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
Acute pancreatitis(AP) is a common disease,which usually exists in its mild form.However,in a fifth of cases,the disease is severe,with local pancreatic complications or systemic organ dysfunction or both.Because the ...Acute pancreatitis(AP) is a common disease,which usually exists in its mild form.However,in a fifth of cases,the disease is severe,with local pancreatic complications or systemic organ dysfunction or both.Because the development of organ failure is the major cause of death in AP,early identification of patients likely to develop organ failure is important.AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas.Destruction of the pancreatic parenchyma first induces an inflammatory reaction locally,but may lead to overwhelming systemic production of inflammatory mediators and early organ failure.Concomitantly,anti-inflammatory cytokines and specific cytokine inhibitors are produced.This anti-inflammatory reaction may overcompensate and inhibit the immune response,rendering the host at risk of systemic infection.At present,there is no specific treatment for AP.Increased understanding of the pathogenesis of systemic inflammation and development of organ dysfunction may provide us with drugs to ameliorate physiological disturbances.展开更多
Rock failure phenomena,such as rockburst,slabbing(or spalling) and zonal disintegration,related to deep underground excavation of hard rocks are frequently reported and pose a great threat to deep mining.Currently,the...Rock failure phenomena,such as rockburst,slabbing(or spalling) and zonal disintegration,related to deep underground excavation of hard rocks are frequently reported and pose a great threat to deep mining.Currently,the explanation for these failure phenomena using existing dynamic or static rock mechanics theory is not straightforward.In this study,new theory and testing method for deep underground rock mass under coupled static-dynamic loading are introduced.Two types of coupled loading modes,i.e.'critical static stress + slight disturbance' and 'elastic static stress + impact disturbance',are proposed,and associated test devices are developed.Rockburst phenomena of hard rocks under coupled static-dynamic loading are successfully reproduced in the laboratory,and the rockburst mechanism and related criteria are demonstrated.The results of true triaxial unloading compression tests on granite and red sandstone indicate that the unloading can induce slabbing when the confining pressure exceeds a certain threshold,and the slabbing failure strength is lower than the shear failure strength according to the conventional Mohr-Column criterion.Numerical results indicate that the rock unloading failure response under different in situ stresses and unloading rates can be characterized by an equivalent strain energy density.In addition,we present a new microseismic source location method without premeasuring the sound wave velocity in rock mass,which can efficiently and accurately locate the rock failure in hard rock mines.Also,a new idea for deep hard rock mining using a non-explosive continuous mining method is briefly introduced.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Acute pancreatitis(AP) is a common disease,which usually exists in its mild form.However,in a fifth of cases,the disease is severe,with local pancreatic complications or systemic organ dysfunction or both.Because the development of organ failure is the major cause of death in AP,early identification of patients likely to develop organ failure is important.AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas.Destruction of the pancreatic parenchyma first induces an inflammatory reaction locally,but may lead to overwhelming systemic production of inflammatory mediators and early organ failure.Concomitantly,anti-inflammatory cytokines and specific cytokine inhibitors are produced.This anti-inflammatory reaction may overcompensate and inhibit the immune response,rendering the host at risk of systemic infection.At present,there is no specific treatment for AP.Increased understanding of the pathogenesis of systemic inflammation and development of organ dysfunction may provide us with drugs to ameliorate physiological disturbances.
基金jointly supported by the State Key Research Development Program of China (Grant No.2016YFC0600706)the National Natural Science Foundation of China (Grant Nos.41630642 and 11472311)
文摘Rock failure phenomena,such as rockburst,slabbing(or spalling) and zonal disintegration,related to deep underground excavation of hard rocks are frequently reported and pose a great threat to deep mining.Currently,the explanation for these failure phenomena using existing dynamic or static rock mechanics theory is not straightforward.In this study,new theory and testing method for deep underground rock mass under coupled static-dynamic loading are introduced.Two types of coupled loading modes,i.e.'critical static stress + slight disturbance' and 'elastic static stress + impact disturbance',are proposed,and associated test devices are developed.Rockburst phenomena of hard rocks under coupled static-dynamic loading are successfully reproduced in the laboratory,and the rockburst mechanism and related criteria are demonstrated.The results of true triaxial unloading compression tests on granite and red sandstone indicate that the unloading can induce slabbing when the confining pressure exceeds a certain threshold,and the slabbing failure strength is lower than the shear failure strength according to the conventional Mohr-Column criterion.Numerical results indicate that the rock unloading failure response under different in situ stresses and unloading rates can be characterized by an equivalent strain energy density.In addition,we present a new microseismic source location method without premeasuring the sound wave velocity in rock mass,which can efficiently and accurately locate the rock failure in hard rock mines.Also,a new idea for deep hard rock mining using a non-explosive continuous mining method is briefly introduced.
