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 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.
Aim Cardiac injury, reflected by the measured concentrations of chemicals released from injured cardiac muscle, is common in acute pancreatitis (AP). However, there is no adequate evidence assessing the impact of cardiac injury on AP-related outcomes. Creatine kinase-myocardial band (CK-MB) mainly exists in the myocardium. Therefore, we sought to evaluate the relationship between the increase in CK-MB and the adverse clinical outcomes of AP. Methods This propensity score-matched study analyzed AP patients admitted to the Department of Gastroenterology in the First Affiliated Hospital of Nanchang University from June 2017 to July 2022. Propensity score matching and multivariate logistic regression analysis were used to explore the relationship between CK-MB elevation and AP outcome variables. Results A total of 5,944 patients were screened for eligibility, of whom 4,802 were ultimately enrolled. Overall, 896 (18.66%) of AP patients had elevated (>24 U/ml) CK-MB levels, and 895 (99.89%) were paired with controls using propensity score matching. The propensity score-matched cohort analysis demonstrated that mortality (OR, 5.87; 95% CI, 3.89–8.84; P < 0.001), severe acute pancreatitis (SAP) (OR, 2.74; 95% CI, 2.23–3.35; P < 0.001), and infected necrotizing pancreatitis (INP) (OR, 3.40; 95% CI, 2.34–4.94; P < 0.001) were more frequent in the elevated CK-MB (>24 U/ml) group than in the normal CK-MB (≤ 24 U/ml) group. Using the multivariate logistic regression analysis, elevated CK-MB levels were independently associated with increased mortality (OR, 2.753, 95% CI, 2.095–3.617, P < 0.001), SAP incidence (OR, 2.223, CI, 1.870–2.643, P < 0.001), and INP incidence (OR, 1.913, 95% CI, 1.467–2.494, P < 0.001). CK-MB elevation was an independent risk factor for adverse clinical outcomes in AP patients. Conclusion CK-MB elevation was significantly related to adverse outcomes in AP patients, which makes it a potentially useful laboratory parameter for predicting adverse clinical outcomes of AP.
Objective To investigate and analyze the risk factors of ventilator-associated pneumonia(VAP) and to take effective preventive countermeasures.Methods Selected 160 cases mechanical ventilation ≥ 48 h patients in our hospital as subjects,and selected 78 cases take place VAP for the VAP group,the remaining 82 cases did not occur in VAP group,to analyze the occurrence of VAP risk factors.Results The difference of age,duration of mechanical ventilation,APACHE Ⅱ score,antacids applications,hospital days between two groups were statistically significant(P 0.05).The two groups in the antibiotics time,serum albumin,the difference was not statistically significant(P 0.05).≥ 65 years of age,duration of mechanical ventilation 5 days,APACHE Ⅱ score ≥15 points,antacids 5 days,the number of days of hospitalization 30 days were VAP risk factors.Conclusion Targeting the risk factors for VAP,to take effective care interventions can significantly reduce the incidence of VAP.
Acute pancreatitis (AP) encompasses a spectrum of pancreatic inflammatory conditions, ranging from mild inflammation to severe pancreatic necrosis and multisystem organ failure. Given the challenges associated with obtaining human pancreatic samples, research on AP predominantly relies on animal models. In this study, we aimed to elucidate the fundamental molecular mechanisms underlying AP using various AP models.
This study sought to investigate the pathological and clinical characteristics of newly developed malignant pelvic tumors during pregnancy.A retrospective analysis was conducted of 20 patients with newly developed malignant pelvic tumors during pregnancy who were admitted to hospital from January 1, 2012 to March 31, 2020. The patients were grouped according to the histological tumor source, evaluated using a chi-square test and Kaplan-Meier analysis, and their clinical and pathological characteristics were examined.Of the 20 patients, 14 had primary tumors and 6 had metastatic tumors. The average age of the patients in the metastatic tumor group was higher than that of patients in the primary tumor group (P=0.038). Notably, patients in both groups were at an advanced tumor stage when they were diagnosed. A significant difference between the 2 groups (P<0.001) was found in the clinical presents and the outcomes. The survival rates of the 2 groups differed significantly (P<0.001). Patients in the primary tumor group all survived without tumors. Conversely, only 1 patient in the metastatic tumor group survived without a tumor during the follow-up period, and 5 patients in this group did not survive. The metastatic rates of the examined placentas were 1/6 and 3/5 for the primary and metastatic tumor groups, respectively (P=0.545). The histological distribution of the newly developed malignant pelvic tumors during pregnancy was diverse, and different to those in the non-pregnancy period. Additionally, 6 patients had metastatic tumors, and the proportion of metastatic tumors was significantly higher than that of non-pregnancy patients (P<0.001; 3.53% vs. 30%). Of the 8 patients with primary ovarian tumors, 5 had borderline tumors (62.5%), and the proportion of borderline tumors was significantly higher than that of non-pregnant patients (9.61% vs. 5/8) in the same period.Newly diagnosed malignant pelvic tumors during pregnancy were different from the non-pregnant in the tissue origin, pathological grade, clinical presenting, and outcomes. The metastatic tumors pose a serious threat to the lives and health of pregnant women.
Abstract Background Although metal stents have been widely used in the endoscopic step-up approach for necrotizing pancreatitis (NP), the exact timing of transmural stent removal has not been well studied. Here, we report a novel strategy for stent removal and compare it with the conventional strategy. Methods This retrospective, nested, case-control study analyzed all adult NP patients who underwent endoscopic transmural necrosectomy (ETN). Clinical outcomes were compared between case group (a novel strategy in which the stents were removed during the last necrosectomy when the ETN endpoint was achieved) and 1:1 necrosis extent matched control group (the conventional strategy in which the stents were removed after necrosectomy when clinical symptoms were relieved and collection was nearly completely resolved, as confirmed by imaging). Results Baseline characteristics was comparable between case group (n=37) and control group (n=37). Three (8.1%) patients in case group and one (2.7%) patient in control group needed additional ETN after stent removal (P >0.05). Nearly all patients (case: 97.3%; control: 94.6%) achieved clinical success. There was no difference in disease-related (case: 40.5%; control: 37.8%) or stent-related (case: 27.0%; control: 16.2%) complications. Case group had a trend of shorter length of stent placement (median: 20.0 days vs. 29.5 days, P >0.05). Conclusions Compared to the convention strategy, the novel strategy of transmural stent removal during last necrosectomy avoids one endoscopy procedure and is feasible, with no need for additional ETN after stent removal, similar improvement in clinical outcomes, and no increase in complications. Prospective multicenter studies regarding the timing of transmural stent removal are needed to further validate our conclusions.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)