Objective To analyze and compare the effect of early surgical treatment and nonsurgical treatment for patients with severe acute pancreatitis.Methods Acccording to the including criteria,five randomized controlled trials of this topic were enrolled into the analysis.The detail about the trial design,characters of the subjects,results of the studies were reviewed and analysed by using Revman 4.2 software.Results Compared with nonsurgical treatment,early surgical treatment was associated with a significantly higher(incidence) of mortality(RR 3.42,95% CI 1.81～6.47,P=0.0002) and complications(RR 3.16,95% CI 2.15～4.64,P

Objective To use the colloidal gold immunochromatography (GICA ) method to conduct the methodological prelimi-nary evaluation on pepsinogen Ⅰ (PGI) reagent kit .Methods The method provide by the Preliminary Evaluation of Clinical Quan-titative Experimental Methods :Approval Guide Second Edition (EP10-A2) formulated according to the Clinical Laboratory Stand-ards Institute (CLSI) was used to continuously detect the low ,moderate and high concentrations of serum for 5 d ,Then the related data were collected for analyzing the dispersion degree ,linearity ,offset ,precision and so on .Results The PGⅠ quality control ser-um (concentration 25 ,50 ,100 μg/L) was detected at low ,medium and high concentration levels ,the linear regression equation ob-tained by analysis was Y=0 .9939X+0 .7433 ,correlation coefficient (R2 )=0 .9992 ;the offsets were 0 .37 ,0 .77 ,0 .78 μg/L re-spectively ,total imprecision was 3 .04% ,1 .17% and 1 .08% respectively .Conclusion The GICA related technical indicators of PGⅠreagent kit reach the standards of EP10-A2 document ,the detection results are accurate with high sensitivity and good stability , and conform to the requirements of clinical applications .

Background: Integrative traditional Chinese and western medicine may be a new approach to improve the eradication rate of Helicobacter pylori (Hp).Aims: To compare the efficacy and safety of Weifuchun tablet versus bismuth combined with standard triple regimen as the first-line therapy of Hp infection.Methods: A total of 141 patients with Hp infection and na(i)ve to treatment were randomly assigned into 3 groups receiving a 14-day eradication therapy.In standard triple therapy group, esomeprazole, amoxicillin and clarithromycin were given twice a day;while in Weifuchun group and bismuth group, Weifuchun tablet and bismuth potassium citrate were added, respectively, to the standard triple therapy.Hp eradication was assessed by 13C-urea breath test at least 6 weeks after the end of treatment.Hp isolates were tested for resistance to antibiotics.Results: One hundred and twenty-eight patients completed the study.Hp eradication rates in Weifuchun group, bismuth group and standard triple therapy group were 83.7%, 91.8% and 79.1%, respectively by ITT analysis and 88.4%, 97.8% and 84.6%, respectively by PP analysis.The eradication rate of Weifuchun group was lower than that of bismuth group and higher than that of standard triple therapy group, but the differences were not statistically significant (P>0.05).Only PP eradication rate of bismuth group was significantly higher than that of standard triple therapy group (P<0.05).The resistant rates of Hp to clarithromycin, amoxicillin and metronidazole were 33.3%, 2.9% and 70.5%, respectively.For eradication of clarithromycin resistant strains, bismuth group was superior to Weifuchun group and standard triple therapy group (100% vs.60.0% and 66.7%, P all <0.05).All three eradication regimens showed good compliance, and no significant difference in incidence of adverse events was found between the three regimens (P>0.05).Conclusions: Weifuchun tablet combined with standard triple regimen is safe and effective for use as first-line treatment for Hp infection, however, the eradication rate is relatively low in cases infected with clarithromycin resistant strains.Bismuth combined with standard triple regimen is a good alternative in areas with high clarithromycin resistance and regions where tetracycline is unavailable.

OBJECTIVETo observe the clinical effect of Shen-reinforcing and menstrual cycle-regulating therapy (SRMCRT) combined with Western medicine (WM) in treating decline in ovarian reserve (DOR).

METHODSTotally 78 patients with DOR were assigned to the traditional Chinese medicine combined WM group (abbreviated as IM group, 40 cases), and the WM group (38 cases) according to random digit table method. Patients in the WM group were treated with hormone replacement therapy, while those in the IM group additionally received SRMCRT. The therapeutic course for all was 3 consecutive months. The therapeutic efficacy was compared between the two groups. The serum levels of follicle stimulating hormone (FSH), FSH/luteinizing hormone (LH), and estradiol (E2), as well as the development of sinus follicles were compared between before and after treatment in the two groups.

RESULTSThe therapeutic effective rate was 92.5% in the IM group, higher than that of the WM group (73.68%, P < 0.05). The serum levels of FSH, FSH/LH, and E2 decreased (P < 0.05) and the number of the sinus follicle increased (P < 0.05) in the two groups after treatment. Besides, IM was superior in decreasing serum levels of FSH and FSH/LH, and increasing the number of the sinus follicle (P < 0.05).

CONCLUSIONSSRMCRT was an effective method for treating ROD. IM was superior in decreasing serum levels of FSH and FSH/LH, and increasing the number of the sinus follicle.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Estradiol ; blood ; Female ; Follicle Stimulating Hormone ; blood ; Hormone Replacement Therapy ; Humans ; Integrative Medicine ; Luteinizing Hormone ; blood ; Ovarian Diseases ; drug therapy ; Ovarian Follicle ; drug effects ; Ovarian Reserve ; Young Adult

Objective To explore the clinical effects of correction the midface depression.Methods From Aug.2010 to Aug.2015,185 cases of midface depression (aged from 18 to 61 years)were corrected by using structural fat grafting technique,the site and volume were placed as follows,tear trough 1ml,lid cheek groove 2 ml,midcheek groove 0.5 ml,anteriorcheek 4-8 ml,nasolabial fold 1-2 ml,nasal alar base 1-2 ml,evator labii superioris 1-2 ml,zygomaticus major 1-2 ml,buccinator 1-3 ml,and upper lip 3-5 ml.Results 185 cases were followed from 3 months to 3 years and the results were evaluated by visual analogue scales;156 cases of midface depression were corrected after the first structural fat grafting,the midface changed from concave to convex,and acquired prominent malar became more attractive;satisfaction of visual analogue scales were more than 80 ％;only 12 cases needed a second grafting.Conclusions The midface concavity can be corrected effectively by using structural fat grafting technique,the results are satisfied and the technique is safe,simple and effective.

Objective To explore the incidence and possible risk factors of restless legs syndrome (RLS) in the maintenance hemodialysis patients.Methods A total of 375 maintenance hemodialysis patients were enrolled in this study from September 1 to 30 in 2012.The diagnosis and assessment of severity were based on the International Restless Leg Syndrome Study Group (IRLSSG) standard.The relevant laboratory parameters and dialysis indicators were collected,such as hemoglobin,serum ferritin,parathyroid hormone,blood flow and dialysis mode.The clinical data were analyzed by multivariate logistic regression method.Results The incidence of RLS was 13.3％ with the severity score of 18.69 ± 0.95.The logistic regression analysis showed that anuria (OR 0.292,95％ CI 0.114-0.750) and β2 microglobulin(OR 1.023,95％C1 1.003-1.044) were the risk factors for RLS in the maintenance hemodialysis patients,while hemoglobin,serum iron and parathyroid hormone were not correlated with RLS.Conclusions The incidence of RLS is high in the maintenance hemodialysis patients.The risk factors of RLS are anuria and β2 microglobulin.Therefore,the preservation of residual renal function and the improvement of dialysis adequacy,especially the removal of the middle molecular weight toxins,may reduce the occurrence of RLS and improve the quality of life in the hemodialysis patients.

Objective Antibiotic resistance has increasingly been recognized as the major cause of treatment failure for Helicobacter pylori infection. The study was designed to compare the propensity of Helicobacter pylori to develop in vitro resistance to five commonly used antibiotics and to investigate the rates of resistance to these five antibiotics. Methods The serial passage tests were done in 7 sensitive Helicobacter pylori strains (2 type strains and 5 clinical isolates) to induce the resistance to amoxycillin, tetracycline, furazolidone, metronidazole or clarithromycin in vitro. The agar dilution tests detecting the minimal inhibitory concentration (MIC) were performed in 165 strains of Helicobacter pylori isolated from 2000 to 2001 to determine the resistance rates to the 5 antibiotics mentioned above. Results Serial passage tests showed that 5 of 7 strains of Helicobacter pylori were induced to be resistant to metronidazole and tetracycline; the inducible multiple of metronidazole was the highest. No strain was induced to be resistant to clarithromycin, but the inducible multiple of one strain was relatively high. No strain was induced to be resistant to amoxycillin or furazolidone, and the inducible multiple of furazolidone was the lowest. The resistance rates of Helicobacter pylori to metronidazole, clarithromycin, amoxycillin, tetracycline and furazolidone were 49.7% (82/165), 7.3%(12/165), 1.2% (2/165), 2.4%(4/165) and 1.2%(2/165), respectively. Conclusions Our study indicate that it is quite easy to induce the resistance to metronidazole,not difficult to clarithromycin, and relatively difficult to furazolidone or amoxycillin. The relative degree of difficulty in inducing the resistance to the drugs other than tetracycline is associated with the resistance rates detected, the fact that may help predict the changing trend of resistance rates in general population.

Objective:To conduct health economic evaluation of Chinese population-based screening and opportunistic testing strategies for the prevention of Helicobacter pylori ( H. pylori)-related diseases. Methods:The Markov models of H.pylori infection caused non-ulcer dyspepsia, peptic ulcer (PU) and gastric cancer were established. The cost and effects of the population-based screening, opportunistic testing, and non-intervention strategies in 100 000 population of our country were simulation calculated. Wilcoxon signed rank test was used for statistic analysis. Single factor sensitivity analysis was performed to analyze the impact of single parameter uncertainty on cost-effectiveness. Probability sensitivity was used to analyze the impact of common uncertainty of all parameters on cost-effectiveness. Results:Compared with opportunistic testing strategy and non-intervention strategy, the total cost of population-based screening strategy was reduced by 0.43 million yuan(-6.63 million yuan to 7.19 million yuan) and 4.45 million yuan(-8.60 million yuan to 27.93 million yuan), quality adjusted life years (QALY), life years and asmptomatic months were prolonged by 888.00 (479.86 to 1 574.10) and 3 032.78 (1 756.04 to 5 007.84), 651.82 (294.73 to 1 211.94) and 1 868.64 (1 045.88 to 3 148.34), 28 381.91 (19 109.54 to 43 736.72)and 102 537.13 (58 649.18 to 176 868.77) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 115 cases(52 cases to 232 cases) and 464 cases(266 cases to 803 cases), 74 cases(33 cases to 148 cases) and 260 cases(149 cases to 453 cases), 46 cases(25 cases to 72 cases) and 369 cases(210 cases to 710 cases), 80 cases(42 cases to 126 cases) and 501 cases(331 cases to 772 cases) respectively, and the differences were statistically significant ( Z=1.99, 10.54, 27.39, 27.39, 27.37, 27.39, 27.39, 27.39, 27.21, 27.28, 27.22, 27.28, 27.38, 27.39, 27.39 and 27.39, all P<0.05). Compared with the non-intervention strategy, the opportunistic testing strategy reduced the total cost by 3.89 million yuan(-2.79 million yuan to 18.18 million yuan), QALY, life years and asymptomatic months were prolonged by 1 764.77 (888.70 to 3 406.62), 1 044.16 (524.46 to 1 912.75) and 62 568.69 (30 054.07 to 129 892.76) respectively, gastric cancer, deaths from gastric cancer, deaths from PU and deaths from various causes were reduced by 311 cases(164 cases to 563 cases), 164 cases (87 cases to 301 cases), 325 cases(162 cases to 644 cases) and 399 cases(234 cases to 684 cases) respectively, and the differences were statistically significant ( Z=14.20, 27.39, 27.38, 27.39, 27.25, 27.25, 27.39 and 27.39, all P<0.01). The results of singlefactor sensitivity analysis showed that the uncertainty of any parameter did not affect the cost-effectiveness of three strategies. The results of probability sensitivity analysis indicated that the probability of cost-effectiveness advantage of the population-based screening strategy was 100% and the common uncertainty of all parameters had no effect on cost-effectiveness. Conclusions:For preventing H.pylori-related diseases, the population-based screening strategy has the lowest average cost and the best average effect. However, non-intervention strategy has the highest average cost and the worst average effect. Population-based screening strategy is worthy of promotion throughout China, and opportunistic testing strategy has a higher clinical practical value.

Objective To evaluate the clinical significance of fetal nasal bone absence and thickened nuchal translucency ( NT) at 11-13 +6 weeks ultrasound screening .Methods A total of 4200 pregnant women with single fetus registered at Mother and Children ’ s Health Care Center in our hospital were examined at 11-13 +6 gestational weeks .Both fetal nasal bone and NT ultrasound evaluation were offered to assess whether nasal bone is absent and NT is thickened (>3.0 mm) in these cases.Particular attention was paid to the relationship between abnormal findings ,karyotype and pregnancy outcome .Results In all, 3492/4200 cases were included in the study with both NT measurement and nasal bone evaluation .Seven hundred and night cases were excluded because of unavailable clinical outcome .Among 3492 fetuses:(1) There were 3 cases absent of nasal bone .Among the 3 cases without nasal bone , 2 cases ( 1 case combined with thickened NT ) were trisomy 21(66.7%,2/3).(2) There were 351 cases with NT>3.0 mm (10.1%,351/3492).Among the 351 cases with thickened NT,there were 4 with trisomy 21 syndromes (1.14%,4/351,1 case combined with nasal bone absence ),1 with trisomy 18 syndrome,1 with Turner syndrome,6 with structural anomalies but normal karyotype (1.71%,6/351).(3)Among the 3139 cases with normal nasal bone and NT ,there were 8 cases with chromosomal or structural anomalies .Conclusions Absent nasal bone and thickened NT are important markers of trisomy 21 in the first trimester ultrasound screening .Thickened NT has significant correlation with other fetal chromosomal and structural anomalies .

Objective: To investigate influence of isometric exercise (IE) training on number of endothelial progenitor cells (EPCs) and level of vascular endothelial growth factor (VEGF) of circulating blood in patients with coronary chronic total occlusion (CTO). Methods: A total of 20 CTO patients were divided into training group (n=10) and control group (n=10). Both groups received routine medication for three months, training group also received three-month IE training (maximal handgrip was used to induce maximum IE of upper limb muscles, leading to temporary physiological ischemia of skeletal muscle),while control group remained sedentary without exercise training. Flow cytometry was used to measure number of blood EPCs, and enzyme linked immunosorbent assay (ELISA) was used to measure serum concentration of VEGF. Results: Before treatment, the differences of levels of blood EPCs and VEGF between two groups were no significant（P>0.05）. Compared with before treatment, there were significant increase in blood number of EPCs [(0.028±0.009)% vs. (0.044±0.016)%] and VEGF concentration [(65.3±15.1) pg/ml vs. (98.5±17.4)pg/ml] after three-month treatment in training group (P=0.015, P<0.01), and they were significantly higher than those of control group after treatment. Compared with before treatment, there were no significant difference in blood number of EPCs and concentration of VEGF after treatment in control group, P>0.05. The blood numbers of EPCs were positively correlated with VEGF concentration in training group and control group (r=0.727, r=0.785, P<0.05 both). Conclusions: Isometric exercise training can increase blood number of EPCs and VEGF concentration in coronary CTO patients, which may contribute to collateral angiogenesis in remote ischemic myocardium.