AIM: To investigate the potential protective effect of exogenous recombinant interleukin-22(r IL-22) on L-arginine-induced acute severe pancreatitis(SAP)-associated lung injury and the possible signaling pathway invol...AIM: To investigate the potential protective effect of exogenous recombinant interleukin-22(r IL-22) on L-arginine-induced acute severe pancreatitis(SAP)-associated lung injury and the possible signaling pathway involved.METHODS: Balb/c mice were injected intraperitoneally with L-arginine to induce SAP. Recombinant mouse IL-22 was then administered subcutaneously to mice. Serum amylase levels and myeloperoxidase(MPO) activity in the lung tissue were measured after the L-arginine administration. Histopathology of the pancreas and lung was evaluated by hematoxylin and eosin(HE) staining. Expression of B cell lymphoma/leukemia-2(Bcl-2), Bcl-x L and IL-22RA1 m RNAs in the lung tissue was detected by real-time PCR. Expression and phosphorylation of STAT3 were analyzed by Western blot. RESULTS: Serum amylase levels and MPO activity in the lung tissue in the SAP group were significantly higher than those in the normal control group(P < 0.05). In addition, the animals in the SAP group showed significant pancreatic and lung injuries. The expression of Bcl-2 and Bcl-x L m RNAs in the SAP group was decreased markedly, while the IL-22RA1 m RNA expression was increased significantly relative to the normal control group(P < 0.05). Pretreatment with PBS did not significantly affect the serum amylase levels, MPO activity or expression of Bcl-2, Bcl-x L or IL-22RA1 m RNA(P > 0.05). Moreover, no significant differences in the degrees of pancreatic and lung injuries were observed between the PBS and SAP groups. However, the serum amylase levels and lung tissue MPO activity in the r IL-22 group were significantly lower than those in the SAP group(P < 0.05), and the injuries in the pancreas and lung were also improved. Compared with the PBS group, r IL-22 stimulated the expression of Bcl-2, Bcl-x L and IL-22RA1 m RNAs in the lung(P < 0.05). In addition, the ratio of p-STAT3 to STAT3 protein in the r IL-22 group was significantly higher than that in the PBS group(P < 0.05).CONCLUSION: Exogenous recombinant IL-22 protects mice against L-arginine-induced SAP-associated lung injury by enhancing the expression of anti-apoptosis genes through the STAT3 signaling pathway.展开更多
BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,...BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.展开更多
BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting ...BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.展开更多
BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHOD...BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.展开更多
Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes tr...Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.展开更多
BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.S...BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.展开更多
BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearanc...BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearance of anti-tumor necrosis factordrugs. Dose-intensified infliximab treatment can be beneficial and is associatedwith lower rates of colectomy. The aim of the study was to present a case of apatient with ASUC and megacolon, treated with hydrocortisone and acceleratedscheme of infliximab that was monitored by drug trough level.CASE SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented withdiarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen.During investigation, a positive toxin for Clostridium difficile and colonic dilatationof 7 cm consistent with megacolon were observed. She was treated with oralvancomycin for pseudomembranous colitis and intravenous hydrocortisone forsevere colitis, which led to the resolution of megacolon. Due to the persistentsevere colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drugtrough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based onthe low infliximab trough level after one week from the first infliximab dose, thepatient received a second infusion at week 1, consistent with the acceleratedregimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical andendoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSIONInfliximab accelerated infusions can be beneficial in ASUC unresponsive to thetreatment with intravenous corticosteroids. Longitudinal studies are necessary todefine the best therapeutic drug monitoring and treatment regimen for thesepatients.展开更多
BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates t...BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates timely intervention.However,the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARY A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea.She also suffered from a significant decrease in exercise capacity,whereas her body temperature was normal.She had severe hypoxemia and hypotension along with a marked aortic valve murmur.Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan.Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve.Transesophageal echocardiography was further performed and vegetations were detected.In addition to adequate medical therapy and ventilation support,the patient underwent urgent and successful aortic valve replacement.Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced.Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSION IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.展开更多
Objective: to study pregnancy complicated with acute severe pancreatitis. Methods: a case of pregnant patients with acute severe pancreatitis admitted to our hospital was studied. Results: postoperative heart rate was...Objective: to study pregnancy complicated with acute severe pancreatitis. Methods: a case of pregnant patients with acute severe pancreatitis admitted to our hospital was studied. Results: postoperative heart rate was 150 beats/min, blood pressure was 160/100mmHg, urgent blood gas analysis: PH6.945, PO2 343mmHg, PCO2 41mmHg, residual alkali -23.4mmol/L, actual bicarbonate 8.8mmol/L, lactate 2.2mmol/L. Conclusion: early diagnosis and treatment of acute pancreatitis during pregnancy are very important.展开更多
Objective: to study the surgical treatment of acute severe craniocerebral trauma in elderly patients. Methods: from September 2016 to September 2019, 80 elderly patients with acute severe craniocerebral trauma were st...Objective: to study the surgical treatment of acute severe craniocerebral trauma in elderly patients. Methods: from September 2016 to September 2019, 80 elderly patients with acute severe craniocerebral trauma were studied. All patients underwent decompressive craniectomy, physical signs monitoring, complications nursing and other work to observe the rescue effect. Results: compared with before and after treatment, GCS score was higher after treatment, and the difference was significant (P < 0.05). Postoperative complications occurred in 3 patients (3.75%). After follow-up, 75 patients recovered well, the recovery rate was 93.75%. Conclusion: comprehensive treatment can improve the prognosis and reduce the incidence of complications in the rescue of elderly patients with acute severe craniocerebral trauma, and the postoperative recovery of patients is good.展开更多
Objective: to analyze the clinical effect of glucocorticoid in the treatment of acute severe cholestatic liver disease. Methods: a total of 60 patients with cholestatic liver disease admitted to our hospital from Janu...Objective: to analyze the clinical effect of glucocorticoid in the treatment of acute severe cholestatic liver disease. Methods: a total of 60 patients with cholestatic liver disease admitted to our hospital from January 2019 to January 2021 were studied. A comparative study was used to analyze the effect of treatment methods on the clinical effect, mainly analyzing the therapeutic effect, the specific changes of total bilirubin, and discussing the incidence of adverse conditions. Results: the total effective rate of glucocorticoid treatment was higher, and the reduction effect of total bilirubin was more obvious. The incidence of adverse conditions was higher after ursodeoxycholic acid treatment, and the results were statistically significant. Conclusion: in order to obtain a good therapeutic effect for acute severe cholestatic liver disease, glucocorticoid can be used in clinical treatment, which can effectively slow down the patient's condition and improve the patient's health, and is worth promoting.展开更多
This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to ...This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.展开更多
Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is sig...Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.展开更多
Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 3...Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.展开更多
BACKGROUND Student standardized patients(SSPs)can serve as valuable tools in teaching acute and severe gastrointestinal tumors.AIM To explore the effect of SSP on scenario simulation teaching and its impact on teachin...BACKGROUND Student standardized patients(SSPs)can serve as valuable tools in teaching acute and severe gastrointestinal tumors.AIM To explore the effect of SSP on scenario simulation teaching and its impact on teaching outcomes.METHODS From July 2021 to June 2024,200 nursing interns were taught about severe gastrointestinal tumor disease.In July 2022 the SSP scenario simulation teaching method was introduced to an observation group of 100 students.A control group of 100 students was taught using traditional methods from July 2021 to June 2022.The traditional teaching included classroom theoretical instruction,laboratory practical teaching,and course assessments.During the practical laboratory sessions,students performed operations using simulation mannequins,and course assessments were based on theoretical test scores combined with practical assessments using the mannequins.The teaching effects of both groups were compared in terms of comprehensive quality and student satisfaction.RESULTS The observation group exhibited significantly higher theoretical and operational scores(P<0.05),a notably livelier classroom atmosphere(P<0.05),and a higher learning satisfaction than the control group(98.00%vs 91.00%)(P<0.05).CONCLUSION SSP combined with scenario simulation teaching enhanced the effectiveness of acute and severe gastrointestinal tumor disease education,improved students’overall quality,and increased their learning satisfaction,making it a valuable approach for wider adoption.展开更多
BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(...BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(HTG-AP).AIM To develop and evaluate a machine learning(ML)model combining intraabdominal pressure(IAP)and procalcitonin(PCT)for SAP prognosis and evaluate its clinical impact across different etiologies.METHODS We retrospectively analyzed 245 patients with pancreatitis(98 patients with SAP).An ML model using 24-h peak IAP and PCT levels was used to predict 28-day mortality.Propensity score matching was used to compare IAP-PCT-guided management with conventional management.RESULTS The ML-IAP-PCT model outperformed the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.853 vs 0.801,P=0.044)and Bedside Index of Severity in Acute Pancreatitis score.IAP-PCT-guided management was associated with lower mortality(15.8%vs 25.0%,P=0.043)and multiple organ dysfunction syndrome(48.7%vs 61.8%,P=0.027)rates.Patients with HTG-AP showed the greatest benefit(multiple organ dysfunction syndrome:39.3%vs 60.7%,P=0.018).CONCLUSION ML-optimized IAP-PCT monitoring provides superior prognostic accuracy and guides management associated with improved outcomes,especially in patients with HTG-AP.Prospective validation is needed to establish causality for this etiology-stratified approach.展开更多
BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aim...BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.展开更多
BACKGROUND Patients with postoperative severe acute pancreatitis(SAP)in the intensive care unit(ICU)face complex challenges arising from physiological and microenvironmental imbalances,psychological stress,and the int...BACKGROUND Patients with postoperative severe acute pancreatitis(SAP)in the intensive care unit(ICU)face complex challenges arising from physiological and microenvironmental imbalances,psychological stress,and the interaction of multiple environmental factors.Traditional nursing models inadequately address this integrated microenvironment,highlighting the need for microenvironment theory-based nursing interventions to optimize outcomes.AIM To evaluate the impact of a microenvironment theory-based nursing intervention model on the prognosis of patients with postoperative SAP in the ICU.METHODS Between January 2022 and December 2024,106 patients with SAP who were admitted to ICU of the Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital)were randomly assigned to two groups:(1)A control group(n=53,routine care);and(2)An observation group(n=53,routine care plus microenvironment theory-based nursing).Postoperative recovery,psychological distress,disease severity,and complication rates were compared between groups.RESULTS The observation group had significantly shorter postoperative flatus,defecation,and hospital stay compared with the control group(P<0.05).The Hamilton Depression Rating Scale(17-item)and Hamilton Anxiety Rating Scale(14-item)scores in the observation group were significantly lower than those in the control group(P<0.05).The observation group had a lower Acute Physiology and Chronic Health Evaluation II score(P<0.05)compared with the control group.The postoperative complication rates were 5.66%(3/53)and 18.87%(10/53)in the observation group and control group,respectively(P<0.05).CONCLUSION In patients with SAP,the microenvironment theory-based nursing intervention model facilitated postoperative recovery,alleviated depression and anxiety,reduced disease severity,and decreased postoperative complications.展开更多
Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for...Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.展开更多
Background Acute severe biliary pancreatitis （ASBP） is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects ...Background Acute severe biliary pancreatitis （ASBP） is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects and reduce the expenditure of ASBP treatment.Methods One hundred and five patients diagnosed with ASBP were referred to our department from January 2004 to July 2009. Diagnosis was based on the 2007 criteria of the Chinese Society of Surgery. Patients were divided into two groups; the E group： 50 patients who underwent endoscopic retrograde choledochopancreatography （ERCP） ＋ endoscopic sphincterotomy （EST） ＋ endoscopic lithotripsy basket （ESR） ＋endoscopic retrograde biliary drainage （ERBD）and enteral nutrition （EN）, and the R group： 55 patients who underwent traditional treatment without ERCP. Subsequently,subjective symptoms, signs, biochemical analysis, serum endotoxin, tumor necrosis factor a, grades by computed tomography （CT）, cost of hospitalization and length of stay were compared between the two groups.Results All enrolled patients complied well with all therapeutic regimens. Endoscopic therapy that combined EN could significantly improve symptoms, clinical signs, laboratory values, tumor necrosis factor a and endotoxin while significantly reducing hospital expenditure and length of hospital stay. The experimental findings revealed that there were obvious advantages in the E group compared with the R group.Conclusions Endoscopic therapy combined with EN is an effective, safe and economic therapeutic regimen of ASBP.展开更多
基金Supported by the Shandong Provincial Science and TechnologyCommittee of China,No.2014GGH218034
文摘AIM: To investigate the potential protective effect of exogenous recombinant interleukin-22(r IL-22) on L-arginine-induced acute severe pancreatitis(SAP)-associated lung injury and the possible signaling pathway involved.METHODS: Balb/c mice were injected intraperitoneally with L-arginine to induce SAP. Recombinant mouse IL-22 was then administered subcutaneously to mice. Serum amylase levels and myeloperoxidase(MPO) activity in the lung tissue were measured after the L-arginine administration. Histopathology of the pancreas and lung was evaluated by hematoxylin and eosin(HE) staining. Expression of B cell lymphoma/leukemia-2(Bcl-2), Bcl-x L and IL-22RA1 m RNAs in the lung tissue was detected by real-time PCR. Expression and phosphorylation of STAT3 were analyzed by Western blot. RESULTS: Serum amylase levels and MPO activity in the lung tissue in the SAP group were significantly higher than those in the normal control group(P < 0.05). In addition, the animals in the SAP group showed significant pancreatic and lung injuries. The expression of Bcl-2 and Bcl-x L m RNAs in the SAP group was decreased markedly, while the IL-22RA1 m RNA expression was increased significantly relative to the normal control group(P < 0.05). Pretreatment with PBS did not significantly affect the serum amylase levels, MPO activity or expression of Bcl-2, Bcl-x L or IL-22RA1 m RNA(P > 0.05). Moreover, no significant differences in the degrees of pancreatic and lung injuries were observed between the PBS and SAP groups. However, the serum amylase levels and lung tissue MPO activity in the r IL-22 group were significantly lower than those in the SAP group(P < 0.05), and the injuries in the pancreas and lung were also improved. Compared with the PBS group, r IL-22 stimulated the expression of Bcl-2, Bcl-x L and IL-22RA1 m RNAs in the lung(P < 0.05). In addition, the ratio of p-STAT3 to STAT3 protein in the r IL-22 group was significantly higher than that in the PBS group(P < 0.05).CONCLUSION: Exogenous recombinant IL-22 protects mice against L-arginine-induced SAP-associated lung injury by enhancing the expression of anti-apoptosis genes through the STAT3 signaling pathway.
基金Supported by Lanzhou Science and Technology Development Plan Project,No.2020-ZD-126。
文摘BACKGROUND Stroke is a common and frequently occurring disease of the nervous system and one of the three major diseases leading to human death.The incidence and mortality of stroke in China increase with age.Overall,70%of patients with stroke have serious disability,which results in heavy burden to their families and the society.AIM To analyze the effects of Qixue Shuangbu decoction and acupuncture combined with Western medicine on immune indexes and digestive tract function in patients with acute severe stroke.METHODS A total of 68 patients with acute severe stroke admitted to Lanzhou Second People’s Hospital between March 2018 and September 2021 were selected and divided into the control and observation groups according to a random number table method.The control group was administered routine Western medicine treatment,such as dehydration,lowering intracranial pressure,anticoagulation,improving cerebral blood circulation and cerebral nerve protection according to the“Guidelines for the Diagnosis and Treatment of Acute Ischemic Stroke in China.”The observation group was administered Qixue Shuangbu decoction via nasal feeding tube on the basis of the routine Western medicine treatment with simultaneous acupuncture.The two groups were compared.RESULTS The acute physiology and chronic health evaluation II,organ dysfunction syndrome score,National Institutes of Health Stroke Scale,and traditional Chinese medicine syndrome scores of the two groups were significantly decreased compared with those measured before treatment,and the complements C3 and C4,and immunoglobulins(Ig)M and G were significantly increased compared with those observed before treatment(P<0.05).After treatment,the scores of the observation group were lower than those of the control group,and the complement and Ig levels were higher than those of the control group(P<0.05).The levels of diamine oxidase(DAO),Dlactic acid(D-LA),and calcitonin gene-related peptide(CGRP)in the two groups were significantly higher than those before treatment,while the levels of lipopolysaccharide,ubiquitin carboxyl-terminal hydrolase 1(UCH-L1),tumor necrosis factor-α(TNF-α),interleukin(IL)-2,and IL-8 were significantly lower than those before treatment(P<0.05).After treatment,DAO,D-LA,and CGRP were higher in the observation group than in the control group,while lipopolysaccharide,UCH-L1,TNF-α,IL-2,and IL-8 were lower than in the control group(P<0.05).The hospitalization time of individuals in the observation group was shorter than that of the control group(P<0.05).CONCLUSION Qixue Shuangbu decoction and acupuncture combined with Western medicine for the treatment of acute severe stroke can regulate intestinal flora,reduce inflammation,improve intestinal mucosal barrier function and immune function related indicators,and promote recovery.
文摘BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.
文摘BACKGROUND： Few studies have reported the effects of early tracheotomy in acute severe asthmatic patients. We report two patients with acute severe asthma who were successfully treated with early tracheotomy. METHODS：The two patients with acute severe asthma were retrospectively reviewed. They had been treated at the Department of Emergency and Critical Care, Renji Hospital, Shanghai Jiaotong University School of Medicine. RESULTS： They developed progressively hypercapnia and severe acidosis, and were not improved after conventional therapies. Early tracheotomy after mechanical ventilation decreased airway resistance and work of breathing, and corrected hypercapnia and acidosis. Adequate gas exchange was maintained after tracheotomy. The two patients were subsequently weaned from mechanical ventilation and discharged. CONCLUSION：Early tracheotomy could be a valuable approach in certain patients with severe asthma.
文摘Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.
文摘BACKGROUND There is paucity of data on outcomes of acute severe ulcerative colitis(ASUC)in older adults(≥60 years of age).AIM To assess steroid non-response rates during the index admission for ASUC in older adults.Secondary outcomes were response to medical rescue therapy and colectomy rates;at index admission,3 and 12 mo.METHODS This retrospective multicentre cohort study included ASUC admissions who received intravenous steroids between January 2013 and July 2020 at two tertiary hospitals.Electronic medical records were reviewed to collect clinical,biochemical,and endoscopic data.A modified Poisson regression model was used for analysis.RESULTS Of 226 ASUC episodes,45(19.9%)occurred in patients≥60 years of age.Steroid non-response rates were comparable in older adults and patients<60 years of age[19(42.2%)vs 85(47%),P=0.618],crude risk ratio(RR)=0.89[95%confidence interval(CI):0.61-1.30],adjusted RR=0.99(0.44-2.21).Rates of response to medical rescue therapy in older adults was comparable to the younger cohort[76.5%vs 85.7%,P=0.46,crude RR=0.89(0.67-1.17)].Index admission colectomy[13.3%vs 10.5%,P=0.598,crude RR=1.27(0.53-2.99),adjusted RR=1.43(0.34-6.06)],colectomy at 3 mo[20%vs 16.6%,P=0.66,crude RR=1.18(0.61-2.3),adjusted RR=1.31(0.32-0.53)]and colectomy at 12 mo[20%vs 23.2%,P=0.682,crude RR=0.85(0.45-1.57),adjusted RR=1.21(0.29-4.97)],were similar between the two groups.CONCLUSION In older adults with ASUC,the steroid non-response rate,response to medical rescue therapy,and colectomy rate at index admission,3 and 12 mo is similar to patients less than 60 years of age.
文摘BACKGROUND Acute severe ulcerative colitis (ASUC) is a complication of ulcerative colitisassociated with high levels of circulating tumor necrosis factor alpha, due to theintense inflammation and faster stool clearance of anti-tumor necrosis factordrugs. Dose-intensified infliximab treatment can be beneficial and is associatedwith lower rates of colectomy. The aim of the study was to present a case of apatient with ASUC and megacolon, treated with hydrocortisone and acceleratedscheme of infliximab that was monitored by drug trough level.CASE SUMMARYA 22-year-old female patient diagnosed with ulcerative colitis, presented withdiarrhea, rectal bleeding, abdominal pain, vomiting, and distended abdomen.During investigation, a positive toxin for Clostridium difficile and colonic dilatationof 7 cm consistent with megacolon were observed. She was treated with oralvancomycin for pseudomembranous colitis and intravenous hydrocortisone forsevere colitis, which led to the resolution of megacolon. Due to the persistentsevere colitis symptoms, infliximab 5 mg/kg was prescribed, monitored by drugtrough level (8.8 μg/mL) and fecal calprotectin of 921 μg/g (< 30 μg/g). Based onthe low infliximab trough level after one week from the first infliximab dose, thepatient received a second infusion at week 1, consistent with the acceleratedregimen (infusions at weeks 0, 1, 2 and 6). We achieved a positive clinical andendoscopic response after 6 mo of therapy, without the need for a colectomy.CONCLUSIONInfliximab accelerated infusions can be beneficial in ASUC unresponsive to thetreatment with intravenous corticosteroids. Longitudinal studies are necessary todefine the best therapeutic drug monitoring and treatment regimen for thesepatients.
基金Supported by National Key Research and Development Program of China,No.2016YFC1301105。
文摘BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates timely intervention.However,the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARY A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea.She also suffered from a significant decrease in exercise capacity,whereas her body temperature was normal.She had severe hypoxemia and hypotension along with a marked aortic valve murmur.Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan.Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve.Transesophageal echocardiography was further performed and vegetations were detected.In addition to adequate medical therapy and ventilation support,the patient underwent urgent and successful aortic valve replacement.Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced.Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSION IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.
文摘Objective: to study pregnancy complicated with acute severe pancreatitis. Methods: a case of pregnant patients with acute severe pancreatitis admitted to our hospital was studied. Results: postoperative heart rate was 150 beats/min, blood pressure was 160/100mmHg, urgent blood gas analysis: PH6.945, PO2 343mmHg, PCO2 41mmHg, residual alkali -23.4mmol/L, actual bicarbonate 8.8mmol/L, lactate 2.2mmol/L. Conclusion: early diagnosis and treatment of acute pancreatitis during pregnancy are very important.
文摘Objective: to study the surgical treatment of acute severe craniocerebral trauma in elderly patients. Methods: from September 2016 to September 2019, 80 elderly patients with acute severe craniocerebral trauma were studied. All patients underwent decompressive craniectomy, physical signs monitoring, complications nursing and other work to observe the rescue effect. Results: compared with before and after treatment, GCS score was higher after treatment, and the difference was significant (P < 0.05). Postoperative complications occurred in 3 patients (3.75%). After follow-up, 75 patients recovered well, the recovery rate was 93.75%. Conclusion: comprehensive treatment can improve the prognosis and reduce the incidence of complications in the rescue of elderly patients with acute severe craniocerebral trauma, and the postoperative recovery of patients is good.
文摘Objective: to analyze the clinical effect of glucocorticoid in the treatment of acute severe cholestatic liver disease. Methods: a total of 60 patients with cholestatic liver disease admitted to our hospital from January 2019 to January 2021 were studied. A comparative study was used to analyze the effect of treatment methods on the clinical effect, mainly analyzing the therapeutic effect, the specific changes of total bilirubin, and discussing the incidence of adverse conditions. Results: the total effective rate of glucocorticoid treatment was higher, and the reduction effect of total bilirubin was more obvious. The incidence of adverse conditions was higher after ursodeoxycholic acid treatment, and the results were statistically significant. Conclusion: in order to obtain a good therapeutic effect for acute severe cholestatic liver disease, glucocorticoid can be used in clinical treatment, which can effectively slow down the patient's condition and improve the patient's health, and is worth promoting.
基金supported by the Scientific Research Project of the Health Commission of Shanxi Province(No.2024003)。
文摘This article reviews research advances in the application of early enteral nutrition(EEN)in elderly patients with severe acute pancreatitis(SAP).Elderly SAP patients are associated with higher mor tality rates due to age-related immune dysfunction,whereas EEN has been demonstrated to improve clinical prognosis,reduce infection and complication rates,and shor ten hospital stays.However,ongoing debates exist regarding the optimal timing,route selection,and complication management of EEN.Through a systematic review of the literature,this study synthesizes current evidence on EEN in elderly SAP populations,critically examines unresolved clinical controversies,and proposes future research priorities to inform evidence-based practice.
文摘Severe acute pancreatitis(SAP)can induce acute respiratory distress syndrome(ARDS)and abdominal compartment syndrome(ACS).Although prone position ventilation(PPV)can improve outcomes in patients with ARDS,there is significant controversy regarding its concurrent use with ACS owing to concerns of increased risk of intra-abdominal pressure(IAP).[1]We present a case of successful PPV application without adverse eff ects.
文摘Background: Severe acute malnutrition (SAM) is one of the major public health problems associated with increased mortality in under-five children. In low-income countries, renal dysfunction (RD) contributes to about 34% mortality in under-five children with severe acute malnutrition. This study aimed to determine the impacts of severe acute malnutrition on the kidney among the admitted under-five children. Methods: In this prospective longitudinal observational study, a total of 190 children aged 6 to 59 months were enrolled from Iringa and Dodoma tertiary hospitals. Socio-demographic, clinical and laboratory data were collected using a structured questionnaire. Estimated Glomerular Filtration Rate (eGFR) and urine albumin creatinine ratio (uACR) were used to determine RD. Data analysis was done using SPSS version 26 and statistical significance was assumed for factors with p-value Results: Out of 190 children with severe acute malnutrition, 36 (19%) had renal dysfunction. Factors associated with RD in malnourished children were the history of local herbs used within one week (AOR = 5.85, 95% CI [1.41, 24.319], p = 0.0152), Acute watery diarrhea with severe dehydration (AOR = 2.15, 95% CI [1.033, 4.711], p = 0.0166), and positive urine leukocytes (AOR = 19.91, 95% CI [4.09, 96.989], p = 0.0002). At three months of follow up, out of 36 children with RD, 20 (55.56%) attained full recovery, while 4 (11.11%) developed chronic kidney disease (CKD). Children with RD had prolonged hospital stays for more than 14 days with a mean 12.25 ± 5.00 days compared to those with no RD with a mean 6.29 ± 1.68 days (p Conclusion: Renal dysfunction is common among children with severe acute malnutrition. It is associated with prolonged hospital stays and increased mortality. Further studies which can determine the burden of RD in children with severe acute malnutrition as compared to those with no severe acute malnutrition are needed.
文摘BACKGROUND Student standardized patients(SSPs)can serve as valuable tools in teaching acute and severe gastrointestinal tumors.AIM To explore the effect of SSP on scenario simulation teaching and its impact on teaching outcomes.METHODS From July 2021 to June 2024,200 nursing interns were taught about severe gastrointestinal tumor disease.In July 2022 the SSP scenario simulation teaching method was introduced to an observation group of 100 students.A control group of 100 students was taught using traditional methods from July 2021 to June 2022.The traditional teaching included classroom theoretical instruction,laboratory practical teaching,and course assessments.During the practical laboratory sessions,students performed operations using simulation mannequins,and course assessments were based on theoretical test scores combined with practical assessments using the mannequins.The teaching effects of both groups were compared in terms of comprehensive quality and student satisfaction.RESULTS The observation group exhibited significantly higher theoretical and operational scores(P<0.05),a notably livelier classroom atmosphere(P<0.05),and a higher learning satisfaction than the control group(98.00%vs 91.00%)(P<0.05).CONCLUSION SSP combined with scenario simulation teaching enhanced the effectiveness of acute and severe gastrointestinal tumor disease education,improved students’overall quality,and increased their learning satisfaction,making it a valuable approach for wider adoption.
基金Supported by Huzhou Science and Technology Bureau Public Welfare Applied Research Project-General Medical and Health Program,No.2021GY21.
文摘BACKGROUND Early risk stratification in severe acute pancreatitis(SAP)remains challenging with traditional scoring systems overlooking etiological heterogeneity,particularly in hypertriglyceridemic acute pancreatitis(HTG-AP).AIM To develop and evaluate a machine learning(ML)model combining intraabdominal pressure(IAP)and procalcitonin(PCT)for SAP prognosis and evaluate its clinical impact across different etiologies.METHODS We retrospectively analyzed 245 patients with pancreatitis(98 patients with SAP).An ML model using 24-h peak IAP and PCT levels was used to predict 28-day mortality.Propensity score matching was used to compare IAP-PCT-guided management with conventional management.RESULTS The ML-IAP-PCT model outperformed the Acute Physiology and Chronic Health Evaluation II score(area under the curve:0.853 vs 0.801,P=0.044)and Bedside Index of Severity in Acute Pancreatitis score.IAP-PCT-guided management was associated with lower mortality(15.8%vs 25.0%,P=0.043)and multiple organ dysfunction syndrome(48.7%vs 61.8%,P=0.027)rates.Patients with HTG-AP showed the greatest benefit(multiple organ dysfunction syndrome:39.3%vs 60.7%,P=0.018).CONCLUSION ML-optimized IAP-PCT monitoring provides superior prognostic accuracy and guides management associated with improved outcomes,especially in patients with HTG-AP.Prospective validation is needed to establish causality for this etiology-stratified approach.
基金supported by Anhui Provincial Scientific Research Preparation Plan Project(2023AH040079)Anhui Provincial Health Research Project(AHWJ2023A10095).
文摘BACKGROUND: Severe acute pancreatitis(SAP) is commonly associated with acute organ failure, but its effects on cerebral function within intensive care unit(ICU) patients remains inadequately researched. This study aims to determine the prevalence of delirium in critically ill patients diagnosed with SAP, and to identify risk factors associated with delirium in this patient population.METHODS: This was a retrospective, multicenter study, which enrolled adult patients diagnosed with SAP who admitted intensive care unit(ICU) for at least 24 h. Patient assessment was conducted using the Richmond Agitation-Sedation Scale(RASS) and the Confusion Assessment Method for the ICU(CAM-ICU). The cumulative incidence of delirium was determined. Demographic, clinical data, and length of ICU stay were compared between patients with and without delirium. A logistic regression model was employed to identify potential risk factors for delirium. RESuLTS: A total of 1,814 patients were included from seven hospitals in Anhui province, China. Delirium was observed in 25.2% of patients. Logistic regression analysis identified APACHE II scores(odds ratio [OR]=3.37, 95% confidence interval [CI]: 1.09–10.43, P=0.04), physical restraint(OR=11.11, 95%CI: 4.35–28.39, P<0.05), invasive mechanical ventilation(IMV)(OR=2.44, 95%CI: 1.41–4.25, P=0.002), and ICU length of stay ≥ 7 days(OR=3.14, 95%CI: 2.27–4.36, P<0.05) as independent risk factors of delirium.cONcLuSION: The present study revealed a substantial incidence of delirium in critically ill patients with SAP, associated with factors including APACHE II score, IMV, physical restraint, and prolonged ICU stays.
文摘BACKGROUND Patients with postoperative severe acute pancreatitis(SAP)in the intensive care unit(ICU)face complex challenges arising from physiological and microenvironmental imbalances,psychological stress,and the interaction of multiple environmental factors.Traditional nursing models inadequately address this integrated microenvironment,highlighting the need for microenvironment theory-based nursing interventions to optimize outcomes.AIM To evaluate the impact of a microenvironment theory-based nursing intervention model on the prognosis of patients with postoperative SAP in the ICU.METHODS Between January 2022 and December 2024,106 patients with SAP who were admitted to ICU of the Fourth Affiliated Hospital of Soochow University(Suzhou Dushu Lake Hospital)were randomly assigned to two groups:(1)A control group(n=53,routine care);and(2)An observation group(n=53,routine care plus microenvironment theory-based nursing).Postoperative recovery,psychological distress,disease severity,and complication rates were compared between groups.RESULTS The observation group had significantly shorter postoperative flatus,defecation,and hospital stay compared with the control group(P<0.05).The Hamilton Depression Rating Scale(17-item)and Hamilton Anxiety Rating Scale(14-item)scores in the observation group were significantly lower than those in the control group(P<0.05).The observation group had a lower Acute Physiology and Chronic Health Evaluation II score(P<0.05)compared with the control group.The postoperative complication rates were 5.66%(3/53)and 18.87%(10/53)in the observation group and control group,respectively(P<0.05).CONCLUSION In patients with SAP,the microenvironment theory-based nursing intervention model facilitated postoperative recovery,alleviated depression and anxiety,reduced disease severity,and decreased postoperative complications.
基金supported by grants from the National Nature Science Foundation of China(82370651 and 82070657).
文摘Background:Hemorrhage remains a formidable complication of severe acute pancreatitis(SAP),with a high mortality rate.However,there is currently no effective method for identifying SAP patients who are at high risk for massive bleeding.The present study aimed to explore risk factors for predicting massive bleeding in SAP patients and to develop a predictive nomogram,which could facilitate early prediction,and timely appropriate interventions.Methods:We conducted a multivariate logistic regression analysis to examine the relationship between massive bleeding and variables including patient demographics,disease severity,laboratory indexes and local pancreatic complications.A novel nomogram was constructed based on these factors,and was vali-dated both internally and externally assessing its discrimination,calibration,and clinical applicability.Results:The study involved 351 patients in the training cohort,104 patients in the internal validation cohort,and 123 patients in the external validation cohort.Logistic regression analysis identified several independent risk factors for massive bleeding,including computed tomography severity index score above 8 points,Acute Physiology and Chronic Health Evaluation II score greater than 16 points,abdominal com-partment syndrome,pancreatic fistula,and sepsis.The nomogram constructed from these factors yielded an area under the receiver operating characteristic curve(AUC)of 0.896 and a coefficient of determination(R²)of 0.093.The Hosmer-Lemeshow test indicated good model fitness(P=0.654).Furthermore,the nomogram demonstrated reliable performance in both validation cohorts.Conclusions:The nomogram showed strong predictive capability for massive bleeding and could be a valuable tool for clinicians in identifying SAP patients at high risk for this complication at an early stage.
文摘Background Acute severe biliary pancreatitis （ASBP） is a severe and fatal disease, and the expenditure is huge and therapeutic effects are still not satisfactory. This study aimed to improve the therapeutic effects and reduce the expenditure of ASBP treatment.Methods One hundred and five patients diagnosed with ASBP were referred to our department from January 2004 to July 2009. Diagnosis was based on the 2007 criteria of the Chinese Society of Surgery. Patients were divided into two groups; the E group： 50 patients who underwent endoscopic retrograde choledochopancreatography （ERCP） ＋ endoscopic sphincterotomy （EST） ＋ endoscopic lithotripsy basket （ESR） ＋endoscopic retrograde biliary drainage （ERBD）and enteral nutrition （EN）, and the R group： 55 patients who underwent traditional treatment without ERCP. Subsequently,subjective symptoms, signs, biochemical analysis, serum endotoxin, tumor necrosis factor a, grades by computed tomography （CT）, cost of hospitalization and length of stay were compared between the two groups.Results All enrolled patients complied well with all therapeutic regimens. Endoscopic therapy that combined EN could significantly improve symptoms, clinical signs, laboratory values, tumor necrosis factor a and endotoxin while significantly reducing hospital expenditure and length of hospital stay. The experimental findings revealed that there were obvious advantages in the E group compared with the R group.Conclusions Endoscopic therapy combined with EN is an effective, safe and economic therapeutic regimen of ASBP.
