Abstact:Objective To explore the clinical characteristics of biliary pancreatitis in children.Methods The clinical data from 10 children with biliary pancreatitis from January 2011 to July 2015 were retrospectively analyzed.Result In 10 children (2 males and 8 females), the average age was 6.1?±?4.9 years old, and the average hospital stay was 8.4?±?3.8 d. There were 4 cases of gallstone, 4 cases of cholestasis, 2 cases of calculus of bile duct, 2 cases of choledochocyst and 1 case of pancreatic divisum. Abdominal pain was the main clinical manifestation in these 10 children. All of them had elevated serum amylase, with the maximum value of 106-922 U/L. Six cases had elevated lipase of 22-2000 U/L. Six cases had abnormal serum alanine aminotransferase. Two cases had hypokalemia. One case had hypoglycemia. Four cases had acid-base imbalance. Abdominal ultrasonography showed pancreatitis in 4 cases. CT showed pancreatitis in all children. All of the children were treated by fasting, lfuid infusion, maintaining water and electrolyte balance, inhibiting gastric acid by omeprazole and inhibiting pancreatic secretion by octreotide. Nine cases were improved by conservative treatment and discharged, and one case was transferred to surgery. Conclusion The incidence of biliary pancreatitis in children is low. The clinical manifestation is atypical. Pancreatic duct abnormalities are more common in young children, in whom the effect of conservative treatment is relatively good.

Objective To investigate the clinical features of acute pancreatitis (AP) in children of differem age.Methods From January 2010 to December 2015,pediatric inpatients with AP were searched by pediatric inpatient medical records retrieval system.According to age,patients were divided into three groups:infant and toddler group (age 0 years to three years),preschool group (age ＞three years to six years) and school-aged group (age ＞ six years to 16 years).The clinical features,etiology and laboratory findings of differem age groups were retrospectively analyzed.One-way analysis of variation or rank sum test was performed for measurement data analysis.Chi-square test or Fisher exact probability test was used for the count data analysis.Results A total of 88 pediatric patients (male 38,female 50) were enrolled,and the mean age was (8.8±4.4) years.Infant and toddler group,preschool group and schoobaged group were 16,14,58 cases,respectively.The average days of hospitalization of infant and toddler group,preschool group and school-aged group were (8.4±1.9),(9.4±2.6) and (7.5± 2.5) days,respectively,and the difference was statistically significant (F=3.649,P=0.030).About 93.2％ (82/88) pediatric patients had abdominal pain.The incidence rate of epigastric distention of school-aged group (34.5％,20/58) was higher than those of infant and toddler group (2/16) and preschool-aged group (1/14).The rate of nausea/vomiting of infant and toddler group was significantly higher than those of preschool group and school-aged group (12/16,4/14 and 46.6 ％ (27/58),respectively),and the differences were both statistically significant (x2 =6.250 and 6.805,both P＜0.05).Biliary pancreatitis was the main etiology of infant and toddler group and preschool group,and the incidence was 6/16 and 6/14,respectively.Whereas,there was a variety of etiologies in school-aged group.There were 20 cases (22.7％) of severe AP.The severe cases were more in the infant and toddler group and preschool group (7/16 and 6/14,respectively),and less in school-aged group (12.1％,7/58).There was no statistically significant difference among the three age groups in blood amylase level,lipase level,white blood cells count,blood glucose level,blood calcium level and blood urea nitrogen (all P＞0.05).The percentage of obese children of school-aged group was significantly higher than those of infant and toddler group and preschool group (31.0％,18/58;1/16 and 1/14,respectively),and the difference was statistically significant (x2 =6.689,P=0.035).In addition,the level of serum total cholesterol of school aged group was higher than that of infant and toddler group and preschool group ((5.1±0.9),(3.9±0.6) and (4.8±0.8) mmol/L,respectively),and the difference was statistically significant (F =13.855,P＜ 0.01).The positive rates of abdominal ultrasound of infant and toddler group,preschool group and school-aged group were 5/16,4/14 and 21.1％ (12/57),respectively,and there was no statistically significant difference (x2 =0.889,P 0.706).The positive rates of magnetic resonance cholangiopancreatography (MRCP) of infant and toddler group and school-aged group were 4/4 and 5/6,respectively,and which were both higher than those of pancreases computed tomography (CT) examination (4/14 and 51.2％,22/43) and those of abdominal ultrasound (5/16 and 21.1％,12/57),and the differences were significant (x2 =6.655 and 15.207,both P＜0.05).Conclusions Obese children is more in school-aged children with AP.Children of this age should pay more attention to life style.Nausea or vomiting symptom is more obvious in the infant and toddler children with AP and the condition is more severe.If children of this age with unexplainable vomiting,AP should be considered.Biliary factors are more common in the infant and toddler children with AP.When children are suspected with abnormal structure of pancreatic and biliary ductal system,MRCP should be conducted.

Objective In order to raise the clinicians' recognition of biliary pancreatitis in children,the clinical features between children with biliary pancreatitis and those with non-biliary pancreatitis were compared.Methods In this retrospective study,a total of 88 children with acute pancreatitis(AP)were enrolled,who stayed at the Department of Pediatrics,Tianjin Nankai Hospital from January 2010 to December 2015.The clinical characteristics,biochemical index(amylase,lipase,glucose,calcium,hepatic and renal function)and imageology examination [pancreatic ultrasound,pancreatic computed tomography,magnetic resonance cholangiopancreatography(MRCP)] were analyzed and evaluated.The etiology of biliary pancreatitis was analyzed.In addition,the clinical features,laboratory examinations and imageology between the children with biliary pancreatitis and those with non-biliary pancreatitis were also compared.Then,multiple Logistic regression analysis was conducted to identify the factors which were significantly associated with biliary pancreatitis independently.Results Of the 88 cases,there were 68 cases of non-biliary pancreatitis,aged(9.5±4.2)years,and 20 cases of biliary pancreatitis,aged(6.7±4.5)years,who represented the plurality(22.7％),including 9 cases of anatomic abnormalities and 11 cases of choledocholithiasis,cholecystolithiasis and cholestasis.Compared with children of non-biliary pancreatitis,children with biliary pancreatitis had more severe condition,there was statistically significance between 2 groups(x2=23.313,P=0.000).However,there was no statistically significance between 2 groups related to the gender,course of disease,hospitalization time,body mass index(BMI)percentile and clinical symptoms(all P>0.05).Children with biliary pancreatitis showed higher levels of serum amylase,serum lipase and urine amylase than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-3.535,-3.980,-2.952,P=0.000,0.000,0.003).In addition,children with biliary pancreatitis had higher levels of alanin aminotransferase(ALT),aspartate aminotransferase(AST)than those with non-biliary pancreatitis,and there were statistically significances between 2 groups(Z=-5.625,-2.341,P=0.000,0.019).However,total bilirubin did not differ significantly between 2 groups(Z=-0.453,P=0.650).There was no statistically significance between 2 groups in relation to white blood cell count,C-reactive protein(CRP),lactate dehydrogenase(LDH),blood urea nitrogen(BUN),creatinine(Cr),calcium and glucose(all P>0.05).Of the 88 cases,all children with AP were fasting,fluid and electrolyte supplementation,acid suppression of omeprazole,and octreotide by conservative treatment,which was an inhibitor of exocrine pancreatic secretion.In addition,children with AP should be given intravenous antibiotics covering gram-negative bacteria in the early stage.Children with non-biliary pancreatitis had better prognosis than those with biliary pancreatitis,and there was a statistical significance between 2 groups(P=0.000).Children with non-biliary pancreatitis had lower recurrence risk than those with biliary pancreatitis,and there was a statistical significance between 2 groups(x2=4.778,P=0.044).The positive rate was higher by abdominal ultrasound(45.0％)and computed tomography(CT)(81.2％)in biliary pancreatitis group than those with non-biliary pan-creatitis group(17.9％,35.2％),and there were statistical significances between 2 groups(x2=4.782,10.554,P=0.029,0.002).However,there was no statistical significance in relation to MRCP between the biliary pancreatitis group(83.3％)and the non-biliary pancreatitis group(85.7％)(P=1.000).In multiple Logistic regression analysis,ALT was an independent predictor of biliary pancreatitis(OR=0.896,P=0.001).Conclusions ALT is the significant risk factor for predicting biliary pancreatitis over other etiology.A biliary cause should be suspected in children with AP who are presented with high levels of ALT.These findings will spur prospective studies to determine the optimal evaluation and management of children with biliary pancreatitis.

Objective To observe the effect of dexamethasone on the levels of IL-12 and IL-13 in bronchoaveolar la-vage fluid (BALF) and serum in rats with Mycoplasma pneumoniae (MP) infection. To explore the mechanism of treatment MP pneumonia by dexamethasone. Methods A total of one hundred rats were randomly divided into four groups:azithromycin in-tervened group (n=25); dexamethasone intervened group (n=25); azithromycin and dexamethasone combination intervened group (n=25);control group (n=25). The rat model of MP pneumonia was established by dropping pneumonia bacterial liquid to its nasal cavity on day 0, 1, 2, and 3. Four groups received different interventions at the second day when the model was estab-lished successfully. Amounts of IL-12 and IL-13 in BALF and serum were measured by ELISA, the inflammatory infiltration of lung tissues was evaluated on day 3, 5 and 8. Results Compared with the control group, the expression of IL-12 and IL-13 in se-rum and BALF in azithromycin intervened group and combination intervened group had a significant difference (P<0.05) on day 3, 5 and 8. Amount of IL-12 in serum in combination intervened group was higher than azithromycin intervened group on day 3, whereas IL-13 was lower than that in azithromycin intervened group (P<0.05). Conclusions Dexamethasone can relieve inflammatory infiltration of lung tissues in rats.

Objective To explore the clinical characteristics and the levels of interleukin-17 (IL-17) in Mycoplasma pneumoniae (MP) pneumonia patients with atopic sensitization.Methods One hundred and sixty-two patients with MP pneumonia were hospitalized at the Department of Pediatrics,Tianjin Nankai Hospital from October 2015 to December 2016.All children with MP pneumonia were evaluated and divided into 2 groups:the atopic group (atopic MP pneumonia children,n =50) and the non-atopic group (non-atopic MP pneumonia children,n =112).Furthermore,30 healthy children were also included in this study as healthy control group at the Department of Pediatrics,Tianjin Nankai Hospital at the same time.The clinical characteristics and laboratory data of MP pneumonia patients of 2 groups were recorded and analyzed.The levels of serum IL-17 of MP pneumonia patients were measured by using enzyme-linked immunosorbent assays.Results Children with atopic MP pneumonia had more severe pneumonia.At the same time,the number of cases of oxygen therapy and glucocorticoid treatment,the duration of glucocorticoid treatment and the history of previous asthma in the atopic group were higher than those in the non-atopic group,and there was statistical difference between 2 groups(all P ＜ 0.05).The level of serum total immunoglobulin E in the atopic group [230.5 (120.8,421.5) IU/mL] was higher than that in the non-atopic group [79.9 (46.1,125.3) IU/mL],and the level of serum lactate dehydrogenase(LDH) in the atopic group [(319.3 ± 118.9) IU/L] was higher than that in the non-atopic group [(255.5 ± 66.6) IU/L],and there were statistical differences between 2 groups (all P ＜0.01).The levels of serum IL-17 in the healthy control group,atopic group and non-atopic group were (60.2 ± 15.7) ng/L,(382.2 ± 181.7) ng/L and(532.3 ± 169.1) ng/L,respectively,and there were statistical differences among the 3 groups (F =105.668,P =0.000).Whereas,the level of serum IL-17 in the atopic group was lower than that in the non-atopic group,there was statistical difference between 2 groups (t =-3.861,P ＜ 0.01).Conclusion Atopy mav cause adverse effects on the childhood MP pneumonia.It was likely to be relevant to low levels of IL-17.

In order to control the quality of all parts of the process for culturing,preparing and using clinically the human embryo olfactory ensheathing cells (OECs),the conduct standard of culturing human OECs from olfactory bulb is formulated. Because the strict conduct process can reduce the human factor as much as possible and ensure the stability of the cell quality. Therefore,during the culturing process of human embryo OECs, as for the embryo sample of OECs from olfactory bulb,the standard of lab condition and cell culture must be set strictly. The key steps of conduct process must be regulated,the freezing and resuscitating process of OECs must be controlled,the test method for microbial contamination during cell culture must be proposed and the risk must be reduced,then the quality of the human OECs from olfactory bulb can be guaranteed during the clinical application.

Objective:To explore predictive value of arterial velocity-pulse index (AVI) and arterial pressure-volume index (API) for early atherosclerosis (AS) in middle-aged population.Methods:A total of 138 middle-aged patients hospitalized in our hospital from May 2016 to Nov 2016 were enrolled.According to coronary angiography (CAG) outcomes, they were divided into AS group (n=86) and non-AS group (n=52).Before CAG, AVI, API and brachial-ankle pulse wave velocity (baPWV) were collected in two groups.General data and arterial stiffness indexes were compared between two groups, and the correlation among AVI, API, baPWV and general data were analyzed.Results:Compared with non-AS group, there were significant rise in AVI [(20.4±4.2) vs.(22.8±5.3)] and baPWV [(14.0±2.5) m/s vs.(16.3±3.0) m/s] in AS group,P<0.01 both.AVI was significant positively correlated with age, SBP, DBP, mean arterial pressure (MAP), pulse pressure (PP), API and baPWV (r=0.219~0.471, P<0.05 or <0.01);API was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, brain natriuretic peptide (BNP), AVI and baPWV (r=0.213~0.726, P<0.05 or <0.01);baPWV was significant positively correlated with age, BMI, SBP, DBP, MAP, PP, AVI and API (r=0.201~0.472, P<0.05 or <0.01).Multi-factor linear regression analysis indicated that SBP was influencing factor for AVI (B=0.162,P=0.001), SBP, DBP and HDL-C were influencing factors for API (B=-0.166~2.146,P<0.05 or <0.01), SBP and HDL-C were influencing factors for baPWV (B=0.116,-3.009,P<0.01 both).Conclusion:Both elevated AVI and baPWV can predict atherosclerosis in middle-aged population

Objective To explore the status and influencing factors of sub-health in inpatient caregivers.Methods A total of 432 caregivers met the inclusion criteria were enrolled.Suboptimal health status questionnaire (SHSQ-25) was used to evaluate the status of sub-health.Sub-health was defined as SHSQ-25 score ≥ 35.100 people undertaking routine physical examinations were enrolled as control group.The incidence and influencing factors of sub-health in caregivers were analyzed.Results (1) The caregivers group valued higher in SHSQ-25score significantly (36.9 ± 8.6 vs.27.5 ± 13.0,P ＜ 0.05).The incidence of sub-health was obviously higher in caregiver group than that in control group (69.9％ vs.39.0％,P ＜ 0.05).(2) A significant difference in the SHSQ-25 scores between female caregivers and male caregivers was observed (37.9 ± 9.0 vs.34.6 ± 7.1,P ＜0.05).The SHSQ-25 score was positively related with age (r =0.578,P ＜ 0.05) and accompanying time (r =0.507,P ＜ 0.05).Parents,children,or spouses of patients got higher scores than other types of caregivers (38.1 ±8.1 vs.31.1 ±8.8,P＜0.05).(3) Among the sub-health caregivers,only 10.9％ of them were aware of their sub-health status.Conclusion The incidence of sub-health may be higher in inpatient caregivers than the general population.Gender,age,accompanying time,and the relationship between patients and caregivers may be influencing factors for sub-health.Effective action should be taken to improve the health status of caregivers.

Objectives Aiming at the current health management mode of chronic disease preven-tion and control as the focus of work, this paper was to evaluate the effect of chronic disease management-based education on clinical teaching and training in cardiovascular medicine. Methods Totally 54 students participating in internship training in Department of Cardiology, the Shanghai Ninth People’s Hospital be-tween July 2013 and Aug 2014 were enrolled. Twenty-eight students were taught by chronic disease man-agement-based method while twenty-six students were taught by traditional method. After the internship training in cardiology, final examination (theoretical exam, skill appraisal and case analysis) were compared between the two groups to assess the teaching efficacy. Questionnaire survey was employed to investigate student satisfaction with chronic disease management-based teaching method. Data were analyzed by SPSS 13.0 software. Quantitative data or enumeration data between two groups were compared by t-test or chi-square test respectively. Results There was no significant difference in the theoretical exam score between two groups (P=0.422). However, the scores of skill appraisal and case analysis in students taught by chronic disease management-based method were significantly higher than those in students taught by traditional method (P<0.05). Most students taught by chronic disease management-based method were satisfied with the novel teaching method. Conclusion In the course of clinical medicine education, the emphasis on the management of chronic diseases can not only significantly improve the quality of clinical teaching in car-diovascular medicine, but also lay the foundation for the implementation of the concept of chronic disease management.

ObjectiveTo explore the feasibility and potential benefit of olfactory ensheathing cell (OEC) intraspinal transplantation in the treatment of intractable chronic neuropathic pain after spinal cord injury (SCI).Methods17 patients, 15 male and 2 female, with intractable chronic neuropathic pain after spinal cord injury was treated by OEC implant from November, 2004 to November, 2007. The age ranged from 18 to 68 (mean 40.4) years. The etiology of cord impairment included car accidents, falls, radiation damage, machine extrusion, gun-shot, and diving. The patients suffered severe persistent pain for 6 to 309 (mean 102.2) months, and the time points when cell therapy were administrated in the patients ranged from 6 to 312 (mean 105.9 months) after their injuries. Olfactory bulbs were harvested and trypsinized down to single fetal OECs. They were cultured for 12～14 days before implant. The fetal OECs were transplanted by injection into spinal cord at opposing ends of the injury site. The degree of pain was assessed and compared before operation and long-term follow-up according to the International Association of Neurorestoratology Spinal Cord Injury Functional Rating Scale (IANR-SCIFRS), i.e., 0 point means extreme pain, uncontrolled; 1 point, severe pain, narcotics required; 2 points, mild pain, ordinary pain killer effective; 3 points, no pain.ResultsThe follow-up and pain reevaluation were performed at 0.5 to 88 months with an average of 17.5 months after cell transplantation. The mean score of pain amelioration is 1.2 points.ConclusionThe OEC intraspinal transplantation appears to have a promising role in treatment of intractable chronic neuropathic pain after SCI.