Imaging classification and analysis of the diagnosis and treatment of infected pancreatic necrosis:a report of 126 cases / 中华外科杂志

Objective: To explore the clinical characteristics of various types of infected pancreatic necrosis(IPN) and the prognosis of different treatment methods in the imaging classification of IPN proposed. Methods: The clinical data of 126 patients with IPN admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from December 2018 to December 2021 were analyzed retrospectively. There were 70 males(55.6%) and 56 females(44.4%), with age(M(IQR)) of 44(17)years (range: 12 to 87 years). There were 67 cases(53.2%) of severe acute pancreatitis and 59 cases (46.8%) of moderately severe acute pancreatitis. All cases were based on the diagnostic criteria of IPN. All cases were divided into Type Ⅰ(central IPN)(n=21), Type Ⅱ(peripheral IPN)(n=23), Type Ⅲ(mixed IPN)(n=74) and Type Ⅳ(isolated IPN)(n=8) according to the different sites of infection and necrosis on CT.According to different treatment strategies,they were divided into Step-up group(n=109) and Step-jump group(n=17). The clinical indicators and prognosis of each group were observed and analyzed by ANOVA,t-test,χ2 test or Fisher exact test,respectively. Results: There was no significant difference in mortality, complication rate and complication grade in each type of IPN(all P>0.05). Compared with other types of patients, the length of stay (69(40)days vs. 19(19)days) and hospitalization expenses(323 000(419 000)yuan vs. 60 000(78 000)yuan) were significantly increased in Type Ⅳ IPN(Z=-4.041, -3.972; both P<0.01). The incidence of postoperative residual infection of Type Ⅳ IPN was significantly higher than that of other types (χ2=16.350,P<0.01). There was no significant difference in the mortality of patients with different types of IPN between different treatment groups. The length of stay and hospitalization expenses of patients in the Step-up group were significantly less than those in the Step-jump group(19(20)days vs. 33(35)days, Z=-2.052, P=0.040;59 000(80 000)yuan vs. 122 000(109 000)yuan,Z=-2.317,P=0.020). Among the patients in Type Ⅳ IPN, the hospitalization expenses of Step-up group was significantly higher than that of Step-jump group(330 000(578 000)yuan vs. 141 000 yuan,Z=-2.000,P=0.046). The incidence of postoperative residual infection of Step-up group(17.4%(19/109)) was significantly lower than that of Step-jump group(10/17)(χ2=11.980, P=0.001). Conclusions: Type Ⅳ IPN is more serious than the other three types. It causes longer length of stay and more hospitalization expenses. The step-up approach is safe and effective in the treatment of IPN. However, for infected lesions which are deep in place,difficult to reach by conventional drainage methods, or mainly exhibit "dry necrosis", choosing the step-jump approach is a more positive choice.

Effect of ultraviolet rays treatment of titanium and titanium alloy on antibacterial property / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the antibacterial property of ultraviolet rays (UV)-treated titanium and its alloy by observing the attachment and colony-forming units (CFU) of Staphylococcus Aureus (Sa) and Fusobacterium Nucleatum (Fn).</p><p><b>METHODS</b>Both of the titanium and its alloy were divided into 2 groups according to the UV treatment protocol as the UV-treated group (UV-Ti, UV-A), and two control groups (C-Ti, C-A) were also prepared. Then the sand-blasted and acid etched titanium and its alloy disks were stored in the dark and sealed containers for 4 weeks and treated with or without UV light for 48 hours. The hydrophilicity of disks were measured using contact angle measuring device. The attachment of the two kinds of bacteria were observed using inverted fluorescence microscope after stained by the Hoechst 33342 which was part of blue fluorescent dyes used to stain DNA and the results were replenished and verified by the Safranine O staining. CFU were used to measure the antibacterial property of the materials.</p><p><b>RESULTS</b>The contact angles of UV-Ti (1.32 ± 0.29)° and UV-A (0.89 ± 0.07)° were smaller than those of C-Ti (81.18 ± 1.46)° and C-A (83.34 ± 0.06)° (P < 0.05). After being cultured on the surface of the two kinds of materials for 15 min, 30 min and 1 h, the attachment of Sa and Fn on the surface of titanium [(31 ± 13, 73 ± 13, 263 ± 49), (10 ± 7, 26 ± 19, 105 ± 37)] and its alloy disks [(64 ± 19, 57 ± 16, 304 ± 53), (11 ± 5, 59 ± 18, 124 ± 53)] which were treated with the UV light were much lower than those in control titanium groups[(139 ± 30, 271 ± 51, 749 ± 172), (164 ± 16, 227 ± 65, 483 ± 64)] and its control alloy group [(174 ± 11, 387 ± 39, 1409 ± 262), (265 ± 45, 374 ± 133, 910 ± 103)] (P < 0.05). What's more, the CFU number of the two kinds of bacteria decreased sharply after the UV treatment (P < 0.05).</p><p><b>CONCLUSIONS</b>UV treatment can reduce the attachment and viability of different kinds of bacteria and the antibacterial effect will at least last for 24 hours.</p>

Bioactivity of ultraviolet ray-treated titanium surface in nitrogen storing environment / 中华口腔医学杂志

<p><b>OBJECTIVE</b>To evaluate the adhesion, proliferation and differentiation of osteoblast-like cells on the ultraviolet (UV)-treated titanium in different storing environment, and to find a way to enhance the bioactivity of titanium and to prevent its age-related degradation.</p><p><b>METHODS</b>Acid-etched titanium disks stored under ambient conditions for 4 weeks and treated with UV light for 48 h.Then disks were divided into three groups and placed in a sealed container for 0 h (no-stored,NO group) , 4 weeks (air-stored, AS group) or in a sealed container filled with nitrogen for 4 weeks (nitrogen-stored,NS group) respectively. A group of UV-untreated titanium served as negative control (NC group).The surface morphology was evaluated using scanning electron microscopy (SEM), and hydrophilicity of disks were measured using contact angle measuring device. Cell counting kit-8 was used to measure the cell adhesion and proliferation. Cell differentiation was evaluated by testing alkaline phosphatase (ALP) activity using ALP reagent kit.</p><p><b>RESULTS</b>There was no difference in surface topography among groups.Contact angels in NS group [(67.70 ± 3.59)°] and NO group [(0.70 ± 0.28)°] were smaller than the others (P < 0.05). Cell adhesion in NS group at 2 h and 4 h point was (0.237 ± 0.006) and (0.578 ± 0.039), respectively, and proliferation at 3 d and 5 d point was (0.743 ± 0.026) and (1.548 ± 0.046) respectively, which were significantly higher than those in AS group [(0.158 ± 0.036), (0.400 ± 0.010), (0.499 ± 0.019) and (1.174 ± 0.062)] and in NC group [(0.161 ± 0.024), (0.390 ± 0.011), (0.508 ± 0.015) and (1.209 ± 0.025)] at the same time point (P < 0.05). How ever the results mention above in the NS group were lower than those in the NO group (P < 0.05). No difference were found between data from the AS group and NS group (P > 0.05). Osteoblast-like cells had an abundant spread on NS and NO group during 2 h incubation, but did not exactly spread on AS and NC group after incubation for 4 h. No difference were found in ALP among groups.</p><p><b>CONCLUSIONS</b>UV treatment can enhance bioactivity of titanium, and nitrogen storage can slow down its biological aging.</p>