Objective To investigate the technique and clinic value of non-operation management for ERCP-related peripancreatic and retroperitoneal abscess. Methods Five patients with post-ERCP peripancreatic and retroperitoneal abscess were reviewed. Guided by ultrasonic or CT, all the 5 pa-tients underwent puncture and the drainage tube was disposed to the lowest place of abscess. Non-op-eration managements for patients also included the use of anti-inflammatory drugs and enzyme activity inhibition drugs. Results All patients responded to the draining treatment and discharged from hospi-tal after complete recovery. There was no conversion to surgical intervention. Mean draining duration was 52. 4(20-90)d and average hospital stay was 91.8(35-165)d. Conclusion Puncture and drainage management is an effective and safe approach for post-ERCP peripancreatic and retroperitoneal ab-scess. It has advantages of less trauma, less pain, fast recovery and low rate of complications. Punc-ture point should be situated at the bottom or lowest position of abscess and drainage can achieve the best results.

Objective To investigate the role of D-dimer in the diagnosis and evaluation of mycoplasma pneumonia.Methods The positive rate and concentration of D-dimer in mycoplasma pneumonia,bacterial pneumonia,viral pneumonia and healthy controls were detected and compared.The positive rate and concentration of D-dimer in patients with systemic inflammatory response syndrome(SIRS)and without SIRS were observed.Changes of D-dimer concentration in patients with mycoplasma pneumonia before and 2 weeks after treatment were observed.Results Compared with bacterial pneumonia group(16.7%),the viral pneumonia group(20.0%)and healthy control group(0.0%),the positive rate of D-dimer in mycoplasma pneumonia group(41.6%)was significantly higher(x2=5.625,4.158,17.308,all P<0.05).The positive rate of mycoplasma pneumonia group with SIRS(64.0%)was significantly higher than that in other groups(x2=17.308,P<0.05).The D-dimer levels of the mycoplasma pneumonia group [(324.4±125.3)μg/L],bacterial pneumonia group[(282.3±95.4)μg/L] and viral pneumonia group[(293.1±92.3)μg/L]were significantly higher than that in the healthy controls[(72.9±22.4)μg/L](t=10.878,11.704,12.698,all P<0.05).The concentration of D-dimer[(381.4±129.4)μg/L] in the mycoplasma pneumonia group with SIRS was significantly higher than that in the other groups(t=2.668,P<0.05).Compared with before treatment,the concentration of D-dimer after treatment in the two groups was significantly lower[(129.3±65.3)μg/L,(89.7±28.6)μg/L](t=2.582,P<0.05).Conclusion The level of D-dimer in children with mycoplasma pneumonia was significantly increased,and the severity of the disease could be reflected.

Objective To observe the ultrastructure and absorption function of colon mucosa in rat with ultra-short bowel syndrome. Methods Totally 30 SD rats were randomly divided into three groups: ultra-short bowel group (90%-95% of the intestine was surgically resected, n = 10), sham group (n = 10), and normal control group (n = 10). All animals were given with enteral nutrition. Scanning electron microscopy was performed 21 days later to observe the morphology of mucosal surface, and transmission electron microscopy was performed to observe the ultrastructural changes of intestinal epithelial cells. The absorption of colon to water, carbohydrates, and amino acid determined after 3 hours of closed perfusion of the colon with D-xylose solution and 15N-glycine on the continuous cycle of colon. Results As shown by the transmission electron microscopy, compared with the normal control group, rats in the ultra-short bowel group showed significantly decreased goblet cells on colonic mucosl surface, increased epithelial cells, longer and denser microvillus, increased area of membrane surface, increased number of cell-cell junctions, increased number of desmosome, tight junction, and gap junctions, higher development of endoplasmic reticulum and dictyosome, and increased number of mitochondria. As shown in the screening electron microscopy, compared with the normal rats, rats in the ultra-short bowl group had significantly deeper colon folds, thicker mucous membrane, increased number of bay openings, and longer and denser microvillus-like structures inside bays. The capability of water absorption was signicatnly higher in the ultra-short bowl group than in the sham group and normal control group (P = 0. 000) . The absorption rates of xylose and 15 N-glycine were also significantly higher in the ultra-short bowl group than in the control group (P ＜ 0. 01). Conclusions The absorption capability can be compensatively increased in rats with ultra-short bowel syndrome. Decreased apoptosis of colon mucosa cells, increased absorption cells, hyperplasia of microvilli, increased area of the membrane surface,and increased number of mitochondria may constitute its material and energy bases.

Objective To assess the volume of epicardial adipose tissue(EAT) and intrathoracic adipose tissue(IAT) and the correlation of EAT,IAT and the EAT/IAT ratio with the severity of coronary artery atherosclerosis in patients with metabolic syndrome(MS) and coronary heart disease(CHD).Methods Ninty-seven MS subjects without coronary atherosclerosis and one hundred and eighteen MS subjects with CHD were enrolled in this study.The volumes of EAT,PAT and IAT were measured using axial data from base to apex traced manually with a dedicated semiautomatic software program-volume.Results (1)Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD had significantly increased age[(60.6± 1 1.4)years vs.(57.9 ± 8.7) years,P=0.001],positive family history of cardiovascular disease(29.7％ vs.21.6％,P=0.03),EAT[(98.3±41.4) cm3 vs.(82.2±39.7) cm3,P=0.001],IAT [(171.3±64.1) cm3 vs.(156.2±48.1) cm3,P=0.001] and HbA1c[(7.1 ± 1.8)％ vs.(6.6±2.3)％,P=0.02],but siginificantly reduced total cholesterol[TC,(4.9 ± 1.2)mmol/L vs.(5.4 ± 1.0) mmol/L,P=0.003],low-density lipoprotein cholesterol[LDL-C,(3.0±1.1) mmol/L vs.(3.6±1.0) mmol/L,P=0.03] and high-density lipoprotein cholesterol[HDL-C,(1.0 ± 0.4) mmol/L vs.(1.1 ± 0.3) mmol/L,P=0.04].(2) In MS subjects without coronary atherosclerosis,the volumes of EAT,pericardial adipose tissue(PAT) and IAT were associated with gender,body mass index(BMI),waist circumference(WC),diabetes mellitus and hyperlipidemia(all P＜0.05); however,in MS subjects with CHD,the volumes of EAT,PAT and IAT were associated with BMI and WC (both P＜0.05).(3) The volumes of EAT and IAT were correlated with calcification grades(r values were 0.45 and 0.50,P values were 0.017 and 0.013,respectively) and Gensini score(r values were 0.476 and 0.563,P values were 0.015 and 0.017,respectively) instead of coronary artery calcifacation score(CACS).Moreover,the EAT/IAT ratio was negatively correlated with CACS(r=-0.321,P=0.028).Conclusions Compared with MS subjects without coronary atherosclerosis,MS subjects with CHD have significantly increased EAT and IAT volumes.In our subjects,the volumes of EAT,PAT and IAT were associated with BMI and WC.Only in MS subjects with CHD,the volumes of EAT and IAT were correlated with caleification and Gensini score.

Objective This study is to analyse the clinical feature and risk factors of morbidity after pulmonary resection for lung cancer in patients older than 70 years. Methods The clinical records of 222 patients older than 70 years who had undergone pulmonary resection for their lung cancer was reviewed. The patients were divided into 3 groups: group Ⅰ including the patients who had severe postoperative complications, group Ⅱ including the patients who had mild complications and group Ⅲ including the patients who had no complications. Moreover, the definitions were made that group A1 = group Ⅰ+ Ⅱ , group B1 = group Ⅲ, group A2 = group Ⅰ and group B2 = group Ⅱ + Ⅲ. Univariate analyses and multivariate binary logistic regressions relating postoperative morbidity to risk factors were performed between the group Al and Bl, A2 and B2, resulting in the identification of the independent risk factors for overall morbidity and major morbidity. Results Preoperative comorbidity was recorded in 161 patients (72.5%). Lobectomy (64.9% ) was the predominant surgical procedure. The median number of dissected LN was 14, with the range of 0 to 57. The overall morbidity was 63.5% , including major morbidity of 13.5%. Perioperative mortality was 1.8% (4 cases). The results of binary logistic regression analyses indicated that the independent risk factors for overall morbidity were preoperative weight loss (P =0.020), ASA score (P＜0.001), MVV (% predicted) (P=0. 020 ) and the number of dissected LN ( P = 0.004 ). The independent risk factors for major morbidity were ASA score ( P =0.003), MVV (% predicted) (P= 0.018) and the location of tumor (P=0.007). Conclusion Preoperative weight loss and numbers of dissected mediastinal lymph nodes were risk factor for lung cancer patients older than 70 years, Proper perioperative management for the elderly patients with high ASA score, low MVV (% predicted) or central tumor, could reduce the major postoperative morbidity.

Objective To analyze the reason of hemoptysis after the bidirectional Glenn shunt procedure on complex congenital heart disease.Methods The feature of imaging data of 24 patients (1 6 males,8 females;age ranges:3-27 years;14 cases of single ventricle,3 cases of tricuspid Atresia,4 cases of pulmonary Atresia,3 cases of double Outlet Right Ventricle)after the bi-directional Glenn shunt procedure were retrospectively studied.Results Six patients had various degrees of hemoptysis (50 - 300 mL)after surgery,except for one case which has bronchiectasis on the left inferior lobe.The common feature of the other 5 cases present as plaque ground glass opacity and pulmonary arteriovenous fistula located at the corresponding subpleural field.After different therapy (three cases were performed endovascular management,2 cases were under expectant treatment),the lesion disappeared or obviously smaller which was clear evidence for the existence and bleeding of fistula.The occurrence of this disease in the present study was nearly 20.8%,which were accord with references.Conclusion Pulmonary arteriovenous fistula should be considered when crypto-genic hemoptysis happened after bi-directional Glenn shunt with complex congenital heart disease which exclude tuberculosis,bron-chiectasis or rupture and bleeding of MAPCAs.Multiple sliced CT angiography can be used to as the first line examination and sup-ply acute evidence for clinic therapy in time.

AIM:To study the effects of methylene blue (MB) on myocardial ischemia/reperfusion (I/R)-induced mitochondrial injury in isolated rat hearts.METHODS:Spragure-Dawley (SD) rats were divided into 3 groups randomly (n=6): control group, I/R model group and MB treatment group (IR+MB group).The isolated rat hearts were prepared and set up to Langendorff perfusion.The rats in I/R+MB group received MB (2 mg/kg) by intraperitoneal injection 2 h before operation.The hearts in control group were perfused with K-H solution for 110 min consecutively.The hearts in I/R group and I/R+MB group were in equilibrium for 20 min, following by 45 min of global ischemia, and then reperfused for 60 min.The heart rate (HR), left ventricular developed pressure (LVDP), left ventricular pressure maximum change rate (±dp/dtmax) and left ventricular end-diastolic pressure (LVEDP) were recorded.The perfusate was collected to determine the activity of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH).The contents of reactive oxygen species (ROS), malondialdehyde (MDA) and adenosine triphosphate (ATP), and the activity of superoxide dismutase (SOD) in the myocardial tissues were all determined.Histopathological examination of left ventricle was performed.The mitochondria from the heart tissues was isolated and the mitochondrial swelling and mitochondrial membrane potential (MMP) were analyzed.RESULTS:Compared with control group, the hearts in I/R group showed poorer function, higher CK-MB and LDH levels in the perfusate, increased ROS and MDA contents, higher SOD activity and less ATP content in the heart tissues (P<0.05).Furthermore, the mitochondrial swelling level increased and MMP reduced in I/R group (P<0.05).Compared to I/R group, MB improved heart function and reduced the release of CK-MB and LDH (P<0.05).MB also decreased ROS and MDA contents, and increased the activity of SOD and the content of ATP (P<0.05).In addition, MB alleviated mitochondrial swelling and restored the reduced MMP (P<0.05).CONCLUSION: MB protects the isolated rat hearts from I/R-induced injury by attenuating the damage of mitochondria.

Objective To develop a simple high-resolution melting ( HRM) analysis method for differentiation of Pc and P2 variants in class 1 integron.Methods DNA fragments containing Pc and P2 variants were amplified from plasmids pACW ( PcW ) and pACWP2 ( PcW-P2 ) respectively , then these purified PCR products and P 2 promoters were analyed full-length amplicon by HRM .Eight DNA fragments containing different Pc promoters were amplified and site-specific mutated from plasmids pACS ( PcS ) , pACH2 ( PcH2 ) , pACH1 ( PcH1 ) , pACW ( PcW ) , genomic DNA of Klebsiellar pneumonia HS07-68 (PcWTGN-10)and HS05-1792(PcH2TGN-10)respectively.The purified PCR products and eight Pc variants were characterized by HRM analyses of an unlabeled probe and full-length amplicon.This assay was applied to the differentiate Pc and P2 variants in 109 class 1 integrons from 95 urine clinical Escherichia coli isolates in Huashan Hospital during 2004 -2007.The differentiation results were compared with that determined by direct sequencing .Results P2 promoter with a significant higher melting temperature ( Tm ) can be identified by HRM analysis clearly .P2 promoters were identified in 2 class 1 integrons and consistent with direct sequencing results .Eight Pc variants were classified into three groups: PcS, PcSTGN-10 , PcW, PcWTGN-10, PcH1, PcH1TGN-10.Using direct HRM analysis.PcH2, PcH2TGN-10 were classified into four groups:PcS, PcH1, PcH2, PcW, PcSTGN-10 , PcH1TGN-10 , PcH2TGN-10 , PcWTGN-10 according to the melting curves of the unlabeled probe .Combined the HRM analyses of the whole amplicon and unlabeled probe , the eight Pc variants can be differentiated from each other .Five different Pc variants, PcS, PcW, PcH1, PcH2TGN-10 and PcWTGN-10 , were identified and consistent with direct sequencing results .Conclusions This developed a simple Pc and P 2 variants differentiation method via simultaneous HRM analyses of an unlabeled probe and full-length amplicon .This method is cost-effective and accurate , could be used in differentiation of Pc and P2 variants of class 1 integrons in clinical isolates .

OBJECTIVE:To study and evaluate the efficacy and safety of homemade sterilized powder for injection of rifampicin(weifunin) in the treatment of pulmonary tuberculosis(PT) and to compared with same import preparation . METHODS:Divide the 121 of bacteriological positive PT patients in the proportion of 1 to 1 with computer automatically into the trial group and the control group used with homemade rifampicin (weifuxin) and import rifampicin(nifu)respectively,the others regimens was same in 2 groups,to evaluate the sputum culture negative conversion rates,X-ray results and adverse drug event etc.after treatment 1 and 2 months . RESULTS: 116 cases were finished ,at the end of 2 month the sputum smear negative conversion rates were 86.21 % and 91.38% (X2=0.780,P=0.377), the sputum culture negative conversion rates were 91.38% and 93.10%(X2=0.120,P=0.729)in the trial group and the control group respectively .The X-ray remarkable effective rates of 2 groups were 82.76% amd 70.69%(X2=2.365,P=0.124)respectively, and the effective rates of the 2 groups were both be 96.55% .The adverse drug event rates were 8.20% and 11.67% respectively, there was on sighificant difference in each indexes .CONCLUSIONS:2 preparation were similar in efficacy ,safety and tolerance.

Objective To observe the clinical efficacy of the photon therapeutic apparatus on type 2 diabetic patients with periph-eral neuropathy .Methods While giving conventional nerve nourishing ,improving microcirculation treatment and nursing ,adjuvant therapy with Carnation-11 photon therapeutic apparatus was applied to one lower limb only of the 20 diabetes mellitus patients with peripheral neuropathy and compare the curative effects by paired observation of the two lower limbs .Results The evaluation score of peripheral neuropathy dropped obviously with ankle reflex and thumb vibration sensation improved greatly after 10 days of treat-ment and remained an unchanged follow -up test 30 days later ,which means the clinical therapeutic effect of the treated limb was significantly superior to the comparison limb .The difference of the curative effects is statistically significant ( P < 0 .05 ) . Conclusion Conventional therapy accompanied by adjuvant treatment of photon therapy can relieve the clinical symptoms and phys-ical signs of diabetic patients with peripheral neuropathy ,which could improve curative effect on diabetic peripheral neuropathy .