Objective The clinical efficacy of pancreatic stent in treating chronic pancreatitis was summarized. Methods The stents were applied in 14 patients with chronic pancreatitis and ductal stricture manifested clinically and roentgenographically. Postoperative abdominal pain, changes in appetite, body weight and fat in stools were observed in follow－ ups. Results The stents, 5～ 10F in caliber, were successfully placed in all patients with first attempt. They were followed up for 210 days ( ranging 28～ 520 days ). The early (3 months ) results showed that the pain remitted in 13/14 (92.9％ ) and 11/13 (84.6％ ) of cases respectively. While abdominal pain persisted in 2 cases inspite of the stents. Along with pain remission the appetite and presence of fat in stools improved associated with increase in body weight. The stents drainage maintained for a median to 256 days (ranging 90～ 520 days) Transient hyperamylasemia occurred in 3 cases. Translocation and occlusion of the stent was found in 1 occasion each on the 98 and 520 day respectively. No other serious complication was detected. Conclusion It is assumed that pancreatic stent is effective to treat chronic pancreatitis with ductal stricture.

Objective To study the technique of double stent drainage on biliary and pancreatic ducts obstruction,and to assess its clinical effectiveness.Methods Firstly,ERCP was done on all patients to investigate the locus and extent of the stricture or obstruction,in order to choice the stent with suitable diameter and length.Then the stents placed into biliary and pancreatic ducts though the guidewires those was inserted into the ducts already.After the operation,the level of serum amylase and clinical symptoms such as jaundice,abdominal pain and diarrhea were observed to assess the therapeutic effect.Results 14 patients diagnosed as biliary and pancreatic ducts stricture or obstruction were treated successfully with this method(5 patients suffered from ampulla cancer,4 carcinoma of head of pancreas,3 carcinoma of duodenum papilla,2 chronic inflammation of head of pancreas).Thirteen patients were placed with 14 plastic biliary stents in their biliary ducts(each was placed with one stent except one with 2 stents),and one patient was placed with metal stent.At the same time,14 pancreatic stents were placed into pancreatic ducts of these patients.The rate of jaundice extinction in 2 weeks,1 month and 3 months after the operation was 50 percent,71 percent and 93 percent respectively.The rate of abdominal pain remission in 2 weeks after operation was 75 percent.Among 7 diarrhea patients ,the clinical symptoms disappeared in 5 patients and were significantly improved in 2 patients one month after the operation.The obstruction and displacement of stents had not been observed in all patients within 3 months after the operation.The complications related to operation had not been observed in all patients within 3 months after the operation.Conclusions The therapy with double stent drainage in biliary and pancreatic duct stricture is safe and effective.It can relieve jaundice and abdominal pain,decrease biliary pressure and improve the exocrine dysfunction of pancreas.

Objective To investigate the occurrence of early complications of diagnostic and therapeutic ERCP and its treatment .Methods Occurrence,kind,treatment and outcome of early complications of diagnostic and therapeutic ERCP were respectively reviewed in 8 579 cases in our hospital between January 1977 and December 1999.Results 112 cases had early complications(1.31%).In diagnostic ERCP morbidity of early complications was 1.30%(95/7290) and it was 1.32%(17/1289)in therapeutic ERCP.Of them,acute pancreatitis occurred in 38 cases(0.44%),billiary infection 30 cases(0.35%),bleeding of digestive tract 26 cases(0.30%),drug reaction 8 cases(0.09%),stone and basket incarceration 5 cases(0.06)%,intestinal perforation 1 cases (0.01%) and retroperitoneal pneumatosis 1 cases(0.01%).Of them,106 patients were cured by conservative therapy.Operations were performed in 5 patients.1 patient died.Conclusion In diagnostic ERCP acute pancreatitis is the most common complication,which may be related to difficulty of cannulation,repeated developing and inappropriately injecting contrast medium. In therapeutic ERPC bleeding of digestive tract is the most common complication ,which is related to the procedure ,jaundice and diabetes.Most of complications can be cured by conservative therapy,but a minority needs operation.

Objective To study the relationship between the cardiac markers in ST-segment elevation myocardial infarction (STEMI) and quality of life (QOL) six months later.Methods N-terminal pro-B-type natriuretic peptide (NT-proBNP),cardiac troponin I (cTnI),creatine kinase isoenzyme-MB (CK-MB)and myoglobin(Myo) was tested in 76 patients with STEMI on admission(0 h) and 24 h after admission.QOL six months later was evaluated by using the SF-36 health survey questionnaire.The relationship between the cardiac markers and QOL was analyzed by multivariate linear regression analysis.Results The total SF-36 scores and the scores of physical function,body pain and general health showed negative linear correlation with NT-proBNP on admission (0 h) and 24 h after admission (P ＜ 0.05).The total SF-36 scores and the scores of physical function and body pain showed negative linear correlation with cTnI on admission (0 h)and 24 h after admission (P ＜ 0.05).The total SF-36 scores and the scores of body pain showed negative linear correlation with CK-MB on 24 h after admission (P ＜ 0.05).The scores of vitality showed negative linear correlation with Myo on admission (0 h) (P ＜ 0.05).Conclusion The higher levels of NT-proBNP,cTnl and CK-MB indicate the lower QOL six months later.

Objective To investigate the influence of endoscopic retrograde cholangiography (ERC), endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (EST) and endoscopic biliary stenting on postoperative pancreatitis. Methods 412 patients referred to ERCP were divide into 7 groups, there were both biliary and pancreatic ducts group (ERCP), biliary duct contrast filling group (ERC), pancreatic duct contrast filling group (ERP), ERCP plus biliary stenting group (stent), ERC plus stent, ERCP plus EST and stone extraction (SE) group, and ERC plus EST and SE group. And the differences of postoperative serum amylase in 4 hours and in 24 hours as well as clinical symptoms were compared among different groups. Results The incidence of postoperative hyperamylasaemia in 4 hours and 24 hours were 17.7% and 4.4% respectively. The incidence of postoperative acute pancreatitis was 3.9%, and ERP group had the highest incidence of postoperative acute pancreatitis among the 7 groups. Conclusions Repeated pancreatic duct contrast filling during ERCP manipulation is the main risk factor for postoperative pancreatitis, and therapeutic ERCP such as EST, stent and SE does not increase the incidence of postoperative pancreatitis.

Objective:To evaluate the influence of prophylactic intra-coronary injection nitroglycerin with diltiazem in patients of acute ST segment elevation myocardial infarction(STEMI) Methods:This study was conducted in 212 patients with acute STEMI who underwent primary percutaneous coronary inter- vention(PCI)in our center from January 2001 to December 2006.The patients were randomly assigned to receive intra-coronary nitroglycerin with dihiazem(n = 87)or none of them(125)before intervention.The clinical data,coronary angiography data after intervention,ST-segment resolution,area under the curve of CK-MB,ejection fraction(EF)and left ventricular end-diastolic di- mension several days alter operation and the major adverse cardiac events(MACE)were analyzed systemically. Results:Ten(11.5%)patients in study group and 28(22.4%)in control group had MACE(P = 0.042).The difference of re-hospitalization was also significant(19.5% vs 37.6%,P = 0.008).No/slow reflow occurred less in study group than in con- trol group,but the difference was not significant.Corrected TIMI frame count was lower(34.4?11.3 vs 38.9?17.2,P = 0.034) and myocardial blush grade was higher(2.65?0.6 vs 2.41?0.7,P =0.018)in study group.ST-segment resolution,area under the curve of CK-MB in 5 days after operation,EF and left ventricular end-diastolic dimension in study group were more significant than those in control group(P

Objective To investigate the effect of PPARγ in acute coronary syndrome (ACS) patients with type 2 diabetes (T2DM) for the severity of coronary atherosclerosis and plaque stability. Methods We selected 102 patients with ACS, including 52 patients with type 2 diabetes mellitus (ACS+T2DM group) and 50 patients with simply ACS (ACS group). Meanwhile, we selected 30 patients without coronary heart disease and T2DM as the control group. All basic clinic data, CAG and the Gensini score were compared among all groups. To all patients, blood was drew when they were enrolled to detect the level of PPARγ and MMP-9. Results Gensini points in the ACS+T2DM group was much higher than that of the ACS group (P < 0.05). The levels of PPARγ of the ACS group and the ACS+T2DM group, when compared with the control group, were decreased significantly, but the level of MMP-9 were increased (all P < 0.05). The level of PPARγ in the ACS+T2DM group was much lower than the ACS group, and the level of MMP-9 was much higher (P<0.05). Gensini scores (r=-0.416, P<0.05), the level of MMP-9(r= - 0.503, P < 0.05) were correlated negatively with the level of PPARγ. Conclusions Complicating with T2DM can aggravate coronary artery disease and plaque instability degree in ACS patients, and PPARγpossibly make an protective effect.

Objective To study the diagnosis value of giant cell temporal arteritis with high frequency ultrasonography and magnetic resonance imaging.Methods The total of 29 cases testified as giant cell temporal arteritis clinically were assessed by high frequency ultrasonography and magnetic resonance imaging.The 29 cases were assessed by high frequency ultrasonography,the 11 cases were assessed by magnetic resonance imaging,mural thickness and lumen diameter of temporal arteries were examined,and were compared with the biopsy specimens.Meanwhile 30 healthy volunteers were randomly selected as control group,the ultrasonography of normal temporal arteries were analyzed.Results All temporal arteries were diaplayed clearly.27 cases were diagnosed for giant cell temopral arteritis by high frequency ultrasonography in 29 cases,the diagnostic accuracy was 93.1％.The 11 cases were diagnosed by magnetic resonance imaging,the diagnostic accuracy was 100％.The imaging features were mural thickness,the lumen stenosis,and partial temporal arteries occluded,the mural was contrasted by Gd-DTPA.Conclusions High frequency ultrasonography and magnetic resonance imaging are noninvasive methods for giant cell temporal arteritis diagnosis,it is important clinical value for therapy.

Objective To investigate the efficacy and safety of Minilase-S on patients with dyspepsia.Methods A randomized,placebo-controlled,double blind and multicenter study was conducted.Two hundred and forty patients with dyspepsia symptoms(anorexia,fullness,abdominal discomfort and distension)were collected according to total symptom scores over 20 with visual analog scales.Each patient was randomly received either Minilase-S(2 capsules t.i.d)or placebo(2 capsules t.i.d)for 2 weeks.The symptoms scores were evaluated at treatment week 1,week 2,and 1 week after discontinued therapy.Results Two hundred and sixteen patients(105 patients in Minilase group and 111 patients in placebo group)finished the study.There was no difference in demographic data,anorexia,fullness,discomfort and distension score and the total symptom score between two groups.However,at treatment week 1,week 2 and 1 week after discontinued therapy,symptoms and total symptom score were significantly decreased in Minilase-S group compared to placebo group(all P value＜0.05).The total effective rates in treatment week 1,week 2 and 1 week after discontinued therapy were 64.76%,77.05%and 66.99%,respectinely,which were higer that those in placebo group(27.93%,37.84% and 29.36%,respectively)(P＜0.05).There was no severe side effects in both Minilase-S and placebo groups.Conclusions Minilase-S can significantly improve symptoms in patients with dyspepsia,which may be as one choice in the management of dyspepsia or in combined therapy.

Objective Re stenosis is the common complication of stenting. This study was designed to investigate the functional changes of fibroblast in local re stenosis esophageal tissue after stenting and its relation to re stenosis. Methods Sixteen healthy adult dogs were divided into four groups. Esophageal stent was placed by means of “autogenous broad fascia transplantation and fixation”. At the end of 1,2,4 and 8 weeks,the dogs were killed, and the esophageal tissue with stent were taken out and analyzed by gross observation, light microscopy and electron microscopy. The expression of proliferation cell nuclear antigen (PCNA) and alpha smooth muscle actin (? SMA) in esophageal tissue at 1,2,4 and 8 weeks after stenting were studied by immunohistochemistry. The contents of hydroxyproline and gross amino acid(AA) in re stenosis tissue were measured by amino acid analysis. Results At week 1 and 2 the inflammatory reaction occurred evidently in stented esophagus, with granulation and fibrosis; in some places esophageal tissues began to proliferate towards the lumen. At week 1 some fibroblasts began to express PCNA and ? SMA, and at week 2 the expression augmented significantly. The content of hydroxyproline and AA was significantly higher in the esophageal tissues at 1 and 2 weeks after stenting than that in normal esophagus. At week 4 and 8 esophageal lumen became narrow conspicuously, with a lot of fibrotic tissue and few inflammatory cells. Only a few fibroblasts displayed the expression of PCNA instead of the expression of ? SMA at week 4. There was no expression of PCNA and ? SMA at week 8. The content of AA at week 4 increased significantly compared with that at week 2, and the level was similar between 4 and 8. Electron microscopy revealed that the fibroblasts were in the state of vigorous proliferation and secretion in esophageal tissue at week 2, and a lot of fibrotic tissue formed at week 8. Conclusions Re stenosis mainly expressed as granulation and fibrosis. At week 4 and 8 the fibrosis becomes stable gradually with the lessening of inflammatory reaction. Within 4 weeks of stenting fibroblast retains active proliferation and secretion, but after week 4 the function of fibroblasts gradually lessen or even lose.