OBJECTIVE:To establish an HPLC-CSP (chiral stationary phase) for the determination of plasma levels of enantiomers of fluoxetine. METHODS: Enantiomers of fluoxetine were separated on a Chirobiotic V column. The mobile phase consisted of methanol-acetic acid-triethylamine (100∶0.04∶0.04) with a flow rate of 1 mL?min-1. The detection wavelength was set at 226 nm.Clozapine was used as the internal standard. RESULTS: Under this chromatographic condition, both R-norfluoxetine and S-norfluoxetine had no interference on the enantiomers of fluoxetine and the internal standard. The calibration curve was linear in the range of 8.1～432 ng?mL-1(r=0.999 8) for R-enantiomer and in the range of 10.8～432 ng?mL-1 (r=0.999 2) for S-enantiomer. The relative recovery of R-fluoxetine and S-fluoxetine in plasma were 97.2%～101.9% and 98.7%～102.2%, respectively. RSD of intraday and interday ranged from 2.6% to 5.3% and from 7.7% to 8.9% for R-fluoxetine, and from 2.1% to 6.7% and from 8.0% to 10.6% for S-fuoxetine, respectively. CONCLUSION: The method is simple, reliable and sensitive, and applicable for the determination and pharmacokinetic study of the enantiomers of fluoxetine in plasma.

Case-based teaching (CBT) on the basis of treatment guidelines was carried out to develop standard medical behavior, improve learning efficiency and students' ability of solving clini-cal problems. In clinical internship teaching, guidelines for common and frequently-occurring respira-tory diseases and CBT were organically combined. Cases were carefully selected and questions were meticulously set. Guidelines were thoroughly analyzed and teaching was reasonably evaluated. There-fore, students' learning interests were initiated and learning efficiency was improved. It not only trained evidence-based medicine thinking of intern students, but also improved the teaching ability of clinical teachers.

ObjectiveEndoscopic suhmucosal dissection (ESD) is a new diagnostic and therapeutical technique for early gastric cancer (EGC).The aim of this study was to evaluate the efficacy and safety of ESD for EGG.MethodsThe data of patients who underwent ESD for EGCs from July 2007 to December 2007 were analyzed retrospectively.One-piece resection rate,histologically complete resection rate (the lateral and vertical margins were free of cancer),operation time,complications,post-ESD ulcer-healing rates and local recurrence were assessed.ResultsA total of 21 EGCs in 20 consecutive patients were treated with ESD.The median age was 56.4 years (range 37-75 years) and the male/female ratio was 1.9(13/7).Out of 21 lesions,20 (95.2%) were resected in one piece.The rate for one-piece resection with tumor-free margins was 90.5% (19/21).Acute minor bleeding during the ESD procedure occurred in 4.8% (1/21).Post-ESD epigastric pain rate was 76.2%(16/21).No acute major bleeding, delayed bleeding and perforation occurred.The median operation time was 50.4 min (range 45-200 min).The pest-ESD ulcer-healing rates was 100% after 8 weeks of oral esomeprazole.After a follow-up with median time of 9.2 months (range 8-12 months),none of the patients experienced residual/local recurrence of early gastric cancer.Conclusion ESD has the advantage of increasing one-piece resection rate and histologically curative resection rates.ESD is a safe and effective treatment for EGC.

Objective To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD)in treatment of patients with early gastric cancer(EGC).Methods A total of 4 3 consecutive patients with EGC were treated with ESD at Changhai Hospital from July 2007 to July 2008.The data referred to one-piece resection,histologically complete resection,operation time,complications,the post-ESD ulcer-healing and local recurrance were retrospectively analyzed.ResultsEn bloc resection was achieved in 97.7 0A(4 2/43)lesions in one-piece resection.The histologically complete resection rate was 95.3%(41/43).Only one patient had acute minor bleeding during the ESD procedure(2.3%,1/43)and one patient had delayed bleeding(2.3%,1/43).Post-ESD epigastric pain was found in 2 2 patients(51.2%).There was no complications such as acute major bleeding,perforation,requiring surgical treatment and death.The median operation time was 60.4 miutes.The post-ESD ulcer-healing was achieved in 100%(42/42)8 weeks after esomeprazole treatment.During follow-uP of 10.3 months(ranged from 8 to 1 8 months),no residual or local recurrence of EGC was seen.Conclusion ESD has the advantages of increasing one-piece resection and histologically curative resection rates.It is a safe and effective procedure in treatment of EGC.

Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.

Objective To investigate the effect of rebamipide on chronic non-atrophic gastritis (NAG) with erosion and its protection of gastric mucosa from Helicobacter priori(Hp) associated lesions.Methods Patients(n=452)with endoscopically confirmed NAG with erosion from 11 hospitals in China were enrolled and randomly assigned at a ratio of 3:1 to receive either rebamipide(100 mg t.i.d.)or sucralfate(1.0 t.i.d.)for 8 weeks.Hp infected patients received eradication treatment before randomization.Symptoms,endoscopic scores and histological changes were recorded before and after therapy.Concentrations of serum prostaglandin E(PGE:)and oxygen free radical(MDA)were measured in patients from 2 centers.Results Per-protocol analysis(n=415)showed that the dyspeptic symptom score in rebamipide group decreased significantly after eight weeks of treatment. The endoscopic inflammation score in rebamipide group also decreased from 2.65 ±0.09 to 0.60±0.10(P<0.001),which was,significantly better than that of sucralfate group(P<0.001).Histological findings were consistent with the endoscopic findings.There Was a significant elevation(P=0.002)in PGE2 concentration in mucesa from rebamipide-treated subjects [(225.4±18.3) pg/g vs.(266.7±14.7)Pg/g] compared with that in sucralfate group.The concentration of MDA significantly decreased from(325.9±65.6)mmoL/g to(216.5±61.5)mmol/g,which is markedly different from that of sucralfate group(P=0.046).No statistical difference was found between Hp eradication group,Hp infection group and Hp negative group,regarding the effect of Rebamipide.Conclusion Compared to sucralfate,Rebamipide demonstrates a superior effect on improvement of dyspepsia symptom and endoscopic findings in erosive NAG,which is not influenced by Hp infection.

Objective To evaluate the safety and efficacy of therapeutic ERCP for patients above 90 years of age.Methods The data of 37 patients of above 90 years who underwent 42 ERCP procedures from January 2001 to December 2009 were studied retrospectively and compared with those of 152 matched patients ( 168 procedures) below 65 years old at a 1∶4 ratio for success rate and complications.Results The rate of complete success,partial success,and failure in observation group was 73.81％ (31/42),19.05％(8/42) and 2.38％ (1/42),respectively,which were similar (P ＞0.05) with those in control group,with complete success rate at 85.12％ ( 143/168),partial success rate at 12.50％ (21/168) and failure rate at 2.38％ (4/168).The rate of terminated operation in observation group (4.76％,2/42) was significantly higher than that of the control group (0.00％,0,P =0.039).The overall rate of complication in observation group was 7.14％ ( 3/42 ),slightly higher than that of the control group ( 6.55％,11/168,P ＞0.05 ).There was no significant difference between the two groups regarding the rates and severity of such complications as pancreatitis,hemorrhage and infection ( P ＞ 0.05 ).No perforation or death was observed.Conclusion Therapeutic ERCP for patients of 90 years or older is safe and effective.Adverse events related to chronic concomitant diseases need early detection and proper management.