypospadias type, average penile head width, average penile subcurvature number, number of dorsal tunica albuginea plication, and the average length of plastic neourethra between group A and group B ( P > 0.05). The average operative time of group A was higher than that of group B. The difference was statistically significant ( P < 0.05). The postoperative follow-up was 3 to 48 months, with an average follow-up of 2 years and 3 months. The complication rate of group A was lower than that of group B [10.81% (4/37) vs 29.27% (12/41)], and the difference was statistically significant ( P< 0.05). Urethral fistula occurred in 3 cases (8.11%), respectively and 6 cases (14.63%) in the two groups, the difference was not statistically significant ( P>0.05); urethral stricture occurred in 1 case (2.70%) and 5 cases (12.20%) respectively, the difference was not statistically significant ( P>0.05), There were 0 case and 1 case (2.44%) of urethral orifice descending or urethral dehiscence respectively, and the difference was not statistically significant ( P> 0.05). Conclusion:TIP with an improved compound flap transfer can reduce the overall postoperative complication rate and is worthy of promotion.

Objective:To investigate the application effect of the compound flap transfer in tubularized incised plate (TIP) urethroplasty.Methods:Children with hypospadias who received TIP in the Department of Pediatric Urology, the Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University from January 2018 to March 2022 were prospectively divided into compound flap transfer group (group A) and traditional TIP group (group B) by random number method. Group A was treated with TIP modified by compound flap transfer, and group B was treated with traditional TIP covered with fascia.The improvement of the compound flap transfer for TIP operation is mainly reflected in the multi-layer cover of the new urethra and the free skin embedded in the incision of the penile head. According to the intention-to-treat (ITT) principle, the final full analysis set (FAS) includes both group A and group B. Some patients were excluded from the analysis of the primary endpoint events due to reasons such as loss to follow-up or treatment group switch. Additionally, the final per-protocol set (PPS) consisting of group A and group B, which adheres to the study protocol, is subjected to statistical analysis.Independent sample t-test or Wilcoxon rank sum test was used for average age, the width of the penile head, degree of chordee, length of neourethra, and operative time. The classification of hypospadias, proportion of dorsal tunica albuginea plication, and incidence of postoperative complications were compared using the Chi-square test or Fisher’s exact test, P < 0.05 was considered statistically significant. Results:According to ITT principles, 50 children were included in FAS group A, ranging in age from 8 months to 15 years and 2 months, with an average age of 4 years. Group B included 50 children, ranging in age from 10 months to 14 years and 9 months, with an average age of 4 years and 1 month. Thirty-seven children in PPS group A were included, ranging in age from 1 year 2 months to 12 years 1 month, with an average age of 4 years. Group B consisted of 41 children, ranging in age from 1 year 2 months to 11 years 9 months, with an average age of 4 years 2 months. Statistical analysis showed that no matter FAS set or PPS, there were no statistically significant differences in the mean age, hypospadias type, average penile head width, average penile subcurvature number, number of dorsal tunica albuginea plication, and the average length of plastic neourethra between group A and group B ( P > 0.05). The average operative time of group A was higher than that of group B. The difference was statistically significant ( P < 0.05). The postoperative follow-up was 3 to 48 months, with an average follow-up of 2 years and 3 months. The complication rate of group A was lower than that of group B [10.81% (4/37) vs 29.27% (12/41)], and the difference was statistically significant ( P< 0.05). Urethral fistula occurred in 3 cases (8.11%), respectively and 6 cases (14.63%) in the two groups, the difference was not statistically significant ( P>0.05); urethral stricture occurred in 1 case (2.70%) and 5 cases (12.20%) respectively, the difference was not statistically significant ( P>0.05), There were 0 case and 1 case (2.44%) of urethral orifice descending or urethral dehiscence respectively, and the difference was not statistically significant ( P> 0.05). Conclusion:TIP with an improved compound flap transfer can reduce the overall postoperative complication rate and is worthy of promotion.

Psoraleae Fructus (PF) is an important traditional herbal medicine with a long history of clinical application. It is widely used to treat various diseases, such as osteoporosis, leucoderma and diarrhea. As a traditional nontoxic herb, it has aroused worldwide concern about the potential risks due to increasing adverse reaction events. This article reviews the botany, ancient records of medical uses, adverse reactions, toxicological research advance and detoxification methods of PF. According to clinical studies, liver injury is the most predominant in PF-related adverse reactions. The underlying mechanisms include bile acid metabolism and transport disorders, oxidative stress, mitochondrial damage, inhibition of liver cell regeneration and inflammatory reactions. Furthermore, the potential toxins of PF are summarized. Traditional methods of processing and compatibility will provide reference for reducing the toxicity of PF, which requires further research. In sum, this work systematically summarizes the reserach progress on the safety of PF, which will provide comprehensive insights into the toxicity of PF and facilitate its safe use and future development.
Drugs, Chinese Herbal/toxicity* ; Fruit/toxicity* ; Liver

Objective:To compare the effectiveness of modified Sugita and modified Shiraki in the treatment of severely concealed penis in children.Methods:A retrospective study was carried out on 72 children with congenital severely concealed penis, who were treated in the Department of Urology, Xuzhou Children′s Hospital Affiliated to Xuzhou Medical University from September 2016 to June 2021.Among them, 32 cases were treated with modified Sugita (modified Sugita group) and 40 cases were treated with modified Shiraki (modified Shiraki group). There was no significant difference in the age, body mass and body mass index between the 2 groups (all P>0.05). The operation time, increased length of the exposed part of the penis after operation, score of parental satisfaction half a year after operation (obtained by using the Likert scale) and postoperative complications (classified according to the modified Clavien-Dindo classification) were compared between the 2 groups.Measurement data comparison between groups were performed by t test, counting data were analyzed by Chi- square test. Results:The operative time of the modified Sugita group and the modified Shiraki group were (50.00±8.03) min and (40.30±9.27) min, respectively.The operative time was significantly different between 2 groups ( t=4.107, P<0.05). The increased length of the exposed part of the penis after operation was (1.80±0.30) cm in the modified Sugita group and (1.90±0.33) cm in the modified Shiraki group, and no significant difference was found between the 2 groups ( P>0.05). Six months after operation, the parental satisfaction score was (4.60±0.56) points in the modified Sugita group and (4.60±0.59) points in the modified Shiraki group.There was no significant difference in the parental satisfaction score between 2 groups ( P>0.05). In 72 cases, only 5 cases had grade Ⅰ complications.Postoperative complications were also not significantly different between the 2 groups ( P>0.05). Conclusions:After treating severely concealed penis in children with modified Sugita and modified Shiraki, the penis has a good appearance.These two surgeries have high parental satisfaction and low complications.They are easy to implement in clinical practice.The operation time of modified Shiraki is shorter than that of modified Sugita.