Severe acute biliary pancreatitis can be treated by nonsurgical and surgical approaches,and choice of the surgical techniques as well as its timing are the keys points to the whole therapy.Early enteral nutrition via placing nasointestinal feeding tube plays an important role in the nutritional support for patients with severe acute pancreatitis.This paper intends to explore the experience in standardizing the therapy for all similar cases via reviewing and summarizing the treating process of a typical patient with severe acute biliary pancreatitis.

Objective To explore the changes of the pressure of sphincter of Oddi(SO)in postoperative patients with cholangiolithiasis.Methods Sixty cases with multiple biliary calculi operation (recurrent cholangiolithiasis group),80 cases with biliary calculi operation at first time(cholangiolithiasis group)and 9 cases with external injuries of pancreas or liver(control group),who were examined in order to identify common bile duct pressure(CBDP),SO basal pressure(SOBP),amplitude of SO contractions (SOCA),frequency of SO contractions(SOF),then comparing the difference of statistics among the three groups.Results CBDP,SOBP,SOCA,SOF in recurrent cholangiolithiasis group and cholangiolithiasis group were significantly higher than those in control group[(13.78 ±9.91),(12.65 ±7.64)mm Hg(1mm Hg =0.133 kPa)vs.(12.54 ± 2.35)mm Hg,(15.27 ± 9.15),(14.89 ± 7.87)mm Hg vs.(13.63 ± 3.27)mm Hg,(106.30 ± 54.70),(98.39 ±38.29)mm Hg vs.(87.65 ±56.38)mm Hg,(6.91 ± 1.92),(6.25 ±2.17)times/min vs.(5.26 ± 2.11)times/min](P ＜ 0.05),but there was no significant difference between recurrent cholangiolithiasis group and cholangiolithiasis group(P ＞ 0.05).Conclusion SO dysfunction resides in the postoperative patients with cholangiolithiasis,and it is possible related with the formation and/or recurrence of cholangiolithiasis.

Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.

BACKGROUND: It is discovered that trace elements in Chinese patent medicine play an important role in pharmaceutical efficacy and structural analysis. A new topic has been formed gradually in a further research on pharmaceutical efficacy and effective components of Chinese patent medicine in the view of inorganic trace elements. The fuzzy classified study on the interrelationship between trace and constant elements of Chinese herbs and therapeutic effects is to discuss the trace-element action of drugs in the holistic aspect of trace elenent and research rather scientifically the holistic coordination among trace elements in Chinese herbs.OBJECTIVE: To determine the contents of 21 kinds of trace and constant elements in Chinese patent medicines in the treatment of cardio-cerebral vascular disease. To study with fuzzy classified method the interdependence between trace, constant elements of drugs and therapeutic effects so as to provide a new approach for the quality evaluation of Chinese patent medicine.DESIGN: Testified observed study based on various Chinese patent medicines.SETTING: Chemistry teaching-research room in a university and department of cardiology in a general hospital of a chemical industrial group corporation.MATERIALS: Twenty-one kinds of common Chinese patent medicines for the treatment of cardio-cerebral vascular diseases in clinic, namely di' ao xinxuekang capsule(DXK), xueshuan xinmaining capsule(XMN), shan haidan capsule(SHD), buchang naoxintong capsule(NXT), linaoxin capsule(LNX), xinnaosu capsule(XNS), lixin wan(LXW), suxiao jiuxin wan (SJX), xinbao wan(XBW), yinxingye pian(YXY), fufang danshen pian (DSP), niuhuang jiangya wan(NHJY), naosaitong pian(NST), qiangli tianma duzhong wan ( TD W ) , tongsaimai pian ( TSM ) , tongmai ningxin infusion(TMNX), maitong capsule(MTC), fufang yinxing wan ( YXW ) , da huoluo dan(DHL), guanxin suhe capsule(GXSH) and xiaoshuan tongluo capsule (XSTL).METHODS: Wet digestion was used to manage samples, atomic absorption spectrophotometric method(AAS) method was used to determine the contents of 10 kinds of trace and constant elements in 21 Chinese patent medicines,namely Na, Ca, Mg, K, Fe, Cr, Ni, Cu, Zn and Mn. Data range method was applied for the standardized management of statistical indexes of various element contents in relevant drugs, dotprod(U, V) method was used to measure correlation coefficient(r) among the classified objects so as to determine fuzzy matrixes in universe. The interrelationship was analyzed between the contents of trace elements of various Chinese medicines and pharmaceutical efficacy. By the analysis of fuzzy matrixes in universe, it was to evaluate firmly on the efficacy similarity of various kinds of Chinese patent medicines with quantitative indexes.MAIN OUTCOME MEASURES: ① Results of element contents; ② Results of fuzzy cluster analysis on elements.RESULTS: The standardized management of statistical indexes was carried on the contents of Na, Ca, Mg, K, Fe, Cr, Ni, Cu, Zn and Mn in various drugs to determine correlation coefficient(r) among the classified objects so as to determine fuzzy matrixes in universe. When(r) = 0.55, there were 9 kinds of drugs similar in cluster, namely xueshuan xinmaining capsule, buchang naoxintong capsule, lixin wan, xin bao wan, qiangli tianmai duzhong wan,tongsaimai pian, maitong capsule, da h uoluo dan and xiaoshuan tongluo capsu le. When(r) =0. 65, there were 6 kinds of drugs similar in cluster,namely buchang naoxintong capsule, xin bao wan, qiangli tianmai duzhong wan, tongsaimai pian, maitong capsule and xiaoshuan tongluo capsule. When(r) =0. 87, there were 2 kinds of drugs similar in cluster, namely buchang naoxintong capsule and xin bao wan.CONCLUSION: It is indicated in the research that the drugs are in rich of trace and constant elements. The larger the correlation coefficient of drugs is,the more similar the pharmaceutical efficacy is. It is discovered the close interrelationship of the trace and constant elements in drugs with their pharmaceutical efficacy. In this research, fuzzy classified method is used to discuss, in the view of trace elements, the similarity of quantitative indexes in efficacy of Chinese patent medicine commonly administrated in the treatment of cardio-cerebral vascular disease, which has provided a new approach for the quality evaluation of Chinese patent medicine.

Objective To investigate the prognostic factors and influencing factors of lymph node ratio (LNR) in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 444 patients with Siewert Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were collected.All the 444 patients underwent radical D2 lymph node dissection,extent of lymph node dissection was inferior mediastinum,around the esophageal hiatus and celiac lymph node.Follow-up usingtelephone interview and outpatient examination was performed to detect patients' prognosis once every 3 months within 2 years postoperatively,once every 6 months from 2 vears to 5 years postoperatively and once every 12 months after 5 years up to October 2016.Observation indicators:(1) follow-up and survival situations;(2) univariate and multivariate factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ[AEG;(3) univariate and multivariate factors analysis affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and the COX regression model.Results (1) Follow-up and survival situations:all the 444 patients were followed up for 1-81 months,with a median time of 52 months.The 1-,3-,5-year overall survival rates of 444 patients were respectively 93.2％,60.3％ and 45.7％.(2) Factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation,invasion depth of tumor,pN staging and staging of LNR were related factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2 =12.332,5.898,36.045,38.847,46.464,P＜0.05).Results of multivariate analysis showed that invasion depth of tumor and staging of LNR were independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG [RR =1.393,1.411,95％ confidence interval (CI):1.137-1.708,1.106-1.801,P＜0.05].(3) Factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were related factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2=20.077,12.618,36.586,P＜0.05).Results of multivariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG (OR=0.684,0.688,0.788,95％ CI:0.485-0.965,0.505-0.936,0.687-0.903,P＜0.05).Conclusions The invasion depth of tunor and staging of LNR are independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG.Tumor diameter,tumor differentiation and invasion depth of tumor are independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.

Objective To discuss the characteristics,diagnosis,mechanism and the prognosis of dilated cardiomyopathy (DCM) induced by accessory pathway (AP).Methods The clinical,electrophysiological and echocardiographic characteristics in four cases,who were diagnosed as AP-induced DCM in the Department of Pediatric Cardiology of Beijing Anzhen Hospital,Capital Medical University from Mar.2011 to Aug.2012,were analyzed before and after ablation.Results The electrocardiograms of the 4 patients all indicated type B ventricular preexcitation.The locations of the APs were the right-sided anteroseptum and the free wall.Dyschronous contractions between posterior wall of left ventricle and interventricular septum were demonstrated by M-Mode echo.The basal segments of the interventricular septum turned thin and moved similar to an aneurysm,with typical bulging during end-systole,which was observed in all cases by two-dimension echo.Dyschronous left ventricular contraction was shown by speckle tracing technique.All patients received successful radio frequency current ablations.Their physical activities and growth improved greatly in the 4 cases.The echocardiographic data demonstrated that their left ventricular contraction recovered to synchrony shortly after the ablation,left ventricular ejection fraction recovered to normal and left ventricular end diastolic diameter decreased to almost normal gradually during the follow-up.Conclusions Overt right-sided APs localized in anteroseptum or free wall may have adverse effects on ventricular wall motion and left ventricular function.They can even result in DCM.Dyssynchronous ventricular contraction induced by right-sided overt accessory pathway may be the vital mechanism.AP-induced DCM is an indication for ablation with good prognosis.

Objective To observe the effects of whole body γ-ray radiation on hematopoiesis and cytokines related to T cell subsets in mouse,to detect the expression of transcription factors of splenic T cell subsets,and to investigate the correlation between hematopoiesis injury and abnormal immune function.Methods Totally 50 BALB/c mice were divided into radiation group and blank control group with the random number table method.The former group were given 5.5 Gy 60Co γ-ray radiation on whole body and another received sham radiation.The numbers of white blood cells and platelets of radiation group were counted at 4,8,12 and 20 d after radiation,and these numbers of blank control mice were counted only at 20 d.Hematopoietic tissue proliferation was evaluated by biopsy sections of mice femur.The contents of Th1,Th2,and Th17 in peripheral blood were detected with cytometric bead array (CBA).The expressions of T-bet/GATA-3 and RORγt/Foxp3 proteins related to the differentiation of T cell subsets in spleen tissue were measured by Western blot.Results The numbers of white blood cells and platelets of radiation group mice were reduced obviously (t WBC =18.48,15.72,9.79,3.30; t PLT =22.52,19.74,11.78,4.70,P ＜ 0.05) compared with blank control group.Biopsy sections showed that bone marrow hematopoietic cells of the radiated mice were less than those of blank group,and adipocytes became more.At 8 d,the marrow suppressions were more obvious than those at 20 d.Serum contents of Th1 cytokines IFN-γ,TNF-α and Th2 cytokines IL-4,IL-6 in the radiation group were higher than those in the blank control group at 8 and 12 d(t IFN-γ =2.93,3.36,t TNF-α =6.09,8.11,6.43,4.49,tIL-4 =4.49,3.18,t IL-6=5.11,8.67,6.67,8.55,P＜0.05).IL-17A secreted mainly by Th17 cells was also higher than the blank (t =3.68,6.24,5.32,4.06,P ＜ 0.05).Compared with the blank control group,the expression of T-bet protein increased significantly (t =5.64,2.75,3.56,4.65,P ＜ 0.05),and the expressions of GATA-3,RORγt,and Foxp3 proteins decreased at 4,8 and 12 d except the RORγt at 20 d (tRORγt =6.79,4.31,4.47,tGATA-3 =3.88,8.06,2.84,3.23,tFoxp3 =10.00,8.06,2.89,5.93,P＜ 0.05).Conclusions 5.5 Gy whole body γ-ray radiation inhibits bone marrow hematopoiesis of BALB/c mice and makes the differentiation and function of T cells to be abnormal,which may be associated with bone marrow hematopoiesis obstacle.

Objective To explore the value of preoperative D-dimer in patients with gastric cancer in judging gastric cancer metastasis and assessing prognosis.Methods Clinicopathological data of 132 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between Jan.2010 and Jan.2011 was analyzed retrospectively in this study.All patients were divided into two groups according to the cutoff value (1.465 mg/L)of D-dimer and the relationships between D-dimer and clinicopathological data were determined by chi-square test.Moreover,the association of preoperative D-dimer and the prognosis was analyzed by Kaplan-Meier analysis and Log-rank test.Univariate and multivaritate Cox model were used to analyze the factors which might affect the survival of the patients and significant independent factors.Results A total of 132 patients were enrolled in this study in accordance with the inclusion criteria.D-dimer was positively correlated with the depth of invasion (x2 =4.996,P ＜ 0.05),age (x2 =4.311,P ＜ 0.05) and distant metastasis of gastric cancer (x2 =16.641,P ＜0.01),but not with thc gcndcr,lymph node metastasis,tumor size,the degree of differentiation and TNM stage (P ＞ 0.05).The mean D-dimer level was (1.39 ± 0.7) mg/L in distant metastasis patients and (0.97 ±0.83) mg/L in non distant metastasis patients (P =0.023),the mean plasma D-dimer level in patients alive at the 5 years after the surgery was (0.78 ± 0.58) mg/L,which was significantly lower than the amounts determined for the deceased patients (0.75 ± 0.58) mg/L (P ＜ 0.01).The Kaplan-Meier curves showed that the patients with gastric cancer had a longer time in the low D-dimer group than in the high D-dimer group,showing a significant difference between the two groups (P ＜ 0.01).Univariate analysis showed that the overall survival rate was significantly correlated with the gender,D-dimer,tumor size,the depth of invasion,lymph node metastasis and TNM stage (P all ＜ 0.05).The D-dimer was proved to be independent risk factor for the prognosis of gastric cancer by multivariate analysis(P ＜ 0.05).Conclusion According to the analysis,D-dimer may be valuable biomarker for metastasis patients,besides,D-dimer was an independent prognostic factor for patients with gastric cancer.

Objective To explore the independent risk factors of lymph-node metastasis (LNM) in patients with early gastric cancer (EGC),and establish a risk-prediction model based on LNM.Method 962 early gastric cancer patients undergoing curative radical gastrectomy in the First Hospital of Anhui Medical University from July 2011 to April 2016 were enrolled in this study.The relationships between different clinicopathologic characteristics and LNM were analyzed by Chi-square test or Fisher exact probability,and the independent risk factors were determined using Logistic regression analysis.Moreover,LNM risk was stratified and a risk-predicting model was established on the basis of the identified independent risk factors for LNM.Further,the risk-predicting model was validated using 962 EGC cases.The discriminatory accuracy of risk-predicting model was measured by area under ROC curve (ROC-AUC).Results Mucosal differentiated cancer ≤2 cm,irrespective of the existence of an ulcer,had low LNM rates (LNMR ＜ 3.0％).Univariate and multivariate analysis revealed that female EGC patients with submucosal,undifferentiated,vessel invasion and tumor size ＞ 2 cm were independent risk factors of LNM for EGC patients,and relative risks were 1.893,3.173,1.956,1.922 and 9.027 respectively (P ＜ 0.05).ROCAUC of risk-predicting model was 0.768 (P ＜ 0.01),which showed high diagnostic accuracy and sensitivity.Conclusion Female EGC patients with submucosal undifferentiated carcinomas measuring ＞ 2 cm with vessel invasion have higher risk of LNM.

ObjectiveTo explore the relationship of blood volume changes and postoperative delirium in elderly patients undergoing surgery for hip fracture.Methods One hundred and fifty elderly patients who underwent surgery for hip fracture were enrolled in the study.Delirium was diagnosed by Confusion Assessment Method(CAM).Preoperative,intraoperative and postoperative data were collected,and the correlation of postoperative delirium and blood volume changes were analyzed by logistic regression analysis.ResultsA total of 59 patients(28 males and 31 females)had delirium after surgery and the occurrence rate of postoperative delirium was 39.3％ (59/150).The average age in delirium group was significantly older than that in the control group[ (77.71 ±6.63)years old vs(73.79 ±5.42) years old,t =-3.958,P ＜0.001 ].The average hemoglobin concentration and hematocrit in delirium group were both less than that in control group whether before surgery or at 7 days after surgery( before surgery:average hemoglobin concentration:[ ( 117.80 ± 16.59)g/L vs( 123.92 ±14.61 ) g/L,t =2.378,P =0.019; hematocrit:(0.355 ± 0.154) vs(0.372 ± 0.210),t =2.291,P =0.023 ;7days after surgery:average hemoglobin concentration:(98.15 ± 11.51 ) g/L vs ( 102.33 ± 9.88 ) g/L,t =2.369,P =0.019; hematocrit:(0.296 ± 0.040 ) vs (0.306 ± 0.030),t =-3.958,P ＜ 0.001 ].There was no significant difference on gender,fracture type,surgical approach,operative time,blood loss and hemoglobin concentration at 1,3 days after surgery between the two groups( P ＞0.05 ).Logistic regression analysis showed that age ( OR 3.280 ),education ( OR 0.389 ),and hemoglobin concentration at 7 days after operration ( OR 1.097) were significantly related to the occurrence of postoperative delirium ( P ＜ 0.05 ).Conclusion Our findings suggest that the risk for postoperative delirium is the result of more than one factor.Older age,continued postoperative low hemoglobin concentration and low degree of education present high risk of delirium in patients underwent surgery for hip fractures.