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??Fluid resuscitation of severe acute pancreatitis with combining drug therapy ZHANG Jian*, YANG Zheng-an, ZHANG Zheng-liang, et al.*Department of Cadres Ward-IV(General Surgery), the Second Affiliated Hospital of Medical School of Xi’an Jiaotong University, Xi’an 710004, China
Corresponding author: ZHANG Jian??E-mail: zhangjian-937@163.com
Abstract Objective To observe and evaluate the effect of VDF therapy (combining use of 6% hydroxyethyl starch 130 /0.4, Dexamethasone and Furosemide) on the severe acute pancreatitis (SAP) during fluid resuscitation stage. Methods During January 2006 and May 2010, 47 consecutive cases of SAP were admitted. They were randomly assigned to VDF therapy group (26 cases) and control group(21 cases). Patients in VDF therapy group were administered with Voluven, Dexamethasone and Furosemide, while Ringer’s lactate was applied to the control group. Otherwise, the two group had the same therapeutic strategies. Results VDF group remarkably improved the systemic inflammatory response after 72h admission, as compared with the control group ???APACHE??score (4.28±1.90) vs. (-1.00±2.87), P <0.01??. It had shorter time interval to reach the stable hemadynamic state ???4.54±1.62??h vs. (7.99±1.66)h, P <0.01?? and total amount of fluid replacement within 72h after admission ???10780±1856??mL vs. (13845±2477)mL, P <0.01?? than control group. The intestinal function recovered faster in VDF group than in control group ??(4.00±1.74)d vs. (5.26±1.92)d, P <0.05??. Compared with control group, VDF therapy significantly decreased the ACS ??3.8% vs.28.6%, P <0.05??, time of hospital stay ???20.12±10.37??d vs. (29.4±15.6)d, P <0.05??and mortality??3.8% vs. 23.8%, P <0.05??. Although there were no statistical differences in complications and transfer to operation in the two group??P >0.05??. Conclusion Combined use of 6% hydroxyethyl starch 130 /0.4 (Voluven), Dexamethasone and Furosemide could improve the severity and prognosis of SAP fast and effectively and decrease the mortality of SAP significantly.     

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??Clinical study of insulin resistance for patients after selective abdominal surgery CHEN Hong*, LI Fei , JIA Jian-guo, et al. *Department of General Surgery, Xuan Wu Hospital of Capital Medical University, Beijing 100053, China Corresponding author: CHEN Hong, E-mail: chenhong@medmail.com.cn Abstract Objective To investigate the risk factors of insulin resistance(IR) after selective abdominal surgery and the mechanism of IR induced by surgery. Methods Fourteen-patients including five male and nine female after selective abdominal surgery between March 2006 and June 2006 at Xuan Wu Hospital of Capital Medical University were studied. Fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 were tested for selective surgery patients on one day before, during and one day after surgery. Insulin resistance index (HOMA-IR) and the index of insulin secretion (HOMA-β) were calculated with homeostasis model assessment (HOMA). Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before and at the end of operation. Results Significant differences were found in fasting blood glucose, fasting plasma insulin, plasma TNF-α and IL-6 of pre-operative 1 day, during operation and post-operative 1 day (P <0.001). A significant elevation of HOMA-IR level was found on post-operative 1 day compared to that before surgery in all patients (P <0.001). However there was no significant difference in HOMA-β among the same two points of time (P=0.103). The result of RT-PCR showed that the expression of GLUT4 mRNA in muscle of patients at the end of operation reduced significantly compared with preoperation (P<0.001). ISI showed negative correlation with operative time(r=-0.736,P <0.001), blooding during operating (r=-0.594,P=0.032) and post-operative TNF-α(r=-0.641,P =0.018). R2 of the equation was 0.687. Conclusion Insulin resistance occurs in selective abdominal surgery patients. The defective site was at postreceptor, and the decrease of content and action of GLUT4 may play an important role in its mechanism. To control the intensity of surgery is helpful for decreasing IR.     

In vitro selection and characterization of resistance to macrolides and related antibiotics in Mycoplasma pneumoniae

Macrolide-resistant mutants of Mycoplasma pneumoniae were selected in vitro from the susceptible reference strain M129, by 23 to 50 serial passages in subinhibitory concentrations of macrolides and related antibiotics, erythromycin A, azithromycin, josamycin, clindamycin, quinupristin, quinupristin-dalfopristin, pristinamycin, and telithromycin. Mutants for which the MICs are increased could be selected with all antibiotics except the streptogramin B quinupristin. Portions of genes encoding 23S rRNA (domains II and V) and ribosomal proteins L4 and L22 of mutants were amplified by PCR, and their nucleotide sequences were compared to those of the susceptible strain M129. No mutation could be detected in domain II of 23S rRNA. Two point mutations in domain V of 23S rRNA, C2611A and A2062G, were selected in the presence of erythromycin A, azithromycin, josamycin, quinupristin-dalfopristin, and telithromycin. Mutants selected in the presence of clindamycin and telithromycin harbored a single amino acid change (H70R or H70L, respectively) in ribosomal protein L4, whereas insertions of one, two, or three adjacent glycines at position 60 (M. pneumoniae numbering) were selected in the presence of both streptogramin combinations. Telithromycin was the sole antibiotic that selected for substitutions (P112R and A114T) and deletions ((111)IPRA(114)) in ribosomal protein L22. Three sequential mutational events in 23S rRNA and in both ribosomal proteins were required to categorize the strain as resistant to the ketolide. Azithromycin and erythromycin A were the only selector antibiotics that remained active (MICs, 0.06 and 1 micro g/ml, respectively) on their mutants selected after 50 passages.     

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??Objective??To investigate the characteristics of the thickness of maxillary sinus membrane corresponding to molars with severe periodontitis??and observe the thickness changes of maxillary sinus membrane at six months after tooth extraction and alveolar ridge preservation by measurements of cone-beam computed tomography??CBCT?? images. Methods??Totally 8 patients with a total of 8 maxillary molars with severe periodontitis intending to receive alveolar ridge preservation and implant placement were recruited in Peking University School and Hospital of Stomatology from February 2016 to November 2017??and another 8 CBCT images of maxillary molars with mild periodontitis were included in the control group. The maximum membrane thickness??maxMT??of the maxillary sinus??and the minimum residual ridge height??minRRH??were measured by CBCT. In the experimental group??the maxMT corresponding to the affected tooth was measured 6 months after the tooth extraction and alveolar ridge preservation. Results??The maxMT of the maxillary sinus in the experimental group was??4.06 ± 1.80??mm??87.5% of the maxillary sinus membranes were found thickening compared to normal thickness??and the minRRH of the molar was??1.09 ± 0.68??mm. The maxMT of the maxillary sinus and the minRRH of the molar in the control group was??1.42 ± 0.38??mm and ??8.50 ± 1.72??mm respectively??and there was no mucosal thickening. There were statistically significant differences between two groups. In the experimental group??the maxMT of the maxillary sinus was changed from??4.06 ± 1.80??mm to??1.55 ± 0.63??mm in six months after alveolar ridge preservation??the proportion of mucosal thickening was decreased to 12.5%??and the difference was statistically significant??P < 0.05??. Conclusion??Maxillary sinus mucosa tends to be thickened in molars with severe periodontitis. The thickness of the maxillary sinus mucosa is likely to return to normal at 6 months after tooth extraction and alvedar ridge preservation.     

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??Ultrasound-guided foam sclerotherapy for superior venous malformations in lower etremity CHEN Shu-qiang*??LIU Hui??CAI Fang-gang??et al. * Department of Ultrasonic Medicine, the 1st Affiliated Hospital of Fujian Medical University,Fuzhou 350005, China
Corresponding author: YE Zhen, E-mail: chenyezhen@gmail.com
Abstract Objective To explore the application of ultrasound-guided foam sclerotherapy for superior venous malformations in lower etremity. Methods Inject lauromacrogol under the guidence of ultrasound for 25 patients with venous malformations in lower extremity was performed between 2009 and 2011 in the 1st Affiliated Hospital of Fujian Medical University.The treatment was followed by the observation of ultrasonogram in lesions during operation and follow-up observation of efficacy. Results Successful results were obtained in 22 patients among the total 25 patients after the fisrst injection instead of recurrence. The equivalent curative effect presents to other 3 patients after repeated injection of lauromacrogol. Conclusion Lauromacrogol,standing for foam sclerosant,can reach approving effect for superior venous malformations in lower extremity. Accurater guidance method can be accommodated by ultrasound.     

Development of inflammatory bowel disease during anti-TNF-α therapy for inflammatory rheumatic disease. A nationwide series

OBJECTIVES: To describe cases of new onset of inflammatory bowel disease (IBD) in patients with inflammatory rheumatic disease (IRD) receiving anti-TNF-α therapy. METHODS: A call for observations of such cases was sent to members of the French "Club rhumatismes et inflammation". Only patients without intestinal symptoms before introduction of anti TNF-α agents were included. RESULTS: During a 2-year period, 16 patients were declared: nine men and seven women, mean age 41.5±17.4 years, 12 patients with ankylosing spondylitis, one with rheumatoid arthritis, one with psoriatic arthritis and two juvenile idiopathic arthritis with enthesitis related arthritis. Overall, 14 patients received etanercept and two had infliximab. The meantime frame between onsets of anti-TNF--α drugs and development of IBD was 29.3±20.1 months. According to endoscopic and histological findings, IBD was classified as typical Crohn's disease in eight cases, Crohn's-like disease in six cases, indeterminate in one case and definite ulcerative colitis in one case. For all cases, each TNF-α blocking agent was discontinued and replaced by another monoclonal anti TNF-α antibody. After a mean follow up period of 23.4±19.5 months, outcome was favorable without recurrent or flaring IBD. CONCLUSIONS: Paradoxical IBD may occur during anti TNF-α therapy for inflammatory rheumatic disease, mostly in patients with spondylarthropathies while receiving etanercept, at a frequency estimated to 0.15% in the French patients with spondylarthropathies exposed to TNF-α antagonists. The IBD mainly corresponded to Crohn's or Crohn's-like disease. On the contrary, new onset IBD is less frequently observed in other cases of IRD and with other TNF--α blockers.     

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??Objective    To evaluate the clinical appearance and periodontal status of impacted maxillary central incisors that had been exposed and aligned after a closed-eruption orthodontic surgical technique. Methods    The subjects consisted of 18 patients who were treated in  Stomatology Hospital of Yantai from 2011 to 2015. Examinations were done after orthodontic treatment for the unilateral labially impacted maxillary central incisors 3 months after retention. The clinical and radiographic variables were compared by SPSS 17.0 software package. Results    The treated central incisors showed no significant difference in plaque and gingival indexes??width of attach gingival or pocket depth??whereas a small but statistically significant increase was found in the clinical crown lengths. The bone support was reduced in the treated incisors??whereas in 4 of the control central incisors??abnormal gingival contour was recorded. Conclusion    This study demonstrates that the overall esthetic and periodontal results can be achieved by treating impacted maxillary central incisors with a closed-eruption orthodontic surgical technique. However??a long term follow-up study on the esthetic outcome is recommended.