Objective To evaluate the effect of surgical treatment for cholecystolithiasis with billiary-cardiac syndrome(BCS). Methods The clinical data of 149 cholecystolithiasis patients with BCS were retrospectively analysed. Results The incidence of BCS in cholecystolithiasis was 39.4%(149/378).All the 149 patients underwent cholecystectomy.No severe complications or death occurred in this series. Three months after operation, 123(82.6%) cases of BCS were followed up. Of them, ECG returned to normal and the symptoms disappeared in 102 cases(82.9%);ECG had no obvious change,but the symptoms improved in 15 cases(12.2%). Conclusions Cholecystectomy is the only effective method for treating cholecystolithiasis with BCS. For patients with asymtomatic cholecystolithiasis,if the patients cardiac function can tolerate operation,a cholecystectomy should also be done.

Objective To investigate the role of hepatic Kupffer cells in acute hemorrhagic necrotizing pancreatitis associated lung injury(AHNP LI) and the therapeutic effects of gadolinium chloride(GdcI_3). Methods Forty-two Wistar rats were randomly divided into four groups:(I) sham operation group;(II) AHNP group;(III) Gdcl_3 (protection) group(Gdcl3 10mg/kg);(IV) Gdcl_3control group(Gdcl_3 10mg/kg).In the sham operation group, the (abdominal) vescera were shifted around for several times and the abdomen was closed.The AHNP model was induced by retrograde intraductal administration of 5% sodium taurcholate(1ml/kg,0.1ml/min).In the Gdcl_3 protection group,Gdcl_3 solution was admmistered by caudal vein injection one day before the AHNP model was made.In these 3 group of animals,specimens were obtained in order at 3h and 6h postoperatively:(1)Blood was withdrawn from the abdominal aorta to determine serum amylase,TNF?,IL-1(in addition,in the sham operation group,blood AST and ALT were determined);(2)A portion of liguefied right lung was obtained to determine MPO;another portion was fixed with 10% formalin for tissue pathological examination;(3)Bronchoalveolar lavage fluid of excised left lung was obtained ,and then alveolar macrophages were isolated,collected and purified.After removal of their nuclear (proteins),the alveolar macrophages were tested to determine NF-?B activation with the use of chemical illumination ELISA method;and (4)pancreatic tissue was reserved for pathological examination.In the Gdcl_3 control group, Gdcl_3 was administered by caudal vein injection,the animals were sacrificed 24h later,and blood was obtained to determine blood AST and ALT. Results In the Gdcl_3 prevention group,the level of MPO in lung tissue,serum (levels) of TNP? and IL-1,and NF-?B activation of alveolar (macrophages) were all significanfly reduced as compared with the AHNP model group(in all,P

Objective To analyze the etiology,diagnosis and therapy of benign biliary strictures and im-prove curative and preventive effects. Methods 212 patients suffering from benign biliary strictures in Nankai Hos-pital from January 2004 to December 2006 were retrospectively analyzed. Results Inflammatory strictures (65.12%,140/215) and strictures caused by operations (20.46%,44/215) were the most two causes. Strictures parts were mainly located in the latter segment of common bile duct 52.09% (112/215). In our group,the stent of strictures parts took 31.37% (64/204), bilioendodraignage 18.13% (37/204), and the modification of strictures parts 43.63% (89/204) as well as resection of stricture parts 1.96% (4/204). Conclusions Inflammatory stricture is the main cause in benign biliary strictures and the main locus is the hinder segment of common bile duct. The di-agnesis of benign biliary strictures before operation is important because it can help to decide the approach way and prognosis. The strategies of curing benign biliary strictures could include operations and endoscopy. The stent of stric-tures parts, bilioendodraignage and the modification of strictures parts are the main treaments for benign biliary stric-tures.

Objective To compare the efficacies and indications of locking compression plate (LCP) and external fixator plus Kirschner wires in treatment of complex intra-articular fracture of the dis-tal radius. Methods Ninety-eight patients with complex intra-articular fractures of the distal radius were treated with volar LCP or external fixator plus Kirschner wires, the efficacies of which were evaluated by comparing the grasping force and wrist function of the patients. Results All the patients were fol-lowed up for an average of 12.4 months, which showed fracture healing in all the patients. According to the wrist function assessment system of New York Orthopedic Hospital (1990), there was no statistical difference in the efficacy of LCP and external f'lxator plus Kirschner wires in treatment of types C1 or C2 fractures (P > 0.05), while the efficacy of external fixator plus Kirschner wires was significantly superior to that of LCP in treating type C3 fracture (P < 0.05). Conclusions For types C1 or C2 intra-articu-lar fractures of the distal radius, the efficacies of LCP and external fixator plus Kirschner wires are simi-lar, while the efficacy of external fixator plus Kirschner wires is superior to that of LCP in treating type C3 intra-articular fracture of the distal radius.

Objective To clarify the effects of sedation with propofol on pro/anti-inflammatory cytokines balance in severe sepsis patients resulted from intra-abdominal infection.Methods Fifteen patients with severe sepsis were randomly divided into two groups,propofol group received intravenous propofol sedation more than 48 hours,and no sedation drug were used in control group,3 volunteers as healthy group.Plasma TNF-?,IL-10 concentrations were measured at admission and 48 hours later,the ratio of TNF-?/IL-10 (T/I) were also calculated.Results Levels of both TNF-?,IL- 10 were significantly elevated in patients compared with healthy group,but no difference between prepofol and control group.The mean load doses of propofol was 0.063 mg/kg and maintained at 0.054 mg/(kg?h).After 48 hours infusion of prepofol,TNF-?,IL-10 decreased significantly compared with admission in propofol group,while no changed in control group.Compared with control group,IL-10 was lower and ratio of T/I was higher in propofol group.Conclusion Sedation with prepofol in severe sepsis patients attenuated the pro-and anti-inflammatory cytokine responses.Moreover, propofol accelerate the shift to Th1.These findings suggest that the influence of sedation drug on immune function must be considered in sepsis patients.

AIM: To establish a quick,accurate,sensitive method for analysing sildenafil citrate illegally added into traditional Chinese medicinal preparation. METHODS: The ultra performance liquid chromatography-quadrupole mass spectrometry method was used.Electrospay ionization(ESI) source was applied and operated in the positive and negative ion mode.The compound of sildenafil citrate illegally added into traditional Chinese medicinal preparations were identified according to the spectrum,chromatographic behavior and mass spectral data by comparison with those of reference substance. RESULTS: Sildenafil citrate was found in two formulations of three. CONCLUSION: The method is selective and sensitive and can be used to detect the sildenafil citrate illegally added into traditional Chinese medicinal preparations.

Objective To study the association of the serum alanine aminotransferase (ALT) level with cardiovascular risks in patients with type 2 diabetes mellitus (T2DM).Methods A total of 676 patients with T2DM who excluded liver disease due to chronic viral hepatitis,autoimmune,drugs,alcohol,and other hereditary were selected.According to the ALT level,676 patients were assigned into elevated ALT group (ALT ＞40 U/L,126 cases) and normal ALT group (ALT 5-40 U/L,550 cases).And normal ALT group were divided into 4 groups on the interquartile distance:group 1 (ALT 5-11 U/L,108 cases),group 2 (ALT 12-15 U/L,114 cases),group 3 (ALT 16-21 U/L,127 cases),group 4 (ALT 22-40 U/L,201cases).The age,duration of diabetes,body mass index (BMI),waist-to-hip ratio (WHR),blood pressure,triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesferol (HDL-C),low density lipoprotein cholesferol (LDL-C),fasting plasma glucose (FPG),2 h postprandial blood glucose (2 hPG),glycosylated hemoglobin (HbA1c),uric acid (UA),fasting insulin and homeostasis model assessment insulin resistance index (HOMA-IR) was compared among these groups.Results The levels of BMI,WHR,diastolic blood pressure,FPG,2 hPG,HbA1c,fasting insulin,TG,HOMA-IR and UA in elevated ALT group were higher than those in normal ALT group [(26.80 ± 3.60) kg/m2 vs.(23.40 ± 3.50) kg/m2,0.95 ±0.05 vs.0.91 ± 0.05,(75.3 ± 9.3) mm Hg (1 mm Hg =0.133 kPa) vs.(69.2 ± 9.5)mm Hg,(9.24 ± 2.56)mmol/L vs.(8.53 ± 2.78) mmol/L,(15.25 ± 4.62) mmol/L vs.(14.37 ± 5.06) mmoUL,(8.31 ± 1.76)％ vs.(7.78 ± 1.94)％,(10.76 ± 6.78) mU/L vs.(7.85 ± 7.04) mU/L,(2.73 ± 2.40) mmol/L vs.(2.20 ± 2.78)mmol/L,4.13 ± 2.76 vs.3.06 ± 2.63,(332.42 ± 95.12) μ mol/L vs.(285.14 ± 79.53) μ mol/L] (P ＜ 0.05),and HDL-C was lower than that in normal ALT group [(1.06 ± 0.27) mmol/L vs.(1.15 ± 0.57) mmol/L] (P ＜0.05).Compared with that in normal ALT group,the age was younger,and the duration of diabetes was shorter in elevated ALT group [(49.6 ± 10.5) years vs.(57.5 ± 11.3) years,(37.9 ±42.0) months vs.(54.5 ± 57.8) months] (P ＜ 0.05).The levels of FPG,2 hPG,HbA1c and UA in group 4 were higher than those in group 1,2,3 [(9.18 ± 3.01) mmol/L vs.(8.33 ± 2.57),(8.38 ± 2.52),(8.45 ± 2.73) mmol/L;(14.56 ± 4.80) mmol/L vs.(13.15 ± 5.72),(13.42 ± 4.56),(13.50 ± 5.17) mmol/L; (7.81 ± 1.98)％ vs.(6.76 ± 1.84)％,(6.79 ± 2.10)％,(6.88 ± 2.43)％; (288.24 ± 78.26) μ mol/L vs.(271.15 ± 75.43),(273.27 ± 71.25),(275.56 ± 69.57) μ mol/L] (P ＜ 0.05) ; HOMA-IR was lower than that in group 1,2,3(2.67 ± 2.65 vs.2.84 ± 2.53,2.98 ± 3.10,3.12 ± 2.57,P ＜ 0.05).Conclusion TheincreaseofALTlevel is associated with the clustered cardiovascular risk factors and insulin resistance in patients with T2DM.

Objective To analyze risk factors in order to predict the in-hospital mortality of patients with se-vere acute pancreatitis (SAP), especially the factor of total cholesterol. Method Factors for predicting in-hospi-tal mortality were evaluated retrospectively from the clinical data collected from 338 SAP patients of Tianjin Nankai Hospital between January 1999 and December 2008 according to the Guidelines for for clinical diagnosis and classi-fication of Acute Panereatitis set by the Society of Chinese Medical Association in 2003. The patients were treated with intensive care, blood routine examination, blood biochemical test and even computed tomography within 24 hours after admission. The patients were divided as per outcome into deceased and survivor group. All patients were admitted within 72 hours after the onset of symptoms. The Off-square test was used for univariate analysis and multivariate test was performed by logistic regression. Results Compared with TC≤3.67 mmol/L, when the TC was between 3.67 -4.37 mmol/L, OR was 0.664 (P = 0.412), while TC was between 4.37 mmol/L and 5.23 mmol/L, OR was 0.144 (P =0.021).The OR was 1.013 (P =0.018) when TC was ≥5.23 mmol/L. The variation of serum TC levels was accompanied with the changes of C-reactive protein (CRP). When the CRP was ≥170 mg/L, OR was 7.074 (P =0.031). When the serum ALB≤30 g/L, OR was 7.224 (P =0.029).Conclusions The CRP, ALB, TC can be used for early predicting the in-hospital mortality of SAP patients. TC is a protective factor when it was between 4.37 mmol/L and 5.23 mmol/L, while it is a risk factor when ≥5.23 mmol/L or≤3.67 mmol/L. CRP> 170 mg/L or ALB < 30 g/L increases the probability of fatal outcome. Low level of albumin is a stronger predictor than the high level of CRP. Moderate elevation of TC level seems to in-crease the resistance to inflammation and hence improving the survival rate of patients with SAP and reducing the in-hospital mortality.

Infection rate and in-hospital treatment were two prognostic factors for SAP recurrence.

Objective To analyze the value of early evaluation in predicting the onset of multiple organ dysfunction syndrome (MODS) in patients with severe acute pancreatitis (SAP). Methods The clinical data of 338 patients with SAP who had been admitted to Tianjin Nankai Hospital from January 1998 to September 2008 were retrospectively analyzed. The patients were divided into MODS group (n = 163) and control group (n = 175) according to whether they did or did not have MODS. Risk factors causing MODS were analyzed by t test and Logistic regression analysis. Results The factors leading to the MODS included white blood cells count≥ 16 ×109/L, serum creatinine≥ 180 μmol/L, serum calcium≥2.5 mmol/L, c-reactive protein≥ 120 mg/L and pH value of blood≥7.35 (χ2 = 51.720, 21.421, 12.393, P < 0.05). The total cholesterol was a protective factor when it was 3.67-5.23 mmol/L. Conclusions Infection, renal insufficiency and hypercalcinemia are early predictive factors for MODS, and infection is the strongest predictive factor. Appropriate elevated total cholesterol can reduce the incidence of MODS.