Objective To investigate the cause and the therapy of acute pancreatitis. Methods 994 patients of acute pancreatitis admitted in the Surgery Ward in Ruijin Hospital between Jan. 2003 to Jan. 2007 were retrospectively analyzed. They were divided into groups according to etiology and therapy. Results In these 994 patients, 825 cases were with biliary origin (83.0%); 24 cases were alcoholic origin (2.41%); 29 cases were hyperlipidemia origin (2.92%); 16 cases were pregnancy origin (1. 61% ), 71 cases were idiopathic origin (7.14%); 4 cases were traumatic origin (0.40%); 25 cases were mixed origin (2.52%).There were 767 cases (77.2%)of mild acute pancreatitis (MAP) and 227 (22.8%) cases of severe acute pancreatitis (SAP). The overall cure rate was 91.2% , 87 cases were dead with a mortality of 8.8%. The mortality of alcoholic acute pancreatitis was 37.5% , which was significantly higher than that in biliary acute pancreatitis. Non - surgical treatment, ERCP + EST, cholecystectomy and exploration of common bile duct, or laparoscopic cholecystectomy after ERCP or debridement treatment was used for biliary acute pancreatitis. All patients underwent debridement treatment were SAP patients with a post-operative mortality of 25.0% , which was significantly higher than those in other treatment group ( P ＜ 0.01 ). There was no significant difference among the other 3 groups as regard to SAP patients and mortality. Conclusions The major cause of acute pancreatitis was biliary factor. Alcoholic pancreatitis was critical with poor prognosis. For biliary acute pancreatitis, the therapeutic efficacies of multiple treatment were not significantly different.

Objective To investigate the therapeutic effects and mechanisms of propofol on acute necrotizing pancreatitis (SAP) in rats.Methods 54 male Sprague-Dawley rats were randomized into three groups with 18 rats in each group:sham-operation group,ANP group,propofol-treatod group.After ANP models were induced,propofol(10 mg·kg~(-1)· h~(-1)) were injected by dorsal vein of penis in the propofoltreated group.The rats in all groups were sacrificed at 3,6,12 hours after induction of the model.The serum amylase,lipase,nitric oxide (NO),TNF-a,superoxide dismutase (SOD),IL-6 were detected;the histopathological score of pancreatic tissue were evaluated.Results At 6 h,the levels of serum amylase in sham-operation group,ANP group,propofol-treatod group were(1743± 370) U/L,(7745± 1030) U/L and (5529± 874) U/L;the levels of serum lipase were(274.9± 36.1)U/L,(1672± 262)U/L and(1219± 207 )U/L;the levels of serum TNF-a were (1.110± 0.276)mg/L,(3.191± 0.279)mg/L and (2.361±0.281 )mg/L;the levels of serum IL-6 were (102.6±28.5)ng/L,(334.1±34.0)ng/L and (268.6±29.8)ng/L;the levels of serum NO were (42.2±18.1)μmol/L,(120.7±22.3)μmol/L and(73.6±19.3)μmol/L;the levels of serum SOD were(120.6± 20.1)U/ml,(54.1± 15.3)U/ml and(85.7± 17,1)U/ml;the histopathological scores were 0.333± 0.408,4.417± 0.665 and 3.500±0.707.The serum levels of amylase,lipase,NO,TNF-a,IL-6 and the histopathological score of pancreas in ANP group were significantly higher than those in sham-operation group group(P＜0.05 ),while the serum levels of SOD were significantly lower(P＜0.05).The serum levels of amylase,lipase,NO,TNF-a,IL-6 and the histopathological score of pancreas in propofol-treated group were significantly lower than those in the ANP group(P＜0.05),while the serum levels of SOD were significantly higher(P＜0.05).Conclusions Propofol could decrease the levels of serum amylase and lipase,reduce pancreatic tissue damage,and had therapeutic effects on ANP in rats.

Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10％ from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10％ was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0％.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)％ vs.(17 ±7)％, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.

Objective Investigate the clinical efficacy of treating retreated smear-positive tuberculosis patients with conventional anti-tuberculosis chemotherapy combined with levofloxacin. Methods Divide 60 retreated smear-positive tuberculosis patients registered in our hospital between October 2012 and October 2014 into two groups using random number table method: levofloxacin group and conventional treatment group. Each group contains 30 patients that were treated for 9 months , and the efficacy the both treatment methods were compared. Results The sputum conversion rate in the levofloxacin group is 93.33% and 96.67% after treating for 6 months and 9 months , respectively; which are substantial higher than that of the conventional treatment group with sputum conversion rate of 70% and 73.33% after 6 months and 9 months of treatment , respectively (P < 0.05). The absorption rate of the levofloxacin group is significantly higher than that of the conventional treatment group (P < 0.05). The cavity improvement rate of the levofloxacin group is 73.33%, which is significantly higher than that of the conventional treatment group (33.33%) (P < 0.05). The clinical efficacy of the LVFX group is substantially higher than the routine treatment group (P < 0.05). The overall effectiveness of LVFX group reached 100% , which is significantly higher than that of the conventional treatment group (86.67%) (P < 0.05). Conclusions Levofloxacin combined with conventional anti-tuberculosis chemotherapy can effectively improve the clinical efficacy in the treatment of tuberculosis.

Objective:To investigate the effect of acute mixed hyperlipidemia on acute myocardial infarct size and the potential mechanism.Methods: Fifty-three Sprague-Dawley(SD) rats were divided into three groups: the control group(n=15) was injected with 1.0 mL 0.9% sodium chloride,the low dose group(n=17) and high dose group(n=21) were injected with 0.5 mL and 1.0 mL 10% Triton WR-1339 solution respectively.Acute myocardial infarction was produced 24 hours after the injection.Serum lipid and the activity of lipoprotein-associated phospholipase A2(Lp-PLA2) were measured before and 24 hours after the injection.Rats were killed 24 hours after ligation and their hearts were excised to evaluate the myocardial infarct size.Results: Serum total cholesterol(TC) and trig1ycerides(TG) concentrations were(6.92?1.48) mmol/L and(11.76?2.76) mmol/L in the low dose group 24 hours after injection,(11.91?0.87) mmol/L and(33.97?5.85) mmol/L in the high dose group,and both increased significantly compared with the baseline.Also serum low density lipoprotein cholesterol(LDL-C) concentration increased(P0.05).Myocardial infarct size was significantly(P

AIM To compare the effects of probimane( Pro), bimolane ( Bim) and razoxane( Raz) on animal tumor metastasis in vivo . METHODS A biological inoculation method for assessment of pulmonary metastasis of Lewis lung carcinoma(3LL) was employed. RESULTS Pro and Bim inhibited the pulmonary metastasis of 3LL both from d 2 and from d 8 injections, but Raz only inhibited the pulmonary metastasis of 3LL from d 2 injections. Pro inhibited the pulmonary metastasis of 3LL more potently than Bim did at equitoxic dosage. CONCLUSION Pro is better in the treatment of pulmonary metastasis of 3LL than Raz for its possible novel molecular mechanisms.

As an important component of modern medicine , the critical care medicine has sprung up for years. Nevertheless, based on the postgraduate education and the further education like 5C training, the existing talent training pattern has been unable to solve the serious problem of the deficiency in the human capital of critical care medicine in hospitals of different levels. With the eco-nomic development of the society and the constant emergence of the new medical technologies , the critical care medical specialty should be quickly established in medical colleges, especially facing the modern demand on curriculum reformation in the undergraduate course. As the “National Compre-hensive Reforms Pilot Unit of Anesthesiology”, the School of Anesthesiology of Wannan Medical Col-lege is obliged to cater for the social need and respond to the national policy. Despite of the insuffi-ciency of teaching and cases, the school endeavors to build up the reformed “2+1+2” curriculum system on the basis of strengthening the major advantages. With the core of the teaching mold reform, the new system aims to enhance the clinical training and introduce the teaching mold reforms of “or-ganic system-based”, PBL and CBL, etc. Therefore, the sound training mold of critical care medicine could be further explored significantly.

Objective To study the expressions of co stimulatory factors CD28 and CTLA 4 on CD3 + T cells in peripheral blood lymphocytes (PBMC) and synovial fluid lymphocytes (SFMC) in patients with rheumatoid arthritis (RA) and the relationship of these molecules with the activity of RA. Methods The lymphocytes were collected from the peripheral blood and synovial fluid in RA patients. The CD3 +CD28 + and CD3 +CTLA 4 + molecules on these cells were measured by dual color fluorescence cytometry. The correlation of the expressions of CD3+CD28+ and CD3 +CTLA 4 + molecules with the activity of RA was statistically analyzed by Spearman. Results ① The level of CD3 +CD28 + in PBMC of RA patients was significantly lower than that of the control group and SFMC ( P

Objective To determine whether acute withdrawal of simvastatin treatment in healthy normocholesterolemic men impairs the brachial artery endothelial function.Methods The study was performed on 16 healthy,young male subjects with desirable serum levels of cholesterol.They were administered with simvastatin(20 mg/d)for 4 weeks.Endothelial dependent flow-mediated vasodilation (FMD)was assessed on the brachial artery using high-resolution ultrasound,and fasting serum lipid profiles as well as vasoactive substances[NO,endothelin(ET)and 6-keto-PGF1α] were measured.The parameters mentioned above were obtained at indicated time points before and after simvastatin treatment. Resuts Simvastatin treatment for 4 weeks significantly improved FMD and reduced low density LDL-C and total TC levels.Withdrawal of simvastatin.however,resulted in dramatic impairment of endothelium- dependent relaxation on the first day after with drawal [(4.6±0.48)%and(10.9±0.89)%,P＜0.01 ], Furthermore,FMD decreased significantly as compared with baseline level[(4.6±0.48)%vs(6.4±0.47)%,P＜<0.01].Serum NO level varied according to the change of endothelial-dependent relaxation(γ=0.496,P＜0.01).After discontinuing simvastatin therapy,plasma ET increased and plasma 6-keto-PGF1α decreased progressively.In addition,serum TC and LDL-C were not significantly modified during the initial 2 days.No correlation was shown between FMD and serum LDL-C level(γ=-0.172,P=0.101). Conclusions Withdrawal of simvastatin not only abrogates the beneficial effect on endothelial function of healthy normocholesterolemic men rapidly,but also induces further endothelial deterioration as compared with pretreatment status.This adverse effect is independent of serum cholesterol.The underlying mechanism may be related to the suppression of endothelial NO production.