Objective To evaluate the efficacy of different methods in preventing pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP).Methods Databases including PubMed,EMBASE,Cochrane Library,Chinese Journal Full-text Database,China Biomedicine Database were searched with key words including endoscopic retrograde cholangiopancreatography,ERCP,post-ERCP pancreatitis,pancreatitis,pancreatic duct stent,non-steroid anti-inflammatory drugs,indometacin,diclofenac,protease inhibitors,nafamostat,ulinastatin,gabexate,somatostain,内镜逆行胰胆管造影,内镜逆行胰胆管造影术后胰腺炎,胰腺炎,胰管支架置入,非甾体类抗炎药,吲哚美辛,双氯芬酸,抑酶剂,萘莫司他,乌司他丁,加贝酯and生长抑素.Literatures published between January 2000 and January 2014 were searched.Randomized controlled studies on prevention of pancreatitis after ERCP which were enrolled in this study were analyzed by 2 independent reviewers.The quality of the literatures was evaluated.All data were analyzed using the RevMan 5.0 software.Data were expressed in odds ratio (OR) and 95％ confidence interval (95％ CI).The heterogeneity of the studies was analyzed using the I2 test.Results Twenty-seven literatures were enrolled in the study.There were 4 701 patients in the experimental group (including patients who were treated by pancreatic stent installation,non-steroidal antiinflammatory drugs,nafamostat,ulinastatin,gabexate,intravenous infusion of somatostain for more than 6 hours,intravenous infusion of somatostain for less than 6 hours,bolus injection of somatostain) and 3 592 patients in the control group (including patients treated without pancreatic duct installation or placebo).The results of Meta analysis showed that pancreatic stent installation,non-steroid anti-inflammatory drugs,nafamostat,intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could significantly decrease the incidence of pancreatitis after ERCP (OR =0.18,0.45,0.31,0.33,0.25,95％ CI:0.09-0.35,0.33-0.61,0.19-0.52,0.20-0.56,0.11-0.55,P ＜ 0.05).Conclusion Pancreatic stent installation,non-steroid anti-inflammatory drugs,nafamostat,intravenous infusion of somatostain for more than 6 hours and bolus injection of somatostain could effectively prevent the incidence of pancreatitis after ERCP.

Objective To investigate the effects of radiotherapy combined with resveratrol( Res)on proliferation, invasion and apoptosis of hepatoma cell line Bel-7404. Methods Bel-7404 cell line was treated with Res(25 μmol·L-1 ) combined with radiotherapy,then divided into four groups( group 1:the control;group 2:radiation at dose of 2 Gy;group 3:radiation at dose of 4 Gy;group 4:radiation at dose of 6 Gy). Cell proliferation and invasion were detected by MTT assay. Cell apoptosis were observed by fluorescence microscopy. Expressions of MMP-2 and VEGF proteins were determined by Western blotting. Results Compared with the control group,cell proliferation and invasion were significantly inhibited,while cell apoptosis was increased in all radiation groups(P〈0. 05). Conclusion The sensitivity of hepatoma Bel-7404 cells to radiation can be enhanced by resveratrol. Radiation therapy combined with resveratrol can inhibit proliferation and invasion of hepatoma cells and increase the cell apoptosis,which may be related with the down-regulation of MMP-2 and VEGF proteins.

Objective To explore the effect of fish oil fat emulsion as perioperative nutritional support on patients with liver cirrhosis and portal hypertension.Methods Randomized controlled clinical trial was performed between September 2011 and September 2017 in patients with liver cirrhosis and portal hypertension who underwent pericardial devascularization and splenectomy.Hypocaloric total parenteral nutritional support (TPN) started from the first day after the operation for 5 consecutive days.Patients were divided into experimental group and control group according to thetype of fat emulsion used.43 patients in experimental group were applied for fish oil fat emulsion injection (10％ Omegaven) + medium long chain structure fat emulsion (20％STG) and 42 patients in control group were applied for medium long chain structure fat emulsion (20％STG).Liver function (total bilirubin and alanine aminotransferase),nutrition index (serum albumin and prealbumin),inflammatory mediators (TNF-α,IL-6 and IL-10) were measured before and after the operation,and the clinical outcomes were observed.Results There was no statistically significant difference in liver function and nutritional indices between the experimental group and the control group (P＞0.05).The inflammatory mediators like TNF-u,IL-6 and IL-10 on the first day after surgery were significantly higher than those before surgery in both groups [experiment group:(225.54±54.78) vs.(61.49±16.47),(74.94±6.36) vs.(39.84±2.77),(77.53±11.4) vs.(46.05±6.13) ng/L;control group:(229.26±62.15) vs.(63.48±13.76),(77.23±7.83)vs.(40.64±3.34),(73.89±7.97)vs.(44.88±5.72) ng/L;P＜ 0.01].With the progress of time,the proinflammatory factors like TNF-α and IL-6 decreased after the operation and the range of decrease was higher in experiment group than in control group [d4-d 1:(-56.88± 31.63) vs.(-35.96±20.02),(-13.52±5.20) vs.(-6.38±2.84) ng/L;d7-d1:(-150.67±42.58) vs.(-132.79±53.35),(-27.04±8.97) vs.(-20.85±6.38) ng/L;P＜ 0.05].The range of increase in anti-inflammatory media IL-10 was higher in experiment group than in the control group (d4-d1:(14.22±13.08) vs.(5.64±3.58) ng/L;d7-d1:(17.78±5.58) vs.(-37.96±11.43) ng/L;P＜0.05).The incidence of grade Ⅲ complications and total complications (4.7％ vs.21.4％,23.3％ vs.45.2％) and hospitalization time [(10.12 ±1.48) vs.(12.33±2.04) d] in the experimental group were significantly lower than those in the control group (P＜0.05).Conclusions In patients with liver cirrhosis and portal hypertension,perioperative nutritional support of fish oil fat emulsion can reduce systemic inflammatory response and operative complications and promote rapid recovery through its two-way regulation of inflammatory mediators.

Objective To investigate the application value of laparoscopic hepatectomy (LH) in the treatment of liver neoplasms. Methods Clinical data of 78 patients with liver neoplasms undergoing hepatectomy in Zhongnan Hospital of Wuhan University from June 2011 to June 2014 were retrospectively analyzed. The patients were divided into the LH group (n=31) and open hepatectomy (OH) group (n=47). The informed consents of all patients were obtained and the local ethical committee approval had been received. Intra-and post-operative situation and liver function of two groups were compared. Normally distributed data of two groups were compared with t test, non-normally distributed data were compared with rank-sum test and the comparison of rate was conducted using Chi-square test. Results Intraoperative blood loss, length of wound, retention time of abdominal drainage catheter, postoperative start time of eating and average postoperative length of hospital stay in the LH group were 150(100-200) ml, 5(4-6) cm, 5(3-6) d, 2(2-2) d and (8±3) d, which were significantly less compared with 300(300-600) ml, 20 (18-20) cm, 8(6-10) d, 3(2-3) d and (12±4) d in the OH group (Z=-5.405,-7.760,-4.366,-3.746;t=-3.608;P<0.05). The hospitalization cost in the LH group was (51±7) thousand yuan, which was significantly higher than (45±10) thousand yuan in the OH group (t=3.198, P<0.05). On the postoperative 1, 3 day, the levels of aspartate aminotransferase (AST) and aspartate aminotransferase (ALT) in the LH group were 94(62-114), 47(42-58) and 116(68-136), 46(39-50) U/L, which were significantly lower than 110(93-158), 152(95-220) and 141(97-236), 49(42-120) U/L in the OH group (Z=-2.416,-6.539,-2.764,-2.229;P<0.05). In the LH group, the serum levels of albumin (ALB) on the postoperative 1, 3 day were (31±6), (35±3) g/L, which were signiifcantly higher compared with (25±5), (34±3) g/L (t=4.958, 2.191;P<0.05). Conclusions LH is an efifcacious and safe treatment for liver neoplasms. Compared with OH, LH has obvious advantages of smaller incision and shorter recovery time.

Objective To analyze the prevention condition of skin tears of inpatients in level-III hospitals, so as to provide basis for making prevention strategies.Methods 14 level-III hospitals were involved in the cross-section survey. Within the same time period, using the same research tools, methods and procedure, 964 trained nurses inspected patients from head to toes, who were selected by convenience sampling, with hospital stay ≥24 h, with age≥18 years old, and with signature on the informed consent documents, and also investigated implementation of prevention measures. Results A total of 18 806 effective cases were obtained, with 238 locations of skin tears in 199 patients found. Incidence of hospital-acquired skin tears was 1. 06%. Implementation rate of risk assessment and nutrients and water supplement was 3. 92% and 10. 35%. Implementation rate of prevention of falling and falling down from bed was 51. 58% and 47. 20%. Usage of assistant tools and emollients accounted for 28. 23% and 2. 69%. Adopting suitable moving techniques and wearing long sleeves, trousers or long stockings accounted for 8.07% and 6.95%. Differences of incidence rate, risk assessment and implementation of prevention measures of skin tears among teaching hospitals, comprehensive hospitals and specialty hospitals were statistically meaningful ( P < 0. 05 for all ) . Conclusions Risk assessment and prevention of skin tears in these 14 level-III hospitals were not satisfactory. Prevention measures vary from different types of the hospitals. In future, nurses should be trained to strengthen awareness of risk assessment and prevention, and implementation rate and consistency of preventive measures should be improved.