Alimentación oral inmediata en pancreatitis aguda: Revisión Sistemática basada en la evidencia actual / Immediate oral feeding in acute pancreatitis: Systematic review based on current evidence / Alimentação oral imediata em pancreatite aguda: revisão sistemática com base em provas actuais

La pancreatitis aguda es una patología cuyo manejo primario abarca medidas con el fin de asegurar el reposo gastrointestinal, la presente revisión sistemática tiene como fin valorar los beneficios obtenidos tras iniciarse una dieta oral inmediata en pacientes con pancreatitis aguda. Se realizó una revisión sistemática, bajo lineamentos PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses), que incluyó ensayos clínicos controlados aleatoriza-dos, la búsqueda fue realizada en PubMed, ScienceDirect y Cochrane, se usaron los términos de búsqueda: "Acute pancreatitis", "Enteral nutrition" "Oral refeed" y "randomized controlado trial", obteniendo 393 artículos. Tras aplicar criterios de inclusión y exclusión, un total de 6 estudios se incluyeron en la revisión, se valoró: complicaciones o eventos adversos, gravedad del cuadro, requerimiento de analgesia, estancia hospitalaria, tolerancia a la dieta y gastos gene-rados, encontrando beneficios estadísticamente significativos, sobre todo en los últimos tres as-pectos. Se concluyó que la alimentación oral inmediata es segura en pacientes con pancreatitis aguda, pese a ello, es imprescindible generar más estudios multicéntricos con el fin de generar evidencia de mayor peso

Acute pancreatitis is a pathology whose primary management includes measures to ensure gastrointestinal rest. The present systematic review aims to assess the benefits obtained af-ter initiating an immediate oral diet in patients with acute pancreatitis. A systematic review was carried out, under PRISMA (Preferred Reporting Items for Systematic reviews and Me-ta-Analyses) guidelines, which included randomized controlled clinical trials, the search was performed in PubMed, ScienceDirect and Cochrane, using the search terms: "Acute pancre-atitis", "Enteral nutrition" "Oral refeed" and "randomized controlled trial", obtaining 393 articles. After applying inclusion and exclusion criteria, a total of 6 studies were included in the review, evaluating: complications or adverse events, severity of the condition, analgesia requirement, hospital stay, tolerance to the diet and expenses generated, finding statistically significant benefits, especially in the last three aspects. It was concluded that immediate oral feeding is safe in patients with acute pancreatitis; nevertheless, it is essential to generate more multicenter studies in order to generate more weighty evidence

A pancreatite aguda é uma patologia cuja gestão primária inclui medidas para assegurar o re-pouso gastrointestinal. Esta revisão sistemática visa avaliar os benefícios obtidos após o início de uma dieta oral imediata em doentes com pancreatite aguda. Foi realizada uma revisão sis-temática segundo as directrizes do PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses),, incluindo ensaios clínicos controlados aleatórios, a pesquisa foi realizada no PubMed, ScienceDirect e Cochrane, utilizando os termos de pesquisa: "Pancreatite aguda", "Nutrição enteral", "Refeição oral" e "ensaio controlado aleatório", obtendo 393 artigos. Após a aplicação dos critérios de inclusão e exclusão, foi incluído um total de 6 estudos na revisão, avaliando: complicações ou eventos adversos, gravidade da condição, necessidade de analgesia, internamento hospitalar, tolerância à dieta e custos gerados, encontrando benefícios estatisti-camente significativos, especialmente nos três últimos aspectos. A alimentação oral imediata é segura em doentes com pancreatite aguda, no entanto, é essencial gerar mais estudos multicên-tricos a fim de gerar provas mais significativas

Pancreatitis aguda en el escenario de hipercalcemia por hiperparatiroidismo primario / Acute pancreatitis in the setting of hypercalcemia due to primary hyperparathyroidism

Introducción: describir el caso de un paciente con pancreatitis aguda secundaria a hipercalcemia por hiperparatiroidismo prImario. Esta es una causa poco frecuente de pancreatitis, asociada a morbimortalidad significativa en caso de no ser diagnosticada oportunamente Caso clínico: un hombre de 44 años, con antecedente de pancreatitis de presunto origen biliar que había requerido previamente colecistectomía, consultó por dolor abdominal y náuseas. Los estudios complementarios fueron compatibles con un nuevo episodio de pancreatitis aguda. Presentaba hipercalcemia y hormona paratiroidea (PTH) elevada, configurando hiperparatiroidismo primario. La gammagrafía informó hallazgos compatibles con adenoma paratiroideo. Se inició tratamiento con reanimación hídrica y analgesia con adecuada disminución de calcio sérico y resolución de dolor abdominal. Después de la paratiroidectomía se logró normalizar los niveles de calcio y PTH. Discusión: la pancreatitis aguda es una condición potencialmente fatal, por lo que la sospecha de causas poco frecuentes como la hipercalcemia debe tenerse en cuenta. El tratamiento de la hipercalcemia por adenoma paratiroideo se basa en reanimación hídrica adecuada y manejo quirúrgico del adenoma, con el fin de evitar recurrencia de pancreatitis y mortalidad. (AU)

Introduction: we describe the case of a patient with acute pancreatitis secondary to hypercalcemia due to primary hyperparathyroidism. This is a rare cause of pancreatitis associated with significant morbidity and mortality if not diagnosed in time. Clinical case: a 44-year-old man with a history of pancreatitis of presumed biliary origin, which had previously required cholecystectomy, consulted for abdominal pain and nausea. The laboratory findings were compatible with a new episode of acute pancreatitis. He presented hypercalcemia and an elevated parathyroid hormone (PTH), configuring primary hyperparathyroidism. Scintigraphy was performed, yielding findings compatible with parathyroid adenoma. Treatment with fluid resuscitation and analgesia was started, resulting in an adequate decrease in serum calcium and resolution of abdominal pain. After parathyroidectomy, calcium and PTH levels were normalized. Discussion: acute pancreatitis is a potentially fatal condition; therefore the suspicion of rare causes, such as hypercalcemia, should be considered. The treatment of hypercalcemia due to parathyroid adenoma is based on adequate fluid resuscitation and surgical management of the adenoma, to avoid recurrence of pancreatitis and death. (AU)

Pancreatitis aguda: Puntos clave. Revisión argumentativa de la literatura / Acute pancreatitis: Key points. Argumentative review of the literature

Introducción. La pancreatitis aguda es una condición gastrointestinal común que se asocia a una importante morbimortalidad. Se estima que su incidencia es de 34 por cada 100.000 habitantes, afecta principalmente a adultos a partir de la sexta década de la vida y en nuestra región es debida en la mayoría de los casos a cálculos biliares. Métodos. Se hizo una revisión de los aspectos fundamentales de esta patología, común y potencialmente mortal. Resultados. El diagnóstico requiere del hallazgo de manifestaciones clínicas, aumento de las enzimas pancreáticas en suero y, en ocasiones, el uso de imágenes diagnósticas. Se puede clasificar en leve, moderada y severa, lo cual es fundamental para determinar la necesidad de tratamiento y vigilancia en una unidad de cuidados intensivos. Conclusión. En la actualidad los pilares de manejo de la pancreatitis aguda son la terapia temprana con líquidos, tratamiento del dolor, inicio precoz de la vía oral y resolución del factor etiológico desencadenante. En presencia de complicaciones o un curso severo de enfermedad, pueden requerirse manejo antibiótico e intervenciones invasivas

Introduction. Acute pancreatitis is a common gastrointestinal condition that is associated with significant morbidity and mortality. It is estimated that its incidence is 34 per 100,000 inhabitants, it mainly affects adults from the sixth decade of life, and in our region, most of the cases are secondary to gallbladder stones. Methods. We present a review of the fundamental aspects of this disease, common and potentially fatal. Results. Diagnosis requires finding clinical manifestations, increased serum pancreatic enzymes, and sometimes the use of diagnostic imaging. It can be classified as mild, moderate and severe, which is essential to determine the need for treatment and monitoring in an intensive care unit. Conclusion. Currently, the pillars of management of acute pancreatitis are early fluid therapy, pain management, early oral food intake, and resolution of the etiology. In the presence of complications or a severe course of the disease, antibiotic management and invasive interventions may be required

Pancreatitis inducida por ácido valproico: reporte de caso / Valproic acid induced pancreatitis: Case report / Pancreatite induzida por ácido valpróico: relato de caso

La pancreatitis en pediatría se consideraba anteriormente una enfermedad poco fre­cuente; en la actualidad se reportan 13.2 casos por 100 000 niños/año. La causa más importante de pancreatitis en la población pediátrica, después de la etiología biliar, son los medicamentos (13% de los casos). Uno de los principales medicamentos como causa de pancreatitis en pediatría es el ácido valproico (AV); el cual puede inducir una pancreatitis aguda. Aquí se presentará el primer caso de pancreatitis por AV en población pediátrica reportado en Colombia. Se trata de un paciente de cuatro años, con trastorno en el neurodesarrollo por un síndrome de TORCH, quien tomaba AV a largo plazo por un trastorno de la conducta. Ingresó a una institución de alta complejidad donde se diagnostica pancreatitis aguda con signos de necrosis en tejido pancreático secundario a uso de AV. Se suspendió el medicamento con resolución de su cuadro clínico y alta médica hacia el día 15

Pediatric pancreatitis was previously considered a rare disease. Currently, 13.2 cases are reported per 100,000 children/year. The most important cause of pancreatitis in the pediatric population, after biliary etiology, are medications (13% of cases). One of the main medications as a cause of pediatric pancreatitis is valproic acid (VA), which can lead to acute pancreatitis. Here we will present the first case of VA pancreatitis in the pediatric population reported in Colombia. This is a four-year-old patient, with a neurodevelopmental disorder due to TORCH syndrome, who was taking VA long-term for a conduct disorder. He was admitted to a highly complex institution where acute pancreatitis was diagnosed with signs of necrosis in pancreatic tissue secondary to the use of VA. The medication was discontinued with resolution of his set of symptoms and medical discharge around day 15.

A pancreatite pediátrica era anteriormente considerada uma doença rara; atualmente, 13,2 casos por 100 000 crianças/ano são relatados. A causa mais importante de pancreatite na população pediátrica, depois da etiologia biliar, são os medicamentos (13% dos casos). Uma das principais medicações como causa de pancrea-tite em pediatria é o ácido valpróico (VA); que podem induzir pancreatite aguda. Aqui apresentaremos o primeiro caso de pancreatite AV na população pediátrica relatado na Colômbia. Trata-se de uma paciente de quatro anos de idade, com transtorno do neuro-desenvolvimento devido à síndrome TORCH, que fazia uso de AV de longa duração para um transtorno de conduta. Ele foi internado em uma instituição de alta complexidade onde foi diagnosticado pancreatite aguda com sinais de necrose no tecido pancreático secundário ao uso de AV. A medicação foi suspensa com resolução do quadro clínico e alta médica por volta do 15º dia

Pancreatitis aguda asociada a cocaína, una complicación inusual. Serie de casos / Cocaine-induced acute pancreatitis, an unusual complication. Case serie / Pancreatite aguda associada à cocaína, uma complicação incomum. Número de casos

La cocaína es una de las sustancias ilegales más consumidas y Colombia no es la ex­cepción. Dentro de las sustancias ilegales es la segunda más consumida después del cannabis. Por su mecanismo mismo de acción, que produce aumento de aminas bióge­nas, se han asociado con la cocaína diferentes riesgos, tanto agudos como crónicos, y dentro de sus complicaciones se han descrito cambios comportamentales, compromiso cardiovascular y neurológico. La coingesta de cocaína y alcohol da lugar a un metabolito conocido como cocaetileno, que lleva a complicaciones cardiovasculares. Poco se ha descrito sobre el riesgo de la cocaína o la coingesta cocaína y alcohol, como un factor sumatorio, para la pancreatitis. Reportamos tres pacientes jóvenes consumidores del alcaloide que desarrollaron pancreatitis aguda, dos de ellos murieron. El objetivo de este reporte es sensibilizar a los trabajadores de la salud sobre otro riesgo para considerar en los pacientes consumidores de cocaína.

Cocaine is one of the most consumed illegal substances and Colombia is no exception. It is the second most consumed among the illegal substances after cannabis. Due to its very mechanism of action, which produces an increase in biogenic amines, different risks, both acute and chronic, have been associated with cocaine, and among its complications, behavioral changes, cardiovascular and neurological compromise have been described. The co-ingestion of cocaine and alcohol gives rise to a metabolite known as cocaethylene, which leads to cardiovascular complications. Little has been described about the risk of cocaine or cocaine and alcohol co-ingestion, as a summative factor, for pancreatitis. We report three young patients consuming the alkaloid who developed acute pancreatitis, two of whom died. The objective of this report is to sensitize health workers about another risk to consider in cocaine-consuming patients.

A cocaína é uma das substâncias ilícitas mais consumidas e a Colômbia não é exceção. Dentro das substâncias ilícitas é a segunda mais consumida depois da maconha. Devido ao seu próprio mecanismo de ação, que produz aumento de aminas biogênicas, diversos riscos, tanto agudos quanto crônicos, têm sido associados à cocaína e, entre suas complicações, têm sido descritas alterações comportamentais, comprometimento cardiovascular e neurológico. A co-ingestão de cocaína e álcool dá origem a um metabólito conhecido como cocaetileno, que leva a complicações cardiovasculares. Pouco tem sido descrito sobre o risco da co-ingestão de cocaína ou cocaína e álcool, como fator somativo, para pancreatite. Relatamos 3 pacientes jovens consumindo o alcalóide que desenvolveram pancreatite aguda, dois dos quais morreram. O objetivo deste relatório é sensibilizar os profissionais de saúde sobre outro risco a ser considerado em pacientes consumidores de cocaína.

A case of neonatal-onset type I hyperlipoproteinemia with bloody ascites / 中国当代儿科杂志

This report presents a case of a male infant, aged 32 days, who was admitted to the hospital due to 2 days of bloody stools and 1 day of fever. Upon admission, venous blood samples were collected, which appeared pink. Blood biochemistry tests revealed elevated levels of triglycerides and total cholesterol. The familial whole genome sequencing revealed a compound heterozygous variation in the LPL gene, with one variation inherited from the father and the other from the mother. The patient was diagnosed with lipoprotein lipase deficiency-related hyperlipoproteinemia. Acute symptoms including bloody stools, fever, and bloody ascites led to the consideration of acute pancreatitis, and the treatment involved fasting, plasma exchange, and whole blood exchange. Following the definitive diagnosis based on the genetic results, the patient was given a low-fat diet and received treatment with fat-soluble vitamins and trace elements, as well as adjustments to the feeding plan. After a 4-week hospitalization, the patient's condition improved and he was discharged. Follow-up showed a decrease in triglycerides and total cholesterol levels. At the age of 1 year, the patient's growth and psychomotor development were normal. This article emphasizes the multidisciplinary diagnosis and treatment of familial hyperlipoproteinemia presenting with symptoms suggestive of acute pancreatitis, including bloody ascites, in the neonatal period.

Contrast-enhanced ultrasound and contrast-enhanced computed tomography for differentiating mass-forming pancreatitis from pancreatic ductal adenocarcinoma: a meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Patients with mass-forming pancreatitis (MFP) or pancreatic ductal adenocarcinoma (PDAC) presented similar clinical symptoms, but required different treatment approaches and had different survival outcomes. This meta-analysis aimed to compare the diagnostic performance of contrast-enhanced ultrasound (CEUS) and contrast-enhanced computed tomography (CECT) in differentiating MFP from PDAC.@*METHODS@#A literature search was performed in the PubMed, EMBASE (Ovid), Cochrane Library (CENTRAL), China National Knowledge Infrastructure (CNKI), Weipu (VIP), and WanFang databases to identify original studies published from inception to August 20, 2021. Studies reporting the diagnostic performances of CEUS and CECT for differentiating MFP from PDAC were included. The meta-analysis was performed with Stata 15.0 software. The outcomes included the pooled sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curves of CEUS and CECT. Meta-regression was conducted to investigate heterogeneity. Bayesian network meta-analysis was conducted to indirectly compare the overall diagnostic performance.@*RESULTS@#Twenty-six studies with 2115 pancreatic masses were included. The pooled sensitivity and specificity of CEUS for MFP were 82% (95% confidence interval [CI], 73%-88%; I2  = 0.00%) and 95% (95% CI, 90%-97%; I2  = 63.44%), respectively; the overall +LR, -LR, and DOR values were 15.12 (95% CI, 7.61-30.01), 0.19 (95% CI, 0.13-0.29), and 78.91 (95% CI, 30.94-201.27), respectively; and the area under the SROC curve (AUC) was 0.90 (95% CI, 0.87-92). However, the overall sensitivity and specificity of CECT were 81% (95% CI, 75-85%; I2  = 66.37%) and 94% (95% CI, 90-96%; I2  = 74.87%); the overall +LR, -LR, and DOR values were 12.91 (95% CI, 7.86-21.20), 0.21 (95% CI, 0.16-0.27), and 62.53 (95% CI, 34.45-113.51), respectively; and, the SROC AUC was 0.92 (95% CI, 0.90-0.94). The overall diagnostic accuracy of CEUS was comparable to that of CECT for the differential diagnosis of MFP and PDAC (relative DOR 1.26, 95% CI [0.42-3.83], P  > 0.05).@*CONCLUSIONS@#CEUS and CECT have comparable diagnostic performance for differentiating MFP from PDAC, and should be considered as mutually complementary diagnostic tools for suspected focal pancreatic lesions.

Arterial partial pressure of oxygen and procalcitonin combined with ROX index predict the timing of tracheal intubation in patients with acute severe pancreatitis / 中华危重病急救医学

OBJECTIVE@#To investigate the efficacy of arterial partial pressure of oxygen (PaO2), procalcitonin (PCT) combined with ROX index in predicting the timing of tracheal intubation in patients with acute severe pancreatitis (SAP).@*METHODS@#A case-control study was conducted. A total of 148 patients with SAP admitted to Hunan Provincial People's Hospital from January 2019 to December 2022 were selected as the research objects. According to whether endotracheal intubation was used after admission during hospitalization, the patients were divided into the intubation group (102 cases) and non-intubation group (46 cases). Gender, age, white blood cell count (WBC), lymphocyte count (LYM), platelet count (PLT), C-reactive protein (CRP), hemoglobin (Hb), PCT, PaO2, arterial partial pressure of carbon dioxide (PaCO2), arterial bicarbonate ion (HCO3-) 1 day after admission, arterial lactic acid (Lac), lactate dehydrogenase (LDH), heart rate (HR), respiratory rate (RR), pulse oxygen saturation (SpO2), oxygenation index (PaO2/FiO2), blood pressure, worst ROX index (ROX index = SpO2/FiO2/RR) within 30 minutes of admission and 30 minutes before intubation of the two groups were measured. Multivariate Logistic regression was used to analyze the independent risk factors for the timing of endotracheal intubation in patients with SAP. The receiver operator characteristic curve (ROC curve) was used to determine the optimal predictive cut-off value for endotracheal intubation.@*RESULTS@#There were no significant differences in age, gender, WBC, LYM, CRP, Hb, LDH, HR and blood pressure at admission between the two groups. The PLT, Lac, PCT and RR in the intubation group were significantly higher than those in the un-intubation group, and HCO3-, PaO2, SpO2, PaO2/FiO2, the worst ROX index within 30 minutes after admission and 30 minutes before intubation were significantly lower than those in the non-intubation group (all P < 0.05). Logistic regression analysis showed that the worst ROX index within 30 minutes before intubation was the largest negative influencing factor for the timing of tracheal intubation in SAP patients [odds ratio (OR) = 0.723, 95% confidence interval (95%CI) was 0.568-0.896, P = 0.000], followed by PaO2 (OR = 0.872, 95%CI was 0.677-1.105, P < 0.001). PCT was the positive influencing factor (OR = 1.605, 95%CI was 1.240-2.089, P < 0.001). ROC curve analysis showed that the area under the ROC curve (AUC) of PaO2, PCT, the worst ROX index within 30 minutes before intubation and the combination to evaluate the tracheal intubation time of patients with SAP were 0.715, 0.702, 0.722 and 0.808, the sensitivity was 78.1%, 75.0%, 81.5% and 89.3%, the specificity was 66.7%, 59.0%, 73.2% and 86.4%, and the best cut-off value was 60.23 mmHg (1 mmHg ≈ 0.133 kPa), 2.72 μg/L, 4.85, and 0.58, respectively. The AUC of the combination of PaO2, PCT and the worst ROX index within 30 minutes before intubation predicted the timing of tracheal intubation in patients with SAP was significantly greater than using each index alone (all P < 0.01).@*CONCLUSIONS@#The worst ROX index within 30 minutes before intubation combined with PaO2 and PCT is helpful for clinicians to make a decision for tracheal intubation in patients with SAP.

Effect of early fluid balance on the prognosis in severe acute pancreatitis / 中华危重病急救医学

OBJECTIVE@#To observe the correlation between early fluid resuscitation and prognosis in patients with severe acute pancreatitis (SAP).@*METHODS@#SAP patients admitted to the department of critical care medicine of the People's Hospital of Chuxiong Yi Autonomous Prefecture of Yunnan Province from June 2018 to December 2020 were enrolled and analyzed retrospectively. All patients were given the routine treatment according to their condition and relevant diagnostic According to their different prognosis, enrolled patients were divided into death group and survival group. The differences in gender, age, acute physiology and chronic health evaluation II (APACHE II) and Ranson score on admission between the two groups were analyzed. Taking 24 hours as an observation day, the fluid inflow, outflow, and net balance at the first, second, and third 24 hours after admission were recorded, and the ratio of the fluid inflow at the first 24 hours to the total fluid inflow in 72 hours (FV24 h-1 st) was calculated as a study index. Using 33% as the standard, compare the proportion of patients in the two groups who achieved FV24 h-1 st < 33%. The differences of various indicators between the two groups were compared, and the effect of early fluid balance on the prognosis of SAP patients was analyzed.@*RESULTS@#Eighty-nine patients were included in the study (41 in the death group, 48 in the survival group). There were no statistically significant differences on age (years old: 57.6±15.2 vs. 49.5±15.2), gender (male: 61.0% vs. 54.2%), APACHE II score (18.0±2.4 vs. 17.3±2.3), and Ranson score (6.3±1.4 vs. 5.9±1.2) between the death group and the survival group at the time of admission on the intensive care unit (ICU) (all P > 0.05). The fluid intake of the death group in the first 24 hours, the second 24 hours and the third 24 hours after admission to ICU was significantly higher than that of the survival group, and the difference was statistically significant (mL: 4 138±832 vs. 3 535±1 058, 3 883±729 vs. 3 324±516, 3 786±490 vs. 3 212±609, all P < 0.05), and the fluid inflow in the death group at the first 24 hours was greater than 4 100 mL. After treatment, the fluid outflow of the death group at the three 24-hour periods after admission on the ICU was an increasing trend, but it was still significantly less than that of the survival group at the three 24-hour periods (mL: 1 242±465 vs. 1 795±819, 1 536±579 vs. 2 080±524, 1 610±585 vs. 2 932±752, all P < 0.01). Due to the fact that the total fluid inflow and total fluid outflow in the three 24-hour periods in the death group were more than those in the survival group, the net fluid balances in the three 24-hour periods in the death group were still significantly more than those in the survival group finally (mL: 2 896±782 vs. 1 740±725, 2 347±459 vs. 1 243±795, 2 176±807 vs. 338±289, all P < 0.01). There was no difference in FV24 h-1 st between the death group and survival group [FV24 h-1 st > 33%: 56.1% (23/41) vs. 54.2% (26/48), P > 0.05].@*CONCLUSIONS@#Fluid resuscitation is an important method for early treatment of SAP, but it also has many adverse reactions. Fluid resuscitation indexes such as fluid inflow, outflow, net balance, and FV24 h-1 st within 24 to 72 hours after admission are related to the prognosis of patients with SAP, and can be used as indicators to evaluate the prognosis of SAP. The optimized fluid resuscitation strategy can improve the prognosis of patients with SAP.

Research progress of hypertonic saline in early resuscitation of acute pancreatitis / 中华危重病急救医学

Local inflammatory reaction and microcirculation disturbance are the early manifestations of acute pancreatitis (AP). Studies have shown that early and reasonable fluid resuscitation of patients with AP can reduce related complications and prevent the deterioration to severe acute pancreatitis (SAP). Traditional isotonic crystalloid (such as Ringer solution) is considered to be a safe and reliable resuscitation solution, but too much and too fast infusion in the early stage of shock will increase the risk of complications such as tissue edema and abdominal compartment syndrome (ACS). Many scholars have found that hypertonic saline resuscitation solution has the advantages of reducing tissue and organ edema, rapidly restoring hemodynamics, inhibiting oxidative stress and inflammatory signal transduction, thereby improving the prognosis of AP patients and reducing the incidence of SAP and mortality. This article summarizes the mechanisms of hypertonic saline in the resuscitation treatment of AP patients in recent years, in order to provide reference for the clinical application and research of AP patients.

Application of machine learning model based on XGBoost algorithm in early prediction of patients with acute severe pancreatitis / 中华危重病急救医学

OBJECTIVE@#To establish a machine learning model based on extreme gradient boosting (XGBoost) algorithm for early prediction of severe acute pancreatitis (SAP), and explore its predictive efficiency.@*METHODS@#A retrospective cohort study was conducted. The patients with acute pancreatitis (AP) who admitted to the First Affiliated Hospital of Soochow University, the Second Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University from January 1, 2020 to December 31, 2021 were enrolled. Demography information, etiology, past history, and clinical indicators and imaging data within 48 hours of admission were collected according to the medical record system and image system, and the modified CT severity index (MCTSI), Ranson score, bedside index for severity in acute pancreatitis (BISAP) and acute pancreatitis risk score (SABP) were calculated. The data sets of the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University were randomly divided into training set and validation set according to 8 : 2. Based on XGBoost algorithm, the SAP prediction model was constructed on the basis of hyperparameter adjustment by 5-fold cross validation and loss function. The data set of the Second Affiliated Hospital of Soochow University was served as independent test set. The predictive efficacy of the XGBoost model was evaluated by drawing the receiver operator characteristic curve (ROC curve), and compared it with the traditional AP related severity score; variable importance ranking diagram and Shapley additive explanation (SHAP) diagram were drawn to visually explain the model.@*RESULTS@#A total of 1 183 AP patients were enrolled finally, of which 129 (10.9%) developed SAP. Among the patients from the First Affiliated Hospital of Soochow University and Changshu Hospital Affiliated to Soochow University, there were 786 patients in the training set and 197 in the validation set; 200 patients from the Second Affiliated Hospital of Soochow University were used as the test set. Analysis of all three datasets showed that patients who advanced to SAP exhibited pathological manifestation such as abnormal respiratory function, coagulation function, liver and kidney function, and lipid metabolism. Based on the XGBoost algorithm, an SAP prediction model was constructed, and ROC curve analysis showed that the accuracy for prediction of SAP reached 0.830, the area under the ROC curve (AUC) was 0.927, which was significantly improved compared with the traditional scoring systems including MCTSI, Ranson, BISAP and SABP, the accuracy was 0.610, 0.690, 0.763, 0.625, and the AUC was 0.689, 0.631, 0.875, and 0.770, respectively. The feature importance analysis based on the XGBoost model showed that the top ten items ranked by the importance of model features were admission pleural effusion (0.119), albumin (Alb, 0.049), triglycerides (TG, 0.036), Ca2+ (0.034), prothrombin time (PT, 0.031), systemic inflammatory response syndrome (SIRS, 0.031), C-reactive protein (CRP, 0.031), platelet count (PLT, 0.030), lactate dehydrogenase (LDH, 0.029), and alkaline phosphatase (ALP, 0.028). The above indicators were of great significance for the XGBoost model to predict SAP. The SHAP contribution analysis based on the XGBoost model showed that the risk of SAP increased significantly when patients had pleural effusion and decreased Alb.@*CONCLUSIONS@#A SAP prediction scoring system was established based on the machine automatic learning XGBoost algorithm, which can predict the SAP risk of patients within 48 hours of admission with good accuracy.

Immune-Related Pancreatitis Caused by Immune Checkpoint Inhibitor Nivolumab:Report of One Case / 中国医学科学院学报

In recent years,great progress has been achieved in the application of immune checkpoint inhibitors (ICI) in tumor immunotherapy.However,a variety of adverse reactions induced by ICI have been reported.Despite the high overall incidence of adverse reactions caused by ICI,some adverse reactions,such as immune-related pancreatitis,are rare in clinical practice.In this paper,a case of immune-related pancreatitis after treatment of advanced gastric cancer with nivolumab was identified.We analyzed the cause,treatment,incidence,and risk factors of the adverse reaction,aiming to improve the clinical diagnosis,treatment,and safe medication of rare adverse reactions associated with ICI.

Aggressive versus controlled fluid resuscitation in acute pancreatitis: A systematic review and meta-analysis of randomized controlled trials / 中华医学杂志(英文版)

BACKGROUND@#Early fluid resuscitation is one of the fundamental treatments for acute pancreatitis (AP), but there is no consensus on the optimal fluid rate. This systematic review and meta-analysis aimed to compare the efficacy and safety of aggressive vs. controlled fluid resuscitation (CFR) in AP.@*METHODS@#The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and Web of Science databases were searched up to September 30, 2022, for randomized controlled trials (RCTs) comparing aggressive with controlled rates of early fluid resuscitation in AP patients without organ failure on admission. The following keywords were used in the search strategy: "pancreatitis," "fluid therapy,""fluid resuscitation,"and "randomized controlled trial." There was no language restriction. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the certainty of evidence. Trial sequential analysis (TSA) was used to control the risk of random errors and assess the conclusions.@*RESULTS@#A total of five RCTs, involving 481 participants, were included in this study. For primary outcomes, there was no significant difference in the development of severe AP (relative risk [RR]: 1.87, 95% confidence interval [CI] 0.95-3.68; P = 0.07; n = 437; moderate quality of evidence) or hypovolemia (RR: 0.98, 95% CI: 0.32-2.97; P = 0.97; n = 437; moderate quality of evidence) between the aggressive and CFR groups. A significantly higher risk of fluid overload (RR: 3.25, 95% CI: 1.53-6.93; P <0.01; n = 249; low quality of evidence) was observed in the aggressive fluid resuscitation (AFR) group than the controlled group. Additionally, the risk of intensive care unit admission ( P = 0.02) and the length of hospital stay ( P <0.01) as partial secondary outcomes were higher in the AFR group. TSA suggested that more studies were required to draw precise conclusions.@*CONCLUSION@#For AP patients without organ failure on admission, CFR may be superior to AFR with respect to both efficacy and safety outcomes.@*REGISTRATION@#PROSPERO; https://www.crd.york.ac.uk/PROSPERO/ ; CRD 42022363945.

Advances in the study of postpancreatectomy acute pancreatitis / 中华外科杂志

Postpancreatectomy acute pancreatitis (PPAP) is an acute inflammation of the remnant pancreas in the early postoperative period caused by a variety of factors. With the progress of related research,PPAP has been confirmed as an independent risk factor for many severe complications such as postoperative pancreatic fistula. In some cases, it progresses to necrotizing PPAP, increasing the risk of mortality. Currently, the International Study Group for Pancreatic Surgery has standardized and graded PPAP as an independent complication, taking into account factors including serum amylase, radiological features, and clinical impact. This review summarizes how the concept of PPAP was proposed, as well as the latest progress in the research related to its etiology, prognosis, prevention, and treatment. However, given the large heterogeneity of relevant studies and the fact that they were mostly retrospective, in the future, it is necessary to place more emphasis on PPAP and elucidate the problems through more standardized studies to optimize strategies for the prevention and management of complications after pancreatic surgery.

A case of duodenal ulcer as prominent manifestation of IgG4-related disease / 北京大学学报(医学版)

A case of IgG4-related disease presented with a duodenal ulcer to improve the understan-ding of IgG4-related diseases was reported. A 70-year-old male presented with cutaneous pruritus and abdominal pain for four years and blackened stools for two months. Four years ago, the patient went to hospital for cutaneous pruritus and abdominal pain. Serum IgG4 was 3.09 g/L (reference value 0-1.35 g/L), alanine aminotransferase 554 U/L (reference value 9-40 U/L), aspartate aminotransferase 288 U/L (reference value 5-40 U/L), total bilirubin 54.16 μmol/L (reference value 2-21 μmol/L), and direct bilirubin 29.64 μmol/L (reference value 1.7-8.1 μmol/L) were all elevated. The abdominal CT scan and magnetic resonance cholangiopancreatography indicated pancreatic swelling, common bile duct stenosis, and secondary obstructive dilation of the biliary system. The patient was diagnosed with IgG4-related disease and treated with prednisone at 40 mg daily. As jaundice and abdominal pain improved, prednisone was gradually reduced to medication discontinuation. Two months ago, the patient developed melena, whose blood routine test showed severe anemia, and gastrointestinal bleeding was diagnosed. The patient came to the emergency department of Beijing Hospital with no improvement after treatment in other hospitals. Gastroscopy revealed a 1.5 cm firm duodenal bulb ulcer. After treatment with omeprazole, the fecal occult blood was still positive. The PET-CT examination was performed, and it revealed no abnormality in the metabolic activity of the duodenal wall, and no neoplastic lesions were found. IgG4-related disease was considered, and the patient was admitted to the Department of Rheumatology and Immunology of Beijing Hospital for further diagnosis and treatment. The patient had a right submandibular gland mass resection history and diabetes mellitus. After the patient was admitted to the hospital, the blood test was reevaluated. The serum IgG4 was elevated at 5.44 g/L (reference value 0.03-2.01 g/L). Enhanced CT of the abdomen showed that the pancreas was mild swelling and was abnormally strengthened, with intrahepatic and extrahepatic bile duct dilation and soft tissue around the superior mesenteric vessels. We pathologically reevaluated and stained biopsy specimens of duodenal bulbs for IgG and IgG4. Immunohistochemical staining revealed remarkable infiltration of IgG4-positive plasma cells into duodenal tissue, the number of IgG4-positive cells was 20-30 cells per high-powered field, and the ratio of IgG4/IgG-positive plasma cells was more than 40%. The patient was treated with intravenous methylprednisolone at 40 mg daily dosage and cyclophosphamide, and then the duodenal ulcer was healed. IgG4 related disease is an immune-medicated rare disease characterized by chronic inflammation and fibrosis. It is a systemic disease that affects nearly every anatomic site of the body, usually involving multiple organs and diverse clinical manifestations. The digestive system manifestations of IgG4-related disease are mostly acute pancreatitis and cholangitis and rarely manifest as gastrointestinal ulcers. This case confirms that IgG4-related disease can present as a duodenal ulcer and is one of the rare causes of duodenal ulcers.

Effect of vitamin D binding protein gene polymorphism on susceptibility and prognosis of severe acute pancreatitis / 中华危重病急救医学

OBJECTIVE@#To investigate the effect of vitamin D binding protein (DBP) gene polymorphism on susceptibility and prognosis of severe acute pancreatitis (SAP).@*METHODS@#A prospective study was conducted. Eighty-three patients with SAP who were admitted to the department of general surgery of Tianjin Fifth Central Hospital from March 2018 to March 2021 were selected as the research objects, and 83 healthy people in the same period were selected as controls. Peripheral blood RNA was extracted and reverse transcribed into cDNA, and the genotype and allele frequency of DBP gene rs7041 locus were detected by fluorescence quantitative analyzer. Hardy-Weinberg equilibrium was used to test the genetic balance. On the day of admission, serum C-reactive protein (CRP) level was detected by scattering immunoturbidimetry, serum procalcitonin (PCT) level was detected by electrochemiluminescence, serum DBP level was detected by enzyme-linked immunosorbent assay (ELISA), and neutrophil to lymphocyte ratio (NLR) was calculated automatically by the instrument. The length of intensive care unit (ICU) stay, the length of hospital stay and prognosis during hospitalization of patients were statistically analyzed. Multivariate Logistic regression analysis was used to screen the influencing factors of SAP occurrence.@*RESULTS@#The results of Hardy-Weinberg equilibrium test showed that the distribution of gene polymorphisms in the two groups of subjects conformed to the law of genetic equilibrium. The frequencies of TT genotype and T allele of DBP gene rs7041 locus in the patients of SAP group were significantly higher than those in the healthy control group [TT genotype: 34.94% (29/83) vs. 9.64% (8/83), T allele: 55.42% (92/166) vs. 38.55% (64/166), both P < 0.01], and the frequency of GT genotype was significantly lower than that in the healthy control group [40.96% (34/83) vs. 57.83% (48/83), P < 0.05]. There was no significant difference in the frequency of GG genotype between the healthy control group and SAP group [32.53% (27/83) vs. 24.10% (20/83), P > 0.05]. Further multivariate Logistic regression analysis showed that TT genotype [odds ratio (OR) = 2.831, 95% confidence interval (95%CI) was 1.582-5.067, P < 0.001] and T allele (OR = 2.533, 95%CI was 1.435-4.472, P < 0.001) of DBP gene rs7041 locus were independent risk factors for SAP in healthy people, while GT genotype was a protective factor for SAP (OR = 0.353, 95%CI was 0.143-0.868, P = 0.041). The levels of CRP, PCT, NLR and DBP in patients with TT genotype of DBP gene rs7041 locus were significantly higher than those in patients with GG/GT genotype on the day of admission in SAP group [CRP (mg/L): 43.25±13.25 vs. 31.86±12.83, PCT (μg/L): 1.53±0.24 vs. 1.21±0.20, NLR: 3.15±0.53 vs. 2.71±0.48, DBP (μg/L): 87.78±19.64 vs. 70.58±18.67, all P < 0.01]. The length of ICU stay in patients with TT genotype of DBP gene rs7041 locus in SAP group was significantly longer than that in patients with GG/GT genotype (days: 11.35±1.58 vs. 9.71±1.35, P < 0.01). The length of hospital stay of patients with TT genotype was longer than that of patients with GG/GT genotype (days: 23.41±3.64 vs. 23.17±3.57), and the in-hospital mortality was higher than that of patients with GG/GT genotype [34.48% (10/29) vs. 29.63% (16/54)], but the difference was not statistically significant (both P > 0.05).@*CONCLUSIONS@#The risk of SAP was significantly increased in patients with TT genotype of rs7041 locus of DBP gene, and the mechanism may be related to the increase of DBP expression. And carrying the TT genotype will prolong the ICU hospitalization time of SAP patients, but the effect on prognosis is not obvious.

El regulador de transmembrana de fibrosis quística (CFTR) disfuncional y sus efectos extrapulmonares / The dysfunction of transmembrane regulator in cystic fibrosis (CFTR) and its extrapulmonary effects

El daño del regulador de transmembrana de fibrosis quística (CFTR) puede causar una enfermedad grave fuera de los pulmones. El canal de cloruro (Cl-) ha sido el más estudiado, sin embargo, el bicarbonato (HCO3 -) tiene un rol muy importante en el comportamiento de las secreciones y la inflamación secundaria. El hecho de que CFTR funcione no sólo como un canal de Cl- sino también de HCO3- es un campo para la investigación y el desarrollo de fármacos para pacientes con daño genético o adquirido, este último frecuente en la población general. Algunos moduladores de CFTR pueden tener un beneficio terapéutico en el tratamiento de pancreatitis en ambas situaciones. La disfunción del CFTR a nivel renal puede resultar excepcionalmente en alcalosis metabólica y reducción del impulso ventilatorio. Hasta la fecha no está claro cuales serian sus efectos en los sistemas gastrointestinal y hepatobiliar.

Transmembrane regulator in cystic fibrosis (CFTR) can cause severe disease outside of the lungs. The chloride channel (Cl-) has been the most studied, however bicarbonate (HCO3 -) has a very important role in the behavior of secretions and secondary inflammation. The fact that CFTR works not only as a Cl- channel but also as an HCO3- channel is a field for research and development of drugs for patients with genetic or acquired damage, the latter frequent in the general population. Some CFTR modulators may have a therapeutic benefit in the treatment of pancreatitis in both situations. CFTR dysfunction at the renal level can exceptionally result in metabolic alkalosis and reduced ventilatory drive. To date it is not clear what its effects on the gastrointestinal and hepatobiliary systems would be.

Pancreatitis aguda por hipertrigliceridemia severa, caracterización en un hospital terciario / Acute pancreatitis due to severe hypertriglyceridemia, characterization in a tertiary hospital

La hipertrigliceridemia severa es una de las principales causas etiológicas de la pancreatitis aguda, donde la literatura internacional la posiciona como la tercera causa. Sus causas gatillantes, comorbilidades, severidad y evolución son importantes de conocer para evitar futuros episodios. En Chile, a nuestro entender, no tenemos literatura sobre esta asociación, por lo que presentamos datos de un hospital terciario, destacando 15 casos de pancreatitis aguda en 5 años de estudio, casi la mitad de ellos con antecedentes previos de hipertrigliceridemia, un porcentaje importante de los casos con cuadros graves y con complicaciones intrahospitalarias y que la diabetes mellitus tipo 2 fue la principal condición asociada a la hipertrigliceridemia severa.

Severe hypertriglyceridaemia is one of the main aetiological causes of acute pancreatitis, with international literature ranking it as the third leading cause. Its triggering causes, comorbidities, severity and evolution are important to know in order to avoid future episodes. In Chile, to our knowledge, we have no literature on this association, so we present data from a tertiary hospital, highlighting 15 cases of acute pancreatitis in 5 years of study, almost half of them with a previous history of hypertriglyceridaemia, a significant percentage of cases with severe symptoms and in-hospital complications, and that type 2 diabetes mellitus was the main condition associated with severe hypertriglyceridaemia.