Objective:To investigate lipid metabolism gene mutations and pathogenicity of hypertriglyceridemia acute pancreatitis (HTG-AP) patients.Methods:Clinical data of 495 HTG-AP patients admitted from June 2018 to June 2020 in the center for severe acute pancreatitis of Eastern Theater General Hospital were retrospectively analyzed. Whole-exome sequencing and mutation verification were performed by next-generation sequencing technology and Sanger sequencing. The pathogenicity of gene mutation was analyzed by population mutation ratio, pathogenicity prediction software, conservation scoring software, protein structure prediction, and in vitro experiments. Results:The mutation ratio of lipid metabolism-related genes, namely LPL, APOA5, LMF1, GPIHBP1, and APOC2, were 14.81%, 55.78%, 43.61%, 1.62%, and 0.61%, respectively. Among them, 44 heterozygous mutations in LPL gene were detected including 36 missense mutations, 5 nonsense mutations and 3 frameshift mutations, which were all rarely carried in single patient. Six HTG-AP patients carried the LPL gene heterozygous mutation c.835C>G (p.Leu279Val). The mean level of serum triglyceride at the onset of HTG-AP was 27.4 mmol/L. All of them had a history of recurrent HTG-AP, and most of them had severe acute pancreatitis. The serum LPL concentration and activity were lower than the normal level. The pathogenicity analysis results suggested that the LPL p.Leu279Val was a rare, highly possible pathogenic and highly conserved gene mutation. The in vitro results showed that the LPL p.Leu279Val could significantly reduce the synthesis and secretion ability of LPL as well as its enzymatic activity. Conclusions:The mutation ratio of lipid metabolism-related genes, including LPL, APOA5, LMF1, GPIHBP1, and APOC2, are relatively high in the HTG-AP patients. The LPL p.Leu279Val is a rare and highly possible pathogenic gene mutation, which may lead to recurrent episodes of HTG-AP.

Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Objective:To investigate lipid metabolism gene mutations and pathogenicity of hypertriglyceridemia acute pancreatitis (HTG-AP) patients.Methods:Clinical data of 495 HTG-AP patients admitted from June 2018 to June 2020 in the center for severe acute pancreatitis of Eastern Theater General Hospital were retrospectively analyzed. Whole-exome sequencing and mutation verification were performed by next-generation sequencing technology and Sanger sequencing. The pathogenicity of gene mutation was analyzed by population mutation ratio, pathogenicity prediction software, conservation scoring software, protein structure prediction, and in vitro experiments. Results:The mutation ratio of lipid metabolism-related genes, namely LPL, APOA5, LMF1, GPIHBP1, and APOC2, were 14.81%, 55.78%, 43.61%, 1.62%, and 0.61%, respectively. Among them, 44 heterozygous mutations in LPL gene were detected including 36 missense mutations, 5 nonsense mutations and 3 frameshift mutations, which were all rarely carried in single patient. Six HTG-AP patients carried the LPL gene heterozygous mutation c.835C>G (p.Leu279Val). The mean level of serum triglyceride at the onset of HTG-AP was 27.4 mmol/L. All of them had a history of recurrent HTG-AP, and most of them had severe acute pancreatitis. The serum LPL concentration and activity were lower than the normal level. The pathogenicity analysis results suggested that the LPL p.Leu279Val was a rare, highly possible pathogenic and highly conserved gene mutation. The in vitro results showed that the LPL p.Leu279Val could significantly reduce the synthesis and secretion ability of LPL as well as its enzymatic activity. Conclusions:The mutation ratio of lipid metabolism-related genes, including LPL, APOA5, LMF1, GPIHBP1, and APOC2, are relatively high in the HTG-AP patients. The LPL p.Leu279Val is a rare and highly possible pathogenic gene mutation, which may lead to recurrent episodes of HTG-AP.

Objective:To investigate the impact of plasmapheresis therapy on the clinical efficacy in predicted severe hypertriglyceridemia-associated acute pancreatitis (HTG-AP) patients.Methods:The clinical data of 500 HTG-AP patients admitted to 36 medical centers across China in the Chinese Acute Pancreatitis Clinical Trials Group-PERFORM database from November 2020 to June 2023 were retrospectively analyzed. Besides the inclusion and exclusion criteria from PERFORM study, patients who had acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score ≥8 or CRP>150 mg/L on admission were included in the final analyses ( n=189). Patients were categorized into the plasmapheresis group ( n=51) and the routine treatment group ( n=138) according to the triglyceride-lowering therapies they received. General data, laboratory findings, AP severity, and clinical outcomes were recorded. Results:Patients undergoing plasmapheresis had higher initial triglyceride levels, APACHEⅡ score, SOFA score, and more organ failure than those receiving routine medical treatment. Results of multivariable logistic regression models showed that the plasmapheresis group, as compared to the routine treatment group, was neither associated with decreased risk of persistent organ failure within 14 days [54.9% (28/51) vs 37.7% (52/138), OR=0.89, 95% CI 0.36-2.21, P=0.810], nor with reduced incidence of organ failure on day 7 [17.7% (9/51) vs 15.9% (22/138), OR=0.60, 95% CI 0.19-1.88, P=0.378]. There was no significant difference on the dynamic changes of serum triglyceride within the first three days of admission ( P=0.108). Conclusions:Early plasmapheresis is not associated with reduced incidence of persistent organ failure in predicted severe HTG-AP patients.

Objective:To investigate the clinical characteristics of first-episode and recurrent acute hypertriglyceridemic pancreatitis (HTGP).Methods:The retrospective cohort study was con-ducted. The clinical data of 313 patients with HTGP admitted to 26 medical centers in China in the Chinese Acute Pancreatitis Clinical Research Group (CAPCTG)-PERFORM database from November 2020 to December 2021 were collected. There were 219 males and 94 females, aged 38(32,44)years. Of the 313 patients, 193 patients with first-episode HTGP were allocated into the first-episode group and 120 patients with recurrent HTGP were allocated into the recurrent group. Observation indica-tors: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) comparison of severity and prognosis in the course of disease within 14 days between the two groups; (3) the association between recurrent HTGP and the risk of persistent organ failure (POF); (4) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent sample t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Wilcoxon rank sum test. Count data were expressed as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Comparison of ordinal data was conducted using the Wilcoxon rank sum test. The Kaplan-Meier method was used to plot the cumulative recurrence rate curve and Log-Rank test was used for survival analysis. The Logistic regression model was used for multivariate analysis, and continuous variables were converted into categorical variables according to the mean value or common criteria. Propensity score matching was performed by 1∶1 nearest neighbor matching method, with caliper value of 0.02. Paired t test or Wilcoxon rank sum test and McNemar′s test were used for comparison between matched groups. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 313 patients,208 cases were successfully matched, including 104 cases in the first-episode group and 104 cases in the recurrent group. After propensity score matching, there was no significant difference in demographic characteristics, severity of illness scores and laboratory test between the two groups ( P>0.05). The elimination of gender, acute physiology and chornic health evaluation (APACHE) Ⅱ score, computed tomography severity index score, systemic inflammatory response syndrome score, sequential organ failure assessment score, apolipoprotein E, C-reactive protein, creatinine, lactic acid dehydrogenase, procal-citonin confounding bias ensured comparability between the two groups. (2) Comparison of severity and prognosis in the course of disease within 14 days between the two groups. There were signifi-cant differences in POF and local complications between the first-episode group and the recurrent group ( P<0.05). (3) The association between recurrent HTGP and the risk of POF. Results of uncor-rected univariate analysis showed that there was no association between recurrent HTGP and the risk of POF ( odds ratio=0.78, 95% confidence interval as 0.46-1.30, P>0.05). Results of multivariate analysis after adjusting for covariates such as gender, age, APACHE Ⅱ score, C-reactive protein, triglyceride and total cholesterol showed that compared with first-episode HTGP, recurrent HTGP was associated with a higher risk of POF ( odds ratio=2.22, 95% confidence interval as 1.05-4.71, P<0.05). Results of subgroup analysis showed that age<40 years was associated with an increased risk of POF ( odds ratio=3.31, 95% confidence interval as 1.09-10.08, P<0.05). (4) Follow-up. Twelve of the 313 patients died during hospitalization, including 9 cases in the first-episode group and 3 cases in the recurrent group. The rest of 301 surviving patients, including 184 cases in the first-episode group and 117 cases in the recurrent group, were followed up for 19.2(15.5, 21.9)months. Results of follow-up showed that for 184 survived patients of the first-episode group, 164 cases were followed up and 24 cases experienced recurrence, for 117 survived patients of the recurrent group,29 cases experienced recurrence, showing a significant difference between the two groups ( χ2=4.67, P<0.05). Conclusion:Compared with first-episode HTGP, patients with recurrent HTGP are more prone to POF and local complications, and are more prone to recurrence after discharge. The risk of POF in recurrent HTGP patients is 2.22 times that of those with first-episode, and the risk is higher in patients with age <40 years.

Objective:To investigate the efficacy and prognosis of CLAG±DAC (Clofarabine, Cytarabine, G-CSF±Decitabine) chemotherapy in patients with relapsed/refractory acute myeloid leukemia (R/R AML) .Methods:Continuous cases of R/R AML treated with the CLAG+DAC protocol or CLAG alone at the First Affiliated Hospital of Soochow University from January 2017 to December 2021 were retrospectively analyzed. The baseline characteristics, individual treatment regimen, treatment effect, disease progression, and survival status of patients were recorded. The factors influencing the efficacy of the CLAG±DAC chemotherapy regimens were analyzed, and the overall survival (OS) time after reinduction was calculated using the Kaplan-Meier method.Results:This study included a total of 53 patients, with 33 male patients and an average age of 40.6 years. Thirty-three patients achieved complete remission (CR+CRi) of the disease after the CLAG±DAC chemotherapy regimen and six patients achieved partial remission (PR), while 14 did not. Thirty-two patients eventually underwent hematopoietic stem cell transplantation, and the median OS of the patients was 55.9 months until follow-up. Patients with disease remission after the application of the CLAG±DAC chemotherapy had a significantly longer survival time than those without remission ( P<0.001). The results of the multifactorial analysis have revealed that combined DAC ( OR=4.60, 95% CI 1.14-23.5, P=0.04) and DNMT3A mutation ( OR=0.14, 95% CI 0.01-0.89, P=0.05) were the factors influencing the efficacy of the CLAG±DAC chemotherapy regimen. The remission rate was relatively higher in patients with R/R AML combined with FLT3-ITD mutation by applying the DAC+CLAG regimen ( OR=10.84, 95% CI 1.48-288.50, P=0.04) . Conclusion:The CLAG±DAC regimen is considered effective in patients with R/R AML, whereas decitabine combined with the CLAG regimen is more suitable for patients with R/R AML combined with FLT3-ITD mutation.

Objective:To explore the effects of health education based on reinforcement theory combined with empowerment theory in patients with chronic obstructive pulmonary disease (COPD) .Methods:From January 2018 to January 2021, convenience sampling was used to select 80 COPD patients admitted to the Respiratory Department of Lishui Hospital of Traditional Chinese Medicine as the subject. Patients were randomly divided into a control group and an observation group with 40 cases each in a 1∶1 ratio using the random number table. The control group received routine health education and psychological intervention, while the observation group was treated with health education based on reinforcement theory combined with empowerment theory. The pulmonary rehabilitation compliance, Short Form of the Profile of Mood States (POMS-SF) and Health-Promoting Lifestyle Profile (HPLP) scores before and after intervention were compared between two groups.Results:After intervention, the total score and all dimension scores of pulmonary rehabilitation compliance in both groups were higher than those before intervention, and the observation group scored higher than the control group, with statistically significant differences ( P<0.05). After intervention, the energy-vitality scores of the two groups were higher than those before intervention, the observation group scored higher than the control group, and the scores of other dimensions were lower than those before intervention, the observation group scored lower than the control group, and the differences were statistically significant ( P<0.05). After intervention, the scores of HPLP in all dimensions in both groups were higher than those before intervention, and the observation group scored higher than the control group, with statistically significant differences ( P<0.05) . Conclusions:Health education based on reinforcement theory combined with empowerment theory for COPD patients can enhance their rehabilitation compliance, effectively improve their mental state, and promote the development of healthy behaviors.

Background and Aims:The occurrence of duodenal fistula following infected pancreatic necrosis(IPN)in the later stage of treatment for acute necrotizing pancreatitis presents a significant clinical challenge.It often leads to severe complications such as difficulty in administering enteral nutrition,electrolyte imbalances,abdominal bleeding,and worsening infections.This study was performed to explore the efficacy of enteral nutrition combined with step-up drainage in treating IPN complicated by duodenal fistula and to share single-center experience. Methods:The clinical data of 66 patients with IPN complicated by duodenal fistula who underwent enteral nutrition combined with step-up drainage in the Severe Pancreatitis Treatment Center of the Nanjing Eastern Theater General Hospital between January 2018 and December 2020 were retrospectively analyzed. Results:Among the 66 patients,the median time from disease onset to the development of duodenal fistula was 53(32-75)d.In 46 cases(69.7％),suspicious digestive fluid-like discharge was observed from drainage tube or double-lumen tube.The diagnosis and location of the duodenal fistula were confirmed in 49 patients(74.2％)through fistulography,while the remaining cases were confirmed via surgical exploration or endoscopy.The duodenal fistulas were mainly located in the horizontal part(33.3％)or descending part(50.0％)of the duodenum.Nutritional access was safely established through nasojejunal tube in 61 patients(92.4％),while 5 patients(7.6％)required surgery to establish the access.Twenty patients(30.3％)experienced secondary abdominal bleeding,and 14 patients(21.2％)died.Among the 52 patients who recovered,49(94.2％)healed through step-up drainage,while 3(5.8％)required surgery due to delayed healing.Of the 49 patients who underwent non-surgical treatment,10(20.4％)achieved fistula closure through drainage tube,and 39(79.6％)achieved closure through continuous lavage drainage via double-lumen tube.The median healing time for duodenal fistula in non-surgically treated patients was 41(29-80)d. Conclusion:Patients with IPN complicated by duodenal fistula are in a critical condition.Enteral nutrition combined with step-up drainage is an effective treatment for these patients.

Objective:To investigate clinical outcome and the risk factors for death in acute pancreatitis (AP) patients complicated with acute kidney injury (AKI).Methods:The clinical data of 232 AP patients complicated with AKI admitted to the Center of Severe Pancreatitis of Jinling Hospital Affiliated to Nanjing University School of Medicine from January 2016 to December 2020 were retrospectively analyzed. Patients were divided into survival group ( n=162) and death group ( n=70) based on the survival status. The two groups' clinical characteristics, biochemical indexes, and renal function indexes were compared. Univariate analysis and multivariate logistic regression analysis were used to analyze the independent risk factors for death in AP patients complicated with AKI. Results:Sixteen patients(6.9%) among the 232 had AKI Ⅰ, 15(6.5%) had AKI Ⅱ, and 201(86.6%) had AKI Ⅲ. Forty-one patients (17.7%) became AKI with a disease course <7 days, 184 patients (79.3%) gradually progressed to acute kidney disease with a disease course of 7-90 days, and 7 patients (3.0%) eventually progressed to chronic kidney disease with a disease course >90 days. Renal replacement treatment (RRT) was administered in 179 patients (77.2%), lasting an average of 14 (7-25) days. 138 patients (59.5%) had their renal function recovered while they were hospitalized, including 9 patients (6.5%) who did so within 7 days, 69 patients (50.0%) within 30 days, and 127 patients (92.0%) within 90 days. The average recovery time was 16 (7-28) days. Seventy patients (30.2%) died during hospitalization, including 8(3.5%) within 7 days, 42(18.1%) within 30 days, and 68(29.3%) within 90 days. Univariate analysis revealed that the proportions of biliary etiology, neutrophil to lymphocyte ratio (NLR), serum cystatin C, sequential organ failure assessment(SOFA) score, AKI Ⅲ proportion, number of patients undergoing RRT, and duration of AKI were significantly higher in the death group compared to the survival group. The number of patients complicated by infected pancreatic necrosis (IPN) and having surgical intervention was also significantly greater than that in the survival group, while the proportion of patients whose renal function recovered was much lower than that in the survival group. The differences were all statistically significant (all P value <0.05). Multivariate logistic analysis showed that SOFA( OR=1.182, 95% CI 1.000-1.396, P=0.049), and IPN( OR=8.403, 95% CI 3.748-18.838, P<0.001) were independent risk factors for death. Conclusions:SOFA score and IPN at admission were independent risk factors for death in AP patients with AKI. Vigilance should be given as soon as possible to improve the outcome of patients through clinical intervention.

Objective:To determine the effect of prolonging the interval of flushing on ports′ function and catheter related complications for cancer patients after completing chemotherapy.Methods:A prospective randomized controlled trial was conducted in 190 patients who undergoing ports-maintenance in outpatient clinical, the First Affiliated Hospital of Sun Yat-sen University, after they finished the chemotherapy from April 2017 to February 2018. According to the random number table, the patients were divided into 4-week group, 8-week group and 12-week group after completing chemotherapy, then returned to the hospital to maintain the port every 4 weeks, every 8 weeks and every 12 weeks, respectively. Then evaluated the function and complications of catheter among different groups.Results:After completion of chemotherapy, the rate of catheters′ patency of tumor patients in 12-week group was 98.5% (66/67), while that in 4-week group was 98.1% (53/54) and in 8-week group was 98.6% (68/69), there was no statistically significant difference on catheters′ patency among different groups ( χ 2=0.48, P>0.05). The rate of catheters′ asymptomatic thrombosis in 12-week group was 18.9% (10/53), which was not significantly different from that of 4-week group 27.0% (10/37) and 8-week group 14.0% (7/50) ( χ 2=2.33, P>0.05). Conclusions:Tumor patients maintaining port every 12 weeks after completion of chemotherapy can ensure the safety of patients using the port. It is favorable for application and promotion of port in cancer patients.