After the initial episode of acute pancreatitis (AP), some patients have a tendency to relapse.With the development of imaging technologies and genetic tests, the diagnostic accuracy of the etiological factors of recurrent acute pancreatitis (RAP) such as dysfunction of sphincter of Oddi, pancreas divisum, and genetic mutations are improved.Clinical studies indicate that etiological treatment by endoscopic approaches may reduce recurrence in some RAP patients.In this article, the progress in etiology, diagnosis and treatment of RAP was reviewed.

Objective To assess the safety of living environment by the elderly, further clarify the relevant factors of the elderly fall in the living environment. Methods The self- made assessment form of fall-related factors of living environment for elderly patients was used to survey 1 076 elderly. Likert five grades score was used for each item, and the higher score demonstrated the safer living environment. Results In the assessment of the safety of living environment, the indoor physical environment (3.94 points), home furniture safety (3.66 points) score was better;home ground and the channel (3.32 points) and outdoor activities places (3.57 points) score was lower. Scores of home′s ground and channel, furniture safety, indoor physical environment and living environment of urban elderly were (23.56 ± 6.49), (44.52 ± 7.72), (11.93 ± 2.49), (105.03 ± 17.82) points, which were better than (22.46 ± 6.39), (42.73 ± 7.95), (11.53 ± 2.39), (101.55 ± 18.15) points of rural elderly (t=2.471-3.495, P <0.05). Conclusions The indoor physical environment, home furniture safety got higher scores, and the scores of ground-channel environment and outdoor activities places were relatively lower. Scores of the safety of living environment in urban are better than in rural. It suggests the elderly living environment need to reduce the incidence of falls.

Objective To study clinical and pathological characteristics and effects of arthroscopic treatment of ankle soft tissue impingement syndrome(ASTIS). Methods A total of 21 cases of ASTIS underwent arthroscopic operations from November 2000 to April 2005.The impingement soft tissues were removed under arthroscope at 13.6?9.9 months after injury.The resected tissues were pathologically examined following surgery.The efficacy of arthroscopy was assessed using the American Orthopaedic Foot and Ankle Society(AOFAS) rating scores. Results Arthroscopic findings showed the most common impingement tissue was synovium(20 cases),followed by distal fascicle of the anterior tibiofibular ligament(5 cases),fibrous scar tissue(4 cases),anterior talofibular ligament(3 cases),and meniscoid tissue(3 cases).ASTIS accompanying cartilage injuries was found in 16 cases.All the cases were followed for 7~60 months(mean,34.3?9.4 months).The AOFAS scores significantly increased postoperatively than preoperatively,with total scores from 67.0?9.7 to 94.0?6.4(t=-7.205,P=0.000) and subjective scores from 20.7?6.6 to 35.7?4.9(t=-5.003,P=0.000). Conclusions Ankle soft tissue impingement syndrome often occurs after ankle sprain along the anterolateral portion of the ankle.Common impingement tissues are synovium,ligament,scar tissue,and meniscoid tissue.Arthroscopic treatment of ankle soft tissue impingement syndrome is satisfactory.

MicroRNA-7(miR-7)was firstly found in Drosophila melanogaster,which participated in the formation of Drosophila wings,eggs and so on.In human being miR-7 is not only involved in cell prolifera-tion and differentiation,but also plays an important role in the development of tumor,especially in lung cancer. Most studies report that miR-7 is low expression in lung cancer with poor prognosis.Improving the expression of miR-7 can inhibit tumor growth.MiR-7 can regulate the expression of BCL-2,EGFR negatively,meanwhile it can regulate the sensitivity of tumor cells to radiotherapy chemotherapy and targeted therapy.Therefore,as a tumor suppressor,miR-7 is expected to become a new target for treatment of lung cancer.

Objective To provide rational use of vancomycin in elderly MRSA-infected patients, compared its pharmacokinetics in the elderly MRSA-infected patients with healthy young subjects.Methods 15 elderly MRSA-infected patients and 15 healthy young subjects were injected with 1.0g vancomycin.Serum concentrations were determined by fluorescence polarization immunoassay(FPIA) in both groups(n infected=15,n healthy =15),then calculated the pharmacokinetic parameters with program 3p97.Results Compared with the healthy group, the elimination half life (t1/2β)were longer, the apparent volume of distribution (Vd)and the area under curve(AUC)were increased,the creatinine clearance(Ccr)were lower in the infected group.The differences of these pharmacokinetic parameters between the two groups were statistically significant(p<0.01) except the peak serum concentrations(p>0.05).Conclusion Vancomycin should be used with decreased dose or increased interval in the elderly MRSA-infected patients, therapeutic drug monitoring and personalized medicine were required.

Objective: To investigate the interactions between carbohydrate derivatives and sodium-glucose cotransporters 2 (SGLT2) using molecular dynamic (MD) method and to explore the mechanisms and structure-activity relationship of SGLT2 inhibitors. Methods: The homologous structure of SGLT2 was modeled, the GROMACS program was used to model eight structures, such as SGLT2, SGLT2-glucose compound, and SGLT2-carbohydrate compound. And the root mean square fluctuation (RMSF) of the key residues and ligands and the interaction energy between the ligands and SGLT2 was investigated by trajectory analysis. Results: The interaction energy calculated by MD method had the higher correlation with experimental results than that by molecular docking method. H80, K154, D158, and Y290 were the key residues involved in the interaction, N75 and F453 were the important residues, and W291, Q295, and S393 might be the auxiliary residues. The ligands had a relatively consistent conformation, and fragments A and C played the more important roles in receptor binding. And the size, rigidity, and polarity increasing could elevate the bonding strength. Conclusion: MD simulation results could display the good performance of the interaction between the ligands and SGLT2, and could give clear guidance for the design of new SGLT2 inhibitors.

Objective To observe the effect ofQizhi Weitong Granules combined with rabeprazole on gastroesophageal dynamics and inflammatory factors in reflux esophagitis (RE) and explore its clinical significance.Methods Nighty-six RE patients from Changping Chinese Medicine Hospital were selected in this study,which randomly divided into control group (n =48) and observation group (n =48).The control group was given rabeprazole 10 mg/time (2 times/d) for 4 weeks.The observation group was given rabeprazole 10 mg/time (2 times/d) and Qizhi Weitong Granule 5 g/time (3 times/d) for 4 weeks.The gastrin and motilin expression was detected by radioimmunity analysis.The IL-17 and IL-23 was detected by ELISA analysis.The rate of clinic effects and adverse reaction was compared.Results There was no significant difference ofgastrin and motilin between the two groups before treatment.After treatment,gastrin and motilin was increased in the two groups (P ＜ 0.05,0.01).However,gastrin and motilin was higher in observation group than that in control group after treatment (P ＜ 0.05).There was no significant difference ofIL-17 and IL-23 between two groups before treatment.After treatment,IL-17 and IL-23 was decreased in the two groups (P ＜ 0.05,0.01).However,IL-17 and IL-23 was lower in observation group than that in control group after treatment (P ＜ 0.05).The rate of clinic effects was 93.8％ in observation group,which was better than 81.3％ in control group (P ＜ 0.05).The rate of adverse reaction was 10.4％ in control group and 8.3％ in observation group.There was no significant difference between two groups.Conclusion Qizhi Weitong Granules combined with rabeprazole can improve gastroesophageal dynamics and inhibit inflammatory response in RE patients,with significantly clinical effect and safety.

[Objective]To study the safety,clinical effect and therapeutic characteristics of distraction apparatus for correcting flexion contracture deformities of the knee joint by evaluating the clinical outcomes and investigating the results of biomechanic test.[Method]Forty-nine patients (included 52 knees) were treated by the standardized distraction apparatus and the comprehensive assessment standard was adopted to evaluate the clinical outcomes.Five patients were examined by three-dimensional CT of the knee joints pre-operatively and post-operatively to observe the changes in the knee structure.To observe the effect of distraction on the popliteal artery and the limb nerves,the popliteal artery diameter and blood flow speed were examined in 15 patients and the regio cruris electromyogram and nerve conduction velocity were examined in 6 patients before and after treatment.Three different means of distraction and measurement were underwent in 3 patients so as to observe the changes in the flexion curve and force of posterior soft tissues of the knee.[Result]All patients (52 knees) regained congruous structure and better function,the final excellent and good result rate was 65%.Three-dimensional CT examination of 5 patients showed that the postoperative knee joint structures were superior to the preoperative ones and there weren't damage of articular surface.The statistic results indicated that the popliteal arteries weren't obviously disturbed by distraction,whereas the limb nerves were probably disturbed temporarily.Three methods of distraction and measurement in 3 patients showed different outcomes,indicating that the effect of distraction on soft tissues was influenced by the distraction method,the ages of patients and the extents of deformities of the limb.[Conclusion]The distraction speed of therapeutic method is safe,reasonable and effective in correcting flexion contracture of the knee joint;The distraction force on posterior soft tissues of the knee is influenced by various elements,thus,the distraction speed should be individualized.Low-load and steady stretch are advantageous to soft tissue regeneration and safer.

Objective:To examine the relation between the alteration of condylar endochondral in response to mandibular protrusion and the action time length by establishing a model of mandibular protrusion on young adult rats.Methods:75 female Sprague-Dawley rats aged 9 weeks were divided into two experimental groups and one control group.In two experimental groups,bite jumping appliances created forward positioning of the condyle for twelve hours and whole day,respectively.The experimental rats,together with the control rats,were sacrificed on days 3,7,14,21 and 30,respectively.Tissue sections were cut in the sagittal plane through the mandibular condyle and were processed for in situ hybridization and immunostaining of type X collagen.Results:The peak of type X collagen protein expression in 24-hour experimental groups appeared on day 21 which was on the top of all experimental groups,while in 12-hour experimental groups it was found on day 30.The results of in situ hybridization were basically in agreement with the results of immunostaining.Conclusion:Both intermittent and continuous mandibular advancement can provoke endochondral ossification in young adult rat condylar,while 24-hour ones can produce more obvious and quicker effect.

Objective To improve the recognition and diagnosis of pseudohypoparathyroidism (PHP). Methods Six subjects with PHP of 4 generations in one family were investigated and studied. There were 4 males (including 2 deaths) and 2 females. The age of 4 surviving patients was from 8 to 55 years. All cases were proved by clinical biochemistry tests. Plain film of hands and head CT scans were performed in 2 selected patients. Results The somatotype of Albright hereditary osteodystrophy (AHO) and short fingers and toes were found in all cases. Radiologic features were as follows:(1)short metacarpals and phalanges.(2)skull thickening and symmetrical calcification of basal ganglia. Conclusion The diagnosis of PHP can be established by close combination of radiologic findings and clinical manifestations.