Objective To study the causes and methods of prevention and treatment of severe acute pancreatitis (SAP) complicated with postoperative duodenal fistula. Methods Twenty-two cases with severe acute (pancreatitis) complicated with postoperative duodenal fistula were retrospectively analyzed . Results Among 184 patients with severe acute pancreatitis undergoing operative treatment,duodenal fistula developed in 22 (patients),and in 15 of the 22 (patients), it occurred 2 weeks after operation.In 18 patients the duodenal fistula healed spontaneously with conservative therapy and 4 patients were cured by re-operation. Conclusions (Duodenal) fistula is related to early operation for SAP,peripancreatic infection,and improper placement of (drainage) tube at time of operation or (prolonged) (placement) of (drainage) tube.Most duodenal fistulas can be (spontaneously) cured by maintaining patent drainage around the fistula, actively controlling peripancreatic (infection), suppression of gastrointestinal secretion, and augmention of nutritional support.

Objective:To search for therapeutic effect of lidocaine in the treatment of acute episode of chronic asthmatic bronchitis.Methods:The 58 cases of patients with acute episode of chronic asthmatic bronchitis admitted to this hospital from August,2004 to July,2007 were divided into group A and group B.Besides group A with lidocaine and group B as control with sodium chloride solution,there were no difference in the other therapeutic measures between group A and Group B.Oxygen was used as the power of spray or aerosolizer,the flow volume of oxygen was 8-10L/min.Group A patients were given 5 milliliters of 2% lidocaine(100mg) by nebulized inhalation three times a day for three days,and Group B patients received 5 milliliters of 0.9% sodium chloride solution by nebulized inhalation three times a day for successive three days.The changes of heart rate,respiratory frequency,forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),partial pressure of oxygen in artery(PaO2) and partial pressure of carbon dioxide in artery(PaCO2) were determined in the group A and B before and after the nebulized inhalation therapy.Results:The results of the heart rate,respiratory frequency,FEV1,PEF,PaO2 and PaCO2 before and after the treatment of the nebulized inhalation were showed as follows,improvement of heart rate and respiratory frequency was more significant in the group with the nebulized inhalation treatment of lidocaine than that in the group as control after 30 minutes,one day and three days of therapy(P

Objective:To discover the risk factors,clinical features,treatment and prognosis of fungal infection in the lungs.Methods:The data of 103 patients suffering from fungal infection in the lungs were analyzed retrospectively.Results:There were ninety percent(91/103) of patients with underlying diseases,mainly chronic obstructive pulmonary disease(COPD) and chronic cor pulmonale.68(66.02%) patients suffered from two or more than two kinds of underlying diseases.Type 2 diabetes also took an important position in all underlying diseases.Clinical manifestations of pulmonary fungal infection showed no specificity.X-ray appearance showed that bronchopneumonitis was predominated(60%).The fungal culture results showed that blastocystis was the major pathogenic fungus,including 73(70.8%)strains of Candida albicans,11(10.7%) strains of Candida tropicalis,10(9.7%) strains of Torulopsis glabrata,6(5.8%) strains of aspergilli and 3(2.9%)trains of mold fungus,and early diagnosis of this disease remained difficult.The results of sputum cultuer showed that 48(46.6%) patients suffered from pumomary fungal infection combined with other bacterial infections,such as Pseudomonas aeruginosa,Acinetobacteria,Methicillin-resistant Staphylococcus aureus(MRSA),Escherichia coli and so on.The mortality of pulmonary fungal infection in this group was high(21.36%).6 patients died from uncontrolled fungal infections in the lungs and other16 patients died from mutiple organ failure due to delayed antifungeal therapy.Conclusions:Pulmonary fungal infection with few specific clinical manifestations and high mortality was an important cause of secondary infections in the patients suffering from many kinds of diseases,which is worthy of more attention in clinic.

Objective　To study the role of α1-antichymotrypsin(α1-ACT)in the pathogenesis of childhood asthma for providing a theoretical base for prevention and treatment of childhood asthma. Methods　Levels of plasma α1-ACT in 30 asthmatic children and 30 healthy children were determined by rocket immunoelectrophoresis. Results　Plasma α1-ACT levels were higher in acute phase than in paroxysmal phase ［（0.4178±0.0815）vs(0.2865±0.0799), t=6.301,P<0.001］ and also higher in asthma group than in control group ［（0.4178±0.0815）vs(0.2876±0.0496),t=7.474,P<0.001］. The plasma α1-ACT levels in asthma group and control of paroxysmal phase were similor ［(0.2865±0.0799) vs (0.2876±0.0496),t=0.064, P>0.05］. The levels of plasma α1-ACT were higher in moderate and heavily attacked patients than that in mild attacked patients ［(0.4553±0.0758) vs (0.3249±0.0926),t=4.187,P<0.001］ and those in control group ［(0.4553±0.0758) vs (0.2865±0.0799),t=9.38,P<0.001］. Conclusion　α1-ACT is involved in pathophysiological course of childhood asthma. Measurement of plasma α1-ACT levels may be helpful in determining the state of the illness and to evaluate the severity and treatment of childhood asthma.

PBL works as a method based on problems,and its theory essence is the con-structivism.With the adjustment of the educational aim,the definition of faculty quality need change correspondingly.Under PBL medical education mode,"faculty"is no longer defined as the traditional"teacher",but as the promoter of medical knowledge for students and the participants of medical type reform.These two are the main characters of PBL medical faculty.

OBJECTIVE:To review the relationship between endothelial progenitor cells and the re-endothelialization of vascular prosthesis in order to find out some effective ways to solve the most frequent complications of asotransplantation,thrombogenesis and intima hyperplasia.DATA SOURCES:A computer-based online search was conducted to identify articles related to endothelial progenitor cells and the re-endothelialization of vascular prosthesis published in Pubmed,Ovid and MD Consult database from January 2000 to December 2006 using the key words of "endothelial progenitor cells,vascular prosthesis,endothelialization".Meanwhile,CNKI database was searched for related papers published between January 2000and December 2006,the keywords were "endothelial progenitor cells,vascular prosthesis,endothelialization" in Chinese.STUDY SELECTION:The literatures included all the related papers about the roles of endothelial progenitor cells in the re-endothelialization of vascular prosthesis.Inclusive criteria:the study types were randomized controlled trials,drug stress test and clinical drug effect test; the samples were both human and animals.Exclusive criteria:Reviews and literatures without controls were excluded.DATA EXTRACTION:Totally 115 related literatures were collected,and 24 were accorded with the inclusive criteria.The excluded were 91 papers of reviews and repeated trials or drug effect studies.DATA SYNTHESIS:These related literatures,including not only animal experiments but also clinical detections,analyzed the relationship between endothelial progenitor cells and the re-endothelialization of vascular prosthesis and correlative promoting mechanisms.CONCLUSION:It is concluded that endothelial progenitor cells play an important role in the endothelialization after vascular prosthesis is grafted in vivo.

Objective: To investigate the protective influence and mechanism of Yishen Huayu Formula on the expression of connective tissue growth factor (CTGF)in the rat with renal interstitial fibrosis. Methods: 150 rats were randomly divided into sham-opration group, model group, Lotensin treatment group, Yishen Huayu high low dose treatment groups. The rat models with renal interstitial fibrosis were induced by unilateral ureteral obstruction. The expressions of CTGF in the kidneys were observed on 3rd, 7th, 14th, 21st, 28th day. The alterations of renal the expressions of CTGF in the kidneys were observed with the ?-actin as intrinsic control. Results: Compared with the control group,the expression of CTGF increased signifi cantly in model group(P

TNF-?,a pleiotropic cytokine with strong proinflammatory and immunomodulatory properties is known to play an important role in inflammatory bowel disease(IBD).The biological effects of TNF-? are elicited by binding to its two cognate recepters,TNFR1 and TNFR2.For a long time,TNF-R1 was considered to be the predominant mediator of TNF-signaling,whereas TNF-R2 was ascribed only auxilliary function.However,there is increasing clinical and experimental evidence for an important independent role of TNF-?/TNFR2 signaling in chronic inflammatory conditions of IBD.The elucidation of the different effects of TNF-signaling in IBD will lead to a better understanding ot the pathogenesis of these diseases and will be the basis for the development of more specific and more efficient therapeutic approaches.

OBJECTIVE:To establish a method for the rapid contents determination of potassium chloride and calcium chloride in Compound sodium chloride injection. METHODS:After diluted in appropriate way,Compound sodium chloride injection was sampled directly and contents of potassium chloride and calcium chloride were determined simultaneously by ICP-OES. The powder was 1 300 W,plasma gas flow rate was 15 L/min,auxiliary cooling gas flow was 0.2 L/min,atomizer flow rate was 0.8 L/min, the peristaltic pump rate was 0.8 L/min,atomizer pressure was 315 kPa,and the observation was axial observation,analysis spec-tral lines of potassium and calcium were 766.490 nm and 315.887 nm. RESULTS:The linear ranges of potassium and calcium were 1.0-12.0 mg/L (r=0.999 7 and 0.999 9);RSDs of precision and reproducibility tests were lower than 1%;recoveries were 98.5%-100.5%(RSD=0.59%,n=9)and 99.3%-102.3%(RSD=0.98%,n=9). CONCLUSIONS:The method is simple,rapid and simple,and can be used for the quality control of Compound sodium chloride injection.

Due to unknown onset time, patients with wake-up stroke and unknown onset stroke areoften excluded from thrombolytic therapy. However, many clinical studies have shown that multimodal imaging techniques can effectively guide wake-up stroke and unknown onset stroke for intravenous thrombolysis. Its endovascular treatment has also made some progress. This article mainly reviews the imaging findings, intravenous thrombolysis, and endovascular therapy in patients with wake-up stroke and unknown onset stroke.