Objective To study the causes and methods of prevention and treatment of severe acute pancreatitis (SAP) complicated with postoperative duodenal fistula. Methods Twenty-two cases with severe acute (pancreatitis) complicated with postoperative duodenal fistula were retrospectively analyzed . Results Among 184 patients with severe acute pancreatitis undergoing operative treatment,duodenal fistula developed in 22 (patients),and in 15 of the 22 (patients), it occurred 2 weeks after operation.In 18 patients the duodenal fistula healed spontaneously with conservative therapy and 4 patients were cured by re-operation. Conclusions (Duodenal) fistula is related to early operation for SAP,peripancreatic infection,and improper placement of (drainage) tube at time of operation or (prolonged) (placement) of (drainage) tube.Most duodenal fistulas can be (spontaneously) cured by maintaining patent drainage around the fistula, actively controlling peripancreatic (infection), suppression of gastrointestinal secretion, and augmention of nutritional support.

Objective:To search for therapeutic effect of lidocaine in the treatment of acute episode of chronic asthmatic bronchitis.Methods:The 58 cases of patients with acute episode of chronic asthmatic bronchitis admitted to this hospital from August,2004 to July,2007 were divided into group A and group B.Besides group A with lidocaine and group B as control with sodium chloride solution,there were no difference in the other therapeutic measures between group A and Group B.Oxygen was used as the power of spray or aerosolizer,the flow volume of oxygen was 8-10L/min.Group A patients were given 5 milliliters of 2% lidocaine(100mg) by nebulized inhalation three times a day for three days,and Group B patients received 5 milliliters of 0.9% sodium chloride solution by nebulized inhalation three times a day for successive three days.The changes of heart rate,respiratory frequency,forced expiratory volume in one second(FEV1),peak expiratory flow(PEF),partial pressure of oxygen in artery(PaO2) and partial pressure of carbon dioxide in artery(PaCO2) were determined in the group A and B before and after the nebulized inhalation therapy.Results:The results of the heart rate,respiratory frequency,FEV1,PEF,PaO2 and PaCO2 before and after the treatment of the nebulized inhalation were showed as follows,improvement of heart rate and respiratory frequency was more significant in the group with the nebulized inhalation treatment of lidocaine than that in the group as control after 30 minutes,one day and three days of therapy(P

Objective:To discover the risk factors,clinical features,treatment and prognosis of fungal infection in the lungs.Methods:The data of 103 patients suffering from fungal infection in the lungs were analyzed retrospectively.Results:There were ninety percent(91/103) of patients with underlying diseases,mainly chronic obstructive pulmonary disease(COPD) and chronic cor pulmonale.68(66.02%) patients suffered from two or more than two kinds of underlying diseases.Type 2 diabetes also took an important position in all underlying diseases.Clinical manifestations of pulmonary fungal infection showed no specificity.X-ray appearance showed that bronchopneumonitis was predominated(60%).The fungal culture results showed that blastocystis was the major pathogenic fungus,including 73(70.8%)strains of Candida albicans,11(10.7%) strains of Candida tropicalis,10(9.7%) strains of Torulopsis glabrata,6(5.8%) strains of aspergilli and 3(2.9%)trains of mold fungus,and early diagnosis of this disease remained difficult.The results of sputum cultuer showed that 48(46.6%) patients suffered from pumomary fungal infection combined with other bacterial infections,such as Pseudomonas aeruginosa,Acinetobacteria,Methicillin-resistant Staphylococcus aureus(MRSA),Escherichia coli and so on.The mortality of pulmonary fungal infection in this group was high(21.36%).6 patients died from uncontrolled fungal infections in the lungs and other16 patients died from mutiple organ failure due to delayed antifungeal therapy.Conclusions:Pulmonary fungal infection with few specific clinical manifestations and high mortality was an important cause of secondary infections in the patients suffering from many kinds of diseases,which is worthy of more attention in clinic.

Objective　To study the role of α1-antichymotrypsin(α1-ACT)in the pathogenesis of childhood asthma for providing a theoretical base for prevention and treatment of childhood asthma. Methods　Levels of plasma α1-ACT in 30 asthmatic children and 30 healthy children were determined by rocket immunoelectrophoresis. Results　Plasma α1-ACT levels were higher in acute phase than in paroxysmal phase ［（0.4178±0.0815）vs(0.2865±0.0799), t=6.301,P<0.001］ and also higher in asthma group than in control group ［（0.4178±0.0815）vs(0.2876±0.0496),t=7.474,P<0.001］. The plasma α1-ACT levels in asthma group and control of paroxysmal phase were similor ［(0.2865±0.0799) vs (0.2876±0.0496),t=0.064, P>0.05］. The levels of plasma α1-ACT were higher in moderate and heavily attacked patients than that in mild attacked patients ［(0.4553±0.0758) vs (0.3249±0.0926),t=4.187,P<0.001］ and those in control group ［(0.4553±0.0758) vs (0.2865±0.0799),t=9.38,P<0.001］. Conclusion　α1-ACT is involved in pathophysiological course of childhood asthma. Measurement of plasma α1-ACT levels may be helpful in determining the state of the illness and to evaluate the severity and treatment of childhood asthma.

PBL works as a method based on problems,and its theory essence is the con-structivism.With the adjustment of the educational aim,the definition of faculty quality need change correspondingly.Under PBL medical education mode,"faculty"is no longer defined as the traditional"teacher",but as the promoter of medical knowledge for students and the participants of medical type reform.These two are the main characters of PBL medical faculty.

OBJECTIVE:To review the relationship between endothelial progenitor cells and the re-endothelialization of vascular prosthesis in order to find out some effective ways to solve the most frequent complications of asotransplantation,thrombogenesis and intima hyperplasia.DATA SOURCES:A computer-based online search was conducted to identify articles related to endothelial progenitor cells and the re-endothelialization of vascular prosthesis published in Pubmed,Ovid and MD Consult database from January 2000 to December 2006 using the key words of "endothelial progenitor cells,vascular prosthesis,endothelialization".Meanwhile,CNKI database was searched for related papers published between January 2000and December 2006,the keywords were "endothelial progenitor cells,vascular prosthesis,endothelialization" in Chinese.STUDY SELECTION:The literatures included all the related papers about the roles of endothelial progenitor cells in the re-endothelialization of vascular prosthesis.Inclusive criteria:the study types were randomized controlled trials,drug stress test and clinical drug effect test; the samples were both human and animals.Exclusive criteria:Reviews and literatures without controls were excluded.DATA EXTRACTION:Totally 115 related literatures were collected,and 24 were accorded with the inclusive criteria.The excluded were 91 papers of reviews and repeated trials or drug effect studies.DATA SYNTHESIS:These related literatures,including not only animal experiments but also clinical detections,analyzed the relationship between endothelial progenitor cells and the re-endothelialization of vascular prosthesis and correlative promoting mechanisms.CONCLUSION:It is concluded that endothelial progenitor cells play an important role in the endothelialization after vascular prosthesis is grafted in vivo.

Intestinal tract is one of the target organ during surgical stress. When surgical stress becomes overwhelming , the integrity of intestinal mucosal barrier is destroyed. Microorganisms and toxin in the intestinal tract then enter blood circulation through the permeable intestinal mucosa, and trigger SIRS and MODS, This processes reversely aggravate intestinal mucosal necrosis and bacterial translocation, and lead to a vicious cycle. Radical total gastrectomy is a major surgical stress. After extensive abdominal surgery, cytokines and inflammatory mediators may cause intestinal mucosal edema, increased intestinal permeability, intestinal villus height reduced, shrinkage of mesenteric blood vessel, reduced blood flow, and intestinal barrier functional deterioration. Whereas ulinastatin can protect intestinal barrier function by reducing surgical stress,alleviating SIRS and improving immunity etc. This article reviewed the investigations of ulinastatin influencing the recovesy of intestinal barrier function after surgical stress.

Objective: To evaluate the role of enteral nutrition with dietary fiber and medium chain triglycerides in postoperative patients with gastric cancer. Methods: Forty patientswith gastric cancer receivedenteral diet with dietary fiber and medium chain triglycerides for 7 days. Enteral feeding was initiated 48hours after surgery. Host biochemistryindicators, nutritional parameters and immunity were monitored. Results: With surgical trauma, patients'nutritional status and immunity were impaired, and after nutritional support, the nutritional and immune parameters increased significantly. Conclusions: In postoperative patientswith gastric cancer, enteral nutrition with dietary fiber and medium chain triglycerides can improve the nutritional status and immunity.

Due to unknown onset time, patients with wake-up stroke and unknown onset stroke areoften excluded from thrombolytic therapy. However, many clinical studies have shown that multimodal imaging techniques can effectively guide wake-up stroke and unknown onset stroke for intravenous thrombolysis. Its endovascular treatment has also made some progress. This article mainly reviews the imaging findings, intravenous thrombolysis, and endovascular therapy in patients with wake-up stroke and unknown onset stroke.

To study the stability of fal emulsion in all types of AU-in-One nutrient admixtures prepared from on morket fat emnlsions and new MCT/LCTs. Admixtures were prepared from domestic fat emulstions and MCT/LCTs separately with amino acids,dextrose,vitamins, electrolyltes and trace elements. They were stored for one day at 25℃ followed by one day at 25℃ and eight days at 4℃. Admixtures of control group were prepared with fat emulsions and MCT/LCTs of other manufacturers and stored under the same conditions. Particle size and distribution, mass percentage of larger particles to theroretical total iol volume were measured by using light seattering spectrophotometer and coulter multisizer accucomp. Osmolality and pH of the samples were also measured. Stability of the all-in-one admixtures was monitored. The results showe that, compare with the control products, the particle size and distribution of domestic fat emulsions and MCT/LCTs, pH and osmolality of the admixtures remained stable during observation.