Objective To observe the effects of marzulene(L-glutamine and sodium gualenate)on cellular immune function in patients with severe acute pancreatitis(SAP). Methods A prospective study method was conducted in which 80 patients with SAP were divided into trial group and control group(each 40 cases)according to the table of random number methods,and in the mean time 20 healthy volunteers were enrolled in the healthy control group. Both SAP groups received standard total parenteral nutrition(TPN)with same quantities of heat and nitrogen, and the trial group additionally accepted intravenous drip of marzulene 0.4 g?kg-1?d-1(once a day)for 7 days,while the control group received the same amount of normal saline intravenous drip for 7 days. One day before treatment and on the 7th day after treatment,the peripheral venous blood samples were collected. The T-lymphocyte proliferation activity was tested by methyl thiazolyl tetrazolium(MTT)assay,and the interleukin-2(IL-2)and interleukin-6(IL-6) secretion levels were detected by enzyme-linked immunosorbent assay(ELISA). Results Compared to the healthy control group,the levels of T lymphocyte proliferation activity〔absorbance(A)value〕and IL-2(ng/L)were markedly decreased and IL-6(ng/L)secretion level was obviously increased before treatment in the two SAP groups(P<0.05 or P<0.01). Compared to prior treatment,the levels of T lymphocyte proliferation activity and IL-2 were significantly increased after 7 days of treatment in the trial group(both P<0.05),and basically restored to normal levels,while in the control group they were progressively decreased(both P<0.05),the levels in trial group being significantly higher than those of the control group(T lymphocyte proliferation activity:1.08±0.27 vs. 0.43±0.25,IL-2:16.5±1.4 vs. 9.4±2.9,both P<0.05),but compared to prior treatment,the level of IL-6 was significantly decreased in the two SAP groups(both P<0.05),the level of IL-6 in control group was recovered to the level of healthy control group,and the level in trial group being significantly lower than that of the control group(18.8±4.5 vs. 22.3±3.1, P<0.05). Conclusions The patients with SAP have cellular immune dysfunction,the manifestations being the suppression of T lymphocyte proliferation and IL-2 and increase of IL-6 release. Early application of marzulene can help to improve the immune function of lymphocytes in patients with SAP.

Satisfactory communication skill is the essential requirement for medical students to become future qualified medical doctors.Clinical clerkship is the key process to absorb medical knowledge and professional skill,cultivate the ability to solve practical problems in medical practice,and develop medical students into qualified doctors by guiding them to reasonably handle physician-patient relationship,better solve medical disputes,and gradually improve their legal awareness.Therefore,medical students should strengthen to cultivate their communication ability,and set up reasonable sense of physician-patient communication.

Objective To investigate the inhibitory effect of ginkgolide B (BN52021) on severe acute pancreatitis (SAP) via detecting the antagonistic effect of BN52021 on platelet-activating factor (PAF). Methods One hundred and eighty Wistar rats were randomly divided into control group (n = 60), SAP group (n = 60) and BN52021 group (n =60) according to the random number table. The 3 groups were divided into 6 subgroups at different time points after operation (1 h, 2 h, 3 h, 6 h, 12 h, and 24 h). The changes of serum amylase in each group were monitored. The expression of platelet-activating factor receptor (PAFR) mRNA and protein was detected by RT-PCR and Western blot, and the pathological changes of pancreatic tissues were observed. All the data were analyzed by one-way ANOVA. Results Serum amylase level and pathological results showed that it was successful in preparing SAP model. The serum amylase levels at postoperative hour 3, 6 and 24 were (4185 ±148) U/L, (3785 ± 124) U/L and (1360 ± 161) U/L in BN52021 group, which were significantly lower than those in SAP group [(4799 ± 107) U/L, (4920 ± 140) U/L, (2283 ± 127) U/L)]. The pathological scores at postoperative hour 3, 6, 12 were 5.95±0. 19, 5.55±0.36, 6.72±0. 30 in BN52021 group, which were significantly lower than those in SAP group (8.85 ± 0.39, 9.15 ± 0.55, 10.10 ±0. 65). The mRNA and protein expression of PAFR were gradually increased at the early stage (0.49 ± 0.09-0.71 ± 0.14 vs 0. 43 ～ O. 06-1.69 ± 0.06), and reached peak at postoperative hour 3. The expression levels of PAFR mRNA and protein in BN52021 group and SAP group at postoperative hour 3 had statistical difference among the 3 groups (F = 4.58, 6.24, P < 0.05). Conclusions The expression of PAFR mRNA and protein in the pancreatic tissue of SAP rats is dynamically changing. PAFR plays an important role in the occurrence and progression of SAP. BN52021 can reduce the expression of serum amylase and improve the pancreatic pathological changes, but it has no effect on the expression of PAFR in pancreatic tissue.

Objective To investigate the clinical features , treatment regimen , and prognosis evaluation of tertiary peritonitis (TP). Methods Seventy-eight cases with TP were randomly enrolled into 2 groups, including the simple western medicine-treated group (32 cases) and the integrated traditional Chinese and western medicine-treated group (46 cases). The prognoses were evaluated according to the acute physiology and chronic health evaluationⅢ (APACHEⅢ, APⅢ) scoring. Results The mortality rate was 71.9% (23 of 32) in patients received the simple western medicine and was 32.6%(15 of 46) in patients received the integrated traditional Chinese and western medicine with significant difference between these two groups (P < 0.01). There was a significant correlation between AP Ⅲscore and actual mortality (r=0.73,P<0.01), and predicted mortality (r=0.76, P<0.01). Conclusions The therapeutic effect is acceptable and satisfactory for the TP patients received the integrated traditional Chinese and western medicine. The AP Ⅲ scoring system can be used to predict the prognosis of TP patients.

The article introduces the advances in the evaluation of transient ischemic stroke (TLA) and reviews them from four aspects, including identifying whether the symptoms accord with the diagnosis of TLA, which blood supply area the ischemia is located in, evaluating the pathogenesis of TIA, and predicting its prognosis.

Objective Alprostadil can improve the clinical efficacy of the treatment of hepatitis B cirrhosis, but little literature is available about its effect on serum inflammatory factors in patients with hepatitis B cirrhosis.This study aimed to investigate the effect of alprostadil on serum inflammatory factors and liver function of the patients with hepatitis B cirrhosis and its possible action mechanisms.Methods We equally randomized 162 cases of hepatitis B cirrhosis admitted to our hospital from August 2014 to July 2015 into a control and an observation group, the former treated by conventional antiviral, liver-protecting and supportive therapies, and the latter with alprostadil in addition, both for 4 weeks.Then, we obtained the serum inflammatory factors, the contents of serum interleukin-6 (IL-6), high sensitive C reactive protein (hs-CRP) and tumor necrosis factor alpha (TNF-α) as well as such liver function indexes as glutamic-pyruvic transaminase (ALT), total bilirubin (TBil) and prothrombin activity (PTA), and compared them between the two groups before and after treatment.Results After 4 weeks of treatment, the effectiveness rate was significantly higher in the observation than in the control group (82.72% vs 62.96%, P<0.05).Compared with the baseline, the patients in the observation group showed significant improvement after treatment in serum IL-6 ([275.62±43.39] vs [97.15±19.73] pg/mL, P<0.05), hs-CRP ([425.54±55.58] vs [50.23±6.69] ng/L, P<0.05), TNF-α ([321.74±80.73] vs [85.45±13.61] pg/mL, P<0.05), ALT ([139.54±37.36] vs [96.13±23.62] μmol/L, P<0.05), TBil ([395.39±41.13] vs [271.55±25.12] μmol/L, P<0.05), and PTA ([38.50±4.19] vs [68.36±8.11]%), and the improvement was significantly better than in the control group (P<0.05).Conclusion Alprostadil helps alleviate the inflammatory condition, improve the liver function, and promote clinical efficacy in patients with hepatitis B cirrhosis.

The appliance of bilingual teaching of Medical Immunology offers an effective means of mastery and communication of the medical essential subject.This study has tried the bilingual teaching of medical immunology for clinical,dentistry and phylaxiology specialty students,discussed the model of bilingual teaching,investigated the teaching effect,analyzed and summarized the teaching experience.After the practice of bilingual teaching,we found that the feasible method of bilingual teaching to apply Chinese as the primary language and pervade English into the medical immunology course.

Objective To evaluate endoscopic sphincterotomy(EST)for the management of choledocholithiasis. Methods Between July 1987 and March 2007,991 cases of choledocholithiasis treated with EST were reviewed,and 710 cases were followed-up. Results All cases were treated with EST.The common bile duct stones were removed in 909 cases(91.7%,909/991).The rate of complications after EST was 6.0%(59/991)including pancreatitls in 29 cases(2.9%),hemorrhage in 18 cases(1.8%),cholangitis in 11 cases(1.1%),and duodenal perforation in 1 case(0.1%).There was no mortality in this group.Follow-up found reflux cholangitis in 51 cases(7.2%)and recurrent choledocholithiasis in 42 cases(5.9%). Conclusion Therapeutic endoscopy for choledocholithiasis is safe and effective.

Objective To explore the effect of comorbidities on the surgical outcomes of elderly patients with hip fracture. Methods The Age,gender,weight,type of fracture,preoperative comorbidities and surgical outcomes of 117 patients aged 80 yr or over who undergoing hip fracture surgery in our hospital were recorded. Patients were divided into rehabilitation group and postoperative in-hospital death group ac-cording to surgical outcomes. The potential predictors of postoperative in-hospital death were identified by univariate model and were then entered into multiple Logistic regression analysis. Results Twenty three patients(19. 7%)had no comorbidity,94 patients(80. 3%)had one or more comorbidities. Ten patients(8. 5%)died in hospital after the operation. Predictors of postoperative in-hospital death were preoperative respiratory diseases and three or more comorbidities. Conclusion Surgical outcomes of elderly patients with hip fracture may be predicted by analysing preoperative comorbidities. Preoperative preparations must be sufficient in order to ensure successful operation.

Objeetive To investigate the risk of hemorrhagic transformation (HT) and the outcome as well as its influencing factors at 3 months after thrombolytic therapy in acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF).Methods Consecutive acute ischemic stroke patients with NVAF were enrolled retrospectively.Their demography,vascular risk factors and other clinical data were collected.The modified Rankin Scale (mRS) was used to evaluate the outcome at 3 months after symptom onset.The mRS score ≤ 2 was defined as good outcome,and ＞ 2 was defined as poor outcome.Results A total of 119 acute ischemic stroke patients with NVAF were enrolled,including 63 males (52.9％) and 56 females (47.1％); their mean age was 72.1± 10.0; 45 (37.81％) were treated with recombinant tissue type plasminogen activator (rtPA),55 (46.2％) had a good outcome and 27 (22.7％) combined with HT.Compared with the poor outcome group,the mean age was younger in the good outcome group (P =0.028).The proportions of the patients with ischemic heart disease and the time from onset to treatment ＞ 4.5 h were lower (P ＜0.05).The baseline systolic blood pressure and diastolic blood pressure,as well as the National Institutes of Health Stroke Scale (NIHSS) score were lower (P ＜0.05),while the proportion of patients receiving intravenous thrombolysis with rtPA was higher (P =0.019).Multivariate logistic regression analysis showed that the patients with ischemic heart disease (odds ratio [OR] 4.572,95％ confidence interval [CI] 1.392-15.014; P =0.012),systolic blood pressure before treatment (OR 1.028,95％ CI 1.007-1.049; P =0.009),baseline NIHSS score (OR 1.058,95％ CI 1.002-1.117; P =0.042) were the independent risk factors for poor outcome,while intravenous thrombolysis with rtPA (CI 0.264,95％ CI 0.102-0.683; P =0.006) was an independent protective factor for poor outcome.The proportions of the baseline systolic blood pressure,fasting blood glucose and NIHSS score,as well as the patients with a history of previous stroke or transient ischemic attack (TIA) in the HT group were significantly higher than those in the non-HT group (all P ＜ 0.05).Multivariate logistic regression analysis showed that the baseline NIHSS score (OR 1.147,95％ CI 1.068-1.231; P＜0.001),baseline systolic blood pressure (OR 1.951,95％ CI 1.921-1.982; P =0.002),and blood glucose level (OR 1.191,95％ CI 1.095-1.294; P ＜ 0.001) were the independent risk factors for HT.Compared with the non-thrombolysis group,the mean age of the thrombolysis group was younger (P =0.021),the baseline systolic blood pressure,fasting glucose and NIHSS scores,as well as the proportions of patients with hyperlipidemia,previous stroke or TIA history,and using antihypertensive drugs before admission were higher (all P ＜ 0.05).The proportion of patients with ischemic heart disease were lower (P =0.035),but the proportion of the patients with a good outcome was higher (P =0.019).Conclusions Patients with ischemic heart disease,systolic blood pressure and higher baseline NIHSS score before treatment were the independent risk factors for poor outcome,while intravenous thrombolytic therapy with rtPA was an independent protective factor for poor outcome; the high baseline NIHSS score,baseline systolic blood pressure and glucose level were the independent risk factors for HT.For acute ischemic stroke patients with NVAF,such as no obvious contraindications for thrombolytic therapy,might benefit from intravenous thrombolytic therapy,and it could not increase the risk of HT,but the blood pressure and glucose level of the patients should be controlled appropriately.