Frequently,there is a lack of safety data about diagnostic method and drug therapy of digestive diseases during pregnancy. It is profitable to understand the limited evidences of safety data about diagnosis and drug therapy of digestive diseases during pregnancy,which will allow the accurate evaluation and risk assessment on diagnostic method and treatment during pregnancy. High-quality clinical study on patients with pregnancy is helpful for the management of common digestive diseases among this special population.

The American College of Gastroenterology( ACG)released the first clinical guideline for drug-induced liver injury( DILI)in June,2014:the diagnosis and management of idiosyncratic drug-induced liver injury( IDILI), which includes all aspects of IDILI,such as risk factors,diagnosis,differential diagnosis and treatment. The guideline discusses especially the issues on herbal and dietary supplements( HDS)induced liver injury and DILI in patients with chronic liver disease. The guideline is of great value for standardizing the clinical diagnosis and treatment,providing the best recommendations for management of the patients with DILI. Since the evidence of research in the field of DILI is relatively weak at this moment,the clinicians should consider the possible individual difference of the patients under the frame of guideline for making the best clinical decision.

Objective To study the effects of lung recruitment maneuvers (RM)with different duration combined with low tidal volume (TV)ventilation in acute respiratory distress syndrome (ARDS) with pulmonary and extra-pulmonary origin(ARDSp / ARDSexp). Methods Twenty-six ARDS patients with ventilation were selected including 10 patients of ARDSp (ARDSp group) and 16 patients of ARDSexp(ARDSexp group). All patients were given intermittent high-positive end expiratory pressure (PEEP) combined with low tidal volume RM in the base of usual ventilation. Effects of different duration of RM were evaluated and compared in the patients of ARDSp / ARDSexp. Results MAP decreased and HR increased when sustaining time of RM was above 60 seconds. Significant differences were showed compared with that before treatment. MAP and HR returned to normal after RM stopped.Compared with the state before RM,Pplat and Crs increased immediately after RM (P<0.05). When RM lasted above 60 seconds, Pplat increased significantly compared with that when RM continue lasted 40-59 seconds.But Crs,OI and SpO2 didn't increase obviously. Treatment effects of RM in patients of group ARDSexp were more obviously than those in patients of ARDSp group. There were 1 case of pneumothorax and 3 cases of pneumoderma in ARDSp group and 2 cases of pneumoderma in ARDSexp group when RM lasted above 60 seconds. Conclusions RM with intermittent high-PEEP on low TV is effective to ARDS and best duration is 40～59 seconds. The patients of ARDSexp, with pulmonary interstitial edema as the main pathology, respond better to RM than patients in ARDSp with pulmonary consolidation.

Objective To investigate the risk factors of syncope symptom in patients with pulmonary embolism (PE).Methods 457 patients with confirmed pulmonary embolism were recruited in the study.They were divided into two groups:the syncope group (44 patients) and the group without syncope (413 patients).The clinical manifestation,laboratory examination,physical examination,imagingof all patients were analyzed by unconditional logistic regression.Results (1) Single factor analysis,prevalence of syncope was 9.6％ (44/457) in these patients with PE.Those with syncope had some higher risk factors,including age over 60,coronary heart disease,hypertension,stroke and lower limb vein thrombosis history.The proportion of falling pressure chest painand centricity thrombus in syncope group were increasing compared with the groupwithout syncope.Pulmonary embolism severity index (sPESI) score was higher than groupwithout syncope.(2) Multivariate analysis showed that hypertension coronary heart disease and Centricity thrombus were the independent correlates of the presence of syncope in the patients with PE.Conclusions Patients who had histories of hypertension and coronary heart disease may have the higher risk factors of syncope.Blood pressure falling and central localization may be more likely to happen in PE patients with syncope.

Objective To investigate the indications and efficacy of endovascular stenting for the treatment of thoracic aortic aneurysm.Methods From March 2005 to October 2008,21 patients with Stanford type B aortic dissection,5 cases of pseudoaneurysm,and 2 patient with intramural hematoma complicated with ulcer of the aortic wall were treated by endovascular stenting under general(2 cases) or local(26 cases) anesthesia in our hospital.Medtronic Talent stent was employed in 10 cases,Medtronic Valiant stent was used in 12,and microinvasive straight-type stent was used in 6 patients.Results The operation was completed successfully in all of the 28 cases.Angiography showed that the gaps in the aorta were closed without endoleak.No patient had chest pain or neurological complications.The patients were discharged in(4.5?1.1) days(range 3-7 days).Five patients developed fever after the operation and were cured by indomethacin in one month.One week after the surgery,in 21 cases,CT scan showed enlarged aortic dissection,improved blood supply,thrombus in the false lumen of the thoracic aorta,and a false lumen in the abdominal aorta.In the 5 cases with pseudoaneurysm,CT scan confirmed that the rupture was closed with thrombus being detected in the lumen.The aortic ulcers that were detected in the 2 cases,who had intramural hematoma,were covered by the stents.Of the patients,a follow-up of(21.3?10.2) months(range 1-40 months) was available in 23 patients,who had no complications during the period.Conclusions Endovascular stenting is a simple,safe and effective method for Stanford type B aortic dissection,pseudoaneurysm,and intramural hematoma,resulting in quick recovery,less complications,and short hospital stay.

Objective To assess the renal safety of adefovir dipivoxil (ADV) in Chinese patients with chronic hepatitis B (CHB).Methods A retrospective study was performed on 1 013 CHB patients from Chinese ADV multicenter clinical trials (ADF30001 and ADF106632).All patients were administrated with ADV 10 mg daily.The serum creatinine and phosphorus levels were measured in different time pointsduring 104-week treatment.Nephrotoxicity was defined as an increase ≥44.2 μ mol/L from baseline in serum creatinine or a serum phosphorus value of ＜ 0.4845 mmol/L on two consecutive occasions.Paired t test was used to analyze serum creatinine and phosphorous data before treatment and at different time points during treatment.Results At week 28,week 52,week 80 and week 104,the median levels of serum creatinine were 74.963,76.996,76.820 and 77.969 μmol/L,respectively,and there were no significant differences from baseline (t =0.91,0.23,0.59 and 0.97,P ＞ 0.05).No patient experienced a ≥ 44.2 μmol/L increase from baseline.For serum phosphorus,the median levels at week 28,week 80 and week 104 were 1.098,1.088 and 1.048 mmol/L,and there were significant decreases from baseline (t =2.34,3.06 and 4.94,P ＜0.05 or ＜ 0.01).The cumulative incidence of serum phosphorus abnormality was 0.8％ (8/104).There were no confirmed serum phosphorous decreases to ＜ 0.4845 mmol/L.Conclusion Two years treatment with ADV (10 mg/d) does not result in marked nephrotoxicity,indicating that ADV 10 mg daily is well tolerated by Chinese patients.

Objective To explore the level of the oxidative stress and the DNA oxidative damage of peripheral blood mononuclear cells (PBMCs) in pulmonary embolism (PE) patients after remission and in acute exacerbation.Methods The PBMCs DNA damage in 35 PE patients (test group) after remission and in acute exacerbation respectively and in 33 healthy persons (control group) was detected by single-cell gel electrophoresissingle (Comet assay).The total antioxidative capacity (TAC) in blood plasma was measured by phenanthroline colorimetric analysis.The contents of malondialdehyde (MDA) in blood plasma was measured by thiobarbituricacid colorimetric analysis.The capacity of glutathion peroxidase (GSH-PX) in blood plasma was measured by the method of improved Hafeman direct determination method (DNTB).Results The level of TAC,GSH-PX in test group after remission were significantly higher than those in acute exacerbation[(6.86 ± 1.21) kU/L vs.(5.18 ± 1.13) kU/L,(165.25 ± 41.96) kU/L vs.(137.23 ± 38.52) kU/L] (P ＜0.01),and they were all significantly lower than those in control group [(7.85 ± 1.44),(189.92 ± 51.32) kU/L] (P ＜ 0.01).The level of MDA in test group after remission was significantly lower than that in acute exacerbation [(5.58 ± 1.89) μmol/L vs.(7.26 ± 2.25) μmol/L] (P ＜ 0.01),and they were significantly higher than that in control group [(3.71 ± 1.52) μmol/L] (P ＜ 0.01).The arbitrary units (AU) of PBMCs DNA damage in PE patients after remission (29.01 ± 6.75) was significantly lower than that in acute exacerbation (42.13 ± 8.01),and they were all significantly higher than that in control group (15.12 ± 4.36),there were significant differences (P＜ 0.01).There were negative correlations between the PBMCs DNA damage and the level of TAC in PE patients after remission and in acute exacerbation (r =-0.695,P ＜ 0.01 ;r =-0.536,P ＜ 0.01).There were positive correlations between the PBMCs DNA damage and the contents of MDA in PE patients after remission and in acute exacerbation (r =0.513,P ＜ 0.01 ;r =0.628,P ＜ 0.01).There were negative correlations between the level of TAC and the contents of MDA in PE after remission and in acute exacerbation respectively (r =-0.534,P ＜ 0.01 ;r =-0.486,P ＜ 0.05).There were positive correlation between the level of TAC and GSH-PX in PE patients after remission and in acute exacerbation (r =0.512,P ＜ 0.01 ;r =0.497,P ＜ 0.01).Conclusions There are oxidation/antioxidation imbalance,oxidative stress and the PBMCs DNA damage in PE patients.There is positive correlation between the PBMCs DNA damage and the oxidative stress.After remission,the level of the oxidative stress and the PBMCs DNA oxidative damage in the same PE patients is improved respectively.

AIM:To evaluate the effects of pilocarpine, brinzolamide and the preservatives of them on corneal epithelial cells and the histopathology of rabbit conjunctiva. METHODS: Fifteen New Zealand white rabbits weighing 1.5 kg to 2.5 kg were randomly divided into three groups. One group with three rabbits served as untreated controls. Pilocarpine 1% and brinzolamide 1% each were administered to the right eyes in one treated group, and the preservatives (chlorobutanol 0.01% in pilocarpine, benzalkonium chloride 0.01% in brinzolamide) to the left eyes. Corneal epithelial damage was evaluated by scanning electron microscopy, and conjunctival specimens were examined under light microscopy. RESULTS: Compared with normal controls, brinzolamide and BAC caused corneal epithelium damage and increased number of inflammatory cells in the conjunctiva, while pilocarpine and the preservative chlorobutanol mainly influenced the corneal epithelium. Brinzolamide produced significantly more damage than pilocarpine (P

Objective Estimating clinical effects of the Therapy of Potassium L-aspartate Injection on Hypokalemia.Methods These hypolalemia patients from the Renji hospital of Shanghai Jiaotong University and Other Two Hospitals,and from March 2007 to May 2008,which were caused from various kinds of reasons.The test group (42 patients) were intravenous dripped by using three rami potassium L-aspartate injection added in 5% Glucose (or saline) 750 mL,the control group (44 patients) were gived two rami chloratum Kalium injection added in 5% Glucose (or saline) 750 mL,the Kalium were 1.10 g/d in both groups,once per day,time of therapy was 7 day.Results The test and control groups effective power after therapy were 86.67% and 91.11%,respectively,there was no significant difference (P=0.3998).The Kalium dose of test group was advanced from (3.18?0.23) mmol/L before testing to (3.73?0.37) mmol/L after therapy,the elevated average was (0.61?0.46)mmol/L,and there was no significant difference (P=0.4722).The accumulation power of Kalium recovery were (51.11?7.45)%,(77.78?6.20)%,(86.67?5.07)%,at the second,the fored and the sevened day,respectively.There was no significant difference between the two groups (P=0.1430).Conclusion The clinical effect was correspond between three rami potassium L-aspartate injection added in 5% Glucose (or saline) 750 ml and the Isodose chloratum Kalium injection,by once per day,and seven days of therapy,which can treat hypokalimeia caused from various kinds of reasons.

Objectives:To investigate the effect of TP 5 on the immune function and infection rate in patients undergoing cardiopulmonary bypass(CPB) operation. Methods:Ninety four patients were divided into two groups to observe the effect of TP 5 on the immune function and infection rate. Results:The immunological parameters in the TP 5 group was better than the control group, and postoperative infection was prevented. Conclusions:TP 5 can improve patients' cell mediated immunity and reduce infection rate.