Comparison of the Profile and Management of Chronic Pancreatitis between China and Western Countries: A Single-Center Experience and Literature Review.

OBJECTIVE: The etiology, clinical presentation, diagnosis, and treatment strategies of chronic pancreatitis (CP) vary significantly between countries. Specifically, the etiology and surgical approaches to treating CP differ between China and Western countries. Therefore, this study aims to compare the disparities in CP profiles and management based on our single-center experience and recent data from the West. METHODS: From January 2007 to December 2017, a total of 130 consecutive patients with histologically confirmed chronic pancreatitis (CP) underwent surgical treatment at the First Affiliated Hospital of Nanjing Medical University. The clinical features, etiology, risk factors, and operative procedures of these CP patients were analyzed and compared with recent data from Western countries. RESULTS: Our patient cohort was predominantly male (3.19:1), with a median age of 50.2 ± 9.8 years. Upper abdominal pain was the most common symptom, present in 102 patients (78.5%). The most common etiology was obstructive factors (47.7%), followed by alcohol (34.6%). The incidence of genic mutation was 2%, significantly lower than rates reported in Western research. Steatorrhea, weight loss, and jaundice were present in 6.9%, 18.5%, and 17.7% of patients, respectively. Pancreatic cysts or pseudocysts were diagnosed in 7 patients (5.4%). The following procedures were performed: Partington procedure in 33 patients (25.4%), Frey procedure in 17 patients (13.2%), Berne procedure in 5 patients (3.9%), Beger procedure in 1 patient (0.8%), pancreaticoduodenectomy in 17 patients (13.1%), pylorus-preserving pancreaticoduodenectomy in 18 patients (13.9%), middle pancreatectomy in 1 patient (0.8%), and distal pancreatectomy in 9 patients (6.9%). Choledochojejunostomy was performed in 14 patients (10.8%), gastroenterostomy in 2 (1.5%), and 15 patients (11.5%) underwent aspiration biopsy. CONCLUSION: Our study confirms that, etiologically, obstructive chronic pancreatitis (CP) is more frequent in the Chinese population than in Western populations. Although diagnostic instruments and operative procedures in China and Western countries are roughly comparable, slight differences exist in relation to diagnostic flowcharts/criteria and the indications and optimal timing of surgery.

Uric acid as a prognostic factor and critical marker of COVID-19.

The purpose of this study is to explore whether uric acid (UA) can independently act as a prognostic factor and critical marker of the 2019 novel corona virus disease (COVID-19). A multicenter, retrospective, and observational study including 540 patients with confirmed COVID-19 was carried out at four designated hospitals in Wuhan. Demographic, clinical, laboratory data were collected and analyzed. The primary end point was in-hospital death of patients with COVID-19. The concentration of admission UA (adUA) and the lowest concentration of uric acid during hospitalization (lowUA) in the dead patients were significantly lower than those in the survivors. Multivariate logistic regression analysis showed the concentration of lowUA (OR 0.986, 95% CI 0.980-0.992, p < 0.001) was able to independently predict the risk of in-hospital death. The mean survival time in the low-level group of lowUA was significantly lower than other groups. When lowUA was ≤ 166 µmol/L, the sensitivity and specificity in predicting hospital short-term mortality were 76.9%, (95% CI 68.5-85.1%) and 74.9% (95% CI 70.3-78.9%). This retrospective study determined that the lowest concentration of UA during hospitalization can be used as a prognostic indicator and a marker of disease severity in severe patients with COVID-19.

Nutritional risk and therapy for severe and critical COVID-19 patients: A multicenter retrospective observational study.

OBJECTIVE: To evaluate the nutritional risk and therapy in severe and critical patients with COVID-19. METHODS: A total of 523 patients enrolled from four hospitals in Wuhan, China. The inclusion time was from January 2, 2020 to February 15. Clinical characteristics and laboratory values were obtained from electronic medical records, nursing records, and related examinations. RESULTS: Of these patients, 211 (40.3%) were admitted to the ICU and 115 deaths (22.0%). Patients admitted to the ICU had lower BMI and plasma protein levels. The median Nutrition risk in critically ill (NUTRIC) score of 211 patients in the ICU was 5 (4, 6) and Nutritional Risk Screening (NRS) score was 5 (3, 6). The ratio of parenteral nutrition (PN) therapy in non-survivors was greater than that in survivors, and the time to start nutrition therapy was later than that in survivors. The NUTRIC score can independently predict the risk of death in the hospital (OR = 1.197, 95%CI: 1.091-1.445, p = 0.006) and high NRS score patients have a higher risk of poor outcome in the ICU (OR = 1.880, 95%CI: 1.151-3.070, p = 0.012). After adjusted age and sex, for each standard deviation increase in BMI, the risk of in-hospital death was reduced by 13% (HR = 0.871, 95%CI: 0.795-0.955, p = 0.003), and the risk of ICU transfer was reduced by 7% (HR = 0.932, 95%CI:0.885-0.981, p = 0.007). The in-hospital survival time of patients with albumin level ≤35 g/L was significantly decreased (15.9 d, 95% CI: 13.7-16.3, vs 24.2 d, 95% CI: 22.3-29.7, p < 0.001). CONCLUSION: Severe and critical patients with COVID-19 have a high risk of malnutrition. Low BMI and protein levels were significantly associated with adverse events. Early nutritional risk screening and therapy for patients with COVID-19 are necessary.

Difference Between Posterior Monteggia Fractures and Posterior Fracture-Dislocation of Proximal Ulna in Adults.

OBJECTIVE: To figure out the difference between patients with posterior Monteggia fractures which were concomitant with proximal radioulnar joint (PRUJ) dislocation and posterior fracture-dislocation of the proximal ulna that were not concomitant with PRUJ. METHODS: From January 2016 to January 2019, 37 consecutive adult patients who had posterior fracture-dislocation of proximal ulna (no PRUJ dislocation, n = 16) and posterior Monteggia fractures (PRUJ dislocation, n = 21) were included. All patients had intraoperative fluoroscopy, computed tomography (CT) scans, and standard radiography (anteroposterior view and lateral view). The mechanism of injury, the cases with open fracture, sustained multiple injuries and classification of fracture was recorded. The clinical details of the patients such as the final range of motion (ROM) and the Broberg-Morrey scores were described. RESULTS: Patients with PRUJ dislocation (ten type A, five type B, and six type D) and those without concomitant PRUJ dislocation (fifteen type A and one type C) exhibited an obvious difference according to the classifications of Jupiter et al. (P = 0.010). Ninety-five percent of patients who had PRUJ dislocation were accompanied by a metaphyseal fracture, while only 50% of the patients who did not have PRUJ dislocation were accompanied by a metaphyseal fracture (P = 0.002). Meanwhile, 16 of 20 metaphyseal fractures had more than one fragment in the group of dislocations, but five of eight metaphyseal fractures were comminuted in the control group. The two groups exhibited an obvious difference (P = 0.009). The 21 patients who sustained a radioulnar dislocation had less mean arc of flexion, pronation, and Broberg-Morrey scores were significantly less than the patients of the control group (flexion: 117.38 ± 14.46 vs 127.50 ± 13.416, P = 0.035; pronation: 59.76 ± 11.88 vs 67.50 ± 6.58, P = 0.017; Broberg-Morrey: 80.48 ± 12.17 vs 88.19 ± 10.28, P = 0.040). CONCLUSIONS: Patients suffering posterior Monteggia fractures had more metaphyseal fractures, more comminuted fractures of the metaphysis, and worse ultimate ulnohumeral motion than patients of posterior fracture-dislocation of proximal ulna.

Identification of a novel coronavirus causing severe pneumonia in human: a descriptive study.

BACKGROUND: Human infections with zoonotic coronaviruses (CoVs), including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, have raised great public health concern globally. Here, we report a novel bat-origin CoV causing severe and fatal pneumonia in humans. METHODS: We collected clinical data and bronchoalveolar lavage (BAL) specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital, Hubei province, China. Nucleic acids of the BAL were extracted and subjected to next-generation sequencing. Virus isolation was carried out, and maximum-likelihood phylogenetic trees were constructed. RESULTS: Five patients hospitalized from December 18 to December 29, 2019 presented with fever, cough, and dyspnea accompanied by complications of acute respiratory distress syndrome. Chest radiography revealed diffuse opacities and consolidation. One of these patients died. Sequence results revealed the presence of a previously unknown ß-CoV strain in all five patients, with 99.8% to 99.9% nucleotide identities among the isolates. These isolates showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843). The virus is phylogenetically closest to a bat SARS-like CoV (SL-ZC45, GenBank MG772933) with 87.6% to 87.7% nucleotide identity, but is in a separate clade. Moreover, these viruses have a single intact open reading frame gene 8, as a further indicator of bat-origin CoVs. However, the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor. CONCLUSION: A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.

Intravenous lidocaine infusion for pain control after laparoscopic cholecystectomy: A meta-analysis of randomized controlled trials.

BACKGROUND: This meta-analysis aimed to assess the efficiency and safety of intravenous infusion of lidocaine for pain management after laparoscopic cholecystectomy (LC). METHODS: A systematic search was performed in PubMed (August 1966-2017), Medline (August 1966-2017), Embase (August 1980-2017), ScienceDirect (August 1985-2017), and the Cochrane Library. Only randomized controlled trials (RCTs) were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata.11.0 software. RESULTS: A total of 5 RCTs were retrieved involving 274 patients. The present meta-analysis indicated that there were significant differences between groups in terms of visual analog scale scores at 12hours (weighted mean difference [WMD]=-0.743, 95% CI: -1.246 to -0.240, P = .004), 24hours (WMD=-0.712, 95% CI: -1.239 to -0.184, P = .008), and 48hours (WMD=-0.600, 95% CI: -0.972 to -0.229, P = .002) after LC. Significant differences were found regarding opioid consumption at 12hours (WMD=-3.136, 95% CI: -5.591 to -0.680, P = .012), 24hours (WMD=-4.739, 95% CI: -8.291 to -1.188, P = .009), and 48hours (WMD=-3.408, 95% CI: -5.489 to -1.326, P = .001) after LC. CONCLUSION: Intravenous lidocaine infusion significantly reduced postoperative pain scores and opioid consumption after LC. In addition, there were fewer adverse effects in the lidocaine groups. Higher quality RCTs are still required for further research.

Sanders II type calcaneal fractures: a retrospective trial of percutaneous versus operative treatment.

OBJECTIVE: The purpose of this study was to compare the clinical results of percutaneous reduction and Steinman pin fixation for Sanders II calcaneal fractures with those of operative management through an extensile lateral approach. METHODS: Fifty-three patients treated with standard open reduction and internal fixation (ORIF group) and 54 patients who had undergone percutaneous reduction and Steinman pin fixation (CRIF group) were retrospectively reviewed. There were no differences between the groups regarding sex, age or fracture classification. Pain and functional outcome were evaluated with a visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Wound complications and radiological results were compared. RESULTS: At a mean follow-up of 40.4 months (24 to 56 months), there were no differences between the two groups in mean AOFAS score, VAS score or radiologically determined variables. Two cases of deep infection and six of poor wound healing occurred in the ORIF group and none in the CRIF group. Subtalar and ankle motion was found to be better in the CRIF group. CONCLUSIONS: Percutaneous reduction and Steinman pin fixation minimizes complications and achieves functional outcomes comparable to those of the open techniques in patients with Sanders II calcaneal fractures.

Optimization of a multi-channel puffer system for rapid delivery of solutions during patch-clamp experiments.

In biological experiments, especially in neuroscience research, it is important to manipulate the extracellular environment efficiently. We have developed a micro-puffing system for local drug delivery to single cells in electrophysiological experiments, and validated the kinetic properties of this instrument. Based on our results, the kinetics of the delivery of solutions and the territory controlled by this system are influenced by several factors: (1) inner diameter (I.D.) of the guide tubing; (2) I.D. of the puffing tip; (3) angle of the puffing tip; and (4) gravity or external pressure applied to the solution. The system can fully control a territory of 200 x 600 micrometer2. The minimum delay in response to drug delivery is 10-20 ms. Switching between different solutions takes less than 100 ms. The minimum volume of solution required by the system is 0.2 ml. Taken together, our results provide useful data for designing and using an efficient drug/solution delivery system in electrophysiological experiments.