Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis (CP).Two major strategies exist:duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD).Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however,the long-term effects have not been thoroughly investigated.We analyzed the long-term outcomes of DPPHR and PD,over follow-up times of at least 1 year,to determine the optimal surgical treatment for CP.Methods We systemically reviewed all CP surgical treatment reports,and only included randomized controlled trials (RCT) comparing DPPHR and PD,excluding unqualified studies using several pre-specified criteria.When multiple publications of a single trial were found,the most comprehensive current data were selected.Characteristics of the study populations and long-term postoperative outcome parameters were collected.The quality of the studies and data was analyzed using RevMan 4.2 software.Results Five trials were qualified for meta-analysis,with 261 participants in total (114 in the DPPHR group and 147 in the PD group).There were no significant differences in the age,gender,or indications for surgery of each group.At the mean of 5.7-year (1-14 years) follow-up examination,DPPHR and PD resulted in equally effective pain relief,exocrine and endocrine function,and similar mortality rates (P ＞0.05); however,DPPHR patients had improved global quality of life and weight gain,and reduced diarrhea and fatigue (P ＜0.05).Conclusion DPPHR and PD result in equal pain relief,mortality,and pancreatic function; however,DPPHR provides superior long-term outcomes.

Objective To investigate the metabolic effects of glucose dependent insulinotropic peptide receptor antagomst pro3 (GIP) in induced diabetes mice about blood glucose,triglyceride,cholesterol,leptin and fatty issue.Methods 27 C57 mice were randomly divided into normal group and diabetes mice group,and the mice in diabetes group were fed with high fat food and intraperitoneal injected streptozocin.Then 1 mouse that random blood giucose lower than 16.9 mmol/L was deleted in diabetes group.The rest mice in diabetes group were divided into two groups,diabetes control group,pro3 (GIP) group.Pro3 (GIP) group was given drug pro3 (GIP).The bloodglucose and glucose tolerance were measured.After treatment for 6 weeks,all mice were sacrificed and fatty tissues were collected.Results After 6 weeks,the blood glucose of the pro3 (GIP) group was obviously lower than diabetes control group (t=8.43,P＜0.01),and insulin levers in 0,30,60 and 120 min were obviously lower than diabetes control group (t =3.90,2.60,6.88 and 3.33,P＜0.05).There was significant difference between pro3 (GIP) group and diabetes control group about inflammatory cells.Moreover,leptin in pro3 (GIP) group was obviously lower than in diabetes control group (t =5.04,P＜0.01),but triglyceride,cholesterol,and adiponectin had no significant difference between two groups.Conclusion Pro3 (GIP) can significantly reduce blood glucose,insulin level,leptin of diabetes mice,and attenuate the inflammatory cells infiltration in fatty issue.

Objective To observe the clinical efficacy and safety of ilaprazole enteric-coated tablets combined with clarithromycin tablets and furazolidone tablets in the treatment of elderly peptic ulcer.Methods Ninety-six elderly patients with peptic ulcer were randomly divided into control and treatment groups with 48 cases per group.Control group was treated with omeprazole enteric-coated capsules 40 mg per time,bid,orally + clarithromycin tablets 0.5 g per time,bid,orally + furazolidone tablets 100 mg per time,qd,orally,continuous treatment for 10 days.Treatment group was treated with ilaprazole enteric-coated tablets 5 mg per time,bid,orally + clarithromycin tablets 0.5 g per time,bid,orally,continuous treatment for 5 days,then treated with ilaprazole enteric-coated tablets 5 mg per time,bid,orally + furazolidone tablet 100 mg per time,qd,orally,continuous treatment for 5 days.The clinical efficacy,Helicobacter Pylori (Hp) positive rate,serum vascular endothelial cell growth factor (VEGF),basic fibtroblast growth factor (bFGF),nitric oxide (NO) and adverse drug reactions were compared between two groups.Results After treatment,the total effective rates of treatment and control groups were 95.83％ (46 cases/48 cases) and 72.92％ (35 cases/48 cases) with significant difference (P ＜0.05).After treatment,the main indexes in treatment and control groups were compared:the Hp positive rates were 4.17％ (2 cases/48 cases) and 20.83％ (10 cases/48 cases),the VEGF were(167.28 ± 12.94) and (145.26 ± 17.87) pg · mL-1,the bFGF were (144.38 ± 14.80) and (123.29 ± 14.46) pg · mL-1,the NO were (31.81 ± 3.50) and (40.92 ± 6.32) μmol · L-1,the differences were statistically significant (all P ＜ 0.05).The adverse drug reactions in the treatment group were dizziness,vomiting and constipation,which in control group were dizziness,rash and diarrhea.The total incidences of adverse drug reactions in treatment and control groups were 8.33％ and 16.67％ without significant difference (P ＞ 0.05).Conclusion Ilaprazole enteric-coated tablets combined with clarithromycin tablets and furazolidone tablets have a definitive clinical efficacy in the treatment of elderly peptic ulcer,which can regulate the levels of serum VEGF,bFGF and NO,without increasing the incidence of adverse drug reactions.

Background More and more Chinese drink hot water from water dispensers while many children were scalded due to this change.The present study aimed to propose a feasible strategy for prevention.Methods A retrospective study was conducted for all water dispensers related pediatric burns admitted to Changhai Hospital from January 2005 to December 2009.Results The number of new cases and incidences of pediatric burns due to hot water from water dispensers was significantly increasing year after year.In the total 238 involved cases,175 cases happened on males and 78.9％ were at the age of 1-4 years.The burn areas were mainly located in upper extremities.All water dispensers in the surveyed families had no isolate protection devices and 85.2％ of their locations were easy for children to reach.Nearly half of the children were in the same room with their guardians when injured.Total 196 burned children were playing the taps of water dispensers before injured,unfortunately,80.6％ of them have not been stopped until burned.Conclusion As the kind of bums is quite serious and with bad outcome,some recommendations should be followed,such as buying water dispensers with protection devices,keeping children from touching them and so on.

Objective To investigate the value of the cardiac CT examination for decision making in middle-aged and elderly patients before planned transcatheter atrial septal defect (ASD) closure. Methods Cardiac CT was performed in 63 adult patients [18 males, aged from 50 to 77 years, mean age (56. 87 ±5.79) years]with ASD before planned transcatheter ASD closure. Coronary CT angiography was made for detection of associated cardiovascular diseases, followed by 3D reconstruction of ASD for determination of the defect size in the GE-workstation, results were compared between transthoracic echocardiography measurement, CT measurement, and atrial septal defect occluder waist diameter. Results Cardiac CT identified additional cardiovascular diseases in 14 patients and decision making was changed based on cardiac CT results. Coronary artery stenosis was detected in 8 patients by cardiac CT, and proved by coronary angiography, and all of them were given comprehensive management: percutaneous coronary intervention and thanscatheter ASD closure were successively performed in 2 cases, and 1 case was referred to surgery for both coronary artery bypass graft and surgical ASD repair, and 5 patients were given pharmacological management for coronary artery disease besides thanscatheter ASD closure. Cardiac CT identified large ASD with insufficient rim tissue in 2 cases and transcatheter closures were abandoned.Cardiac CT screened out 1 case from those with insufficient posterior inferior rim by transthoracic echocardiography, and transcatheter ASD closure was successfully pedormed. Cardiac CT ruled out ASD in 1patient. In addition, cardiac CT detected 1 partial abnormalous pulmonary vein connection and 1 ductus arteriosus in this cohort. A correlation on ASD measurements was found between CT size and TTE size(r =0. 80,P ＜ 0. 01 ; Y =0. 84X + 8. 85, R2 =0. 63, P ＜ 0. 05 ), and between ASO size and CT size ( r =0. 92,P ＜ 0. 01 ; Y =0. 93X + 4. 78, R2 =0. 84,P ＜ 0. 05 ). Conclusion In middle-aged and elderly patients with ASD for possible transcatheter closure, cardiac CT is valuable on determing ASD size and morphology and could provide incremental information for optimizing clinical management for ASD patients.

Objective To analyze the incidence and cause of complications during and after interventional therapy for congenital heart disease (CHD). Methods From April 1986 to April 2009, 388 out of 6029 patients with CHD developed complications during and post interventional therapy, another 5 patients died post procedure, clinical data from these 393 patients were retrospectively analyzed. The patients with severe functional insufficiency requiring intervention or surgery during and after interventional therapy were classified as severe complications. Results The overall complication rate was 6. 44% [7.69% post atrial septal defect occlusion, 4.20% post patent ductus arteriosus (PDA) occlusion, 1.31% post percutaneous balloon pulmonary valvuloplasty, 14.94% post veatricular septal defect occlusion, 3.13% post percutaneous closure of aortopulmonary collaterals, 30.95% post catheter embolotherapy of pulmonary arteriovenous malformations, 12.50% post transcatheter closure of coronary artery fistulae, 20.00% post transcatheter closure of ruptured sinus of Valsava aneurysm, 66. 67% post percutaneous balloon aortic valvuloplasty]. The severe complication rate was 0.65% (39/6029). The procedure-related mortality rate was 0.08% (5/6029), 0.26% (2/761) post percutaneous balloon pulmonary valvuloplasty, 0.05% (1/2070)post PDA occlusion, 9.10% (1/11) post balloon atrial septostomy, 33.33% (1/3) post percutaneous balloon aortic valvuloplasty. Emergency Cardiovascular surgery rate was 0.22% (13/6029). Selective surgery was required in 0.13% (8/6029)of patients post procedure. Two patients (0.03%) received permanent pacemaker implantation. Conclusions The severe complications and mortality rate of interventional therapy for CHD are relative low. Post procedure follow-up is needed fro monitoring possible procedure-related complications.

Objective To investigate the antibacterial resistance in nationwide's tietiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations (MICs) were tested using agar dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2017 guideline.Results A total of 4333 pathogenic isolates from 18 tertiary hospitals in 18 cities nationwide over the period from July 2015 to June 2016 were studied.Based on the MIC results,Escherichia coli and Klebsiella pneumoniae showed extended spectrum β-lactamase (ESBLs) phenotype rates of 59.4％ and 27.5％,respectively;decreased by 7 to 10 percentage points comparing the last time.Carbapenems,amikacin,moxalactam,β-lactam/β-lactamase inhibitor combinations,tigecycline,and fosfomycin displayed desirable antibacterial activity against Enterbacteriaceae,but a significant increasing of carbapenems resistance Klebsiella pneumoniae were noted.For non-fermenting Gram-negative isolates,resistance rate of Pseudomonas aeruginosa and Acinetobacter baumannnii to imipennnem were 29.5％ and 69.8％ and multidrug-resistant (MDR) detection rate were 35.6％ and 78.3％,extensively drug-resistant (XDR) were 10.2％ and 72.5％,respectively.Klebsiella pneumoniae isolated from children were more resistant to β-lactam than those from adults and the old people,so bacterial resistance in children is an important problem in China.Conclusion Though the decline of ESBLs detection rate,carbapenem non-susceptible Klebsiella pneumoniae rates continued to increase,which should be paid more attention.

Objective To investigate the gram-positive coccus resistance in nationwide's tietiary hospitals and understand the trend of antimicrobial resistance.Methods All the clinical isolates were collected from 18 hospitals and the minimal inhibitory concentrations (MICs) were tested using agar/broth dilution method recommended by Clinical and Laboratory Standards Institute (CLSI) in central laboratory.The susceptibilities of isolates to antimicrobial agents were determined by using CLSI or European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2017 guideline.Results A total of 2301 Gram-positive cocci isolated from 18 hospitals in 18 cities nationwide were studied.Based on the MIC results,the prevalence of methicillin resistant Stapylococcus aureus (MRSA) and methicillin resistant Stapylococcus epidermidis (MRSE) were 39.9％ and 86.6％ respectively.No vancomycin insensitive Staphylococcus was detected.Staphylococcus aureus were 100％ susceptibile to linezolid and teicoplanin,but resistant or insensitive for drugs other than vancomycin were observed among Coagulase Negative Staphylococci (CoNS).Antibiotic resistance rate of Enterococcus faecalis and Enterococcusfaecium to ampicillin were 4.5％ and 85.1％.The detectation rate of vancomycin resistant Enterococcus(VRE) was 2.1％.Nonsusceptibility rate of Enterococcus faecalis to linezolid was 7.8％,showing slight increase than last time.The prevalence of penicillin nonsusceptible Streptococcus pneumoniae (PNSSP) was 6.6％ based on non-meningitis and parenteral administration criterion;while for cases of oral penicillin,the rate was 70.0％,was as flat as last time.There were no significant differenees of resistance rates of Stapylococcus aureus,Stapylococcus epidermidis Enterococcus faecalis and Enterococcus faecium among various groups such as different department,age,or specimen source.Conclusion Compared with past surveillance result,VRE detection ratio was steady,while MRSA detection ratio decreased.The emergence of resistance and non-susceptible strains to new antibiotics such as linezolid,tigecycline and daptomycin should be payed more attention.