Objective To explore a rational treatment program for the non-surgical treatment of severe acute pancreatitis (SAP) in the early stage. Methods The data of 123 cases of SAP treated from 1986 to 2004 were collected and divided into two groups according to admission time and treatment procedure. Group A:53 cases admitted from 1986 to 1992,treated mainly by operation. Group B :70 cases admitted from 1992 to 2004 ,treated mainly by non-surgical procedures. Results The mortality rate in group A and B was 33.9 %(18/53) and 7.1% (5/70),respectively,while the incidence rate of complications such as ARDS,shock,renal failure,pancreatic abscess,cardiac failure in group A was 28.3%(15/53),16.9%(9/53),20.8%(11/53),16.9%(9/53),24.5%(13/53),and in group B was 14.3%(10/70),7.1%(5/70),7.1%(5/70),2.8%(2/70), 4.2%(3/70),respectively. There was significant difference between the two groups (P

ObjectiveTo observe the effect of insulin detemir combined with acarbose in treatment of patients with type 2 diabetes (T2DM).Methods32 T2DM patients whose blood glucose control was poor receiving twice daily isophane protamine biosynthetic human insulin( Novolin 30R) combined or not combined with oral hypoglycemic drugs,were switched to receive insulin detemir injection once daily and oral acarbose three times daily for 12 weeks.By self-contrasted method,observed blood glucose before and after three meals,before sleeping,glycated hemoglobin ( HbA1c),change of body mass index( BMI),incidence of hypoglycemia,compliance and satisfaction of patients (by questionnaire) before and after treatment.ResultsAfter treatment,the blood glucose before and after three meals,before sleeping and HbA1 c declined sigmifieatly ( t =11.212,14.997,10.863,17.950,11.108,14.034,12.422,22.764,all P ＜0.01 )compared to state before treatment.The rate of hypoglycemia in the day was 3.1％,without nocturnal symptoms of hypoglycemia.BMI had certain declining,but there was no statistical significance (P ＞ 0.05).The compliance and satisfaction of patients were in a higher rate (x2 =10.255,9.143,all P ＜ 0.01 ).ConclusionInsulin detemir combined with acarbose could effectively control the blood glucose,incidence of hypoglycemia,without increasing body mass,achieve good compliance and satisfaction of patients.

Since its first application for radical gastrectomy, laparoscopic surgical technique has been used for almost 20 years. Howev-er, given the complexity of the anatomic plane and vessels of stomach and the particular operation of laparoscopic instruments, lapa-roscopic lymph node dissection is still a difficult technique that requires experience. An appropriate approach is the key point to the success of laparoscopic lymph node dissection. On the basis of lymphatic drainage routes and anatomy of perigastric lymphatic sys-tem, different approaches are selected to dissect periodic gastric lymph nodes safely and radically. Surgery is performed according to the patient's position, surgeons' stance, and sequence of lymphadenectomy for laparoscopic gastrectomy and lymph node areas, such as suprapancreatic, cardial, and splenic hilar areas. In this article, we introduce different surgical approaches of laparoscopic radical gastrectomy with extended lymphadenectomy to provide information for surgeons who want to perform this surgery.

Objective To explore the clinical effectiveness of urokinase perfusion and drainage in patients with hypertension cerebral hemorrhage broken into ventricles.Methods Patients with hypertension cerebral hemorrhage broken into ventricles(35 cases)underwent urokinase perfusion and drainage.Clinical effect was observed and the nursing point was summarized.Results Of the 35 patients,20 cases acquired good recovery,13 cases were mildly disabled,2 case were severely disabled,no death occurred.The complications mostly consisted of secondary hemorrhage,infection,disfunction.Conclusions The early lateral ventricle drilling operation,postoperative urokinase perfusion and drainage,active complications prophylaxis and treatment,rehabilitation training can reduce mortality and improve the quality of patients' life.

Objective To investigate the clinical characteristic of laparoscopic cholecystectomy(LC) for elderly patients with gallstone. Methods A retrospective analysis was made on the clinical data of 310 patients over 60 years old with gallstone treated by LC at our hospital from May, 1993 to March, 2001. Results Of the 310 patients, 193 cases (62.9%) were accompanied by diabetes, cardiovascular diseases and/or bronchitis. During the operation, 49(15.8%) in 310 patients with severe adhesion surrounding gallblader which made LC difficultly. 6 turned to operation, other 304 patients had LC succeessfully without serious complication. Conclnsions Despite the general condition, the organism degeneration and function recession, immunity function decrease accompaned with other diseases in the elderly patient, the LC has less injury, less pain and less complications, So LC is the optimal method for the elderly patients with gallston.

Objective To explore the correlation between serum hs-CRP and β-cell finction in patients with gestational diabetes mellitus(GDM).Methods The levels of hs-CRP in 60 patients with GDM(GDM group)and 30pregnant women with normal glucose tolerance(NGT group)were detected.Insulin resistance was assessed by the homeostasismodel insulin resistance index(HOMA-IR),Insulin secretion by the homeostasis β-cell funetiOn index(HOMA-β).Results The levels of hs-CRP and HOMA-IR were higher in GDM group than in NGT group.There was significant difference between two groups(P＜0.01);HOMA-β was lower in GDM group than in NGT group,there was significant difference between two groups(P＜0.05).The level of hs-CRP was correlated with age,pre-pregnant bodymass-index(BMI),screening BMI,fasting blood glucose(FBG),fasting insulin(Fins),and HOMA-IR(r=0.222,0.649、0.862、0.923、0.935、0.941,P＜0.05 or P＜0.01),but was inversely related with HOMA-β(r=-0.872,P＜0.01).Multiple stepwise regression analysis indicated that HOMA-IR and HOMA-β was the most important effect factors of hs-CRP.Conclusion The level of hs-CRP increased in women with GDM.which was related to insulin resistance(IR)and insulin secretion,and it maybe participate in the pathogenesis of GDM.

Objective To apply the Intelligent Device for Energy Expenditure and Activity(IDEEA)system to evaluate the locomotion of patients with protrusion of intervertebral disc(PID)quantitatively and dynamically.Methods 8 patients with PID and 9 volunteers as controls performed a series of daily activities in their nature environment.They were monitored with IDEEA.Results The velocity of flexion forward,time flexion forward,time stand up,time sit down of the patients were significant different to the controls(P<0.05),and the walking speed of the former was slower(P<0.05)than the latter's.Conclusion Physical performance of the PID patients was significantly reduced.The IDEEA can be a good tool to evaluate their ability of locomotion in their daily living.

Objective To observe the effect of Shenmai injection combined concurrent chemoradiotherapy on immune function in patients with locally advanced non-small cell lung cancer.Methods A total of 80 patients with locally advanced non-small cell lung cancer were randomly divided into treatment group and control group.In treatment group,40 patients received simultaneous three-dimensional conformal radiotherapy combined with TP(docetaxel+cisplatin)chemotherapy,while given Shenmai injection in the process of concurrent chemoradiotherapy.In control group,40 patients only received chemoradiotherapy.The changes of T cell subsets were observed between the two groups.Results It showed no significant differences in percentages of CD+3,CD+4,CD+16CD+56and CD+4/CD+8 ratio between two groups pre-treatment(all P＞0.05).There were no significant adverse reactions occurred after received Shenmai injection in treatment group.Conclusion It play an important role in improving immune function of patients with locally advanced non-small cell lung cancer who received Shenmai injection combined concurrent chemoradiotherapy.

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combinedsaphenous nervegreat Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distallypedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot.

ObjectiveTo investigate the efficacy of laparoscopic spleen-preserving hilar lymph nodes dissection based on splenic hilar vascular anatomy.MethodsFrom July 2010 to March 2011,the clinical data of 39 patients with advanced proximal gastric cancer who underwent laparoscopic spleen-preserving hilar lymph nodes dissection at the Union Hospital of Fujian Medical University were retrospectively analyzed.Different types of vascular anatomy were analyzed,and different methods of lymph node dissection in the splenic hilus were adopted accordingly.ResultsThe operation was successfully performed on all the patients,with no conversion to open surgery or splenectomy due to splenic vascular or parenchyma injury.There were 4 types of splenic artery running,including type Ⅰ (25 patients),type Ⅱ (8 patients),type Ⅲ (4 patients) and type Ⅳ (2 patients).There were 2 types of the end branches of splenic artery,including concentrated type (28 patients) and dispersion type (11 patients).The splenic lobial vessels of all the patients were anatomically classified and divided into 4 types,including a single branch of splenic lobial vessels in 3 patients,2 branches in 24 patients,3 branches in 11 patients and multibranches in 1 patient.The mean number of short gastric vessels was 3.2 ± 1.4 (range,2-6).The time for dissection of the lymph nodes in the splenic hilum,number of lymph nodes dissected in the splenic hilum,volume of operative blood loss,duration of hospital stay and incidence of complications were ( 30 ±7)minutes,2.8 ±2.1,(20 ±7)ml (range,0-55 ml),(10 ± 1) days and 10％ (4/39).All patients were followed up until March,2012. One patient had hepatic metastasis,and no patient died postoperatively.ConclusionFamiliar with the variation of splenic hllar vascular anatomy is helpful in mastering and promoting laparoscopic spleen-preserving hilar lymph nodes dissection.