Extracellular heat-shock protein 70 aggravates cerulein-induced pancreatitis through toll-like receptor-4 in mice

Background In patients suffering from acute pancreatitis, the pathogenesis is not completely understood, and several recent studies in vitro suggested that heat shock proteins might play an important role in cell signaling. To investigate the possible role of extracellular heat shock protein 70 （Hsp70） in pancreatitis, toll-like receptor-4 （TLR4）-deficient and wild-type mice were administered with exogenous Hsp70 during the course of cerulein-induced pancreatitis （CIP）. Methods Acute pancreatitis was induced by 5 intraperitoneal injections of cerulein at hourly intervals, and then treated with recombinant Hsp70 through the caudal vein 4 hours after the start of cerulein injections. Subsequently serum amylase and serum cytokines levels were detected. Histologic alteration of the pancreas was evaluated. Tumor necrosis factor alpha （TNF-α） concentrations and myeloperoxidase （MPO） activity in both pancreas and lungs were analyzed. The nuclear factor kappa B （NF-κB） activation in pancreatic tissue was measured using a sensitive RelA enzyme-linked immunosorbent assay. Results Treatment with recombinant Hsp70 to wild-type mice in CIP resulted in significant aggravation of inflammation in pancreas, elevated levels of serum cytokines, up-regulation of pulmonary MPO activity and increase of lung tissues TNF-α concentrations. In contrast, treatment with Hsp70 to TLR4-deficient mice had little effect on serum cytokines levels pancreatic inflammation, pulmonary MPO activity and TNF-α concentrations. Conclusions The results suggest that extracellular Hsp70 might induce systemic inflammatory response syndrome （SlRS）-Iike response in vivo and TLR4 might be involved in the Hsp70-mediated activation of inflammatory reaction in the progression of CIP without infection.     

Hyperthermia enhances the anticancer-drug induced cytotoxicity in hepatocellular carcinoma cell line SMMC-7721

Objective： Hyperthermia is an attractive addition to multidisciplinary approaches to clinical cancer treatment. The efficiency of hyperthermia depends on the elevation of the temperature and the duration of treatment. It has been reported that in vitro and in vivo hyperthermia enhanced the cytotoxic effect of certain anticancer drugs. However, this enhancement varies, depending on the drug used and the scheduling of treatments. Thus, the combination effect of chemotherapy and hyperthermia remains unclear. In this study, we aimed to investigate whether concurrent exposure of human hepatocellular carcinoma cells SMMC-7721 to chemotherapeutic agents andhyperthermia could increase anticancer effects. Methods ： Two chemotherapeutic agents, cisplatin and hydroxycamptothecin, were applied. The MTT assay was performed to evaluate the growth inhibition of SMMC-7721 induced by anticancer drugs with and without hyperthermia. Flow cytometric analysis was used for the assessment of apoptosis after treatments. Results： The percentages of growth inhibition of SMMC-7721 induced by cisplatin （10μg/ml） alone, hydroxycamptothecin （1μg/ml）alone, hyperthermia alone, cisplatin and hyperthermia, hydroxycamptothecin and hyperthermia, were 20.77%, 13.65%, 32.46%, 62.76%, 71.89%, respectively. The percentages of apoptosis of five treatments are 5.56%, 3.96%, 10.16%, 24.32%, 20.42%, respectively. Conclusion： While both hyperthermia and anticancer drugs can individually induce apoptosis and anti-proliferation effect, the combination of the two treatments induce significantly higher apoptosis and cytotoxicity than hyperthermia or anticancer drugs treatment alone. These data suggest a synergistic benefit when hyperthermia and anticancer drugs used concurrently.     

Application of endoscopic retrograde cholangiopancreatography in biliary-pancreatic diseases

Background Endoscopic retrograde cholangiopancreatography （ERCP） has been used increasingly for the treatment of choledocholithiasis, gallstone pancreatitis, and benign or malignant bile duct or pancreatic duct stenosis. The purpose of this study was to evaluate ERCP for the diagnosis and therapy of biliary-pancreatic diseases. Methods A total of 2075 patients who underwent diagnostic and therapeutic ERCP from June 2001 to March 2009 were analyzed retrospectively. Achievement and complication rates were calculated, and the therapeutic effect was observed. Results In all the 64 cases who underwent diagnostic ERCP, the procedure was successful, in 2011 cases therapeutic ERCP was performed, and the success rate was 94.6%. In the therapeutic ERCP cases, 1434 （93.0%） were successful among the 1542 cases of choledocholithiasis, and 422 （90.0%） of the 469 cases with benign or malignant bile duct or pancreatic duct stenosis, or acute obstructive suppurative cholangitis with stent placement or endoscopic nasobiliary drainage were successful. Fifty-nine （90.8%） cases of the 65 who underwent a pre-cut for pancreatic sphincterotomy were successful. Complication rate was 5.1% and the most frequent complication was acute pancreatitis （4.4%）. Conclusions ERCP is one of the major diagnostic and therapeutic methods for biliary-pancreatic disease. Therapeutic ERCP is a minimally invasive, safe and effective treatment method for various biliary-pancreatic diseases.     

Relationship between Carbachol Hyperstimulation-Induced Pancreatic Acinar Cellular Injury and Trypsinogen or NF-KB Activation in Rats in vitro

The relationship between M3 cholinergic receptor agonist （carbachol） hyperstimulationinduced pancreatic acinar cellular injury and trypsinogen activation or NF-κB activation in rats was studied in vitro. Rat pancreatic acinar ceils were isolated, cultured and treated with carbachol, the active protease inhibitor （pefabloc）, and NF-κB inhibitor （PDTC） in vitro. Intracellular trypsin activity was measured by using a fluorogenic substrate. The cellular injury was evaluated by measuring the leakage of LDH from pancreatic acinar ceils. The results showed that as compared with control group, 10-3 mol/L carbachol induced a significant increase of the intracellular trypsin activity and the leakage of LDH from pancreatic acinar cells. Pretreatment with 2 mmol/L pefabloc could significantly decrease the activity of trypsin and the leakage of LDH from pancreatic acinar cells （P〈0. 01） following the treatment with a high concentration of carbachol （10^-3 mol/L） in vitro. The addition of 10^-2mol/L PDTC didn＇t result in a significant decrease in the activity of trypsin and the leakage of LDH from pancreatic acinar cells treated with a high concentration of carbachol （10^-3 mol/L） in vitro （P〉0. 05）. It was concluded that intracellular trypsinogen activation is likely involved in pancreatic acinar cellular injury induced by carbachol hyperstimulation in vitro. NF-κB activation may not be involved in pancreatic acinar cellular injury induced by carbachol hyperstimulation in vitro.     

Acupuncture Treatment for Multiple Aortitis ——A Clinical Report of 40 Cases

In order to evaluate the therapeutic effects of acupuncture-moxibustion on multiple aortitis, 80 cases （with involvement of the main arteries in the head and arms） were randomly divided into a treatment group treated with acupuncture-moxibustion, and a control group treated with TCM and western drugs. The therapeutic effects were compared. The total effective rate was 95% in the treatment group （including 15% of the cure rate and 62.6% of the marked relief rate）, and the total effective rate was 75% in the control group （including 12.5% of the marked relief rate）. There was a significant difference in the therapeutic effects （P〈0.01） between the two groups. It can be concluded that acupuncture-moxibustion is obviously superior to the routine drug therapy for treatment of multiple aortitis.     

Value of diffusion-weighted imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis: a meta-analysis

Background Several previous studies have shown that diffusion-weighted imaging （DWl） can provide additional information for focal pancreatic lesions by demonstrating more restricted diffusion in solid malignant tumors than in chronic pancreatitis, which can be indicated by a decreased apparent diffusion coefficient （ADC）. However, these studies have a modest sample size and convey inconclusive results. The aim of this study was to determine, in a meta-analysis, the diagnostic performance of quantitative diffusion-weighted magnetic resonance imaging in distinguishing pancreatic carcinoma from mass-forming chronic pancreatitis. Methods We determined the sensitivities and specificities across studies. A summary receiver operator characteristic （sROC） curve was constructed to calculate the area under the curve （AUC）. Results The pooled sensitivity of DWI was 0.86 （95% Cl： 0.80-0.91） and the pooled specificity was 0.82 （95% CI： 0.72- 0.89）. The AUC of the sROC was 0.91 （95% CI： 0.88-0.93）. Conclusions DWl may be a potentially technically feasible tool for differentiating pancreatic carcinoma from mass- forming chronic pancreatitis. However, large-scale randomized control trials are necessary to assess its clinical value.     

Regulating effects of arsenic trioxide on cell death pathways and inflammatory reactions of pancreatic acinar cells in rats

Background It is accepted that inflammatory cytokines play a key role in the development of acute pancreatitis, so blocking the initiation of inflammatory reactions may alleviate pathological changes of acute pancreatitis. We studied the regulatory effect of arsenic trioxide （As2O3） on apoptosis and oncosis of pancreatic acinar cells in vitro and in vivo and its therapeutic effect on acute pancreatitis. Methods Pancreatic acinar cells were isolated by collagenase digestion method. Apoptosis and oncosis of isolated pancreatic acinar cells were detected with Hoechst 33258＋PI or Annexin V＋PI double fluorescent staining. Amylase and lactate dehydrogenase release were measured. Acute pancreatitis was induced in Wistar rats by intraperitoneal injections of caerulein, and apoptosis was detected with terminal dUTP nick-end labeling method. Tumor necorsis factor α （TNF-α） mRNA, myeloperoxidase, nuclear factor-κB and histological grading of pancreatic damage were measured. Results There was an increased apoptosis but a decreased oncosis of pancreatic acinar cell after the treatment with AS2O3. The levels of lactate dehydrogenase and amylase release were markedly decreased in As2O3 treated group. Myeloperoxidase content, TNF-α mRNA level, nuclear factor-κB activation and pathological score in As2O3 treated group were significantly lower than in the untreated group. Conclusions As2O3 can induce apoptosis and reduce oncosis of pancreatic acinar cell, thus resulting in reduced release of endocellular enzyme of acinar cells, reduced inflammatory cell infiltration and decreased the production of inflammatory cytokines, so that the outcome of alleviated pathological changes was finally achieved.     

Findings of cholangiopancreatography in pseudotumorous pancreatitis.

The cholangiopancreatographic findings in 22 patients with pseudotumorous panereatitis (PTP) were evaluated on the basis of endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC). All patients were found with a focal mass in the pancreas based on the findings of ultrasound and / or CT. However, only one patient had been diagnosed correctly as suffering from chronic pancreatitis by ERCP. Normal pancreatic duct was found in 4 patients. There were five patients having abnormal pancreatic ducts, but findings of ERCP could not provide definite diagnosis. In the remaining 12 patients the abnormalities of pancreatic and / or bile ducts were strikingly similar to those found in pancreatic carcinoma. Double duct sign was also seen in one patient. All these 12 patients were incorrectly diagnosed as having pancreatic carcinoma. It is concluded that ERCP / PTC has little value in detecting PTP.     

A retrospective study on diagnosis and treatment of severe acute pancreatitis.

Severe acute pancreatitis is highly controversial on its diagnostic criteria, the optimum time for surgery, the selection of surgical procedures, and the prevention and treatment of complications. We treated 40 patients with severe acute pancreatitis from July 1983 to July 1988. The comparison of clinical and laboratory data of severe acute pancreatitis and mild acute pancreatitis showed that in some patients neither Ranson's nor Bank's criteria are reliable in classifying or predicting the severity of the disease. The coexistence of acute peritonitis and bloody ascites with elevated amylase level is very helpful to identify the local conditions of pancreatic necrosis and hemorrhage. We suggest early operation (within 48 hours) be applied in severe acute pancreatitis. In our series, five types of surgical procedures were used. We consider that proper treatment of acute respiratory distress syndrome (ARDS) is most important in the management of severe pancreatitis.

     

Ultimate treatment for a patient with severe traumatic brain injury without intake for 192 hours after Wenchuan massive earthquake

At 14：28 （2：28 pm） on May 12, 2008, a magnitude 8 earthquake, which was a rare event, occurred inSichuan Province of China and led to deaths of thousands of people. In the Longmen Mountain fault zone, which is located 40 miles from the earthquake center at Wenchuan, the Chinese military used a variety of treatment methods to rescue the injured and successfully treated a victim with severe traumatic brain injury （TBI） who survived without food or water intake for 192 hours. Two hundred and twenty-four hours after the earthquake, the patient underwent craniotomy and removal of an intracerebral hematoma. The injury to the patient was severe and the rescue time was the longest for this earthquake. Detailed information is provided in this report.     

Radical surgery for Budd-Chiari syndrome through exposure of the entire inferior vena cava of the hepatic segment

Background Several kinds of radical surgery for the treatment of Budd-Chiari syndrome （BCS） have been devised. We have described preliminary efforts to treat BCS using a novel radical resection technique to expose the entire inferior vena cava （IVC） of the hepatic segment. Methods Sixty patients with BCS were treated by radical resection, including 46 men and 14 women. BCS patients ranged in age from 11 to 62 years, with 3 months to 11 years since the BCS diagnosis. The lesions included membrane occlusion of the IVC in 16 patients, double membranes within the IVC in 2 patients, double membranes within the IVC and the hepatic vein （HV） in 3 patients, IVC membrane with distal thrombosis in 10 patients, long segment thrombosis of the IVC in 5 patients （organized thrombosis in 2 patients, fresh thrombosis in 3 patients）, occlusion of the outlet of the HVs due to mural thrombosis in 2 patients, segmental occlusion of the IVC in 3 patients, membranes within the HV with IVC stenosis due to protrusion of HV stent in 1 patient, HV membranes in 11 patients, extensive occlusion of HVs in 1 patient, the whole IVC tumor thrombus with tumor thrombus of 2/3 right atrium resulting from a posterior peritoneum tumor in 1 patient, IVC leiomyosarcoma in 2 patients, IVC leiomyosarcoma with tumor thrombus into 1/2 right atrium in 1 patient, IVC thrombosis extending into right atrium in 1 patient, compression of supra-hepatic segment of IVC due to fiber trabs in 1 patient. Results All lesions were successfully resected under direct supervision. Three procedures were performed under extracorporeal circulation, 52 patients with catheterization of the right atrium, 4 patients with a cell saver, and one patient with auto-retrieval of blood. The retrieved blood was from 300 ml to 4000 ml. Transfusion of banked blood was from 400 ml to 2000 ml for 14 patients. For the other patients no transfusion of banked blood was required. One patient died of renal failure peri-operatively. Newly formed IVC membrane was found for one recurrent patient whose IVC thrombosis was removed one year prior. Restenosis of the IVC was observed post-operatively without symptoms in one patient. In the other patients, no recurrent symptom was found during the follow-up periods. Conclusion This novel surgery provides a clear visual field during the procedure and yields satisfactory short and Iona-term results.     

Dan Zhi Xiao Yao Yin Combined With Auricular-Point-Pressing for Treatment of Optic Atrophy-A Clinical Observation of 51 Cases

To evaluate the therapeutic effect of Dan Zhi Xiao Yao Yin (丹栀消遥饮 Decoction of Moutan Bark and Capejasmine) combined with auricular-point- pressing therapy for treatment of optic atrophy. The visual acuity and visual field was observed in the 51 cases (58 eyes) from the treatment group that were treated with Dan Zhi Xiao Yao Yin combined with auricular-point-pressing therapy and the 43 cases (49 eyes)from the control group that were treated with routine western drugs at the end of the trial (60 days). The effective rates of increase in visual acuity obtained in the treatment and the control groups were 79.3% and 44.89% respectively and enlargement in visual field were 61.9% and 22.6% respectively. Statistical analysis showed that there were significant differences between two groups (P＜0.05). The therapeutic effect of Dan Zhi Xiao Yao Yin combined with auricular-point -pressing therapy in increasing the visual acuity and enlarging the visual field was superior to that of the routine western drugs.     

Diagnosis and endovascular treatment of spontaneous direct carotid-cavernous fistula

Background Spontaneous direct carotid-cavernous fistula （CCF） is relatively rare and few reports have been found in the literature. The aim of this paper was to report the clinical characteristics, imaging findings and curative effect of endovascular treatment for patients with spontaneous direct CCF. Methods We retrospectively analyzed the clinical data of nine patients with spontaneous direct CCF admitted between May 2003 and November 2007 and the outcomes.of endovascular treatment. Sudden neuro-ophthalmological symptoms were the most common clinical presentation at diagnosis （n=8）. No patients had a history of head trauma. Cerebral digital subtraction angiography （DSA） was performed on all cases under local anesthesia and seven cases received endovascular treatment. Results In eight patients, internal carotid angiograms recorded during the early arterial phase revealed aneurysms located in the cavernous sinuses, and in one patient, a dilated internal carotid artery （ICA） was seen. Among the nine cases, seven received endovascular treatment via a transarterial approach and complete occlusion of the fistula was obtained with no technique-related complications, one died suddenly before treatment and one gave up treatment. A detachable balloon was used as the embolic material in two cases, a detachable balloon and detachable coil as the embolic material in two cases, balloon-assisted coil embolization in two cases and covered stents were successfully placed in the parent vessel to exclude the aneurysm and fistula from circulation in one case. During a follow-up period of 3-48 months, all treated patients remained asymptomatic except for one patient who suffered from ipsilateral decreased vision. Conclusions Most spontaneous direct CCF may be caused by a ruptured intracavernous aneurysm with direct shunting into the cavernous sinus. Endovascular treatment seems to be a safe and effective method for treating spontaneous direct CCF.     

Effect of Shengmai injection (生脉注射液) on vascular endothelial and heart functions in patients with coronary heart disease complicated with diabetes mellitus

Objective： To study the effect of Shengmai injection （生脉注射液, SMI） on vascular endothelial and heart functions in coronary heart disease patients complicated with diabetes mellitus （CHD-DM）. Methods： One hundred and twenty patients with CHD-DM, their diagnosis confirmed by coronary arteriography, were equally randomized into a control group treated with conventional treatment and a treated group treated with conventional treatment plus SMI. The changes in blood levels of nitric oxide （NO）, endothelin-1 （ET-1） and angiotensin Ⅱ （Ang Ⅱ）, as well as endothelium-dependent vascular dilating function and heart function in the patients were observed before treatment and after the 3-week treatment. Results： After being treated with SMI for 3 weeks, in the treated group, blood level of NO was raised significantly from 69.8±33.1 μmol/L to 120.1±50.8μmol/L, and ET-1 was lowered from 70.1±32.1 ng/L to 46.2±21.3 ng/L, respectively （P〈0.01）; that of Ang Ⅱ was lowered from 81.3±24.3 ng/L to 50.2±27.3 ng/L （P〈0.01）; brachial arterial post-congestion blood flow increasing rate was raised from 389.4±26.3% to 459.3±27.8% （P〈0.01）; and the improvement in heart function as seen through the ejection fraction （EF） was increased from 44±5% to 68±6% （P〈0.01）, all the changes being more significant than those in the control group （all P〈0.01）. Conclusion： SMI can improve not only the endothelial function in CHD-DM patients, but also heart contraction significantly.     

Establishment of an Infected Necrotizing Pancreatitis Model by Retrograde Pancreatic Duct Injection of Sodium Taurocholate and E. coli in Rats

A stable and reliable infected necrotizing pancreatitis （INP） model in rats was established in order to study the pathophysiological mechanism and pathological development role of INP and explore the new therapeutic methods for the diseases. Forty-six SD rats were randomly divided into 5 groups. The animals in group A received the injection of 5% sodium taurocholate into the pancreatic duct and those in group B underwent that of E. coli into the pancreatic duct. The rats in groups C, D and E were subjected to the injection of 5% sodium taurocholate in combination with different concentrations of E. coli （10^3, 10^4, 10^5/mE, respectively） into the pancreatic duct. The dose of injection was 0.1 mL/100 g and the velocity of injection was 0.2 mL/min in all the 5 groups. Eight h after the injection, the survival rate of animals was recorded and the surviving rats were killed to determine the serum content of amylase and perform pathological examination and germ cultivation of the pancreatic tissue. The results showed that acute necrotizing pancreatitis model was induced by injection of 5% sodium taurocholate into the pancreatic duct. The positive rate of germ cultivation in group A was 12.5%. The acute necrotizing pancreatitis model was not induced by injection of E. coli into the pancreatic duct and the positive rate of germ cultivation in group B was 0. The INP model was established in groups C to E. The positive rate of germ cultivation was 60%, 100% and 100% and 8-h survival-rate 100%, 100% and 70% in groups C, D and E, respectively. It was concluded that a stable and reliable model of INP was established by injection of 5% sodium taurocholate in combination with 10^4/mL E. coli into the pancreatic duct with a dose of 0.1 mL/100 g and a velocity of 0.2 mL/min. The pathogenesis of INP might be that the hemorrhage and necrosis of pancreatic tissue induced by sodium taurocholate results in weakness of pancreatic tissue in fighting against the germs. Meanwhile, the necrotic pancreatic tissue provides a good p     

Sequential defunctionalization followed by thyroxine supple- mentation as preoperative preparation of hyperthyroid patients undergoing thyroidectomy

Background Preparing hyperthyroid patients for thyroid surgery with a combination of antithyroid drugs and thyroxine has long been controversial because this combination usually results in only partial inhibition of thyroid function. We therefore used large doses of antithyroid drugs to completely inhibit the synthesis of thyroxine and render the thyroid gland defunctionalized. We then administered physiologic doses of thyroxine to inhibit thyroid-stimulating hormone secretion. We have named this treatment “sequential thyroid defunctionalization followed by thyroxine supplementation.”
Methods Four hundred and seventy-one hyperthyroid patients seen at our hospital were divided into experimental and control groups. The control group was treated preoperatively with antithyroid drugs and iodine preparation. The experimental group was further divided into four subgroups and treated with “sequential thyroid defunctionalization followed by thyroxine supplementation”. Each of the four subgroups received different doses of antithyroid drugs and thyroxine for differing time periods. Thyroid function was assessed at each stage of treatment, as were operative blood loss volumes and postoperative complications.
Results Compared to the control group, the four experimental groups showed less thyroid congestion and surface varices at surgery. Patients in subgroup A also had thyroid glands that were almost histologically normal. The mean operative blood loss volume of the experimental group was less than that of the control group （（326±163） ml in the control group; （196±57） ml in subgroup A; （230±71） ml in subgroup B; （240±80） ml in subgroup C; and （312±97） ml in subgroup D）. The postoperative complication rate of the experimental group was 8.64% （21/243） whereas that of the control group was 17.54% （40/228）.
Conclusions Sequential thyroid defunctionalization followed by thyroxine supplementation is effective in reducing the bleeding volume and postoperative complication rate in     

Etiology,Pathology, Management and Prognosis of Chronic Pancreatitis in Chinese Population: A Retrospective Study

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis(50.70%), 19 cases of alcoholic chronic pancreatitis(13.38%), 14 cases of autoimmune pancreatitis(9.86%) and 37 cases of undetermined etiology(26.06%). Pathologically, the average inflammatory mass diameter was 3.8±3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head(n=97), neck(n=16), body(n=12), tail(n=15) and whole pancreas(n=2) influenced the choice of surgical procedures. Ninety-four patients(66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer(QLQ-C30) a decrease from 76±22 to 14±18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.     

Therapeutic effects of potassium sodium hydrogen citrate on melamine-induced urinary calculi in China

Background In 2008, a sharp increase of the number of children diagnosed with urinary calculi was observed in China, 9433 children were diagnosed as having melamine-induced urinary calculi at outpatient clinic in Beijing Children＇s Hospital. This study examined the therapeutic efficacy of potassium sodium hydrogen citrate （PSHC） used to treat melamine-induced urinary stones in Chinese children who consumed melamine-containing infant formula. Methods Seventy-two infants and children （average age （18.2±7.7） months） who were diagnosed with urinary calculi were icuidomly divided into three treatment groups using the SAS Plan program. Group 1 was given a low dose （1 g/d） of PSHC, group 2 was given high dose of PSHC （2 g/d） and group 3 was given no PSHC （control group）. The dose of drug was adjusted according to the baseline urinary pH. This study analyzed the influence of the dose of PSHC, the age of patients, stone size and position, and urinary pH on the level of efficacy of PSHC （cured, effectively treated or not cured）.Results After 1-6 months of therapy, 19 patients from group 1, five patients from group 2 and six patients from group 3 were cured. Five patients from group 1, five patients from group 2 and four patients from group 3 were effectively treated. There were significant differences in therapeutic efficacy between the two treatment doses after 3 and 6 months as measured by the increase in the successful expulsion rate and time of melamine-induced urinary calculi. After 6 months the mean time of expulsion of urinary calculi in groups 1 and 2 was significantly shorter than in the control group. Conclusions PSHC can significantly increase the successful expulsion rate and time of melamine-induced urinary calculi. The therapeutic efficacy is affected by PSHC dose, treatment duration, calculi position, and urinary pH. There is no relationship between the therapeutic efficacy and the stone size or patient age.     

Stent-grafting for unfavorable abdominal aortic aneurysm: a practical challenge

Background The endovascular treatment of abdominal aortic aneurysm （AAA） has improved greatly in the last 15 years. The present study aimed to evaluate the endografting experience for the treatment of unfavorable abdominal aortic aneurysm （uAAA）.
Methods During December 2001 and December 2007, 41 patients with uAAA were treated with endografting using concomitant techniques. Patients were followed up for 1 to 48 months （mean 20.5 months）.
Results Technical success rate was 97.6% （40/41） with 1 failure converted to open surgery for an unaccessed iliac stenosis. Nine （22.5%） type Ⅰ endoleaks （5 proximal and 4 distal） were observed on the completion angiograms and successfully corrected with aortic cuffs and iliac extensions during the procedure. Twenty-two of the planed adjunctive procedures were concomitantly performed just before endograft-implantation. There were 2 （5.0%） type Ⅰ endoleaks at 30 days; one type Ⅰ patient was treated by open conversion, another type Ⅰ patient died from a rupture before treatment in the ward, causing a 2.5% of initial mortality. The two type Ⅱ endoleaks were observed without aneurismal expansion. No buttock or leg claudication or ischemic colitis occured. During late follow-up, one additional death occurred from stroke. One new type Ⅰ endoleak was encountered from thrombocytopenia, which caused a 2.6% secondary endoleak that converted to an open surgery in the third month after a failed transabdominal banding of the aortic neck in the second month. All type Ⅱ endoleaks had disappeared in the third and sixth month. The Endografts did not present signs of material fatigue and no other type of endoleak formed. One patient presented with left limb ischemia, which underwent percutaneous transluminat angioplasty. There was no additional aneurysm rupture or any endograft imgration. Conclusion The endografting with concomitant procedures is a feasible and efficient alternative for managing unfavorable AAAs, achieving low morbidity and mortality rates and has a good clinical outcome.