Pancreatic necrosis (IPN) is a serious complication of acute pancreatitis (AP), with a mortality reported to be as great as 32.0%. At present, it is considered that patients with proven or suspected infected necrotizing pancreatitis, invasive intervention (i.e. percutaneous catheter drainage, endoscopic transluminal drainage/ necrosectomy, minimally invasive or open necrosectomy) should be delayed where possible until at least 4 weeks after initial presentation to allow the collection to become 'walled-off'. With the development of endoscopic technology, endoscopic transmural (stomach or duodenum) drainage and necrosectomy has been recommended as one of the preferred methods for walled-off necrosis. This article introduces the diagnosis and evaluation of the walled-off necrosis ; the indications, operation procedures, postoperative evaluation and management of postoperative complications of endoscopic transmural drainage and necrosectomy. At last, the research progress of endoscopic drainage and debridement in recent years was introduced.

Objective To analyze the clinical characteristics of patients with acute pancreatitis (AP) in Jiangxi Province.Methods From 2007 to 2012,the data of 2 625 hospitalized patients diagnosed as AP were retrospectively analyzed.The changes of composition in gender,age and etiology during 2007-2009 time period and 2010-2012 time period were compared.Mann Whitney U test was performed for non-normal distribution measurement data analysis and x2 test was for count data analysis.Results Among the 2 625 patients with AP,from 2007 to 2009 there were 1 028 cases and 1 597 cases in the period 2010 to 2012.The ages of the patients in these two period were 50(38,61) and 50 (40,63) years old,respectively.There was statistically significant difference in the age distribution between these two period (U=783 635.5,P＜0.05).Biliary factor was the most common cause of AP in the two time period 2007 to 2009 and 2010 to 2012,which accounted for 55.9％ (575/1 028) and 62.9％ (1 005/1 597),respectively,and the difference was statistically significant (x2=12.778,P＜ 0.01).Alcoholic AP accounted for 1.9％ (19/1 028) and 7.3％ (117/1 597),respectively,hyperlipidemic AP were 14.0％ (144/1 028) and 17.7％ (283/1 597),and idiopathic AP were 22.0％ (226/1 028) and 5.9％ (94/1 597),all the differences were statistically significant (x2 =38.204,6.330 and 151.416,all P＜0.05).In male patients,biliary AP accounted for 52.4％ (732/1 398),which was lower than that of female patients (69.1％,848/1 227),and the difference was statistically significant (x2 ＝76.524,P＜0.01).Alcoholic AP and hyperlipidemic AP accounted for 9.0％ (126/1 398) and 21.4％ (299/1 398) in male patients,which were significantly higher than those of female patients (0.8％,10/1 227; 10.4％,128/1 227),and the differences were statistically significant (x2 89.396 and 57.585,both P＜0.01).Biliary AP accounted for 79.9％ (631/790) in elderly group,which was higher than that of non elderly group (51.7％,949/1 835),and the difference was statistically significant (x2＝182.720,P＜0.01).In elderly group hyperlipidemic AP and alcoholic AP accounted for 2.5％ (20/790) and 1.3％ (10/790),which were significantly lower than those of non-elderly group (22.2％,407/1 835; 6.9％,126/1 835),and the differences were statistically significant (x2 =156.524 and 35.262,both P＜0.01).Conclusions The middle-aged and elderly people are the vulnerable population of AP.Biliary factor is the most common cause of AP,especially in the female and elderly.The proportions of hyperlipidemic AP and alcoholic AP both significantly increase,in the male higher than that of the female and in the non-elderly higher than that of the elderly.The proportion of idiopathic AP significantly decreases.

Intrahepatic cholangiocarcinoma (ICC) is an important liver malignancy next only to hepatocellular carcinoma, accounting for 15%-20% of primary liver cancer. In recent years, the incidence rate of ICC tends to increase globally; however, due to its insidious onset, high degree of malignancy, and strong invasive ability, most patients are in the advanced stage when attending the hospital and thus miss the most appropriate timing for surgery. With the continuous development of next-generation sequencing, the treatment of ICC gradually develops towards the direction of individualization and precision. This article introduces the basic research advances in the pathogenesis, molecular typing, and early diagnosis of ICC and reviews the clinical translational research of ICC in recent years, so as to provide new ideas for the treatment and clinical research of ICC.

Objective To compare the discrepancy between the new (2012) and the old (1992) Atlanta classification criteria for defining severity, organ failure and local complications in patients with acute pancreatitis (AP).Methods Demographic, clinical and laboratory data of 2 305 consecutive AP patients with onset less than 3 days, were collected between January 2005 to December 2013 in the First Affiliated Hospital of Nanchang University.Severity, organ failure and pancreatic local complications were respectively classified by the old Atlanta classification and the new revised Atlanta classification.Multi-factor scoring system and single serum marker were recorded and calculated using the acute pancreatitis database.Results In 2 305 patients with AP, there were 301 cases (13.1％) diagnosed with acute respiratory failure, 136 cases (5.9％) with shock, 105 cases (4.6％) with acute renal failure, 296 cases (12.8％) with gastrointestinal bleeding, based on the old Atlanta classification criteria.According to the severity, 900 cases (39.0％) were classified as mild acute pancreatitis (MAP), 1 405 cases (61.0％) as severe acute pancreatitis (SAP).However, based on the new Atlanta classification criteria, there were 686 cases (29.8％) with acute respiratory failure, 129 cases (5.6％) with acute renal failure, 107 cases (4.6％) with circulatory failure.Consequently, 998 cases (43.3％) were classified as MAP, 937 cases (40.7％) as moderately severe acute pancreatitis (MSAP), 370 cases (16.1％) as SAP.The incidence of respiratory failure was lower than that of the old standard.In SAP patients by new criteria, the discharge rate in critical condition and mortality were not only higher than those in MSAP patients (17.0％ vs 4.1％, 4.1％ vs 1.5％, respectively , all P ＜ 0.001), but also higher than those in SAP patients by the old classification (17.0％ vs 7.2％ ,4.1％ vs 2.1％, all P ＜ 0.001).Conclusions The diagnostic criteria of organ failure are different between the new and old Atlanta classification.The SAP patients classified by the new standard have worse outcome than those by the old standard.More attention needs to be paid to critical patients stratified by the new standard.

Objective To explore the effect of low concentration 5-fluorouracil combined with triamcinolone acetonide on rabbit ear hypertrophic scar model.Methods White rabbits post-traumatic scars were randomly divided into A,B,C and D groups,each group contained 18 cases.Group A was given triamcinolone acetonide and low concentration 5-fluorouracil,Group B was given low concentration 5-fluorouracil,Group C was given triamcinolone acetonide and Group D was used as the control group.The dynamic changes of the scar were observed by naked eyes,hematoxylin-eosin (HE) staining and van Gieson (VG) staining through microscope.Vascular endothelial growth factor (VEGF) and CD34 were detected and compared within 4 groups by immunohistochemical staining.Results We successfully established a rabbit ear scar model.It was observed that the scars of Groups A,B and C had been shorter and flatter than Group D,close to the normal tissue.In HE and VG staining,the number of fibroblasts,inflammatory cells,blood vessels in groups A,B and C had been decreased,compared with Group D.Immunohistochemical results showed that the positive rates of VEGF and CD34 from the most to the lest were Groups D,B,C and A.The scar proliferation index from the most to the lest were Groups D,B,C and A.Conclusions The effect of low concentration 5-fluorouracil in treatment of the rabbit ear hypertrophic scar is better than that of triamcinolone acetonide.Low concentration 5-fluorouracil combined with triamcinolone acetonide has a synergistic effect in treatment of hypertrophic scar,which has better effect than that of low concentration 5-fluorouracil or triamcinolone acetonide alone.

Since more than 30 years ago, endoscopic retrograde cholangiopancreatography and papillary myotomy have been used to remove the cause of acute biliary pancreatitis. In the past 10 years, minimally invasive endoscopic technology has developed rapidly and has been widely used in the treatment of late complications of acute pancreatitis, such as infectious pancreatic necrosis, pancreatic pseudocyst, disconnected pancreatic duct syndrome, and gastrointestinal fistula. This article focuses on the advances in the application of endoscopy in the treatment of acute pancreatitis.

Objective The study was conducted to investigate the incidence of metabolic syndrome ( MS) and hyperuricemia in Chinese community residents, and to assess differences of menopausal status and genders in the relationship between MS and serum uric acid ( SUA ) levels. Methods A total of 10191 subjects ( 5838 postmenopausal women, 726 premenopausal women, and 3627 men) were recruited in this cross-sectional study. All participants received standard questionnaire survey, physical examination, oral glucose tolerance test, and laboratory examination ( serum uric acid, serum lipid, liver and kidney functions ) . MS was diagnosed according to the International Diabetes Federation ( IDF) criteria. Hyperuricemia was defined as SUA>420μmol/L for men and>360μmol/L for women. Results The prevalence of hyperuricemia was 14. 4％ in men, 11. 8％ in postmenopausal women, and 6. 2％ in premenopausal women. The prevalence of MS was 35. 2％ in men, 46. 2％ in postmenopausal women, and 28. 9％ in premenopausal women. The body mass index, waist circumference, and triglycerides levels were most strongly associated with SUA levels in all groups, while the correlation coefficients of these factors were higher in females than those in males. Individuals in the highest SUA quartile had 3. 538-fold, 2. 088-fold, and 1. 404-fold increased risk of MS as compared with those in the lowest quartile in premenopausal women, postmenopausal women, and men, respectively. The risks of developing each components of MS in females were higher than those in males. Conclusions There is an association between SUA level and MS, and the relationships between SUA levels and MS were much closer in females than those in males. Individuals with higher SUA levels were more likely to develop MS and its components than those with lower SUA levels. Premenopausal women with high level of SUA may have the highest risk of developing MS in Chinses community residents.

Objective:To compare the clinical value of sequential organ failure assessment (SOFA) score and revised Marshall score in evaluating organ function in acute pancreatitis (AP).Methods:From January 2013 to December 2017, at the Department of Gastroenterology of The First Affiliated Hospital of Nanchang University, the clinical data of 3 957 hospitalized AP patients were collected through the AP electronic database. AP was diagnosed and the severity of the disease was classified according to the revised Atlanta classification criteria. Organ function was evaluated by modified Marshall score and SOFA score. The correlation between SOFA score and mortality, pancreatic necrosis were analyzed. Chi-square test and Spearman correlation analysis were performed for statistical analysis.Results:The incidences of circulatory failure and renal failure determined by the SOFA score were higher than those of the modified Marshall score (4.80%, 190/3 957 vs. 3.03%, 120/3 957; 10.11%, 400/3 957 vs. 6.44%, 255/3 957), and the differences were statistically significant ( χ2=1 599.54 and 2 237.19, both P<0.01). Two score systems were consistent in determining the incidence of respiratory failure, which were 32.22% (1 275/3 957). The incidences of persistent circulatory failure (≥48 h) and persistent renal failure (≥48 h) determined by the SOFA score were higher than those of the modified Marshall score (1.64%, 65/3 957 vs. 0.76%, 30/3 957; 4.78%, 189/3 957 vs. 3.69%, 146/3 957), and the differences were statistically significant ( χ2=1 458.37 and 2 398.01, both P<0.01). The incidence of persistent respiratory failure (≥48 h) was same determined by two score systems, which were 10.24% (405/3 957). The proportion of patients with severe AP determined by SOFA score was higher than that of the modified Marshall score (25.30%, 1 001/3 957 vs. 18.83%, 745/3 957), and the difference was statistically significant ( χ2=718.216, P<0.01). The results of Spearman correlation analysis showed that SOFA total score was positively correlated with the overall mortality and the incidence of pancreatic necrosis (correlation coefficients r were 0.540 and 0.211, respectively), and the differences were statistically significant (both P<0.01). Conclusion:SOFA score can comprehensively evaluate organ function in AP and is an important approach in determining prognosis.

Objective:To investigate the current situation and influencing factors of humanistic care needs of family members of pregnant women in maternal intensive care unit, and to explore the relationship between humanistic care needs of family members of pregnant women in maternal intensive care unit, relocation stress level and perceived social support ability, so as to provide a basis for clinical nursing staff to implement targeted humanistic care for family members of pregnant women in maternal intensive care unit.Methods:From July to December 2022, 267 family members of pregnant women who were observed in the Maternal Intensive Care Unit of Maternity Hospital Affiliated to Nanjing Medical University/Nanjing Maternal and Child Health Hospital were selected as the research objects by the convenient sampling method. The general information questionnaire, Humanistic Care Needs Scale for Family Members of Pregnant Women in the Obstetric Intensive Care Unit, Family Relocation Stress Scale for Intensive Care Unit Patients and Perceived Social Support Scale were used to carry out a cross sectional investigation.Results:The scores of humanistic care needs, relocation stress scale and perceived social support scale were (175.32 ± 16.04), (35.12 ± 8.11), (57.30 ± 15.43) points, respectively. The length of maternal intensive care unit stay ( B=1.301, P<0.05), the family′s role changed for the first time ( B=2.328, P<0.05), the delivery mode doesn′t match the family′s expectations ( B=-2.407, P<0.05), maternal admission to maternal intensive care unit due to childbirth complications ( B=3.228, P<0.05), relocation stress level of intensive care unit patients′ family members ( B=0.891, P<0.05), and family members′ perceived social support ability ( B=0.461, P<0.05) were the influencing factors of humanistic care needs of maternal family members in maternal intensive care unit factors, which explained 83.2% of the total variation. Conclusions:The humanistic care needs of family members of pregnant women in maternal intensive care unit are at a high level. Medical staff should pay more attention to the family members of pregnant women who stay in maternal intensive care unit for a long time, undergo role change for the first time, have unexpected delivery mode and stay in maternal intensive care unit due to childbirth complications, so as to provide them with more comprehensive humanistic care and establish multiple support system, in order to improve the level of humanistic care for the family members of maternal intensive care unit.

Objective To clarify the accuracy of APACHEⅡ, Ranson, BISAP and CTSI scoring systems for predicting the progression of mild acute pancreatitis ( MAP ) to moderate acute pancreatitis ( MSAP) and severe acute pancreatitis ( SAP ) , and death risk of patients with acute pancreatitis ( AP ) . Methods All data from 2080 consecutive adult patients who were admitted within 3 days of disease onset were selected from AP database between 2014 and 2017. The severity was classified according to the revised Atlanta classification systems. Patients who died during hospitalization or discharged automatically were defined as patients at risk of death. The predictive accuracies for MSAP, SAP and death risk were compared using receiver operating characteristic ( ROC) curves. Results The 2080 patients with AP were divided into MAP (n=857, 41. 2％), MSAP ( n =892, 42. 9％), and SAP ( n =331, 15. 9％) according to the revised Atlanta classification system. ROC curve analysis showed APACHEⅡ score, Ranson score, BISAP score and the CT severity index ( CTSI) had no predictive value for MSAP, but have predictive value for SAP and death risk. APACHEⅡ score had the highest accuracy in predicting SAP with area under the curve ( AUC) values of 0. 785 and 0. 746 on the 1st and 2nd day after admission, respectively, and the APACHEⅡscore on admission day 1 had the highest accuracy in predicting death risk (AUC =0. 845). Conclusions Various scoring systems had predictive value only for SAP and death risk, and APACHEⅡ score had the highese accuracy in predicting SAP and death risk.