Acute pancreatitis( AP)is a common gastrointestinal emergency,which comprises mild acute pancreatitis ( MAP),moderately severe acute pancreatitis( MSAP)and severe acute pancreatitis( SAP). Most patients with MAP and MSAP present as a mild,self-limiting disease with low morbidity and mortality,however,patients who suffer from SAP will experience serious local and/or systemic complications associated with high mortality. Therefore,early assessment of disease severity is important for clinical management. Procalcitonin( PCT),a pro-peptide of calcitonin,is an inflammatory mediator that can be used to differentiate bacterial and non-bacterial infection. Recently,the effect of PCT on AP has attracted more and more attentions. This article reviewed the advances in studies on PCT and AP.

Objective To establish a method of HPLC assay for determining emodin in Yishi Granules.Methods The effective components in Yishi Granules were determined by HPLC.The chromatographic conditions were as follows:Alltech C18 column(250 mm? 4.60 mm,5 ? m),mobile phase consisting of methanol-0.1 % phosphoric acid(80:20),flow rate at 1 mL? min-1,detecting wavelength being 254 nm,and the column temperature being 30 ℃.Results The separation and the linearity were good in the range of 32.8～ 131.2 ?g,r=0.999 9.The average recovery of emodin was 100.20 %,and RSD=1.52 %(n=6).Conclusion The quantitative method for determining the active components of Yishi Granules is simple,feasible and reproducible,and is beneficial for the quality control of Yishi Granules.

Objective To study the effects of rhubarb on the mitogen-activated protein kinase (MAPK) sig-naling transducfon pathway in rats with severe acute pancreatitis (SAP),and to investigate the treatment mecha-nism of rhubarb on SAP. Method One hundred SD rats were provided by from the Animal Center of Nanjing Uni-versity. All animals were randomly divided into sham operation (n=33), SAP (n=33) and rhubarb groups (n=34). SAP model was induced by retrograde injection of 5% sodittm taurocholate. Rhubarb was given with 10% rhubarb decoction (2 mi/100 g) at the time of pancreafitis induction in the rhubarb groups. At 1, 3, 6, and 12 h after the models were established,animals were killed. MAPK activity in pancreatic tissue was examined by West-em blotting and the mRNA levels of TNF-α and IL-6 in pancreatic tissues were detected by RT-PCR. All data were analyzed by SPSS statistical software and statistical differences between values from two sroups were determined by the Student's t -test. Results MAPK activity, TNF-α and IL-6 mRNA levels in pancreatic tissues were signifi-cantly enhanced in the SAP group compared with the sham operation group (all P<0.01). Rhubarb treatment markedlyinhibited MAPK activation,TNF-α,IL 6 mRNA (all p<0.01). Conclusions Rhubarb can alleviate the inflammatory response of SAP by down-regulating MAPK activity.

Objective To evaluate the therapeutic efficacy of a combination of proton pump inhibitor(PPI) and hydrotalcite for endoscopic submucosal dissection (ESD) induced ulcer.Methods Eightyone consecutive patients who underwent ESD were randomly assigned to either the group of PPI and hydrotalcite therapy ( drug combination group,n =41 ) or the PPI group ( n =40).Delayed bleeding rates were monitored and compared.The main upper abdomen symptoms 1-wk later and ulcer healing rates and ulcer diameter 4-wk later were compared between the two groups.Results There was no significant difference in delayed bleeding rate (P ＞ 0.05 ).At the end of first week after ESD,the combination therapy was significantly more effective than the PPI alone in reducing frequencies and severity of upper abdominal pain and upper abdominal distention,while there was no significant difference between the two groups in relieving belch and nausea.A better ulcer healing rates and a smaller ulcer diameter were observed in the combination group at the end of 4 weeks ( P ＜ 0.05 ).Conclusion The combination therapy of hydrotalcite and PPI can relieve upper abdominal symptoms and improve the healing rate of ESD induced ulcer.

ObjectiveTo explore the safety and efficacy of endoscopic dilatation combined with submucosal injection of triamcinolone acetonide in treatment of benign esophageal stricture.MethodsThe patients of benign esophageal stricture proved by biopsy were randomly divided into three groups.Group A were treated by expansion only,group B were injected with triamcinolone acetonide submucosal combined with expansion,and we treated group C by another injection a week later on the basis of treatment in group B.A 12 months' follow-up was conducted,the dysphagia score,the cure rate.time to sustained symptom relief,re-expansion time interval and adverse reactions were recorded.ResultsSome patients experienced chest pain and regurgitation after the procedure and all improved by corresponding managements.No complications including massive bleeding,infection,perforation or local tissue atrophy were observed.The dysphagia scores in 3 groups after the procedure were all improved ( P ＜ 0.05 ),and no significant difference was noticed between 3 groups (P ＞ 0.05 ).At the end of the follow-up,the duration of dysphagia remission and the interval between 2 consecutive dilatation in Group A were 14.4 ± 3.2 weeks and 18.2 ± 3.7 weeks,respectively,which were significant shorter than those in Group B ( 19.3 ±3.9 weeks and 24.6 ±4.2 weeks,respectively) and those in Group C (20.2 ±4.2 weeks and 26.1 ±4.5 weeks,respectively),while there was no difference between Groups B and C.The cure rate in Group C (43.5％,10/23) was significantly higher than that of Group A (29.2％,7/24) or Group B (27.3％,6/22),while there was no difference between Groups A and B.ConclusionEndoscopic dilatation combined with submucosal injection of triamcinolone acetonide is safe and may improve the symptoms of dysphagia and delay the re-stenosis for patients with benign esophageal stricture,meanwhile,multi-frequency treatment may improve the cure rate.

One hundred and forty six elderly patients with constipation undergoing colonoscopy during March 2012 and August 2013 were randomly assigned to trial and control groups.Seventy patients in trial group received Macrogol electrolytes powder combined with Chinese herb medicine Simo decoction for bowel preparation and 76 patients in control group received macrogol electrolytes powder only.The first defecation,times of defecation and tolerance of patients were compared between two groups.The quality of bowel preparation was evaluated by endoscopists with Boston Bowel Preparation Scale (BBPS).The first defecation time was shorter in trial group than that in control group (55.7 ± 27.9 vs.72.9 ± 34.8,P ＜ 0.05).However,no statistical significance was found in the times of defecation and tolerance of patients between two groups.The mean BBPS score in trial groups was higher than that in control group (7.87 ± 1.08 vs.6.97 ± 0.96,P ＜ 0.05).Chinese herb medicine Simo decoction combined with conventional method shows satisfactory result for bowel preparation in elderly patients with constipation undergoing colonoscopy.

Objective To review the experience on the surgical management for advanced gastric carcinoma with portal hypertension. Methods In this study, 14 advanced gastric carcinoma with portal hypertension patients were analyzed retrospectively, liver cirrhosis was found in 13 cases. In 10 esophageal variceal patients, 5 had upper gastrointestinal bleeding history. All of those cases were associated with different degree of hypersplenism. The tumours situated at the upper third of the stomach in 2 patients, middle and upper third in 2 and lower third in 10. Five patients underwent curative distal subtotal gastrectomy and splenectomy, 2 cases did radical distal subtotal gatrectomy and pericardial devascularizaion, 2 curative distal subtotal gastrectomy combined with splenic artery ligation,2 did total gastrectomy and pericardial devascularizaion,2 cases did radical proximal gastrectomy and pericardial devascularization and 1 patient did distal subtotal gastrectomy only. Results Three died from extensive wound bleeding, jejunal fistula and liver failure respectively. 3 patients were complicated by left subdiaphragmatic abscess, hepatic dysfunction and massive ascites individually. The morbidity and mortality rate were 42.86% and 21.43% respectively. Conclusion The surgical procedures for patients of advanced gastric carcinoma with portal hypertension caused a considerably high postoperative mortality and morbidity rate.

Eighteen patients with early cancer and precancerous lesions of esophagogastric junction underwent multiband mucosectomy (MBM) in Yangzhou First People's Hospital from January 2013 to February 2014.The clinicopathological data of patients were analyzed retrospectively and the short-term efficacy and safety of MBM were evaluated.Operations were successful in all 18 cases.The mean operative time was 35.8 min.Intraoperative bleeding occurred in 3 cases and successfully managed by endoscopic hemostasis.Small perforation occurred in 1 patient and was closed by metal clips.Pathological examination showed mucosal cancer in 5 cases,high-grade intraepithelial neoplasia in 8 cases and low-grade intraepithelial neoplasia in 5 cases.No relapse of cancer was found during follow-up.Results indicate that MBM is an effective and safe method in treatment of early cancer and precancerous lesions in the esophagogastric junction.

Mutations and polymorphisms of genes associated with pancreatic function are involved in the development and progression of pan-creatitis. In addition,systemic inflammatory response also affects the severity of pancreatitis,while mutations and polymorphisms of genes which encode inflammatory factors and cytokines can regulate the expression of such factors and thus affect the progression of systemic inflam-matory response. This article reviews the association between pancreatitis and polymorphisms of genes related to cationic trypsinogen,pancre-atic secretory trypsin inhibitor,cystic fibrosis conductance regulator,inflammatory factors,and cytokines.