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 investigate the risk factors and their early warning effectiveness for the occurrence of early neurological deterioration (END) in patients with moderate traumatic brain injury (modTBI).Methods:A retrospective cohort study was conducted to analyze the clinical data of 265 patients with modTBI admitted to the Second Affiliated Hospital of Fuyang Normal University from January 2018 to April 2023. There were 165 males and 100 females, with age range of 20-91 years [(59.5±14.4)years]. The patients were divided into END group ( n=46) (17.4%) and non-END group ( n=219) (82.6%) according to whether the Glasgow Coma Score (GCS) decreased by 2 points or more within 72 hours after injury. Data of the two groups were recorded, including gender, age, basic diseases (hypertension and diabetes), cause of injury (traffic injuries, falls, etc), vomiting before admission, admission GCS, first CT scan time, epilepsy, brain contusion, subarachnoid hemorrhage, types of intracranial hematoma (epidural, subdural, and intracerebral hematoma), types of fracture (skull base fracture and skull fracture), laboratory indicators [platelet count (PLT), blood potassium level, serum total calcium concentration, thrombin time (TT), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), level of fibrinogen (FIB), and level of D-dimer. Correlations between above-mentioned indicators and occurrence of END among modTBI patients were assessed and the independent risk factors were revealed by univariate and multivariate binary Logistic regression analysis. Receiver operating characteristic (ROC) curve and area under curve (AUC) were used to evaluate the early-warning effectiveness of each risk factor for END. Results:Univariate analysis showed that admission GCS, first CT scan time, epidural hematoma, subdural hematoma, intracerebral hematoma, serum potassium level, FIB and D-dimer were statistically correlated with occurrence of END among modTBI patients ( P<0.05 or 0.01). Multivariate binary Logistic regression analysis showed that admission GCS≤10 points ( OR=0.53, 95% CI 0.34, 0.84, P<0.01), first CT scan time≤2.0 hours ( OR=0.58, 95% CI 0.37, 0.92, P<0.05), epidural hematoma ( OR=0.26, 95% CI 0.10, 0.69, P<0.05), intracerebral hematoma ( OR=0.14, 95% CI 0.04, 0.44, P<0.01), level of FIB≤2.3 g/L ( OR=0.34, 95% CI 0.18, 0.64, P<0.01), level of D-dimer>10.4 mg/L ( OR=1.04, 95% CI 1.02, 1.07, P<0.01) were independent risk factors for END among modTBI patients. ROC curve analysis showed that the first CT scan time had relatively higher early warning value (AUC=0.79, 95% CI 0.74, 0.84), level of D-dimer (AUC=0.75, 95% CI 0.70, 0.80) and level of FIB (AUC=0.70, 95% CI 0.65, 0.76) had moderate early warning value, which was higher than that of admission GCS (AUC=0.62, 95% CI 0.56, 0.68), intracerebral hematoma (AUC=0.62, 95% CI 0.56, 0.68) and epidural hematoma (AUC=0.60, 95% CI 0.54, 0.66). The combination of the risk factors revealed superior early warning efficiency for END (AUC=0.90, 95% CI 0.85, 0.93). Conclusions:Admission GCS≤10 points, first CT scan time≤2.0 hours, epidural hematoma, intracerebral hematoma, level of FIB≤2.3 g/L and level of D-dimer>10.4 mg/L are independent risk factors for END among modTBI patients. The early warning value of the first CT scan is the highest, followed by D-dimer and FIB, and the early warning effectiveness of admission GCS, intracerebral hematoma and epidural hematoma is ordinary.The combination of the above risk factors has better early warning efficiency for occurrence of END among modTBI patients.

Objective To preliminarily analyze the acute myocardial damage and important risk factors caused by sepsis in children in Qinghai, and analyze and discuss preventive measures on the basis of the foregoing. Methods The study selected 385 children with sepsis in our hospital from January 2016 to December 2020 and included 158 children with acute myocardial damage caused by sepsis (case group), and the remaining 227 cases (control group) were not seen Myocardial damage. The study collects basic information such as sociodemographic information of all children, and collects serum troponin I (cTnI) and CK-MB levels (determined by chemiluminescence method); as well as serum CRP levels and PCT levels. To compare and analyze the levels of related indexes in children with myocardial damage, and the differences from those in the control group. Then analyze and see the risk factors that are potentially associated with acute myocardial damage. Use SPSS statistical software package to analyze the data. cTnI enzyme-labeled immunoassay assay, reagents are provided by Nanjing Jidan Biotechnology Co., Ltd.; medicine is (0.00~0.01) μg/mL, cTnI level normal group (≤0.01 μg/mL) and cTnI level elevated group ( > 0.01 μg/mL) ); CK-MB>5 ng/mL is the positive standard for myocardial muscle injury; CRP medical reference value < 8mg/L, PCT< 0.1 ng/mL; CRP is detected by the turbidimetric method, and the instruments and reagents are manufactured by German Deling BNⅡ specific protein analyzer and original matching reagents. Pediatric Critical Case Score (PCIS) and Pediatric Death Risk Factor Score (PRISM Ⅲ) (evaluate twice, take the lowest value). Results In this study, the majority of male children were male, and the proportion of children with active myocardial damage had a higher proportion of low-grade fever. At the same time, the disease was more severe than the control group. It can be seen that the PCIS score is lower and the PRISM Ⅲ is higher. The difference is statistically significant. (P<0.05). The serum troponin I (cTnI), CK-MB, CRP, and PCT levels in the case group were significantly higher than those in the control group, and the differences were statistically significant (P<0.05); the serum albumin levels were significantly lower than those in the control group, and the differences were statistically significant Scientific significance (P<0.05); the risk factor analysis was carried out with the presence of myocardial damage as the dependent variable, and the potential influencing factors as the independent variables (social demographic factors, basic conditions of hospitalization, levels of indicators related to myocardial damage, etc.). Including single factor analysis (adjustment for potential confounding factors) and multivariate analysis. The results showed that increased age, low fever, increased PCT, low albumin level ( ≤ 25g/L), and increased PRISMⅢ were risk factors for myocardial damage (P<0.05). Conclusions Acute myocardial damage caused by sepsis in children with sepsis can be seen in male children, and children with active myocardial damage have a higher proportion of low-grade fever. At the same time, the condition is more severe than that of the control group. It can be seen that the PCIS score is higher. Low, higher PRISMⅢ, and other significant characteristics; analysis of potential influencing factors suggests that increased age, low fever, increased PCT, low albumin levels, and increased PRISMⅢ are positively correlated with the increased risk of acute myocardial damage in children. Therefore, it is planned to be clinically 1. Pay attention to older children with low fever and more critically ill children; 2. Detect or monitor the levels of PCT and albumin in children to early warn the occurrence of myocardial damage; carry out necessary and timely warning and prevention.

Objective:To investigate the characteristics and risk factors of local recurrence in resected pancreatic cancer.Methods:The clinicopathological data of 190 patients in whom recurrent sites can be identified after radical resection of pancreatic cancer from Sep 2013 to Aug 2020 at the Cangzhou Central Hospital were retrospectively analyzed. The survival time and clinicopathological characteristics of local recurrence were compared with those of other recurrence types. Cox risk regression model was used to analyze the risk factors of local recurrence.Results:The recurrence sites were local (49 cases, 25.8%), liver (53 cases, 27.9%), lung (35 cases, 18.4%), peritoneal (25 cases, 13.2%) and multiple sites (28 cases, 14.7%). Patients mRFS and mOS were 17.8 months and 30.9 months respectively. The clinicopathological features of patients with local recurrence were compared with those of other recurrence types [tumor diameter ( P=0.023), preoperative CA199 level ( P=0.021), peripancreatic nerve plexus invasion ( P=0.031), lymphovascular invasion ( P=0.004), surgical margin state ( P<0.001) and postoperative adjuvant chemotherapy ( P=0.038)]. Tumor diameter ( P=0.018), peripancreatic nerve plexus invasion ( P=0.002) and postoperative adjuvant chemotherapy ( P=0.004) were independent factors for local recurrence in resected pancreatic cancer, and only peripancreatic nerve plexus invasion was not associated with other recurrence types. Conclusions:Local recurrence in resected pancreatic cancer has important impact on the prognosis of patients. Peripancreatic nerve plexus invasion is an independent factor affecting local recurrence.

Objective To analyze the clinical characteristics and risk factors of myocardial damage in children with mycoplasma pneumonia in Qinghai area, and to provide evidence for clinical diagnosis and treatment. Methods A total of 328 children diagnosed with mycoplasma pneumonia in Qinghai region from June 2016 to June 2020 were selected as the research subjects. According to whether they were complicated with myocardial damage, they were divided into the control group (no myocardial damage, n=185) and the experimental group (complicated with myocardial damage, n=143). The data of the children were collected by using a questionnaire made by our hospital. These included gender, age, fever duration, initiation time of macrocyclic esters and fever degree, etc., and the levels of CK-MB, CK, CTNNI, NT-proBNP, CRP, LDH and RDW were determined. RESULTS: There were no significant differences in age, gender and complications between the two groups (P>0.05). There were statistically significant differences in the use time, fever duration and fever degree between the two groups (P<0.05). In terms of laboratory indicators, there were statistically significant differences in the levels of CK-MB, CK, cTNnI, NT-probNP, CRP, LDH and RDW between the two groups (P<0.05).Logistic regression analysis showed that the duration of fever (OR=3.105), the start time of macrolides (OR=1.457), the degree of fever (OR=2.495), CRP(OR=1.853) and RDW(OR=1.358) were the risk factors for myocardial damage in children with mycoplasma pneumonia in Qinghai area (P<0.05). Conclusion The duration of fever, the initiation time of macrolide drugs, the degree of fever, CRP and RDW are independent risk factors for myocardial damage in children with mycoplasma pneumonia in Qinghai area. The early use of macrolide drugs can prevent myocardial damage, improve the treatment effect and improve the prognosis of children.

Objective:To investigate the short-term outcome of Heidelberg triangle dissection in laparoscopic pancreaticoduodenectomy (LPD) for pancreatic cancer.Methods:The clinical data of 84 patients with pancreatic head cancer who underwent LPD from July 2015 to September 2020 in the Department of Hepatobiliary and Pancreatic Surgery of the Cangzhou Central Hospital were retrospectively analyzed. According to the scope of surgical dissection, the patients were divided into the control group ( n=45) and the Heidelberg group ( n=39). In the control group, routine lymph node dissection was performed, and in the Heidelberg group, all blood vessels, lymphatic tissue and nerve tissue in the Heidelberg triangle area were dissected on the basis of routine lymph node dissection. Operation-related indicators (operation duration, intraoperative blood loss, cases of patients with intraoperative blood transfusion, fasting time and hospitalization duration after operation), postoperative complications (pancreatic fistula, biliary fistula, lymphatic fistula, bleeding and delayed gastric emptying) and postoperative pathological parameters (surgical margin, degree of differentiation, tumor size, cases of nerve invasion, number of dissected lymph nodes, lymph node metastasis and TNM stage) were compared between the two groups. Results:Compared with the control group, the operation time of the Heidelberg group was longer [ (334.85±24.95)min vs (305.09±24.54)min], theincidence of lymphatic fistula was higher (15.4% vs 2.2%), the rate of >1 mm at surgical margin was higher (76.9% vs 53.3%), and the total number of lymph nodes dissection was more [ (11.31±2.46) vs (9.49±2.28)]. All the differences between the two groups were statistically significant ( P<0.05). However, there were no significant differences on the intraoperative blood loss, cases of patients with intraoperative blood transfusion, postoperative hospital stay and fasting time, incidence of pancreatic fistula and biliary fistula, bleeding, delayed gastric emptying, degree of differentiation, tumor size, cases of nerve invasion, lymph node metastasis and TNM stage between the two groups. Conclusions:LPD combined with Heidelberg triangle dissection for pancreatic cancer was feasible and safe, which can increase the R 0 resection rate, remove more lymph nodes, reduce the local recurrence of pancreatic cancer and improve the prognosis of patients.

Objective to investigate the feasibility of laparoscopic radical resection for hilar cholangiocarcinoma.Methods From June 2016 to June 2018,30 patients with hilar cholangiocarcinoma (HCC) underwent total laparoscopic radical resection.Results Surgery was successfully performed in all cases without conversion,15 cases underwent hilar bile duct resection,and hilar lymph node dissection,14 cases underwent left hemi-hepatectomy and caudate lobectomy,and 1 case underwent extrahepatic bile duct resection.The operation time was 258-336 min,(286.8 ± 18) min,intraoperative bleeding was 60-210 ml (139.7 ±38.0) ml.Postoperative bile fistula occurred in 5 cases,healed conservatively after 5 days,stress ulcer in 1 case,and intestinal anastomotic bleeding in 1 case,were all cured by themselves.Postoperative hospitalization was 7-12 days (mean 8.9 d).After 6-12 months follow-up,3 cases died of recurrent and metastatic cancer after 6 months of operation,27 cases were alive.Conclusion Total laparoscopic radical resection of hilar cholangiocarcinoma is safe and feasible.

Objective To investigate the clinical features of Menetrier disease and the related treatment progresses.Methods The clinical data of 7 patients with Menetrier disease who were admitted to Cangzhou Central Hospital from Jan 1997 to Mar 2018 were retrospectively analyzed.Results There were 3 males and 4 females.The main clinical manifestations were abdominal pain (n =5),loss of appetite (n =4),nausea and vomiting (n =2),weight loss (n =4),edema (n =3),hypoalbuminemia (n =6) and anemia (n =6).All patients had typical imaging findings.Two of the patients underwent non-surgical treatmen with temporary symptom reliefs.Finally,6 patients received surgical treatment including Subtotal gastrectomy in 1 patient,total gastrectomy in 5 patients.All the 6 cases underwent surgery successfully with no serious complications.5 cases were followed-up data until April 2018.All were in good condition,Hemoglobin and albumin levels were within the normal range.Conclusion According to the clinical manifestations and the related auxiliary examinations,this disease is easy to diagnose.Surgical treatment is the only way to cure Menetrier disease.

Objective To investigate the association between gallstone and non-alcoholic fatty liver disease (NAFLD)in middle-aged and elderly Chinese. Methods A cross-sectional study was conducted in 8934 Chinese adults from Jiading District, Shanghai. Questionnaire interview, anthropometric measurements, biochemical evaluation, and abdominal ultrasonography were performed in all the participants. Results Compared with participants without gallstone,individuals with gallstone had significantly higher prevalence of NAFLD(28.8% and 42.9%,respectively;P<0.01). Using participants without gallstone as the reference,participants with gallstone were associated with an increased risk of NAFLD after adjustment for multiple covariatesodds ratios(OR)and 95% confidence interval(CI)was 1.39(1.45-1.69). In addition,compared with participants without cholecystectomy, participants with cholecystectomy were associated with an increased risk of NAFLD(OR=1. 44, 95% CI 1. 04-1.99). Conclusion The presence of gallstone and cholecystectomy were positively associated with NAFLD in middle-aged and elderly Chinese.

A method for the determination of three volatile elements (mercury, arsenic and selenium) in soils by one-time digestion was established.The digestion of samples was carried out in an automatic program temperature controlled graphite digestion instrument by aqua regia + hydrofluoric acid+boric acid.Hydride generation atomic fluorescence spectrometry (HG-AFS) was used to determine the contents of mercury, arsenic and selenium in the same digestion solution.The accuracy of the method was verified by the results of the soil environment samples of certified reference materials GSS-1-GSS-8 from the Center of the National Standard.The contents of soil mercury, arsenic and selenium obtained by this method were consistent with the standard values of these elements provided by the Center of the National Standard.In comparison with the current standard methods, the one-time digestion method was simplified, the pre-processing time was saved, and the reagent consumption was reduced.The method had wide range of application, high sensitivity, low detection limit, which was especially suitable for trace analysis of bulk samples, and also it could be used as a rapid digestion method for the measurement and governance of heavy metals in polluted soils.