Abstract Acute pancreatitis (AP) is a common digestive disease characterized by inflammation of the pancreas. MiR-155 plays a role in promoting inflammation and inhibiting the activation of anti-inflammatory pathways. Impaired autophagy could promote zymogen activation, abnormal acinar cell secretion, cell death, and the inflammatory response to aggravate AP. The aim of this study was to ascertain the effect of silencing miR-155 on AP through its effects on inflammation and impaired autophagy in vivo. In this study, AAV(adeno-associated virus)-mediated miR-155 and miR-155 sponge were injected through the tail vein of mice. After 3 weeks, AP was induced by intraperitoneal (IP) injections of cerulein. Pancreatic and pulmonary tissues were analyzed after 24 h. Silencing of miR-155 ameliorated pancreas and lung damage in three AP models of mice by preventing accumulation of autophagosomes that are unable to fuse with lysosomes and decreasing pancreatic inflammation by targeting TAB2. 3-MA could reduce the aberrant accumulation of autophagosomes, which alleviates the pancreas damage that was aggravated by increasing miR-155 levels. These findings demonstrate that the inhibition of miR-155 holds promise for limiting pancreatitis.
Children's exposure to secondhand smoke (SHS) at home has numerous adverse health effects. This study evaluated the effects of a pediatric in-patient department-based pilot smoking cessation intervention for household members to reduce children's SHS exposure and encourage smoking cessation. A pre-post test design study was designed to assess the effectiveness of a telephone counseling intervention on household members of hospitalized children in pediatric departments. Data were collected with a standardized Chinese language questionnaire. At the three-month follow-up survey, the proportions of household members who reported adopting complete smoking restriction at home (55%), did not smoke at home at all (37%), did not allow others to smoke in the car (70%), or did not allow others to smoke around the child (57%) were significantly higher than the self-reported responses at the baseline survey. The proportions of household members who reported smoking at home (49%) and in the car (22%) were significantly lower than the baseline survey. Overall, 7% of the participants had reported quitting smoking after three months. Pediatric in-patient department-based telephone counseling for smoking cessation was found to be acceptable to Chinese parents. The intervention encouraged few parents to quit smoking, but encouraged more parents to take measures to reduce children's SHS exposure.
To investigate the dynamic changes in gastric varices in patients with acute pancreatitis (AP) and to develop a novel nomogram for the early prediction of sinistral portal hypertension (SPH).This was a retrospective, case-control study with an analysis of the quantitative, dynamic computed tomography imaging results of SPH in patients with moderate and severe AP with a long-term follow-up. Multivariate logistic regression analysis and nomogram were employed.The SPH group (n = 94) and non-SPH group (n = 94) were matched. The dynamic changes showed an increasing trend in the diameter of gastric fundus, short gastric, gastric coronary, and gastroepiploic veins, which did not recover during the one-year follow-up. Multivariate analysis showed that male (adjusted odds ratio (adjOR), 8.71; 95% confidence interval (CI), 2.86-26.53; P < 0.001), body mass index ≥27.5 kg/m2 (adjOR, 5.49; 95% CI, 1.85-16.29; P = 0.002), prothrombin time ≥12.6 s (adjOR, 2.82; 95% CI, 1.11-7.17; P = 0.03), and the patency of splenic vein [stenosis (adjOR, 8.48; 95% CI, 2.13-33.71; P = 0.002), and occlusion (adjOR, 34.57; 95% CI, 10.87-110.00; P < 0.001)] were independently associated with the development of SPH. The nomogram incorporating these factors demonstrated good discrimination, calibration and clinical utility. The area under the curve was as high as 0.92 (95% CI, 0.87-0.95).The dynamic changes in varices in SPH are long-term and slowly progressing. Males and obese patients with abnormal splenic veins and coagulopathies are at high risk for developing SPH. A simple nomogram tool helps in the early, accurate prediction of SPH.
Abstract Background and Aim Currently, endoscopic drainage (ED) and percutaneous drainage (PD) are both widely used effective interventions in the management of patients with symptomatic pancreatic fluid collections (PFCs). This study aimed to compare the clinical effectiveness and safety of ED to those of PD in the treatment of PFCs. Methods A prospective cohort study of PFC patients who underwent ED or PD was conducted between January 2009 and December 2017. In this study, the initial success rate, adverse events, intervention, requirement of surgical treatment, hospital mortality within 30 days, length of hospital stay, and expenses during hospitalization were monitored, and a follow‐up investigation of treatment outcome was conducted. Long‐term recovery, recurrence, and mortality were determined according to telephone follow up. Results In total, 129 patients were included in the study; 62 patients underwent ED, and 67 patients underwent PD during the 8‐year study period. Initial treatment success was considerably higher in patients whose PFCs were managed by ED than in patients whose PFCs were managed by PD (94.9% vs 65.0%, P = 0.003). The rate of procedural adverse events, reintervention, length of hospitalization, and expense were all higher in the PD group than in the ED group, but the long‐term recovery rate and requirement of surgical intervention were not clearly different between patients who underwent the two treatment measures. Conclusion ED of symptomatic PFCs was associated with higher rates of initial treatment success, lower rates of reintervention and adverse events, and a shorter hospital stay than PD of symptomatic PFCs.
Abstract Objective: To estimate the cancer incidence and mortality in 2012 in Guangdong province by analyzing the cancer data of selected population-based cancer registries in Guangdong province in 2012. Methods: Eight of nine population-based cancer registries submitted cancer data to the Guangdong Provincial Centre for Disease Control and Prevention (Guangdong CDC), whose data met the data quality criteria were included for analysis. The statistics of selected registries, stratified by areas, gender, age and cancer types, were used to estimate the cancer incidence and mortality in 2012 in Guangdong province according to the population data in Guangdong province. Segi's population and the national census population in 2000 were used for calculating the age-standardized rates (ASR). Results: A total of 15,084,942 people, accounted for 17.47% of all population in Guangdong province, were covered in 8 selected population-based cancer registries in 2012. The percentage of cases morphologically verified (MV%) and the percentage of death certificate-only cases (DCO%) were 72.84% and 0.87%, respectively, and the mortality/incidence (M/I) ratio was 0.56. It was estimated that there were 211,300 new cancer cases and 117,300 cancer deaths. The incidence crude rate (CR), the ASR by Chinese standard population (ASRC) and by world standard population (ASRW), and the accumulated rate (AR) (0.74 years) were 250.20/100,000 (265.39/100,000 in males, 234.29/100,000 in females), 207.04/100,000, 201.34/100,000 and 22.91%, respectively, in Guangdong province in 2012. The incidence CR and ASRC were 267.25/100,000 and 221.43/100,000 in urban areas, and 215.51/100,000 and 178.77/100,000 in rural areas, respectively. The death CR, ASRC, ASRW and AR (0.74 years) were 148.44/100,000 (190.95/100,000 in males, 105.06/100,000 in females), 103.73/100,000, 102.44/100,000 and 11.68%, respectively, in Guangdong province in 2012. The death CR and ASRC were 164.57/100,000 and 105.46/100,000 in urban areas, and 124.63/100,000 and 99.97/100,000 in rural areas, respectively. Top 5 cancers were lung cancer, liver cancer, female breast cancer, colon cancer and nasopharyngeal cancers (NPC), and top 5 death cancers were lung cancer, liver cancer, colon cancer, stomach cancer, and NPC in Guangdong province in 2012. Conclusions: Lung cancer, liver cancer, female breast cancer, colon cancer and NPC were the major economic cancer burdens and health concerns in Guangdong province in 2012. Early prevention, diagnosis and treatment of different cancers, survival quality improvement and cancer burden reduction, are important issues we faced in cancer control and prevention. Keywords: Cancer registration; malignancy; incidence; mortality; Guangdong province Submitted Mar 14, 2016. Accepted for publication Apr 12, 2016. doi: 10.21147/j.issn.1000-9604.2016.03.05
Abstract Background To investigate the association between features of necrotic collections on endoscopic ultrasound (EUS) and outcomes of the endoscopic transmural step-up approach. Methods This was a retrospective cohort study analyzing patients with necrotic collections underwent endoscopic transmural step-up approach. According to the amount of solid necrotic debris quantified as a percentage of the total collection size, participants were divided into three groups: <30% (group 1), 30%-50% (group 2), and >50% (group 3). Results Out of a total of 134 patients, the mean necrotic collection size was 8.5 (7.0, 10.0) cm, with <30% (group 1), 30%-50% (group 2) and >50% (group 3) solid debris present in 52, 59, and 23 patients, respectively. Patients with more solid necrotic debris needed more sessions of necrosectomy (group 1, 1 (0, 1) time vs. group 2, 1 (1, 2) time vs. group 3, 2 (2, 3) times, P<0.001), more likely experienced stent occlusion (group 1, 9.6% vs. group 2, 16.9% vs. group 3, 34.8%; P<0.05), and had a longer hospital stay (group 1, 25.5 (17.3, 44.0) days vs. group 2, 28.0 (19.0, 41.0) days vs. group 3, 40.0 (30.0, 58.0) days; P<0.05). Procalcitonin (OR, 6.14; 95% CI, 1.40-26.94; P<0.05) and any organ failure (OR, 11.51; 95% CI, 2.42-54.78; P<0.01) were independently associated with clinical failure of the endoscopic transmural step-up approach. Conclusions More solid debris on EUS predicted more sessions of necrosectomy, stent occlusion, and hospital stay. Procalcitonin and organ failure are risk factors for clinical failure of the endoscopic transmural step-up approach.
Abstract Background: Early prediction of the severity of acute pancreatitis (AP) is important but there is no preferred method in China. We aimed to develop and validate a simple-to-use predictive nomogram for persistent organ failure (POF) on admission in patients with AP. Methods: Data from 816 consecutive patients was obtained from internal (Chengdu) retrospective datasets and formed the training cohort for nomogram development. Data from 398 and 880 consecutive patients from internal (Chengdu) and external (Nanchang) prospective datasets formed the validation cohorts (all admitted < 48 hours of symptom onset). Univariate and multivariate logistic regressions were used to identify independent prognostic factors to establish the nomogram for POF. The calibration curves, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance of the nomogram and its clinical utility. The area under the receiver-operating characteristic curve (AUC) with 95% CI and likelihood ratio as well as post-test probability were applied. Measurements and main results: Age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion were identified as independent prognostic factors for POF and were included in the nomogram model (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This predictive nomogram had good predictive ability for POF (C-indexes of 0.88, 0.91 and 0.81 for the training and two validation cohorts) and promising clinical utility (DCA: better or equivalent than prognostic scores; CIC: high clinical net benefit). The AUC of (0.91 [0.88-0.94] and 0.81 [0.79-0.84]), negative likelihood ratio (NLR 0.11 and 0.29), post-test probability of negative (0.9% and 6.7%) of the nomogram were superior in predicting POF than all other routinely used clinical prognostic scoring systems in both validation cohorts. Similar findings were observed for predicting major infection (superior to other prognostic scores) and mortality (superior or equally to others). Conclusions: The validated nomogram comprises 6 independent prognostic factors to predict major clinical outcomes of patients with AP in two distinct Chinese centers. This mobile terminal-based nomogram should be validated in other settings and considered for clinical practice and trial allocation, until more accurate biomarkers are discovered.
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