Objective To evaluate the clinical value of the three-category classification of severe acute pancreatitis (SAP).Methods Clinical data of 337 traditional SAP patients,who were admitted to Peking Union Medical College Hospital (PUMCH)from January 2001 to December 2012,were retrospectively studied.These patients were classified into moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) according to the latest 2013 Atlanta Classification.SAP patients were further categorized as critical acute pancreatitis (CAP) and non-CAP.Disease severity,therapy and prognosis among three groups were compared.Results Among the total 337 traditional SAP patients,253 were classified as MSAP and 84 as SAP.In the group of SAP,40 patients were categorized as CAP and 44 as non-CAP.Compared with non-CAP patients,CAP patients had significantly higher mortality rate which was 70％ (28/40).Other results were all significantly higher in CAP group rather than non-CAP group,including ICU admission rate 77.5％(31/40),length of ICU stay (15.5 ± 20.6) days,Ranson,APACHE Ⅱ,BISAP,MCTSI,modified Marshall scores 4.6 ± 1.4,16.8 ± 5.8,3.0 ± 1.0,8.6 ± 1.7,and 7.4 ± 2.9,respectively (P ＜ 0.01 in each endpoint).These parameters of SAP group were also significantly higher than those of MSAP group (P ＜0.01).Conclusions Using the new three-category classification to distinguish traditional severe acute pancreatitis,namely MSAP,SAP,and CAP,can better reflect the severity of disease,predict outcome and guide clinical management.

Objective To study the feature of bone metabolism in different phase of elder type 2 diabetic nephropathy (DN) patients.Methods One hundred and fifty elder type 2 DN patients (non-microalbuminuria group,microalbuminuria group,clinic proteinuria group,DN renal inadequacy group and DN uremia group,each group was 30 cases),60 elder non-DN patients in chronic renal failure (CRF) (non-DN renal inadequacy group and non-DN uremia group,each group was 30 cases) ,and 30 elder healthy people (control group) were selected to observe the changes of osteocalcin (OT),β -crosslaps,parathyroid hormone ( iPTH),alkaline phosphatase (AKP),serum calcium (Ca),serum phosphorus (P) and Ca × P.Results In non-microalbuminuria group,microalbuminuria group and clinic proteinuria group,OT and β -crosslaps levels were lower than those in control group,and the lowest in microalbuminunia group (P＜0.01).In DN renal inadequacy group and DN uremia group,OT and β -crosslaps levels were higher than those in control group(P＜0.01).In the phase of CRF,OT,β -crosslaps and iPTH had no statistic difference between DN patients and non-DN patients,but had linear correlation.Serum P level was higher in DN renal inadequacy group and DN uremia group than that in control group(P＜0.01).Either DN or non-DN,serum P had more influence to Ca × P than serum Ca.Conclusions In the different phase of elder type 2 DNpatients,the effect of bone metabolism is different because of the different injury of renal function.Bone metabolism in the different phase has respective feature and mechanism,with low turnover in the first and high turnover in the end.

Objective To determine the diagnostic accuracy of alarm features in predicting upper gastro intestinal malignancy in patients who received gastroscopy examination.Methods A retrospective analysis of patients who underwent gastroscopy from Oct 2014 to Oct 2015 was conducted.Biopsy or surgical pathological findings served as the golden standard.The main outcome measure was the diagnostic accuracy of alarm features.Results Among 921 gastrointestinal outpatients,39 patients (4.2％) with malignancy were detected,including 13 (33.3％) with esophageal cancer,24 (61.5％) with gastric cancer and 2(5.1％) with duodenal ampulla cancer.36 patients (92.3％) were found with advanced cancer.In 137patients who had alarm features,21 (15.3％) were found to have malignancy and all were advanced.The sensitivity,specificity,positive predictive value and negative predictive value of alarm features were 53.8％(21/39),86.8％ (766/882),15.3％ (21/137) and 97.7％ (766/784),respectively.Conclusions Alarm features have a definite but limited value in predicting upper gastrointestinal malignancy.Noninvasive screening methods for Chinese patients are still needed to reduce unnecessary endoscopy workload.

0.05).Between subgroups divided by the clinical restoration time,the CP IgM seropositive rate of the tachy restoration group was significantly higher than that in the deferred group(P0.05).Among subgroups divided by the clinical manifestation,the subgroup of paralysis plus disorder of consciousness had significant higher CP IgM seropositive rate than other groups(Pa

Objective To evaluate the effects of infective necrosis (IN) on prognosis in moderately severe or severe acute pancreatitis (AP).Methods According to the revision of Atlanta classification,from January 2001 to January 2015,admitted patients with moderately severe or severe AP were retrospectively analyzed.According to whether with the presence of persistent organ failure (POF) and / or IN,the patients were divided into four groups:group one with weither IN nor POF,group two with IN but without POF,group three with POF but without IN,group four with both IN and POF.The differences in disease severity and prognosis among groups were compared.Logistic regression and Cox proportional hazard regression model were used to analyze the effect of IN on prognosis.Results A total of 375 moderately severe or severe AP patients were enrolled.There were 211,43,90 and 31 patients in group one,two,three and four,respectively.A total of 121 (32.3％) patients with POF,74 (19.7％) patients with IN,and death in 63 (16.8％) patients.The mortality rate in patients with IN was 32.4％ (24/74),and which was 13.0％(39/301) in patients without IN.The mortality rates of group one,two,three and four were 1.9％(4/211),11.6％(5/43),38.9％(35/90) and 61.3％(19/31),respectively;mortality rate was in a trend of increasing,and the difference was statistically significant (x2 =109.672,P＜0.01).Both IN (OR=8.24,95％CI2.09 to 32.46) andPOF (OR=8.31,95％ CI2.48 to 27.87)were independent risk factors of mortality of AP patients (both P＜0.01).Both IN (OR=2.04,95 ％CI 1.19 to 3.48,0.002) and POF (OR=5.25,95％CI 2.36 to 11.65) also were independent risk factors of shortened survival time of AP patients (both P＜0.01).Conclusions IN is an independent risk factor of disease severity and poor prognosis in AP.The prognosis is the worst in AP patients with both POF and IN.

Objective To discuss the short-term currative effect of horizontal osteotomy across injured vertebral forⅤdegree old frac-ture-dislocations of thoracolumbar spine.Methods The data of 4 patients who received horizontal osteotomy across injured vertebral internal fixation in our hospital from April 2010 to October 2012 were retrospectively analyzed,of which 1 case with T8-9 fracture dislocation,2 cases with T10-11 fracture dislocation,1 case with T11-12 fracture dislocation.The Franke1 classification of all patients were grade A.Results All 4 cases were achieved completely fracture reduction and followed-up for 2-14 months(an average of 7.4 months),who could get sitting posi-tion with the support of brace 1 week after operation.The postoperative follow-up indicated that all 4 cases got fusion,but there was no improve-ment for Franke1 classification.Conclusion The method of horizontal osteotomy across injured vertebral forⅤdegree old fracture-dislocations of thoracolumbar spine has good short-term clinical effect,with the advantages of shorter operation time,less bleeding and good reduction effect.

Objective To study the short-term clinical efficacy and its possible mechanism of refractory hypertension(RH) treated by continuous veno-venous hemofiltration (CVVH) in maintenance hemodialysis (MHD) patients. Methods Thirty-four MHD patients with RH treated with CVVH enrolled in the treatment group,all these patients were treatment of 2 -3 times,each time 8 - 10 hours. Thirty MHD patients with wellcontroled blood pressure were recruited as control. Changes of blood pressure, dry weight, plasma levels of parathyroid hormone (PTH), renin ( RA), angiotensin Ⅰ , Ⅱ ( AT Ⅰ , AT Ⅱ ), aldosterone ( Ald ) were observed before and after hemodialysis. Results In the treatment group,compared with pre-treatment, the blood pressure decreased significantly with an effective rate of 64.7% and efficient rate of 100. 0%. Before treatment, plasma RA was ([1.10 ±0.25] μg/(L · h)and [0:78 ±0.26] μg/(L · h),AT Ⅰ was [0.89 ±0.21] μg/L and [ 0. 52 ± 0. 14 ] μg/L, AT Ⅱ was [ 177.68 ± 89.46 ] ng/L and [ 89. 25 ± 12. 84 ] ng/L, Ald was [72. 06 ± 11.47 ]ng/L and [ 48.92 ± 8. 65 ] ng/L, PTH was [ 306. 81 ± 69. 37 ] ng/L and [ 248.76 ± 134. 62 ] ng/L in the treatment and control group respectively. All the measurements in the treatment group were significantly higher than those in the control group (P ＜ 0. 05 ). In the treatment group, compared to pre-treatment, plasma RA significantly decreased ( [ 1.10 ± 0. 25 ]μg/ ( L · h) vs [ 0. 76 ± 0. 17 ] μg/( L · h ), as well as AT Ⅰ ( [ 0. 89 ±0.21]μg/L vs [0.50 ±0.12] μg/L),ATⅡ([177.68±89.46]ng/L vs [ 87.13±14.22] ng/L),Ald ([72.06±11.47]ng/Lvs [ 46. 01± 9. 86 ] ng/L ) and PTH ( [ 306. 81 ±69.37]ng/L vs [ 186.53 ±32.93 ] ng/L) ( P ＜ 0. 05 ). However, there was no significant changes in the above mentioned measurements between before and after hemodialysis in the control group (P ＞ 0. 05). Conclusion CVVH may be an effective methods in the treatment of MHD patients with RH, and its antihypertensive mechanisms may be that CVVH can effectively remove the excess water in the body, and reduce plasma RA, AT Ⅰ , AT Ⅱ ,Ald and PTH levels.

Objective To study the clinical diagnosis and treatment of malignant gastrointestinal stromal tumor. Methods To retrospectively analyze the clinical data of 28 cases with malignant gastrointestinal stromal tumors underweat surgical treatment . Results The malignant gastrointestinal stromal tumor in adults were more than 50 years old,71.4%(20/28) ,and common clinical symptoms were gastrointestinal bleeding,anemia,and pain. The lesion site: 19 cases of gastric bowel, 8 cases of small intestine, 1 case of colon, radical excision in 22 cases, local excision palliative resection in 5 cases, three cases were multi-visceral resection. Conclusion Malignant gastrointestinal stromal tumor could be diagnosed by the means of endoscopic imaging and clear,and preoperative diagnosis was difficult. Surgical resection was the pathology diagnosis and treatment of primary method,if necessary,to ensure multi-visceral resection of the tumor to prevent recurrence of thoroughness, had important significance.

Objective To explore the feasibility of delineation of the atherosclerotic plaque in carotid artery using compressed sensing three dimensional motion-sensitized driven equilibrium prepared rapid gradient echo (CS-3D MERGE) technique. Methods Twenty-three patients who underwent carotid endarterectomy (CEA) were enrolled prospectively. In all patients, bilateral carotid arteries were scanned by CS-3D MERGE and contrast-enhanced MR angiography (MRA) simultaneously. Image quality of CS-3D MERGE images was scored. Images from the CS-3D MERGE sequence and contrast-enhanced MRA were used to measure the carotid stenosis, which were divided into four groups:normal group, mild stenosis group, moderate stenosis group, and severe stenosis group. The results were compared between the two methods. And images from the CS-3D MERGE sequence were compared with corresponding histology in identifying major plaque components including lipid rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and calcification (CA). Spearman rank correlation coefficient was used to compare the correlation between the CS-3D MERGE sequence and contrast-enhanced MRA in measuring the carotid stenosis. Agreement was tested comparing images from the CS-3D MERGE sequence with corresponding histology in identifying major plaque components including lipid-rich necrotic core, intraplaque hemorrhage, and calcification. Results Twenty-three CEA patients finished bilateral CS-3D MERGE scanning successfully. Image quality was 3.16±0.25. There was an excellent correlation between CS-3D MERGE and MRA in measuring stenosis (r=0.95, P<0.01). The agreement between CS-3D MERGE and histological results for LRNC detection was 76.2% (16/21). It was less sensitive for IPH detection (71.4%, 15/21). CS-3D MERGE identified all CA accurately (100.0%, 21/21). Sensitivity and specificity were 86.6% (13/15) and 50.0% (3/6) for LRNC, 73.3% (11/15) and 66.6% (4/6) for IPH, 100.0% for CA respectively(16/16, 5/5). Conclusion CS-3D MERGE, a single sequence, can be used to quantify carotid stenosis and plaque components conveniently.

Objective To build the experimental basement for the clinical use of cytokines induced killer(CIK)cells from the cord blood mononuclear cells(CBMNC)in tumor adoptive cellular immunotherapy, an effective protocol for their proliferation in vitro and cytotoxicity of CIK cells was established.Methods The lymphocytes from umbilical cord blood were isolated by density gradient centrifugation and suspended in medium with CD_3 mAb,rIL-2,rIL-1 and IFN-? as inducing agents to prepare CIK cells.At the same time, the lymphokine activated killer(LAK)and CBMNC were set as controls,which were only added IL-2 and not any cytokines during the whole culture.The changes of CIK cells before and after induction were observed with microscope and the phenotypes of the cells were analyzed by using flow cytometry.The proliferation of CIK cells were determined by trypan blue exclusion assay and the cytotoxic activity to lung cancer cell were tested with MTF method.Results According to the experiment,combining use of four types of cytokines could generate a great deal of CIK cells possessing highly cytotoxicity.From day 5 CIK cells became to prolif- erate and reached the peak at day 14.During the whole period,the relative percentage of CD_3~+ CD_(56)~+ cells in- creased significantly.Compared with LAK cells,which reached the proliferation peak at day 7 and then showed no evident proliferation.The control cells(CBMNC)showed no evident change of phenotypes and proliferation.CIK cells showed a higher antitumor activity on the tumor cells than LAK cells and CBMNC in vitro.Conclusion Umbilical cord blood can generate a great deal of CIK cells combining used with cy- tokines.Compared with classic LAK cells,umbilical cord blood CIK cells have the advantages of rapid prolif- eration speed and powerful cytotoxicity.CIK cells will be promising as a new strategy for the adoptive cellular immunotherapy of tumor.