Acute pancreatitis is one of the most common acute abdominal disease requiring acute hospitalization worldwide.As severe acute pancreatitis associated with mortality up to 30％,rational diagnosis and management requires up-to-date evidence-based treatment guidelines.The Guidelines for the surgical management of acute pancreatitis composed by the International Association of Pancreatology (IAP) was published in 2002,since then there have been substantial improvements in the management of acute pancreatitis.The collaboration of the IAP and the American Pancreatic Association (APA) was undertaken to revise these guidelines using an evidence-based approach in 2013 and published their new guidelines 2013 IAP/APA evidence-based guidelines for the management of acute pancreatitis few months ago.This paper presented the understandings of this new guidelines and compared with related guidelines abroad.

Objective To investigate the mechanism of acute patella bone cartilage fracture,and further study its diagnosis and treatment of clinical significance.Methods Collecting 21 cases of the acute patella bone cartilage fracture from July 2005 to December 2007.Eleven patients were male and ten were female,with the mean age of 31.6 (16～46) years.All the patients were treated using the arthroseopic microfracture technique after MR examination.Results All patients were followed up 6 to 18 months,did not show patellofemoral joint pain. Evaluated by Tagner rating,excellent outcomes were found in 17 cases,good in 4 cases,satisfactory results in 100% cases.Conclusion The arthroscopic microfracture technique in treatment of the patella cartilage fracture method is simple,easy to operate,can significantly improve knee function and pain,as well as the quality of life.

Objective To investigate how to prevent deep-vein thrombosis(DVT) after total knee replace-ment(TKR).Methods Deep vein thrombosis in 87 patients after TKR from 2004 to 2007 in the Third Hospital Affiliated to Suzhou University was retrospectively analyzed.Results Amony the 87 patients,13 were found having deep vein thrombosis,5 of 38 using low-molecular-weight beparin after TKR having deep vein thrombosis,6 of 35 cases using aspirin after TKR having deep vein thrombosis,5 of the 10 eases using mechanical preventive measures having deep vein thrombosis.The difference between low-molecular-weight heparin and aspirin group was not statistically significant.Conclusion Using low-molecular-weight heparin before TKR can prevent the occurrence of deep-vein thrombosis.Using epidural anesthesia,and a low-molee-ular-weight heparin drugs or aspirin after TKR can better prevent the formation of deep-vein thrombosis.

Objective To evaluate the rationale of pancreatoduodenectomy for the treatment of chronic local pancreatitis in the head of pancreas.Methods Eleven patients underwent pancreatoduodenectomy for chronic local pancreatitis in the head of pancreas with 7 cases treated by Whipple′s operation and 4 by pylorus preserving pancreatoduodenectomy.Results Postoperative stress ulcer and wound infection occurred and were cured subsequently in one each.Postoperative follow up showed good quality of life in all the 11 patients.Conclusions Pancreatoduodenectomy is an effective cure for patients suffering from chronic local pancreatitis of the head of the pancreas refractory for conservative therapy.

0. 05). No significant difference was found in maternal and neonatal complications between the ANCA( + ) and ANCA(－) subgroups in S-PE subjects. But those 4 cases who developed renal function insufficiency patients were ANCA( + ). Conclusions ANCA might be associated with renal diseases in preeclampsia women, and further studies is required to determine whether ANCA is involved with the pathogenesis of preeclampsia.

We report a case of a 35-year-old right-handed male patient with drug-resistant mesial temporal lobe epilepsy who developed ipsilateral occipital hematoma after right temporal anterior lobectomy and amygdalohippocampectomy. Patient did not report taking any drugs with anticoagulant effect, such as aspirin or valproate. There was no past history of hypertension and the pre-operation tests were normal. Pre-operative brain magnetic resonance imaging revealed no abnormality in the right occipital lobe. Overdraining of cerebrospinal fluid may have triggered this remote cerebellar hemorrhage.

Objective To evaluate the efficacy of anterolateral decompression and internal fixation on the treatment of old thoracolumbar vertebrae fracture with associated incomplete paraplegia. Method the clinical findings of 26 cases with old thoracolumber vertebrae fracture with associated incomplete paraplegia treated by anterolateral decompression and internal fixing were reviewed retrospectively. Results All cases were followed up for 6 months through 2.5 years. The angle of kyphosis was 23?preoperatively and 6?postoperatively. According to Frankel's grading, there were two cases at grade A, three at grade B, five at grade C, seven at grade D, nine at grade E before operation and one at grade A, three at grade B, four at grade C, six at grade D and 12 at grade E after operation. Conclusion Anterolateral decompression and internal fixation is the treatment of choice for the old thoracolumber vertebrae fracture associated with incomplete paraplegia, especially for spinal deficit generated by displacement of the middle column.

Objective To detect the expression of osteopontin (OPN) in cervical local tissues of patients with chronic cervicitis, cervical intraepithelial neoplasia (CIN), cervical cancer. To investigate the possibility that OPN is used as tumor marker of cervical cancer. Methods The expression of OPN in 25 cases of chronic cervicitis, 18 cases of CIN and 21 cases of cervical cancer was detected by immuohistochemistry SP method. Results The positive expression rates of OPN in the chronic cervicitis, CIN and the cervical cancer had a rising trend (48 %, 77.78 % and 80.95 %, respectively) and their differences had statistical significant (P <0.05). The OPN expression level in cervical cancer had no statistical correlation with age, tumor size, clinical stage and other clinical pathological features (P >0.05). Although OPN expression level in cervical cancer wasn' t related with tumor clinical stage, positive expression rates of OPN had a gradually increased trend along with the clinical stage. Conclusion High expression of OPN is found in cervical cancer and may be related to the occurrence and development of cervical cancer.

Objective To investigate the mechanism that cause allelic dropout of amelogenin gene on X chromosome(Amel-X)when using routine Sullivan106/112 bp primer set in sex identification and discuss its influence on the forensic sex identification and the clinical diagnosis.Methods Amel-X dropout was validated with Sullivan212/218 bp and Haas-Rochholz80/83 bp primer sets.Amplification of amelogenin gene was used to analyze dropout of the Amex-X followed by sequencin.Results Sullivan212/218 bp and Hgas-Rochholz80/83 bp primer sets could be used to identify gender correctly.Three types of point mntation were observed in the forward primer binding region of the Sullivan106/112 bp primer set by sequencing in the lost Amel-X,including single point mutation at 2nd and 13th sites,respectively,and heterozygous multiple point mutations at 2nd and 13th sites.Conclusions Point mutation in the primer binding region may result in a failure to amplify amelogenin allele and thus lead to a null allele.This finding should be mid attention to because it may interfere with the sex identification.

Objective To study the impact of local fractionated irradiation on lung metastasis in H22-bearing mice, and to explore its mechanism involved. Methods Subcutaneous transplantation tumor model bearing with H22 was established. Mice were divided into three groups as healthy control, tumor control and irradiation groups. The size of subcutaneous tumors was measured and lung metastasis was observed. The expressions of PCNA, VEGF and MVD were detected immunohistochemically. The plasma levels of CD4 and CD8 were determined by using flow cytometry. Results The tumor size in irradiated group was smaller than that in tumor control group. The tumor inhibition rate in irradiated group was 30%.Lung metastasis in irradiated group was more severe than that in tumor control group (x2 = 8.31,4.48,9. 60, P＜ 0.05 ). The expressions of PCNA, VEGF and MVD in two groups were statistically different( t =23.78,-2.47, -6.43, P ＜ 0. 05). The levels of CD4 and CD8 in irradiated group were statistically different compared to healthy control group ( t = 4. 72 and 3.31, P＜ 0.05 ). Conclusions For the H22 model, radiation might inhibit the local transplantation tumor, but increase the risk of lung metastasis.