There was never a time in history that so many disciplines and specialists participate and try to lead the clinical management for acute pancreatitis. Chaos remains at bedside, and episodes of under-intervention and especially over-treatment frequently happened. Physicians are easily confused by questions and controversies in management for acute pancreatitis. We have reviewed the articles in acute pancreatitis and made our recommendations based on the latest evidences.

BACKGROUND:Intertrochanteric fractures can be generaly treated by surgical treatment. Along with deep research on the biomechanics of the proximal femur, proximal femoral locking compression plate appears recently. The locking plate fixation is not strong, can reduce the local stress shielding, and maintain optimal system stability, but fracture fixation failure often occurs due to the inappropriate choice of nail plate. OBJECTIVE:To evaluate the value of digital orthopedics technology in preoperative planning in locking plate fixation for intertrochanteric fracture. METHODS: Forty intertrochanteric fracture patients receiving CT tomography femur upper segment were selected and divided into two groups. In the conventional group, after reading X-ray films and CT images, patients received locking plate fixation. In the computer planning group, before repair, fracture model was established using Mimics software to segment fracture fragments, simulate operation reset and 3-matic software was used to reconstruct locking plate and screws. Locking plate was assembled with Mimics to obtain the best plate position, best screw angle and screw length. Proximal femoral locking compression plate fixation was performed. Fluoroscopy times, operation time, blood loss and fracture healing time were compared in both groups. RESULTS AND CONCLUSION: Three-dimensional models of proximal femur were reconstructed, and a series of data were obtained. The optimal position of each plate was obtained from each patient. The screw length was predicted, so preoperative operation planning was realized. Al patients were folowed up for 6-20 months. Fluoroscopy times, operation time, and blood loss were significantly less in the computer planning group than in the conventional group (P < 0.05). No significant difference in fracture healing time was detected between the two groups (P > 0.05). These findings suggest that digital orthopedics technology used in intertrochanteric fracture can simulate the locking plate position, determine the screw placement angle and length of the screw in advance, and reduce fluoroscopy times, operation time, blood loss and screw position misalignment.

0.05),but,serum AST and ALT were significantly decreased on the 12th hour in arterialization group(P

Objective To investigate the effect of chronic intermittent hypoxia on blood pressure,sympathetic nerve activity and myocardial mitochondrial oxidative stress status in aged rats.Methods Chronic intermittent hypoxia(CIH)rat models were established.A total of 84 male Wistar rats(3-4 and 23-24 months old,respectively)were randomly and equally divided into four groups according to age:young control group,young CIH group,aged control group and aged CIH group.CIH exposure lasted for 3 weeks.The arterial blood pressure,the frequency of carotid sinus nerve action potential,the lung function,the levels of catecholamine,aconitase/fumarate ratio (A/F),plasma superoxide dismutase(SOD)in the plasma were measured and compared between four groups.Results The arterial blood pressure was significantly higher in young CIH group than in the young control group[(150.4 ±25.6)mmHg vs.(102.2±7.4)mmHg,P＜0.01].There was no significant difference in the arterial blood pressure between the aged CIH group[(132.8 ±16.2) mmHg] and the aged control group[(127.1 ± 26.8)mmHg].The minute volume ventilation was significantly lower in the aged control group than in young controlgroup[(331.7±53.5)ml· min-1 · kg-1vs.(554.8±111.9)ml· min-1 · kg-1P＜0.05].The min-1 · kg-1 ventilation showed no significant difference between the agedCIH group[(354.1±51.9)ml· min-1 · kg-1]and the aged control group[(331.7 ±53.5)ml· min-1 · kg-1].The rate of CSN frequency change by hypoxia stimulation was lower in the aged control group than in young control group[(6.2± 5.5)times vs.(11.8 ±6.6)times,P＜0.01],and was lower in the aged CIH group than in the young CIH group[(22.2 ± 13.5) times vs.(44.2± 12.1) times,P＜0.01].The levels of plasma norepinephrine and epinephrine were higher in the young CIH group than in the control group[(39.0±8.9)nmol/L vs.(20.8±10.6)nmol/L,(48.1±13.6)nmol/L vs.(26.7 ± 14.3)nmol/L,both P＜0.05].The levels of plasma norepinephrine and epinephrine showed no significant difference between the aged control group and the young control group,also no significant difference was found between the aged CIH group and the aged control group.The A/F ratio was lower in the young CIH group than in the young control group[(0.26±0.13)vs.(0.58 ±0.04),P＜0.01].The A/F ratio was lower in the aged control group than in the young control group [(0.29±0.02)vs.(0.58± 0.04),P＜0.01],but there was no significant difference in the A/F ratio between the aged CIH group and the aged control group.The level of SOD was significantly lower in the young CIH group than in the young control group [(5.30 ±± 0.90) NU/mgprot vs.(6.10 ± 1.73)NU/mgprot,P＜0.05].There was no significant difference in SOD level between aged control group and aged CIH group.Conclusions The effect of CIH on blood pressure in aged rats is different from the youth rats.This study shows adecreasedsympathetic nervous over activity and a reducedmitochondrial oxidative stress in aged rats.Aging probably suppresses two important pathogenic mechanisms,by which CIH affects blood pressure,therefore releases CIH induced blood pressure abnormality.

Objective To investigate the pathogentic factor of severe acute pancreatitis(SAP)-associated lung injury and the protective function of octreotide combined with alinastatin on SAP-associated lung injury in rats.Methods Eighty SD rats were randomly divided into 5 groups.Sham operative(S)group,SAP group,(octreotide)(O)group,ulinastatin(U)group and octreotide + ulinastatin (O+U)group,and each group was divided into 6h,12h sub-groups.After AP models were induced,the serum concentration of amylase(AMY),tumor necrosis factor?(TNF-?),malondiadehyde(MDA),and the concentration of(myeloperoxidase)(MPO) in lung tissue were determined;and the pancreas and lung pathology were graded,the changes of the above-mentioned indexes after using octreotide and ulinastatin were compared.Results(1)Compared to SAP group,AMY,TNF-?,MDA,MPO,and pancreas pathology score were decreased significantly in each of the 3 therapy groups during the same period;and at 12h,in O+U sub-group,lung pathology score also decreased compared to SAP group(P

Objective To explore the elimination effect of radix Pulsatillae extracts on R plasmid of pseudomonas aeruginosa.Methods R plasmids of pseudomonas aeruginosa were isolated from the sputum of elderly patients suffering from respiratory infection,and the elimination test of radix Pulsatillae extracts on these plasmids was performed in vitro and in vivo.Results Being treated with the extracts for 24,48 and 72 h in vitro,the elimination rate of R plasmids was 0,1.8 %and 3.4 %respectively,while in SDS(sodium dode canesulphonate)control group the elimination rate was 0,0.8 %and 1.6 %respectively.Being treated with the extracts for 24,48 and 72 h in vivo,the elimination rate was 0,2 %and 12.8 %respectively,and 0 in the control group.Conclusions Both in vitro and in vivo,radix Pulsatillae extracts have an elimination effect on R plasmid of pseudomonas aeruginosa,and the effect in vivo is stronger than that in vitro.

Noise is a common occupational hazardous factor in the workplace. In addition to the specific damage to the auditory ， system of workers it can also harm the cardiovascular system and cause a serious disease burden. The mechanism of ， occupational noise on the cardiovascular system of workers is mainly oxidative stress inflammation and vascular endothelial ， - - - damage. As a stressor noise mainly leads to the changes of sympathoadrenal medullary system and hypothalamic pituitary ， ， ， - ， adrenal axis. The substances that play an important role include catecholamines cortisol angiotensin Ⅱ endothelin 1 - endothelial nitric oxide synthase and interleukin 6. The population epidemiological studies have shown that occupational noise ， exposure can lead to elevated blood pressure abnormal electrocardiogram and elevated blood lipids in workers. The influencing （ ， ， ） factors include noise characteristics intensity cumulative noise exposure and frequency and noise combined with other （ ， ， ， - ， occupational hazards such as high temperature welding fumes organic solvents hand transmitted vibration and work ） ， ， ， shifts . However due to the influence of research conditions experimental design and other factors some research conclusions still have limitations. More prospective and comprehensive studies are needed to verify the relevant conclusions in the future.

Objective To explore the health-relate quality of life(QOL) status of adult persistent allergic rhinitis (PAR);the change of QOL of pro-post specific immunotherapy (SIT) and pharmacotherapy .Methods Skin prick tests(SPT) were performed on PAR patients .According to the results ,80 adult cases that were allergic to dermatophagoides were enrolled in ENT outpatient clinic of affiliated hospital of Nantong University from April to August 2011 .The patients were randomly allocated to receive either specific immunotherapy(n=40) or pharmacotherapy (n=40) ,all of them were given RQLQ before and after half-year treatment ;40 cases without any allergic diseases were chosen from ENT in-patient department ,and were given RQLQ .The scores of previous treatment of the PAR group were compared with health control group ,then compared with the scores of post-treatment ,and also compared the scores of post-treatment between the immunotherapy group and pharmacotherapy group .Results The scores of the PAR patients were higher than that of health control patients in all dimensions of RQLQ (P< 0 .05) ,and the most troublesome problems were nasal symptoms .The scores of the patients who received SIT were evidently lower than that of pro-treatment in all dimensions of RQLQ(P<0 .05) ,the scores of the patients who received medical treatment were also lower than before (P<0 .05) , and the scores of the SIT group were lower than the pharmacotherapy group (P<0 .05) .Conclusion The QOL of adult patients with PAR was improved after SIT or drug treatment ,and QOL improvement is more obvious treat by SIT .

Objective To analyze the indications and evaluate the efficacy of the needle to 'double reverse' traction reset,inside and outside double column locking plate internal fixation with MiPPO for tibial plateau fractures.Methods From August 2015 to March 2017,a total of 31 patients with tibial plateau fractures in our hospital were divided into treatment group and control group.The treatment group with 12 cases were treated with the needle to be 'double reverse' traction reset,inside and outside double column locking plate MiPPO fixation.The control group with 19 cases received open reduction and internal fixation with locking plate.Results In treatment group,the operation time was (51.3±6.5)minutes,the intraoperative bleeding was (60±8.7)mL.In the control group,the operation time was (68.5±6.6)minutes,the intraoperative bleeding was (230±7.8)mL.The operation time and blood loss of treatment group were less than those of control group,the differences were statistically significant(P<0.05).The postoperative X ray film of fracture showed that the bone plate and screw position were ideal compared with those before operation,no complication occurred.Conclusion The needle 'double inverse' traction and locking plate MiPPO fixation treatment have good clinical effect for patients of Schatzker Ⅴ,Ⅵ tibia platform fracture,with less complication.

Objective To investigate the biomechanical characteristics of the acromioclavicular joint,put forward the treatment of acromioclavicular joint dislocation based on the principle of anchor and apply to clinic.Methods From August 2011 to March 2015,24 patients with the acromioclavicular joint dislocation in department of orthopedics of Chinese Medicine Hospital of Changshu were divided into the treatment group and the control group,with 12 cases in each group.The treatment group were treated by vertical suspension buttons steel cable system based on principle of anchor,while the control group were treated by the hook plate technology.The clinical results of the two groups were evaluated by Karlsson score system.Results All the patients were followed up for 6 to 12 months.In terms of the curative effect in the treatment group,there were 11 cases of excellent and 1 case of good,with the excellent and good rate of 100%,and no complication occured.In the control group,there were 7 cases of excellent and 3 case of good,with the excellent and good rate of 83.3%.And there was 1 case of subacromial osteolysis.Conclusion To treat acromioclavicular joint dislocation above Rockwood Ⅲ with vertical suspension buttons steel cable system based on principle of anchor may be an ideal treatment method.