ObjectiveTo observe the distribution of traditional Chinese medicine （TCM） syndrome types in advanced pancreatic cancer patients， and explore the association between median survival time and different TCM syndromes and different intervention times of Chinese herbal medicine （CHM）. MethodsThe clinical data of 136 advanced pancreatic cancer patients who have received CHM for more than 3 months were collected retrospectively， including gender， age， family history， smoking history， drinking history， location of disease， lymph node metastasis， multiple distant metastasis， western medicine treatment methods， TCM diagnosis and treatment information， and survival time. The Kaplan-Meier （KM） estimator was used， and the median survival time of patients was calculated. The TCM syndrome type of each patient was judged， and the main single syndrome types and compound syndrome types were summarized. The median survival time was compared among different compound syndrome types. The patients were further divided into the group of those having received CHM ≥6 months and those having received CHM ＜6 months. Whether receiving CHM ≥6 months was taken as the grouping variable， while the matching variables were age， gender， family history， smoking history， drinking history， location of disease， lymph node metastasis， multiple distant metastasis， surgery， chemotherapy， and radiotherapy when propensity score matching was performed， and the difference in median survival time between the two groups of patients before and after matching was compared. ResultsFor 136 cases of advanced pancreatic cancer， the top five single syndromes were spleen qi deficiency， liver blood stasis， liver qi stagnation， spleen dampness， and liver heat. The main compound types were liver constraint， spleen deficiency and blood stasis syndrome， liver-gallbladder damp-heat and blood stasis syndrome， liver constraint， qi stagnation and spleen deficiency syndrome， spleen-stomach yang deficiency and blood stasis syndrome， and spleen deficiency and dampness-heat internal accumulation syndrome. The overall median survival time before and after matching was 12.47 （7.70，17.10） months and 13.77 （8.83，17.20） months， respectively， and was significantly higher in the group treated with CHM ≥ 6 months than that treated with CHM ＜6 months （P＜0.05）. Among the 136 patients before matching， the median survival time of patients with spleen deficiency and dampness-heat internal accumulation syndrome was longest ［16.23 （14.17，19.40） months］， while that of patients with spleen-stomach yang deficiency and blood stasis syndrome was the shortest ［7.33 （5.80，12.83） months］. For patients with liver constraint， spleen deficiency and blood stasis syndrome， liver-gallbladder damp-heat and blood stasis syndrome， and spleen-stomach yang deficiency and blood stasis syndrome， those having received CHM ≥ 6 months have much longer median survival time than those having received CHM ＜6 months （P＜0.05）. Among the 108 patients after matching， the median survival time of those with spleen deficiency and dampness-heat internal accumulation syndrome was the longest ［15.23 （7.67，18.27） months］， while that of spleen-stomach yang deficiency and blood stasis syndrome was the shortest ［8.80 （6.90，16.17） months］. For patients with liver-gallbladder dampness-heat and blood stasis syndrome and spleen-stomach yang deficiency and blood stasis syndrome， the median survival time was higher in the group treated with CHM ≥ 6 months treated with CHM ＜6 months （P＜0.05）. ConclusionAfter treatment with CHM， advanced pancreatic cancer patients with spleen deficiency and damp-heat internal accumulation had a better prognosis， while those with spleen-stomach yang deficiency and blood stasis had a worse prognosis. Treatment with CHM ≥ 6 months could extend the median survival of advanced pancreatic cancer patients with liver-gallbladder damp-heat and blood stasis syndrome and spleen-stomach yang deficiency and blood stasis syndrome.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective:To explore the diagnosis and treatment of lymphoepithelioma-like intrahepatic cholangiocarcinoma(LEL-ICC).Methods:The retrospective and descriptive study was conducted. The data of 7 patients with pathological diagnosis of LEL-ICC after hepatectomy who were treated in Lishui Central Hospital in Zhejiang Province from December 1, 2009 to January 30, 2024 were collected. There were 2 males and 5 females. The age range was from 40 to 64 years old, with a median age of 52 years old. All 7 patients showed no obvious clinical symptoms.We analysed the imaging manifestations, pathological features, treatmentsand prognoses of patients.Postoperative follow-upswere conducted via telephone, with a focus on whether the patient had relapsed. The deadline was February 20, 2024.Results:Five cases underwent ultrasound examination, of which 4 cases showed hypoechogenicity and 1 case showed hyperechogenicity. 7 cases underwent MRI examination, showing low signal on T1WI, high signal on T2WI, and high signal on diffusion-weighted imaging. 2 cases had type A enhancement, 2 cases had type B enhancement, and 3 cases had type C enhancement. All 7 cases received surgical treatment, 2 cases were received prophylactic transarterial chemoembolization (TACE) after surgery, and 3 cases were received systemic chemotherapy after surgery; All 7 cases underwent postoperative follow-up, with a follow-up time of 1-166 months and a median follow-up time of 56 months. One case developed hilar and retroperitoneal lymph node metastasis after surgery for 6 months, and underwent surgical treatment. After surgery, chemotherapy was performed. 25 months later, right adrenal gland metastasis reappeared, and after combined treatment, the metastatic lesion was reduced and the patient received surgical treatment and chemotherapy, and there is currently no recurrence. The remaining 6 cases showed no recurrence.Conclusions:LEL-ICC lacks specific clinical symptoms and imaging manifestations, diagnosis relies on histopathological and immunohistochemical examinations. Comprehensive treatment with surgical intervention as the main approach can lead to better prognosis for patients.

Objective:To conduct the clinical effect achieved by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis.Methods:From June 2021 to December 2022, a study was conducted on patients with bilateral bromhidrosis in the Department of Plastic Surgery, Jining First People’s Hospital. The study used a self-control method, with one side undergoing axillary flap trimming combined with scraping through small axillary incisions (designated as Group A), while the other side underwent direct axillary flap trimming through central axillary incisions (designated as Group B). Randomization was achieved using a number table method for both sides. In Group A, two short incision lines of 0.5-1.0 cm were designed on both sides of the armpit. These incisions separated all layers of the skin, and excised the sweat glands and fat tissue. Additionally, two drainage openings were left in the surgical area to maintain two drainage tubes through the surgical incision. In Group B, the incision lines of 2-3 cm were designed in the central axillary area. After incision and dissection, four drainage tubes were retained in the operation area. The efficacy evaluation consisted of three aspects: the surgical outcome one month post-operation, categorized as cure, effective, or ineffective; the recurrence of bromhidrosis six months post-operation; and the occurrence of surgical complications. SPSS 25.0 software was used for data analysis, and chi-square test was applied for the comparisons between the two groups in terms of response rate, recurrence rate, and complication rate. A statistically significant difference was determined at the P<0.05 level. Results:A study was conducted on 62 patients, aged between 16 and 35 years, with bilateral bromhidrosis, including 38 males and 24 females. In Group A, 55 patients achieved complete cure, while 7 patients experienced significant improvement, resulting in an overall effectiveness rate of 100%. However, 5 cases of recurrence were observed, with a recurrence rate of 8.1%. Additionally, there were 1 case of subflap hematoma, 2 cases of flap erosion, and 1 case of scar hypertrophy, resulting in a complication rate of 6.5%. In Group B, 58 patients achieved complete cure, while 4 patients experienced improvement, resulting in an overall effectiveness rate of 100%. Three cases of recurrence were reported within 6 months, with a recurrence rate of 4.8%. Furthermore, there were 4 cases of subflap hematoma, 4 cases of flap erosion, 2 cases of flap necrosis, and 4 cases of scar hypertrophy, resulting in a complication rate of 22.6%. Statistical analysis showed no significant difference in treatment response rate ( χ2=0.34, P=0.559) or postoperative recurrence rate ( χ2=0.53, P=1.000) between the two groups. However, the complication rate in Group A was significantly lower than that in Group B ( χ2=6.50, P=0.011). Conclusion:The clinical outcome is satisfactory, achieving a high rate of effectiveness by the combination of axillary flap trimming and scraping through small axillary incisions in treating bromhidrosis. And the complications are fewer compared to the direct axillary flap trimming through central axillary incisions.

Objective:To explore the clinical manifestations, diagnosis and treatment methods, and prognosis of acute portal vein thrombosis after hepatectomy.Methods:Retrospective case analysis was used in the case data of 11 patients with acute portal vein thrombosis after hepatectomy, who were treated in Lishui Central Hospital of Zhejiang Province from January 2018 to August 2023, including their demographic characteristics, clinical manifestations, test results, imaging examinations, treatment plans, and prognosis.Results:The diagnostic time of PVT was 4-15 days after surgery. 5 cases were main portal vein thrombosis, including 2 cases who were accumulated splenic vein and superior mesenteric vein, and 6 cases were portal vein branch thrombosis. 2 cases had fever, 3 cases had abdominal distension, 3 cases had ascites, and 5 cases had no obvious clinical symptoms. Patients may experience elevated bilirubin, elevated transaminase, prolonged prothrombin time, and elevated D-2 dimer levels during PVT. 10 cases were diagnosed through CT enhancement, and 1 case was first diagnosed through ultrasound examination. 11 patients who diagnosed with PVT were received anticoagulant therapy, with 6 patients receiving a combination of circulatory improvement drugs. One patient progressed to liver failure, and 10 patients had thrombus disappearance, who were receivedsatisfactory clinical efficacy.Conclusions:Early detections and treatments are the key to treating the acute PVT after hepatectomy. If possible, anticoagulant therapy should be used as soon as possible after surgery. For main grade 3 portal vein thrombosis, early surgical thrombectomy should be considered. At present, there is a lack of effective prevention and prediction methods for acute PVTafter hepatectomy, and thefurther research and exploration are needed.

OBJECTIVE To observe th e efficacy and safety of intermittently repeated application of levosimendan in the treatment of right heart failure of pulmonary hypertension. METHODS A total of 70 cases of right heart failure of pulmonary hypertension were collected from the First Affiliated Hospital of Guangxi Medical University during Jan. 2019-May 2021，and then randomly divided into control group and observation group ，with 35 cases in each group.In control group ，the patients with moderate risk of classification of pulmonary hypertension were given Tadalafil tablets and Ambrisentan tablets ，while the patients with high risk were given Tadalafil tablets ，Ambrisentan tablets and Treprostinil injection ；both were given anti-right heart failure drugs at the same time. On the basis of treatment in the control group ，patients in the observation group were additionally intravenously pumped with levosimendan injection 12.5 mg，once a month ，at a rate of 0.05-0.1 μg/（kg·min），3 months in total. Response rate of therapy ，improvement of risk stratification of pulmonary hypertension after treatment ，and average pulmonary artery pressure ，six-minute walk distance （6MWD），serum level of N-terminal pro brain natriuretic peptide （NT-proBNP），right atrial pressure （RAP），oxygen saturation in mixed venous blood （SvO2），cardiac index （CI），right ventricular ejection fraction （RVEF），early diastolic tricuspid inflow velocity/early diastolic tricuspid annular velocity （E/Ea），tricuspid annular plane systolic excursion（TAPSE），right ventricular end-diastolic diameter （RVEDD），right ventricular end-systolic diameter （RVESD）before and after treatment ，and the occurrence of adverse reactions were observed in 2 groups. RESULTS The total response rate of observation group was significantly higher than control group after treatment （P＜0.05）. After treatment ，average pulmonary artery pressure，NT-proBNP level ，RAP，E/Ea，RVEDD and RVESD of 2 groups were significantly lower than before treatment ，while 6MWD，SvO2， CI， TAPSE and RVEF were significantly higher than before treatment ；NT-proBNP level and E/Ea of observation group were significantly lower than control group ， while 6MWD，CI，TAPSE and RVEF were significantly higher than control group （P＜0.05 or P＜0.01）. There was no significant difference in average pulmonary artery pressure ， risk stratification improvement cases of pulmonary hypertension ， RAP， SvO2， RVEDD， RVESD and the incidence of asymptomatic hypotension between 2 groups（P＞0.05）. CONCLUSIONS Intermittently repeated application of levosimendan can improve the function of right heart of pulmonary hypertension complicated with right heart failure and has good safety.

Objective:To investigate the difference of functional connectivity(FC) between the habenula and other brain regions in the patients with first-episode current depression (fMDD) and remitted depression (rMDD).Methods:Thirty-five patients with first-episode current depression (fMDD), 35 patients with remitted depression (rMDD) and 30 healthy controls (HC) matched with gender, age and education years were scanned by resting-state fMRI. Hamilton Depression Scale (HAMD 17) was used to assess the severity of the patients. After preprocessing, seed-based FC analysis was performed on the habenula. Pearson correlation analysis was performed between the FC values and HAMD 17 and duration of disease. Results:(1) Compared with the HC group, FC decreased between the habenula and left middle occipital gyrus(l-MOG) in fMDD group (x, y, z=-48, -84, 3, t=-4.335, P<0.05), while FC increased between the habenula and left supramarginal gyrus (x, y, z=-66, -30, 36, t=4.876, P<0.05), left superior frontal gyrus(l-SFG) (x, y, z=-6, -33, 51, t=4.402, P<0.05), left inferior parietal lobe(l-IPL)( t=3.300, P<0.05) and right inferior parietal lobe(r-IPL) ( t=3.557, P<0.05) in fMDD group. Compared with the HC, FC decreased between the habenula and l-MOG (x, y, z=-48, -84, 3, t=-4.321, P<0.05) and left thalamus (x, y, z=-9, 3, 3, t=-3.971, P<0.05) in rMDD group, while FC increased between the habenula and left middle temporal gyrus(l-MTG)( x, y, z=-48, -39, 9, t=4.062, P<0.05), left supramarginal gyrus (x, y, z=-51, -15, 45, t=2.906, P<0.05), l-SFG (x, y, z=-24, -21, 39, t=3.044, P<0.05), l-IPL ( t=2.880, P<0.05) and r-IPL ( t=3.512, P<0.05) in rMDD group. (2) FC decreased in fMDD group between the habenula and right orbitofrontal cortex(r-OFC) ( t=-3.899, P<0.05) and l-MTG ( t=-4.023, P<0.05) than rMDD group, while FC increased between the habenula and left supramarginal gyrus ( t=4.157, P<0.05), l-SFG( t=3.327, P<0.05), left thalamus ( t=3.316, P<0.05) and l-IPL ( t=3.909, P<0.05) than rMDD group. (3)There was no significantly correlation between the HAMD 17 and the FC value changes among the different regions, and was marginal significantly correlation between duration of disease and the FC values from the habenula and l-MOG( r=0.328, P=0.063). Conclusion:Both fMDD and rMDD show abnormal FC between the habenula and default mode network, visual network and reward network, which may be related to the pathogenesis of depression. The FC of the habenula in rMDD still had not recovered to normal.

Objective To explore the effect of supplemental parenteral nutrition (SPN) combined with early enteral nutrition (EN) for enhanced recovery in postoperative liver cancer patients.Methods From June 2015 to June 2018,liver cancer patients admitted to our hospital were randomly divided into two groups with 47 patients receiving SPN combined with early EN in the study group and 45 patients receiving early EN in the control group.Results There were no significant difference in bilirubin recovery,liver enzyme recovery,postoperative exhaust and defecation time and complication rate between the two groups (P ＞ 0.05).In study group prealbumin (PAB) synthesis recovered faster (F =7.89,P =0.006),albumin use was significantly lower (t =-2.29,P =0.0024),and postoperative hospital stay was shorter (t =2.46,P =0.016).Conclusion In ERAS patients with liver cancer,the combination of SPN and early EN provide reasonable energy support to improve nutritional status and accelerate patient recovery.

Objective To explore the developmental characteristics of white matter volume in autism spectrum disorder (ASD) children longitudinal.Methods From May 2011 to September 2014,37 ASD children (ASD group)and 27 developmental delays (DD) children (control group) were treated at the Child Mental Health Research Center,Nanjing Brian Hospital Affiliated of Nanjing Medical University,and the children whose age,gender and developmental quotient matched with the ASD children were scanned by structure magnetic resonance imaging (sMRI) at the age of 2-3 years old and 4-5 years old respectively.Region of interest (ROI) technology was adopted to investigate the change of the cerebrum white and the sub-lobes structure white matter volume with time.Then the correlation between clinical symptoms and brain white matter volume changes was analyzed.Results Among the 2-3 years old,compared with the control group,the white matter volume of the total brain[(383 521.84 ±6 427.57) mm3 vs.(364 014.06 ±6 856.97) mm3],the left cerebral hemisphere [(191 609.35 ± 3 206.60) mm3 vs.(181 695.89 ± 3 389.54)mm3],temporal lobe [(41 860.49 ±816.38) mm3 vs.(39 444.18 ± 834.85) mm3] and the right temporal lobe [(21 312.79 ± 414.07) mm3 vs.(20 084.22 ± 412.13) mm3] were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age or the total brain volume as the covariate,the differences disappeared(all P ＞ 0.05).Among the 4-5 years old,compared with the control group,the white matter volumes of the total brain[(417 651.42 ± 6 443.86) mm3 vs.(394 317.27 ± 6 404.86)mm3],left cerebral hemisphere [(208 714.16 ±3 214.61) mm3 vs.(197 192.82 ±3 262.02) mm3],right cerebral hemisphere [(208937.26±3242.09) mm3 vs.(7 124.45 ±3 193.13) mm3],frontal lobe [(107 107.46±1 681.99) mm3 vs.(100 326.19 ± 1 883.24) mm3],left frontal lobe [(54 569.63 ± 846.85) mm3 vs.(51 177.25 ±979.09) mm3],right frontal lobe [(52 537.83 ± 841.99) mm3 vs.(49 148.94 ±928.31) mm3],temporal lobe [(45 189.75 ± 833.29) mm3 vs.(42 487.73 ± 786.27) mm3],left temporal lobe [(22 204.21 ±411.77) mm3 vs.(20 922.90 ± 418.46) mm3],and right temporal lobe [(22 985.54 ± 426.93) mm3 vs.(21 564.83 ± 378.78) mm3]were significantly larger in the ASD group,and the differences were statistically significant (all P ＜ 0.05).With the analysis of covariance with age as the covariate,the differences still existed (all P ＜ 0.05).With the analysis of covariance with the total brain volume as the covariate,the differences disappeared (all P ＞ 0.05).For longitudinal analysis,there was a significant difference in the white matter volume between the whole brain,left cerebral hemisphere,right cerebral hemisphere,frontal lobe,left frontal lobe,fight frontal lobe,temporal lobe,left temporal lobe,right temporal lobe and the differences were statistically significant (F =5.521,5.533,5.459,5.830,5.800,5.723,4.857,4.418,5.159,all P ＜0.05).There was a positive correlation between the changes of the volume of whole brain,the white matter volume in the whole brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe,right parietal lobe and Childhood Autism Rating Scale (r =0.367,0.343,0.321,0.349,0.296,0.308,0.351,all P ＜ 0.05).Conclusions Among the 2-3 years old,the white matter volume of the brain regions have been increased significantly in ASD.Among the 4-5 years old,the increase of the white matter volume of the brain regions implicated more widely which mainly concentrated in the frontal and temporal lobe in ASD.The severity of the clinical symptoms of ASD may be associated with the white matter volume of the total brain,bilateral cerebral hemisphere,frontal lobe,parietal lobe and right parietal lobe.

Objective To observe the effect of vancomycin-loaded calcium sulfate for one-stage treatment of chronic osteomyelitis.Methods A retrospective case series study was made on 26 patients with chronic osteomyelitis treated from January 2014 to April 2016.There were 23 males and 3 females,with a mean age of 35.8 years (range,16-90 years).After focus debridement of osteomyelitis,the cavities were filled with vancomycin-loaded calcium sulfate and systemic antibiotics were used.Meanwhile,gentamicin was added to patients showing unclear pathogens.Three patients underwent flap transfer surgery simultaneously due to the inadequate soft tissue coverage.Wound healing,local redness and swelling,sinus recurrence,recovery of osteomyelitis and repair of bone defect were detected after operation.Results All patients were followed up for 6-30 months (mean,19.5 months).Primary healing was achieved in all patients.One patient experienced wound exudate and was effectively managed by dressing change,one patient experienced inadequate local soft tissue coverage and was effectively managed by a second flap transfer surgery,and one patient remained wound unhealing after two surgeries and was cured by infected bone resection using the Masquelet induced membrane technique.Follow-up showed local bone defect was repaired in all patients without bone infection recurrence.Conclusions For patients with chronic osteomyelitis,one-stage surgery with vancomycin-loaded calcium sulfate can control infection with simultaneous repair of bone defect.Therefore,the procedure is a simple and effective method and worthy of clinical practice.