Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologica...Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.展开更多
Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of se...Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.展开更多
BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution seconda...BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.展开更多
BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of...BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.展开更多
Currently,detecting SARS-CoV-2 RNAs is a standard approach for COVID-19 diagnosis.However,there is an urgent need for reliable and rapid serological diagnostic methods to screen SARS-CoV-2-infected people including th...Currently,detecting SARS-CoV-2 RNAs is a standard approach for COVID-19 diagnosis.However,there is an urgent need for reliable and rapid serological diagnostic methods to screen SARS-CoV-2-infected people including those who do not have overt symptoms.Most emerging studies described serological tests based on detection of SARS-CoV-2-specific IgM and IgG.1–4 Although detection of SARS-CoV-2-specific IgA in serum has been reported in few papers,5,6 analyses of IgA levels in a larger number of COVID-19 patients are still lacking.展开更多
With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serio...With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.展开更多
Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of infection.Traditionally open surgical debridement was the only too...Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of infection.Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity.This approach is however associated with poor outcomes.Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches.Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds:Delay,Drain and Debride.Patients can be managed in the intensive care unit and any intervention should be delayed.Percutaneous drainage can be utilized first and early in the course of the disease,followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary.Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach.The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.展开更多
Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid c... Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid collections include acute fluid collections, acute and chronic pancreatic pseudocysts, pancreatic abscesses and pancreatic necrosis. Before the introduction of linear endoscopic ultrasound (EUS) in the 1990s and the subsequent development of endoscopic ultrasound-guided drainage (EUS-GD) procedures, the available options for drainage in symptomatic PFCs included surgical drainage, percutaneous drainage using radiological guidance and conventional endoscopic transmural drainage. In recent years, it has gradually been recog-nized that, due to its lower morbidity rate compared to the surgical and percutaneous approaches, endoscopic treatment may be the preferred first-line approach for managing symptomatic PFCs. Endoscopic ultrasound-guided drainage has the following advantages, when compared to other alternatives such as surgical, per-cutaneous and non-EUS-guided endoscopic drainage.EUS-GD is less invasive than surgery and therefore does not require general anesthesia. The morbidity rate is lower, recovery is faster and the costs are lower. EUS-GD can avoid local complications related to per-cutaneous drainage. Because the endoscope is placed adjacent to the fluid collection, it can have direct ac-cess to the fluid cavity, unlike percutaneous drainage which traverses the abdominal wall. Complications such as bleeding, inadvertent puncture of adjacent viscera, secondary infection and prolonged periods of drainage with resultant pancreatico-cutaneous fistulae may be avoided. The only difference between EUS and non-EUS drainage is the initial step, namely, gaining access to the pancreatic fluid collection. All the sub-sequent steps are similar, i.e., insertion of guide-wires with fluoroscopic guidance, balloon dilatation of the cystogastrostomy and insertion of transmural stents or nasocystic catheters. Wi展开更多
AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between J...AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.展开更多
目的:探讨降钙素原(procalcitonin, PCT)检测在肺癌发热患者感染诊断中的应用价值及与癌性发热鉴别诊断中的应用。方法:回顾性收集2013年1月至2018年10月在我院行血清PCT检测的140例肺癌患者的临床及实验室资料,将患者分为感染伴发热、...目的:探讨降钙素原(procalcitonin, PCT)检测在肺癌发热患者感染诊断中的应用价值及与癌性发热鉴别诊断中的应用。方法:回顾性收集2013年1月至2018年10月在我院行血清PCT检测的140例肺癌患者的临床及实验室资料,将患者分为感染伴发热、感染不伴发热、无感染伴癌性发热、无感染无发热4组,比较4组患者的血清PCT水平,绘制接受者操作特性(receiver operating characteristic,ROC)曲线评价血清PCT在肺癌感染与癌性发热鉴别诊断中的价值。结果:感染肺癌患者中,小细胞肺癌的血清PCT水平高于非小细胞肺癌(4.322 vs 0.142;Z=-4.240,P<0.001);有转移患者的血清PCT水平高于无转移患者(0.609 vs 0.111;Z=-2.517,P=0.006)。感染伴发热血清PCT水平为0.652(0.290~1.147)μg/L最高、其次为癌性发热无感染组0.439(0.174~1.074)μg/L、再次为感染不伴发热组0.378(0.117~0.581)μg/L、最低为无感染无发热组0.126(0.038~0.451)μg/L。PCT诊断肺癌患者感染的最佳截断点为0.349μg/L,曲线下面积为0.645±0.043,灵敏度、特异度分别为0.449、0.769;PCT诊断未发热肺癌患者感染的最佳截断点为0.098μg/L,曲线下面积为0.678±0.051,灵敏度、特异度分别为0.518、0.763;PCT诊断发热肺癌患者感染的最佳截断点为0.954μg/L,曲线下面积为0.704±0.074,灵敏度、特异度分别为0.341、0.939。结论:血清PCT作为一种快速、简单、易获得的一项实验室诊断指标,可以作为肺癌发热患者感染诊断及的一项参考指标,但血清PCT水平升高并不完全意味着感染。展开更多
The SEIR epidemic model studied here includes constant inflows of new susceptibles, exposeds, infectives, and recovereds. This model also incorporates a population size dependent contact rate and a disease-related dea...The SEIR epidemic model studied here includes constant inflows of new susceptibles, exposeds, infectives, and recovereds. This model also incorporates a population size dependent contact rate and a disease-related death. As the infected fraction cannot be eliminated from the population, this kind of model has only the unique endemic equilibrium that is globally asymptotically stable. Under the special case where the new members of immigration are all susceptible, the model considered here shows a threshold phenomenon and a sharp threshold has been obtained. In order to prove the global asymptotical stability of the endemic equilibrium, the authors introduce the change of variable, which can reduce our four-dimensional system to a three-dimensional asymptotical autonomous system with limit equation.展开更多
文摘Severe acute pancreatitis (SAP) develops in about 25% of patients with acute pancreatitis (AP). Severity of AP is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis pathomorphologically. Risk factors determining independently the outcome of SAP are early multi-organ failure, infection of necrosis and extended necrosis (> 50%). Up to one third of patients with necrotizing pancreatitis develop in the late course infection of necroses. Morbidity of SAP is biphasic, in the first week strongly related to early and persistence of organ or multi-organ dysfunction. Clinical sepsis caused by infected necrosis leading to multi-organ failure syndrome (MOFS) occurs in the later course after the first week. To predict sepsis, MOFS or deaths in the first 48-72 h, the highest predictive accuracy has been objectified for procalcitonin and IL-8; the Sepsis- Related Organ Failure Assessment (SOFA)-score predicts the outcome in the first 48 h, and provides a daily assessment of treatment response with a high positive predictive value. Contrast-enhanced CT provides the highest diagnostic accuracy for necrotizing pancreatitis when performed after the first week of disease. Patients who suffer early organ dysfunctions or at risk of developing a severe disease require early intensive care treatment. Early vigorous intravenous fluid replacement is of foremost importance. The goal is to decrease the hematocrit or restore normal cardiocirculatory functions. Antibiotic prophylaxis has not been shown as an effective preventive treatment. Early enteral feeding is based on a high level of evidence, resulting in a reduction of local and systemic infection. Patients suffering infected necrosis causing clinical sepsis, pancreatic abscess or surgical acute abdomen are candidates for early intervention. Hospital mortality of SAP after interventional or surgical debridement has decreased in high volume centers to below 20%.
文摘Approximately 20% of patients with acute pancreatitis develop a severe disease associated with complications and high risk of mortality. The purpose of this study is to review pathogenesis and prognostic factors of severe acute pancreatitis （SAP）. An extensive medline search was undertaken with focusing on pathogenesis, complications and prognostic evaluation of SAP. Cytokines and other inflammatory markers play a major role in the pathogenesis and course of SAP and can be used as prognostic markers in its early phase. Other markers such as simple prognostic scores have been found to be as e^ective as multifactorial scoring systems （MFSS） at 48 h with the advantage of simplicity, efficacy, low cost, accuracy and early prediction of SAP. Recently, several laboratory markers including hematocrit, blood urea nitrogen （BUN）, creatinine, matrix metalloproteinase-9 （MMP-9） and serum amyloid A （SAA） have been used as early predictors of severity within the first 24 h. The last few years have witnessed a tremendous progress in understanding the pathogenesis and predicting the outcome of SAP. In this review we classified the prognostic markers into predictors of severity, pancreatic necrosis （PN）, infected PN （IPN） and mortality.
基金supported by grants from the National Natural Science Foundation of China(81372613 and 81170431)Doctoral Fund of Ministry of Education of China(21022307110012)Special Fund of Ministry of Public Health of China(210202007)
文摘BACKGROUND： Severe acute pancreatitis（SAP） remains a clinical challenge with considerable morbidity and mortality.An early identification of infected pancreatic necrosis（IPN）, a life-threatening evolution secondary to SAP, is obliged for a more preferable prognosis. Thus, the present study was conducted to identify the risk factors of IPN secondary to SAP. METHODS： The clinical data of patients with SAP were retrospectively analyzed. Univariate and multivariate logistic regression analyses were sequentially performed to assess the associations between the variables and the development of IPN secondary to SAP. A receiver operating characteristic（ROC） curve was created for each of the qualified independent risk factors. RESULTS： Of the 115 eligible patients, 39（33.9%） progressed to IPN, and the overall in-hospital mortality was 11.3%（13/115）.The early enteral nutrition（EEN）（P=0.0092, OR=0.264）, maximum intra-abdominal pressure（IAP）（P=0.0398, OR=1.131）and maximum D-dimer level（P=0.0001, OR=1.006） in the first three consecutive days were independent risk factors associated with IPN secondary to SAP. The area under ROC curve（AUC） was 0.774 for the maximum D-dimer level in the first three consecutive days and the sensitivity was 90% and the specificity was 58% at a cut-off value of 933.5 μg/L; the AUC was 0.831 for the maximum IAP in the first three consecutive days and the sensitivity was 95% and specificity was 58%at a cut-off value of 13.5 mm Hg. CONCLUSIONS： The present study suggested that the maximum D-dimer level and/or maximum IAP in the first three consecutive days after admission were risk factors of IPN secondary to SAP; an EEN might be helpful to prevent the progression of IPN secondary to SAP.
文摘BACKGROUND:Early assessment of the severity of acute pancreatitis is essential to the proper management of the disease.It is dependent on the criteria of the Atlanta classification system.DATA SOURCES:PubMed search of recent relevant articles was performed to identify information about the severity and prognosis of acute pancreatitis.RESULTS:The scoring systems included the Ranson’s or Glasgow’s criteria ≥3,the APACHE II classification system ≥8,and the Balthazar’s criteria ≥4 according to the computed tomography enhanced scanning findings.The single factors on admission included age >65 years,obesity,hemoconcentration(>44%),abnormal chest X-ray,creatinine >2 mg/dl,C-reactive protein>150 mg/dl,procalcitonin >1.8 ng/ml,albumin <2.5 mg/dl,calcium <8.5 mg/dl,early hyperglycemia,increased intra-abdominal pressure,macrophage migration inhibitory factor,or a combination of IL-10 >50 pg/ml with calcium <6.6 mg/dl.CONCLUSION:The prediction of the severity of acute pancreatitis is largely based on well defined multiple factor scoring systems as well as several single risk factors.
基金We acknowledge funding support from the Strategic Priority Research Program of the Chinese Academy of Sciences(XDB29030104)National Natural Science Foundation of China(Grant Nos.:31870731 and U1732109)+2 种基金the Fundamental Research Funds for the Central Universities(WK2070000108)a COVID-19 special task grant supported by Chinese Academy of Science Clinical Research Hospital(Hefei)(YD2070002017 and YD2070002001)the new medical science fund of USTC(WK2070000130).
文摘Currently,detecting SARS-CoV-2 RNAs is a standard approach for COVID-19 diagnosis.However,there is an urgent need for reliable and rapid serological diagnostic methods to screen SARS-CoV-2-infected people including those who do not have overt symptoms.Most emerging studies described serological tests based on detection of SARS-CoV-2-specific IgM and IgG.1–4 Although detection of SARS-CoV-2-specific IgA in serum has been reported in few papers,5,6 analyses of IgA levels in a larger number of COVID-19 patients are still lacking.
基金jointly supported by the National Natural Science Foundation of China(grant numbers:51973172,and 51673155)the Natural Science Foundation of Shaanxi Province(No.2020JC-03 and 2019TD-020)+5 种基金State Key Laboratory for Mechanical Behavior of Materials,and the Fundamental Research Funds for the Central Universitiesthe World-Class Universities(Disciplines)and the Characteristic Development Guidance Funds for the Central UniversitiesOpening Project of Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research,College of Stomatology,Xi’an Jiaotong University(No.2019LHM-KFKT008)the Key R&D Program of Shaanxi Province(No.2019ZDLSF02-09-01,2020GXLH-Y-019)Innovation Capability Support Program of Shaanxi Province(Program No.2019GHJD-14,2021TD-40)Scientific Research Program Funded by Shaanxi Provincial Education Department(Program No.18JC027).
文摘With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.
文摘Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15%that reach 30%in case of infection.Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity.This approach is however associated with poor outcomes.Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches.Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds:Delay,Drain and Debride.Patients can be managed in the intensive care unit and any intervention should be delayed.Percutaneous drainage can be utilized first and early in the course of the disease,followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary.Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach.The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.
文摘 Pancreatic fluid collections (PFCs) develop secondary to either fluid leakage or liquefaction of pancreatic necrosis following acute pancreatitis, chronic pancreatitis, surgery or abdominal trauma. Pancreatic fluid collections include acute fluid collections, acute and chronic pancreatic pseudocysts, pancreatic abscesses and pancreatic necrosis. Before the introduction of linear endoscopic ultrasound (EUS) in the 1990s and the subsequent development of endoscopic ultrasound-guided drainage (EUS-GD) procedures, the available options for drainage in symptomatic PFCs included surgical drainage, percutaneous drainage using radiological guidance and conventional endoscopic transmural drainage. In recent years, it has gradually been recog-nized that, due to its lower morbidity rate compared to the surgical and percutaneous approaches, endoscopic treatment may be the preferred first-line approach for managing symptomatic PFCs. Endoscopic ultrasound-guided drainage has the following advantages, when compared to other alternatives such as surgical, per-cutaneous and non-EUS-guided endoscopic drainage.EUS-GD is less invasive than surgery and therefore does not require general anesthesia. The morbidity rate is lower, recovery is faster and the costs are lower. EUS-GD can avoid local complications related to per-cutaneous drainage. Because the endoscope is placed adjacent to the fluid collection, it can have direct ac-cess to the fluid cavity, unlike percutaneous drainage which traverses the abdominal wall. Complications such as bleeding, inadvertent puncture of adjacent viscera, secondary infection and prolonged periods of drainage with resultant pancreatico-cutaneous fistulae may be avoided. The only difference between EUS and non-EUS drainage is the initial step, namely, gaining access to the pancreatic fluid collection. All the sub-sequent steps are similar, i.e., insertion of guide-wires with fluoroscopic guidance, balloon dilatation of the cystogastrostomy and insertion of transmural stents or nasocystic catheters. Wi
文摘AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
文摘目的:探讨降钙素原(procalcitonin, PCT)检测在肺癌发热患者感染诊断中的应用价值及与癌性发热鉴别诊断中的应用。方法:回顾性收集2013年1月至2018年10月在我院行血清PCT检测的140例肺癌患者的临床及实验室资料,将患者分为感染伴发热、感染不伴发热、无感染伴癌性发热、无感染无发热4组,比较4组患者的血清PCT水平,绘制接受者操作特性(receiver operating characteristic,ROC)曲线评价血清PCT在肺癌感染与癌性发热鉴别诊断中的价值。结果:感染肺癌患者中,小细胞肺癌的血清PCT水平高于非小细胞肺癌(4.322 vs 0.142;Z=-4.240,P<0.001);有转移患者的血清PCT水平高于无转移患者(0.609 vs 0.111;Z=-2.517,P=0.006)。感染伴发热血清PCT水平为0.652(0.290~1.147)μg/L最高、其次为癌性发热无感染组0.439(0.174~1.074)μg/L、再次为感染不伴发热组0.378(0.117~0.581)μg/L、最低为无感染无发热组0.126(0.038~0.451)μg/L。PCT诊断肺癌患者感染的最佳截断点为0.349μg/L,曲线下面积为0.645±0.043,灵敏度、特异度分别为0.449、0.769;PCT诊断未发热肺癌患者感染的最佳截断点为0.098μg/L,曲线下面积为0.678±0.051,灵敏度、特异度分别为0.518、0.763;PCT诊断发热肺癌患者感染的最佳截断点为0.954μg/L,曲线下面积为0.704±0.074,灵敏度、特异度分别为0.341、0.939。结论:血清PCT作为一种快速、简单、易获得的一项实验室诊断指标,可以作为肺癌发热患者感染诊断及的一项参考指标,但血清PCT水平升高并不完全意味着感染。
基金This research is supported by the NNSF of China (19971066)
文摘The SEIR epidemic model studied here includes constant inflows of new susceptibles, exposeds, infectives, and recovereds. This model also incorporates a population size dependent contact rate and a disease-related death. As the infected fraction cannot be eliminated from the population, this kind of model has only the unique endemic equilibrium that is globally asymptotically stable. Under the special case where the new members of immigration are all susceptible, the model considered here shows a threshold phenomenon and a sharp threshold has been obtained. In order to prove the global asymptotical stability of the endemic equilibrium, the authors introduce the change of variable, which can reduce our four-dimensional system to a three-dimensional asymptotical autonomous system with limit equation.
