In recent years,endoscopic technique has become a basic procedure for the diagnosis and treatment of biliary and pancreatic diseases,thus the procedure-related complications of ERCP and endoscopic sphincterotomy(EST) become prominent day by day. Post-EST bleeding is one of the most serious complications of the procedure,and its first line treatment involves a variety of endoscopic techniques,such as epinephrine or fibrin glue local injection,electric coagulation and heat probe,clamps and covered metal stents. If these are not successful,transcatheter arterial embolization or surgical operation should be considered. In this article,the above-mentioned treatment modalities of post-EST bleeding were reviewed.

Objective To analyse the effect of repaglinide combined with Zhenqi Jiangtang Capsules on βcell function in elderly patients with type 2 diabetes mellitus.Methods 60 elderly patients were collected from harbour branch of Hainan provincial People's hospital, who were diagnosed with type 2 diabetes mellitus .All patients were randomly divided into experimental group and control group, 30 cases in each group, 2 groups of patients were given control diet, moderate exercise, and other conventional adjuvant therapy.Control group was treated with repaglinide orally on the basis of routine adjuvant treatment, 1 mg/times, three times per day,experimental group were given Zhenqi Jiangtang Capsules based on the treatment in control group,4 grains/times,three times per day.Both groups were treated for 4 weeks, after the end of treatment, blood glucose levels,serum insulin levels,βcell function and serum lipids in all patients were detected.ResuIts After treatment, compared with control group, the levels of blood glucose, HbA1c and AUCg in experimental group were significantly lower ( P<0.05 );the insulin levels 30 min,60 min, 120 min after meal were significantly higher (P<0.05);the HOMA-IR of patients was significantly lower(P<0.05);IRG, AUCi and AUCi/AUCg were significantly higher (P<0.05);the serum TC, TG, LDL levels were significantly lower, serum HDL levels were significantly higher(P<0.05).ConcIusion Repaglinide combined with Zhenqi Jiangtang Capsules can significantly reduce the blood glucose and lipid levels in elderly patients with type 2 diabetes, improve the function of pancreatic beta cells, promote postprandial insulin secretion and improve insulin resistance.

In the paper, 32 lots of intravenous immunoglobulin (IVIG)were tested by an animal model,the hypotensive test of rats. A linear correlation was found between prekallikrein activator (PKA)activity and hypotensive reaction if the inflow of human IVIG was made rapid (r=0.96,n=23). The preliminary observations indicated that it would be satisfactory that the PKA activity was below 35IU/ ml and the size of reduction in blood pressure was not 15% higher than that of control animal's level.The rat model can provide a method for safe usage of the intravenous immunoglobulin and reliable detection of and control over the residual PKA activity in blood products.

OBJECTIVE To observe the therapeutic effectiveness and safety of the indigenous teicoplanin in intensive care unit(ICU) patients with severe infections of Gram-positive(G+) cocci.METHODS Sixty patients with severe Gram-positive bacteria infection received teicoplanin which was produced by Xinchang Pharmaceutical Factory of Zhejiang Medicine Co,Ltd.by infusion for 7-14 d.Dosage was adjusted according to the creatinine clearance rate.Maximum temperature,APACHEⅡ score,indicators of inflammatory response,liver and kidney function,microbiologic examination and adverse reactions were observed before treatment and the end of 7-14 day treatment.RESULTS Seventy-two strains of Gram-positive cocci were isolated from 60 patients,in which meticillin-resistant Staphylococcus aureus(MRSA),meticillin-resistant S.epidermidis(MRSE),Enterococcus faecium,E.faecalis,S.haemolyticus and E.gallinarum accounted for 58.33%,8.33%,16.67%,5.56%,8.33% and 2.78%,respectively.After treatment,59 strains of Gram-positive cocci were eliminated while 13 strains were not eliminated and bacteriological eliminated rate(calculated by strains) was 86.1%;In this group,twenty-eight patients were cured while twenty-two cases were markedly improved.The total bacteriological eliminated rate was 81.94%.The incidence of adverse reactions was low and only a slight increase or decrease in platelet count was observed which didn′t require special treatment interventions.CONCLUSIONS Indigenous teicoplanin has certain therapeutic effectiveness and is safe for severe Gram-positive bacteria infected patients,particularly for septic patients with organ damage in ICU.In patients highly suspected with meticillin-resistant staphylococci or enterococci infection,teicoplanin may be a choice for initial empirical treatment.

Objective To observe critical patients with thrombocytopenia,and exam their coagulation function,so as to diagnose disseminated intravascular coagulation(DIC)in the early stage.Methods Totally 56 critical patients complicated with thrombocytopenia were enrolled in the investigation;complete set of DIC tests were performed.A total of 26 cases were diagnosed as DIC according to the criteria from the International Society of Thrombosis Haemostasis(ISTH).The sensitivity,specificity,accuracy,likelihood ratio,predictive value of prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),antithrombin Ⅲ and bleeding signs(including petechia and ecchymosia)were calculated by applying fourfold table.Results The specificity of PT prolongation and Fg reduction was 87.0%;the sensitivity of ATⅢ decrease,and each of PT prolongation,Fg reduction,and bleeding(including petechia and ecchymosis)were as high as 96.0%.Conclusion Multi-markers based on thrombocytopenia are likely to improve sensitivity and specificity of DIC diagnosis.

SUMMARY Regenerationofbonetissue,aswellasothertissues,requiresinvolvementandinteraction of cells,scaffolds and relevant growth factors,among which growth factors play a crucial role in maintai-ning the stability of microenvironment.Nel-like-type 1 molecule (NELL-1 ),a novel growth factor in tis-sue engineering,has been studied intensively in recent years.Researches mainly covered gene and pro-tein structure and their expression profiling,biological function,molecular mechanisms and disease rele-vance.NELL-1 expressed in embryonic tissue is essential for growth and development of bone tissue. NELL-1 presents excellent abilities of inducing bone and cartilage regeneration,especially with high spe-cificity to chondrocyte lineage.Compared with classic osteogenic growth factor bone morphogenetic pro-tein 2 (BMP-2),the process of osteogenesis interacted with NELL-1 exhibits stronger specificity,higher bone density and fewerside effects.Furthermore,a recent study shows synergistic effects of NELL-1 and BMP-2.NELL-1 enhances the osteogenic reaction induced by BMP-2 of cells and notably declines in-flammation response caused by BMP-2.This review evaluates the current research progress of the function and application of NELL-1 by the systematic method of evidence-based medicine.

Objective To evaluate the efficacy of STERRAD (r) 100S (low temperature hydrogen peroxide gas plasma sterilization system) by comparing with formaldehyde steam. Methods From 2005.1 to 2005.3, totally sterilization of 2 760 pieces of operating tools were carried out with formaldehyde steam. From 2005.1 to 2005.3, totally sterilization of 4 950 pieces of operating tools in 180 circles were carried out with STERRAD (r) 100S. The instrument damage rate, operating infection rate and satisfaction rate of medical workers of 2 groups were compared. Results All data were in favor of the efficacy of STERRAD (r) 100S. Conclusions STERRAD (r) 100S is a safe, effective, low temperature, and cost-effective sterilization system..

This study is to explore the activation of the Ca2+/CaM/CaN signal pathway in 5-HT-induced proliferation of rat pulmonary artery smooth muscle cells (PASMCs) and the inhibitory effect of m-nisoldipine (m-Nis) on this pathway. PASMCs were cultured with the explant technique. The proliferation of PASMCs was evaluated by MTT assay. Confocal microscopy was used to measure the change of [Ca2+]i. The mRNA expression of CaM and CaN was evaluated by RT-PCR and the activity of CaN was measured according to the instruction of kits. The results of MTT assay suggested that 5-HT (1 micromol x L(-1)) significantly induced the proliferation of rat PASMCs (P < 0.01), which was inhibited obviously by m-Nis (P < 0.05 or P < 0.01). Similarly, m-Nis inhibited 5-HT-induced elevation of [Ca2+]i (P < 0.01). The mRNA expression of CaM, CaN and the activation of CaN were also inhibited by m-Nis at different degrees (P < 0.05 or P < 0.01). Thus, the results of this study suggested that Ca2+/CaM/CaN signal pathway played an important role in 5-HT-induced proliferation of rat PASMCs, the inhibition of m-Nis on proliferation of rat PASMCs may be related to the blockage of Ca2+/CaM/CaN signal pathway by inhibiting the elevation of [Ca2+]i.

Objective To study the 2244G→A, 2299 A→G single nucleotide polymorphism (SNP) in the 5' regulatory regions of Toll-like receptor 4 (TLR4) in patients with Gram negative bacteria infection in Shenzhen locality, and to discuss the occurrence, course and prognosis of patients with sepsis. Method Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to detect the genotype of TLR4. After the whole blood DNA of patient was extracted and PCR was amplified, the products were 500bp and 599 bp, and were cut by endonuclease Mae Ⅱ and Sph Ⅰ respectively to determine the SNP 2244G→A and 2299 A→G in TLR4. These two kinds of allele frequencies were statistically calculated in all patients. In the meantime, the incidence of septic shock, average hospitalized days, cost and prognosis of all patients were recorded. Statistical analysis was performed with SPSS version 16 software. ANOVA was used for comparison among multiple groups, and t -test and Sighed rank test were used for paired comparison. Results The 2299 and 2244 sites in the 5' regulatory regions of TLR4 gene of patients with Gram negative bacteria infection in Shenzhen locality had various degrees of changes in single nucleotide. Compared with the documented data from Chinese people in general, there was a significant difference in 2299A→G genotype frequency in residents of Shenzhen locality ( P < 0.05). But there were no statistically significant difference in mortality, incidence of septic shock, average days of ICU stay or ICU cost between TLR4 SNP positive and negative groups of patients. Conclusions There is a wide range of genetic variation in the 2299 and 2244 sites in the 5' regulatory regions of TLR4 among citizens of Shenzhen locality with unique distribution. The 2299A→G genotype frequency probably has differences in distribution and population. The pathogenesis and the prognostic factors of sepsis are complicated, whereas the gene polymorphism may be just one of the factors affecting the prognosis of patients with Gram negative bacteria infection.

Aim To explore the effect of m-Nisoldipine(m-Nis) on 5-HT-induced proliferation,migration of rat PASMCs and to study the mechanisms.Methods PASMCs were cultured with the explant technique,and were divided into 6 groups:control group,5-HT(1 μmol·L~(-1)) group and m-Nis(10~(-5),10~(-6),10~(-7),10~(-8) mol·L~(-1))group.MTT assay was used to evaluate the proliferation of PASMCs,and transwell chambers were used to detect the migration of PASMCs.In addition,the expression of PCNA and the phosphorylation of ERK1/2 were evaluated by Western blot analysis.Results m-Nis inhibited the proliferation(P<0.05 or P<0.01)and migration(P<0.01)of rat PASMCs induced by 5-HT obviously.Similarly,Western blot analysis of PCNA indicated that the expression of PCNA was significantly higher in 5-HT group than that in control group(P<0.01).Whereas,in four m-Nis treated groups,the level of PCNA was markedly decreased(P<0.05 or P<0.01).Meanwhile,m-Nis 10~(-5),10~(-6) and 10~(-7) mol·L~(-1) pretreatment also reduced 5-HT-induced phosphorylation of ERK1/2 obviously(P<0.05 or P<0.01).Conclusion m-Nis inhibits 5-HT-induced proliferation and migration of rat PASMCs obviously,which may be related to the inhibition of PCNA expression and the blockage of ERK1/2/MAPK signal pathway.