AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 ...AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderate severe pancreatitis,potentially resulting in health costs savings.展开更多
BACKGROUND： The Atlanta criteria for acute pancreatitis （AP） has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS： The ...BACKGROUND： The Atlanta criteria for acute pancreatitis （AP） has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS： The clinical features, severity classification, out- come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria （RAC） and the original Atlanta criteria （OAC）.展开更多
This paper compares the spatial and environmental impacts of rapid growth through the five decades in Atlanta, Georgia and Shanghai, PRC. Both metropolitan areas represent the prime demographic and economic engines of...This paper compares the spatial and environmental impacts of rapid growth through the five decades in Atlanta, Georgia and Shanghai, PRC. Both metropolitan areas represent the prime demographic and economic engines of their respective regions, and exhibit some of the worst environmental degradation problems, though from significantly different sources. Atlanta epitomizes spatial patterns of sprawl arising from an unfettered topographic and economic setting. Shanghai, in a political economy transitioning from decades of centralized constraint, seeks to spread out some of the world’s densest core settlement population to its inner suburbs. Remotely sensed photographic images are utilized to classify land use changes, while census figures and environmental data are integrated in a Geographic Information System to correlate shifts through time.展开更多
BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited....BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.展开更多
BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To asses...BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.展开更多
BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investi...BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.展开更多
文摘AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderate severe pancreatitis,potentially resulting in health costs savings.
基金supported by a grant from Shanghai Science and Technology Committee(12411950500)
文摘BACKGROUND： The Atlanta criteria for acute pancreatitis （AP） has been revised recently. This study was to evaluate its practical value in classification of AP, the severity assessment and management. METHODS： The clinical features, severity classification, out- come and risk factors for mortality of 3212 AP patients who had been admitted in Ruijin Hospital from 2004 to 2011 were analyzed based on the revised Atlanta criteria （RAC） and the original Atlanta criteria （OAC）.
文摘This paper compares the spatial and environmental impacts of rapid growth through the five decades in Atlanta, Georgia and Shanghai, PRC. Both metropolitan areas represent the prime demographic and economic engines of their respective regions, and exhibit some of the worst environmental degradation problems, though from significantly different sources. Atlanta epitomizes spatial patterns of sprawl arising from an unfettered topographic and economic setting. Shanghai, in a political economy transitioning from decades of centralized constraint, seeks to spread out some of the world’s densest core settlement population to its inner suburbs. Remotely sensed photographic images are utilized to classify land use changes, while census figures and environmental data are integrated in a Geographic Information System to correlate shifts through time.
文摘BACKGROUND Patients with concurrent acute biliary pancreatitis(ABP)and acute cholangitis(AC)may experience exacerbated clinical consequences due to bile duct stones.However,studies exploring this topic remain limited.AIM To compare the clinical presentation and outcomes of patients experiencing AC with and without ABP.METHODS This single-center retrospective cohort study included 358 patients with AC who underwent endoscopic retrograde cholangiopancreatography(ERCP)between January 2016 and December 2017.Patients were divided into two groups:AC with ABP(n=90)and AC without ABP(n=268).Clinical characteristics,laboratory data,ERCP results,primary study outcome[intensive care unit(ICU)admission],and secondary outcomes including 30-day mortality,length of hospital stay,and 30-day readmission rate were analyzed and compared.RESULTS All patients in the AC with ABP group had interstitial pancreatitis.The AC with ABP group had significantly higher white cell count(WBC)counts(13.1×10^(3)/μL vs 10.4×10^(3)/μL,P=0.007)and more abnormal WBC results(61.1%vs 42.3%,P=0.015).Liver biochemical tests,AC severity,ERCP success,adverse events,ICU admissions,30-day mortality,hospital stay,and readmission rates did not differ significantly between the two groups.Univariate analysis showed no significant link between concurrent ABP and ICU admission,although significance was marginal in moderate/severe ABP cases(P=0.051).In the multivariate analysis,age(P=0.035)and cardiovascular dysfunction(P<0.001)were independently associated with length of ICU stay.CONCLUSION Concurrent interstitial ABP and AC did not significantly affect outcomes.Age and cardiovascular dysfunction were stronger predictors of ICU admission and should guide clinical monitoring and management.
基金The Institutional Ethics Committee of Liaoning Provincial People’s Hospital approved the study,No.(2023)K037.
文摘BACKGROUND Percutaneous cholecystostomy(PC)can be used as a bridging therapy for moderately severe acute biliary pancreatitis(MSABP).Currently,there are only a limited number of reports of MSABP using PCs.AIM To assess the short-term outcomes of early PC in MSABP and factors associated with recurrence and death in MSABP.METHODS Patients who received conservative treatment or PC for acute biliary pancreatitis(ABP)in Liaoning Provincial People’s Hospital from January 2017 to July 2022 were collected.A total of 54 patients with MSABP who received early-stage PC and 29 patients who received conservative treatment.The short-term efficacy of PC was evaluated.Depending on whether there is a recurrence,compare the characteristics of the pre-PC and explore the factors of recurrence.Pre-PC features were compared and predictors were discussed,depending on the outcome.RESULTS After 3 days of PC treatment,patients experienced a reduction in inflammatory markers compared to the conservative group.After PC,patients were divided into non-recurrence(n=37)and recurrence(n=10)groups,and the results showed that age was an independent correlation affecting ABP recurrence[odds ratio(OR)=0.937,95%confidence interval(CI):0.878-0.999;P=0.047<0.05].Patient outcomes were divided into non-lethal(n=47)and lethal(n=7)groups,and Charlson Comorbidity Index(CCI)was a risk factor for mortality(OR=2.397,95%CI:1.139-5.047;P=0.021<0.05).CCI was highly accurate in predicting death in MSABP(area under the curve=0.86>0.7).When the Youden index maximum was 0.565,the cut-off value was 5.5,the sensitivity was 71.4%,and the specificity was 85.1%.CONCLUSION PC is an important method in the early years(<72 hours)of MSABP.Age is a protective factor against recurrence of ABP.High pre-PC CCI is significantly associated with mortality.
文摘BACKGROUND:Serum C-reactive protein(CRP) increases and albumin decreases in patients with inflammation and infection.However,their role in patients with acute pancreatitis is not clear.The present study was to investigate the predictive significance of the CRP/albumin ratio for the prognosis and mortality in acute pancreatitis patients.METHODS:This study was performed retrospectively with 192 acute pancreatitis patients between January 2002 and June 2015.Ranson scores,Atlanta classification and CRP/albumin ratios of the patients were calculated.RESULTS:The CRP/albumin ratio was higher in deceased patients compared to survivors.The CRP/albumin ratio was positively correlated with Ranson score and Atlanta classification in particular and with important prognostic markers such as hospitalization time,CRP and erythrocyte sedimentation rate.In addition to the CRP/albumin ratio,necrotizing pancreatitis type,moderately severe and severe Atlanta classification,and total Ranson score were independent risk factors of mortality.It was found that an increase of 1 unit in the CRP/albumin ratio resulted in an increase of 1.52 times in mortality risk.A prediction value about CRP/albumin ratio >16.28 was found to be a significant marker in predicting mortality with 92.1% sensitivity and 58.0% specificity.It was seen that Ranson and Atlanta classification were higher in patients with CRP/albumin ratio >16.28 compared with those with CRP/albumin ratio ≤16.28.Patients with CRP/albumin ratio >16.28 had a 19.3 times higher chance of death.CONCLUSION:The CRP/albumin ratio is a novel but promising,easy-to-measure,repeatable,non-invasive inflammationbased prognostic score in acute pancreatitis.
