“听茶”是一种境界

宋代的罗大经曾写过一首茶诗云:"松风桧雨到来初,急引铜瓶离竹炉。待得声闻俱寂后,一瓯春雪胜醍醐。"第一句就是说水沸时声如松桧林中的风雨。另一首古诗则更写出了煮茶水时的天籁之声:"砌虫唧唧万蝉催,忽有千车捆载来。听得松风并涧水,急呼缥色绿瓷杯。"于是我试着静下心来听茶,慢慢地听到了茶音。磁炉上,烧上一壶开水,水底漾起极小的气泡时。

Outcome of patients with acute, necrotizing pancreatitis requiring drainage-does drainage size matter?

AIM:To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number. METHODS:We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated. RESULTS:Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality. CONCLUSION:Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis.Large bore drainages did not prove to be more effective in controlling the septic focus.

Self-expanding metallic stents drainage for acute proximal colon obstruction

AIM: To clarify the usefulness of the self-expanding metallic stents (SEMS) in the management of acute proximal colon obstruction due to colon carcinoma before curative surgery.METHODS: Eighty-one colon (proximal to spleen flex) carcinoma patients (47 males and 34 females,aged 18-94 years,mean = 66.2 years) treated between September 2004 and June 2010 for acute colon obstruction were enrolled to this study,and their clinical and radiological features were reviewed.After a cleaning enema was administered,urgent colonoscopy was performed.Subsequently,endoscopic decompression using SEMS placement was attempted.RESULTS: Endoscopic decompression using SEMS placement was technically successful in 78 (96.3%) of 81 patients.Three patients’ symptoms could not be relieved after SEMS placement and emergent operation was performed 1 d later.The site of obstruction was transverse colon in 18 patients,the hepatic flex in 42,and the ascending colon in 21.Following adequate cleansing of the colon,patients’ abdominal girth was decreased from 88 ± 3 cm before drainage to 72 ± 6 cm 7 d later,and one-stage surgery after 8 ± 1 d (range,7-10 d) was performed.No anastomotic leakage or postoperative stenosis occurred after operation.CONCLUSION: SEMS placement is effective and safe in the management of acute proximal colon obstruction due to colon carcinoma,and is considered as a bridged method before curative surgery.

Is there an acute exercise-induced physiological/biochemical threshold which triggers increased speed of cognitive functioning? A meta-analytic investigation

Purpose： The purpose of this study was to examine, using meta-analytic measures, the evidence regarding the optimal exercise intensity at which improvements in speed of cognitive function are triggered. Specifically, it was hypothesized that the catecholamine, lactate, and ventilatory thresholds is the point at which significant improvements in speed of cognitive function are observed. Methods： We compared mean effect sizes for threshold studies and for those studies where exercise intensity was classed as moderate （40%-- 79% VO2 or equivalent） but in which the thresholds were not measured. Results： Random effects meta-analysis showed significant, moderate, mean effect sizes for studies at the threshold （g = 0.58, Z = 2.98, p 〈 0.003） and for those during moderate intensity exercise but in which the threshold was not measured （ g = 0.54, Z = 5.0l, p 〈 0.001）. There was no significant difference between mean effect sizes, which suggests that the thresholds are unlikely to represent a trigger point. Conclusion： Moderate intensity exercise, even below the thresholds, can induce improved speed of cognition, possibly due to a combination of increased peripheral catecholamine concentrations inducing vagal/nucleus tractus solitarii pathway activation and central increases due to perceptions of stress.

Prospective evaluation of intestinal decompression in treatment of acute bowel obstruction from Crohn’s disease

Background:Conservative therapy for Crohn’s disease(CD)-related acute bowel obstruction is essential to avoid emergent surgery.The present study aimed to evaluate the efficacy of using a long intestinal decompression tube(LT)in treatment of CD with acute intestinal obstruction.Methods:This is a prospective observational study.Comparative analysis was performed in CD patients treated with LT(the LT group)and nasogastric tube(the GT group).The primary outcome was the avoidance of emergent surgery.Additionally,predictive factors for failure of decompression and subsequent surgery were investigated.Results:There were 27 and 42 CD patients treated with LT and GT,respectively,in emergent situations.Twelve(44.4%)patients using LT were managed conservatively without laparotomy,while only nine(21.4%)patients in the GT group were spared from emergent surgery(P<0.05).Both in surgery-free and in surgery patients,the time to alleviation of symptoms was significantly shorter in the LT groups than in the GT groups(both P<0.01).C-reactive protein decrease after intubation and 48-hour drainage volume>500mL were predictors of unavoidable surgery(both P<0.05).The rate of temporary stoma and incidence of incision infection in the LT surgery group were significantly lower than those in the GT group(both P<0.05).No significant differences were observed in the frequency of medical and surgical recurrences between the LT and GT groups(all P>0.05).Conclusions:Endoscopic placement of LT could improve the emergent status in CD patients with acute bowel obstruction.The drainage output and changes in C-reactive protein after intubation could serve as practical predictive indices for subsequent surgery.Compared to traditional GT decompression,LT decompression was associated with fewer short-term complications and did not appear to affect long-term recurrence.