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简介：Necrotizingpancreatitisisanuncommonyetseriouscomplicationofacutepancreatitiswithmortalityratesreportedupto15%thatreach30%incaseofinfection.Traditionallyopensurgicaldebridementwastheonlytoolinourdisposaltomanagethisseriousclinicalentity.Thisapproachishoweverassociatedwithpooroutcomes.Managementhasnowshiftedawayfromopensurgicaldebridementtoamoreconservativemanagementandminimallyinvasiveapproaches.Contemporaryapproachtopatientswithnecrotizingpancreatitisand/orinfectiouspancreatitisissummarizedinthe3Ds:Delay,DrainandDebride.Patientscanbemanagedintheintensivecareunitandanyinterventionshouldbedelayed.Percutaneousdrainagecanbeutilizedfirstandearlyinthecourseofthedisease,followedbyendoscopicdrainageorvideoassistedretroperitoneoscopicdrainageifnecrosectomyisdeemednecessary.Opensurgeryisnowlessfrequentlyperformedandshouldbereservedforcasesrefractorytoanyotherapproach.Themanagementofnecrotizingpancreatitisthereforerequiresamultidisciplinarydynamicmodelofapproachratherthanbeingasurgicaldisease.

简介：AbstractAcute pancreatitis (AP) is a common and potentially life-threatening pancreatic inflammatory disease. Although it is usually self-limiting, up to 20% of patients will develop into severe AP. It may lead to systemic inflammatory response syndrome and multiple organ dysfunction, affecting the lungs, kidneys, liver, heart, etc. Surviving patients usually have sequelae of varying degrees, such as chronic hyperglycemia after AP (CHAP), pancreatic exocrine insufficiency, and chronic pancreatitis. Lacking specific target treatments is the main reason for high mortality and morbidity, which means that more research on the pathogenesis of AP is needed. Ferroptosis is a newly discovered regulated cell death (RCD), originally described in cancer cells, involving the accumulation of iron and the depletion of plasma membrane polyunsaturated fatty acids, and a caspase-independent RCD. It is closely related to neurological diseases, myocardial infarction, ischemia/reperfusion injury, cancer, etc. Research in the past years has also found the effects of ferroptosis in AP, pancreatic cancer, and AP complications, such as acute lung injury and acute kidney injury. This article reviews the research progress of ferroptosis and its association with the pathophysiological mechanisms of AP, trying to provide new insight into the pathogenesis and treatment of AP, facilitating the development of better-targeted drugs.

简介：Acutepancreatitisduringpregnancyisarareevent,andcanbeassociatedwithhighmaternalmortalityandfetalloss.Gallstonediseaseisthoughttobethemostcommoncausativefactorofacutepancreatitis,but,inmanycases,thecauseremainsunclear.Wereportacaseofa36-year-oldwomanat35wkofgestation,whopresentedwithseverepainconfinedtotheupperabdomenandradiatingtotheback.Thepatientwasdiagnosedwithacuteidiopathicpancreatitis,whichwasmanagedconservatively;sherecoveredwithinseveraldaysandthendeliveredahealthybaby.Thereforeitisimportanttoconsideracutepancreatitiswhenapregnantwomanpresentswithupperabdominalpain,nauseaandvomitinginordertoimprovefetalandmaternaloutcomesforpatientswithacutepancreatitis.

简介：BackgroundApulmonary-infectedpatienthadseverehyponatremiathatlastedtwodaysduringhospitalization.Wecouldnotfindanyhistorysuchasgluttony,liverandgalldisease.Theexaminationofliverfunctionreportedthatthehepaticenzymologyisnormal.InICU,wequicklyfoundhemodiastasereachedatextremelyhighlevel.TheberryCTindicatedthattheheadofpancreasswellingandtheboundarywasobscureandeffusive.Thepatientwasdiagnosedasacutepancreatitis.Thiscaseraisesaquestiontous:Doesseverehyponatremiacauseacutepancreatitis?Ithasnotbeenreported.MethodsWeestablishedacuteanimalmodelofhyponatremiathatdidnotincludeanyotherelectrolytechaos.Aftertheanimalmodelofhyponatraemiacompleted,serumamylaselevelsandpathologicalexaminationwereanalyzed.ResultsThehyponatremiamodels,outof16rats,onlyfourrats'serumsodiumwerelessthan120mmol/L.Inthesefourrats,besidesserumsodium,theremainingelectrolyteswerenormalandserumlipidswereinnormalrange,onlyonerat'sserumamylaseincreasedsignificantlymorethanfourtimesofthenormalcontrolgroupanditspathologicalfindingshintedpancreaticedema.ConclusionsTheexperimentalmodelsuccessfullyduplicatedtheclinicalandpathologicfeaturesofpancreatitisinducedbyhyponatraemia.Throughthiscasereport,wehopethatattentioncanbepaidtochangesinserumamylasewhenhyponatremiaappeared.

简介：Enteralnutritionhasbeenstronglyrecommendedbymajorscientificsocietiesforthenutritionalmanagementofpatientswithacutepancreatitis.Providingsevereacutepancreatitispatientswithenteralnutritionwithinthefirst24-48hofhospitaladmissioncanhelpimproveoutcomescomparedtoparenteralnutritionandnofeeding.Newresearchisfocusinginonwhenandwhattofeedtobestimproveoutcomesforacutepancreatitispatients.Earlyenteralnutritionhavethepotentialtomodulatetheimmuneresponses.Despitethisconsistentevidenceofearlyenteralnutritioninpatientswithacutepancreatitis,clinicalpracticecontinuestovaryduetoindividualclinicianpreference.Achievingtheimmunemodulatingeffectsofenteralnutritionheavilydependonproperplacementofthefeedingtubeandmanaginganytubefeedingassociatedcomplications.Thecurrentarticlereviewstheimmunemodulatingeffectsofenteralnutritionandpro-andprebioticsandsuggestssomepracticaltoolsthathelpimprovethepatientadherenceandtolerancetothetubefeeding.Properselectionofthetypeofthetube,closemonitoringofthetubeforitsplacement,patencyandsecuringitsproperplacementandroutinecheckingthegastricresidualvolumecouldallhelpimprovetheoutcome.Usingpeptide-basedandhighmediumchaintriglyceridesfeedingformulashelpimprovingfeedingtolerance.

简介：Chronicpancreatitisisanongoingdiseasecharacterizedbypersistentinflammationofpancreatictissues.Withdiseaseprogression,patientswithchronicpancreatitismaydeveloptroublesomecomplicationsinadditiontoexocrineandendocrinepancreaticfunctionalloss.Amongthem,apseudoaneurysm,mainlyinducedbydigestiveenzymeerosionofvesselsinproximitytothepancreas,isarareandlife-threateningcomplicationifbleedingofthepseudoaneurysmoccurs.Atpresent,noprospectiverandomizedtrialshaveinvestigatedthetherapeuticstrategyforthisrarebutcriticalsituation.Theroleofarterialembolization,thetimingofsurgicalinterventionandevensurgicalproceduresarestillcontroversial.Inthisreview,wesuggestthatdynamicabdominalcomputedtomographyandangiographyshouldbeperformedfirsttolocalizethebleedersandtoevaluatetheassociatedcomplicationssuchaspseudocystformation,followedbyarterialembolizationtostopthebleedingandtoachieveearlystabilizationofthepatient’scondition.Withadvancesandimprovementsinendoscopicdevicesandtechniques,therapeuticendoscopyforpancreaticpseudocystsistechnicallyfeasible,safeandeffective.Surgicalinterventionisrecommendedforableedingpseudoaneurysminpatientswithchronicpancreatitiswhoareinanunstablecondition,forthoseinwhomarterialembolizationofthebleedingpseudoaneurysmfails,andwhenendoscopicmanagementofthepseudocystisunsuccessful.Ifableedingpseudoaneurysmislocatedoverthetailofthepancreas,resectionisapreferentialprocedure,whereasifthelesionissituatedovertheheadorbodyofthepancreas,relativelyconservativesurgicalproceduresarerecommended.

简介：AbstractAcute pancreatitis (AP) is a common acute abdominal condition of the digestive system. In recent years, treatment concepts, methods, and strategies for the diagnosis of AP have advanced, and this has played an important role in promoting the standardization of AP diagnosis and treatment and improving the treatment quality of AP patients. On the basis of previous guidelines and expert consensus, this guideline adopts an evidence-based, problem-based expression; synthesizes important clinical research data at home and abroad in the most recent 5 years; and forms 29 recommendations through multidisciplinary expert discussion, including diagnosis, treatment, and follow-up. It is expected to provide evidence support for the treatment of AP in the clinical setting in China.

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简介：Theuseofenteralfeedingaspartofthemanagementofacutepancreatitisdatesbackalmosttwodecades.Thisreviewdescribestheindicationsforandlimitationsofenteralfeedingforthetreatmentofacutepancreatitisusingup-to-dateevidence-baseddata.Asystematicreviewwascarriedouttoanalysecurrentdataontheuseofenteralnutritioninthemanagementofacutepancreatitis.Relevantliteraturewasanalysedfromtheviewpointsofenteralvsparenteralfeeding,earlyvsdelayedenteralnutrition,nasogastricvsnasojejunalfeeding,andearlyoraldietandimmunonutrition,particularlyglutamineandprobioticsupplementation.Finally,currentapplicableguidelinesandtheeffectsoftheseguidelinesonclinicalpracticearediscussed.Thelatestmeta-analysessuggestthatenteralnutritionsignificantlyreducesthemortalityrateofsevereacutepancreatitiscomparedtoparenteralfeeding.Tomaintaingutbarrierfunctionandpreventearlybacterialtranslocation,enteralfeedingshouldbecommencedwithinthefirst24hofhospitaladmission.Also,thesafetyofnasogastricfeeding,whicheasestheadministrationofenteralnutrientsintheclinicalsetting,islikelyequaltonasojejunalfeeding.Furthermore,anearlylow-fatoraldietispotentiallybeneficialinpatientswithmildpancreatitis.Despitetheinitialencouragingresults,thecurrentevidencedoesnotsupporttheuseofimmunoenhancednutrientsorprobioticsinpatientswithacutepancreatitis.

简介：肝的动脉pseudoaneurysm(幸运)是很稀罕的疾病但是在复杂并发症的情况下，有很高的死亡。幸运的最普通的原因是象肝活体检视那样的因医生之治疗而引的损伤，transhepatic胆汁的排水，胆囊炎和hepatectomy。幸运可以也与象与联系的感染或发炎那样的复杂并发症发生腐败emboli。幸运与尖锐胰腺炎在病人很少被报导了。根据我们知道，没有尖锐自发的胰腺炎特别地引起的一个案例的报告。我们报导在一个61岁的女人发展了的尖锐自发的胰腺炎引起的幸运的一个案例。开始由于未知原因与尖锐胰腺炎介绍的女人。在保守管理以后，她的症状似乎改善了。但是在承认以后的八天，腹的疼痛突然地再变得更坏。腹的计算断层摄影术(CT)被再核对，它检测了没在以前的腹的CT被看见的新幸运。内视镜后退因为hemobilia的怀疑，cholangiopancreatography(ERCP)作为加重的腹的疼痛的一个原因被执行。ERCP由在cholangiogram上在远侧的普通胆汁管在两耳细颈瓶和几充满缺点的开始观察新鲜的血块证实了hemobilia。没有象embolization或外科的结扎那样的任何特别治疗，幸运thrombosed自发地。在分泌物以后的三个月，腹的CT证明在左侧面的片断的那幸运消失了。

简介：Acutepancreatitis(AP)isafrequentdiseasewithdegreesofincreasingseverityresponsibleforhighmorbidity.Despitecontinuousimprovementincare,mortalityremainssignificant.Becausehypovolemia,togetherwithmicrocirculatorydysfunctionleadtopooroutcome,fluidtherapyremainsacornerstoneofthesupportivetreatment.However,poorclinicalevidenceactuallysupporttheaggressivefluidtherapyrecommendedinrecentguidelinessinceavailabledataarecontroversial.Fluidmanagementremainsunclearandleadstocurrentheterogeneouspractice.DifferentstrategiesmayhelptoimprovefluidresuscitationinAP.Ononehand,integrationoffluidtherapyinaglobalhemodynamicresuscitationhasbeendemonstratedtoimproveoutcomeinsurgicalorsepticpatients.Tailoredfluidadministrationafterearlyidentificationofpatientswithhigh-riskofpooroutcomepresentinginadequatetissueoxygenationisamajorpartofthisstrategy.Ontheotherhand,newdecisionparametershavebeendevelopedrecentlytoimprovesafetyandefficiencyoffluidtherapyincriticallyillpatients.Inthisreview,weproposeapersonalizedstrategyintegratingthesenewconceptsintheearlyfluidmanagementofAP.ThisnewapproachpavesthewaytoawiderangeofclinicalstudiesinthefieldofAP.

简介：瞄准：为了评估磁性的回声cholangiopancreatography(MRCP)，与磁性的回声(先生)一起的调查结果在自体免疫的胰腺炎(AIP)想象病人。方法：有AIP的九个病人经历了MRI，MRCP，内视镜后退cholangiopancreatography(ERCP)，计算断层摄影术，和ultrasonography。在类固醇治疗前后拿的MRCP和先生图象被考察并且与另外的成像形式相比。AIP盒子的MRCP调查结果与有胰的头的癌的10个盒子的那些相比。结果：在MRCP上，在ERCP上注意的主要的胰腺的管的缩小的部分没被设想，当主要的胰腺的管的非包含的片断被设想时。近似的主要的胰腺的管的在上游的膨胀的度比在胰腺的癌的情况下看温和。更低的胆汁管的狭窄或阻塞在8个病人被检测。先生图象在T1加权的先生图象上与减少的信号紧张显示出胰的增大，T2加权的先生图象上的增加的信号紧张，并且，在3个病人，低亚硫酸钠强烈像囊的边界。在类固醇治疗以后，以前没设想主要的胰腺的管的部分被看见，与胆汁管狭窄的改进一起。胰腺的增大减少了，并且T1加权、T2加权的先生图象上的反常信号紧张成为了isointense。结论：MRCP不能区分从与胰腺的癌看见的主要的胰腺的管的狭窄与AIP看见的主要的胰腺的管的不规则的变窄。然而，与在T1加权、T2加权的先生图象上显示出反常信号紧张的胰腺的增大的先生成像一起的MRCP调查结果在支持AIP的诊断是有用的。

简介：尖锐胰腺炎是能触发全身的inammatory回答的本地织物损害描绘的inammatory疾病。胰腺炎的那么脉管的复杂并发症是病态和死亡的一个主要原因。在尖锐胰腺炎的肺的栓塞被报导了很稀罕。我们与尖锐胰腺炎报导了肺的栓塞的一个案例。一个38岁的女人爆发了没有明确的动机的上面的腹部疼痛。她没有恶心并且呕吐，发烧，呼吸困难，咳嗽和咳痰，胸疼痛。病人在本地医院里与尖锐胰腺炎被诊断了。病人与抗菌素和质子泵禁止者被对待，并且腹部疼痛稍微被减轻。但是病人向前来了有一点血的咳嗽和咳痰，进步呼吸困难。腹部的计算tomographic扫描揭示了胰腺炎。胸的随后的计算机断层摄影术angiography揭示了肺的栓塞(两个都击倒恰好肺的动脉的肺的动脉，左肺的动脉和分支)。病人的呼吸困难与thrombolytic治疗和anticoagulation治疗变好。肺的栓塞是胰腺炎的稀罕却潜在地致命的复杂并发症。对这复杂并发症的熟悉将帮助它的早诊断，治疗并且阻止肺的栓塞，稀罕却灾难的现象。

简介：Severeacutepancreatitis(SAP)cancausesystematicinflammatoryresponsesyndrome(SIRS),whichleadstoinjuryorfailureoftheinternalorgansandsystems.1Amongthem,acuterespiratorydistresssyndrome(ARDS)isasevereorfatalcomplication.Inthisarticle,theearlypreventivetreatmentforSAPcombinedwithlunginjureisstudied.

简介：全身的corticosteroids与联系IgG4的胆管炎为自体免疫的胰腺炎代表标准治疗。为类固醇依赖者疾病，azathioprine被用于宽恕的维护。Mycophenolatemofetil被用于最近为自体免疫的肝炎移植免疫力的抑制和更多；然而，没有案例报告与自体免疫的胰腺炎在成年病人在mycophenolatemofetil的使用上标明日期。有调停IgG4的自体免疫的胰腺炎和对类固醇倔强、azathioprine偏狭的联系IgG4的胆管炎的一个病人与mycophenolatemofetil被对待，它禁止denovoguanosine合成和B和T淋巴细胞生产的封锁。到用在4瞬间的治疗经期上两次每日的嘴的1000mg的mycophenolatemofetil和uptitration的介绍在病人精力水平和血葡萄糖控制与改进被联系并且没与任何不利事件被联系。没有胆汁的stent，病人被管理。然而，当泼尼松剂量每天到达了11mg时，有症状，黄疸，transaminases的增加，和hyperbilirubinemia的回来。在在有联系IgG4的自体免疫的胰腺炎和联系IgG4的胆管炎的一个成年病人的mycophenolatemofetil使用的第一份报告，mycophenolatemofetil的介绍没有不利事件安全、容忍得好，但是它没启用类固醇的中止。Mycophenolatemofetil和另外的immunomodulatory治疗应该继续与倔强或周期性的自体免疫的胰腺炎在病人的大子集为宽恕的维护学习。

简介：AbstractObjective:Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods:We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results:The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3, P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1, P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4, P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1, P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81, P <.001).Conclusion:VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.

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简介：关于为心脏性的吃惊的处理的levosimendan的使用的编辑的一封信被介绍。

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