Objective Computational fluid dynamics software combined with finite element method was used to conduct 2D numerical simulation of pancreaticobiliary junction, and analyze the influence of biliopancreatic ampullary diaphragm, opening direction and shape of duodenal papilla on occult pancreaticobiliary reflux(OPBR). Methods The data of anatomical structure of pancreaticobiliary junction were obtained from online information. Pancreaticobiliary junction was reconstructed in 2D by computational fluid dynamics Fluent 2020R2 software. Different models were drawn for the pancreaticobiliary junction according to the following parameters: biliopancreatic ampullary diaphragm (with/without), opening direction of duodenal papilla(biased to the side of bile duct/central/biased to the side of pancreatic duct). A total of 6 models were used to analyze the risk factors for OPBR. Results When the anatomical structure of the biliopancreatic duct confluence was normal, that was, the ampullary diaphragm exists, no matter how the shape of the duodenal papilla and the opening direction changed, there was no pancreaticobiliary reflux. When the common channel was >5 mm due to the absence of the ampullary diaphragm and duodenal papilla was biased to the side of bile duct, a small amount of pancreatic juice refluxed into the lower end of the bile duct. When the common channel was >5 mm due to the absence of the ampullary diaphragm and duodenal papilla open position was in the middle of the biliopancreatic duct, the velocity and flow rate of pancreatic juice entering bile duct increased, and the degree of reflux was maintained at the lower end of the bile duct. When the common channel was >5 mm due to the absence of the ampullary diaphragm and the duodenal papilla was biased to the side of pancreatic duct, the degree of pancreaticobiliary reflux was more serious, and pancreatic juice reflux was observed throughout the entire bile duct. On the basis of this reflux model, the length of common channel of biliopancreatic duct was shortened, and the opening of outflow tract was enlarged, and the phenomenon of pancreaticobiliary reflux disappeared. Conclusions Based on the Fluent study, it is found that anatomical structures such as ampullary diaphragm and duodenal papilla were closely related to the occurrence of OPBR. Pancreaticobiliary reflux can be terminated by shortening the common channel length of pancreaticobiliary junction and expanding the opening of outflow tract.

Objective To investigate the mechanism of Xiaochengqi decoction(XCQD)in the treatment of acute pancreatitis(AP)based on network pharmacology and molecular docking.Methods Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform(TCMSP)was used to screen the active components of Rhubarb-Trifoliate-Magnolia officinalis and Swiss Target Prediction(STP)to predict the drug targets.The relevant targets of AP were screened in the databases of DrugBank,GeneCards,Online Mendelian Inheritance in Man(OMIM),Therapeutic Target Database(TTD)and Pharmacogenomics Knowledge Base(PharmGKB).The target protein interaction network was constructed by String software,and the network was drawn by Cytoscape and analyzed by topology,respectively.R3.6.2 was used for Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analysis.Autodock 4.2.6 and Vina were used for molecular docking.Results A total of 124 related therapeutic targets were obtained.Eleven targets,including retinoblastoma 1(RB1),protein kinase B(PKB),cyclin D1(CCMD1),v-myc avian myelocytomatosis viral oncogene homolog(MYC),estrogen receptor1(ESR1),reticuloendotheliosis virus oncogene homolog A(RELA),activator protein-1(AP-1),p53,mitogen-activated protein kinases(MAPK 1,3 and 14),were found to be the core targets by network topology analysis.GO and KEGG enrichment analysis showed that XCQD could play a role in the treatment of AP by regulating the apoptosis,proliferation and differentiation of pancreatic cells,inhibiting oxidative stress,etc,among which,phosphatidylinositol 3 kinase-protein kinase B(PI3K-Akt)signaling pathway is the most important one.In terms of molecular docking,Naringenin-MAPK1,Naringenin-MAPK3,Naringenin-PKB,Nobiletin-p53,Nobiletin-AP-1,Luteolin-CCND1,Luteolin-RELA,Tetramethoxyluteolin-MAPK14,Aloe-emodin-MYC and catechin-ESR1 showed good docking activity due to their low free energy.Conclusion By using network pharmacology and molecular docking,it was confirmed that XCQD had the characteristics of multi-channel and multi-target action and revealed the material basis and mechanism in the treatment of AP,which provided references for the extensive application of classical prescriptions and the theoretical basis for the later basic research.

Objective To investigate the clinical characteristics,treatment methods,and clinical outcomes of open injury of foot and ankle in children.Methods From February 2004 to June 2010,35 children with open injury of foot and ankle were treated,including 22 males and 13 females,aged from 3 years to 14 years (average,8.4 years).Twenty-eight cases resulted from traffic accidents; 7 cases occurred from sharp instruments and machine-related crush injuries.Thirty cases were associated with bone fractures,and according to the Gustilo classification of open fractures,five cases were Type Ⅰ injuries,eight cases were Type Ⅱ injuries and 22 cases were Type Ⅲ.Twenty three cases (type Ⅰ,type Ⅱ and type Ⅲ) underwent surgical debridement and/or internal fixation with skin flap grafting.Twelve type Ⅲ cases underwent debridement,temporary Kirschner wire or plaster fixation and VSD in the first stage of treatment.In the second stage of treatment,fracture reduction and internal fixation (with or without bone graft) + skin flap grafting was performed in all 12 cases.Results Thirty patients (85.7％) were followed-up for an average of 38.7months (range,6-89 months).Skin grafting was performed in two Type Ⅱ cases that developed necrosis in parts of the wound.Wound healing time was an average of 8.3 weeks (range,3-15 weeks).One Type Ⅲ case suffered chronic osteomyelitis with the formation of a sinus tract.Two cases suffered from club foot ab normalities 3 years postoperatively.All three patients above mentioned healed after treatment.In 12 type Ⅲpatients with staged treatment,the flap survived,and its color and elasticity were good.Healing time ranged from 3 to 8 weeks (average,6.8 weeks).According to the Maryland standard,17 cases were excellent,9good,3 fair,and 1 bad; the excellent and good rate was 86.7％.Conclusion Traffic accidents are the major causes of open foot and ankle trauma in children.A good surgical outcome can be achieved when patients receive staged treatment that is appropriate to injury severity.