Objective To investigate the importance for early operation in severe acute pancreatitis (SAP) treatment. Method We retrospectively compared the mortality of 37 cases of SAP gradeⅡthat were treated by non-operative and early operative methods.Result The mortality of the nonoperative group was significantly higher than operative group (88.9% to 42.1%). Conclusion In the early course of SAP, nonoperative treatment should not overemphasized and,operation should be considered as a therapeutic method according to different pathophysiological changes.

Objective To observe the therapeutic efficacy of endoscopic pancreaticobiliary duct drainage for acute necrotizing pancreatitis. Methods 41 cases of acute necrotizi ng pancreatitis were randomly divided into pancreaticobiliary duct drainage (21 causes) group and control group (20 cases).Results The procedure was successful in all 21 cases. The difference bet ween the two groups was statistically significant including hospital stay 〔(2 8?12) days vs. (37?19) days,P

Objective To investigate risky factors,and predictability of portal vein thrombsis in patients with portal hypertension caused by hepatic cirrhosis after spleenectomy and portaazygous devascularization. Methods Between Jan 2004 to Nov 2009,clinical data of 27 patients suffering from postoperative PVT were compared with 37 patients admitted during the same period without postoperative PVT. Results There were 4 factors proved to be risk factors for PVT.Perioperative peripheral platelet count (postoperative to preoperative) 、D-dimer、the whole blood viscosity and the blood flow of portal vein postoperatively.The right predictive rate of PVT was 87.3%. Conclusion The risk factors of PVT are the ratio of platelets、D-dimer、the whole blood viscosity and the blood flow of portal vein postoperatively.By this method it is probable that postoperative PVT is predictable.

Objective To study the risk factors for spontaneous rupture of primary hepatic carcinoma.Methods The clinical data of 31 patients with spontaneous rupture of primary hepatic cancer admitted to our hospital from Jan 1999 to Dec.2008 were retrospectively analyzed,and compared with 31 randomly selected concurrent patients without rapture of HCC.Results Three factors were shown to be the risk factors for spontaneous rupture of primary hepatic carcinoma.Those were APTT,HBeAg and the greatest height of tumor protrusion above the surface of liver.Conclusions APTT,HBeAg and the greatest height of tumor protrusion above the surface of liver are risk factors for spontaneous rupture of primary hepatic carcinoma.

At present, the formal bariatric surgery approved by the American Society for Metabolic and Bariatric Surgery (ASMBS) includes adjustable gastric banding (AGB), sleeve gastrectomy (Sleeve gastrectomy, SG). ), Roux-en-Y gastric bypass (Roux-en-Y gastric bypass, RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), mini gastric bypass (Mini-gastric bypass, MGB), single anastomosis gastric bypass (OAGB) and partial endoscopic surgery. According to the Chinese Society for Metabolic and Bariatric Surgery (CSMBS), the Chinese Obesity and Metabolic Surgery Database (COMES Database), and the Chinese Obesity and Metabolic Surgery Database (COMES Database), the Chinese Society for Metabolic and Bariatric Surgery (CSMBS) Chinese Obesity and Metabolic Surgery Collaborative, COMES Collaborative), Shanghai Weight Loss and Diabetes Surgery Data Management System, Shandong Province Weight Loss and Metabolic Surgery Case Registration System, Jiangsu Province Weight Loss and Metabolic Surgery Data Registration System, Great North China Weight Loss and Metabolic Surgery Statistics from the clinical data database and the Greater China Weight Loss and Metabolic Surgery Database. The domestically developed and approved bariatric surgery methods include RYGB, SG, MGB, OAGB, BPD-DS, AGB, combined sleeve gastrectomy (SG Plus), Jejunoileal Bypass (Jejunoileal Bypass, JJB), single stoma duodenal transposition (SADI-S), intragastric balloon (Balloon). However, there are still some irregular bariatric surgeries in China, which will cause some uncommon complications and bring great pain to patients. At the same time, it is also a huge challenge for regular bariatric surgeons who perform corrective surgeries. This article will review the revision surgery after bariatric surgery in China in the past 20 years, discusses a series of problems caused by non-standard bariatric surgery and the development of regular bariatric surgery.

Objective To observe the anti-inflammatory effect and opportunity of continuous blood purification (CBP) for treatment of patients with severe acute pancreatitis (SAP). Methods A retrospective study was conducted. One hundred and sixty patients with SAP admitted into the Department of Critical Care Medicine of the First Hospital of Wuhan from May 2013 to February 2017 were enrolled, and they were treated after admission by continuous vein-venous hemofiltration (CVVH) with blood flow volume 150-200 mL/min, displacement fluid velocity 2000-3500 mL/h and maintenance of ultrafiltration rate 35 mL·kg-1·h-1. According to the acute physiology and chronic health evaluationⅡ (APACHE Ⅱ) scores in 24 hours after admission, the patients were divided into four groups: 15-19 scores (group A), 20-24 scores (group B), 25-29 scores (group C), ≥ 30 scores (group D), 40 cases in each group. Before and after treatment for 72 hours, the difference of serum adiponectin, endotoxin, tumor necrosis factor-α (TNF-α), interleukin (IL-6, IL-8) were compared, the changes of APACHE Ⅱ score, multiple organ dysfunction syndrome (MODS) score, systemic inflammatory response syndrome (SIRS) score, and also complications and mortality in 14 days after treatment were observed for the patients. Results Compared with those before CVVH treatment, the levels of endotoxin, TNF-α, IL-6, IL-8 were significantly decreased, adiponectin was significantly increased among the various APACHEⅡ score groups after CVVH treatment, and the changes of various index amplitude variations in groups B and C were more obvious [endotoxin (EU/L): 2.9±1.0 vs. 3.6±1.5, 3.1±1.2 vs. 3.8±1.4; TNF-α (μg/L): 100.5±15.3 vs. 177.5±24.6, 113.7±17.2 vs. 190.4±25.8; IL-6 (μg/L): 107.3±13.5 vs. 230.5±32.4, 118.2±16.1 vs. 244.6±30.2;IL-8 (μg/L): 201.5±25.7 vs. 355.6±47.2, 215.4±29.4 vs. 376.4±47.3; adiponectin (mg/L): 21.9±3.6 vs. 17.6±3.4, 20.8±3.7 vs. 15.8±2.9, all P < 0.05]. Compared with those before treatment, the scores of APACHEⅡ, MODS and SIRS in groups A, B and C were significantly decreased after treatment, among which the changes of the index amplitude variation of group B and group C were more significant (APACHEⅡ: 16.2±1.4 vs. 22.9±1.7, 18.2±1.4 vs. 28.3±2.1; MODS score: 4.4±1.5 vs. 7.7±1.5, all P < 0.05), the scores of APACHE Ⅱ and SIRS in group D were not significantly decreased, but on the contrary the MODS score had an increasing tendency. After treatment, the 14-day mortality was 0%, 0%, 12.5%, 47.5% in group A, B, C, D respectively (χ2 = 8.350, P = 0.039 ), and the incidence of complications was 32.5%, 52.5%, 60.0%, 80.0% after CVVH in group A, B, C, D respectively(χ2 = 27.04, P = 0.028). Conclusion Early CBP treatment can decrease the inflammatory reaction of SAP patients, and the CBP therapeutic effect is relatively good if it is carried out for SAP patients with 20 ≤ APACHE Ⅱ score < 30.

Objective To explore the causes and management of postoperative complications of laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods The retrospective cross-sectional study was conducted.The clinical data of 450 patients with metabolic diseases who underwent LRYGB between June 2004 and November 2016 were collected,including 283 (58 in hospital consultation) in the First Affiliated Hospital of Jinan University,140 in the Jihua Hospital Affiliated to Jinan University and 27 in the Zhengzhou Hospital of Jinan University.Observation indicators:situations of surgical completion,follow-up situations,occurrence,treatment and prognosis of complications.Follow-up using outpatient examination and telephone interview was performed to detect postoperative complications once at month 1,3,6 and 12 within 1 year postoperatively and once every year after 1 year postoperatively up to March 2017.Measurement data with skewed distribution were described as M (range).Count data were evaluated by the ratio,and comparison between groups was analyzed using the chi-square test.Results All the 450 patients with metabolic diseases underwent successful LRYGB,including 50 receiving LRYGB during surgical internship period and 400 receiving LRYGB after surgical internship period,without conversion to open surgery.All the 450 patients were followed up for 70 months (range,1-153 months).Twenty-seven patients had postoperative complications,with an incidence of 6.00％ (27/450).The incidence of postoperative complications was 20.00％(10/50) in 50 patients receiving LRYGB during surgical internship period and 4.25％ (17/400) in 400 patients receiving LRYGB after surgical internship period,with a statistically significant difference (x2 =16.86,P＜ 0.05).Of 27 patients with postoperative complications,1 was complicated with fulminant acute pancreatitis and died from multiple organ failure at day 15 postoperatively,5 with intra-abdominal bleeding,2 with anastomotic leakage,3 with gastrojejunal anastomosis stenosis,2 with gastrojejunal anastomosis ulcer,1 with improper anastomosis,1 with respiratory failure,1 with umbilicus infection,3 with internal hernia,2 with dumping syndrome,6 with weight-loss failure (1 refused to undergo revision surgery),and patients with postoperative complications were improved or cured by surgery or conservative treatment except one death.Conclusions The incidence of complications in patients receiving LRYGB after surgical internship period is significantly reduced,and complications needs to make the individualized treatment plan.

Objective To observe multiple metabolic changes within one year after Roux-en-Y gastric bypass (RYGB) surgery in obese patients with type 2 diabetes mellitus, and to evaluate the index of the gastric bypass surgery and the determination of applicable population. Methods The clinical and laboratory data before and after surgery in 112 patients diagnosed as type 2 diabetes mellitus by RYGB were included in this study. According to BMI, these patients were divided into two groups: normal group (≤ 25kg/m2), and the overweight group (> 25 kg/m2). The physiologic and biochemical indexes of the patients were followed up at 1, 3, 6, 12 months, respectively. The statistical analysis was performed by SPSS17.0 software. Results Compared with the preoperative period, the levels of HbA1c and HOMA-IR in the postoperative period were significantly increased in the two groups. Principal component analysis showed that the postoperatively contributions of BMI and HbA1c in 6 months was bigger than that of the other indexes, while HOMA-β, HOMA-IR had larger contributions after 6-month postoperative period. Conclusion Various metabolic indexes in patients with type 2 diabetes improve significantly within one year after surgery, and the complete remission rate is gradually increased. The indexes including weight, blood glucose, serum lipids, HOMA-βand HOMA-IR in overweight and obese group have more significant improvements than those in normal group. Obese patients are more appropriate for the surgical treatment. The indexes, such as BMI, HbA1c,HOMA-βand HOMA-IR, should help to evaluate the operating effectiveness and preoperative indications.

Objective:To compare the clinical effect of anterior and posterior resection,bone grafting and internal fixation on the spinal tuberculosis.Methods:82 cases of patients with spinal tuberculosis in our hospital from February 2014 to August 2015 were selected and randomly divided into the control group and the observation group with 41 cases in each group.Both groups received conventional anti tuberculosis treament and underwent debridement bone graft and internal fixation treatment,the control group underwent anterior internal fixation,while the observation group underwent posterior internal fixation.The operation time,intraoperative blood loss,low back pain relief time,ambulation time and hospitalization time were compared between two groups.All patients were followed up for 6 months,the Frankel grade and serum Thl7 cell related factors levels were compared between two groups before and after operation.Results:The low back pain relief time,ambulation time and hospitalization time of observation group were significantly shorter than those of the control group(P＜0.01).After operation,the Frankel classification grade A and B ratio of observation group were significantly higher than those of the control group (P＜0.05),the serum IL-10,IL-17,IL-23 and TGF-beta 1 levels were significantly lower than those of the control group (P＜0.01).Conclusion:Anterior resection combined with posterior bone graft inFixation could effectively promote the rehabilitation of spinal tuberculosis,reduce the severity of spinal injury,relieve the inflammatory response and promote the recovery of immune function.

Objective:To study the application of powder comprehensive properties characterization of cefuroxime axetil in batch changes .Methods:The stability and change of the powder before the batch change of cefuroxime axetil were measured by an FT 4 mul-tifunctional powder flow tester .The flow rate, compression rate, shear property, air inflation and air permeability were measured .The corresponding powder index was established .After the batch change , the above indices were detected to assess whether meeting the re-quirements.Results:The volume index of three batches of products after the batch change was within the optimal range .Conclusion:The batch changes of cefuroxime axetil have no effect on the smooth progress of cefuroxime axetil production , which provides a new rap-id verification method for preparation manufacturers .