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 explore the efficacy and safety of conversion from calcineurin inhibitor (CNI) to sirolimus (SRL) as major immunosuppressive therapy in lung transplant recipients.Method Retrospective analyses were conducted for the clinical data of all the patients undergoing lung transplantation in Wuxi People's Hospital between January 2011 and December 2014.Sixteen were given conversion treatment with Sirolimus in the postoperative irnmunosuppressive therapy.We analyzed the opportunity and reasons in the conversion treatment,and the safety,effectiveness and complications of the conversion treatment.Result The follow-up period was 8 to 25 months,and the median time of conversion was 6 months after operation (2-18 months).The indications of conversion concluded:malignant tumor (n =8),renal dysfunction (n =5),lymphangioleiomyomatosis (n =1) and intractable diarrhea caused by CNIs (n =2).Four cases suffered from interstitial pneumonitis associated with Sirolimus and one case suffered from spontaneous pneumothorax,and they all conversed back to CNIs.In those patients,cancer recurrence occurred in 4 cases (of them,there were 3 deaths),and 3 patients developed chronic rejection.Those recipients receiving the conversion treatment due to renal dysfunction showed recovery of renal function to some extent.Conclusion It's effective and safe to converse the immunosuppressive therapy based on Sirolimus.Sirolimus should be reduced or withdrawn when interstitial pneumonitis associated with Sirolimus occurred.

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.

Objective To explore the epidemiology,etiology and prevention strategy of early respiratory infections (≤1 month) in lung transplantation recipients with donation after cardiac death donors.Method The clinical data of donors and recipients,particularly on early respiratory infections,were retrospectively analyzed in 17 lung transplantations.Result From Jan.2015 to Apr.2015,12 episodes of early respiratory infections (≤ 1 month) in 17 lung transplantation recipients occurred (12/17,70.6％).The organisms most frequently involved were bacteria:Pseudomonas aeruginosa (4/26,15.4％),Klebsiella pneumoniae (4/26,15.4％),Staphylococcus aureus (3/26,11.5％),and Acinetobacter baumannii (3/26,11.5％).Of 26 bacterial strains,3 were Methecillin resistant Staphlococcus aureus,3 were carbapenem resistant Acinetobacter baumanni,2 were carbapenem resistant Pseudomonas cepacia,2 were extended spectrum b-lactamase-producing Klebsiella pneumoniae,and one was carbapenem and quinolone resistant Pseudomonas aeruginosa.Conclusion The morbidity of early infections is high in lung transplantation recipients.In our experience,bacterial respiratory infections are most common in the early post-transplant period (≤ 1 month).Incidence of Aspergillus spp.and Cytomegalovirus pneumonia is lower than before lung transplantation,probably due to the spread of universal prophylaxis.

0.05). But there were significant differences between them and the stronger positive rate cases. There were significant differences between the positive and stronger positive rate of MTS 1 protein comparing normal gastric mucosa to small intestinal type(84.6%,61.5%), colonic type(85.7%, 50.0%) of IM and gastric carcinoma (83.0%,60.4%)( P

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.

OBJECTIVETo observe the effects of electroacupuncture (EA) at "Sanyinjiao" (SP 6) on urodynamics indices in rats with overactive bladder (OAB) after cystostomy, and to explore its regulation mechanism on bladder function.

METHODSForty-eight Sprague-Dawley female rats which received cystostomy were randomly divided into a blank group (group A), a blank Sanyinjiao group (group B), a blank non-acupoint group (group C), a model group (group D), a model Sanyinjiao group (group E) and a model non-acupoint group (group F), 8 rats in each one. The model of OAB was established with 1% acetic acid solution perfused into the bladder in the group D, group E and group F. No treatment was given to the group A and group D. Acupuncture was applied at bilateral "Sanyinjiao" (SP 6) in the group B and group E, followed by EA after the arrival of qi. Acupuncture was applied at bilateral non-acupoint in the group C and group F, followed by EA with continuous wave, 2 Hz of frequency for 30 min. The treatment was given for continuous 5 urination cycles. The BL-420 E+ biological function experiment system was used to measure and record the changes of indices of bladder pressure and urodynamics.

RESULTSCompared with the group A, the bladder capacity and urine output in the group B were significantly increased (both P<0.05), and the urination rate was increased in the group C (P<0.05); the differences of each index between group C and group B were not statistically significant (all P>0.05). Compared with the group D, the capacity pressure, bladder capacity, detrusor pressure, urinary output and urination rate in the group E were all increased (all P<0.05). Compared with the group F, the capacity pressure and detrusor pressure in the group E were increased (both P<0.05).

CONCLUSIONThe EA at "Sanyinjiao" (SP 6) could significantly improve urine function in rats with OAB after cystostomy, but its regulation effect on urination is not obvious in rats with non-OAB.

Acupuncture Points ; Animals ; Cystostomy ; Disease Models, Animal ; Electroacupuncture ; Female ; Humans ; Rats ; Rats, Sprague-Dawley ; Urinary Bladder ; physiopathology ; surgery ; Urinary Bladder, Overactive ; physiopathology ; surgery ; therapy

Objective To evaluate the clinical effect of lung transplantation for pediatric pulmonary artery hypertension (PAH).Methods The recepter 1 and 2 with idiopathic pulmonary artery hypertension (IPAH) were diagnosed by right catheterization.The heart fuction was NYHA IV.The pulmonary artery pressure and mean pulmonary artery pressure were 110/70mmHg and 148/72 mmHg respectively.They underwent bilateral sequential lung transplantation with extracorporeal membrane oxygenation (ECMO) support.During operation,the ECMO support time was 550 min and 450 min and the blood loss was 3000 ml and 1200 ml respectively.The recepter 3 with end-stage congenital ventricular septal defect with Eisenmenger syndrome (ES) who had received open heart exploration underwent right single lung transplantation and ventricular septal defect repair under cardiopulmoanry bypass(CPB).There were ventricular septal defect and bidirectional shunt through UCG assessment The pulmonary artery pressure and mean pulmonary artery pressure were 110/60 mmHg.CPB time was 244 min.The three recepters had the same ABO blood group and the similar body type with the three donors.Results The recepter 1 and 2 was sustained by ECMO after operation for 16 h and 13h respectively.But unstable hemadynamics and acute left heart failure occured on 3rd and 4th day after the operation respectively.We treated them with ventilate support and tracheotomy on 3rd and 6th day respectively.They were also treated with cardiotonic; dieresis and the patients were weaned away from the ventilation on 33rd and 12ed day after the operation respectively.The transplanted lung of the receptor 3 had pneumochysis in the first 3 days.The patient was treated with ventilate support and tracheotomy on 7th day and was weaned from the ventilation on 12ed day after the operation.An acute rejection episode occurred on 14th day.The cordioform and heart function of the three cases improved and especially the receptor 3 had intact repaired of ventricular septal defect.They were discharged from the hospital on 93rd,32ed and 62ed day afer the operation.The heart function all reached NYHA I and the pulmonary artery pressure and mean pulmonary artery pressure was reduced to 54/32 mmHg,60/36 mmHg and 53/39 mmHg respectively.The three cases have been followed up for 41 months,21 months,and 82 months.They are having an excellent quality life.Conclusion Lung transplantation is effective to improve the quality of life for end-stage pediatric pulmonary artery hypertension even with slight right ventricular dysfunction with satisfying short-term results.

Objective To observe the characteristic of the functional magnetic resonance imaging (fMRI) brain map in health adult undergoing clenching and relaxing the fist, for exploring the essence of the fMRI brain map in patients suffering from motor dysfunction by cerebrovascular accidents. Methods Twelve healthy volunteers had been chosen to partake the experience. Everyone had accomplished the following three actions separately: (1) Only clenching and relaxing the fist of left hand. (2) Only clenching and relaxing the fist of right hand. (3) Clenching and relaxing the fist of both hands at one time. The data had been analyzed statistically using analysis of functional neuroimages (AFNI) software. Results Under condition of F (6,1121), P = 0.005. Only clenching and relaxing the fist of left hand had gained the following brain functional area: right precentral gyms, left parietal,right superior temporal gyrus,right parietal, right parahippocampal gyrus, right superior frontal gyrus, right medial frontal gyrus, left precuneus, right superior parietal lobule, right middle frontal gyrus, left superior frontal gyrus. Only clenching and relaxing the fist of right hand had gained the following brain functional area: left precentral gyms, left postcentral gyrus right parietal, right medial frontal gyrus. Clenching and relaxing the fist of beth hands simultaneously had gained the following brain functional area: left precentral gyms,left postcentral gyrus, right precentral gyrus, right postcentral gyrus. Conclusions Hand movement (clenching and relaxing the fist) has its own specific brain activated areas. The brain areas activated by clenching and relaxing the fist of both hands simultaneously concentrate in the motor area of both cerebral hemisphere. The brain areas activated by clenching and relaxing the fist of single hand contain not only the motor area, but also the supplementary motor area. As compared with the right handedness, the brain areas activated by clenching and relaxing the fist of left hand is more widespread.