1.5 cm in diameter) are significant risk factors for the failure of stone clearance. Prophylactic cholecystectomy of an acalculous gallbladder is unnecessary.

Objective To investigate clinical value of procalcitonin (PCT ) in guiding treatment of infection in elderly patients with heart failure .Methods A total of 120 cases of elderly patients with heart failure and infection were divided into control group (50 cases) ,receiving conventional anti-infection treatment ,and observation group(70 cases) ,receiving adjusted anti-infection treat-ment based on serum PCT levels .Treatment efficiency ,cost of treatment ,hospitalization duration and other indicators were com -pared between the two groups .Results Effective rate of observation group was 78 .57% ,which was not significantly different with the 78 .00% of control group ( P > 0 .05) .Cost of treatment ,hospitalization duration ,application time of antibiotics ,antibacterial drug costs ,superinfection and mortality were significantly different between the two groups (P< 0 .05) .After treatment ,levels of e-rythrocyte sedimentation rate ,C-reaction protein ,white blood cells and neutrophil in the two groups were significantly improved (P< 0 .05) .After treatment ,C-reaction protein level of observation group was lower than control group (P < 0 .05) .Conclusion PCT based anti-infection treatment could help shorten the treatment time ,reducing treatment costs and improving outcomes ,and might be worthy of clinical application .

ObjectiveTo investigate the clinicopathologic features,therapy,and prognosis of primary small cell carcinoma of the pancreas.MethodsDatabases including Chinese Journal Full-text Database,VIP Database for Chinese Technical Periodicals,Medline/Pubmed,and OVID were searched electronically up to April 2012.A systematic review was performed together with one case in our hospital.ResultsTwenty-eight articles fulfilling the criteria consisting of 46 patients with pathologically confirmed diagnosis of primary small cell carcinoma of the pancreas were studied,together with 1 patient in our Drum Tower Hospital,finally 47patients were included.The results of this systematic review showed:( 1 ) Primary small cell carcinoma of the pancreas was more common in men with a median age of 62.The most common clinical presentations were abdominal pain,jaundice and weight loss.Para-neoplastic syndrome was rarely observed.(2)Most cases were found to have abnormally elevated serum levels of neuron-specific enolase.CT displayed heterogeneous,and marked enhancing masses in most cases.The conclusive diagnosis depended on histological confirmation.(3)63.8％ of the cases were found to be associated with metastasis at the time of diagnosis.The overall median survival time was 28 weeks.(4) There was no consensus on the treatment of primary small cell carcinoma of the pancreas. Chemotherapy was currently considered as the treatment of choice among the systematic management for these patients.ConclusionsPrimary small cell carcinoma of the pancreas was a rare and aggressive neuroendocrine tumor with a poor prognosis.

Clerkship teaching of neurology is one of the important contents in clinical neurological teaching.Application of problem-based learning in combination with heuristic teaching can mobilize the initiative of students,enlighten their thoughts,arouse their flexibility and creativity and deepen the understanding of knowledge so as to achieve the purpose of improving clinical teaching effects.

AIM To investigate the effects of trifluoperazine on naloxone precipitated withdrawal symptoms in morphine dependent rats and mice, and its pharmacological mechanisms. METHODS\ Naloxone precipitated tests in morphine dependent rats and mice were used. RESULTS\ Trifluoperazine(2～20 mg?kg -1 ) dose dependently inhibited naloxone precipitated withdrawal jumping, wet dog shakes, paw tremor and weight loss in morphine dependent mice. With ip trifluoperazine (5～20 mg?kg -1 ), most of positive withdrawal symptoms, including jumping, wet dog shakes, defeacation, weight loss, teeth chattering, salivation, diarrhea, ptosis and irritating, induced by naloxone in morphine dependent rats were significantly reduced. Apomorphine (2～8 mg?kg -1 ), a mixed DA 1/DA 2 receptor agonist, did not affect inhibition of trifluoperazine on naloxone precipitated withdrawal symptoms in morphine dependent mice. However, nifedipine(5～20 mg?kg -1 ), a L type voltage sensitive calcium channel blocker, enhanced a pharmacological action of trifluoperazine against naloxone precipitated symptoms in morphine dependent mice. CONCLUSION\ Trifluoperazine attenuates naloxone precipitated withdrawal symptoms in morphine dependent rats and mice by inhibiting the activity of post receptor calmodulin, but it does not antagonizes DA 2 receptor, in central nervous system.

Objective To analyze the etiology and clinical features of isolated gastric varices.Methods A retrospectives analysis was carried out in 31 patients with isolated gastric varices between January 2003 and January 2008.The patients records including data of etiology,clinical presentation,imaging studies and therapeutic modalities were reviewed.Results Those who had isolated gastric varices were accounted for 7.38 0A (31/420)of all patients with gastroesophageal varices.The etiologies were left-sided portal hypertension(14 cases,45.2%),liver cirrhosis(8 cases,25.8%),unknown origin(6 eases,19.4%),hepatocellular carcinoma(2 cases,6.5%),portal cavernous transformation(1 case,3.2%).Twenty-one patients(67.7%)had variceal hemorrhage.Splenomegaly was present in 21 cases(67.7%),among which 10 cases(32.3%)had concomitant hypersplenism.Venous involvement was identified in 18 patients(splenic vein obstruction in 9 cases and portal vein involvement in 9 cases).Surgical therapy was performed in 8 cases,selerotherapy in 3 cases,and medical therapy in 20 cases.Conclusions Left-side portal hypertension is responsible for most of the isolated gastric varices,and some of which are also caused by liver cirrhosis.Surgery is the appropriate procedure of choice in management of hemorrhage and recurrence.

Objective To investigate the changes in pentane (marker of lipid pemxidation) concentuation in the expired air induced by hepatic ischemia-reperfusion(IR)injury in rabbits.Methods Thirty healthy male Japanese white rabbits weighing 2.4-3.0 kg Were randomly divided into 2 groups(n=15 each):group Ⅰ sham operation and group Ⅱ hepatic IR.Anesthesia was induced with 3% pentobarbital 30mg/kg iv and maintained with The animals were tracheostomized and mechanically ventilated.Femoral artery and vein were cannulated for BP monitoring and blood sampling.Hepatic blood flow was occluded for 25 min followed by 180 min reperfusion.The expired air was collected before(baseline,T0)and at 1,10 and 25 min of ischemia and at 1,10,25,60,120 and 180 rain of reperfusion (T1-9) for determination of pentane concentration which was extracted by solid phase micro-extraction (SPME) and detected by gas chromatography-mass spectrography(GC-MS).Blood samples were also taken at the above time points for measurement of serm ALT,AST and SOD activities and MDA concentration.The animals were killed at the end of 180 min reperfusion.Liver specimens were obtained for histology.Results There was no significant difference in age,body weight,MAP and HR between the two groups.There was no significant change in pentane concentration in the expired air and the ALT,AST and SOD activities and MDA concentration at all time points as compared with the baseline in sham operation group.In IR group the pentane concentration in the expired air was significantly increased at T4,5 and the ALT and AST activities and MDA concentration were significantly increased and SOD activity was significantly decreased at T7-9 as compared with the basehne and the sham operation group.Conclusion The pentane concentration in the expired air can reflect the occurrence of lipid peroxidation during hepatic IR injury.

Objective To study the effect and possible mechanism of diazoxide on myocardial ischemia/reperfusion (I/R) injury in diabetic rats, and the influence of insulin intervention which aims to maintain blood sugar levels within the normal range on the protective function of cardiomyocytes. Methods 126 health male Sprague-Dawley (SD) rats were intraperitoneally injected with one dose of 60 mg/kg streptozotocin (STZ) to reproduce diabetic model. The diabetic rats were randomly divided into seven groups, with 18 rats in each group. Myocardial I/R model was established by 30 minutes ligation of the left anterior descending branch of the coronary artery, and 120 minutes blood circulation recover. Sham group was only threaded without ligation. Rats in I/R group, diazoxide group (DZ group), and Ottawa vine penicillin (WNT) group were infused intravenously with 2 mL of 0.1% dimethyl sulphoxide (DMSO), DZ (7 mg/kg), and WNT (15 μg/kg), respectively, after 25 minutes of ischemia. Sham group was only injected with 2 mL of 0.1% DMSO. DZ+WNT group was infused with WNT 5 minutes before the injection of DZ. Insulin intervention (RI) group received a continuous insulin infusion to maintain the blood sugar at the level of 4-6 mmol/L. RI+DZ group was infused with DZ after ischemia for 25 minutes based on blood sugar control. Hemodynamic parameters in each group were monitored continuously. The pathological changes of myocardium were observed with hematoxylin and eosin (HE) staining. The expressions of phosphorylated protein kinase B (p-Akt) and phosphorylated glycogen synthase kinase-3β (p-GSK-3β) were determined by Western Blot. Results Compared with sham group, the cardiac functions of the intervention groups were significantly decreased, and severe myocardial injury was observed. Compared with I/R group, the cardiac functions of intervention groups were not obviously improved. However, after insulin intervention by which blood sugar was maintained within normal range, the cardiac function and myocardial injury were further aggravated. Compared with sham group (the expression value of sham group was set as 1), the expressions of p-Akt in other groups including I/R group, DZ group, RI group, and RI+DZ group showed no statistically significant difference (gray value: 1.07±0.09, 1.03±0.07, 1.07±0.07, 1.02±0.08 vs. 1.00, all P > 0.05). However, the expressions of p-Akt were decreased in WNT group and DZ+WNT group as compared with those of sham group and I/R group (gray value: 0.54±0.06, 0.51±0.05 vs. 1.00 and 1.07±0.09, all P < 0.05). The expressions of p-GSK-3βshowed no statistically significant difference in I/R group, DZ group, WNT group, and DZ+WNT group as compared with sham group (gray value: 0.97±0.08, 1.00±0.11, 0.98±0.06, 0.97±0.09 vs. 1.00, all P > 0.05). However, the expression of pGSK-3β was increased in RI group, RI+DZ group as compared with sham group and I/R group (gray value: 1.68±0.08, 1.70±0.05 vs. 1.00 and 0.97±0.08, all P < 0.05), and it was significantly higher in RI+DZ group than that of DZ group (gray value: 1.70±0.05 vs. 1.00±0.11, P < 0.05). Conclusions Diazoxide after myocardial injury could not protect the myocardium from I/R injury in diabetic rats, and did not trigger the activation of the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Insulin intervention by which blood sugar was maintaine d within the normal range exacerbates myocardial I/R injury in diabetic rats.

Objective To study the content of volatile oil from old leaves, tender leaves, fallen leaves and seeds of cinnamomum camphora tree in Hunan, China. To prepare and identify the volatile oil of its β-cycoldextrin inclusion compound. Methods The volatile oil was extracted by water-steam distillation. With inclusion rate as the index, trituration method, saturated water solution method and ultrasound method were compared. The optimum conditions were investigated by the orthogonal test. The inclusion compound was identified by thin-layer chromatography (TLC), ultraviolet visible spectrum (UV-Vis) and differential scanning calorimetry (DSC). Results From June to July, the average content of volatile oil extracted from old leaves, tender leaves, fallen leaves and seeds were 1.58%, 1.52%, 0.84% and 1.39%, respectively. The optimum preparation conditions were as follows:the ratio of β-cyclodextrin and volatile oil was 10∶1, the adding water was 4 times and inclusing time was 2 h. Before and after inclusion, the spectrum of TLC and UV-Vis of volatile oil showed no obvious change. The DSC of inclusion compound,β-cycoldextrin, volatile oil and the mixture had significant differences. Conclusion The amount of the volatile oil from old leaves is higher. The optimized condition of inclusion is stable and reasonable.

Objective To investigate the causes of an outbreak of healthcare-associated infection with methicillin-resist-ant Staphylococcus aureus (MRSA)in a neurosurgical intensive care unit(NSICU).Methods Epidemiological investigation on 8 patients with lower respiratory tract infection (LRTI)in a NSICU between June 15 and June 28,2104 were performed by combination methods of prospective and retrospective survey.Results The attack rate of MRSA LRTI in NSICU patients was 22.86%,a total of 16 MRSA isolates were detected from patients’clinical specimens,nasal vestibule,as well as hospital surroundings during the period,pulsed-field gel electrophoresis (PFGE)result revealed that infection outbreak was caused by two subtypes of MRSA;risk factors analysis showed that long length of stay in ICU and aspiration of spu-tum through bronchoscopy were risk factors for MRSA LRTI.Conclusion Contamination of bronchoscope was the key factor for this epidemic spread of healthcare-associated MRSA infection.