The incidence of severe acute pancreatitis in children is lower.But it has abrupt onset and atypical symptoms.The fatality rate is relatively high.This paper will review the progress on the diagnosis and treatment of severe acute pancreatitis.

Objective: To evaluate the clinical effect of individualized enteral nutritional (EN) support in severe stroke patients.Methods: Totally 120 severe stroke patients with nutritional risk were divided into two groups according to single or double admission number.The 60 patients in the intervention group received an individualized EN with different formula and concentrations according to the clinical status,and supplemented trace elements as occasion required.In the routine group, the patients received EN with standard formula.The energy supply was 83-125 kJ· kg-1·d-1 in both groups.Blood albumin(Alb), pre-albumin(PA), hemoglobin(Hb) and vitamin C(VC) were examined before and after the 21-day nutritional support.The lung infection and gastrointestinal (GI) complications were observed, and the hospital stay and cost were recorded as well.Results: After 21 day''s nutrition support, the serum levels of Alb, PA and VC in the intervention group were not statisticly significant than before (P＞0.05), and the serum levels of Alb, PA and VC were significantly higher than those in the routine group(P＜0.05).The incidence of complications in the in the intervention group was lower than that in the routine group (P＜0.05), and the length of hospital stay and hospitalization was shorter than that in the routine group (P＜0.05).Conclusion: Individualized enteral nutritional support can significantly improve nutritional status, reduce inflammation reactions and GI complications in severe stroke patients, which is worthy of clinical use.

Objective To establish a high sensitive spectrophotometry for determination of trace cadmium in the water. Methods A complicated ion-association complex of Cd(Ⅱ)-potassium iodide-malachite green was formed in the phosphate acid, and the addition of gelatine could enhance the sensitivity of the reaction.The maximum absorption of the ion-association complex was at 680 nm,the effect of experimental conditions such as the reagents concentration,the temperature and the influence of foreign matters were considered.Results In the optimum condition(6.0 ml of 40% potassium iodide-aseorbic acid solution,0.5 ml of 5.0 mol/L phosphate acid solution,0.5 ml of 0.5% gelatine solution,1.5 ml of 1.0?10~(-3)mol/L malachite green solution in a 25ml volumetric flask,diluted with water and mixed well and determined immediately),the linear regression equation was △A=0.011+ 0.957 c,r=0.998 5.Beer's law was obeyed in the range of 0.02 ?g/ml to 0.80 ?g/ml for Cd(Ⅱ)and the limit detection was 0.02 ?g/ ml.The composing ratio of the complex was MG:Cd:I=2:1:4,and its apparent molar absorptivity coefficient was 1.08?10~5 L/(mol? cm).The recovery rates of Cd(Ⅱ)were 97.0%-101.5%,RSDs were 1.36%-3.58%.Conclusion This method is sensitive,simple, rapid and is applicable to the determination of the trace Cd(Ⅱ)in water.

Objective To introduce the clinical apply of middle and small skin defect in finger injury with lateral arm free perforator flap.Methods (1) Ten cadavers were injected with a modified lead oxide-gelatin mixture.Later,CT scan,three-dimensional reconstruction of the cutaneous perforator vessels on the later arm.Then simulate the flap design.All cadavers were dissected before CT scanning.(2) Eighteen cases of middle and small skin defects in finger injury were treated with lateral arm free flap.The defect area were from 3 cm × 4 cm to 6 cm × 9 cm.Results Our research showed that the average caliber diameter of perforators of profunda brachial artery(PBA) was (0.71 ± 0.15) mm,and Posterior radial collateral artery(PRCA) was (0.94±0.22)mm.The results of pedicle length of perforator of PBA was (2.74 ±0.42) cm:(2.96 ±0.37) cm,and PRCA was (4.78 ±0.63) cm:(4.86 ±0.51) cm.3D reconstructive results showed that the perforators of PBA and PRCA dominated the lateral upper arm area.The flap of 18 cases survived after the operation.The wound of providing area was directly sutured or skin grafting and got healing.All cases were followed up for 6 months to 3 years,and the average follow-up time was 11 months.There was a little swelling on the outlooks of the flap,but the texture and sensation of the flap was good.Conclusion The lateral arm free perforator flap has a stable vessel pedicle,good texture and sensation,so it was a good method to repair middle and small skin defect in finger injury.

Objective: To study the effect of short exposure to high levels of fluoride on cellular structure and the DSP expression of odontoblasts of mice molars. Methods: 32 4-day-old ICR mice were randomly divided into two groups. The experimental animals were received a single intraperitoneal dose of 20 mg(n =8) andlO(n=8) mg NaF/kg( body weight) respectively. Equal doses of NaCl were given to the controls (n = 8 for each group). The injected volume was kept constant (10 μ/g). After 24 hours all mice were sacrificed. HE staining and immunohistochemical staining were used to observe the structural changes and the expression of DSP in odontoblasts of mouse molar at different stages. SPSS 13.0 software package was used to analyze the results. Results: The secretory odontoblasts distorted and lost its normal column contour. The immunohistochemistry results demonstrated that the expression of DSP was more intense than that in control group. Results of statistics analysis showed there were significant differences between the two groups(P<0.01). No remarkable differences were found in mature odontoblasts. Conclusion: Short exposure to high concentration of fluoride can enhance the expression of DSP in the secretory odontoblasts,and inhibit differentiation of the odontoblasts and matrix secretion. This lead to the abnormal development of dentinogenesis.

OBJECTIVETo study the effect of melatonin on the gastrointestinal motility and plasma levels of the stress hormone in overtraining rats.

METHODThirty adult SD rats were randomly divided into three groups (n = 10): control group, over-training group, melatonin intervention group. 30 min before each training, rats in the control and over-training groups were fed with normal saline (15 mg/kg) once a day and 5 times per week, while rats in the melatonin intervention group were administrated with melatonin, perfusion in the intervention group (15 mg/kg). Excessive training group and melatonin intervention group rats were subjected to excessive training at 5 times a week for 6 weeks. After 6 weeks, the gastric emptying rate, small intestinal propulsion ratio and levels of plasma motilin (MTL) and calcitonin gene-related peptide (CGRP), cortisol (CORT) and catecholamines (CA) were observed in all groups.

RESULTSCompared with the control group, the gastric emptying rate, small intestinal propulsion ratio and levels of plasma MTL, CORT and CA were increased significantly (P < 0.01) while the content of CGRP was reduced (P < 0.01) in over-training group. After treated with melatonin, this trend was reversed, that was, the gastric emptying rate, small intestinal propulsion ratio and levels of plasma MTL, CORT and CA were surpressed significantly (P < 0.01) while the content of CGRP was improved obviously (P < 0.01) in over-training group.

CONCLUSIONMelatonin plays an important role in protecting gastrointestinal tract from dysfunction, in which MTL, CGRP, CORT and CA are all involved.

Animals ; Calcitonin Gene-Related Peptide ; blood ; Catecholamines ; blood ; Fatigue ; Gastrointestinal Motility ; Hydrocortisone ; blood ; Melatonin ; pharmacology ; Motilin ; blood ; Physical Conditioning, Animal ; Rats ; Rats, Sprague-Dawley ; Stress, Physiological

Objective To study the clinical characteristics of the surgical treatment of cardiac valve disease in elderly patients.Methods Between January 2004 and February 2009,43 patients aged ≥65 underwent cardiac valve operation were enrolled as elderly group,85 patients aged <65 underwent the same operation served as control group in the same period,analyzed the clinical characteristics and difference between the two groups.Results The mortality of elderly group was higher than that of control group [11.6%(5/43) vs 2.4% (2/85),P<0.05].In elderly group,the duration of staying in ICU [(73.8±15.9) h],mechanical ventilation [(40.4±10.1)h],postoperative hospitalization time [(23.7±6.3) d]and the morbidity of postoperative complications [23.3%(10/43)]were higher than those of control group [(43.1±8.6)h,(28.5±5.8) h,(15.6±3.8) d,5.9%(5/85)](P<0.05 or <0.01).Conclusions Although there are high risks in patients aged 65 years and elderly with cardiac valve disease,the treatment results would be satisfactory ff select the right operating time and do full preparation with reasonable surgery strategy,the mortality and morbidity of postoperative complications could be reduced.

Since the oral rehydration salts solution(ORS) has been used to treat acute diarrhea of children, there are different kinds of ORS in order to satisfy the need of clinical work. They are the initial WHO-ORS, other substances-supplemented ORS and the reduced osmolarity ORS, each of which has their own efficiency and advantage.

Expressed emotion was the describing term about the guardian of patients' emotiveness tendency to patients,which reflected attitude,tolerance degree and the coping way in crisis.It was a robust predictor of relapse of schizophrenia.Studies showed that the family intervention for the high expressed emotion guardian of patients could effectively reduce the disease relapse.By summarizing the expressed emotion's concept,assessment tools,influence factors,family interventions,the paper aimed to innovate perfect interventions and promote the patients recovery.

AIM: To determine tanshinone Ⅱ_A and salvianolic acid B by HPLC gradient elution. METHODS: HPLC was used with Hypersil-ODS C_(18) column(150 mm?4.6 mm,5 ?m).The mobile phase consisted of methanol-water 0~20 min(35-90:6510),20-25 min(90-95:10-5),25-30 min(95:5)gradient elution.The flow rate was 1.0 mL/min with column temperature at 30 ℃.The UV detection wavelength was at 286 nm in 0-20 min and 270 nm in 20-30 min,respectively. RESULTS: The linear range of tanshinone Ⅱ_A and salvianolic acid B were in the range of 0.014 448-0.096 32(r=0.999 97), and 0.198 6-3.972 ?g(r=0.999 94),respectively.The average recoveries were 99.62%(RSD=2.28%) and 100.58%(RSD=2.5%),respectively.(CONCLUSION:) The method is accurate、sensitive、reproducible,and suitable for the quality control of Chaidan Jieyu Granules.