Objective To evaluate the efficacy of endoscopic variceal ligation and somatostatin for esophageal varices bleeding.Methods Eighty patients with hepatic cirrhotic esophageal varices bleeding were allocated into two groups,forty in endoscopic variceal ligation(EVL)group and the others in somatostatin(stilamin)group.Results Initial hemostasis rates(including emergency hemostasis and no bleeding for 72 hours)and one-month rebleeding rates in EVL group and somatostatin group were 97.5% vs 80%(P0.05).The hepatic encephalopathy rates were 2.5% vs 15%(P0.05).Conclusion Endoscopic variceal ligation is superior to somatostatin for hepatic cirrhotic esophageal varices bleeding.EVL can lower the rate of hepatic encephalopathy.

Objective To study efficacy of L-ornithine-L-aspartate (Hepa-Merz) in treatment for nonalcoholic steatohepatitis (NASH) and its effect on lowering serum level of triglycerine MethodsTotally, 30 patients with nonalcoholic steatohepatitis diagnosed by liver function test, B ultrasound scanning and liver biopsy were treated by intravenous infusion of L ornithine L aspartate (Hepa Merz) 10 g daily for 21 days Activities of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) and serum level of triglycerine (TG) were determined for all the cases before and after treatment Results Activities of serum ALT and AST and serum level of TG were restored to normal in 29 (96 7%) and in 28 (93 3%) of 30 patients, respectively, after treatment No serious adverse effects were found during treatment Conclusions L ornithine L aspartate (Hepa Merz) is a safe and effective drug in treatment for nonalcoholic steatohepatitis, and can lower serum level of triglycerine significantly

Objective To investigate the minimal and optimal concentration of ropivacain for epidural anesthesia in patients with breast cancer.Methods 103 patients with breast cancer ASA Ⅰ-Ⅱ undergoing elective radical mastectomy were conducted with epidural anesthesia.T2-3 were selected as a puncture site.A catheter was inserted into the epidural space in a cephalic direction for 3.5-4.0 cm.The concentration of ropivacain was produced by the test of up-down sequential allocation technique.20-25 ml of 0.20 ％ ropivacaine was given after a test of 0.20 ％ 5 ml ropivacaine.If the anesthesia was effective (VAS≤3),the next concentration was down 0.01％,while the VAS was more than 5,the next concentration was up 0.01％.The anesthesia effect and segments of block were measured with acupuncture.Blood pressure (NIBP),heart rates(HR),blood oxygen saturation (SPO2),blood gas and VAS were monitored during operation.Nasal catheter oxygen inhalation was used in routine method.Results The median effective concentration (EC50) of ropivacaine was 0.10 ％ determined by the formula of dixon and massey.The 95 ％ confidence intervals was 0.1022 ％-0.1065 ％.The least and the best analgesic concentration of ropivacaine for the upper thoracic epidural block was 0.14 ％ and 0.17 ％-0.18 ％ respectively.Conclusion The minimal and the optimal analgesic concentration of ropivacaine for the upper thoracic epidural block are 0.14 ％ and 0.17 ％-0.18 ％respectively,and which provides a safe and rational use of ropivacaine for the clinic.

Objective To assess the influence between managements in emergency room(ER) andoutcome of severe traumatic brain injury (TBI),in order to provide inference for treatment.Methods A retrospective analysis was performed in severe TBI patients and recorded next indexes.(1) The managements in ER,including endotracheal intubation and oxygenation,fluid resuscitation,and mannitol intake.(2) The vital signs arriving at ICU,including systolic pressure and blood oxygen saturation.(3) Prognostic indicators including inhospital mortality and days during ICU,the scores of Glasgow outcome scale (GOS) at discharge and 6 months after injury.Results In 140 severe TBI patients,65 patients (46.4％) died during ICU.The mortality of patients with endotracheal intubation [65.0％ (39/60)] was significantly higher than that without endotracheal intubation [32.5％(26/80)](P＜ 0.01).The mortality in whether fluid resuscitation and using mannitol had no significant difference [44.7％ (46/103) vs.51.4％ (19/37),49.2％ (31/63) vs.44.2％ (34/77)] (P ＞0.05).In days during ICU,there was no significant difference among the three treatment measures (P＞ 0.05).In GOS grade at discharge and 6 months after injury,the proportion of 4 and 5 grade were 8.3％ (5/60) and 25.0％ (15/60) in patients with endotracheal intubation,while 27.5％ (22/80) and 52.5％ (42/80) in patients without endotraeheal intubation (P ＜ 0.01).In fluid resuscitation and using mannitol patients,there were no significant difference(P ＞ 0.05).Conclusion Treating severe TBI patients in ER,endotracheal intubation should be carefully chosen,fluid resuscitation and mannitol may not be given.

Objective To investigate the value of double-balloon enteroscopy and CT enterography for the diagnosis of intestinal Crohn disease ( CD ) . Methods Data of 125 patients with suspected CD undergoing double-balloon enteroscopy and CT enterography were reviewed. Diagnosis was made based on pathological,endoscopic findings and clinic follow-up results. Detection rates and diagnostic rates of double-balloon enteroscopy and CT enterography for intestinal CD were compared. Results The detection and diagnostic rates of intestinal CD by double-balloon endoscopy were 62. 4％( 78/125) and 94. 8％ ( 74/78) , respectively. The sensitivity, specificity and accuracy of double-balloon enteroscopy in the diagnosis of intestinal CD were 100. 0％, 92. 2％ and 96. 8％, respectively. The detection and diagnostic rates of intestinal CD by CT enterography were 44. 8％( 56/125 ) and 89. 3％ ( 50/56 ) , respectively. The sensitivity, specificity and accuracy of CT enterography in the diagnosis of intestinal CD were 67. 6％, 88. 2％ and 76. 0％, respectively. Both the detection rate and the diagnostic rate of double-balloon enteroscopy in intestinal CD were higher than those of CT enterography. Conclusion Double-balloon enteroscopy shows high application value for the diagnosis of intestinal CD, but CT enterography before enteroscopy can guide the selection of endoscopic approach, reduce economic expenditure and alleviate patients' pain, so CT enterography could be the first choice for intestinal CD patients with contraindications of enteroscopy.

Objective:To explore the effect of probiotics Lactiplantibacillus plantarum(LP) WCFS1 by gavage on acute necrotizing pancreatitis (ANP) and associated ileum injury in mice. Methods:Twenty-four healthy male mice were gavaged with broad-spectrum antibiotics for 3 weeks to establish microbiota-depleted mice, and then randomly divided into control group (CON), ANP model group (ANP), LP gavage group (LP) and LP gavage and ANP induced group (LP+ ANP) , with 6 mice in each group. Mice in LP and LP+ ANP group were treated by gavage of LP (1×10 9 CFU/ml, 0.2 ml/day per mouse) for 1 week, while CON and ANP were gavaged with sterile phosphate buffered saline for 1 week instead. The ANP model was induced by intraperitoneal injection with caerulein (100 μg/kg) for 10 times with 1-hour interval between two injections and the 10th injection with lipopolysaccharide(LPS) 5 mg/kg intraperitoneally, and the mice were sacrificed 2 h later. Levels of LP in stool and ileal mucosa were detected by real-time PCR; the pancreas and ileum were collected for pathological examination to observe the extent of tissue inflammation and to score the pathology. Serum amylase activities were determined by enzymatic kinetic chemistry; serum inflammators levels and intestinal permeability were detected by ELISA; levels of inflammators in pancreatic and ileal tissues were detected by real-time PCR; ileal tight-junction proteins (occludin, claudin-1 and ZO-1) were measured by immunofluorescence staining. Results:LP levels in the stool and ileal mucosa of mice were significantly increased after LP gavage, and the differences were statistically significant (913.30±39.12 vs 2.39±1.39, 23.11±0.50 vs 1.38±0.28, all P value <0.05). The pathological scores of pancreatic tissue of CON, LP, ANP and LP+ ANP group were (0.26±0.41), (0.17±0.26), (8.55±0.46) and (6.30±0.45); the serum amylase activities were (219.70±19.73), (217.60±11.30), (2896.24±98.32) and (1837.13±131.60)U/L, IL-1β were (0.87±0.28), (1.4±0.85), (67.41±6.45) and (36.33±5.65)pg/ml, IL-6 were (0.74±0.27), (0.16±0.16), (280586.12±39163.92) and (107912.75±31283.47)pg/ml, IL-10 were (35.52±5.27), (50.99±15.34), (2008.45±184.83) and (3070.35±403.71)pg/ml; the expression level of pancreatic IL-1β mRNA was 1.42±0.39, 0.95±25, 20.53±0.50 and 10.69±1.01, IL-6 mRNA was 1.31±0.44, 0.93±0.023, 21.97±1.71 and 11.54±1.75, IL-10 mRNA was 0.93±0.14, 0.75±0.15, 0.99±0.21 and 1.76±0.19; there was no significant difference between LP and CON group, and pancreatic pathological scores, serum amylase、IL-1β and IL-6 levels, and the expression level of pancreatic IL-1β and IL-6 mRNA were significantly decreased in LP+ ANP group compared with those in ANP group, while serum IL-10 levels and the expression level of pancreatic IL-10 mRNA were significantly increased compared with ANP group, and all the differences were statistically significant (all P values <0.05). The pathological scores of ileal tissue of CON, LP, ANP and LP+ ANP group were 0, 0, (3.17±0.41) and (1.67±0.52); the levels of serum DAO of CON, LP, ANP and LP+ ANP group were (0.03±0.03), (0.02±0.02), (0.50±0.05) and (0.49±0.06)ng/ml; LPS levels were (2.75±0.35), (3.74±0.28), (7.19±0.92) and (5.88±0.38)ng/ml; the expression level of ileal IL-1β mRNA was 1.21±0.20, 1.17±0.09, 1.81±0.25 and 1.63±0.21; IL-6 mRNA was 1.01±0.29, 2.83±0.42, 54.45±8.50 and 16.87±4.42; IL-10 mRNA was 1.12±0.41, 6.09±2.51, 11.65±1.47 and 29.86±2.93. There was no significant difference between LP and CON group, except that the ileal IL-10 mRNA expression was significantly higher than that of CON group. Ileal pathological scores, serum LPS levels and the expression level of ileal IL-6 mRNA were significantly lower in LP+ ANP group than those in ANP group, while the expression level of ileal IL-10 mRNA was significantly higher than that of ANP group; the expression of ileal tight junction proteins (ocludin, claudin-1, ZO-1) was significantly higher than those in ANP group, and all the differences were statistically significant (all P values <0.05). Conclusions:LP WCFS1 gavage could ameliorate the injury of pancreatic and ileal barrier in caerulein-induced ANP mice.