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Early versus delayed intervention in necrotizing acute pancreatitis complicated by persistent organ failure

Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 63-68页

作者： He Zhang Lin Gao Wen-Jian Mao Jie Yang Jing Zhou Zhi-Hui Tong Lu Ke Wei-Qin Li Medical School of Southeast University 87 DingjiaqiaoNanjing 210009China Center of Severe acute pancreatitis(CSAP) Department of General SurgeryJinling HospitalMedical School of Southeast UniversityNo.305 Zhongshan East RoadNanjing 210002China

Background:Current guidelines for the treatment of patients with necrotizing acute pancreatitis(NAP)recommend that invasive intervention for pancreatic necrosis should be deferred to 4 or more weeks from disease onset to allow necrotic collections becoming“walled-off”.However,for patients showing signs of clinical deterioration,especially those with persistent organ failure(POF),it is controversial whether this delayed approach should always be *** this study,we aimed to assess the impact of differently timed intervention on clinical outcomes in a group of NAP patients complicated by ***:All NAP patients admitted to our hospital from January 2013 to December 2017 were screened for potential *** were divided into two groups based on the timing of initial interven-tion(within 4 weeks and beyond 4 weeks).All the data were extracted from a prospectively collected ***:Overall,131 patients were included for *** them,100(76.3%)patients were in-tervened within 4 weeks and 31(23.7%)underwent delayed *** for organ failure prior to intervention,the incidences of respiratory failure,renal failure and cardiovascular failure were not signifi-cantly different between the two groups(P>0.05).The mortality was not significantly different between the two groups(35.0%vs.32.3%,P=0.83).The incidences of new-onset multiple organ failure(8.0%vs.6.5%,P=1.00),gastrointestinal fistula(29.0%vs.12.9%,P=0.10)and bleeding(35.0%vs.35.5%,P=1.00),and length of ICU(30.0 vs.22.0 days,P=0.61)and hospital stay(42.5 vs.40.0 days,P=0.96)were com-parable between the two ***:Intervention within 4 weeks did not worsen the clinical outcomes in NAP patients compli-cated by POF.

关键词： necrotizing acute pancreatitis Persistent organ failure Early intervention Delayed intervention Clinical outcomes

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Splanchnic vein thrombosis in necrotizing acute pancreatitis: Detection by computed tomographic venography

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World Journal of Gastroenterology 2014年第44期20卷 16698-16701页

作者： Wei Jiang Jing Zhou Lu Ke Gang Li Zhi-Hui Tong Wei-Qin Li Jie-Shou Li Research Institute of General Surgery Jinling Hospital Medical School of Nanjing University

AIM: To assess the diagnostic accuracy of computed tomographic venography(CTV) for splanchnic vein thrombosis(SVT) detection in necrotizing acute pancreatitis(AP) ***:Forty-three patients with necrotizing AP who underwent both CTV and digital subtraction angiography(DSA)within 3 d were analyzed in this retrospective comparative *** CTV procedures were performed with a dual-source CT *** presence and location of SVT were determined via blinded imaging data ***:According to the DSA results,17(39.5%)of the total 43 patients had *** sensitivity,specificity,positive and negative predictive values of CTV for SVT detection were 100%(95%CI:77.1%-100%),92.3%(95%CI:73.4%-98.7%),89.5%(95%CI:65.5%-98.2%)and 100%(95%CI:82.8%-100%),***:CTV is an effective examination for SVT detection in patients with necrotizing AP with high positive and negative predictive values.

关键词： Splanchnic vein Thrombosis necrotizing acute pancreatitis Computed tomographic venography Digital subtraction angiography

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Inhibition of xanthine oxidase alleviated pancreatic necrosis via HIF-1α-regulated LDHA and NLRP3 signaling pathway in acute pancreatitis

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Acta Pharmaceutica Sinica B 2024年第8期14卷 3591-3604页

作者： Juan Rong Chenxia Han Yan Huang Yiqin Wang Qi Qiu Manjiangcuo Wang Shisheng Wang Rui Wang Juqin Yang Xia Li Chenggong Hu Zhiyao Chen Lihui Deng Wei Huang Qing Xi Dan Du West China Center of Excellence for pancreatitis Institute of Integrated Traditional Chinese and Western MedicineWest China Hospital/West China Medical SchoolSichuan UniversityChengdu 610041China State Key Laboratory of Bioactive Substance and Function of Natural Medicines Institute of Materia MedicaChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050China Advanced Mass Spectrometry Center Research Core FacilityFrontiers Science Center for Disease-related Molecular NetworkWest China HospitalSichuan UniversityChengdu 610213China Proteomics-Metabolomics Platform Research Core FacilityInstitutes for Systems GeneticsWest China HospitalSichuan UniversityChengdu 610093China Biobank West China HospitalSichuan UniversityChengdu 610093China West China School of Nursing Sichuan UniversityChengdu 610041China Department of Critical Care Medicine West China HospitalSichuan UniversityChengdu 610041China

acute pancreatitis(AP)is a potentially fatal condition with no targeted treatment *** inhibiting xanthine oxidase(XO)in the treatment of AP has been studied in several experimental models and clinical trials,whether XO is a target of AP and what its the main mechanism of action is remains ***,we aimed to re-evaluate whether XO is a target aggravating AP other than merely generating reactive oxygen species that trigger *** first revealed that XO expression and enzyme activity were significantly elevated in the serum and pancreas of necrotizing AP *** also found that allopurinol and febuxostat,as purine-like and non-purine XO inhibitors,respectively,exhibited protective effects against pancreatic acinar cell death in vitro and pancreatic damage in vivo at different doses and treatment time ***,we observed that conditional Xdh overexpression aggravated pancreatic necrosis and *** mechanism analysis showed that XO inhibition restored the hypoxia-inducible factor 1-alpha(HIF-1α)-regulated lactate dehydrogenase A(LDHA)and NOD-like receptor family pyrin domain containing 3(NLRP3)signaling pathways and reduced the enrichment of^(13)C_(6)-glucose to^(13)C_(3)-***,we observed that clinical circulatory XO activity was significantly elevated in severe cases and correlated with C-reactive protein levels,while pancreatic XO and urate were also increased in severe AP *** results together indicated that proper inhibition of XO might be a promising therapeutic strategy for alleviating pancreatic necrosis and preventing progression of severe AP by downregulating HIF-1α-mediated LDHA and NLRP3 signaling pathways.

关键词： Xanthine oxidase inhibitor Multi-omics HIF-1a necrotizing acute pancreatitis Lactate Therapeutic target NLRP3 Metabolic flux

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