Objective: To discuss the treatment of pancreatic encephalopathy(PE).Methods: Recombinant human growth hormone (rhGH)(Saizen)were applied in patients of severe acute pancreatitis(SAP) with suspicious early PE that presented with mental disorders. rhGH was also used in combination with somatostatin as the therapeutic method for SAP and its complication.Dosage and administration: Saizen 4U was injected intramuscularly twice a day for 5～7 days.Results: In 7 patients of this group, all of them showed improvement in the aspect of mental dysfunction and the symptoms disappeared after 48～72 hours. In 13 SAP cases underwent combined application of rhGH and somatostatin, no PE was observed.Conclusion: Application of rhGH showed therapeutic effect on the early manifestations of PE. It also suggested that combined use of rhGH and somatostatin could decrease the occurance of PE.

Objective To find a novel operative modality with sphincter preservation in the treatment of middle and low rectal carcinoma. Methods Pull through lower resection was performed on 28 rectal cancer patients. The distance between the anal verge and the lower margin of the tumor was 6～8cm(20 patients) or 8～10cm(8 patients), including 8 patients in Dukes A stage, 16 Dukes B and 4 Dukes C. The resected line from tumor distal margin was 2cm, 3cm, and 4cm, respectively. Results There was no operative death, anastomotic fistula or anastomotic stenosis in these cases. Mean follow up period was 30 months. Local recurrence was found in two cases (7.1%) 18 months after the operation, and 26 cases were cancer free till the end of the follow up. Defecation was satisfactorily controlled 8～12 weeks after the operation. Conclusions Pull through Welch procedure could meet the criterion of the radical resection of rectal carcinoma,and keep the internal and external sphincter muscles intact in the superior lower anterior resection. The normal defecationcan can maintain after the operation due to the preservation of internal and external sphincter muscles.

Objective To study on the value and safety of early endoscopic retrograde cholangiopan-creatography (ERCP)and endoscopic sphincterotomy (EST) in acute biliary pancreatitis. Methods Ninety-two patients with acute biliary pancreatitis underwent early ERCP (within 72 hours) and received endoscopic therapy (ERCP group). Another 40 patients with acute biliary pancreatitis were treated conservatively without ERCP (control group). The disappearance of abdominal pain, decrease of serum amylase level, the mean days and costs of hospitalization and complications were observed in all patients. Results In ERCP group, all patients were performed EST, stones in 72 choledocholithiasis patients had been removed with net-basket or air pocket. Ten cases of severe acute biliary pancreatitis received endoscopic pancreatic duct stents drainage. Ninety two cases of acute biliary pancreatitis received endoscopic nasal catheter bile drainage. The days of the disappearance of abdominal pain, the decrease of serum amylase levels, the cost of the hospitalization and the days of the hospitalization were significantly shorter in the early ERCP group than in the control group. The mortalities in ERCP and control group were 8. 3% and 33. 3% respectively. Conclusion Early ERCP endoscopic therapy is a safe procedure has the superiorities in lowering the mortality, hospital days and expense.

Objective:To study the expression and clinical significance of neuron-specific enolase,chromogranin and synaptophysin in islet cell tumors.Methods:Twenty-one paraffin-embedded specimens with islet tumors and 3 cases cholangiocarcinoma and tissue nearby the tumor were recruited from Jan 1988 to Jun 2001.The S-P method was used for the detection of chromogranin,synaptophysin and neuron-specific enolase.Results:There were positive expressions of neuron-specific enolase,chromogranin and synaptophysin in 19,15 and 18 cases respectively,while negative results were observed in 3 cases of cholangiocarcinoma and the para-cancer tissue.Conclusion:CG,SYN and NSE may be specific tumor markers of islet cell tumors and combined detection can help to enhance the sensitivity.

Objective To investigate the therapeutic effect of ehlorpromazine in rats with acute necrotizing pancreatitis (ANP). Methods 120 healthy female SD rats were randomly divided into three groups: normal control group (NC group, n=30); acute necrotizing pancreatitis group (ANP group, n=45) and chlorpromazine treatment group (CPZ group, n=45). ANP was induced by the injection of 5% sodium taurocholate (1 ml/kg) into pancreatic duct, NC group were injected with same amount of saline. 0.4% chlorpromazine (0.25 ml/100 g) was intraperitoneally administered in CPZ group at 0 h, 24 h, 48 h after ANP was established. Same amount of normal saline was given to ANP group and NC group in the same way and at the same time points. The rats were sacrificed at 24, 48, 72 h after ANP was induced. The blood samples were collected for analysis of serum amylase (AMY), phospholipase A2 (PLA2), interleukin-6 (IL-6). Pancreas was harvested for evaluation of pathologic changes. Results The pathologic changes in ANP group were compatible with pathologic changes of ANP. The pathologic scores in CPZ group was 3.57±0.73 at 72 hours after ANP induced, which was significantly lower than 13.29±1.03 in ANP group. The serum amylase and PLA2 levels in CPZ group at 72 hours after ANP induced were (1658.0±277.0) U/L and ( 12.26±1.40) ng/ml respectively, the corresponding values of ANP group were (3666.7±1233.0) U/L and (16.81±1.13)ng/ml, respectively. The difference was statistically significantly (P＜0.01). The serum IL-6 levels of CPZ group at 24,48 72 hours were (116.27±14.49) pg/ml, (75.35±6.17) pg/ml, (82.75± 8.86) pg/ml respectively, the corresponding values of CPZ group were (160.88±27.19) pg/ml, (111.77± 19.10)pg/ml, (125.51±30.71) pg/ml respectively. There was a significant difference between the two groups (P＜0.01). Conclusions Chlorpromazine may have a therapeutic effect on ANP.

Objective:To investigate the clinical characteristics of elderly patients with coronavirus disease 2019(COVID-19), in order to provide scientific evidence for the diagnosis and treatment of COVID-19 in elderly patients.Methods:Clinical data of 102 patients with COVID-19 admitted to the B11 East Ward of the Zhongfaxincheng campus and the E1-3 ward of the Guanggu Campus of Tongji Hospital affiliated to Huazhong University of Science and Technology in Wuhan from 1 February 2020 to 28 February 2020 were retrospectively collected and analyzed.Patients were categorized into 2 groups: the elderly group(≥60 years old)and the young and middle-aged group(<60 years old). Differences in epidemiological features, demographics, clinical symptoms, laboratory results and imaging findings between the two groups were retrospectively analyzed.Results:Among 102 patients with COVID-19, 58 were in the elderly group(≥60 years old), with a median age of 67.0(63.8, 71.0)years old, and 44 in the young and middle-aged group(<60 years old), with a median age of 47.5(38.0, 51.8)years old.There was no significant difference in gender ratio between the two groups( χ2=0.033, P=0.855). Of 102 patients, 42.0%(21/50)had close contact with an infected person, 14.0%(7/50)were from infection clusters, and 18.0%(9/50)had suspected hospital-acquired infections.Fever and cough remained the most common symptoms, but gastrointestinal symptoms such as nausea, poor appetite, diarrhea and muscle cramps were also warning signs.Fatigue and cough were the most common presenting symptoms in elderly male patients.Bilateral patchy infiltrates(57.9%, 22/38)and ground-glass opacities(42.1%, 16/38)were the main imaging features and 42.1%(16/38)patients had multiple areas of the lungs involved.Over 50% patients had increased levels of blood glucose, D-dimer, fibrinogen, C-reactive protein, procalcitonin, multiple cytokines and neutrophil-to-lymphocyte ratio, as well as decreased levels of albumin, hemoglobin, hematocrit, lymphocytes and serum calcium.Compared with the young and middle-aged group, the elderly group had higher rates of abnormality in levels of D-dimer and serum calcium( χ2=7.067 and 4.166, P=0.008 and 0.041). Conclusions:Fever and cough are the most common symptoms in elderly patients with COVID-19.Elderly patients with COVID-19 have multiple abnormalities in clinical laboratory test results, which show a certain level of specificity compared with young and middle-aged patients.

Objective To investigate the effect and mechanism by which PPARγ ligand, rosiglitasone, regulates the expression of CD40 and intercellular adhesion molecule 1 (ICAM-1) in the rat peritoneal mesothelial cells (RPMCs) induced by lipopolysaccharide (LPS). Methods RPMCs were harvested from Sprague-Dawley rat peritoneal cavity and maintained under defined in vitro conditions. The cells were randomly divided into groups as follows: medium, LPS (5 mg/L), LPS (5 mg/L)+BAY11-7085(5 μmol/L, NF-κB inhibitor), rosiglitazone (10 μmol/L or 20 μmol/L, peroxisome proliferator-activated receptor γ activator), LPS (5 mg/L)+rosiglitazone (10 μmol/L)+GW9662 (3 μmol/L, peroxisome proliferator-aetivatcd receptor γ antagonist), and LPS (5 mg/L)+vehicle (DMSO 0.2 ml/L). The expressions of CD40 and ICAM-1 RNA in RPMCs were examined by RT-PCR after 3 hour treatment, and the protein expressions of CD40, ICAM-1, p-NF-κB p65 and p-IκBα were examined by Western blot or immunofluorescence after 24 hour treatment. Results Following treatment with LPS, both the expressions of CD40 and ICAM-1 protein in RPMCs were up-regulated significantly (P<0.05), and the phosphoralation of p65 was increased greatly (1.10±0.17 vs 0.55±0.06, P<0.05). BAY11-7085 (5 μmol/L) significantly decreased the protein expression of p-p65 (0.22±0.11 vs 1.10±0.17, P<0.01), CD40 (0.34±0.02 vs 0.50±0.06, P<0.05) and ICAM-1 (0.35±0.16 vs 0.74±0.03, P<0.05). Pretreated with rosiglitazone for 3 h then added with LPS for 1 h, the levels of p-p65, CD40 and ICAM-1 in RPMCs were significantly decreased compared with those of LPS group (0.77±0.08 vs 0.90±0.10, P