Objective To investigate the clinical efficacy and safety of ulinastatin combined with octreotide in the treatment of acute pancreatitis.Methods The clinical data of 50 patients with acute pancreatitis were retrospectively analyzed.According to different methods of treatment,they were divided into two groups.25 patients in the control group were treated with octreotide alone,while 25 patients in the observation group were treated with ulinastatin combined with octreotide.The clinical treatment effect and the incidence of complications were compared between the two groups.Results The total effective rate of the observation group was 96.00％,which was significantly higher than 80.00％ of the control group,the difference was statistically significant (x2 =9.64,P ＜ 0.05).The recovery time of abdominal pain and distension,recovery time of serum amylase,recovery time of urine amylase and the average hospitalization time of the observation group were (4.83 ± 1.21) d,(3.49 ± 1.08) d,(4.26 ± 1.17) d,(15.24 ± 3.16) d,which were significantly shorter than those of the control group (t =6.56,7.30,6.82,7.11,all P ＜ 0.05).The incidence rate of complications of the observation group was 12.00％,which was significantly lower than 36.00％ of the control group,the difference was statistically significant (x2 =8.56,P ＜ 0.05).Conclusion Ulinastatin combined with octreotide has significant effect in the treatment of acute pancreatitis,which can improve the symptoms and promote the early recovery,and the incidence rate of complication is low and the safety is high,which is worthy of clinical application and promotion.

Physical examination of the nervous system is a very practical clinical skill.Based on our experience,we have found that conventional teaching approaches are not satisfactory in fully enabling medical trainees to master these skills and use them efficiently in clinical settings.Therefore we have developed a novel approach which involves prioritizing and standardizing examination procedures,imposing goal-oriented practices,improving teaching methodology and intensifying repeatitive exercises.This systemic approach has yielded considerable success that is not achievable through conventional teachings.

Objective To evaluate the advantages and disadvantages of Narcotrend(NT)in monitoring the depth of anesthesia when compared with the bispectral index.Methods Eighty ASA Ⅰ or Ⅱ patients of both sexes,aged 19-60 yr,undergoing elective surgery,were enrolled in this clinical study.Propofol was given by target-controlled infusion(TCI).After the initial target plasma concentration of 2.1 μg/ml was achieved,the concentration was increased by 0.3 μg/ml every 30 s until the patients lost consciousness.Then the effect-site concentralion of propofol was increased by 0.5μg/ml to maintain anesthesia and rocuronium 0.8 mg /kg was injected intravenously 30 s later.Tracheal intubation was performed 3 min after rocuronium injection.Mean arterial pressure (MAP),HR,NT value and BIS value were measured before TCI of propofol(baseline),al loss of consciousness,immediately before rocuronium administration,2 min after rocuronium administration,during intubation,and at 1 and 3 min after intubation.Results NT and BIS values were significantly decreased at loss of consciousness as compared with the baseline value(P ＜ 0.01).NT and BIS values were significantly lower at 2 min after rcuronium administration than before rocuronium administration(P ＜ 0.05).Compared with that before intubalion,HR and MAP were significantly increased during intuhation,and at 1 and 3 min after intubation,while no significant change was found in NT and BIS values(P ＞ 0.05).Conctusion NT can monitor the sedative effecl induced with TCI of propofol accuralely,the myoelectric activity exerts an obvious effect,and the accuracy of NT for monitoring the analgesic effect is lower.NT and BIS are comparable with respect to the advantages and disadvantages.

OBJECTIVE To investigate the induc-ing factors of Bell’s palsy. METHODS From Febru-ary to May 2005, 262 outpatients of Bell’s palsy were surveyed for 9 inducing factors. RESULTS The mean age of onset was 39?17 years old. The ratio of male to female and of left to right were 48:52. Forty-eight patients denied all inducing factors, while 214 pa-tients (81.7 %) had at least one factor. Cold was found in 53.5 % of the patients, fatigue in 22.5 %, viral infec-tion in 18.7 %, recurrence in 11.8 %, psychological stress in 11.5 %, family history in 7.6 %, puerperal period in 1.5 %, and molar infection of the affected side in 1.5 %. CONCLUSION Bell’s palsy is likely to be a set of disease. Most of patients with Bell’s palsy had inducing factors. Avoid these factors may reduce the incidence of Bell’s palsy. Further investigate will fractionize Bell’s palsy to several diseases includ-ing true idiopathic peripheral facial paralysis and some definite diseases.

Objective:To evaluate the clinical effect of laryngofissure without tracheotomy.Method:One hundred and sixteen cases of laryngofissure without tracheotomy in our department were analyzed retrospectively.Result:Of 116 cases, 101 cases had the laryngeal carcinoma; 9 cases had laryngeal stenosis; 6 cases had benign tumor of larynx. All the incisions were healed by first intention; and postoperative duration of hospital stay were 7 to 20 days. Three cases recurred in 101 cases of laryngeal carcinoma (2.97%), and underwent reoperation,the 5 year survival rate was 100%. One case recurred in 9 cases of laryngeal stenosis, and underwent reoperarion of laryngoplasty with T-tube implanted. No recurrence in 6 cases of benign tumor of larynx.Conclusion:Laryngofissure without tracheotomy have the advantage of less trauma , fast rehabilitation and no destroying the normal respiratory functions. It is completely feasible so long as surgeons grasp the adaption of operation strictly and select suitable cases.

BACKGROUND:Neurotrophin-3 is found in the repair of spinal cord injury in the role of the strongest neurotrophic factor.It can effectively promote axonal regeneration through the glial scar tissue in repairing spinal cord injury.OBJECTIVE:To construct recombinant lentiviral vectors for gene delivery of homo sapiens neurotrophin-3(hNT3),and to investigate the expression of hNT3 gene in Schwann cells after transfection.DESIGN,TIME AND SETTING:Observational experiment was performed from June 2007 to March 2008 at the Central Laboratory of Changhai Hospital.MATERIALS:Bilateral sciatic nerves were harvested from 3-day-old Sprague Dawley rats for culture and identification of Schwann cells.Three-plasmid lentivirus systems:pGC-E1-EGFP,pHelper 1.0 and pHelper 2.0 were gained from Shanghai Chemical Technology Co.,Ltd.METHODS:pGC-E1-hNT3-EGFP plasmid was constructed by double restriction enzyme digestion and ligation,and then the plasmid was transformed into E.coli DH5?.Purified pGC-E1-hNT3-EGFP plasmids from the positive clones was confirmed by PCR and sequencing.293T cells were cotransfected with lentiviral vector pGC-E1-hNT3-EGFP,pHelper 1.0 and pHelper 2.0 by Lipofectamine 2000 to produce lentivirus.2 mL recombinant virus complete culture solution was added according to multiplicity of infection=1,4,8,10,12.The titer of virus was tested according to the expression level of enhanced green fluorescent protein.The control groups were Schwann cells and Schwann cells transfected by no-loaded lentivirus.MAIN OUTCOME MEASURES:The lentiviruses were transduced to Schwann cells,and the transfection efficiency was examined by flow cytometry,the overexpression of hNT3 was determined by Real-time PCR and Western blotting.RESULTS:The exogenous gene sequence of the recombinant hNT3 was completely in accordance with that of its open reading frame in GeneBank.The titer of concentrated virus was 5?107 TU/L.After recombinant LV-hNT3 infection,Schwann cells gave off strikingly bright green fluorescence,and the transfection efficiency amounted to 85%(multiplicity of infection=10).Real-time RCR test showed that the hNT3 mRNA were highly expressed in hNT3-Schwann cells,while did not express in the control group.Western blotting showed the hNT3 expression in Schwann cells.CONCLUSION:Construction of hNT3 gene lentiviral vector can transfect Schwann cells leading to an efficient overexpression of hNT3.

Objective To study the effect of different dose fractionation on overall survival in patients with limited-stage small cell lung cancer (LS-SCLC). Methods LS-SCLC patients treated with radical combined chemotherapy and radiotherapy (RT) between January 2001 and Dec 2007 were analyzed retrospectively. According to the dose fractionation schemes, patients were divided into three groups:conventional fractionated RT (1. 8 -2.0 Gy,once daily), hyperfractionated RT (1.4 Gy, twice daily) and hypofractionated RT (2. 5 Gy,once daily). Overall survival, disease free survival and pattern of failures of the three groups were compared. A total of 177 patients were enrolled, including 63 patients in conventional fractionated RT group, 79 in hyperfractionated RT group and 35 in hypofractionated RT group. Results The overall follow-up rate was 96. 6%. The patient numbers with follow-up of more than 2 and 5 years were 153 and 92, respectively. The median survival time of the entire group was 22. 4 months, and the 2-and 5-year survival rates were 43.4% and 23. 5%, respectively. The 2-year survival rates for three groups were 31%, 46% and 59% (x2 =7.94,P=0.019), respectively. The 2-year disease free survival for three groups were 20%, 31% and 40% ( x2 = 4. 86, P = 0. 088 ), respectively. In the pairwise comparisons,patients in hypofractionated RT group have better survival than those in conventional fractionated RT group ( x2 = 7. 81, P = 0. 005 ), the effect of hyperfractionated RT group lies between the hypo-and the conventional fractionated RT groups, but no significant differences were detected ( x2 = 2. 31, P = 0. 128; x2 = 2. 95, P =0. 086). The mildest side effect was found in the hypofractionated RT group. No statistically significant differences were found in the patterns of first failure. Conclusion The hypofractionated RT scheme showed potential survival benefits for patients with LS-SCLC and should be considered in the setting of randomized clinical trials.

Aim To investigate the influence of sarpog-relate hydrochloride (SH)on the pharmacokinetic pro-file of dextromethorphan (DM),the typical substrate of CYP2D1 /2,in rats when they were administered co-instantaneously.Methods A total of 1 2 SD rats were randomly divided into two groups:the control group (DM,1 0 mg·kg-1 )and the sarpogrelate group (SH, 1 0 mg·kg-1 ;DM,1 0 mg·kg-1 ),which received in-tragastric administration.Plasma samples were collected immediately before and at different time points after drug administration.A LC-MS /MS method was used to determine the concentrations of DM in rat plasma. Pharmacokinetic parameters were analyzed using Drug and Statistics (DAS 2.0).Results There were signif-icant differences in the pharmacokinetic parameters of DM,including T1 2 (2.49 h ±0.93 h vs 1 .47 h ±0.20 h,P <0.05 ),Cmax (325.7 μg·L -1 ±1 33.2 μg· L -1 vs 1 04.5μg·L -1 ±52.4 μg·L -1 ,P <0.05), AUC0 -t(785.5 μg·L -1 ·h ±451 .9 μg·L -1 ·h vs 244.8 μg·L -1 ·h ±1 68.3μg·L -1 ·h,P <0.05) and AUC0 -∞(804.7 μg·L -1 ·h ±445.6 μg·L -1 ·h vs 251 .4 μg·L -1 ·h ±1 73.4 μg·L -1 ·h,P<0.05 )between the two groups.Conclusion SH could significantly inhibit the elimination of DM,the substrate of CYP2D1 /2 in rats.

Aminoglycoside antibiotics, due to their strong antibacterial effects and broad antimicrobial spectra, have been very commonly used in clinical practice in the past half century. However, aminoglycoside antibiotics manifest severe ototoxicity and nephrotoxicity, and are one of top factors in hearing loss. In this study, three members of the aminoglycoside antibiotics family, gentamycin, neomycin and streptomycin, were chosen as the representatives to be investigated for their toxicity to the embryonic development and the larva hair cells in zebrafish, and also to their target genes associated with hearing-related genes. The results showed that: (1) the lethal effect of all three drugs demonstrated a significant dependence on concentration, and the severity order of the lethal effect was streptomycin > neomycin > gentamycin; (2) all the three drugs caused the larva trunk bending in resting state at 5 dpf (day past fertilization), probably due to their ototoxicity in the physical imbalance and postural abnormalities; (3) impairment and reducing of the hair cells were observed in all three cases of drug treatment; (4) four genes, eya1, val, otx2 and dlx6a, which play an important role in the development of hearing organs, showed differential and significant decrease of gene expression in a drug concentration-dependent manner. This study for the first time reports the relevance between the expression of hearing genes and the three ototoxic antibiotics and also proved the feasibility of establishing a simple, accurate, intuitive and fast model with zebrafish for the detection of drug ototoxicity.

Objective To investigate the predictive value of plasma lipoprotein phospholipase A2 (Lp -PLA2 )and D -dimer in patients with hypertension complicated with stroke.Methods 70 hypertensive patients with stroke were selected as A group,72 patients with simple hypertension were selected as B group,and 71 healthy sub-jects were selected as C group.The light transmitting method was used to detect serum Lp -PLA2 ,and immunoturbi-dimetry was used to detect plasma D -dimer.The clinical value of the two joint detection and single detection in prediction of hypertension complicated with stroke was analyzed.Results The plasma Lp -PLA2 and D -dimer levels of A group were (471.88 ±181.49)ng/mL,(982.54 ±373.28)μg/mL,which were higher than those of B group[(195.17 ±34.74)ng/mL,(263.57 ±29.70)μg/mL]and C group[(122.94 ±46.25)ng/mL,(96.44 ± 8.49)μg/mL](F =189.7,171.1,all P =0.000).The plasma Lp -PLA2 level of A group was positively correlated with D -dimer(r =0.692,P <0.01).The plasma D -dimer >252g/mL forecast hypertension stroke risk sensitivity was 83.3% and specificity was 98.6%,the plasma Lp -PLA2 >176.36ng/mL forecast hypertension stroke risk sen-sitivity was 92.9% and specificity was 83.1%,and the combined prediction of hypertension stroke risk sensitivity was 87.6%,specificity was 93.5%.Conclusion The plasma levels of Lp -PLA2 and D -dimer are significantly increased in hypertensive patients with stroke,and the combined detection of the two indicators can improve the prediction of stroke risk in patients with hypertension.