BACKGROUND:Traditional Chinese medicine compound prescription has a long history in the treatment of primary osteoporosis,and the curative effect is definite,but the medication rule and mechanism are not clear. OBJECTIVE:Using the methodology of data mining and network pharmacology,to explore and verify the law of drug use and molecular mechanism of modern traditional Chinese medicine in the treatment of primary osteoporosis. METHODS:The relevant documents included in CNKI,WanFang,VIP and PubMed were used as data sources,and the relevant data were statistically counted and extracted by Microsoft EXCEL2019,IBMSPSS25.0 and other software.The high-frequency drugs obtained from the data statistics were analyzed by association rules analysis and cluster analysis,and the core drug combination of traditional Chinese medicine compound prescription in the treatment of primary osteoporosis was obtained by combining the two results.The therapeutic mechanism of this combination was explained by network pharmacology and verified by molecular docking. RESULTS AND CONCLUSION:Finally,151 articles were included and 207 prescriptions were selected,involving 285 flavors of Chinese herbs.(1)Ten groups of important drug combinations were obtained through the above two analyses,among which the core drug combination with the highest confidence and improvement was"Drynaria-Eucommia-Angelica."The key components of the combination in the treatment of primary osteoporosis were quercetin,kaempferol,naringenin and so on.The core targets were SRC proto-oncogene,phosphoinositide-3-Kinase regulatory subunit 1 and RELA proto-oncogene.The main pathways were cancer signaling pathway,JAK-STAT signaling pathway,VEGF signaling pathway,and NF-κB signaling pathway.(2)The key active components were docked with the core targets,and the two showed a good combination.To conclude,Chinese herbal compound therapy in the treatment of primary osteoporosis can use a variety of active components to exert its efficacy through multiple signal pathways and acting on multiple targets,which can provide a theoretical basis for the research and development of new drugs for the follow-up treatment of primary osteoporosis.

Objective:To compare the efficacy of monopolar electric scissors and harmonic scalpel in Da Vinci robot-assisted distal pancreatectomy.Methods:A total of 31 patients undergoing Da Vinci robot-assisted distal pancreatectomy at the Affiliated Hospital of Xuzhou Medical University from July 2020 to December 2023 were included. There were 9 males and 22 females, aged (54.4±15.7) years. Thirty-one patients who underwent Da Vinci robot-assisted distal pancreatectomy by monopolar electric scissors were included in the monopolar electric scissors group ( n=12), with a multi-joint flexible rotating mechanical arm to complete the dissection and separation and the other were inducled in harmonic scalpel group ( n=19). Operation time, intraoperative blood loss, spleen preservation, postoperative exhaust time, postoperative hospital stay, postoperative complications and total hospitalization cost were compared between the two groups. Results:Postoperative pathology confirmed that among the 31 patients, there were 6 cases (19.4%) serous cystadenomas, 5 cases (16.1%) mucinous cystadenomas, 3 cases (9.7%) pancreatic neuroendocrine tumors, 6 cases (19.4%) solid pseudopapilloma, 5 cases (16.1%) pancreatic cysts, and 3 (9.7%) benign cystic lesions, 3 cases (9.7%) were not easily classified. All the operations were successfully completed without conversion to laparotomy or death. There were no significant differences in operation time, intraoperative blood loss, splenic preservation rate, postoperative hospital stay and total hospitalization cost between the two groups (all P>0.05). The exhaust time in the monopolar electric scissors group was (2.8±0.7) d, which was shorter than that in the harmonic scalpel group (3.6±0.7) d, and the difference was statistically significant ( t=-2.88, P=0.007). There was no postoperative bleeding in both groups. In the monopolar electric scissors group, there were 4 cases of postoperative complications, all of which were pancreatic fistula, including 2 cases of biochemical leakage and 2 cases of B-grade pancreatic fistula. In the harmonic scalpel group, 8 cases had postoperative complications, 7 cases of pancreatic fistula, including 3 cases of biochemical leakage, 4 cases of B-grade pancreatic fistula, and 3 cases of abdominal infection, which were cured after treatment. There was no significant difference in the incidence of postoperative complications between the two groups ( P=0.717). Conclusion:The application of monopolar electric scissors in Da Vinci robot-assisted distal pancreatectomy could be safe and feasible in experienced hands, which could also utilize the advantages of robot system.

Objective:To determine the median effective dose (ED 50) of remimazolam for preoperative sedation in pediatric patients of different ages. Methods:This was a prospective study. American Society of Anesthesiologists Physical Status classification I or Ⅱ pediatric patients, aged 1-6 yr, scheduled for elective surgery in our hospital from July to December 2023, in whom the preoperative anxiety was still not relieved after non-drug intervention (preoperative separation anxiety score [PSAS]≥3), were selected. According to the age, the children were divided into 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group. A child's PSAS score = 1 at the time of separation from parents was classified as satisfactory sedation, and a PSAS score ≥ 2 was classified as unsatisfactory sedation. The initial dose of remimazolam in each group was 0.3 mg/kg, dose ratio 1.15. If the child was satisfactorily sedated, the next patient received a lower dose of remimazolam, or conversely if the child was not satisfactorily sedated, a higher dose was given in the next patient. The test was ended when 7 alternating waveforms appeared. The Dixon-Massey method was used to calculate the ED 50 and 95% confidence interval. Results:In 1-<2 yr group, 2-<3 yr group, 3-<4 yr group, 4-<5 yr group and 5-6 yr group, a total of 120 children were included in this study, with 26, 23, 21, 27 and 23 cases, respectively, and the ED 50 (95% confidence interval) of remimazolam for preoperative sedation was 0.152 (0.126-0.178), 0.159 (0.135-0.183), 0.171 (0.147-0.196), 0.150 (0.126-0.174), and 0.146 (0.121-0.170) mg/kg, respectively. There was no significant difference between the groups ( P>0.05). Conclusions:The ED 50 of remimazolam for preoperative sedation is 0.152, 0.159, 0.171, 0.150 and 0.146 mg/kg for every 1 yr in children aged 1-6 yr, and the age factor does not affect the preoperative sedative effect of remimazolam in children of this age group.

Objective:To explore and analyze the reliability and safety of sham feeding in facilitating the recovery of gastrointestinal function after laparoscopic appendectomy (LA), by using a new device, the Artificial Intelligence Bowel Tone Monitoring System.Methods:The data of 100 cases in Shaanxi Provincial People′s Hospital from Dec. 2020 to Sep. 2022 with acute appendicitis operated by LA who met the inclusion criteria. In this prospective study, participants were divided by random number table into a control group and an experimental group, with 50 cases in each group. The control group performed routine postoperative LA care, and the experimental group performed routine postoperative LA care and sham-feeding state care. The age, gender, recovery time of postoperative bowel sounds, time of first postoperative anal discharge, postoperative nausea and vomiting, abdominal distention, dry mouth and halitosis, and postoperative abdominal pain and other complications were recorded. GraphPad Prism 9.0 and SPSS 22.0 software were adopted to conduct data organization and analysis.Results:There were 100 valid cases in this trial. There were no statistical differences between the two groups in terms of gender, age, duration of surgery, abdominal pain and other symptoms ( P>0.05). The recovery time of bowel sounds after surgery was (8.92±0.56) h in the experimental group and (10.55±0.88) h in the control group, which was statistically significant ( t=10.99, P<0.0001); the recovery time of bowel sounds after surgery was (20.10±0.50) h in the experimental group and (20.96±0.59) h in the control group. There was a statistically significant difference between the two groups ( t=7.84, P<0.0001); there was a statistically significant difference between the experimental group (22%) and the control group (42%) for postoperative nausea and vomiting ( χ2=4.60, P=0.032); there was a statistically significant difference between the experimental group (16%) and the control group (52%) for postoperative abdominal distension ( χ2= There was a statistical difference between the experimental group (40%) and the control group (68%) ( χ2=7.89, P=0.005). The number of hospitalization days in the control group was (11.40±2.47) days and the days in the experimental group was (9.30±2.01) d, the difference between the two groups was statistically significant ( t=4.65, P<0.001); the hospitalization cost in the control group was (27 270.11±2 645.30) yuan and the cost in the experimental group was (23 669.68±2 841.28) yuan, the difference between the two groups was statistically significant ( t=6.56, P<0.001). Conclusion:To a certain extent, sham feeding can accelerate the recovery of gastrointestinal function in patients after LA, reduce the common postoperative discomfort, length of stay and hospital costs of patients.

Objective:To compare Da-vinci robotic surgical system with laparoscopic surgery for the repair of hiatal hernia.Methods:The clinical data of 115 patients undergoing minimally invasive Nissen fundoplication at the Department of Hernia and Abdominal Wall Surgery, the Affiliated Hospital,Xuzhou Medical University from Dec 2019 to May 2022 were retrospectively studied. After propensity score matching (PSM), 46 cases in each group were included:Robot-assisted surgery (RS group) and laparoscopic surgery (LS group). Postoperative complications were collected and GERD Questionnaire (GERDQ) were used as the standard in evaluation of the results.Results:Patients in RS group had less intraoperative bleeding ( P<0.001), shorter postoperative gastrointestinal recovery time ( P<0.001), and shorter postoperative hospital stay ( P=0.002). The LS group had a shorter operative time ( P<0.001) and lower total hospital cost ( P<0.001). GERD-Q scores decreased significantly in both groups at 3 and 6 months postoperatively compared with preoperative scores ( P<0.001). There was no statistically significant difference between the two groups in the incidence of postoperative complications ( P>0.05). No recurrence was seen in both groups during postoperative follow-up. Conclusion:Da-vinci robot-assisted repair of hiatal hernia is as safe and feasible as laparoscopic procedures, with less intraoperative trauma and quicker, earlier recovery.

Objective:To investigate the safety and efficacy of using bio-artificial dura mater to wrap around skeletonized hepatic artery during pancreatoduodenectomy in the prevention of gastroduodenal artery(GDA)stump related delayed bleeding.Methods:Clinical data were collected from 45 patients undergoing the bio-artificial dura mater wrapping skeletonized hepatic artery during pancreatoduodenectomy from Oct 2022 to Apr 2023 at Department of General Surgery, the Affiliated Hospital of Xuzhou Medical University.Results:Among the 45 patients, the bio-artificial dura mater was used to completely wrap the GDA stump and part of the common hepatic artery and the proper hepatic artery. The mean operative time was (308.1±93.1) min, the mean wrapping artery time was (18.7±7.5) min. Clinically relevant postoperative grade B pancreatic fistula (CR-POPF) occurred in 6 cases (13.3%), and intra-abdominal infection in 2 cases (4.4%).The rate of bile leakage was 2.2%.There were no second surgical operation, nor perioperative death. Postoperative delayed bleeding occurred in one case (2.2%) on the right hepatic artery branch near the hepatic portal. No pseudoaneurysm formation, nor bleeding occurring in any of the arteries wrapped by bio-artificial dura mater (including the GDA stump) after PD. There were no postoperative hepatic artery wrapping complications, such as hepatic artery stenosis, mesh-associated fluid accumulation and infection.Conclusion:Bio-artificial dura mater wrapping skeletonized hepatic artery technique in the process of pancreaticoduodenectomy can reduce the risk of delayed bleeding due to erosion of GDA stumps in case of post-PD pancreatic fistula.

Objective:To compare surgery-related indicators, patient recovery status, perioperative complications and risk factors affecting the occurrence of postoperative grade Ⅲ or higher complications in patients undergoing laparoscopic gastric mesenchymal tumor surgery with different visceral fat areas.Methods:Clinical data of 116 patients with gastric interstitial tumor in Shaanxi Provincial People′s Hospital from April 2014 to June 2020 were retrospectively analyzed, including 44 male patients and 72 female patients, with patient aged from 25 to 88 years old and the mean age was (61.8±10.7) years, including 54 patients in the high VFA group and 62 patients in the low VFA group. SPSS 23.0 was used for statistical analysis, and t-test and χ2 test were applied to compare and analyze the patients′ surgery-related indexes, postoperative recovery status, complications within 30 d after surgery and differences in Clavien-Dindo classification of complications, while univariate and multifactorial analyses were used to study the factors affecting the occurrence of postoperative grade Ⅲ or higher complications. Results:Patients in the high VFA group had a higher body mass index than in the low VFA group, and the difference was statistically significant ( t=4.48, P<0.001); patients in the high VFA group had longer operative time ( t=2.88, P=0.005), more intraoperative bleeding ( t=2.17, P=0.032), longer period of fasting ( t=2.73, P=0.008), longer time for defecation ( t=4.46, P<0.001) and bowel movement ( t=4.62, P<0.001), and longer postoperative hospital stay ( t=3.43) compared with those in the low VFA group ( t=2.73, P=0.001), prolonged defecation ( t=4.46), prolonged bowel movement ( t=4.62), and prolonged postoperative hospitalization ( t=3.43), with statistically significant differences ( P<0.05); the incidence of postoperative complications was significantly higher in the high VFA group (31.4%) compared with the low VFA group (14.5%) ( χ2=4.78, P=0.029); among them, the incidence of postoperative pulmonary infection was significantly higher in patients in the high VFA group (12.9%) compared with those in the low VFA group (1.6%), and the difference between them was statistically significant ( χ2=4.16, P<0.05); while the differences in postoperative incision-related complications, anastomotic fistula, lower limb venous thrombosis, and intestinal obstruction were not statistically significant ( P>0.05). The incidence of postoperative complications above grade Ⅲ of the Clavien-Dindo complication classification was significantly higher in patients in the high VFA group (16.7%) compared with those in the low VFA group (4.8%), and the difference between the two was statistically significant ( χ2=4.35, P<0.05); univariate analysis revealed that operative time ≥300 min and increased VFA were the risk factors for postoperative grade Ⅲ or higher complications, while VFA was not an independent risk factor. Conclusion:Larger visceral fat area increases the difficulty of laparoscopic gastric mesenchymal tumor surgery operation, and also affects patients′ postoperative recovery, leading to increased postoperative complications, but VFA is not an independent risk factor affecting the occurrence of postoperative grade Ⅲ or higher complications in patients with gastric mesenchymal tumor.

Objective:To investigate the risk factors affecting the occurrence of perioperative complications in patients with locally progressive gastric cancer undergoing radical gastric cancer treatment.Methods:The clinical data of 129 patients with locally progressive gastric cancer from January 2017 to December 2019 in Shaanxi Provincial People′s Hospital were retrospectively analyzed, including 98 males and 31 females, with an age ranged from 27 to 79 years and a mean age of (60.61±10.00) years. The postoperative complications of 129 patients with gastric cancer were firstly counted, and then the relationship between clinical data such as patients′ general condition, intraoperative status and pathological indexes and the occurrence of perioperative complications was analyzed by using univariate analysis, and significant factors were included in the logistic regression model for multifactor analysis to study the independent risk factors for the occurrence of perioperative complications.Results:Of the 129 patients, 25 cases (19.38%) had postoperative complications, including 10 cases (7.75%) with Clavien-Dindo classification combined with grade Ⅲ or higher complications. The results of univariate analysis suggested ACCI score >4 (30.76% vs 68.00%, χ2=11.86, P=0.001), body mass index ≥25 kg/m 2 (24.03% vs 60.00%, χ2=12.18, P=0.001), and preoperative hypoproteinemia (17.30% vs 36.00%, χ2=4.25, P=0.039), vascular cancer embolism (14.42% vs 40.00%, χ2=7.70, P=0.006), operative time ≥ 400 min (26.92% vs 52.00%, χ2=5.84, P=0.016), intraoperative bleeding ≥ 400 mL (13.46% vs 44.00%, χ2=12.03, P=0.001) were risk factors for the development of perioperative complications in patients with locally progressive gastric cancer. Multifactorial analysis showed that ACCI score >4, body mass index ≥25 kg/m 2, preoperative hypoproteinemia, vascular cancer embolism, and intraoperative bleeding ≥400 mL were independent risk factors for the occurrence of perioperative complications in patients with locally progressive gastric cancer ( P<0.05). Conclusions:The occurrence of perioperative complications in locally progressive gastric cancer hands was closely associated with ACCI score, body mass index, preoperative hypoproteinemia, vascular cancer embolism and intraoperative bleeding. ACCI score is expected to be a predictor of the occurrence of perioperative complications in patients with locally progressive gastric cancer.

Objective:To study the use of the da Vinci robot in distal pancreatectomy.Methods:The data of 53 patients who underwent minimally invasive distal pancreatectomy at the Department of General Surgery of the Affiliated Hospital of Xuzhou Medical University from February 2017 to March 2022 were retrospectively analysed. There were 16 males and 37 females, aged (48.2±16.9) years. These patients were divided into the robot assisted pancreatectomy group (the robot group, n=18) and the laparoscopic pancreatectomy group (the laparoscopic group, n=35) based on the surgical treatment methods. The operations were performed by the same team of surgeons. All patients were diagnosed to have benign or borderline malignant tumors of body and tail of pancreas by preoperative examinations. The success rate of spleen preservation distal pancreatectomy, operation time, intraoperative bleeding, and postoperative complications (including pancreatic fistula, postoperative bleeding, abdominal infection) were compared between the two groups. Results:Spleen preserving distal pancreatectomy was successfully carried out in 13 patients (72.2%) in the robot group and 15 patients (42.9%) in the laparoscopic group. The rate of spleen preservation in the robot group was significantly higher than that in the laparoscopic group (χ 2=4.11, P=0.043). Intraoperative blood loss (104.4±69.3) ml and time to first postoperative passage of flatus were (3.7±1.0) d in the robot group were significantly better than the laparoscopic group (199.4±102.9) ml and (4.8±1.3) d, respectively (both P<0.05). The total incidence of complications in the robot group was 7 cases (38.9%), compared with 14 cases (40.0%) in the laparoscopic group, with no significant difference between the two groups(χ 2=0.006, P=0.938). Conclusions:Robotic-assisted distal pancreatectomy was safe and feasible, and it had advantages in resulting in better spleen preservation than laparoscopic distal pancreatectomy.

Objective To evaluate the effect of Ulinastatin injection on inflammation, hemodynamics, oxygenation index (PaO₂/FiO₂) and prognosis in patients with septic shock. Methods A retrospective analysis was performed on clinical data of 109 patients with septic shock from January 2017 to December 2019. Patients were divided into observation group (n=73) and routine group (n=54) according to the treatment regimens. The two groups were given anti-shock treatment according to the relevant guidelines, and observation group was additionally given Ulinastatin. The inflammatory factors, hemodynamic parameters and PaO₂/FiO₂ and recovery were compared between the two groups before and after treatment. Results The levels of IL-6, TNF-α and PCT at 7 d of treatment were significantly decreased in the two groups (P<0.05), and the levels of IL-6, TNF-α and PCT of observation group were lower than that of routine group (P<0.05). At 12 h, 24 h and 72 h of treatment, the MAP, CI and PaO₂/FiO₂ were significantly increased in the two groups (P<0.05) while the EVLWI and SVRI were significantly decreased (P<0.05), and the MAP and PaO₂/FiO₂ of observation group at the same time were higher than that of routine group while the EVLWI was lower than that routine group (P<0.05). At 7 d of treatment, the APACHE-II score, mechanical ventilation time and ICU stay time of observation group were lower than that of routine group, and the incidence rates of MODS in the two groups were 4.11% and 14.81% respectively (P<0.05), and the mortality rates were 1.37% and 7.41% respectively (P>0.05). Conclusion Ulinastatin could be beneficial in septic shock, which could reduce inflammatory response, improve hemodynamic parameters and microcirculation perfusion, and put a positive effect on promoting rehabilitation and improving prognosis.