OBJECTIVE:To evaluate the economics of somatostatin,ulinastatin,octreotide and gabexate preventing hyperamy-lasemia and pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP). METHODS:Medical records of 316 cho-ledocholithiasis patients underwent ERCP were selected from our hospital during Jul. 2008-Apr. 2016,and then divided into blank control group(58 cases),somatostatin group(64 cases),ulinastatin group(65 cases),octreotide group(68 cases)and gabexate group (61 cases) according to the use of protease inhibitor. Before ERCP,blank control group received routine treatment as fast-ing,parenteral nutrition support,acid suppression,etc. Based on it,other 4 drug groups received prophylactic drug use according to package inserts 6 h before ERCP. The incidence of hyperamylasemia and pancreatitis after ERCP,VAS scores 3,24,48 h after surgery and the occurrence of ADR were compared among 5 groups. The cost-effectiveness analysis was used to evaluate the eco-nomics of therapy plans in each group. RESULTS:Compared with blank control group,hospitalization time of somatostatin group, ulinastatin group,octreotide group and gabexate group were shortened significantly;the incidence of hyperamylasemia and pancre-atitis were significantly decreased;VAS score 3,24,48 h after surgery were significantly decreased,with statistical significance (P<0.05). Compared among 4 groups,above indexes had no significant difference,and the incidence of ADR was in low level and had no statistical significance(P>0.05). The cost-effectiveness ratio of somatostatin group was the lowest and has cost-effec-tiveness advantage. The results were supported by incremental cost-effectiveness and sensitivity analysis. CONCLUSIONS:Soma-tostatin,ulinastatin,octreotide and gabexate can significantly prevent the occurrence of hyperamylasemia and pancreatitis after ER-CP,and relieve pain with good safety. Somatostatin can achieve the best therapeutic efficacy at the lowest cost,so it is the best plan for hyperamylasemia and pancreatitis after ERCP.

Quality variation and ecotype classification of Chinese herbal medicine are important scientific problems in Daodi herbal medicine research. The diversity of natural environmental conditions has led to form unique multi-Daodi, multi-product areas that produce particular Chinese herbal medicine. China is one of three big American ginseng (Panax quinquefolium L.) producing areas worldwide, with over 300 years of application and 40 years of cultivation history. Long-term production practice has led to the formation of three big advocate produce areas in China: Northeast province, Beijing and Shandong. P. quinquefolium L. grown under certain environmental conditions will develop long-term adaptations that will lead to more stable strains (different ecotypes). P. quinquefolium L., can vary greatly in quality; however, the ecological mechanisms causing this variation are still unclear. Root samples were collected from four-year-old cultivated P. quinquefolium L. plants in the three major genuine (Daodi) American ginseng-producing areas of Northeast province, Beijing and Shandong province, China. Ultra-performance liquid chromatography was used to analyze the contents of eight ginsenosides (Rg1, Re, Rb1, Rb2, Rb3, Rc, Rd, Rg2). Data for nine ecological factors, including temperature, moisture and sunlight, were obtained from the ecological database of Geographic Information System for Traditional Chinese Medicine. Soil samples from the sampling sites were collected. Effective boron and iron, available nitrogen and potassium, as well as other trace elements and soil nutrients, were determined by conventional soil physicochemical property assay methods. Analytical methods of biostatistics and numerical taxonomy were used to divide ecotypes of the three main Panax quinquefolium L. producing areas in China based on ginsenoside content, climate, soil and other ecological factors. To our knowledge, this is the first time that ecological division of P. quinquefolium L. producing areas in China has ever been conducted. The results show that there are two chemoecotypes of P. quinquefolium L. in China: ginsenoside Rb1-Re from outside Shanhaiguan, and ginsenoside Rg2-Rd from inside Shanhaiguan. Similarly, there are two types of climatic characteristics: inside Shanhaiguan (Beijing, Shandong) and outside Shanhaiguan (Northeast). This suggests that the formation and differentiation of chemoecotypes of P. quinquefolium L. is closely related to variability of the climatic and geographical environment. Additionally, ecological variation of the three main producing areas, characteristics of two climatic ecotypes, and soil characteristics are also discussed and summarized. These results provide experimental scientific evidence of the quality variation and ecological adaptation of P. quinquefolium L. from different producing areas. They also deepen our understanding of the biological nature of Daodi P. quinquefolium L. formation, and offer novel research models for other multi-origin, multi-Daodi Chinese herbal medicines ecotypes. In addition, the results demonstrate the critical need for improving quality, appropriate ecological regionalization and promoting industrialized development of P. quinquefolium L.

Objective:To analyze the effects of proton pump inhibitors(PPIs)on the prevention of stress ulcers(SU)in elderly patients with acute respiratory distress syndrome(ARDS), and to analyze related factors for the risk of short-term death.Methods:This study was a multicenter retrospective cohort study.Two hundred elderly ARDS patients diagnosed and treated at Peking University International Hospital, Anzhen Hospital and Ezhou Central Hospital from November 2017 to December 2019 were continuously included.These patients were treated with PPIs(omeprazole, pantoprazole, rabeprazole, lansoprazole and esomeprazole)within 48 hours after ICU admission to prevent SU and were considered as the PPI group.According to the propensity score matching method, 200 elderly ARDS patients admitted to the hospitals with similar ages, medical history and sequential organ failure assessment(SOFA)scores who did not use PPIs were selected as the control group.All patients were followed up for 30 days.Kaplan-Meier survival analysis and the log-rank test were used to compare the 30-day mortality risk between the two groups.Cox regression analysis was used to analyze the relevant factors affecting the 30-day mortality.The 30-day mortality risk and the incidence of clinically significant gastrointestinal bleeding were evaluated among patients using different PPIs.Results:The average time of PPI use was 8.4±4.4 d in the PPI group.In the control group, 38.0% of patients were treated with H 2 receptor antagonists, and the average time of use was 8.1±5.2 days.There was no significant difference in the 30-day all-cause mortality risk between the two groups(20.5% or 41 cases vs.23.5% or 47 cases, P>0.05). The incidences of clinically significant upper gastrointestinal tract bleeding(2.5% or 5 cases vs.7.0% or 14, P<0.05), gastrointestinal bleeding(5.5% or 11 cases vs.12.5% or 25 cases, P<0.05)and hospital-acquired pneumonia(9.0% or 18 vs.4.0% or 8 cases, P<0.05)had significant differences between the PPI group and the control group.Multivariate Cox regression analysis showed that age>70 years( HR=1.845, 95% CI: 1.131-3.010, P<0.05), arterial oxygen partial pressure <78.0 mmHg(1 mmHg=0.133 kPa, HR=2.143, 95% CI: 1.317-3.487, P<0.01), SOFA score>14( HR=3.603, 95% CI: 1.741-7.456, P<0.01)and blood lactic acid>3.8 mmol/L( HR=2.725, 95% CI: 1.437-5.167, P<0.01)were related factors for the 30-day mortality.Compared with the control group, there was no significant difference in 30-day mortality between the five subgroups taking different PPIs including omeprazole, pantoprazole, rabeprazole, lansoprazole and esomeprazole( P>0.05), and the incidence of clinically significant gastrointestinal bleeding was significantly reduced( P<0.05), but there was no significant difference between the five PPIs subgroups( P>0.05). Conclusions:Although PPIs have no effect on short-term death in elderly ARDS patients, it can increase the risk of hospital acquired pneumonia while reducing the occurrence of gastrointestinal bleeding.With PPI use, advanced age, low arterial oxygen partial pressure, high SOFA score and high blood lactate are risk factors for the 30-day mortality.

Objective To discuss the clinical effects of laparoscopic therapy and duodenoscopic therapy in the treatment of biliary severe acute pancreatitis.Methods A total of 140 patients with biliary severe acute pancreatitis(BSAP) in our hospital was assigned into laparoscopic therapy group(60 cases) and duodenoscopic therapy group(80 cases) according to the treatment plan,and indicators in both groups were compared,including acute physiology and chronic health evaluation(APACHE Ⅱ score),WBC,CRP,the operation time,intraoperative blood loss,hospitalization time,hospitalization fee,complication rate,cure rate,mortality rate,abdominal pain disappearing time,body temperature recovered to normal time,blood amylase recovered to normal time,amino acid transaminase(ALT) recovered to normal time,total bilirubin(TBIL) recovered to normal time,alkaline phosphatase(ALP) recovered to normal time.Results APACHE Ⅱ scores and the levels of WBC,TBIL,ALT and CRP in both groups were significantly decreased after surgery(P＜0.05),but there were no statistical differences between the two groups at the same time point after treatment(P＞0.05).The operative time and the intraoperative blood loss in the duodenoscopic therapy group were significantly less than those in laparoscopic therapy group(P＜0.05).There were no statistical differences between the two groups of hospitalization time,complication rate,cure rate,mortality rate,abdominal pain disappearing time,temperature returned to normal time,blood amylase recovered to normal time,ALT recovered to normal time,TBIL recovered to normal time,ALP recovered to normal time(P＞0.05).Conclusion In early stage,both laparoscopic therapy and duodenoscopic therapy can treat BSAP effectively,and their therapeutic effects are nearly similar.