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Objective:To establish the best evidence-based approach for early fluid resuscitation management in patients with severe acute pancreatitis (SAP).Methods:A literature search was conducted utilizing evidence-based nursing methods to identify relevant evidence on the management of early fluid resuscitation in patients with SAP. The search followed the hierarchical order of the " 6S" evidence pyramid, including databases such as China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (SinoMed), Wanfang Database, UpToDate, NICE, RNAO Guidelines Network, Pancreatology International, WHO Association Website, JBI, Cochrane, PubMed, EMBASE, and CINAHL. The search was limited to articles published from the establishment of each database to March 2022. The literature quality evaluation tools and an evidence pre-grading system from the JBI Evidence-Based Health Care Center were employed to assess the quality of the literature included in the study. Additionally, the FAME structure was utilized to evaluate the feasibility, appropriateness, clinical significance, and validity of the evidence.Results:Nine articles were finally incorporated into the analysis, including four guidelines, one evidence summary, two systematic reviews, and two expert consensus articles. 21 pieces of evidence pertaining to early fluid resuscitation management in patients with SAP was summarized, encompassing five key aspects: resuscitation timing, type of fluid infusion, total volume and speed of fluid infusion, dynamic monitoring, and fluid resuscitation goals. It was advisable for patients diagnosed with SAP to promptly receive fluid resuscitation, ideally within 72 hours of diagnosis. The initial choice for fluid resuscitation was lactated Ringer′s solution, with the addition of human albumin as a supplementary colloid solution. The quantity of fluid administered within the first 24 hours of rehydration should constitute approximately 33.3% of the total rehydration volume within the 72 hours time-frame. In the case of patients experiencing early shock or dehydration, it was advised that the fluid rate administered should be 5-10 ml·kg -1·h -1 within the first 24 hours of admission. Additionally, an infusion of 20 ml/kg of fluid can be administered within the initial 30-45 minutes. It was recommended to assess the adequacy of early fluid resuscitation every 4-6 hours, ensuring that the resuscitation objective could meet at least two of the following criteria: urine output of 0.5-1 ml·kg -1·h -1, mean arterial pressure of 65-85 mmHg, central venous pressure of 8-12 mmHg, heart rate below 120 beats/min, central venous oxygen saturation of at least 70%, and a decrease in hematocrit levels to 30%-35%. Conclusions:The most compelling evidence supporting the implementation of early fluid resuscitation management in patients with SAP is derived from an evidence-based nursing approach, which could effectively improve patient care outcomes.
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Objective:To evaluate the efficacy of transgastric combined with percutaneous endoscopic treatment for infected pancreatic necrosis (IPN).Methods:Clinical data of 19 IPN patients who received transgastric combined with percutaneous endoscopy at the Gastroenterology Intensive Care Unit of Nanjing Drum Tower Hospital from August 2015 to August 2020 were retrospectively studied. The clinical efficacy and the procedure-related complications were analyzed.Results:The mean procedure of endoscopic transmural drainage (ETD) was 1.1±0.3 times. During ETD procedure, lumen-apposing metal stents (LAMS) were placed in 9 patients, metal coated stents in 2 patients, double pigtail plastic stents in 7 patients, and only a nasal cyst drainage tube in 1 patient. All 19 patients received 12-14 F drainage catheters for drainage during the first percutaneous catheter drainage (PCD) treatment with the mean number of catheters of 1.8±1.2. Double cannulas was subsequently replaced in 3 of them for continuous drainage, and a percutaneous metal coated stent was replaced in 1 patient. The culture results of drainage fluid were 11 cases of gram-negative bacilli and gram-positive cocci, 4 cases of gram-positive cocci, 1 case of gram-positive bacilli, 3 cases of gram-negative bacilli. Among 19 patients, 4 cases had concurrent fungal infections. The mean number of debridement was 3.1±1.8 times, 2 cases of which were treated with endoscopic transluminal necrosectomy combined with percutaneous endoscopic necrosectomy. The mean procedure per patient was 6.1±2.4 times. Bleeding occurred in 1 case (5.3%) after the operation. But the bleeding was successfully stopped after endoscopic hemostasis. No serious complications such as gastrointestinal fistula, perforation or pancreatic fistula occurred. One patient died due to sepsis, and 18 other patients showed significant absorption of IPN after the treatment. None of the 19 patients were transferred to laparotomy.Conclusion:Transgastric combined with percutaneous endoscopic approach is safe and effective for IPN.
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The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.
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The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.
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Animales , Ratones , Ratas , Diferenciación Celular , Flavanonas , Ratones Endogámicos C57BL , Vaina de Mielina/metabolismo , Oligodendroglía/metabolismo , Remielinización , Transducción de Señal , Serina-Treonina Quinasas TOR/metabolismoRESUMEN
Objective To investigate the value of endoscopic ultrasound ( EUS)-guided drainage via upper gastrointestinal tract for peripancreatic fluid collection. Methods The clinical data of 103 patients with peripancreatic fluid collection undergoing EUS-guided drainage via upper gastrointestinal tract from May 2006 to July 2017 in Nanjing Drum Tower Hospital were retrospectively analyzed, the treatment and postoperative complications were summarized. Results Among the 103 patients, 101 ( 98. 1％) were punctured successfully, and patients were punctured mostly through the gastric wall (97. 1％, 100/103). There were 29 cases of metal stent placement, and 66 plastic stent placement. Ten patients underwent ERCP with pancreatic stent placement. After operation, 8 patients underwent percutaneous drainage, and 1 surgical drainage. Complications occurred in 14 ( 13. 6％) cases, including stent displacement in 5 cases, and postoperative infection in 9 cases. There was no perforation, bleeding, pancreatic fistula, other serious complications or death. Conclusion EUS-guided drainage is safe and reliable for peripancreatic fluid collection.
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Objective To assess the application value of lumen-apposing,fully covered,self-expandable metal stent (LAMS) in the treatment of peripancreatic fluid collection (PFC).Methods From July 2015 to July 2017,at Drum Tower Hospital Affiliated to Medical School of Nanjing University,the patients with PFC who received LAMS under endoscopic ultrasound were enrolled.The inclusion criteria was the first treatment,age ≥ 18 years old,PFC diameter ＞ 6 cm and clinical manifestations of compression,or increased diameter of PFC after continuous observation,or signs of infection,course ＞four weeks,and the distance between the cyst wall and the digestive gastrointestinal wall less than 1 cm;exclude other pancreatic cystic lesions,such as serous cystic neoplasm,mucinous cystic neoplasm and solid pseudopapillary neoplasm.The clinical data of enrolled patients were retrospectively analyzed,and the efficacy and postoperative complication were summarized.Results A total of 27 patients with PFC were enrolled.All patients were successfully punctured and placed with LAMS.The percentage of complete drainage rate of PFC was 96.3％ (26/27).The median LAMS maintenance time was 26 days,with a range of four to 135 days.Seventeen patients received debridement treatment through LAMS,and the number of debridement treatment was (2.5± 1.3) times.Two patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and were placed with pancreatic stent,five patients received percutaneous drainage,and one patient underwent surgical drainage.Among 27 patients with PFC,eight patients (29.6％) coexisted with complications,including stent displacement in two cases,postoperative infection in three cases,perforation in two cases and bleeding in one case.They all improved after conservative treatment and none of them died.Conclusion LAMS is effective and relatively safe in the treatment of PFC,and may change the clinical treatment strategy of PFC.
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Objective To investigate the effect of visiting time on the incidence of complications, hospital expenses and stays, and to provide theoretical basis for the timely treatment of patients with esophageal foreign bodies. Methods Data of 130 patients with diagnosis of esophageal foreign bodies in the Drum Tower Hospital from June 2010 to June 2017 were retrospectively studied. The patients were divided into two groups( Group A, visiting time≤24 hours;Group B, visiting time>24 hours) according to duration from ingestion to effective treatment. Clinical features including gender, age, locations and types of foreign bodies, complications, therapeutic methods, hospitalization stays and costs were analyzed. Results The most common foreign bodies that were swallowed were fish bones in both groups [ 40. 0％ ( 20/50) ,50. 0％( 40/80) ] , followed by pig and chicken bones, dentures and jujube pips. Foreign bodies commonly blocked the upper and middle esophageal tract [ 98. 0％ ( 49/50 ) , 96. 3％ ( 77/80 ) ] , but rarely the lower esophageal tract. Compared with group A, the incidence of complications [ 61. 3％ ( 49/80) VS 36. 0％ ( 18/50) ] , hospitalization expenses ( 1. 28 ± 1. 14 thousand yuan VS 0. 77 ± 0. 92 thousand yuan ) , and stays ( 9. 06 ± 10. 08 d VS 5. 22 ± 3. 32 d ) of group B were significantly higher ( all P < 0. 05 ) . Conclusion Treatment within 24 hours results in fewer complications, less costs and shorter postoperative hospitalization stays for patients with esophaged foreign bodies.
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Objective To explore clinical effect of arthroscopic circumpatellar denervation in anterior knee pain of patellofemoral osteoarthritis and its correlation with cartilage degeneration.Methods Totally 104 patients with anterior knee pain of patellofemoral osteoarthritis were randomly divided into two groups.Patients in control group(n =52) were treated with arthroscopic debridement,and those in combined group(n =52) were treated with arthroscopic debridement plus circumpatellar denervation.All the patients were followed-up for 6 months.The WOMAC scores,knee function recovery were compared between two groups,and the changes of WOMAC score among different degrees of cartilage degeneration were analyzed.Results The WOMAC score of pain,morning stiffness and joint function were significantly improved in combined group than those in control group at 6 months after surgery(P ＜ 0.05).At 6 months after surgery,the score of range of activity and walking distance in both groups were all increased,and combined group had more remarkable increase than that of control group(P ＜ 0.05).Compared with before surgery,the total WOMAC score in patients with grade Ⅰ-m at 6 months after surgery significantly decreased (P ＜ 0.05),while there was no significant difference in patients with grade Ⅳ level between before surgery and 6 months after surgery (P ＞ 0.05).Conclusion Arthroscopic debridement plus circumpatellar denervation for anterior knee pain of patellofemoral osteoarthritis can effectively relieve pain symptom,promote the recovery of knee joint function,especially suitable for patients with cartilage degeneration of Ⅰ ～ Ⅲ.
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ObjectiveTo investigate the diagnostic value of single balloon enteroscopy (SBE) for obscure gastrointestinal bleeding.MethodsA total of 78 SBE procedures was conducted on 72 patients with obscure gastrointestinal bleeding,with 40 via oral route and 38 via anal route.The procedure time,insertion depth and rate of positive finding were recorded.ResultsFor 40 SBE procedures performed via oral route,the mean procedure time was 60 minutes ( 15-110 minutes),and the mean insertion depth was 195 cm at the distal end of Trentz ligament (30-240 cm).For 38 SBE procedures performed via anus,the mean procedure time was 75 minuets (30-120 minutes),and the mean insertion depth was 160 cm at the proximal end of ileocecal valve (50-200 cm ).The whole diagnostic yield of obscure gastrointestinal bleeding was 62.5％.ConclusionSBE is a safe and useful tool for the diagnosis of obscure gastrointestinal bleeding.
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Objective To investigate the diagnostic value of intraductal ultrasonography for the quality of biliary stricture.Methods Data of the patients who had received operation because of biliary stricture after IDUS examination from 2006 to 2010 were collected.IDUS results were compared with those of operation.Results There were 43 cases of malignant strictures and 6 benign strictures in total.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of intraductal uhrasonography for the quality of biliary stricture were 97.7％ ( 42/43 ),83.3％ ( 5/6 ),97.7％ ( 42/43 ),83.3％ (5/6) and 95.9％ (47/49),respectively,which were significantly higher than conventional imaging like ultrasound B,CT and MRCP.Twenty one cases in 32 were diagnosed as malignant biliary stricture with cytological brushing,with the diagnostic accuracy of 65.6％.All cases had been diagnosed by IDUS.Conclusion Intraductal ultrasonography is of high diagnostic value for biliary stricture.However,cytological brushing based on IDUS is of limited diagnostic value for malignant biliary stricture.
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Objective To detect the expression of Beclin1 and Bcl2 in invasive pituitary adenomas and to explore the relationship of Beclin1 and Bci2 in invasive pituitary adenomas and the relativity between the 2 genes.Methods 61 specimens were classified into invasive group (32 cases) and non-invasive group (29 cases) according to the comprehensive evaluation of invasive pituitary adenomas.lmmunofluorescence analysis and RT-PCR were adopted respectively to detect the protein and mRNA expressions of Beclinl and Bcl2.The difference and relativity of Beclin1 and Bcl2 expression in invasive group and non-invasive group were analyzed.Results 32 specimens of pituitary adenoma were invasive and 29 were non-invasive.Beclin1 protein and mRNA expressions were lower in the invasive group than in the non-invasive group (P ＜0.01 ).Bcl2 protein and mRNA expressions were higher in the invasive group than in the non-invasive group (P ＜0.01 ).Pearson related analysis showed that Beclin1 mRNA expression was negtively correlated with Bcl2 mRNA expression in the invasive group ( r =-0.42,P =0.028 ).Conclusions Beclinl expression is decreased in invasive pituitary adenomas.The invasiveness of pituitary adenoma is closely related to the high expression of Bcl2 protein and mRNA,and the low expression of Beclin1 protein and mRNA.The inhibition of the autophagy may lead to the enhancement of the invasiveness of pituitary adenomas and that inhibition may come from the interaction of Beclin1 and Bcl2.
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Objective To investigate the effect of JNK signal pathway in acute necrotizing pancreatitis (ANP) associated lung injury.Methods A total of 24 SD rats were randomly divided into sham group and ANP group,ANP rats were induced by retrograde injection of 5％ sodium taurocholate into common bile duct.The rats were sacrificed 12 and 24h later,and the pancreas and lung tissue were resected and underwent routine pathologic examination,ELISA method was used to detect the level of TNF-α and IL-1β in lung tissue.Expression of JNK mRNA was detected by real time PCR,and the expression of JNK protein were evaluated by Western blotting.Results There was bleeding,necrosis,large amount of inflammatory cells infiltration in pancreatic tissue; and there was edema,pulmonary consolidation,interstitial edema,inflammatory cells infihration in lung tissue in ANP group.The levels of TNF-α and IL-1β,JNK mRNA,JNK protein,phosphorylation JNK were ( 374.3 ± 124.0) pg/ml,(649.0 ± 114.9) pg/ml,2.57 ± 0.76,1.40 ± 0.81,0.81 ± 0.20 in ANP group,which were significantly higher than those in with sham group[( 218.2 ± 68.4)pg/ml,(524.3±58.4)pg/ml,1.03±0.11,0.32±0.11,0.32±0.11,P＜0.05].Conclusions JNK signal pathway plays an important role in experimental ANP associated lung injury in rats.
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Objective To investigate the clinical value of fetal echocardiography in prenatal diagnosis of complete vascular ring. Methods Ultrasound images of 6 cases with complete vascular ring were retrospectively analysed and summarized, all cases were confirmed by autopsy after termination of pregnancy. Results Right aortic arch and left ductus arteriosus formed U shaped comlete vascular ring coursing around the trachea in 5 cases, left aortic arch and right aortic arch formed O shaped complete vascular ring in 1 case on three-vessel trachea view. Color Dopple flow imaging aided in identifying various components of the vascular ring. Conclusions Fetal echocardiography is of great clinical value in prenatal diagnosis of complete vascular ring. Three-vessel trachea view is important for screening with particular attention to the relationship of the aortic and duct arches to the trachea.
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Objective To evaluate the safely and efficacy of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and its related procedures in patients older than 85 years.Methods Data of patients older than 85 who underwent ERCP between 2004 and 2009 (group A, n =52) were reviewed and compared with those of patients aging 70-84 years (group B, n = 329).Results The rate of patients with underlying disorders of other systems in group A was significantly greater than that of group B (100.0% vs.77.5% , P < 0.05) , as well as the rate of multiple procedures to achieve stone clearance (42.3% vs.28.8% , P <0.05).There were no significant differences between 2 groups regarding the rates of complication (7.7% vs.4.9% ) and post-procedure mortality (1.9% vs.0.6% ).Conclusion Therapeutic ERCP and related procedures are safe and effective in patients aging over 85, and advanced age should not be regarded as the contraindication of the procedure.
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Objective To observe the changes of Interstitial cells of Cajal (ICC) and c-kit mRNA expression in jejunum of rats of experimental acute necrotizing pancreatitis ( ANP), and to investigate its possible mechanism of gastrointestinal dysmotility.Methods 24 male SD rats were randomly divided into ANP group and control group with 12 rats in each group.ANP rats were induced by choledochal retrograde injection of 5% sodium taurocholate.1.0 ml of methylene blue was injected through gastric tube 23 h after induction,and 1 h later the rats were sacrificed.The distance from pylorus to methylene blue stained place was measured,and intestinal motility was assessed by testing small intestinal propulsion rate.Pancreatic and intestinal tissues were routinely sent to pathological examination.Immunohistochemical staining and RT-PCR method was used to detect the c-kit protein and mRNA expression of ICC in jejunum.Ultrastructures of ICC were evaluated by transmission electron microscopy.Results Destroyed lobular structure of pancreatic acinar cells, flake bleeding and focal necrosis, large amount of inflammatory cell infiltration was observed;mucosal edema,erosion and inflammatory cell infiltration was also observed.Compared with control group, the small intestinal propulsion rate of ANP group decreased significantly [ (41.55 ± 3.85 ) % vs ( 68.66 ± 2.66 ) %, P ＜ 0.05 ) ],fewer positive c-kit area ( 56.11 ± 5.09 vs 88.47 ± 4.49, P ＜ 0.05 ) and fewer c-kit mRNA expression (0.64±0.33 vs 1.29 ±0.91, P ＜0.05) was detected.Vacuolation of mitochondria of ICC in ANP group and decreased surrounding apophyses, vague connecting structure with adjacent smooth muscle cells were observed.Conclusions Decrease of ICC and ultrastructural changes play an important role in intestinal dysmotility during ANP, and the changes of ICC may be resulted from the reduced expression of c-kit gene.
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Objective To analyze the clinical features of acute hyperlipidemic panereatitis,and to investigate the therapeutic strategies.Methods In this retrospective study,44 patients with hyperlipidemic pancreatitis admitted to our hospital from January 2003 to December 2007 were enrolled,60 patients with acute pancreatitis of other etiologies were enrolled as the control group.Results The proportions of patients with overweight or obesity,hyperglycemia,fatty liver and hypertension were 81.8%,59.1%,54.5% and 68.2%,respectively;these were significantly higher than those in control group,which were 16.7%,16.7 %,13.3 % and 23.3 %,respectively (P＜0.05 or＜0.01).The proportion of patients with lithiasis was lower in HLP group than that in control group (13.6% vs 60.0%,P＜0.05).There was no difference in the proportions of patients with chronic alcoholism between two groups.The Ranson score,CTSI,complications in HLP group were 3.15±0.07,4.46±2.58 and 3.2±1.7,respectively;these parameters were significantly higher than those in control group,which were 1.62±0.22,2.62±1.90 and 0.9±1.2 (P＜0.05 or ＜ 0.01 ).The level of serum amylase in HLP group was 580±222 mmol/L,which was significantly lower than that of control group (1361±472 mmol/L,P ＜ 0.01 ).The triglyceride (TG) level was linearly correlated with Ranson score in HLP group ( r = 0.77,P ＜ 0.05 ),but there was no linear correlation between TG level and Ranson score in the control group.Conclusions There was a close relationship between HLP and metabolic syndrome.Serum TG was positively correlated with the severity of HLP.
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Objective To investigate the early diagnosis and treatment of primary gastrointestinal malignant lymphoma( PGIML). Methods The clinical materials of 33 cases with PGIML from 1997 to 2005 were retrospectively studied. Results The diagnosis rate of gastroenteroscopy was 44. 4% . The most common immune phenotype was B-cell lineage (90. 9% ). Of the 33 PGIML patients, 30 were treated with operation, 2 with H. poli elimination and 1 gave up treatment. Among the operation cases and operation plus chemotherapy cases 19/21 cases (90. 5% )and 6/9 cases (66. 7% ) survived more than 2 years respectively, the other 6 cases died. Conclusion It is hard to diagnose PGIML in early stage. The effectiveness of surgery on treating PGIML should be further confirmed by profound prospective randomized trials.