Chronic pancreatitis (CP) is a chronic inflammatory and fibrotic disease of the pancreas caused by a variety of causes. The basic treatment principle of CP is to remove the etiology, control the symptoms, improve the pancreatic secretory function and prevent the complications. At present, more and more studies have been conducted on CP treatment strategies. The step-up approach and the surgery first approach are both effective strategies for CP treatment. In clinical practice, endoscopic intervention can be the preferred treatment for pancreatic pseudocyst, pancreatic duct stone, and biliary stenosis. Partington operation is the first choice for dilated main pancreatic duct patients without pancreatic head lesion. Patients with pancreatic head lesions should be intervened with the Beger or Frey operation. For patients without main pancreatic duct dilatation, pancreatectomy should be performed according to the specific lesion location. The total pancreatectomy is advisable for patients with total pancreatic inflammatory disease or multiple lesions of pancreas. Surgeons should follow the individualized and multidisciplinary treatment concepts and strategies in choosing surgical procedures, especially for the control of surgical indications, timing and methods. The authors comprehensively analyze the research progress at home and abroad, elaborate the endoscopic treatment and surgical intervention strategies of CP in order to further optimize the overall efficacy of CP.

Consensus ; Humans ; Pancreatitis ; classification ; diagnosis

Objective To evaluate the effect of ameliorating the pancreatic microcirculation in the early stage on the patients with severe acute pancreatitis(SAP). Methods 84 SAP patients admitted from 1995-1998 and 1998-2001 were retrospectively analyzed. Routine united management were given to 44 SAP patients in the former period (FP)(1995-1998),and special regime aimed at improving the microcirculation and preventing cell Ca 2+ overload besides routine management were given to 40 SAP patients in the later period(LP)(1998-2001).Results Cure rate (85.0%) in FP group was significantly higher than that of LP group(68.2%)(P

Objective To evaluate the inhibitory effects on Candida albicans of vagina cells transferred with antimicrobial peptide LL-37 and human defensin 5 (HD5) recombinant plasmids and observe secretion of IL-8.Methods ( 1 ) The epithelial cells from female vagina were culture primarily.The pcDNA3.1 ( + )/HD5-EGFP and pcDNA3.1 ( + )/LL-37-EGFP eukaryotic recombinant plasmids were separately or jointly transferred into the fourth generation of vaginal epithelial cells.Two test groups were defined:one test group was no Candida albicans group including four subgroups which were untransferred group,HD5 group transferred with pcDNA3.1 ( + )/HD5-EGFP,LL-37 group transferred with pcDNA3.1 (+)/LL-37-EGFP,combining transferring group transferred with pcDNA3.1 ( + )/HD5-EGFP and pcDNA3.1 ( + )/LL-37-EGFP; the other test group was with Candida albicans group which the Candida albicans were coincubated with the four subgroups described above.(2) For examination of cytokines and chemokines,at 6,12,24 and 48 hours,the supernatant of every group was collected.ELISA was applied to detect the levels of LL-37,HD5 and IL-8.At each time point,the growth inhibition of Candida albicans was calculated by glucose consumption testing.Results ( 1 ) The max level of LL-37,HD5 and IL-8 reached max level after being transferred for 24 hours,then showed decreasing trend.The secretion of LL-37,HD5 and IL-8 was significant higher in combining transferring group in Candida albicans group than other groups,and the secretion level of LL-37,HD5 and IL-8 was (100.16 ±0.81 ) ng/ml,(58.50 ±2.08) μg/ml and ( 101.03 ± 1.59) pg/ml (P ＜0.01 ).(2) In different time point,the absorbance of each subgroup without Candida albicans declined slowly,and there were no statistically significant difference (P ＞0.05 ),as while as in LL-37 subgroup and HD5 subgroup with Candida albicans.In group with Candida albicans,the absorbance of combining transferring subgroup were 3.210 ± 0.010,3.150 ± 0.030,3.099 ± 0.030 and 2.970 ±0.040 at 6,12,24 and 48 hours,respectively,which was significantly higher than those in the other cells (P ＜ 0.01 ),and the declined trend was the slowest.Conclusions The antifungal ability of vaginal epithelial cell became stronger after being transferred with LL-37 and HD5 recombinant plasmids.LL-37 and HD5 could also possess immunomodulatory activity and induce chemokine IL-8 production.

Pancreatic cancer is a highly malignant, fast progressive and bad prognostic digestive system neoplasm and the incidence has increased significantly in recent years.With the improvement of people's living standard and changes of lifestyle and diet, diabetes also shows an arising trend.More and more studies have shown that diabetes is closely associated with the occurrence of pancreatic cancer and may be an independent risk factor for pancreatic cancer.This article reviews the research progress on the relationship between diabetes and pancreatic cancer.

Contraindications ; Humans ; Surgical Sponges

Background and purpose:Gastric cancer is one of the leading causes of cancer death throughout the world.When compared with optimal supportive care alone,combination chemotherapy yields a significant advantage in the management of advanced gastric cancer.However,no single regimen has emerged or been accepted as being clearly superior over another.Here we investigated the efficacy and safety of "docetaxel+ cisplatin + fluorouracil" 5-day combination chemotherapy as treatment in patients with advanced gastric cancer.Methods:Between 2004 January and 2005 July,we enrolled 30 patients [males 22,median age 53 years(range 28-72)] with advanced gastric cancer.The regimen consisted of docetaxel 75 mg/m~(2) on day 1,cisplatin 15 mg/ m~(2) on days 1-5,and fluorouracil 500 mg/ m~(2) on days 1-5,every 3 weeks.All patients received over two cycles of this regimen.Results:A total of 99 cycles were administered.Mean cycle number per patient was 3.3.The administered dose intensity of docetaxel was 23.5 mg/m~(2)/week,fluorouracil 735 mg/ m~(2)/week and cisplatin 14.7 mg/ m~(2)/week,which corresponded to 94%,97.5% and 92.3% of planned doses.Of these patients,16(53.3%) achieved a partial response,8(26.6%) stable disease,and 6 patients(20%) showed progressive disease.The median time to progression was 5.1 months.(95% CI 4.1-6.0 months).Median overall survival was 9.9 months.(95% CI 8.1-11.6 months).Leukopenia occurred during 36.7% of cycles(36 of 99 cycles);18.2% grade Ⅰ,10.1% grade Ⅱ,5.0% grade Ⅲ and 3.0% grade Ⅳ.Anemia occurred in 12.1%(12 of 99 cycles);7.1% grade Ⅰ and 5.0% grade Ⅱ.Thrombocytopenia was 15.2%(15 of 99 cycles) and all were grade Ⅰ or Ⅱ.Diarrhea,stomatitis and hypersensitivity occurred in 16.7%(5 out of 30 patients),respectively.Neutropenic fever occurred in two patients(6.7%) and myalgia in nine(30%).Conclusions:Docetaxel combined with fluorouracil and cisplatin is an active and tolerable regimen for the treatment of patients with advanced gastric cancer.

Objective To investigate the drug resistance genes of extended-spectrum beta- lactamase-producing bacteria in 49 strains.Methods Extended-spectrum ?-lactamase -producing strains were detected by the disc diffusion test.The techniques of polymerase chain reaction,sequence analysis, pulsed-field gel electrophoresis were used to analyze the genotype and homology of extended-spectrum ?- lactamase-producing strains.Results The incidence of ESBL-producing strains from E.coli,K pneumoniae,K oxytoca,was 20% in 2000,and 40% in 2003.Among the 49 ESBLs producers the most common genotype was CTX-M-14( n=33).The others were CTX-M-3,CTX-M-9,CTX-M-12,CTX-M-15, CTX-M-24 and SHVSa.Both two CTX-M subtypes,CTX-M-3 and CTX-M-14,were detected in one strain. However,4 ESBL-producing strains confirmed by phenotype remained untyped.The results showed that the ESBLs producers were not closely related,except for two strains of E.coli and two strains of K.pneumoniae which were homgenic respectively.Concolusions The incidence of ESBL-producing strains increases with years.The most common genotype of ESBLs is CTX-M.There is no evidence for epidemiologic spread of ESBL-producers by pulsed-field gel electrophoresis.

Objective To investigate the antimicrobial resistance in the clinical strains isolated from Tongji Hospital to the antimicrobial agents commonly used in 2012.Methods Antimicrobial susceptibility was tested by Kirby-Bauer method.The minimum inhibitory concentration (MIC) of penicillin and ceftriaxone for Streptococcus pneumoniae and vancomycin for Staphylococcus spp.were determined by E-test.All data were analyzed by WHONET 5.6 software.Results A total of 8 191 strains were isolated in 2012,including gram-positive bacteria (2 815,34.4%)and gram-negative bacteria (5 376,65.6%). The top five pathogenic bacteria isolated from outpatients were Escheria coli,Pseudomonas aeruginosa,coagulase-negative Staphylococcus (CNS),Klebsiella spp.and Staphylococcus aureus.For the isolates from non-ICU inpatients,the top five were E.coli,S.aureus,Acinetobacter spp.,Klebsiella spp.and P.aeruginosa.For those isolated from ICU patients,the top five were Acinetobacter spp.,S.aureus,P.aeruginosa,Enterococcus spp.and E.coli.The prevalence of MRSA and MRCNS was 58.1% and 64.3%,respectively.Seventeen strains of vancomycin resistant Enterococcus were identified, including 13 strains of E.faecium with VanA and 4 strains of E.gallinarum with VanA and VanC.The percentage of antimicrobial resistance in E.faecium was significantly higher than that in E.faecalis (P<0.05).A total of 94 strains of carbapenem-resistant Enterobacteriaceae were detected.The prevalence of penicillin-non-susceptible S.pneumoniae in children was much higher than that in adults. The prevalence of carbapenem-resistant P.aerugonosa and Acinetobacter spp. was 28.1% and 56.2% respectively.Beta-lactamase was produced in 41.8% of the H.influenzae and 98.6% of the M. catarrhalis isolates. Conclusions The prevalence of multidrug resistant strains has been increasing, especially vancomycin-resistant Enterococcus and carbapenem-resistant Enterobacteriaceae.

Objective To investigate distribution and drug resistance of pathogenic bacteria in lower respitatory tract infection. Methods Distribution and drug resistance of pathogenic bacteria in lower respitatory tract infection of patients in ICU and non-ICU of our hospital during 2013 were retrospectivly analyzed. The pathogens were identified by manual methods routinely and those difficult to be identified were analyzed by using the VITEK-2-COMPACT instrument. Antimicrobial susceptibility of these isolates were tested by Kirby-Bauey methods routinely. Results In total, 956 strains were isolated from lower respitatory tract infection of patients in ICU, including 231 strains of gram-positive cocci (24. 2%), 680 strains of gram-negative bacteria (71. 1%), 45 strains of fungi (4. 7%). In patients of non-ICU, 4 464 strains were isolated, including 1 090 strains of gram-positive cocci (24. 4%), 3 226 strains of gram-negative bacteria (72. 3%), and 148 strains of fungi (3. 3%). Staphylococcus aureus, acinetobacter baumannii and pseudomonas aeruginosa were the most frequent isolates in patients of ICU and non-ICU. The overall prevalence of methicillin resistant staphylococcus aureus (MRSA) in staphylococcus aureus was 87. 0%in ICU and 74. 0% in non-ICU. MSSA was sensitive to the most antibiotics ( more than 80. 0% of the strains were sensitive to common antibiotics) except penicillin, erythromycin and clindamycin. MRSA was sensitive to trimethoprim-sulfamethoxazole and fosfomycin (more than 75. 0% of the strains were sensitive to the antibiotics) except for vancomycin, teicoplanin and linezolid. Acinetobacter baumannii was more resistant to the antibiotics (less than 40. 0% of the strains were susceptible to the antibiotics). Pseudomonas aeruginosa from ICU was more resistant to the antibiotics ( less than 50. 0% of the strains were sensitive to the antibiotics) than that from non-ICU. Stenotrophomonas maltophilia was sensitive to trimethoprim-sulfamethoxazole, levofloxacin and minocycline (more than 80. 0% of the strains were sensitive to the antibiotics). Escherichia coli and Klebsiella pneumoniae were sensitive to Piperacillin-tazobactam and Amikacin except for meropenem and imipenem ( more than 80. 0% of the strains were sensitive to the antibiotics) . Conclusion Gram-negative bacteria was the most frequent isolate in lower respitatory tract infection of our hospital during 2013. Staphylococcus aureus, acinetobacter baumannii and pseudomonas aeruginosa were the most frequent isolates in ICU and non-ICU. Resistance to the antibiotics was more common in ICU than in non-ICU. Antibiotics should be prescribed according to bacterial resistance results reasonably in order to prevent the spread of drug-resistant strains.