Objective To investigate the prophylactic effects of pancreatic duct stenting (PDS) combined with non-storied anti-inflammatory drug (NSAID) on post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) in difficult bile duct cannulation .Methods One hundred and eight patients who experienced difficult bile duct cannulation during hospitalization from January 2012 to November 2016 in the Department of Gastroenterology of the hospital were enrolled for the study .The patients were ran-domly divided into 4 groups:i.e.Group A that underwent simple PDS , Group B that received NSAID , Group C that were treated with PDS combined with NSAID and Group D that had routine ERCP without preventive measures for PEP .The levels of serum amylase be-fore surgery, 4 and 24 hours after ERCP were observed closely .The scores of abdominal pain were evaluated by VAS method , and the levels of serum amylase , the rate of post ERCP and scores of abdominal pain after ERCP were compared between the 4 groups.Results Four hours after ERCP, serum amylase levels of group B and group C were all significantly lower that those of group D (P<0.05). Serum amylase levels of group A, B and C 24 hours after ERCP were all significantly lower that those of group D (P<0.05).The rate of PEP 24 hours after ERCP for group A and C was 0%, which was obviously lower than that of group D (7.4%)(P<0.05).The VAS scores of various groups 4 and 24 hours after ERCP were significantly higher than that before ERCP (P<0.05).The VAS scores of groups B and C 4 and 24 hours after ERCP were all significantly higher than that of group D (P<0.05), and the VAS scores of group B 4 and 24 hours after ERCP was obviously lower than that of group A (P<0.05).Only at hour 24 after ERCP, the VAS pain scores of group A were higher than that of group D (P<0.05).Conclusion After ERCP, pancreatic duct stenting combined with non-storied anti-inflammatory drug could reduce the rates of hyperamylasemia and PEP , as well as the scores of abdominal pain scores after ERCP, and also could effectively prevent the incidence of pancreatitis after PEP .

Objective To investigate the treatment method and effect of intensive early fluid resuscitation on the patients with severe acute pancreatitis ( SAP) in acute reaction stage .Methods Fifty-eight patients with SAP treated in the hospital from Aug .2008 to Mar.2010 were randomly divided into the treatment group (n=30) and the control group (n=28).The patients in the former group were given intensive early fluid resuscitation , either with hydroxyethylstarch and an increased amount of colloidal fluid or occasionally with a certain amount of plasma and albumin .Physiological saline and/or balanced salt solution were used as crystal fluid , with a ratio of 1∶2-1∶1.The patients in the latter group were supplemented or treated with an effective circulating blood volume and electrolyte im -balance correction .They were daily infused with a certain amount of plasma and albumin .Analyses were made on such reactions as re-spiratory failure , renal insufficiency and cardiac dysfunction in the acute reaction stage in patients with SAP .Results With regard to the incidence of complications during the acute reaction stage for the patients of the 2 groups, the incidence of respiratory failure , renal insufficiency and cardiac dysfunction in the patients of the treatment group was significantly lower than that in the patients of the control group, with statistical significance(P<0.05).With regard to the amount of daily fluid infusion for the groups during the acute reaction stage, the amount of infusion for the treatment group was significantly lower than that for the control group , with statistical significance (P<0.05).Conclusion Effective and active early fluid resuscitation during the acute reaction stage in SAP patients could decrease the incidence of complications .The supplementation of Hydroxyethylstarch and the increase in the ratio of colloidal fluid could produce better resuscitative effects on patients with SAP .

Objective To investigate the incidence of non-infectious diseases at different stages of a prolonged escort missiononboard the frigate.Methods The constituent ratio of non-infectious diseases occurred at different stages of a prolonged escort missionby a certain frigate was calculated,and the incidence of various non-infectious diseases at different stages was compared accordingly.Results For non-infectious diseases occurred during the whole course of the mission,the top 3 non-infectious diseases were lumbarmuscle strain,insomnia and motion sickness.Then came dermatitis,dental ulcer,xerophthalmia,trauma and cardiovascular diseases.The onset stages (early,middle and late stages)of various non-infectious diseases were different from one another.The incidence oflumbar muscle strain,insomnia,dermatitis,dental ulcer and xerophthalmia at late stage of the mission was significantly higher than thatat the early stage(P <0.01),and the incidence of motion sickness at the early stage was significantly higher than that at late stage(P <0.01).Conclusion With the extension of the escort mission,the incidence of lumbar muscle strain,insomnia,dermatitis,dentalulcer and xerophthalmia increased,while the incidence of motion sickness decreased.

Objective: To investigate the effects of andrographolide on extracellular signal-regulated kinase 1/2 (ERK1/2) signaling pathway and tumor necrosis factor-α (TNF-α) expression in lipopolysaccharide (LPS)-activated macrophages. Methods: LPS-activated mouse peritoneal macrophages were cultured in media with different concentrations of andrographolide. Cytotoxicity of andrographolide was detected by cell counting kit-8. The macrophages were lysed, and then expressions of phosphorylated ERK1/2, JNK and p38 and nuclear factor-κB inhibitor (IκBα) protein were detected by Western blotting and TNF-α mRNA expression was detected by reverse transcription-polymerase chain reaction. Supernatants of the macrophages were used to detect content of TNF-α protein by enzyme-linked immunosorbent assay. Results: Andrographolide at 1-100 μg/mL showed no cytotoxicity on LPS-activated mouse peritoneal macrophages. Andrographolide inhibited ERK1/2 phosphorylation in LPS-activated murine peritoneal macrophages, which was concentration-dependent (P<0.01). Andrographolide at 1-25 μg/mL had no effects on phosphorylation levels of JNK and p38 and IκBα degradation in LPS-stimulated mouse peritoneal macrophages. In activated macrophages, TNF-α expression was inhibited by 12 μg/mL andrographolide and 20 μmol/L PD98059 (inhibitor of ERK1/2 signaling pathway) at both mRNA expression and protein secretion levels. Conclusion: In LPS-activated macrophages, andrographolide may inhibit the expression of TNF-α by inhibiting ERK1/2 signaling pathway.

Objective To investigate the effects of macrophage inflammatory protein-1α (MIP-1α) combined with molecule 4-1BB L on the tumorigenicity of hepatocellular carcinoma cells in vivo. Methods Mouse MIP-1α (mMIP-1α) expressed Hepa 1-6 cells were transfected with m4-1BBL recombinant retrovirus, the anti-histidinol cells clones were selected and amplified. The expression of m4-1BB L was confirmed by flow cytometry. The growth curve of Hepa 1-6 cells transfected with mMIP-1α and m4-1BBL alone or together was drawn and compared. C57B/L Mice were randomly divided into 7 groups, 9 mice in each group, injected with mMIP-1α+m4-1BB L Hepa 1-6 cells, m4-1BB L Hepa 1-6 cells, mMIP-1α Hepa 1-6 cells, Hepa 1-6 cells, pLXSHD Hepa 1-6 cells or PBS respectively. The tumorigenicity of hepatocellular carcinoma cells and the mice survival rate were compared between each groups. Results Hepa 1-6 mMIP-1α+m4-1BB L cells which expressed both mMIP-1α and m4-1BB L were successfully established. The expression of mMIP-1α and m4-1BB L alone or together did not affect the growth curve of Hepa 1-6 cells. Observed for 5 weeks, no tumor developed in Hepa 1-6 mMIP-1α+m4-1BB L injected mice. The tumorigenicity of Hepa 1-6 mMIP-1α+m4-1BB L was lower than that of Hepa 1-6 mMIP-1α or Hepa 1-6 m4-1BB L in vivo. The survival rate of Hepa 1-6 mMIP-1α+m4-1BBL injected mice(9/9) was higher than that of Hepa 1-6 m4-1BB L injected mice (6/9)or Hepa 1-6 mMIP-1α injected mice (1/9). Conclusion Chemokine MIP-1α combined with costimulatory 4-1BB L lowered the tumorigenicity of hepatocellular carcinoma cells in vivo, and prolonged the mice survival period.

Taking Suxi Healthcare Center in Yiwu City, Zhejiang province as an example, the paper analyzed the present mission and organizational characteristics of township healthcare centers in China, especially their dual functionality of community public health and primary medicare. Based on such analysis, it designed a matrix-based model for organizational structure and job performance management for such heslthcare centers. The features are as follows. 1) The two dimensions of the matrix structure refer to the departments for medical treatment and the multi-village doctors team in the community, respectively and jointly offering primary medicare and public health services; 2) Jobs are designed based on the organizational structure and functionality. Every job carries out dual Junctions as described and managed by the job description and target responsibility certificate; 3) The job responsibility certificate is a breakdown of the balanced scorecard of the healthcare center, as divided between the departments for medical treatment and the multi-village doctors team; 4) The balanced scorecard of the township healthcare center is designed based on its strategic mission and developing plan. The entire organizational design and management of the center are built on the strategic orientation and logical programmed research.

Objective To investigate hypolipemic treatment of hyperlipidemic panereatiti(HLP)with integrated traditional Chinese and western medicine.Methods Cinical data of 20 patients of HLP were analyzed retrospectively.Eight patients in the control group were treated with conventional therapies,while 12 patients in the treatment group were treated as follows:①Enema with 180ml solution(50% magnesium sulfate 30 ml.Glycerin 60ml,water 90ml).②Rhubarb gastrogavage with 9 g tid.③Intravenous drip with 24 g salvia miltiorrhiza qd.Results The treatment group had significant difference comparing with the control group in terms of the serum TG in 48 hours(P<0.01),time of autonomous bowel movement recover(P<0.01),days of abdominal pain disappear(P<0.05),days of hospitalization(P<0.01).Conclusion The treatment of Enema with 180 ml solution.Rhubarb gastrogavage with 9g tid,and Intravenous drip with 24 g salvia miltiorrhiza qd can relieve the symptoms of HLP and decrease blood-fat greatly.

Objective To analyze the relationship between the change of serum vascular epidermis growth factor(VEGF) level and curative effect of pancreatic cancer treated by gamma rays, and evaluate it clinical significance. Methods The serum VEGF level of thirty patients with pancreatic cancer treated by gamma rays were determined before and one month after treatment. The relationship between curative effect,survival, life quality and the serum VEGF level was analyzed. Results The serum VEGF level of 30 cases before treatment was (624.1 ± 144.3) pg/ml, whereas one month after treatment it was (279.3 ± 83.4) pg/ml(P ＜0.01 ). In the 19 patient whose serum VEGF level decreased by more than 50%, CR + PR was gained in 18 patients, improved quality of life in 7 patients, and in the 11 patient whose serum VEGF level decreased by less than 50%, CR + PR in 7 patients, improved quality of life in 1 patient( P = 0.012, P = 0. 028). In 24patients who completed 2 years follow-up, 11 of 15 patients whose serum VEGF level decreased by more than 50% survived more than 1 year, which was higher than that of the patients whose serum VEGF level decreased by less than 50%. Conclusions The serum VEGF level decreased significantly after gamma rays treatment and the extent of decrease could be used as a surrogate to evaluate the therapeutic efficacy.