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Objective To evaluate the efficacy and safety of early endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in patients of acute biliary pancreatitis (ABP).Methods Databases including PubMed,EMBASE,Cochrane library,CBM,CNKI,WanFang data and VIP data were searched with " Endoscopic retrograde cholangiopancreatography" "Endoscopic sphincterotomy" "ERCP" "Pancreatitis" "Biliary pancreatitis" resection up to September 2017.Randomized controlled trails (RCTs) conternming the comparison of ERCP with EST versus conservative management in ABP patients were enrolled in the study.Two reviewers independently screened literature,extracted data,and assess the risk of bias of the included studies.The Meta-analysis was conducted by RevMan 5.3 software.Results A total of 10 RCTs involving 1 752 cases were included in the Metaanalysis.The results of Meta-analysis showed that compared with the control group,early ERCP with EST reduced the systemic complication rate of ABP (RR =0.66;95％ CI:0.47-0.93;P ＜ 0.05).However,there were no significant differences in overall mortality,local complication rate,and ERCP related complication rate in ABP between early and selected ERCP with EST treat (P ＞ 0.05).Subgroup analyses indicated that early ERCP with EST therapy reduced the mortality of severe acute biliary pancreatitis (SABP),ABP with biliary obstruction and within 24 hours of admission (RR =0.48,0.35,0.25;95％ CI:0.24-0.96,0.17-0.74,0.09-0.73;P ＜ 0.05);decreased the local and systemic complication rate of SABP,ABP with biliary obstruction (RR =0.56,0.54,0.51,0.51;95％ CI:0.37-0.86,0.33-0.91,0.32-0.81,0.32-0.80;P ＜ 0.05);reduced the local and systemic complication rate of SABP (RR =0.42,0.47;95％ CI:0.25-0.70,0.25-0.87;P ＜0.05) and shortened the hospital stay of SABP (MD =-11.22 d;95％ CI:-16.09--6.36;P ＜ 0.01).However,there were no significant differences of overall complication rate in ABP without biliary obstruction and hospital stay in MABP.Conclusion Early ERCP with EST therapy appears to be safe and effective for ABP patients.
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Objective To observe the effect of motor nerve baby-sitting and different babysitting stages on nerve regeneration in nerve root re-implantation for brachial plexus avulsion injury.Methods Twenty-four SD rats were used to induce the brachial plexus avulsion injury.C5-7 roots were avulsed and C6 anterior root was re-implanted to the spine cord via a posterior approach.Branches erupting from C6 and the branches affiliated to the musculocutaneous nerve were cut away via an anterior approach.Re-implanted C6 anterior root was connected singly with musculocutaneous nerve.After that,the end of one branch of medial pectoral nerve was sutured to the lateral musculocutaneous nerve.The animal was divided into persistence motor nerve baby-sitting group (Group A,n =12) and protophase motor nerve baby-sitting group (Group B,n =12) according to the random number table.Electrophysiological evoked potential,muscle wet weight and muscle fiber cross-sectional area were measured at postoperative 2 and 3 months.Results At postoperative 2 and 3 months,the restoration rates of motor evoked potential in Group A [(12.2 ± 3.3) ％ and (15.1 ± 3.5) ％] revealed significant differences from these in Group B [(30.1 ±4.2)％ and (54.8 ±9.6)％] (P ＜0.01),the restoration rates of muscle wet weight in Group A [(75.9 ± 5.3) ％ and (92.7 ± 8.6) ％] were similar with (76.4 ± 7.3) ％ and (94.3 ± 4.4) ％ in Group B (P ＞ 0.05),and the restoration rates of muscle fibrin cross section area in GroupA [(74.4±5.5)％ and (88.5±7.5)％] were similar with (76.9±6.7)％ and (92.9± 3.5) ％ in Group B (P ＞ 0.05).Conclusions Motor nerve end-lateral baby-sitting can improve functional restoration of the skeletal muscle in the early stage after nerve root re-implantation,but prevent functional restoration of skeletal muscle in the late stge.On the contrary,protophase motor nerve babysitting avoid the inhibitory effect in the late stage,which gains better restoration rate of muscle motion evoked potential.
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Objective To sum up the techniques of radiofrequency ablation assisted laparoscopic liver resection .Methods A ret-rospective analysis was done based on the clinical data of 16 patients undergone radiofrequency ablation assisted laparoscopic liver resection from July 1 ,2011 to July 30 ,2012 .Results Sixteen patients were all received successful total laparoscopic liver resection . Anatomical liver resection was carried out on 5 patients including 2 left hemihepatectomy ,2 left lateral segmentectomy ,1 right pos-terior lobectomy ,and 11 patients underwent nonanatomical hepatectomy .None was transected under regional hepatic blood inflow occlusion .The mean operation time was 125 minutes(range 35-335 minutes) ,mean blood loss 310 mL(range 20~1 100 mL) ,and mean hospital stay 9 days(range 5 to 16 days) .No operation death and postoperative complications occurred .The patients were fol-lowed up for 2 to 12 months ,1 recurrence was found in patients with Ⅶ segment hepatocellular carcinoma 60 day after operation . Conclusion The application of radiofrequency ablation assisted laparoscopic liver resection can effectively control the resection mar-gin hepatic blood inflow to ensure the success of operation and reduction of complications .
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Objective To study the early therapeutic principle of severe acute pancreatitis(SAP)complicated with intra-abdominal hypertension(IAH).Methods We reviewed 32 cases SAP complicated with IAH from January 2003 to January 2008 in our department.All cases' clinical features and early management were summarized.Results The intra-abdominal pressure of all the cases was above 15cmH2O.5 deaths occured in non-operation treated cases,6 deaths in the 11 operated cases,and all the dead cases reached the standard of ACS.Conclusions The uses of early individualized treatment can decrease the opportunity of decompressive operation,we can effectively improve the therapeutic effect of SAP complicated with IAH and reduce the probability of complicating with ACS.
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OBJECTIVE:To introduce coordinate localization method as a new pharmaceutical care method to provide reference for rational use of drug in cancer patients. METHODS:The way that clinical pharmacists assisted physicians in prescribing for cancer patients with coordinate localization method was interpreted combining with examples. RESULTS:Coordinate localization method was conducive to rational use of drug in cancer patients and pharmacist’s self- quality construction. CONCLUSION:Coordinate localization method can effectively assist the doctor to prescribe rationally.
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OBJECTIVE:To study the influence of different doses of naloxone on focal cerebral ischemia reperfusion injury in rats and to explore its mechanism.METHODS:The rats were randomly divided into the sham operation group,the model group,the naloxone group(high dosage,moderate dosage,and low dosage)and the positive control group.The modified Longa method was applied to establish the models of focal cerebral ischemia reperfusion in rats.Infarct size,neurological deficit scores,superoxide dismutase(SOD)activity,malondialdehyde(MDA)content in serum of the model rats were detected.The ultrastructures of the brain tissues were observed by electron microscopy.RESULTS:Ischemia reperfusion injury in model rats resulted in increased neurological deficit scores,larger infarct size,decreased activity of SOD in serum and increased content of MDA.The pathological change and ultrastructural change were evident.The above indices were improved in all the groups administered with different doses of naloxone.CONCLUSIONS:Naloxone has protective effects on rat brain injury caused by focal cerebral ischemia reperfusion,whose mechanism might be related to inhibition of lipid peroxidation.
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OBJECTIVE:To introduce the concept of evidence-based medicine and pharmacoeconomics to the pharmacists so as to promote rational use of drugs METHODS:The evidence-based medicine was described in detail concerning the fundamental,procedure,actions,limitations and directive function to hospital,and in comparison with the advanced level of pharmacoeconomics in foreign countries,the pharmacoeconomics in China was analyzed in respect of the developing history,research scope,personnel training,monograph and periodicals and the quantity and quality of research work RESULTS & CONCLUSION:The evidence-based medicine and pharmacoeconomics are still in starting period in China,however,after entering WTO,they have proved to be important day by day and will greatly improve the level of rational use of drugs in our country