Pancreatic abscess(PA)is the most serious complication of severe acute pancreatitis(SAP),which can lead to systemic and/ or local complications,and even death. PA cannot be resolved automatically after the formation. Once diagnosed,early drainage,anti-infection and nutrition support should be undertaken,the most important is early drainage. In the past,the treatment of PA was mainly based on surgical treatment. With the development of minimally invasive techniques,endoscopic ultrasound(EUS)guided drainage and percutaneous catheter drainage(PCD)offer a new way for the treatment of PA. Preventing and early diagnosis of PA become a challenge in the treatment of SAP. This article reviewed the progress in diagnosis and treatment of SAP complicated with PA.

Anti-Bacterial Agents ; adverse effects ; Humans ; Integrative Medicine ; Kidney Diseases ; chemically induced ; therapy

Objective To explore the effects of AKT2 expression in pancreatic cancer cell line Panc-1 on the sensitivity towards to gemcitabine.Methods The expression vector pAKT2 shRNA was constructed and transfected into Panc-1 cells by lipofecton.The mRNA and protein expression levels of AKT2 were detected by RT-PCR and Western blot assays,respectively.The changes of gemcitabine sensitivity after shRNA were examined by the MTT assay.Results The mRNA and protein levels of AKT2 in Panc-1 cells were significantly decreased after the transfection,and the median inhibition concentration of gemcitabine against Panc-1 cells was reduced from (1.96 ± 0.22) mg/L to (0.24±0.03) mg/L.The sensitivity of Panc-1 cells to gemcitabine was increased significantly after pAKT2-shRNA transfection.Conclusion The sensitivity of Panc-1 cells to gemcitabine could be enhanced by pAKT2-shRNA.

Objective To study the effect of RNA interference suppressing the expression of AKT2 on sensitivity of human pancreatic cancer cell line xenograft in nude mice to gemcitabine.Methods The human pancreatic cancer cell implanted tumor mode1 in the nude mice was established.By abdominal cavity administration and intratumoral injection,the mice bearing tumor were treated with gemcitabine in combination with vector of pAKT2-siRNA.Tumor growth of tumor tissues was observed,the AKT2 mRNA and protein expression levels in tumor tissues detected by RT-PCR and immunohistochemistry respectively,and tumor apoptosis measured by Tdt-mediated dUTP nick end labeling(TUNEL).Results In chemotherapy+AKT2-siRNA group the expression of AKT2 mRNA and protein was significantly lower than in control group,chemotherapy group and chemotherapy+blank plasmid group.The tumor weight and tumor volume in chemotherapy+AKT2-siRNA group were significantly reduced as compared with those in other three groups.The inhibition rate and apoptosis rate in chemotherapy+AKT2-siRNA group were significantly higher than those in other three groups.Conclusion Sensitivity of human pancreatic cancer cell line to gemcitabine could be significantly improved by RNA interference suppressing the expression of AKT2.

OBJECTIVE:To observe the curative effects and safety of compound glycyrrhizin injection combined with chemotherapy in the treatment of enteron malignant tumor at intermediate and advanced stage.METHODS:100patients were randomized into treatment and control group,the treatment group were given compound glycyrrhizin injection combined with chemotherapy,while the control group was treated with only chemotherapy,the curative effects and side effects were observed and compared between2groups.RESULTS:The short-term effective rates in the treatment group and the control group were58%and36%respectively(P

Objective: To explore the effects of ramipril, trimetazidine and the combination of ramipril and trimetazidine on renal cell apoptosis index (AI) and cytochrome C (Cyt-C) expression in experimental rats with chronic heart failure (CHF).
Methods: CHF model was established by partially banding of abdominal aorta superior to renal artery in experimental rats. A total of 50 male Wistar rats were randomly divided into 5 groups: Sham operation group, Model group, Ramipril group, Trimetazidine group and Combination (ramipril and trimetazidine) group.n=10 in each group. Renal tubular cell AI was examined by TUNEL method, mRNA and protein expressions of Cyt-C were detected by RT-PCR and Western Blot analysis in each group respectively.
Results: Compared with Sham operation group, Model group had increased AI of renal tubular cells, increased mRNA and protein expressions of Cyt-C,P<0.01. Compared with Model group, Ramipril group, Trimetazidine group and Combination group showed decreased AI of renal tubular cells (20.02 ± 1.14) %, (20.10 ± 1.2) % and (14.27 ± 1.40) % vs ( 40.82 ± 1.31) %; reduced Cyt-C mRNA expression (0.54 ± 0.06), ( 0.56 ± 0.05) and (0.44 ± 0.04) vs (0.89 ± 0.03); reduced Cyt-C protein expression (1.50 ± 0.11), (1.58 ± 0.12) and (0.75 ± 0.06) vs (2.53 ± 0.10); the most reduction was obtain by Combination group, allP<0.01.
Conclusion: Ramipril and trimetazidine can inhibit renal cell apoptosis and effectively improve the renal function in CHF rats. Combined medication is better than either of them alone.

Objective To clarify the influence on component and pharmacological action of Astragalus polysaccharides (APS) as complementary therapeutic agents prepared by different extraction and purification techniques. Methods Components of APS prepared by different extraction and purification techniques were analyzed, and these APS were used for synergy and attenuation of chemotherapy, radiotherapy treatment with H22 liver cancer and Lewis lung cancer of tumor-bearing mice, and also used for the regulation of immune function to immunosuppression mice. Results Experimental data were analyzed by means of statistical method to get pharmaco-result: A3 (extracted by microwave assistance and purified by membrane separation) > A4 (extracted by refluxing and purified by membrane separation) > A1 (extracted by refluxing and no purification)≈ A2 (extracted by microwave assistance and no purification). There were no significant differences on pharmacodynamic action between A1 and A2. However, compared with A1 and A2,it was worth noting that A3 and A4 exhibited good pharmacodynamic action. Then A3-in and A4-in, the samples in dialyzer after dialysis, were separated and purified to get homogeneous APS, which were the principal constituents of APS in dialyzer, with the molecular weight (Mw) of 7669 and 14 142 determined by HPGPC, respectively. The average Mw of APS outside of the dialyzer, A3-out was 3102 and A4-out 3256, which were the main compositions of A3 and A4, accounted for 79.63% and 53.92%, respectively. Conclusion APS with Mw about 5000 Da exhibit better antitumor effect and immunological activity. Refluxing, microwave assistance extractions, and membrane enrichment techniques bring different cases on Mw distribution, components and pharmacodynamic action, and obviously exhibit relationship among component, Mw distribution, and pharmacological action.

Objective:To investigate the effectiveness of heart rate deceleration capacity (DC) measurement in predicting the car-diotoxicity of malignant tumor patients treated with epirubicin-based chemotherapy. Methods:The clinical medical records, including CK-MB and cTnI levels and dynamic electrocardiogram (ECG) parameters before and after each chemotherapy cycle, of 140 patients treated with epirubicin-based chemotherapy were analyzed. Patients were divided into the DC>4.5 ms group and the DC≤4.5 ms group based on the calculated DC values. The CK-MB and cTnI levels and the dynamic ECG parameters of the two groups were compared af-ter two and four cycles of chemotherapy. Results:Patients in the two groups exhibited no statistically significant difference in their rele-vant clinical and pathological data before receiving chemotherapy (P>0.05). However, after four cycles of chemotherapy, the DC≤4.5 ms group showed a significantly greater increase in serum CK-MB and cTnI concentrations over the pre-chemotherapy levels compared with the DC>4.5 ms group. After two and four cycles of chemotherapy, the DC≤4.5 ms group also exhibited a significantly greater in-crease in mean heart rate (beats/min) and supraventricular and ventricular arrhythmia counts (times/24 h) over the pre-chemotherapy values compared with the DC>4.5 ms group (P<0.05). After four cycles of chemotherapy, 23 cases showed abnormally elevated cTnI levels in the DC≤4.5 ms group. In this group, patients with elevated cTnI level exhibited no statistically significant difference in CK-MB and cTnI concentrations, mean heart rates, and supraventricular and ventricular arrhythmia counts compared with those with nor-mal cTnI level before chemotherapy (P>0.05). However, the DC values of patients with elevated cTnI were significantly lower than those with normal cTnI level (P<0.05). Conclusion:The risk of epirubicin-induced cardiotoxicity increased with decrease in DC value. The DC test was shown to be an effective predictor of the risk of epirubicin-induced cardiotoxicity.

Objective To investigate the reliability of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in assessing the severity of acute respiratory distress syndrome (ARDS) in critically ill patients.Methods Forty-six patients with ARDS,who were admitted in our emergency intensive care unit,aged 18-72 yr,weighing 46-72 kg,of Acute Physiology and Chronic Health Evaluation Ⅱ score 11-25,were divided into 3 groups:PaO2/FiO2 ≤ 100 mmHg severe group (n =16);100 mmHg ＜PaO2/FiO2 ≤ 200 mmHg moderate group (n =14);200 mmHg ＜PaO2/FiO2 ≤ 300 mmHg mild group (n=16).Before treatment,and at 24 and 72 h after diagnosis of ARDS,PVPI,EVLWI,cardiac index (CI),and intrathoracic blood volume index (ITBVI) were measured,and blood gas analysis was performed.PaO2/FiO2 was calculated.The 28 day fatality after admission to hospital was recorded.Person correlation of PVPI and EVLWI with PaO2/FiO2,ITBVI and CI was analyzed.Results The PVPI,EVLWI and fatality rate were significantly higher at each time point in moderate group and severe group than in mild group,and in severe group than in moderate group (P＜0.05).The correlation coefficient between PVPI and PaO2/FiO2 was 0.778,and between EVLWI and PaO2/FiO2 was-0.437 (P＜0.05).There was no correlation between CI and ITBVI (P＞0.05).The correlation coefficient between EVLWI and PaO2/FiO2 was-0.448,and between EVLWI and ITBVI was 0.347 (P＜0.05).There was no significant difference between the correlation coefficient between PVPI and PaO2/FiO2 and the correlation coefficient between EVLWI and PaO2/FiO2 (P＜0.05).Conclusion PVPI and EVLWI both can assess the severity of ARDS in critically ill patients,showing a consistent reliability.

Objective To investigate the effects and mechanisms of bile on small intestine mucosal barrier.Methods Fifty Wistar rats were assinged into 3 groups randomly: obstructive jaundice(OJ) group(n=20),biliary external drainage group(n=20) and control group(n=10).Ten days after operation,the plasma endotoxin level was determinated,the terminal ileum mucosas was obtained to be morphologically measured by light microscope,and immunohistochemistry and Western blot were uesd to examine the expressions of tight junction proteins zona occludens-1(ZO-1) and occludin in the mucosas.Results Atrophy significantly appeared in the distal ileum mucosas in OJ group.Compared with control group,the intestinal villus height,mucosa thickness and crypt depth in OJ group were obviously decreased 27.8%,21.7%,and 25.4%(P=0.001,0.001,0.040).There were no differences between external drainage group and control group(P=0.050,0.070,0.080);While the values of external drainage group were significantly higher than those in OJ group(all P=0.001).The level of plasma endotoxin was up to(1.49?0.27) EU/ml in OJ group compared with control group((0.27?0.09) EU/ml),P=0.001.In external drainage group,the value was(0.91?0.25) EU/ml,which was obviously higher than that in control group and lower than that in OJ group(all P=0.001).Immunohistochemical study showed strong positive expression of ZO-1 dropped from 7/10 in the control group to 6/20 in OJ group(P=0.040),occludin expression was 8/10 in control group and 7/20 in OJ Group(P=0.020);expressions of them in external drainage group(8/20(P=0.100,0.210) and 9/20(P=0.060,0.200)) displayed no significant differences compared with the other twogroups.Quantitative testing of Western blot showed the expressions of ZO-1 and occludin in OJ group were significantly lower than those in control group(P=0.001,0.010),the values in external drainage group were higher than those in OJ group(P=0.005,0.014).The expression of ZO-1 was lower in external drainage group than that in control group(P=0.001),and there was no significant difference of occludin between the two groups(P=0.062).Conclusion Lack of intestinal bile will undermine the intestinal tight junction protein composition,and make intestinal mucosal barrier impaired.The intestinal barrier more severely injured when biliary tract obstructs because of multiple factors.Bile plays an important role in the maintenance of intestinal mucosal barrier.