RESUMO
The present study aimed to investigate early risk factors for hyperlipidemic acute pancreatitis (HLAP) in order to open up novel routes for its prevention and treatment. Demographics, laboratory data obtained within 48 h, enhanced computed tomography (CT) imaging data and the modified CT severity index (MCTSI) for 111 patients with HLAP who were assessed at Ordos Central Hospital (Ordos, China) between January 2015 and October 2017 were retrospectively analyzed. Of these, 17 patients progressed to infectious pancreatic necrosis (IPN) and 14 patients progressed to organ failure (OF), the occurrence of which were the study outcomes. The patients were divided into pairs groups: IPN and non-IPN, as well as OF and non-OF, and differences between the groups were determined regarding various clinicopathological parameters. Furthermore, univariate and multivariate regression analyses were performed to identify parameters associated with the risk of progression to IPN or OP. On univariate analysis, the following parameters were deemed as being significantly associated with the risk of IPN: Serum calcium ions, C-reactive protein (CRP), extent of necrosis, procalcitonin (PTC) and the MCTSI. Furthermore, calcium ions, red cell distribution width (RDW), extent of necrosis and the MCTSI were significantly associated with the risk of OF on univariate analysis. Multivariate logistic regression analysis for these parameters then indicated that CRP (P=0.014), RDW (P=0.025) and the extent of necrosis (P=0.022) were significant and independent predictors of progression; thus, these are early risk factors for patients with HLAP. Receiver operating characteristic curves were generated to evaluate the predictive value of these factors, and the area under the curve for the three parameters was 0.863 [95% confidence interval (CI), 0.646-0.886], 0.727 (95% CI, 0.651-0.803) and 0.833 (95% CI, 0.739-0.936), respectively. Therefore, CRP, RDW and the extent of necrosis are early predictive indexes for the risk of progression in HLAP.
RESUMO
INTRODUCTION AND HYPOTHESIS: Rectovaginal fistula (RVF) is an abnormal epithelium-lined connection between the rectum and vagina. The primary effective treatment is surgical repair, but recurrence remains a challenge. Magnetic compression anastomosis (MCA), an alternative to suturing, has been developed to generate an anastomosis between various hollow viscera. We hypothesized that the MCA approach could be used to treat RVF. METHOD: We designed a novel MCA device for RVF treatment and evaluated the magnetic compression procedure in a RVF pig model in comparison with the traditional suturing procedure. Following satisfactory outcomes, we also applied the MCA procedure to a human patient with recurrent RVF. The MCA device was designed based on the anatomical characteristics of the pig vagina and previous literature. The pig RVF model were established surgically (n = 12), and compression and control groups were each treated. The data were analyzed by one-way analysis of variance. RESULTS: qqExcept in one animal in each group, the RVF site was smooth and healing was complete. Histological analysis confirmed complete healing of the RVF with high histological continuity to neighboring tissues. The compression procedure applied to our patient with RVF was successful. The patient recovered quickly without complications, and RVF did not recur during a 15-month follow-up. CONCLUSIONS: From this preliminary investigation, MCA using our novel device appears to be a safe, simple, and effective nonsurgical procedure for the treatment of RVF.
