Infectious necrosis is one of severe local complications caused by acute pancreatitis,and the mortality rate was reported to be up to 10％ ～ 20％.Traditional open surgical debridement used to be the sole option for this disease.Nevertheless,this approach is associated with poor outcome.Currently,conservative treatment and minimally invasive procedures are more favorable.The treatment for infectious necrosis caused by acute pancreatitis can be summarized as 3D,representing delay,drain,debride.The patients usually receive initial treatment in ICU division,and surgical intervention is then delayed.Percutaneous drainage can be firstly performed in the early course of the disease,followed by necrotic tissue debridement with laparoscopic or video-assisted retroperitoneal procedures.Open surgical debridement is now rarely used,which is merely performed for certain refractory cases.The management of acute pancreatitis infected necrosis therefore is a clinical question that requires a multiple disciplinary team rather than a simply surgical disease.This paper reviewed the relevant issues.

In recent years,postoperative mortality rate of pancreatic resection has dropped below 5％,while the complication rate still remains as high as 30％ ～ 50％.Postoperative pancreatic fistula and abdominal abscess are two serious complications after pancreatic resection,with the incidence of 10％ ～28％.Deep understanding of the physiological functions of the pancreas together with the research and development of new medications has improved the prognosis of patients with pancreatic fistula.This article gave a brief overview on the progress in this regard.

Adult ; Aged ; Biomarkers, Tumor ; analysis ; Carcinoma, Non-Small-Cell Lung ; blood ; genetics ; pathology ; Cell Differentiation ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Keratin-19 ; genetics ; Leukocytes ; metabolism ; Lung Neoplasms ; blood ; genetics ; pathology ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Staging ; RNA, Messenger ; biosynthesis ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Survival Analysis

Objective To investigate the treatment of perinail refracture after surgery of proximal femoral fracture.Methods From January 2010 to January 2015,we treated perinail fractures in 31 patients who had undergone surgery for proximal femoral fracture.They were 11 men and 20 women,with an average age of 75.6 years (range,from 24 to 87 years).On average,their refracture occurred 9.4 months after primary fixation (range,from 3 to 60 months).With reference to the Vancouver classification of peri-prosthestic refractures in the proximal femur and the position and bone quality of perinail refractures,we tried to classify the perinail fractures and chose different treatment protocols accordingly.In our cohort,6 were type A,5 type B,15 type C,and 5 type D.Type A cases were treated conservatively,and types B and C cases with locking compression plate or less invasive stabilization system.In one case of type D,dynamic hip screws were implanted to fixate the femoral neck fracture after removal of the original intramedullary nail,and hip replacement was conducted in the other 4 after removal of the original intramedullary nail.Results The operation time averaged 2.1 hours (range,from 1.6 to 3.0 hours) and intraoperative bleeding 600 mL (range,from 150 to 800 mL) in this cohort.Of them,27 were followed up for an average of 15 months (range,from 12 to 24 months),giving a follow-up rate of 87.1％ (27/31).Six type A fractures obtained bone union after protected weight-bearing walking for 12 weeks.All the 16 fractures of types B and C healed after an average period of 4.2 months (range,from 3 to 6 months).Of the 5 type D fractures,one obtained bone union 12 weeks after change into dynamic hip screwing and 4 had fine functional recovery after hip replacement.No infection,nonunion,or implants failure occurred.Conclusions We have set an exploratory classification system for the perinail refractures at the proximal femur with reference to the Vancouver classification of peri-prosthestic refractures.Our classification can provide effective guidance for the treatment of perinail refracture after surgery of proximal femoral fracture.

Objective To analyze the status of pediatric health resources allocation and services supply,evaluating the equity of pediatric health resources allocation and services supply.Methods Cross-sectional data in 2011 and time series data from 2005 to 2011 are used to comparative analysis of children's hospitals,pediatricians,pediatric beds,pediatric outpatient visits,and pediatric inpatient visits status quo.Suggestions were raised to pediatric health resources allocation and services supply.Results Setbacks found in China in this regard are lack of children hospitals,shortage of backup personnel pediatricians,low proportion of pediatric beds in resource,imbalance in the supply of pediatric outpatient services,and pediatric inpatient services which fall short of demand.Conclusion Pediatrics health resources allocation should highlight provincial and regional equity and efficiency step by step,easing the significant conflicts between the deployment and service supply of pediatric health resources by a variety of means.

Aim To investigate the influence of Tanshinone ⅡA on cytokine secreted by kuppfer cells via LPS stimulation,and explore its mechanism of therapying chronic hepatic disease. Methods The liver cell and kupffer cells were isolated and the model of liver cell injuries was made induced by LPS and D-GlaN, and the effects of TanshinoneⅡA was observed on the injuries of liver cell induced by lipopoly-saccharide(LPS) and D-Galactosamine(D-GlaN). Cytokine were released secreted by kupffer cells through LPS stimulation and the contents of TNF-?,IL-6,IL-8 were determined by radio-immunoassay. The hepatocyte morphological character was observed by HE stain,the expressions of TNF-?、CD14、iNOS、eNOS in kupffer cell were explored by immunohistochemical, double-decker chamber was used for observing the damage of hepatocyte caused by cytokine secreted by kupffer via LPS stimulation. Results Tanshinone ⅡA could restore the injury of liver cell induced by D-GlaN and LPS, the levels of ALT、MAO、LDH-L、GSH-S and contents of MDA were significantly reduce.It could inhibit TNF-? IL-8 secreted by kupffer cells through LPS stimulation ,and the expressions of TNF-?、CD14 Inos、eNOS in kupffer cell through LPS stimulation were inhibited. Blocking injuries of the inflammatory cytokine release excessive on liver cell, it hadn′t the protect action on liver cell damage suffer from inflammatory cytokine.Conclusion The mechanism of Tanshinon ⅡA of blocking liver cell injuries induced by D-GlaN and LPS may be correlation with inhibiting the excessive cytokine by kupffer cells

OBJECTIVE:To study the chemical constituents of Zingiberis Rhizoma.METHODS:The compounds of Zingiberis Rhizoma were classified and purified by silica gel,Sephadex LH-20 column chromatography and thin layer chromatography (TLC).The structure of compounds were analyzed and identified according to chemical property and spectrum data.RESULTS & CONCLUSIONS:Five compounds were isolated from Zingiberis Rhizoma,i.e.methyl-6-gingerol (1),4-gingerol (2),β-eudesmol (3),2,5-dihydroxybisabola-3,10-diene (4),6-shogaol (5).The compounds 2,3,4 are isolated from Zingiberis Rhizoma for the first time.

Objective To observe the influence of secondary spasmodic torticollis on the balance of hemiplegic stroke survivors and to compare the effects of different treatment protocols.Methods Fifty-six secondary spasmodic torticollis patients after stroke were randomly divided into three groups based on the type of treatment.The botulinum toxin (BTX) group received BTX-A injections and common support treatment plus rehabilitation training (n =19),the medication therapy group received oral baclofen and common support treatment plus rehabilitation training (n =18),and the routine rehabilitation group received only routine rehabilitation therapy (n =19).In addition,19 stroke cases without spasmodic torticollis served as a control group.They also were treated with routine rehabilitative treatment alone.Before and after 2 months of treatment,balance was assessed using Berg's balance scale,and spasmodic torticollis was evaluated using Tsui's scale.Results Before treatment the balance of the control group members was significantly better than that of the other three groups.After 2 months of therapy,balance function had improved significantly in all four groups.The balance of the botulinum toxin group was better than that of the medication and routine rehabilitation groups.After treatment,Tsui scale scores in the medication and botulinum toxin groups were significantly lower than before treatment,and the scores in the botulinum toxin group were significantly lower than in the medication and routine rehabilitation groups.There was no significant difference in Tsui scale scores before and after treatment in the control group.Conclusions Spasmodic torticollis inflaences the recovery of balance function in hemiplegic patients after stroke.Treating the spasmodic torticollis can improve their balance.Treatment with BTX-A combined with common support treatmcnt and rehabilitation training showed significant curativeeffect.

Objective To observe the influence of spasmodic torticollis on the rehabilitation prognoses of patients with neurogenic dysphagia.Methods One hundred and three dysphagic patients were recruited,of which 82 had spasmodic torticollis and 21 did not.The subjects with spasmodic torticollis were divided randomly into a medication therapy group (21 cases) which accepted medication plus swallowing training,a common therapy group (20 cases) accepting common support treatment plus swallowing training,a combined therapy group (20 cases) accepting common support treatment,medication,plus swallowing training as well,and a group of 21 cases accepting only routine rehabilitation therapy ( the routine rehabilitation group).The 21 cases without spasmodic torticollis served as a control group,and they were treated with routine rehabilitative treatment.The swallowing function of all patients was evaluated before and after therapy using videofluoroscopic swallowing study techniques.Results There was no significant difference with regard to the swallowing function among the groups before treatment except that the swallowing function of the control group (without torticollis) was significantly better than that of the other 4 groups.After treatment,swallowing function had improved significantly in all 5 groups.The average improvement in the routine rehabilitation group was,however,significantly less than in the others.After treatment there was no significant difference between the combined therapy group and the no torticollis control group with regard to swallowing function.Conclusions Spasmodic torticollis influences the recovery of swallowing function in dysphagic patients.Therapy for spasmodic torticollis can improve swallowing among dysphagic patients with spasmodic torticollis.

The tumor microenvironment (TME), a dynamic and complex local environment, interacts with the tumor cells and is closely related to tumor growth, metastasis, immune escape and drug resistance. Thus, targeting the TME has been a worldwide focus in cancer therapy. Many natural products possess the advantages of multiple targets, multiple pathways and wide pharmacological functions, and are the main source of antitumor drugs. In recent years studies have found that some natural products had advantageous effects on the TME. In this review, we summarize the components and functions of the TME and some natural products that target the TME, with references to the drug therapy of cancer.