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Objective:To analyze the effects of infectious complications [infected pancreatic necrosis (IPN) and extra-pancreatic infection (EPI)] on the outcomes of patients with severe acute pancreatitis (SAP), and evaluate the differences in infection time, infection site and infecting species between SAP patients with infections complications.Methods:The clinical data of 66 SAP patients with combined infectious complications admitted to Xuanwu Hospital, Capital Medical University from January 2014 to December 2020 were retrospectively analyzed, and SAP patients were divided into IPN group ( n=7), EPI group ( n=14) and co-infection (EPI+ IPN) group ( n=45) according to the type of infection. Whether the study data conformed to a normal distribution was assessed by the Shapiro-Wilk test, normally distributed measures were expressed as mean ± standard deviation ( ± s), and ANOVA was used for comparison between groups; skewed measures were expressed as median (interquartile range) [ M ( Q1, Q3)], and the rank-sum test was used for comparison between groups. Bonferroni correction was used for multiple group comparisons ( P value significance level reduced to 0.017). Quantitative data were compared between groups using the χ2 test or Fisher's exact probability method. Results:There were no statistical differences between the three groups in terms of baseline data at admission (gender, age, etiology, modified CTSI score, degree of pancreatic necrosis, and number of organ failure) ( P>0.05), patients in the EPI group were referred earlier than the other two groups ( P<0.05). In clinical treatment, patients in the IPN group and co-infection group required multiple minimally invasive interventions compared with those in the EPI group ( P<0.05), and the number of patients requiring combined nutritional support, length of intensive care unit stay, and total length of hospital stay were higher in the co-infection group than in the other two groups ( P<0.05). In addition, 360 strains of pathogenic bacteria were cultured in this study, with Gram-negative bacteria being the most common, and patients with SAP were more likely to have EPI in the early stage of disease onset, with bacteremia and respiratory tract infections in the early stage (≤14 d), and bacteremia, urinary tract infections, and catheter-associated infections in the late stage (>14 d). Conclusions:Among patients with SAP, patients in the co-infection group had higher surgical intervention, nutritional support and length of hospital stay than those in the single infection group. It is advisable to prioritize EPI in SAP patients with suspected infections, and the common infectious strains in SAP patients are still predominantly Gram-negative bacteria, and clinicians need to adjust the treatment plan in a timely manner according to the changes in patients′ conditions.
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Acute pancreatitis (AP) is an inflammatory disease of the pancreas. Its pathogenesis is not only related to abnormal activation of trypsinogen, but also related to calcium overload, mitochondrial dysfunction, impaired autophagy and endoplasmic reticulum stress. However, the mechanism has not been fully elucidated and needs to be further studied. Currently, there is no effective treatment for AP. It is difficult to prevent the loss of pancreatic function. An in-depth understanding of the pathophysiological mechanisms of AP may help to identify the potential therapeutic targets. Therefore, the purpose of this study is to review recent advances in the mechanism of AP in order to provide more research direction for treatment.
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Objective:To investigate the computed tomography (CT) features and diagnosis and treatment of emphysema pancreatitis (EP).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 12 patients with EP who were admitted to Xuanwu Hospital of Capital Medical University from January 2017 to June 2020 were collected. There were 10 males and 2 females, aged from 25 to 71 years, with a median age of 42 years. All patients received CT examination. Step-up treatment or one-step surgical treatment was performed on patients according to their conditions. Observation indicators: (1) CT features; (2) bacteriological characteristics; (3) treatment and follow-up. Follow-up using outpatient examination was conducted at postoperative 1, 3, 6 months to detect survival of patients up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) CT features: 1 of the 12 patients underwent abdominal+pelvic CT plain scan, and 11 cases underwent abdominal+pelvic CT plain scan and enhanced scan of arterial and portal venous phase. CT examination of 12 patients showed diffuse enlargement of the pancreas, unclear borders and a large amount of exudation around the pancreas. Pancreatic necrotic tissues accounted for >30% of the total pancreatic volume; the Balthazar CT score was 10 (range, 8-10). Of the 12 patients, 5 cases showed that the exudation or necrosis involved bilateral prerenal fascia, 7 cases only involved the left prerenal fascia; the necrotic infection area of 11 patients formed obvious wraps. The distribution of pancreatic, peripancreatic infection and gas in 12 patients: 6 cases had pancreatic, peripancreatic infection and gas located in Ⅰ+Ⅱa area, 3 cases located in Ⅰ+Ⅱa+Ⅲ area, 2 cases located in Ⅰ+Ⅲ area, and 1 case located in Ⅰ area. There was gas in the pancreatic parenchyma in 12 patients, with fluid in the abdominal cavity and pelvic cavity. (2) Bacteriological characteristics: the culture results of peripancreatic necrotic issues in 12 patients were all positive for the pathogenic specimens, and 27 strains were cultured. Klebsiella pneumoniae was the most common in the culture of necrosis from 12 patients, followed by Escherichia coli and Enterococcus bacteria. Fungus was found in the culture of necrosis from 1 patient. Of the 12 patients, 5 had negative blood cultures and 7 had positive blood cultures. A total of 14 strains were cultured, with Klebsiella pneumoniae being the most common; fungus was found in the blood culture from 4 patients. (3) Treatment and follow-up: 1 patient underwent percutaneous catheter drainage, 7 underwent step-up surgical treatment, 4 underwent one-step surgical treatment; 11 patients undergoing surgical treatment received laparoscopic-assisted removal of pancreatic necrotic tissue, including 1 case with exploratory laparotomy due to abdominal hemorrhage. Of the 11 patients undergoing surgical treatment, 7 cases received the left retroperitoneal approach surgery (including 1 case combined with the upper abdominal median approach), 2 cases received the upper abdominal median transomental sac approach surgery, 1 case received the right retroperitoneal approach surgery, and 1 case received the left rectus abdominis approach surgery. The number of operations of all the 11 patients were (3.1±0.9)times, the number of step-up treatments was (3.6±0.8)times, and the number of one-step surgery was (2.3±0.5)times. Nine of 12 patients had organ dysfunction that lasted for more than 48 hours during the treatment, which received surgical treatment after organ support and anti-infection therapy. All the 12 patients were followed up for 6 months after operation, of which 9 cases were cured after treatment and 3 cases died including 1 case dying of bleeding and 2 cases dying of septic shock combined with multiple organ failure.Conclusions:Emphysema pancreatitis is complicated by pancreatic necrosis, which is characterized by pancreatic and peripancreatic gas accumulation on CT. Most patients with EP have organ failure. Surgery is an important treatment for EP.
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Exosomes are extracellular vesicles containing DNA, RNA and protein. They participate in intercellular communication and play an important role in tumor growth and metastasis. Exosomes exist in a variety of body fluids. Blood, urine and cerebrospinal fluid can be separated and extracted. Exosomes derived from tumor cells have the characteristics of tumor cells. Studies have shown that exosomes are involved in many processes of tumorigenesis and development, including information transmission between tumor cells, invasion and metastasis of tumor cells. Exosomes can also be used as carriers to deliver drugs to target cells, which has the potential of targeted therapy. In the process of tumor treatment, drugs can be designed based on the targeted recognition characteristics of exosomes, so as to improve the bioavailability of anti-tumor drugs, reduce adverse reactions and enhance the therapeutic effect. The research and application of exosomes are very challenging. There is a huge heterogeneity in the types, sizes and sources of exosomes, and the production mechanism is also very complex. This paper reviews the extraction and identification methods of exosomes, and reviews the clinical application of tumor derived exosomes.
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Malignant tumors usually have no obvious clinical symptoms in the early stage. Most patients are already in the advanced stage when they are diagnosed. Some patients have lost the opportunity for operation, resulting in poor prognosis. Therefore, how to find the best therapeutic target for such patients and improve the prognosis of patients has gradually become the focus of scholar′s attention. Recently, Kruppel-like factor (KLF) is a transcriptional regulator that can bind to the target DNA, and its family plays an important role in the occurrence and development of malignant tumors. It has also been confirmed that the KLF family affects the proliferation, differentiation and migration of tumor cells, but the specific mechanism is still not fully elucidate. Consequently, in order to further explored the effect of the KLF family on tumors, this study intends to briefly review the roles and regulatory mechanisms of the KLF family in the cell proliferation, differentiation and migration of malignant tumors, hoping to provide new target for the biological treatment of tumors.
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Objective@#To survey the bacterial spectrum and drug sensitivity in patients with necrotizing pancreatitis (NP) complicating with extra-pancreatic infection(EPI).@*Methods@#The clinical data of 79 NP with EPI patients from Jan 1, 2016 to Dec 31, 2018 were retrospectively analyzed. The strain identification and drug sensitivity test of positive specimens were statistically analyzed.@*Results@#A total of 219 strains of pathogenic bacteria were isolated, including 106(48.4%) gram-negative bacteria, 69(31.5%) gram-positive bacteria and 44(20.1%) fungi. The common pathogenic bacteria were Pseudomonas aeruginosa (10.1%), Staphylococcus epidermidis (9.1%) and Acinetobacter baumannii (9.1%). The resistance of common extrapancreatic pathogenic bacteria to penicillin and first and second generation cephalosporins was common.@*Conclusions@#The pathogenic bacteria of NP complicated with EPI were mainly Gram-negative bacteria, and the common sites of extra-pancreatic infection were bacteremia and respiratory tract. The third, fourth generation cephalosporins or carbapenems can be used empirically.
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Objective To survey the bacterial spectrum and drug sensitivity in patients with necrotizing pancreatitis (NP) complicating with extra-pancreatic infection (EPI).Methods The clinical data of 79 NP with EPI patients from Jan 1,2016 to Dec 31,2018 were retrospectively analyzed.The strain identification and drug sensitivity test of positive specimens were statistically analyzed.Results A total of 219 strains of pathogenic bacteria were isolated,including 106 (48.4％) gram-negative bacteria,69 (31.5％) gram-positive bacteria and 44 (20.1％) fungi.The common pathogenic bacteria were Pseudomonas aeruginosa (10.1％),Staphylococcus epidermidis (9.1％) and Acinetobacter baumannii (9.1％).The resistance of common extrapancreatic pathogenic bacteria to penicillin and first and second generation cephalosporins was common.Conclusions The pathogenic bacteria of NP complicated with EPI were mainly Gram-negative bacteria,and the common sites of extra-pancreatic infection were bacteremia and respiratory tract.The third,fourth generation cephalosporins or carbapenems can be used empirically.
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Exosomes are small membrane bound vesicles typically 30 ～ 150 nm in size which are widely distributed in the body fluids.The cytosol is rich in proteins and nucleic acids which mediates communication between different cells and transporting substances.Exosomes are involved in pancreatic cancer initiation and progression by promoting the formation of tumor microenvironment,enhancing gemcitabine resistance.GPC1 + circulating exosomes and high exosome levels of microRNA-10b serve as potertial non-invasive diagnostic tools to detect pancreatic cancer in the early stage.Meanwhile,exosomes could successfully deliver genetic drugs,anticancer drugs to target cells.In this article,we provide a review on the recent advances on exosomes in the diagnosis and treatment of pancreatic cancer.
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<p><b>OBJECTIVE</b>To investigate the clinical feature, diagnostic and therapeutic experience of autoimmune pancreatitis (AIP).</p><p><b>METHODS</b>Twenty-one patients with AIP treated in the First Affiliated Hospital, Harbin Medical University from January 2006 to July 2014 were analyzed retrospectively. There were 15 men and 6 women among the 21 cases and the age ranged from 36 to 64 years. The characters of diagnosis and treatment of AIP were explored through clinical symptoms, imaging features, serologic test results, diagnostic treatment, and histopathologic characteristics.</p><p><b>RESULTS</b>All the patients showed obstructive jaundice and upper abdominal pain to different extents as major manifestations and the levels of serum IgG4, CA19-9, CEA were elevated in 16 cases (76.2%), 6 cases (28.5%) and 3 cases (14.2%), respectively. CT showed diffuse enlargement of the pancreas in 9 cases, localized pancreatic head enlargement in 3 cases and focally pancreatic mass in 9 cases. AIP was confirmed by extrapancreatic involvement, radiological and serological results plus biopsy in 11 cases (52.4%), interpretation of response to steroid in 3 cases (14.3%) and open laparotomy in 7 cases (33.3%). Surgery included choledochojejunostomy in 3 cases, cholecystojejunostomy in 1 case, pancreaticoduodenectomy in 2 cases and distal pancreatectomy combined with splenectomy in 1 case. The pathologic results displayed massive lymphocytes and plasma cells infiltration in the pancreatic tissues as well as parenchymal fibrosis. Except for 1 patient who had no symptom, the regular steroid therapy was performed (oral prednisone) and all the patients were cured. The follow-up time range was from 3 to 93 months, 4 cases (19.0%) were recurrent followed by the symptoms alleviated after the steroid was applied again.</p><p><b>CONCLUSIONS</b>AIP is rare and characterized by non-specific clinical manifestations so that the early diagnosis is difficult with a high misdiagnosis rate. The clinicians should strengthen the recognition of AIP and the definite diagnosis depends on the combination of clinical manifestations, radiological, serological and histopathological results so as to avoid the unnecessary operation.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Autoimmune Diseases , Diagnosis , Therapeutics , Biopsy , CA-19-9 Antigen , Blood , Carcinoembryonic Antigen , Blood , Diagnostic Imaging , Immunoglobulin G , Blood , Pancreas , Pathology , Pancreatectomy , Pancreatitis , Diagnosis , Therapeutics , Retrospective Studies , Steroids , Therapeutic UsesABSTRACT
Autoimmune pancreatitis (AIP) is a rare form of chronic pancreatitis which is closely related with abnormal autoimmune.To some extent,it is too difficult to identify the diagnosis between AIP and pancreatic cancer.The treatment includes hormone therapy and surgery.In this article,based on accumulating the experience in the diagnosis and treatment of AIP cases for many years and reviewing the related literatures,we evaluate its type,the etiology and the clinical presentations,as well as summarize the typical characteristics of pathology,radiology and serology.